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Tuesday, 7 June 2011

Why is prescribing still rising?

Now here’s an interesting question (or two) for you:
Do you believe that offering more “talking therapy” on the NHS should increase or decrease the amount of psychotropic drugs prescribed in the UK?
Do you think that an increase of 3600 therapists would produce greater or lesser use of Prozac in the UK?

Before you wonder if this is a trick question, it isn’t designed to be. It has been a long standing assumption that the reason most long term prescribing occurs is because of the absence of alternatives. Before any of you object and say that the use of both is current “good practice”, Id point out that one of the key arguments for introducing IAPT (Increasing Access To Psychological Therapies) was that depression could be treated for around £800 per person through therapy, rather than the more costly use of anti-depressants.

Why am I raising this? Simply because data that has just been released that demonstrates that there has been a rise of 46% in the number of antidepressants that have been prescribed between 2006 and 2010. Please note the size of the increase – 46%! In other words we are not just talking an increase here, but an increase of a half over just four years – a period that maps exactly onto the training and introduction of 3600 new therapists.

SDS is currently running its BPS Approved Certificate in Resource Based Therapies in London, Leeds and Birmingham

It would appear that such an introduction hasn’t even TOUCHED such prescribing. In fact a cynic might even wonder if the two might be linked in some way. The Guardian states that the increase is due to the recession. However, even a cursory glance at the data indicates that the overall trend both predates the recession by 2 years and that the overall trend has not been effected by the onset of the recession, possibly because unemployment level increases have been (relatively) low (so far) in comparison with earlier recessions in the 1990s and 1980s.

Maybe this is the reason why the pharmaceutical industry never complained about the introduction of IAPT, with a total investment of towards £700 million - the biggest financial investment in the training of professionals in behaviour and emotion change skills, in history. Maybe they knew something all along that we didn’t! In fact, although I was as excited as anyone with the introduction of IAPT, I always had doubts as to whether it would achieve what it claimed to. Leaving aside questions of whether you can translate costings from treatment in a research setting to the costs in the general community, it always struck me that bigger issues were stacked up against it.

SDS is currently running its BPS Approved Certificate in Resource Based Therapies in London, Leeds and Birmingham

There is a bigger problem that we face in attempting to help people who are distressed or need to change their behaviour. This problem is the “pathologisation” of behaviour and normal emotional states in our society. The biggest, but not the only, cause of this is the increasing classification and extension of medical diagnosis to a growing range of normal experiences. Shyness becomes “Social Anxiety”, worrying becomes “Generalised Anxiety Disorder (GAD)” and unhappiness becomes “Depression”. This means that increasingly large sections of the population are seen as “suffering” from a “condition” or mental “health” problem, which we know requires “treatment” in a “medical “ (or quasi-medical) setting. Equally, it is worth pointing out that there has never been a single diagnosis in history that has not had a pharmaceutical answer identified for it. The increase in diagnostic categories has also been accompanied by the increasing widening of their use – whether we are talking about the term “depression” or “PTSD”. Physical diagnoses have largely not been extended but their associated social categorisation has been. Hence the term “disability” is used to cover a considerably wider range of behaviours and conditions today that was the case 20 years ago for instance.

I don’t want to suggest there have been no benefits whatsoever from this change. However, the price we pay psychologically, socially and financially is an increasing tendency for us to view ourselves as “pathological” in some medical or quasi medical way. With this in mind, a "medicine" seems like a very logical next step … or at the very least a useful adjunct to other forms of help.

This issue of “pathologisation” crops up continually here at The Skills Development Service.

My colleagues and I attempt to address it with our clients and through our training on an almost continuous basis. Indeed, I genuinely think that the time is ripe for promoting an alternative way of conceptualising our work with our clients. A new way of helping us and a new way to conceptualise what we are trying to do. Our focus on “Resource Based Therapies” is designed to revolutionise the way we think and work with clients, to focus on their strengths, what causes them to thrive and what they would like to be doing as an alternative to having their current problem.

SDS is currently running its BPS Approved Certificate in Resource Based Therapies in London, Leeds and Birmingham

Come and join us and have your thinking challenged about the way you are working at present. Most importantly, have your passion for your work reinvigorated. Over the coming weeks I will be highlighting a number of key elements of what an alternative looks like and how it can revolutionise your work with clients. Speak with you again soon.

Take care
Paul Grantham
Consultant Clinical Psychologist
The Skills Development Service Ltd


  1. Dear Paul,

    I am a counsellor with little a no knowledge of drugs. Over the last twelve years, clients have asked if I thought they needed to take drugs or if they should stop taking them. My stock answer has always been they should discus this with their G.P. or your consultant.

    Yes, medication does have an important place, but the client/patient does need to look at their life both past and present. They need to address or resolve issues with the help of a counsellor. either before or alongside medication. I firmly believe that medication can and does only mask the problem and can become a crutch. - R.P

  2. This has certainly got me thinking.

    What changing times we are in.

    I would like so to do your resource based skills course. What is wrong with
    Newcastle? This is the only area where training is lacking at the standard
    you offer. EVERYWHERE seems to be 'down south'.

    There are loads of people who would be interested I am sure.

    I will try to get to one one day, but I want to now! (frustration). - J.D

  3. Having skimmed through you e-mail I do agree with you that there seems to be an increasing belief that we are no longer able to 'live with' and or 'manage' most of our emotions, as you say everything seems to be pathologised and 'treated' rather than patients/clients learning to cope with and manage the ups and downs of life.

    I would love to be able to join you or even discuss this further but in the relentless NHS we are stuck ploughing though endless eating disordered patients and trying to avoid 'breatching targets'.

    It is quicker and easier for GP's and psychiatrists to prescribe medication rather than spend time talking to the patient.
    Sad, but I think true, not enough time. -P.R

  4. Many people in today's world seek outside and not inside themselves.

    We now live in a Brain washed society and people have lost the ability to
    think for themselves.

    People who seek growth, invest in others and if the others are any good at what they do bring out the best in them.

    As far as psychotropic drugs are concerned, I believe they are appropriate only when all other avenues have failed and if have to be used in the last instance to be only prescribed for a short period when all else has failed
    in order to balance brain chemistry that in turn affect emotional patterns of behavior.

    Mental health for instance is a something that has the ability to affect each and every one of us. We are not immune. The outcome will depend on the individual, And their ability to deal with situations.

    As they say poo makes you grow.

    However not every one will agree with that and in fact some suffer terribly.

    From my work and personal experience, putting a plaster on a would for example Prozac that has been prescribed by the Gp due to trauma and shock is possibly appropriate in the initial stages, however, leaving an individual
    on them longer than necessary is inappropriate to the individual.

    Eventually an individual will explode with unresolved emotional traumas. Talk therapies are not the only way forward for people to cope and increasing them will not encourage people to look inside themselves.

    People are individual and I believe they need to be encouraged to remain open to what is available to them and invest in what is right for them.

    That's what I think for what it is worth.

    Good luck - J.C


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