Description

Medication-free treatment in mental care

Medication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication based on patients’ autonomy and shared decision-making. There is a long-standing debate within the mental health field about the use of psychotropic medications. One of the primary reasons for controversy is the effectiveness and safety of medication-free treatment, especially for individuals with severe mental illnesses such as schizophrenia or bipolar disorder. Psychotropic medications have been a cornerstone of treatment for these conditions, and there is concern that discontinuing or avoiding medication may lead to worsening symptoms or relapse. It's important to note that while patients with mild to moderate mental disorders have long had access to nonmedication treatments, those with severe mental disorders, such as schizophrenia or psychosis, have primarily relied on medication as the core of their treatment [1]. However, recent reviews have revealed substantial variation in the effectiveness of psychosocial interventions in combination with minimal or no medication for severely mentally ill patients, suggesting that there is still much to learn about the most effective approaches for this group [2]. There is a need to shed light on the evolving landscape of mental health care and the unique challenges and opportunities presented by medication-free treatment. For this reason, the article “Medication-free mental health treatment: A focus group study of milieu therapeutic settings” is important and relevant, both for the field of practice and the research field.

The establishment of medication-free mental health wards with various treatment options represents a step towards providing more person centered care. Introducing milieu therapy, which is a recommended intervention for severely mentally ill persons, in a medication-free unit, requires significant changes to the traditional medicationbased psychiatric setting. The focus group study of medication-free treatment in milieu therapeutic settings [3] examines how milieu therapists experience working with medication-free treatment for people with serious and long-term mental health challenges. The study explored what may be required to succeed with medication-free treatment in milieu therapeutic settings. The main finding was that medication-free treatment requires working together on holistic and personal health promotion. The study highlights the potential for personal growth in seemingly ordinary interactions between milieu therapists and patients, underscoring the importance of day-to-day exchanges in building a patient's sense of identity and belonging. To succeed with medication-free treatment in milieu therapeutic settings, milieu therapists must have time to focus on the individual patient, be professional companions, help the patients to make changes in their life, and work together in multidisciplinary teams with a focus on personal health promotion for the individual patient. This underscores the importance of understanding patients' individual needs and readiness for change while striving to create a therapeutic milieu that supports their well-being and recovery. The conclusion is that milieu therapists must engage with and take more responsibility in the patient’s process of health promotion. This may challenge the dominating medical paradigm within mental health care [3].

Humanistic approaches can offer a supportive framework for medication-free treatment in mental care. A humanistic perspective in mental health care strongly emphasizes the person's autonomy, personal growth, and self-actualization. The humanistic perspective on medication-free treatment doesn't necessarily advocate for the complete exclusion of medication. Instead, it promotes an approach that values individual choice, personal growth, and a holistic understanding of mental health care. While medication treatment addresses the relief of symptoms, a medication-free treatment focuses on helping patients develop coping skills and strategies for managing their condition, psychosocial support, lifestyle adjustments, and stress management, empowering and enabling individuals to have a greater sense of control over their mental health. This comprehensive approach can be helpful for many patients and should be assessed in each individual case, considering the specific needs and circumstances of each person. It is essential to consider the unique needs and preferences of individual patients in determining the most appropriate treatment approach. However, the most effective approach often involves a combination of treatments, including medication when appropriate, along with milieu therapy, other therapies, support, and lifestyle changes to address the multifaceted aspects of mental health. The most important thing is that the patients participate actively and are involved in all decisions to be made regarding their own treatment. There is a need for more research in this area to ensure the best possible treatment for patients in mental care [4].

References

1. Sohler N, Adams BG, Barnes DM, Cohen GH, Prins SJ, Schwartz S. Weighing the evidence for harm from long-term treatment with antipsychotic medications: A systematic review. American Journal of Orthopsychiatry. 2016; 86: 477.

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3. Beyene LS, Hem MH, Strand EB. Medication-free mental health treatment: a focus group study of milieu therapeutic settings. BMC psychiatry. 2023; 23: 707.

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4. Yeisen RA, Bjornestad J, Joa I, Johannessen JO, Opjordsmoen S. Psychiatrists’ reflections on a medication-free program for patients with psychosis. Journal of Psychopharmacology. 2019; 33: 459-65.

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Citation: Short Commentary on Medication Free Mental Health Treatment: A Focus Group Study of Milieu Therapeutic Settings ASEAN Journal of Psychiatry, Vol. 24(S4) December, 2023; 1-2.