Putting the onus on the individual suffering from the society rather than on causal societal issues.

Dear Editor, the title “to improve mental healthcare we first need to build respect for psychiatry” chosen by Waters to illustrate Smith’s take up of the presidency of the Royal College of Psychiatrists deserved comment.(1)

Certainly, building respect seems a prerequisite as psychiatry has been on a very slippery slope for long with the pharmaceuticalisation of life.(2) However, this issue is absent from Smith’s key messages. In contrast she claimed “the chronic underfunding of mental health care must be tackled urgently“ while: a) in 2020/21, local CCGs spent £12.1 billion on mental health, learning disability and dementia services in England (14.8% of the total funding allocated to CCGs for health services) and NHS England spent a further £2.2 billion on specialised commissioning for mental health services;( https://commonslibrary.parliament.uk/research-briefings/sn06988/) b) the growing social crisis calls for better social welfare as poor education, housing and employment nurture poor mental health.(3-5)

Further, in the same issue Waters’ report of Smith‘s call for a public information campaign about the consequences to British teenagers of smoking cannabis is also questioning.(6) Smith stated “Banning is not going to be helpful because prohibition doesn’t really work. But education is really important.” As an advocate of evidence-based policymaking, I note this is ideology, not evidence: partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement.(7). Similarly, education must be based on evidence, this is not the case of her claim “some cannabis is good cannabis, actually. The stuff that has high cannabidiol content can be good for mental health.” This looks like to the “Foot in the Door” technique, a persuasion strategy used in marketing to promote sales. Coincidentally, I note that the National Rifle Association also claims that restrictions do not work and funds youth education programs for firearms and safety.(https://www.friendsofnra.org/grants/programs/)

1 Waters A. To improve mental healthcare we first need to build respect for psychiatry. BMJ. 2023;380:p381. doi: 10.1136/bmj.p381.
2 Braillon A, Lexchin J, Blumsohn A, Hengartner MP. The “pharmaceuticalisation” of life. BMJ. 2019;365:l1972. Published 2019 May 8. doi:10.1136/bmj.l1972
3 Smith NR, Marshall L, Albakri M, Smuk M, Hagell A, Stansfeld S. Adolescent mental health difficulties and educational attainment: findings from the UK household longitudinal study. BMJ Open. 2021;11(7):e046792. Published 2021 Jul 25. doi:10.1136/bmjopen-2020-046792
4 Saul H, Gursul D, Hoskin L, Buckman J. Unemployment and insecure housing are linked to less successful treatment for depression. BMJ. 2022;378:o2182. Published 2022 Sep 16. doi:10.1136/bmj.o2182
5 Marmot M. A health crisis is a social crisis. BMJ. 2019;365:l2278. Published 2019 May 24. doi:10.1136/bmj.l2278
6 Waters A. Cannabis consumption by UK teens is a ticking time bomb, warns president elect. BMJ. 2023;380:p407. Published 2023 Feb 22. doi:10.1136/bmj.p407
7 Hall W. What are the policy lessons of National Alcohol Prohibition in the United States, 1920-1933?. Addiction. 2010;105(7):1164-1173. doi:10.1111/j.1360-0443.2010.02926.x


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