Mental health drugs: Breakthrough or burden?

By Karen Allen BBC Health Correspondent

Mental health campaigners are hailing today's decision by NICE as a landmark in the treatment of schizophrenia.

Many psychiatrists are a little more sanguine - describing it as a "useful step" in what has been a hotly debated issue both in the medical press and in hospital staff rooms.

New doesn't always mean better - indeed not all patients on the older drugs will face terrible side effects and more research is needed about the long term effects of the newer ones - but what today's decision does do is introduce greater choice.

Choice that is not constrained by cost.

It also means many hundreds, possibly thousands of people with schizophrenia could be spared the traumatic and deeply unpleasant side effects associated with some of the older treatments.

It's an important ruling not least because it gives patients more power to help make decisions about their treatment and because it tips the balance in favour of the newer so called "cleaner" drugs (which have fewer side effects) even though they are 17 times more expensive than the older ones. It will mean that the annual drugs bill rises by about £70 million but NICE has reasoned that in the long term this is cost effective. The NHS spends in the region of £1billion a year hospitalising people with schizophrenia.

The atypical antipychotics are likely to allow more people to live in the community, so offsetting the additional expense in the long term.

Will they benefit?

The big question is this. Will the 210,000 people who campaigners estimate could benefit from the drugs actually get them?

The Department of Health thinks they should but Whitehall doesn't have to make the difficult day to day funding decisions.

It's the primary care trusts and Health Authorities that have this task.

Health Minister Lord Hunt saysthat without question these more expensive drugs should be made available.

But money spent on newer antipsychotics may have to come from diverting funds away from other health services - possibly services that have a wider lobbying power than mental health - and that's going to be an uncomfortable decision for anyone to make.

Limited funds

It is true that years of underfunding in mental health is being recognised.

An extra £300m is being committed to improving mental health services over the next three years.

But that money has already been earmarked to pay for amongst other things, more beds and more community health staff.

It does beg the question does that leave enough in the pot to pay for new drugs?

That's something about which no-one is prepared to speculate.