Wednesday 22 June 2011


I am contemplating the excellent feedback we had last week from a major training event on treatments for serious mental illness. We went into detail about both medical and talking therapies, assisted by our good friend and leading Welsh mental health pharmacist Wendy Davies from Cardiff and Vale LHB and the pioneering team of talking therapists from Hywel Dda LHB.

Discussion about antipsychotic and other mental health drugs has been clouded in ideological squabbling over the years, between the antipsychiatric "movement" on the one hand and over-defensive doctors on the other. Much of this debate has left out the people who matter - the patients and their families who aren't interested in philosophical hair-splitting about the nature of mental illness but who do want the best treatments available to aid recovery and improve the quality of their lives.

Information, negotiation, and being prepared to try things out are the way forward for patients who still often find it hard to get their own view heard let alone be offered choices.

I do think there is an important but neglected point which has been lost in the fog of controversy. Some patients (by no means all) tell us rationally enough that the side effects arising from their specific experience of antipsychotic medication for them outweigh benefits which they acknowledge (of course sometimes treatment just doesn't help but that's quite another matter) so that they want to discuss whether they might manage better without medication.

I do not detect much sympathy for this group of patients who are not behaving irrationally, still less trying to make an antipsychiatric point, but trying to achieve the best result for themselves. However, they are often labelled "non-compliant" and lumped together with patients who might indeed be failing to take their medication by reason of their mental illness.

Nobody is pretending that it is easy to distinguish rational and less rational reasons why patients form their opinions about medication but there should be much more effort put into talking therapies which directly address symptoms of serious mental illness or else assist people to adapt themselves to live successfully with their symptoms rather than take drugs which can severely debilitate them.

Is it not reasonable, for example, for some people who hear voices to wish to come to terms with that symptom and avoid using powerful and toxic drugs in an attempt to dampen down or remove those voices, if that works better for them? But where is the support for such an approach? Is it considered seriously as an option?

Of course this isn't going to work for everybody and may indeed only be a serious option for a minority of those with psychotic symptoms, at least on the basis of current knowledge (whereas the use of medication for lower level mental health problems could and should be drastically reduced). Our strong advice is that patients do not stop taking or reduce their medication without discussing the issues with their doctor. But there is no harm in asking, especially if you are having a lot of problems with side-effects (and, anyway, a different drug might improve matters).

For Hafal's comprehensive guide to treatments for severe mental illness, both medical and psychological, see here.