Issue 15 – June 2009Author: Sarah Keenan (firstname.lastname@example.org)
- Many people feel they have little influence over making decisions about their psychiatric medication.
- It is important for people who take, or are thinking about taking psychiatric medication to feel supported in asking questions about medication, finding out about alternative ways of coping with distress and accessing relevant and understandable information. Medication groups are one way of facilitating this.
Implications for practice
- Clients require clear and timely information about both the costs and benefits of psychiatric medication. This information should be given in a supportive context.
- It can be helpful for clients to hear about models which make sense of distress from different perspectives, and which acknowledge medication’s limitations, for example the drug centred model1.
- It can be helpful for people who use or have used psychiatric drugs to meet with others so that they can share experiences and gain mutual support.
ContextClients’ adherence to psychiatric mediation is often viewed as a hugely significant aspect of their care. Centring so clearly on medication compliance can result in ignoring the context of people’s lives and can leave both individuals and their families believing that medication is the only answer to coping with distress. This can place people in a position where they feel they have to cope alone with difficult experiences from medication, and that there is no alternative. For those who do want to question or reduce the amounts of medication, it can be difficult to find professionals to support this process. In a piece of research commissioned by MIND that asked about people’s experiences of coming off medication, Psychiatrists and General Practitioners were identified as the least helpful group of staff in terms of assisting people to withdraw2. The same study also revealed that people encountered a wide range of difficulties when attempting to withdraw, these included fear of relapse, lack of information, opposition from doctors, lack of support and threat of compulsion if withdrawal was attempted.
Drug Centred ModelThe dominant rationale for the use of medication within mental health services relates to understanding people’s distress as an illness for which they need a chemical cure. In contrast the drug centred model1, 3 argues that psychiatric medication causes abnormal (rather than “cured”) brain states which can have both helpful and detrimental effects. Moncrieff (20081, 3) draws parallels between the function of psychiatric drugs and that of alcohol in helping with social anxiety. Whilst drinking alcohol may make social situations feel easier, no one presumes that alcohol has permanently cured people from lack of confidence, or has balanced an alcohol deficiency in the brain. That is not to say that these drugs are never helpful, but rather that there should be a more transparent understanding about what they do. The theoretical understanding about the function of medication is important. Once it is possible to view these drugs as a tool rather than a cure, it highlights the need to collaborate with service users to do a cost / benefit analysis of their experiences of taking psychiatric drugs. Furthermore, the model makes it more intuitive to think about alternatives to medication and relate the causes of distress to “toxic mental environments”4, rather than faulty brain states.
Sharing Information and Gaining Social SupportGiven that mental health professionals differ in opinion about the role of medication, where does this leave the service user who may be considering their options? Often this is a lonely decision making process, with little support and many feeling they do not have a choice at all. Groups of service users who have an interest in psychiatric medication have started to form around the UK. The first group the “Thinking about Medication Group” was started by Guy Holmes (clinical psychologist) and Marese Hudson (service user) in Shropshire. When evaluated it was found to be extremely valuable in facilitating access to information about medication and alternative ways of coping with distress, but also in providing social support and helping group members to have a more active role in their relationships with mental health professionals5. Since then groups have started in Hebden Bridge, Leicester and most recently Nottingham. The groups have different emphases including: supporting people to reduce their medication, information gathering or facilitating community action (see Openmind 20086, for a review). For example the Leicester “Living with Psychiatric Medication Group”, have recently developed a drug paraphernalia amnesty which aims to redesign pharmaceutical company advertising on pens and stationary as part of a protest against the ethics of the pharmaceutical industry. For more information contact the group on LWPM@live.co.uk
“The Mind Medication Group”In April 2008 the Nottingham “Mind Medication Group” started to meet. It was supported in its development by members of the Hebden Bridge, Leicester and Shropshire groups. It consists of a group of between five and ten service users who meet fortnightly at Middle Street Resource Centre in Beeston. They are also joined by two members of staff. Part of the group’s strength lies in providing a source of social support. It also invites speakers to share information about alternatives to psychiatric treatment or talk about particular aspects of psychiatric treatment. Previous topics have included: a pharmaceutical drug rep talking about the ethics of their industry, meditation, Cognitive Behavioural Therapy, the Involvement Team, Expert Patients and Homeopathy. The group would welcome new members who might be interested in joining them in mutual support and learning more about medication and alternative methods of coping with distress.
- Moncrieff, J. (2008a). The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Hampshire: Palgrave Macmillan.
- Read, J. (2005). Coping with Coming Off: MIND’s Research into the experiences of people trying to come off psychiatric drugs. London: MIND Publications.
- Moncrieff, J. (2008b). The Truth about Psychiatric Drugs. Openmind, 151, 6 – 11.
- Holmes, G. (2006). Toxic Mental Environments. Clinical Psychology Forum, 164, 39 – 43.
- Holmes, G. & Hudson, M. (2006). An evaluation of a Thinking About Medication Group. www.shropsych.org/publications
- Holmes, G., Hudson, M., LWPM, May, R. (2008). Coping with coming off. Openmind, 150, 12 – 13.
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