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From: firemonkey on 21 Sep 2008 19:28
http://frontierpsychiatrist.co.uk/why-has-psychiatry-become-so-dominant-in-mental-health-services/

"Although psychiatrists cannot claim to �run� mental health services, as
things stand they take ultimate responsibility for the individual care
of most patients in the mental health system. But good practice in
mental health care involves more than just psychiatrists, and other
professions such as psychologists and mental health nurses, could also
make a valid claim to be in charge of patient care.*

The status of doctors in the treatment of mental health is actually
historic. At the time of the establishment of asylums there were no
effective treatments on offer for psychiatric disorders so doctors�
medical qualifications were irrelevant. However doctors� social standing
and accountability meant it was felt that they would be effective
guardians of against abuse of patients.

One argument for the continuing prominence of psychiatry is the overlap
between mental and physical diseases. For instance, thyroid problems can
mimic depression and the argument runs that a psychiatrist should be on
hand to identify these instances. This argument is not especially solid,
as although physical problems are occasionally picked up by
psychiatrists, general practitioners should sift these problems out
before referring to psychiatrists.

A second argument is that �medical model� of psychiatry is successful at
treating mental illness. This is not just simply prescribing drugs for
patients, as this could be done by doctors without their current status,
but also that a doctor brings to the table a pragmatic approach to the
treatment of patients that draws on scientific method. Although the
medical model is much maligned, as being too narrow and too dominant, it
also entails a benign paternalism and a willingness to accept
responsibility, which some, but of course not all, in their time of
sickness may welcome.

Consultation by a doctor is often valued by patients and staff alike
despite the fact that a lot of patients are seen by psychiatrists do not
have problems related to anything that could be characterized as an
�illness�. Why this should be so has societal roots beyond the scope of
this piece. It has not been unusual for me to be asked to give a
�doctor�s opinion� on matters of importance when there is no obvious
reason for why I should be qualified to do this, except a willingness to
stick my neck out. When working in the community I have often felt that,
as many people with mental health problems often have very
unsatisfactory social situations, patients would be better off seeing a
social worker once a month who could then refer onto me if necessary
rather than the current situation which is the other way around.

* I am aware the situation is more nuanced than this paragraph portrays.
In a CMHT, many patients will go nowhere near a psychiatrist;
furthermore the new mental health act contains provision for other
professions to become patient RMOs.2
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