‘You are not broken, the system is’ – new NFP pushes for less medication

This can and should change. Not Broken Project has been created to promote transparency about the disadvantage of over-medicalising and pathologising distress and to advocate for a shift in mental health policy towards addressing the social, developmental and environmental roots of mental distress, reducing reliance on medication-first approaches.

As many as seven million Australians are taking mind-altering drugs for emotional distress and behavioural challenges (including anxiety, depression, ADHD and OCD). That is more than one in four. Either you or someone close to you is part of that chilling statistic.

And those numbers, among the highest in the world, are growing.

Behind statistics, of course, are real people, with their hopes and fears, worries and pleasures, challenges and triumphs.

Life can be tough, chaotic, even overwhelming; distress is part of the human condition. What is different now is the dizzying complexity of life, the increased number of sources of stress, and the fraying of networks that traditionally kept us connected. Little wonder we can feel bent, even broken.

Validation of symptoms can be a positive experience, but assuming a person may need drugs for life is disempowering, stigmatising and false – and it brings, for many, other forms of harm very different from the condition for which the drugs were prescribed.

Not Broken Project originated in our decades-long work – Jon Jureidini as a clinician-researcher in Adelaide, Paul Denborough as a clinician in Melbourne, and draws on the work of Mark Horowitz, the lead author of the first clinical guidelines for deprescribing psychiatric drugs, in the UK, who is an advisor to the project.

A not-for-profit advocacy initiative with a broad public remit currently attached to a university research group, NBP debuted in October at a symposium in Melbourne. NBP’s governing committee is composed of clinicians, people with lived experience and seasoned professionals with expertise in communications, community-based advocacy and research.

Not Broken Project acknowledges that some people respond well to biomedical treatments. But there is no scientific evidence to support the ‘chemical imbalance’ hypothesis of mental distress – the idea that something is wrong or broken in a person’s brain on a biological level that a drug can fix – that is used to justify widespread prescription of drugs.

A closer look at the evidence for the effectiveness of these drugs, including antidepressants, shows many of them work only slightly better than placebo (sugar pills).

People often start these medications hoping for relief, and some do get short-term benefits.

But many also face serious side effects: emotional numbing, sexual dysfunction, weight gain, and long-term dependence. Withdrawal can be harrowing. Some people find themselves worse off than when they started. The negative effects of these drugs can be life-altering, and withdrawing from them can be exceedingly difficult. In Australia, no meaningful help exists for deprescribing.

Against the default assumption that distress always signals a “broken brain”, we argue for balanced care, whereby biomedical options remain available, but social and relational interventions are funded and offered alongside them.

Current drug-based approaches lead to ineffective government spending and distorted support systems, and they discourage development of better solutions.

Medical labels can be helpful in validating patients’ experience of distress. But they also stigmatise, disempower, and tend to suggest a lifelong disorder when there is none.

In applying medical labels too readily, we overload an already stretched medical system. We must not conflate those of us who might experience serious distress with those in need of intensive psychiatric care.

So, what might reform look like? Our aim is that most people seeking help for mental distress or behavioural challenges will be able to access support without being left feeling that they have a lifelong deficit that can only be helped by biomedical intervention.

There will be greater attention to and support for social and interpersonal solutions that help people manage their particular circumstances.

When doctors prescribe drugs to relieve mental distress or behavioural challenges, they will do so understanding that in most cases they are suppressing symptoms, not correcting an underlying chemical imbalance.

The goal is rebalancing, not elimination. Those with severe illness still need access to medications and specialist care. It is our aim that policy reform will prioritise safer prescribing, improved social supports, and robust referral pathways.

We recommend safeguards: ring-fenced funding for social supports; independent evaluation; lived-experience oversight; and legislative protections so reforms expand services rather than shrink them.

Change requires clinician education, audit and feedback, pharmacist-led reviews, decision tools, and time and funding for alternatives. Pilot programs show combining these measures works better than single actions.

Deprescribing must be structured, person-centred, and interdisciplinary: it requires careful medication review, tapering, pharmacist involvement, and psychological and social supports.

The starting point is so often distress in response to adversity and challenge. Family violence, housing insecurity, homelessness, financial strain, unemployment, job insecurity, juggling of caring responsibilities, relationship stresses – the list is extensive, daunting and intensely human.

Triaging distressed people to non-medical services and support should be an integral part of reforming a system that is failing millions of people just like you.

Not Broken Project is a not-for-profit established last month by Adelaide clinician-researcher Professor Jon Jureidini, and Melbourne clinician Dr Paul Denborough. Its message is that mind-altering medications are not necessarily the answer to the distress of modern Australian life.

For more, please follow Not Broken Project.