30 July 2002

Response of the Irish Section of the Royal College of Psychiatrists to Schizophrenia Ireland Survey

The Irish section welcomes the recent publication of the Schizophrenia Ireland survey. Positive points from the survey include the high rate of atypical anti-psychotics prescribed in Ireland. These medications have similar efficacy to typical and older anti-psychotics but considerably less side effects. This has been confirmed by users own experience outlined in the survey.

In the UK the National Institute for Clinical Excellence published its guidelines for the use of atypical anti psychotics only last month. (These guidelines are linked to this statement for information. As they are published by a UK body they are aspirational and non-binding) After reviewing the research evidence to date, the UK National Institute recommends that atypical anti psychotics should be used as the first line agent in the treatment of newly diagnosed schizophrenia and should be should be considered as treatment options for individuals currently receiving typical anti psychotic drugs who, despite adequate symptom control, are experiencing unacceptable side effects, and for those in relapse who have previously experienced unsatisfactory management or unacceptable side effects with typical anti psychotic drugs.

The results of the Schizophrenia Ireland survey demonstrate that Irish psychiatrists prescribing habits are moving in line with international best practice. The confirmation by the survey that employment training, education, supportive psychotherapy and similar therapies to aid users following the acute phase of the illnesses are in short supply and unevenly distributed across the country is in line with the experience and concerns of Irish Psychiatrists.

The document on which Irish psychiatry has been based (Planning for the Future) is almost 20 years old and yet has not been fully implemented in several areas. In many areas full multidisciplinary teams are still not available to provide the full range of services and therapies to users. The funding per head of population for mental health services varies fivefold depending on the part of the country one lives in. Also, as a percentage of health spending, the amount of funding devoted to psychiatry has been consistently dropping over the last decade.

This inequity is highlighted by this timely survey and demonstrates the need for users and carers groups and the professionals (medical, nursing, social workers, psychologists, occupational therapists) involved in delivering the service to work together to obtain the required level of funding to provide the services required and deserved.

On the issue of discussion of side effects and provision of information about side effects there are a number of points. Unfortunately, a significant number of people who are commenced on anti psychotic medication for the first time do so as involuntary detained patients. Naturally, in such circumstances it may not always be possible to fully involve the person in the choice of medication but the family or carer should be consulted.

Under the new mental health act, every person who is detained will have to receive a written plan of his or her proposed treatment (Section 16, 2 c). This should go some way to addressing users concerns. At present, it would be surprising if a psychiatrist did not go through the effects and side effects of medication they were to prescribe to a patient and certainly it is normal practice to enquire at each clinic visit for side effects. However, there always has to be a balance drawn between the benefit of a medication and its side effects.

It must be born in mind that the ideal situation that both psychiatrists and service users would wish to attain is very dependant on resources. It is common for a doctor in a routine psychiatric clinic to see 15-20 people in a morning. Given such a workload, the time for each person is limited and is certainly unsatisfactory for both parties. The lack of full multidisciplinary teams and the full range of therapies for service users are of grave concern to the Irish Section of the Royal College of Psychiatrists and obviously to Schizophrenia Ireland.

Irish psychiatry is simply under funded and under resourced and the responsibility for this does not lie with those who work in the service but with the health boards, the department and ultimately the Government of the day.

Further information
Young Communications 01-6680530\087-2471520