Aurora Comms Blog

The Brain Game

Posted on 02. Dec, 2009 by NW1er in Health

Writing this month’s Aurora top 20 got me thinking about mental health issues and how this is managed in the UK. A range of opinions and challenges exist in this area, making it a complicated one for all involved. Below I explore the topic in some more depth.

Prevalence and approach
In the year 2000 one in six adults in Great Britain had a neurotic disorder (such as anxiety and depression) and one in 200 had a psychotic disorder such as psychosis and schizophrenia, according to two reports from the Office for National Statistics. Since the early 1990s we have seen a sharp increase in the number of people receiving treatment for mental health conditions and the Office for National Statistics explains this in terms of a doubling in the proportion of patients receiving medication from 1993 to 2000; but has this trend continued into the 21st Century or have treatment approaches become more holistic?

Department of Health announcements over the last two years have promised vast cash injections to improve access to talking therapies and to increase the number of people delivering these services. Some healthcare professionals (HCPs) are concerned that this will lead to a dilution of patient services, with talking therapy now being delivered by HCPs with limited experience. This is clearly a therapy area with a diversity of opinion in relation to how to best manage patients.

Lack of linearity
Linear, causal reasoning often fails to provide a significant explanation of mental health conditions because there tends to be many reasons for why an individual experiences a psychological issue - rarely can the (mis)workings of a single neurotransmitter be identified as the sole factor in the condition. On top of this, chemicals and neuronal structures within the brain do not work in isolation, so modifying one may affect many more. This explains why there is often debate about treatment approaches and also means that when it comes to mental health, there aren’t any ‘hard and fast’ rules.

The lack of linearity of psychological conditions makes them fascinating topics for the media to report, especially when it comes to speculation about celebrity ‘breakdown’. Clinical depression is no longer a taboo subject and other topics such as process addictions and anxiety issues can easily fill column inches. What this means is that the media and the public have familiarity with certain psychological disorders and a range of stakeholders get reported as opinion leaders in the media - making it hard for one clinical view point to get the greatest share of voice.

The debate about treatment approaches also runs to a deeper, philosophical level: hypothesising that all mental health issues can be ‘corrected’ by adjusting the balance of chemicals in the brain or improving the speed of synaptic reactions leads to a reductionist conclusion - that human behaviour can be totally explained by physiology. This is a difficult theory for many people to swallow as it implies that the complex layers of social systems surrounding an individual play a very limited role in mental health. Beyond this, it raises questions about the nature of personality and the soul.

Diversity of disciplines
Due to this lack of linearity in psychological disorders, treatment strategies often involve a number of disciplines such as neurology, psychiatry and therapy. This means that in relation to mental health issues, healthcare communicators have segmented specialists to communicate with. Effective communication requires understanding the nuances of clinical practice and attitudinal trends - communicators need to delve deep to understand what ‘switches on’ these disparate opinion leaders, how messages should be tailored to them and what communication channels are most effective for reaching them.

Communicating with primary care
The management of mental health can become even more complex in primary care. Misdiagnosis can pose a challenge, particularly because of the very short amount of time available for conducting consultations. For example, a bipolar patient may appear to be experiencing depression on the first surgery visit - if a primary care professional sees that patient without context, then an inappropriate diagnosis may result. In this example, the bipolar disorder may go unrecognised because the depression-busting therapy is assumed effective, when in fact it may induce mania. Such eventualities tend to lead to disappointing outcomes for the patient and an extended consultation period.

Other issues to consider with primary care include the over-shadowing influence of the side-effects of old treatments. GPs may still be reluctant to prescribe anti-psychotic medications because first generation treatments had significant side-effects which discouraged patients from taking them. GPs need to be convinced that any medication provides a return-on-investment in terms of delivering effective results for the patient that avoid the patient unnecessarily presenting after a poor experience. Communicators need to consider the heritage of their brand and any associations that may be held with the class of drug when communicating about treatment approaches with GPs.

Communicate with vision
Interestingly, the diagnosis of mental health conditions, such as bipolar disorder, is often based on patient-reported information and observational methodology. A famous study in the 1970s, DL Rosenhan’s On being sane in insane places, highlighted difficulties with this approach. Whilst studies relating to the mind have undoubtedly advanced in forty years, data capture in relation to mental health may pose a challenge in another form; patient benefits are subjective and difficult to quantify so it may be difficult to demonstrate cost-effectiveness when economic modelling. This means that products and therapies designed to address mental health issues need to demonstrate their value and social worth in new and compelling ways.

Working in mental health requires the vision to understand the motivations of disparate key opinion leaders and the very sensitive nature of the individual patient’s condition. Watch this space to see how policy develops….

Tags: mental health