SAMH`s position statement on medicines used in mental health

SAMH Position Statement
Medicines used in Mental Health
February 2013
Policy review by: February 2014
Psychiatric medication can be a vital and often successful element in
the treatment of mental ill-health. Medications can also support and
supplement many forms of non-medical therapy.
People must have access to a range of treatments and be
empowered to play an active role in deciding which medications are
best suited to them and how they are used.
The standards and guidelines which apply to prescribing in Scotland
must be properly implemented and fully adhered to.
The initial training and continuing professional development of GPs
and Psychiatrists should be revised to include a stronger focus on
prescribing for mental health
SAMH is frequently asked for views on psychiatric drugs, by mental health
service users, carers, professionals, and by politicians and the media. It is
clearly an issue which affects a great many people and which can polarise
People’s experiences of the medicines used in mental health can vary greatly.
Psychiatric drugs target mood and behaviour, meaning that their effects on
individuals can be more unpredictable than their counterparts for physical illness,
and finding the right drug can be largely a question of trial and error.
For these reasons, it is vitally important that service users enjoy an open
relationship with the person responsible for making the prescription. They should
be treated as equal partners in the prescription process, with easy access to all
the information they need to make informed choices. Furthermore, it is essential
that the range of standards and guidelines relevant to prescribing in Scotland are
properly promoted, understood and implemented.
It is rare for a psychiatric treatment not to have both enthusiasts and detractors.
For over 50 years, drugs have been the mainstay of psychiatric treatment. Many
people have found them to be helpful, even life-savers but others have had less
positive experiences. Some argue that our treatment system is too dependent on
drugs, as opposed to other treatments.
Medicines used in mental health are usually prescribed by either Psychiatrists or
GPs. Examples of psychiatric drugs currently being prescribed in Scotland
include Antidepressants, Antipsychotics, and mood stabilisers. The most recent
annual summary of prescribing statistics1 for mental health drugs shows
increases in the prescribing rates for all groups of drugs over the previous 12
months. It is also estimated that 11.3% of the Scottish population aged 15 and
over make daily use of antidepressant drugs.2 This may indicate an increasing
reliance on psychiatric drugs and raise concerns about over-prescribing but it
could also reflect the effective diagnosis and treatment of mental health
conditions, in line with good clinical practice.
A broad range of standards and guidelines have been introduced which are
relevant to prescribing and treatment practice in Scotland. This includes
guidance issued by the General Medical Council,3 which asserts that doctors
must reach agreement with patients on the use of any proposed medication and
treatment by exchanging information and clarifying concerns. The Scottish
Intercollegiate Guidelines Network (SIGN) has developed a number of guidelines
which outline prescribing and treatment options for a range of conditions, such as
specific guidance on the non-pharmaceutical management of depression. NHS
Boards in Scotland are also required to develop and implement Integrated Care
Pathways (ICPs), clearly detailing the various interventions that must be offered
to mental health service users, as well as those that must be offered to people
with a specific condition.
NICE guidelines are not specifically developed for use in Scotland but Scottish
practitioners often take account of them because of their value as the latest,
evidence based, clinical guidelines developed by experts in the relevant field.
The NICE guideline for depression in adults specifically states that
antidepressants should not be used to treat mild depression, instead
recommending guided self-help, online CBT or group physical activity4.
SAMH’s own research5 has consistently shown that a majority of people find
medications to be useful in helping them to manage mental ill-health. However,
this is not always the case and some people do not feel that they are afforded
choice or given enough information about medications and the range of
treatment options available to them. In addition, some people report
experiencing unwanted side-effects but do not always feel that their concerns are
taken seriously, whilst others believe that their use of medication is not
adequately monitored and reviewed.
Despite many positive developments in prescribing for mental health, it is clear
that more remains to be done to improve the prescribing process and empower
people to become active partners in decisions about which treatment options are
best suited to them. If properly implemented, the various standards and
guidelines which relate to prescribing could go far to bring about improvements in
this regard. Recent changes to the way that GPs and Psychiatrists are
appraised and validated also bring new opportunities to afford increased priority
to good prescribing practice.
SAMH is making the following recommendations to the Scottish Government,
Local Authorities, National Health Service for Scotland (NHS), General Medical
Council (GMC), Royal College of General Practitioners (RCGP), Royal College of
Psychiatrists (RCPsych), NHS Education for Scotland (NES) and Healthcare
Improvement Scotland (HIS):
Prescribers should be able to demonstrate that patients’ views about
medication and treatment are explored and their choices taken
seriously at the point of prescribing. This could be investigated
using patient experience surveys.
HIS should develop a resource for prescribers to make it explicitly
clear when a particular guideline or standard applies i.e. NICE, SIGN
and/or ICP. Access to this information should then be demonstrated
as part of appraisal and revalidation.
The GMC, RCGP, RCPsych and HIS should strengthen training in
prescribing. This should include reviewing the RCGP and RCPsych
curriculum to give greater prominence to the knowledge and skills
needed for safe prescribing.
Greater attention should be given to prescribing for mental health in
the continuing professional development of GPs and Psychiatrists.
For example, new prescribing learning resources should be
promoted to doctors as part of the Continuing Professional
Development modular Credit-Based System.
The GMC, RCGP and RCPsych should enable prescribers to record
educational activities, audits, and procedures specifically relating to
prescribing. This should then be reviewed during Appraisal to
identify areas for improvement.
The GMC, RCGP, RCPsych and HIS should ensure that prescribers
regularly review their repeat prescribing and medication monitoring
procedures, and can demonstrate the outcomes of these reviews.
Information Services Division, Prescribing & Medicines: Medicines for Mental
Health Financial Years 2002/03 to 2011/12, 25 September 2012
2 Publication Summary Prescribing & Medicines: Medicines used in Mental
Health Financial years 2001/02 – 2010/11, Information Services Division ,
September 2011
General Medical Council, Good practice in prescribing medicines - guidance for
doctors, 2008
NICE, CG90, Depression in adults: the treatment and management of depression in adults,
SAMH, All You Need To Know (2003) & What’s The Script (2013)