By Dr David Laing Dawson
Nor does it require argument and more research comparing one component to another. This is it:
- Early intervention, thorough assessment.
- Treatment with medication by a knowledgeable physician/psychiatrist.
- A good working relationship between psychiatrist and patient and his or her family.
- Adequate housing with support.
- A supportive family.
- Ongoing education for patient and family about illness and treatment.
- A wise, grounded counselor/therapist/support worker.
- Easy access and rapid response support team for crises and emergencies.
- Healthy diet and exercise.
- Good general medical care.
- Membership, belonging to a group or organization of some kind.
- Daily routine.
- An activity that provides some sense of worth and value.
When the support systems are in place, and a good working relationship has developed between the psychiatrist and patient and family, pharmacological treatment can be (safely) titrated down (or up) to the lowest effective maintenance dosages. Occasionally, with close monitoring over a long period of time, this can mean trials of no medication.
In the real world there are dozens of reasons this ideal is not often achieved, or only partially achieved. And some of those reasons include the interminable nonsense spouted by the Mad in America Group, inter-professional rivalries for prestige and money, illness deniers, would-be gurus, and politicians and planners listening to this nonsense.