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Sunday, 8 October, 2000, 23:30 GMT 00:30 UK
Doctors 'ration best mental health drugs'
head in hands
Only one in eight get the latest drug treatments
Less than one in eight people with a severe mental illness are receiving the drug treatments experts believe they should have.

New guidance on treating people with schizophrenia, due out this month, will recommend that patients should routinely be treated with atypical anti-psychotic drugs.

But research conducted by a leading charity reveals that only 12% of patients are prescribed these drugs and as many as two thirds are not even offered them by their doctors.

The newer class of drugs have fewer side-effects but are much more expensive than older anti-psychotic drugs which are still more routinely prescribed in the UK.

Conflicting advice

The atypical anti-psychotics such as risperidone and clozapine are much less likely to cause serious side-effects such as shaking.

But they are much more expensive than the older drugs and are much less widely used in the UK than in the US and other parts of Europe.

drug dispensing
Newer drugs have fewer side effects
Confusion over which drugs to prescribe has been fuelled by conflicting advice in the past and will be aired again in a debate organised by the Health Service Journal in Westminster this week.

Widely used guidance from the Maudsley Hospital in London has just been updated and it recommends that all patients diagnosed with schizophrenia should routinely be put on an atypical anti-psychotic.

"And if that doesn't work, they should be prescribed another atypical anti-psychotic and if that isn't suitable they should be prescribed another." said Maudsley pharmacist David Taylor.

But that conclusion is at odds with the recommendations of the NHS

If the NHS is to fully fund 'atypical' anti-psychotics, their use should be justified by trial data clearly supportive of their use in everyday practice

NHS Centre for Reviews
Centre for Reviews and Dissemination which has called for more research before the newer drugs are routinely used.

According to its report on the subject last December: "If the NHS is to fully fund 'atypical' anti-psychotics, their use should be justified by trial data clearly supportive of their use in everyday practice."

And it is cost that is at the heart of the problem for, according to the National Schizophrenia Fellowship, in the simplest terms the new drugs can cost 100 times as much as the older ones.

"But if you compare with the cost of long term treatments for other conditions like diabetes the atypicals aren't that expensive," said Paul Corry of the NSF.

"And it is quality of life measures we need to look, at such as whether people can develop a social network, hold down a job or live unsupported in decent accommodation."

Form of discrimination

The Maudsley's David Taylor suggests that the reluctance to pay for newer treatments is a form of discrimination against people with a mental illness.

"Part of the problem is that it's difficult to measure things like quality of life, but if you look at other areas of health care, when a new drug comes along with much fewer side-effects, then the old treatments are unceremoniously dumped even if they are cheaper," he said.

The NSF argues that there should not be restriction on the use of atypical anti-psychotics but research among 2,600 patients conducted with Mind and the Manic Depression Fellowship indicates the drugs are being strictly rationed.

More than 60% of patients were not given any choice about the drugs they received.

"We want to put the person with schizophrenia at the centre

Paul Corry, National Schizophrenia Fellowship

Follow up with focus groups found that, even when people were experiencing severe side-effects with the older drugs, their doctors refused to try them on the more modern treatments.

"These drugs should be freely available and tailored to individual need," said Mr Corry.

"We want to put the person with schizophrenia at the centre- it's no use academics and people in white coats arguing about what works for them."

The National Institute of Clinical Excellence will produce definitive guidance on treatment of schizophrenia but it is at least a year off.

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