People suffering from mental illness are frequently being misdiagnosed or receiving inadequate treatment, according to a group of leading psychiatrists.

The doctors say that patients with serious problems are often referred to psychologists and social workers rather than clinicians and do not receive the medical therapies they need.

“Treatment is often little more than jollying people along,” said Professor Nick Craddock, of the Medical School at Cardiff University, one of 36 signatories of a letter published today in the British Journal of Psychiatry.

“If a GP suspected a patient had cancer, he wouldn't dream of referring him to anybody other than a cancer specialist. A cancer patient might need jollying along, but what he really needs is the correct diagnosis and treatment. That's what he gets from a specialist. But patients with mental illness are not automatically referred to psychiatrists. If they only see a social worker, there's every chance that mental illness, or underlying physical illness, will be missed. Patients are getting a bum deal.”

Describing their letter as a “wake-up call” to British psychiatry, the psychiatrists say that the desire not to stigmatise people has also done damage by implying that there is no such thing as mental illness. Patients are now known as “service users” rather than patients — even though, when asked, 67 per cent preferred the word patient and only 9 per cent service user. Treatments are provided at “mental health” centres, not mental illness clinics.

Psychiatry, the group says, is the only medical speciality to adopt an approach that so distorts its original purpose. “For those with severe mental illness, to avoid medicalisation is at best confusing and at worst damaging or even life-threatening ... these individuals are being let down by the current state of affairs.”

The changes came about under a scheme, New Ways of Working, established in 2005. GPs now refer patients with symptoms of mental illness to a team of up to eight people, which will include psychologists, nurses, social workers and a psychiatrist.

There is no guarantee that the patient will be seen by the psychiatrist, the only doctor on the team. The psychiatrist, a clinician with a medical qualification as well as higher training in psychiatry, is the only member of the team able to diagnose mental or physical illness with any certainty. The result, says Professor Craddock, is that patients may be prescribed “psychosocial support” rather than medical treatment, only to find in six months' time that they have a treatable mental illness for which they could have been prescribed drugs or behavioural therapy.

Physical illnesses that may underlie a mental condition include thyroid disorder or, less commonly, cancer of the brain.

Professor Craddock and his co-signatories are not claiming that psychosocial treatments do not have a place, but they claim it is vital that patients are seen by a psychiatrist first. “Psychiatrists may not be the best people to deliver treatments, but they are the best to make assessments,” Professor Craddock said.

Professor Sue Bailey, registrar of the Royal College of Psychiatrists, said: “We are in the process of finalising the development of a questionnaire for our members that will tease out key issues, and tell us where New Ways of Working is working well and where there are challenges.”

A spokeswoman for the Department of Health said: “The introduction of New Ways of Working has been widely welcomed by service users, carers and psychiatrists. Working with multidisciplinary teams has allowed the needs of people who use mental health services to be better met and frees up psychiatrists' time to work with more complex clinical cases.”

Extent of the problem

— 14,863 deaths were caused by mental health disorders in Britain in 2006

— 25 per cent of people experience mental health problems each year

— 29 per cent of women have been treated for mental health problems, compared with 17 per cent of men

— 10 per cent of children under 15 have a mental health disorder

— 20 per cent of older people suffer from depression

— 400 people in every 100,000 in Britain self-harm

Source: www.mentalhealth.org.uk

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