With more talk in mind – Dr John Read

This is a great article Id like to share

Sydney Morning Herald, the Age Melbourne

Any review of Victoria’s mental health services must look beyond psychiatry.

John Read

September 15, 2011


SERIOUS problems in Victoria’s mental health system have been revealed recently in The Age. The important thing now is to find solutions. In doing so we should remember that although Victoria is in the spotlight, similar ”crises” occur regularly all over the world. Perhaps this is because Victoria is not alone in having a system based on fundamentally flawed principles.

 Mental health services have become increasingly dominated by psychiatry’s ”medical model”, which claims that feeling depressed, anxious or paranoid is primarily caused by genetic predispositions and chemical imbalances.

 This has led to alarming rises in chemical solutions to distress. In New Zealand, one in nine adults (and one in five women) is prescribed antidepressants every year.

 The public, however, in every country studied, including Australia, believes that mental health problems are caused by issues such as stress, poverty and isolation. The public also prefers talking therapies to drugs and electroconvulsive therapy (ECT).

 Research suggests the public is right. For example, the single best predictor of just about every mental health problem is poverty, followed by other social factors such as abuse, neglect and early loss of parents in childhood, and – once in adulthood – loneliness and a range of adverse events including losses and defeats of various kinds.

 Meanwhile, reviews of studies on anti-depressants (which only recently have been able to include those previously kept secret by drug companies) conclude that they are superior to placebos only for those at the extreme end of the ”most severe” group of depressed people. This represents less than 10 per cent of the people who are receiving these drugs.

 A recent Cochrane review (the type most highly regarded in the scientific community) for risperidone, a leading anti-psychotic drug, ”suggests that there is no clear difference between risperidone and [a] placebo”.

 A placebo (from the Latin meaning ”I please”) is not necessarily a bad thing. Indeed the talking therapies are effective partly because, if done well, they too instil hope and expectations of recovery.

 The problem is that psychiatric drugs often have serious adverse effects. Anti-psychotics, for instance, can cause rapid weight gain, loss of sexual function, diabetes, heart disease, neurodegeneration and reduced life span.

 As previously reported, my review of ECT studies (with Professor Richard Bentall of Liverpool University) found that this treatment is ineffective for most recipients and frequently causes permanent memory loss. This in itself can be depressing.

 ECT also has a slight but significant risk of death, most frequently from cardiovascular failure.

 Inpatient units are equally ineffective and can also be damaging. When will we learn that putting large numbers of extremely distressed people in the same building is not a good idea?

 What I conclude from all this is that any review of mental health services in Victoria, or anywhere else for that matter, should probably be led by anyone other than a psychiatrist – and certainly not in Victoria’s case the state’s Chief Psychiatrist, whose job, according to Dr Ruth Vine herself, is “to watch over how the system is functioning”.

It is unfair to expect Dr Vine to take an objective view on the failure of the system for which she is responsible. That lack of objectivity is amply demonstrated by her claims that ECT is “safe and effective” and that the problem is the public’s “negative” views. Perhaps a lawyer from the Mental Health Legal Centre might be a good choice.

 Any review should include mental health service users and their families, and other mental health professionals, including social workers, occupational therapists, psychologists and nurses.

(Psychiatric nurse Philip Lynch reminds us that there are thousands of staff “who quietly continue to do important work every day, often in challenging circumstances”; so why only listen to the doctors?)

 The review should also investigate what percentage of people receive drugs, and what percentage receive safer, more effective alternatives, and how a better balance can be achieved. It must scrutinise the contact and transactions between psychiatrists and drug company reps and consider ways to reduce or eliminate these, and as well find ways to reduce the pressure on psychiatrists by helping them feel OK about sharing decision-making. When things go wrong, as they inevitably will sometimes, everyone should share responsibility, and support one another.

 The review would need to explore the ”recovery model” recently introduced in many other countries, including New Zealand. (No, I am not saying New Zealand is superior to Australia – except, of course, when it comes to rugby.)

 Further, the review would need to learn from the many innovative non-government organisations, such as Voices Vic and Mind, and study ways to prevent mental health problems developing – perhaps by focusing on providing safe and nurturing environments in the first few years of life. Also, simply listen to the public.

 Finally, The Age can assist by reporting the issues without exaggerated headlines such as “1000 DEATHS”.

 Dr John Read is a professor of clinical psychology at Auckland University. He advises that no one should reduce or come off medication on the basis of information in this article but should, if they have concerns, consult the prescribing doctor.



Interview on Radio NZ with Dr John Read

Here is a link to the Radio NZ interview on Thursday 25th November with Dr John Read

It is an excellent interview in response to an interview on Radio NZ with a Doctor whose visit to New Zealand was sponsored by the drug companies.

As always Dr Read is eloquent in his summation of the issue of medications and their use for treatment of those who hear voices.

Letters re Influence of Pharmaceutical Companies in New Zealand

Some of you may have already seen these letters published in the Sunday Star times. A statement on the influence of drug companies on the way we are buying and using prescription medicines. I have also inserted a link to the article to which  Dr John Read is writing about. Surely independent advisers are necessary? Here are the letters below, one from Dr John Read, and another from Janette Saxby an alcohol and drugs clinician.
The first one was in the July 25th edition – reproduced here (I couldn’t find it online)
  A responsible response from the Ministry of Health to your article, “Flu Experts linked to drug firms”(July 18), might have been to consider an audit to determine how many other advisers were in the pay of drug companies. Instead, one of its deputy director-generals is reported to justify the use of such advisers because New Zealand is too small to find experts independent of commercial influence. Even in the US, however, the majority of “experts” employed by their FDA have links to the pharmaceutical industry.
An audit might start with mental health, where the pharmaceutical industry has effectively lobbied governments to purchase ever larger numbers of very expensive, but minimally effective, psychiatric drugs. Prescriptions of antidepressants and antipsychotics continue to grow, despite research showing that both have little benefit compared to placebo pills and have serious adverse effects. The fastest growing drug group, however, is methamphetamine-type stimulants for children with severe difficulty concentrating and sitting still, the side effects of which include an average of one centimetre a year reduced growth.
The Ministry should not be naive and ensure the advice they receive is uncontaminated by commercial interests.
                                        Dr John Read
Psychology Department
University of Auckland.
In todays Sunday Star times was a letter backing Dr John Read’s submission.
Dr John Read of Auckland University’s Psychology department suggested ( letters to the editor July 25) that the government has been lobbied by the pharmaceutical industry to provide ever-increasing numbers of psychiatric drugs. He states that some of the drugs are expensive and only minimally effective. He is frighteningly accurate in his assessment and cites the increase in both anti-depressant and also stimulants for children are not effective and in some cases, quite detrimental. Working in mental health in this country and in particular in working with youths, I was astounded at how quickly drugs were prescribed to those under 18, despite there being very little evidence for their efficacy.
Not only are anti-depressants being over-prescribed, so the reliance on prescription painkillers is growing. Substance abuse is not just limited to alcohol and cannabis but prescription pain medication is a growing problem in this country.
I am grateful that he shares his insight not only with the public through this forum but also has influence over students studying psychology at Auckland University and in future we may see some more enlightened practice with less reliance on drugs.”
Janette Saxby
Alcohol and Drugs clinician
Waikuku Beach Canterbury