Tuesday 18 February 2014


All aboard for Hafal's and our partners' campaign on treatments

Fascinating exclusive interview with Consultant Pharmacist Professor Stephen Bazire by Mental Health Wales here.

The Professor, a valuable friend to Hafal, is a world leader in setting out accessibly the pluses and minuses of drugs for mental illness. He has a subscription website but there is a free version run by the National Centre for Mental Health which you can see here.

I think his remarks about the typical versus atypical antipsychotic debate are timely and incisive. It actually isn't that helpful to compare the two categories as a whole. In practice it is much better to look at each medicine separately and consider its efficacy, side effects, risks and management/monitoring requirements - all of which vary widely within each category.

Nevertheless, and I know the Prof wouldn't disagree, it remains vitally important to guard against use of poor, cheap, older drugs for reasons of cost and without the patient and their family knowing what else is available.

I think the NICE guidelines are penny-pinching - psychosis is too serious a condition to justify a "try something cheap first" approach. Prescribers should be able to choose the best drug for the patient from a range of both typicals and atypicals.

I recollect that in the US I saw expensive antipsychotics being prescribed to patients on Medicaid as the first option not because the system is generous but because the hard-nosed private insurers whom the government contracted for this work had worked out that it was cheaper in the long run because patients got better and cost less in terms of care and support!

Not sure I agree quite so much with the Professor about anti-depressants. He points to the positive effect on rates of suicide but I think it is likely that over-prescription, especially in Wales, is damaging lives on a very large scale. It is a subtle point because you can't easily measure the decrease in vigorous engagement in life which these drugs can cause. But you can see those effects in people who take antidepressants, even to the point where you can guess that somebody has started using them just through casual acquaintance. They should not be used lightly but, yes, they should be used to protect and assist some people with at least significant problems.

Anyway, the interview is vital reading so please follow the link above. And look out for the next edition of Mental Health Wales which has a focus on treatments, a preliminary for our campaign on treatments which will commence in October (when our campaign on physical health, due to start in May, is completed). No peace for the wicked.