Meeting of the Parliament 21 January 2014
In any mental health debate, the prescribing of antidepressants is inevitably raised. It is worth keeping it in mind that medication for mental illness is as valid as medication for coronary heart disease or for arthritis. It is a legitimate form of treatment, when it is appropriately used.
It is fair to say that recently there have been changes to prescribing practices for antidepressants, which has to some extent been because of concerns about how they were being provided to individuals. Sometimes they were prescribed for very short periods and sometimes for extended periods, when clinical evidence has not been so good, in terms of their use. Some of the most recent prescribing data show that clinicians are likely to have individuals on antidepressants for longer and at higher doses because clinical evidence now demonstrates that that is a much more effective way to get the benefit of that medication. When the statistics come out, it looks as if more people are receiving antidepressants for longer, but that reflects the change in prescribing practice. When we talk about such things we need to be very careful that we do not give the impression that use of medicines in treatment of mental illness is in some way secondary.
I want to address access to psychological therapies. Jim Hume raised the point that we should not limit our ambitions to a target of 18 weeks. It is fair to say that Scotland is the only part of the UK that has set such a target in order to drive improvement in access to psychological therapies. It is worth noting that in Scotland the average time for access to such therapies is not 18 weeks, but nine weeks. If a patient requires an urgent referral to a clinical psychologist or another type of therapy, the normal process is the same as the one that is used to refer someone to an orthopaedic surgeon. A person can have an urgent referral, so that they are seen quickly.
There has been an increase in the number of psychologists in the NHS in Scotland and there is a range of equally important therapies that patients can benefit from. There has been mention of physical activity, which can help a person’s mental health and wellbeing. We have the social prescribing aspect of the mental health strategy, which is the green pad: the idea of prescribing physical activity or something else that can help mental wellbeing, rather than medication. The mental health strategy is looking to encourage that and take it forward.
In his contribution, Neil Findlay outlined the scale of the international issue and the increasing problem of suicide around the globe. Between 800,000 and 1 million suicides a year take place around the world, which is why the World Health Organization has set a target to reduce suicides by 10 per cent by 2020. We want to ensure that our strategy helps us to play our part in reducing suicides overall. It is worth noting that in 2012, Scotland’s suicide rate fell below the world global monthly suicide rate, to 14 per 100,000, against the global rate of 16 per 100,000. We are moving in the right direction, but we have to do more.
Neil Findlay also raised issues around data in the strategy and data that he got from local authorities. The data all come from the General Register Office of Scotland and can be broken down into health board and local authority areas. There are some differences because in 2010 the WHO issued guidance that resulted in a change to the coding of particular deaths, which meant that some drug deaths are now classed as suicides. However, the GRO still produces two sets of data: one with the new coding and one with the old coding, which shows the 18 per cent reduction. That is why there is a difference in the data that Neil Findlay referred to, which are being measured against data that were collected over the 10 years of the choose life programme, which started before the GRO introduced its change after the WHO made its recommendations.
A number of members have also made reference to the impact that suicide has on families. I am struck, but not surprised, by the number of members who have been touched in some way by the suicide of a family member or a friend. In my opening speech, I made the extremely important point that suicide is preventable. The data show us that the vast majority of individuals who commit suicide were, prior to doing so, receiving treatment in the form of medication for a mental illness, or had been in contact with GPs, A and E departments or other services.