Dublin: EXPOSED: Scandal Of How Prescribed Anti-Psychotic Drugs Are Killing-Off Psychiatric Patients

5 Aug

5m drug prescriptions for mental health a year:

MORE than five million prescriptions for powerful drugs to treat depression, psychosis, anxiety or lack of sleep are being written every year, costing in excess of €110 million, official figures have revealed.

The true extent of so-called “pill-popping” in Ireland, however, is much more as the only figures recorded are for medical card holders and people claiming through drug payment schemes, which accounts for less than half the population.

Figures compiled by the Irish Examiner from the HSE’s 2009 Primary Care Reimbursement Service show 14,000 prescriptions for anti-depressants, benzodiazepines (addictive tranquillising pills), anti- psychotics and sleeping tablets were being written every day, at a cost of €113m. The drugs are now being prescribed as often as common antacid tablets.

A report in 2002 found 11.6% of the adult medical card population were using benzodiazepines.

Since that report, the prescribing of Valium and Xanax, both used to treat anxiety and panic, have increased dramatically, with 399,798 prescriptions written for Xanax in 2009, compared with 283,000 in 2005.

The Mental Health Commission, during the inspections of 2010, found the use of benzodiazepine in both acute and long-stay units was widespread. In total, 57% of in-patients were prescribed benzodiazepines. Of these, 62% were on regular doses of the highly addictive drugs.

Nine anti-depressants, most of which are selective serotonin re-uptake inhibitors (SSRIs), were prescribed more than 2.2 million times in 2009.

Basil Miller, director of communications at the Wellbeing Foundation, said it is clear from the data that anti-depressants are grossly over-prescribed.

“This is largely down to inappropriate prescribing, where anti-depressant scripts are written as first recourse for depression when all the guidelines state that they are not to be used as a first treatment for depression and are not appropriate for mild to moderate depression.

“Because counselling and talk therapy, which work better for depression, are not widely available in the general medical service and are costly in private practice, pills are prescribed which should not be prescribed,” he said.

“Virtually everyone who presents with depression gets a pill. As severe depression is diagnosed in only 5% of cases, this means that 95% of patients are being given anti-depressants contrary to guidelines.

“If the guidelines were followed, the bill for anti- depressants would be €3m, not €60m. It’s time to spend that €57m on talk therapies which work, rather than lining the pockets of the drug companies by paying for the wrong — and ineffective — treatment.”

In relation to anti-psychotic drugs, usually prescribed for schizophrenia, bipolar disorder or to manage psychosis, former mental health inspector Dr Dermot Walsh maintains that second generation anti-psychotics — such as the current most commonly prescribed olanzapine (better known as Zyprexa) — cause “substantial adverse effects”, compromising life expectancy in psychiatric patients.

Dr Walsh said that there is emerging evidence that some changes in the structure of the brain, previously thought to be the consequence of the schizophrenic process, may actually be treatment-related.

NEWS UPDATE:

AN Irish Examiner investigation into prescribing patterns of tranquilising and stimulant drugs shows that pharmaceuticals to help anxiety and depression are being dished out in alarming numbers.

An analysis of the top 100 drugs reveals that, in 2009, the latest year for which data is available, more than €60 million was spent on anti-depressants, while a further €53m was spent on benzodiazepines (tranquilliser drugs), anti-psychotics and sleeping tablets.

The sector watchdog, the Mental Health Commission, says it is worried about the widespread use of benzodiazepine medication among the long-stay and elderly population in mental health services, and about the emphasis on a pharmacological approach in services in general. While just the top 100 drugs are published, overall in the medical card and drug payment scheme, prescriptions for medications which have an effect on mood — either stimulating or tranquillising — were written at a rate of almost 20,000 scripts a day in 2009. The drugs, classified as psycholeptics and psychoanaleptics cost €148m and account for 10% of all pills prescribed through the schemes. Other uses which were excluded for this article, include Alzheimer’s, dementia and narcolepsy.

ANTI-DEPRESSANTS:

Nine anti-depressants, most of which are selective serotonin reuptake inhibitors (SSRIs), were prescribed more than 2.2m times in the medical card and drug payment schemes in 2009.

One of those, escitalopram, cost €15m alone, even though it is simply a newer version of citalopram, the active ingredient in the SSRI anti-depressant, Cipramil. So while the older version costs far less, both are being prescribed.

This is a technique used by pharmaceutical companies to charge more for what is essentially a copycat medication. Several studies have found that second-generation antidepressants, despite differences in drug classification and cost, offer patients very similar benefits and only minimal differences in risks. SSRIs have been the source of much controversy in recent years. Findings of the US drugs watchdog the FDA resulted in a black box warning on SSRI and other antidepressant medications regarding the increased risk of suicidal behaviour in patients younger than 24.

The family of Shane Clancy, who took his own life after stabbing his friend, Sebastian Crean, to death, believe the antidepressant he had been prescribed, citalopram, drove him to do what he did.

In giving expert evidence at his inquest, psychiatrist Professor David Healy said in a small but significant minority of patients using SSRIs can give rise to violent behaviour including self-harm, suicide and violence towards others. Prof Healy said he had had clinical experience of two men with no prior history of violence who became homicidal after a week on citalopram where the problem cleared up once treatment had stopped.

ANTI-PSYCHOTICS:

In relation to anti-psychotics, former mental health inspector Dr Dermot Walsh maintains second-generation anti-psychotics — such as the most commonly prescribed in this country, olanzapine — cause substantial adverse effects compromising life expectancy in psychiatric patients.

“As shown by studies such as CATIE and CUTLASS 1, these second-generation drugs have little therapeutic advantages over their predecessors but cost much more,” he said.

Equally of concern, Dr Walsh said, is emerging evidence that some changes in brain structure, previously thought to be the consequence of the schizophrenic process, may actually be treatment related.

Dr Walsh said while campaigners are vocal on the issue of outlawing electroconvulsive therapy (ECT), no one is shouting about the damage which the use of such drugs, administered to unwilling or incapable patients, could be doing.

NEWS UPDATE:

THE closure of Victorian-era psychiatric institutions has been official Government policy for more than 40 years, yet hundreds of mental health patients still remain in outdated, unsuitable buildings.

Those who remain in such facilities are the elderly and often the most vulnerable patients.

The Irish Examiner has learnt that, as late as June, St Finan’s hospital in Killarney, Co Kerry, which is in use since 1849, and has been blacklisted by Mental Health Commission inspectors for many years, is still taking admissions from the psychiatric unit at Kerry General Hospital.

It is understood four patients were admitted over the course of a week in June, as there was nowhere else for the patients to go.

Though most wards at St Finan’s have closed, 20 people remain in the sprawling, dilapidated building, while another 20 reside in a separate building on the hospital grounds, built in the 1970s. Sources say the old building is “falling down” and that heating and lighting costs are mammoth.

Staff at all levels are frustrated, disenchanted and upset at the living conditions of the residents in their care and of the working conditions they had to face each day.

This is compounded by the fact that a new unit built by the Kerry Mental Health Association, also on the hospital grounds, has been lying idle for two years due to a lack of resources.

Sources expressed frustration and anger that it has not opened as promised.

In many areas, such is the pressure to close old hospitals, that sources maintain that patients are once again being inappropriately placed and it is a case of “moving the problem from A to B”.

Elderly people with mental health problems are being moved to private nursing homes which, it has been suggested, might not be able to cope with the needs of the patients.

For example, in Dublin, elderly patients were moved from another black-listed hospital, St Ita’s, which lies on isolated grounds in rural Co Dublin, but the plan is that they will be moved back to the campus next year to a new unit.

In Carraig Mór, in Cork city, 21 so-called “voluntary” patients ranging in age from 30 to 78 live on an upstairs ward.

They were moved there from the now closed Victorian-era Our Lady’s Hospital in Cork. The unit they live in now was once part of the buildings of the old hospital.

Similarly at St Stephen’s Hospital, Glanmire, in Cork, there are about 71 long-stay patients.

Originally a sanatorium located on extensive grounds in a rural setting, elderly patients were earlier this year moved from Heatherside Hospital, in Buttevant, which was closed, to both St Stephen’s and St Mary’s Orthopedic Hospital in Cork city.

These “second-generation” institutions stand accused of once again warehousing people inappropriately.

Consultant psychiatrist Dr Siobhán Barry said that although these people are probably not used to anything but institutional living, it is still wrong to move them out of one institution and into another.

“The problem was that people never got reintegrated and so remained in these places, and the potential for real tragedy is that this could still be happening today.”

Plans to sell the last remaining hospitals — such as St Ita’s and St Finan’s — with large land banks never came to fruition and now, with the collapse in the property market, the HSE has been left to work with them rather than fully close and sell them and their extensive lands.

Because of this, says Dr Barry, long-stay residents continue to live in dilapidated and often deeply impoverished and stigmatising environments instead of community-based residential facilities.

Another issue with this cohort of older patients is that they are classified as voluntary, even though they have essentially been detained for many years.

Mental health law expert Dr Darius Whelan said these people urgently need to be classified as involuntary patients.

“If you take Carraig Mór, there is a unit where all the patients are classified as voluntary. They are long-stay residents but regarded as voluntary as they were admitted under the 1945 act. Even under current act, there is no requirement that they be assessed under the tribunal system.”

Dr Whelan said all patients deprived of their liberty must be entitled to a form of periodic review. He said, however, there would be a cost involved in this as it would mean more tribunals, so this could be the reason why the situation is not remedied.

NEW PLANS REVEALED:

CONSULTANT-led home-based crisis intervention teams are set to be developed in Waterford, Wexford, Carlow, Kilkenny and Tipperary during the course of next year, the Irish Examiner can reveal.

The seven day services, with an on-call facility at night, will provide assessment and intervention for people with acute illness, enabling treatment in a home environment.

Other services being developed include three high support residences at St John’s Community Hospital, Enniscorthy, Co Wexford.

Two houses will accommodate 13 people with severe intellectual disabilities and challenging behaviour who are currently living in St Senan’s Hospital. A third house will accommodate a further 13 long stay patients from St Senan’s. It is hoped they will be available for occupation in July 2012.

A community nursing unit is being developed next to Wexford General Hospital to accommodate 20 mental health places for older people.

A comprehensive plan is also in place for the delivery of modern services in south Tipperary which has a €20m investment package to re-configure services.

A 10-12 bed high support hostel will be built, as will a 40-bed community nursing unit to replace St Luke’s Hospital in Clonmel with modern community-based facilities.

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