- Find out about the latest medical treatments for serious mental illness
- Ask your doctor to prescribe the most appropriate medication for you as an individual
- Find out about the side effects and management requirements of your medication and talk to your psychiatrist, GP, CPN, Community Pharmacist or the mental health pharmacist at the hospital
- Take the right amount of medication which has the most benefit for you
Medication forms a significant part of treatment for many clients and is often not an “either/or issue”. Medication must be effective and have minimal side effects.
Most people do not receive modern mental health treatment. In recent years, a number of new medicines have become available which offer more positive action in relation to both positive and negative symptoms whilst having less side-effects than older medication. Unfortunately, too often, these newer medicines are not prescribed.
Medicines are available in various forms (tablets, injections or liquids). These drugs can have side-effects for which additional medication can be prescribed.
The National Institute for Clinical Excellence has provided guidance on the use of newer (Atypical) Antipsychotic Drugs for the Treatment of Schizophrenia (Technology Appraisal Guidelines No.43) should be considered alongside the existing traditional medicines as one of the first choice options for treatment.
What does a Clinical Guideline Really Mean?
Clinical guidelines are recommendations on the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales. They sit alongside, but do not replace, the knowledge and skills of experienced health professionals
Once NICE guidance is published, health professionals are expected to take the Institute’s guidance fully into account when exercising their clinical judgement. However, NICE guidance does not override the individual responsibility of health professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their guardian or carer. For example, if an individual patient was allergic to a drug recommended in the guideline, it would be appropriate for their health professional to prescribe an alternative.
NICE Clinical Guideline on Schizophrenia
- Recognises that 1:100 will experience schizophrenia
- Recognises that with appropriate treatment, the majority of people will improve or recover
This guidance recommends:
- Early treatment
- Holistic care in recovery
- Partnership working – client and services
- Good information
- Full Assessment
- Choice of treatment / medication and Advance Directives
What is the Guidance to Clients in the Use of Atypicals?
- Your doctor should discuss with you which antipsychotic drug you should take. Your doctor should explain the benefits and side effects of the drugs, and if appropriate consult your advocate or carer. Decisions about which drugs you are prescribed should be made jointly with you and your doctor, and you should understand what the side effects of the medicine might be.
- If you have been newly diagnosed with schizophrenia then your doctor should consider prescribing you one of the following atypical (newer) oral antipsychotic drugs: amisulpride, olanzapine, quetiapine, risperidone or zotepine.
- If you are currently taking typical (older) antipsychotic drugs that are controlling your symptoms of schizophrenia but are causing side effects that you and your doctor agree are unacceptable, then your doctor should consider prescribing you an oral atypical antipsychotic (amisulpride, olanzapine, quetiapine, risperidone, sertindole or zotepine).
- NICE does not recommend that you change to one of the atypical (newer) antipsychotic drugs if you are currently taking typical (older) antipsychotics that are controlling your symptoms of schizophrenia and are not causing unacceptable side effects.
- If there is evidence that you have what is known as treatment-resistant schizophrenia or TRS (where the drugs you are taking are not controlling your symptoms of schizophrenia), then your doctor should prescribe you clozapine.
- If more than one of the atypical antipsychotic drugs is suitable for you, your doctor should prescribe the least expensive drug.
- If it is not possible for you to have a full discussion with your doctor about which drug should be prescribed, for example because you are having a relapse or acute schizophrenic episode, then your doctor may prescribe an atypical antipsychotic because of the lower risk of side effects. In these circumstances, your doctor should discuss your drug treatment with your carer or advocate if possible and appropriate.
- It is recommended that “advanced directives” are developed and kept in your care programme. Advanced directives are instructions written by you and your healthcare team, that describe what you would like to happen if you are not able to be involved in a discussion with your doctor at a time you require treatment (for example during a relapse of acute schizophrenic episode).
- Treatment with antipsychotic drugs should be part of an overall package of care that addresses your medical, emotional and social needs. Your doctor and key worker should monitor, on an ongoing basis, your progress and how well the drugs you are taking are working, and any side effects you are experiencing. This is particularly important if you have just changed from one antipsychotic to another.
- A typical and typical antipsychotic drugs should not be prescribed at the same time except for short periods if you are changing drugs.
For some patients these side effects can be more isolating and socially unacceptable than the schizophrenia itself. These side effects may include shaking or trembling, muscle twitches or spasms that can be permanent or can disappear after stopping the drugs. Other side effects may be blurred vision, a dry mouth, weight gain or fits. For many people these traditional medicines control the symptoms of their schizophrenia without side effects, however for others the side effects they experience are so distressing that they may stop taking their medicine which means the symptoms of their schizophrenia can become uncontrolled to the extent that they require hospital care.
Comments from Clients
- “The old drugs should be banned. Everyone should be able to get the newer, atypical drugs, regardless of how much they cost – they save lives.” – Ann from Wales who spent years in a special hospital until a switch to an atypical enabled her to leave
- “It’s obvious that the new drugs work. People like me are working, have a social life, and just live our lives. That isn’t possible on the old drugs – you feel like you’re reduced to jelly.” – Martin from Kent who experienced serious side effects on older medicines.
- “New medication has allowed both me and my husband to have a better quality of life. In the year before I started taking atypical medication I attempted to commit suicide 12 times and was in hospital six times. Since I began taking the medication 18 months ago, I have not been in hospital and am able to do voluntary work.” – Diana from Southampton.
- “The modern medication has really worked for me. I’ve been well now for three years but before that I had a terrible time on the older medications, with symptoms like Parkinson’s disease.” Joe, 26, from London.
To read a comprehensive guide to medications for mental illness, please click on this link: http://www.choiceandmedication.org/ncmh/
The range of mental health services in Wales should include psychological as well as psychiatric interventions, and must offer:
- Access to effective treatments to control the disabling and distressing symptoms of serious mental illness.
- Comprehensive mental health services available to all who need them.
- Proper care management: assessment, planning, implementation and review by a multi-disciplinary team, but co-ordinated by a named individual.
- An appropriate legislative framework, which reflects the values if the individual while ensuring public confidence in mental health services.
The focus should be on rehabilitation and recovery rather than on containment, and modern treatments now offer a greater chance to achieve this.
This is highlighted in Key Action 23 of Standard 6 of the National Service Framework for Wales: “A comprehensive evidence based range of psychological therapies must be available across Wales, with access to more specialist services.”
Most people do not receive modern mental health treatment. In recent years, a number of new medicines have become available which offer less side effects and more positive action in relation to both positive and negative symptoms. Yet, too often, these newer medicines are not prescribed.
The choice/range of treatment and therapy which can be considered in an holistic approach are:
One of the main treatments used in various forms (tablets, injections or liquid). The drugs can have side-effects for which additional medication can be prescribed.
Structured and time-limited support to assist individuals with emotional difficulties and psychological problems and processes. Included here will be cognitive therapy, group therapy and family therapy.
When based in or co-ordinated from hospital this often involves occupational therapy to regain and learn new social and life skills.
- Alternative therapies
Often referred to as ‘complementary therapies’ these can be offered alongside conventional, medication based treatments. Alternative therapies include: art therapy, music therapy, aromatherapy and reflexology.
Individuals may gain strength, support and comfort from their spiritual and religious beliefs.
This section will be developed with further information on each section, but in the meantime we can offer the following links:-
The National Institute for Clinical Excellence which has recommended to the NHS in England and Wales that newer, (atypical) antipsychotics should be considered alongside the existing traditional medicines as one of the first choice options for treatment.
The British Psychological Society – understanding mental illness; causes and treatment.
Rethink has additional information on treatment and therapy.
Additional information, use and current research on complementary therapies can be found in the ‘About Mental Health’ – ‘Strategies, treatment and therapies’ section of the Mental Health Foundation site at www.mentalhealth.org.uk
In recent years complementary therapies have become increasingly popular as a way of treating physical or mental ailments – and maintaining wellbeing. A 2005 survey commissioned by London’s Diagnostic Clinic showed that 68 per cent of people believed in the effectiveness of alternative therapies. It is currently estimated that 1 in 5 Britons use complementary health care – spending £130 million a year in the process – and that there are 50,000 complementary therapy practitioners in the UK.
With this increase in popularity has come calls for complementary therapy to have a greater role in mainstream care. In 2004 Secretary of State for Wales Peter Hain put forward proposals to enable complementary medicines to be available on the NHS. In a speech last year he argued his case, stating: “I believe this will make for better health and will ultimately reduce costs to the NHS by encouraging patients to take on a greater role in protecting their own health.”
In light of the growing popularity of complementary therapies, and their increased mainstream use, the UK Government announced in 2004 that complementary therapy was to be more closely regulated. Last March, the Assembly Government also launched the Complementary Treatment Award Scheme for Wales to identify best examples of integrated health care.
- So what is complementary medicine?
‘Complementary’ therapies are exactly that: they are therapies that can complement conventional Western medicine when used in conjunction with it (while not necessarily providing an alternative to conventional medicine, as the term ‘alternative medicine’ tends to imply). Complementary medicine is used by many people in the treatment and prevention of a wide range of conditions and illnesses, but it is also thought by some to play a part in a generally healthy lifestyle and promote the health and wellbeing of a person.
• Does complementary therapy work?
This is a contentious point. Much of the evidence of the effectiveness of complementary therapies is anecdotal, and scientific evidence tends to be uneven. Hafal states: “We will only recommend treatment and therapies which are backed by scientific analysis. Scientific research into complementary therapy has shown that some therapies work in some instances, but in many cases the evidence is simply not there. However people must be free to make their own choices.”
Hafal Tip – If you are interested in using complementary therapies check carefully with a GP that there are no adverse side effects.
Discussing ‘traditional medicines’, the World Health Organisation concludes: “Scientific evidence from randomised clinical trials is only strong for many uses of acupuncture, some herbal medicines and for some of the manual therapies. Further research is needed to ascertain the efficacy and safety of several other practices and medicinal plants.” (For more information, go to: www.who.int)
The Mental Health Foundation agrees, stating: “Much of the existing research into the use of complementary therapies in mental health is in the form of case reports only, with few comprehensive clinical trials or research reviews having been carried out. Where research does exist, it is often difficult to access.”
However, a report commissioned by the Prince of Wales and produced by economist Christopher Smallwood last year did suggested that conditions such as stress can benefit from complementary therapies (it was suggested that herbal medicines in particular could be beneficial in the treatment of depression).
Hafal Tip – If you want to use a complementary therapy, make sure you use appropriately qualified practitioners. Go to the Federation of Holistic Therapists website (www.fht.org.uk*) or the British Complementary Medicine Association website (www.bcma.co.uk*)
* Please note that Hafal is not responsible for the content of external internet sites
- So what are the main therapies available? We look at some popular examples…
|Therapy name||What it involves|
|Acupuncture||A branch of traditional Chinese medicine used to manage illness and maintain health, acupuncture involves inserting fine needles into the body to stimulate a healing response.|
|Alexander technique||A movement therapy that involves hands-on support as a teacher aids you in overcoming bad movement habits.|
|Aromatherapy||Essential botanical oils are added to the bath or massaged into the skin, inhaled directly or diffused to scent an entire room for therapeutic effect.|
|Herbal medicine||Medicinal extracts of herbs are used to treat a number of ailments or promote well-being. These can be administered in a number of different forms, including tablets and ointments.|
|Homeopathy||To treat a condition, tiny doses of minerals that would produce the same symptoms in a healthy person are administered.|
|Hypnotherapy||Involves inducing a relaxed, hypnotic state and accessing the subconscious mind so that memories are more easily retrieved, and healing suggestions can be absorbed.|
|Massage||Performing hand movements on the skin of the body, including stroking and applying pressure, to treat a variety of conditions or promote wellbeing.|
|Nutritional therapy||Using diet to treat ailments and prevent illness by rectifying any vitamin, mineral and other nutrient deficiencies or imbalances.|
|Reflexology||A specialised system of foot massage that sees the whole body mapped out on the sole of the foot: the corresponding points on the foot are massaged to treat ailments throughout the body.|
|Reiki||A Japanese system of channelling healing energy into the client. Involves a practitioner placing their hands over the client (but not necessarily touching them).|
|Shiatsu||A Japanese method of massage that applies pressure to specific points in the body to restore the body’s energy balance.|
|T’ai chi||A Chinese martial art based on flowing body movements that induce a relaxed and balanced state.|
|Yoga||Originating in India, yoga is a spiritual practice that involves physical exercises and postures, breathing techniques and meditation.|