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Can Laypeople Replace Psychologists, Psychiatrists in the Treatment of Depression?

I was recently intrigued by the claims made — and that went completely unchallenged — by Vikram Patel, a psychiatrist who was interviewed by Wired Science’s Greg Miller. I guess my expectations for something appearing on Wired should be readjusted.

Patel claimed that specially-trained health professionals could provide enough care to people that they may be able to treat clinical depression successfully. (The article suggests these are the same as “laypeople,” but really, they’re not.) With skills learned in as little as 2 days.

An amazing claim? You bet. One based in reality? Let’s find out…

3 Comments to
Can Laypeople Replace Psychologists, Psychiatrists in the Treatment of Depression?

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  1. With people who say to me the idiotic things as said above by Dr Patel, I suggest why don’t all trained and seasoned therapists stop working for just 2 weeks and let the general public fill in for us. And that is all it will take, just 2 weeks, because those who have been getting responsible and efficacious interventions will quickly realize that just talking to a family member, friend, neighbor, or the guy/gal who got a few days to weeks of “intense on the job training” won’t really be providing therapy, just a proverbial hand on the shoulder and the textbook “you’ll get through this, just be tough”.

    What just pisses me off the most in reading this post is simply this: why do I have colleagues who say such stupid, irresponsible, and reckless things that only demean and diminish our true abilities and responsibilities for the mental health field? If I was in the room hearing the absolute idiocy being uttered by Dr Patel, I would just blatantly ask back, “so are you basically saying psychiatric and psychological training programs are a waste of time, and we should eliminate these professions, so we can dumb down the importance of providing appropriate psychotherapy to people who would agree to see people every 2-4 weeks a visit, just go by some ITP manual to define progress by satisfying checklist simplifications like going to automobile repair shop to check the fluids and replace the brakes every 30,000 miles?!”

    Oh, my mistake, that has already been done by some in the profession these past couple of decades. So, maybe we don’t even need social workers now, just anyone who completes a community college degree, or wait, why go that far, just teach basic psychology in high school and get a vocational degree from “Psychology Shop”?

    We can summarize mental health with just the basics taught in 1 week:

    don’t hurt yourself or others.
    if you are depressed, think happy thoughts.
    if you are anxious, let go of the fear.
    if you are obsessive, think about other things.
    if you are traumatized, stay away from further trauma and think safe thoughts.
    if you are feeling panic, take deep breaths.

    But, if you are manic, or psychotic, or cognitively impaired, or so depressed you can’t let go of suicidal thoughts, don’t talk to me, find a doctor!

    Oh, but all those doctors were deemed unnecessary after these “replacements” were set up to take over and simplify psychotherapy.

    I guess the Dr Patels of the world just want to work in chronic inpatient units, or correctional facilities, or sit in academic offices and write books that claim to set the standards for mental health care that no doctors will ever provide anyway.

    It really is idiocy to hear doctors say such lame and irresponsible things. But, it is what psychiatry as a whole has done, it is solely a biochemical imbalance anyway, so at the end of the day, why should people with mental health problems need to talk, just open their mouths and swallow these pillS, and then sit back and feel better tomorrow.

    Oops, you psychopharmacologists didn’t think that one through fully, it doesn’t take a psychiatrist to do this now either. After all, those PCPs, NPs, psychologists in states allowing Rx access, and I wouldn’t be surprised if PAs are writing psychotropic Rxs these days as well, they all can diagnose and write for psych meds without psychiatric expertise.

    Oh, my bad, they got it in those weekend CME courses Dr Patel sells for non physicians now.

    And the circle is complete. Sorry for this rant, but, it is what lack of vision and attention to the detail leads to, by forfeiting defense not only the value of the profession, but the needs of the patients we took an oath to protect and heal, and thus this lack of vision leads to the demise of the profession, by either indirect or misguided self destruction. Or, maybe it is intentional?

    Hey, just my opinion.

  2. I appreciate Dr. Grohol’s skeptical analysis of this proposal. One major problem with it is encapsulated in this quote from Dr. Patel:

    “Most of our patients are women with depression linked to an unhappy marital relationship. So a counselor would identify the relationship as the reason the patient is feeling withdrawn and not sleeping well…”

    But without appropriate professional assessment, it is not possible for a paraprofessional “counselor” to conclude that a person’s depression and insomnia are caused by an unhappy relationship–though this may indeed be one contributing factor.

    Depression, anxiety, and insomnia are often due to a multiplicity of interacting factors, ranging from medical problems (such as sleep apnea) to undiagnosed substance dependence to the early stages of dementia.

    Increased ease of access to professional medical and psychological care is not an easy goal to achieve, but it is still an essential part of a good national health care system.

    Ronald Pies MD

  3. I hear you very well Doctors and understand your argument. One question, in which countries do you practice in? I am no doctor and have no mental health training, but I do have a mental health illness. I have had it for over 16 years. The disorder took the better chunk of my life, something I can never get back. I barely remember my teenage years let alone my early adulthood. My experience with conversion disorder was challenging, confusing and excruciating. I can still remember how all my limbs would become stiff and cold that I could not afford to stand or walk. I dreaded the tremors, the fits and persistent dystonia as they rendered my tiny body powerless and lifeless. My chest got so tight and breathing became very difficult and painful. It was a nightmare turned into reality that never seemed to have a last season. I felt like it was my last day every-time I had these attacks. I was never able to make a word as my jaws would be locked. I dreaded the memory loss that is present till now. I sought help from every specialized doctor I could think of, from cardiologists to neuron-surgeons but no test could explain the cause of these neurological or medical symptoms I had. In the end some of them said that I was faking these things to get attention while others never believed me. I was often told that all this was in my head and not real. My family,friends and teachers were not supportive either. It was a nightmare knowing that something was wrong with me yet no one knew anything about it. So I sunk deeper and now I have Borderline personality disorder with dissociative symptoms.
    Had my doctors been equipped enough, they would have provided me with mental health first aid or referred me early enough and the problem wouldn’t have escalated. Had my family, friends and teachers been aware of this they would have provided me with basic mental health care. I think when it comes to this issue, everyone should and must be involved. Living in a developing country, Swaziland, where there is only one psychiatrist and four qualified psychologists, Dr. Patel’s approach applies. If these ‘lay people’ are trained and are under constant supervision of mental health specialists, I think this concept can really be a success story. Swaziland has a population of 1.2million, centralized psychiatric services, has the highest HIV prevalence in the world, gender inequality, high rate of sexual abuse and other forms of abuse, over 60% living below the poverty line and life expectancy is at 47years. The country is also scarcely populated and many have to travel long distances to access psychiatric services. Don’t you think this is already overwhelming enough for just 5 people?
    I think Dr. Patel is trying to provide an option that I think would be very workable in places like Swaziland. There are so many countries in Africa without even a psychiatrist let alone a mental hospital, for example Mozambique.
    I think training key people like say the police, teachers, community leaders etc would be very vital. These people interact a lot with the public and just providing them with basic mental knowledge like; skills to be able to identify early signs of mental health problems, how to use basic mental health assessment tools, how to support those with mental illness, how care for themselves are caregivers and when and how to refer this person-nothing to do with prescriptions.
    For general health workers, the same thing applies, except they get in-depth training on diagnosis and other assessment tools and also when to refer the client.
    We have had cases of the police shooting mentally ill people because they were holding a knife or a stone. We have had people attempting suicide, taken to hospital and after recovery they are sent back home without any psychological help. We have had cases of young children being psychologically and physically abused by their female relatives after finding out that the father or uncle has been abusing them. The children are seen as rivals by the female relative(s).
    My partner and I (has no mental health training) started an organization to promote mental health in Swaziland and currently we have a Clinical Psychologists from the abroad who is helping train different groups to be able to provide basic mental health care. We are also in contact with the country’s only Psychiatrist. We don’t have mental health resources but we are making use of the human resources we have and building their skills and I think that counts.



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