LETTER:Information needed on drug use in psychiatry

From Dr S. P. Sashidharan

and Dr P. Bracken

Sir: We should be grateful to Mind, Marjorie Wallace and others for highlighting the issues surrounding the use and abuse of drugs used in psychiatry (Letters, 12 and 13 June). Such drugs have been prescribed widely for nearly four decades now, with the enthusiastic support of the profession and the pharmaceutical industry. However, the limitations and side- effects of their use have not been fully acknowledged.

Mind's publication of the concerns about the serious side-effects and debilitating long-term consequences of psychotropic drugs is timely and requires a reasoned and sympathetic response from the mental health professions, especially psychiatrists. However, there are two other issues relevant to this debate. While there is impressive evidence that medications may have a useful role in alleviating many of the immediate symptoms associated with mental illness, it is unlikely that they are curative, or that their benefits outweigh the risks associated with continuous and long-term use. The increasing use of these drugs as the mainstay of psychiatric treatment is also often associated with a lack of acknowledgement of underlying social and psychological antecedents of most mental illness.

We have serious concerns about the lack of choice that many patients experience in relation to prescription of these drugs and, in particular, the almost routine use of these drugs in controlling behaviour, especially in hospital settings. This is especially true in relation to minority ethnic groups, particularly Afro-Caribbean patients referred to psychiatric services. There is evidence that the major tranquillisers are being used inappropriately, usually in doses much larger than the generally agreed guidelines. This has led to increasing disenchantment with the use of medication in the community at large and, regrettably, the potential benefits from prudent use of this medication are ignored in such a context.

Following the death of Orville Blackwood, a young black man in Broadmoor Hospital, an inquiry recommended a review of the prescription of such drugs, but regrettably this has not resulted in any major changes in the prescribing habits of psychiatrists. It is time that we, as a profession, started listening to the genuine and legitimate concerns of our service users and mental health organisations about the use of psychiatric drugs.

Yours sincerely,

S. P. SASHIDHARAN

Clinical Director,

North Birmingham

Mental Health Trust

P. BRACKEN

Consultant Psychiatrist

Department of Psychiatry

University of Birmingham

16 June