Search terms: pharma

Lakeman, R. (2014, March 27-28). Lost in translation: Research, recovery and the relationship (keynote). Paper Presented at the '2nd International Psychiatric Congress: Mental Health & Recovery' [Internationaler Psychiatriekongress:zu seelischer Gesundheit und Recovery]. University Bern Psychiatric Services. Switzerland

This paper addresses the promise of evidence based or research informed mental health care and the reality of everyday practice. No amount of evidence seems to have a great impact on mental health policy and practice unless it is in accord with the dominant discourse of the time. Examples of approaches / projects with a positive evidence base which do or have struggled for recognition include:- psychotherapy, soteria, and open dialogue; Examples of approaches / projects with a poor or negative evidence base which persisted despite the evidence:- insulin Coma Therapy, pharmacological treatment of mild to moderate depression, and maintenance treatment in psychosis. This paper considers what shapes the dominant discourse Mental health service reform and culture and suggests that recovery ought to be a counter-cultural social movement.

Hurley, J., & Lakeman, R. (2021). Making the case for clinical mental health nurses to break their silence on the healing they create: A critical discussion. International Journal of Mental Health Nursing, 30(2), 574-582.

This discursive paper aims to clarify what roles mental health nurses identify as being within their scope of practice in clinical settings. It also aims to highlight any consumer benefits arising from these roles. Role theory and its relationship with identity are critically discussed as a framework to explain how contemporary mental health nursing roles are poorly understood and undervalued within mental health services. In order to meet the aims of the paper literature written in the last five years by clinical mental health nurses reporting their roles, and outcomes of those roles were searched. This literature was then considered through the lens of social constructionism that premises truths are accessed and then constructed though relationship based language. Six core mental health nursing roles were identified across international settings. The MHN is a psychotherapist. The MHN is a consumer advocate. The MHN is a physical health therapist. The MHN is a psycho‐pharmacological therapist. The MHN is a relationship focussed therapist and finally the MHN is an aggression management therapist. While European and American nurses reported consumer benefit emerging from these roles those from Australia and the United Kingdom did not. The roles reported on were largely instrumental ones that offered little clarity towards the identity of our profession, nor its worth to consumers or funders of services. Mental health nurses will only have their true breadth of clinical capabilities recognized where there is a consistent construction emerging from clinicians in clinical settings on the efficacy of their clinical work.

Lakeman, R. (2015). In a Pharmaco-Centric Era, Mental Health Nursing is More Important Than Ever. ABC Religion and Ethics, 8 Oct 2015. Online:

The prevailing naive bio-pharmaco-centric approach to human distress has not been found to be helpful to most and often serves to obscure alternative ways of viewing and addressing problems.

O'Brien, L., Lakeman, R., & O'Brien, A. (2013). Managing potential conflict of interest in journal article publication, International Journal of Mental Health Nursing, 22(4), 368-373.

The issue of potential conflict of interest and its risk to professional integrity in journal article publication has been strongly debated in medical circles. Most medical journals adhere to international requirements for disclosure of potential conflict of interest. The debate on this issue in nursing, and specifically mental health nursing, has been neither prolific nor strong, despite nursing's potential to influence particular viewpoints about treatment and indeed to prescribe particular treatments; and nursing being a target for pharmaceutical industry marketing. The purpose of this paper is to raise debate about potential conflict of interest in journal article publication and to make recommendations for the management of such potential for this journal.

Lakeman, R. (2010). Mental health nursing is not for sale: rethinking nursing's relationship with the pharmaceutical industry. Journal of Psychiatric and Mental Health Nursing, 17(2), 172-177.

The relationship between nursing and the pharmaceutical industry is conflicted. The pharmaceutical industry holds commercial interests which are incompatible with the interests of nursing and service users. Nursing and nurses are courted by the industry, most obviously to influence prescribing practices but also to promote a world view that psychiatric drugs are essential, and to sanitise the image of the industry (which has recently been rocked by fresh accusations of unethical practice). Nursing's image, the public trust it enjoys and ultimately good relationships with service users stand to be tarnished unless nursing rethinks its relationship with the industry. Nursing ought to reposition (or restore its position) next to service users rather than next to the pharmaceutical industry.

This paper was peer reviewed and originally accepted for publication in Mental Health Practice. It was even advertised for publication. However, it was withdrawn by a new editor. A satisfactory explanation was not provided and despite a request for the grounds for this editorial decision to be shared with readership this was not provided either.

Cutcliffe, J., & Lakeman, R. (2010). Challenging Normative Orthodoxies in Depression: Huxley's Utopia or Dante's Inferno? Archives of Psychiatric Nursing, 24(2), 114-124.

Although there appears to be a widespread consensus that depression is a ubiquitous human experience, definitions of depression, its prevalence, and how mental health services respond to it have changed significantly over time, particularly during recent decades. Epistemological limitations notwithstanding, it is now estimated that approximately 121 million people experience depression. At the same time, it should be acknowledged that the last two decades have seen the widespread acceptance of depression as a chemical imbalance and a massive corresponding increase in the prescription of antidepressants, most notably of selective serotonin reuptake inhibitors (SSRIs). However, questions have been raised about the effectiveness and iatrogenic side effects of antidepressants; related questions have also been asked about whose interests are served by the marketing and sales of these drugs. Accordingly, this article attempts to problematize the normative orthodoxy concerning depression and creates a "space" in which an alternative can be articulated and enacted. In so doing, the article finds that the search for a world where the automatic response to depression is a pharmacological intervention not only ignores the use of alternative efficacious treatment options but may also inhibit the persons' chance to explore the meaning of their experience and thus prevent people from individual growth and personal development. Interestingly, in worlds analogous to this pharmacologically induced depression-free state, such as utopias like that in Huxley's Brave New World, no "properly conditioned citizen" is depressed or suicidal. Yet, in the same Brave New World, no one is free to suffer, to be different, or crucially, to be independent.

Lakeman, R., & Cutcliffe, J. (2009). Misplaced epistemological certainty and pharmaco-centrism in mental health nursing. Journal of Psychiatric and Mental Health Nursing, 16(2), 199-205.

This paper examines a trend and bias in nursing to overstate the evidence in support of pharmacological treatments. Examples of uncritical and emphatic statements of fact are drawn from recently published literature. Treating theories of biological causation of mental illness as fact and overstating the efficacy of pharmacological treatment leads to a pharmaco-centric view of mental distress and practice. This view is unscientific, and can be potentially dangerous in that it may constrain nurses from seeking the most appropriate responses to address the complex needs of those in need of nursing care

Lakeman, R. (2001). Making sense of the voices. International Journal of Nursing Studies, 38(5), 523-531.

Hearing voices is a common occurrence, and an experience of many people in psychiatric/mental health care. Nurses are challenged to provide care, which is empowering and helps people who hear voices. Nursing practice undertaken in partnership with the voice hearer and informed by a working explanatory model of hallucinations offers greater helping potential. This paper uses Slade's (1976. The British Journal of Social and Clinical Psychology 15, 415-423.) explanatory model as a framework for exploring interventions which may assist people in exerting some control over the experience and which might be used alongside pharmacological interventions. Principles and practical ideas for how nurses might assist people to cope with and make sense of the experience are explored.

Hurley, J., & Lakeman, R. (2022, September 7-9). Non authors of our own demise: Articulating our clinical worth is vital for future opportunity. Presented ACMHN’s 46th International Mental Health Conference. Mental Health Nursing in a climate of change. Marriott Resort, Gold Coast, QLD

The Productivity Commission and Victorian Royal Commission reports starkly outline the longstanding systemic flaws within Australian mental health services. These reports also signpost areas of opportunity for mental health nursing. These opportunities include positioning mental health nurses more prominently in community based services, delivering psychotherapeutic interventions and in early intervention roles. Additionally, opportunity exists in specific areas of need such as rural and regional workforce shortages. In short, within this era of potential reform we are almost uniquely positioned to be a major contributor, given the volume of our workforce and breadth of capability. However, those guiding policy and funding responses for reform remain mostly oblivious to our capabilities, despite assertive efforts.
One key reason for this lack of recognition is that politicians and their supporting public servants have little understanding of what a mental health nurse does, who they are and most importantly what clinical outcomes they achieve. This paper offers an overview of recent and current research detailing precisely such understandings. Data presented will demonstrate that mental health nurses have a breadth and depth of clinical capabilities in pharmacology, psychotherapy and aggression management, as well as advocacy and physical health (Hurley & Lakeman, 2020). Themes from a recent scoping review of mental health clinical roles highlight the fusion of both technical and non-technical capabilities that the mental health nurse enacts within these roles. Finally, evidence on mental health nurses under stating and minimising the value of their work will also be presented (Lakeman & Hurley, 2020).
It is challenging to make others communicate our capability and hence contribution to reform agendas. However, we do have influence on how we articulate our craft to others and should do so more often, more assertively and with greater clarity.

Hurley, J., Lakeman, R. & Browne, G. (2014 Oct 7-9). Happiness and mental health nursing: growing our core identity. Paper presented at the 40th Annual Conference of the ACMHN: Honouring the Past, Shaping the Future. Sofitel Melbourne

The seminal work of Victor Frankel in forming Logotherapy and more recent studies exploring the construct of happiness suggest that individuals need a core purpose, so as to experience contentment and well-being. This paper applies this principle to the mental health nursing profession through proposing we have been distracted from our core purpose for half a century; most often by the sparkling lure of inflated promises by pharmaceuticals. Arguably, our hegemonic relationships with other disciplines also results in MHNs responding to the purposes and philosophies of the medical and psychology disciplines, resulting in a professional depression and stagnation of growth. Additionally, roles associated with custodial care further erode the humanistic and caring drivers that initially led many to the profession.

Efforts to illuminate the contribution of MHNs have produced a plethora of consumer satisfaction and identity studies; mostly showing satisfied consumers. However, such studies capture 'what is' rather than 'what could be’ the core purpose of MHNs and are hence limiting. Forwarded is that for MHNs to recapture this purpose that they need to evolve the therapeutic relationship into a more substantial therapeutic alliance, with a deeper adoption of consumers’ views and formalised talk based intervention capabilities. Credentialed MHNs have demonstrated that they are amply qualified in providing evidence talk based treatments to those with the most complex problems. Furthermore, most have advanced training in one or more schools of psychotherapy. This future direction can return MHNs to their core purpose and possibly, professional happiness.

Lakeman, R. (2000, 10 - 11 June 2001). Helping and hearing voices. Paper presented at the The North Queensland Sub-branch of the Australian and New Zealand College of Mental Health Nurses Winter Symposium, Arcadia Resort, Magnetic Island, AU.

This paper uses Slade's (1976) explanatory model as a framework for explaining hallucinations and considering helping interventions, which may be used alongside pharmacological interventions. Principles and practical ideas for how nurses might assist people to cope with and make sense of the experience are explored.

Lakeman, R. (1998, 27 - 29 November). Bridging social and clinical conceptions of hearing voices. Paper presented at the Centres and Margins, Eastern Institute of Technology, Taradale, New Zealand.

One cannot begin to make sense of coping experience without an understanding of the person's social world and how this informs and interacts with perceptions, and the attribution of personal meaning to the experience. The 1990s have been called the 'decade of the brain’. Today a person’s experience can be manipulated in a myriad of ways through the use of pharmacological agents. Because it is possible to completely ameliorate voices does not mean that we should. More than ever we need to extend our understanding of the voice hearing experience and bridge social and clinical conceptions.

Lakeman, R. (2013). Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life. Psychosis, 6

Lakeman, R., & Buckley, S. (2009). Book Review: Straight Talk about Psychiatric Medication for Kids. Mental Health Practice, 12(7), 9.

This book claims to anticipate and answer all the questions readers may have about mental, emotional, or behavioural problems in young people that could be treated with medication. The potential market is the parents of the 7.5-14 million American kids (p.1) who the author claims suffer from psychiatric disorders. This is a big market which in part explains the reason for this book. Trust in psycho-pharmacological treatments and by association medicine has also been somewhat shaken in the US by the exposure of widespread off-label prescribing of psychiatric drugs to children in recent years and this text purports to offer a balanced, trustworthy source of information….

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