I think that we overprescribe in Scotland and particularly in mental health. I think a number of years ago there was a recognition that antidepressant prescribing, particularly, was too high and that for many people some sort of psychological therapy was probably more appropriate.
The difficulty we have is that there is such a long waiting list still for those treatments, generally four to six months. And, even when people are referred for this type of treatment, GPs will still routinely prescribe an antidepressant while they are waiting.
When I give the patients’ perspective at the conference, one of the things I’ll hope to promote is supported decision-making, where patients themselves are thoroughly and completely involved in making decisions about their own medication, rather than it simply being the professional as the expert telling them what they should be taking.
One of the challenges is that GPs have to become much more knowledgeable about mental health and mental health medicines. Very often we find that, while GPs will challenge and change or reduce medication for lots of common physical health conditions, where something has been prescribed by a psychiatrist they tend not to touch it.
We have seen cases of someone who has been prescribed something short-term while they were on a ward, still on the same medicine several years later simply because the GP thinks ‘if a psychiatrist said that they should take it, who am I to change it?’.
I think the direction of travel is positive. We are recognising the skills of other professionals. If you want to have a chat about your medicines, why shouldn’t you talk to a pharmacist rather than a GP? I think there is a bit of re-education needed for patients to understand that pharmacy is more than just the shop where you pick up your prescription. Pharmacists can be a very valuable source of information and advice.
I accept that some people may not want to be equal partners in decisions about their medicines. There are those who really don’t want to know what medicines they are taking – they’re content to take the pink one in the morning and the blue one in the afternoon.
Increasingly, though, as people become more educated about medical matters and more able to manage their own condition, they feel more able to challenge; to ask, for instance, that a medicine they are on is reduced or stopped. As for antibiotics and other medicines, we need to take more seriously whether people still need to be on a medicine for long periods.
My own experience is fairly mixed in that I have been on and off a number of different medicines: some of which were very helpful at the time, and some of which were not. One very good psychiatrist once said to me that one should think of prescribing in mental health as an art-form rather than a science. Some medicines will work very well for one patient and simply do nothing for another patient with the same condition, yet the only way to know is to try it out.
Many of these drugs have serious side-effects that need to be monitored, so managing them is not just about mental health but also the physical aspects and the effects the medicine has on the body in other ways.
I think there always needs to be constant review of whether a medicine that was once appropriate for you, still is – or whether there should be a change. People’s conversations with healthcare professionals about their medicines for mental illnesses needs to continue for as long as they are taking them. My hope is that we can think about medicines as an ongoing discussion, the writing of the prescription being the beginning not the end of the matter.
Gordon Johnston is a patient advocate and a Board Member of the Mental Welfare Commission for Scotland.