Jan 26, 2019
This week on MIA Radio, we
interview Professor Jim van Os. Professor van Os is Chairman of the
Division of Neuroscience at Utrecht University Medical Centre,
Utrecht, The Netherlands, and Visiting Professor of Psychiatric
Epidemiology at King’s College, Institute of Psychiatry in
London. He trained in Psychiatry in Casablanca, Bordeaux and
the Institute of Psychiatry and the Maudsley Royal Hospital in
We last spoke with Jim for the podcast in August 2017 and this
time we focus on a recent paper written by Jim and co-authors that
was published in the journal World Psychiatry in
January 2019. The paper is entitled ‘The diagnosis
evidence-based group-level symptom-reduction model as organizing
principle for mental health care. Time for change?‘
In this episode we discuss:
- What the diagnosis evidence-based group-level
symptom-reduction model is and how it currently informs
mainstream mental healthcare.
- How mental health funding and mental health professional
partners work together to monitor and assess the effects of current
- How this curative medical model is attractive, but often fails
to work for patients.
- That the focus on biological, brain-based diseases and symptoms
conflicts with the experience of people who are attempting to
develop a narrative view of their difficulties and suffering.
- That the paper is an attempt to start a discussion about
building a synthesis between the diagnosis, symptom-based medical
world and the lived experience of individual people.
- How the creation of specific and discrete diagnoses has
reinforced the symptom-led approach to mental health and has also
necessitated the stratification of doctors into silos of
- How Jim favors a spectrum-based approach over a fixed diagnosis
and that an example is autism spectrum disorder as described in DSM
- The limitations of using ‘target symptom reduction’ as an
outcome measure for mental health.
- That symptom reduction can be beneficial in the short-term but
is not a good long-term measure of recovery.
- That the paper attempts to make clear how important
individual experiences are and the need to be sensitive to the
existential domain, saying “restoration of health is not the
goal, it is the means to enable a person to find and pursue
meaningful goals, accordingly, the person’s existential values
- That the evidence suggests that any treatment effect or
improvement is often down to meaningful interaction rather than the
specific expertise of the treating professional.
- That, in many countries, we still see a huge gulf between
mental healthcare and social care which remain separate and remote
from each other and that this separation is not how the person
experiences their world.
- The importance of including lived experience in the evidence
base, particularly because randomized controlled trials, considered
the gold standard of evidence, are often not conclusive in the
field of mental health.
- That, in mental health, evidence shows that 30% to 40% of the
response is down to placebo and the expectation of being
- That the desire is to make the existential domain the primary
lens through which to view human experience and to respond to
mental or emotional suffering.
- That, arguably, ‘love is the most powerful evidence-based
treatment in mental health’.
Professor Jim van
group-level symptom-reduction model as the organizing principle for
mental health care: time for change?
Tedx: Maastricht, Connecting to
ISPS Liverpool Conference Jim
Van Os Keynote Address
Schizophrenia does not
© Mad in America 2019