Newsletter No. 7

Newsletter No 7
01/09/05 14:07
Keeping People Informed
Naomi Eisenstadt’s visit to Melbourne
Antidepressants Under Attack

There is an article in the June 2005 issue of the Australian and New Zealand Journal of Psychiatry entitled “What patients and carers want to know: an exploration of information and resource needs in adult mental health services”. It describes how, over a four month period, patients and identified carers were interviewed about carer involvement.
The study found that information given to them was generally inadequate and unhelpful. The authors expressed the hope that their survey would be used to improve services.
Consumers have, in fact, been saying this for years. It is a hopeful sign that at last it is getting into the scientific literature, but there would still be an understandable cynicism that it will actually lead to changes in management.
What is it that consumers and carers want? The leading items on the list were:
* Opportunity to attend information sessions about key mental health issues.
* Written information about Community Health Services.
* Written agreement about key people involved with care.
* Meeting with a consumer consultant or staff member of the follow-up service.
Not all of these apply to every case. However, a high quality service would agree with every one of these issues. Why, then, are they not being done?
It is almost certain the reason is pressure of work leads to cutting corners. How can this be avoided? One way would be a checklist of issues to be dealt with when arranging follow-up (in addition to the mandatory case summary). This would help the follow-up clinicians and the quality of service, as well as helping consumers and carers. It seems a reasonable thing to ask of service Directors.
Allan Mawdsley

Naomi Eisenstadt’s visit to Melbourne

Naomi Eisenstadt (picture below), Director of the Sure Start Program, visited Melbourne for two weeks from 2nd August 2005, as the Creswick Foundation Visiting Professor at the Royal Childrens Hospital Centre for Community Child Health. Sure Start is the British-government sponsored early child development program.



Ms Eisenstadt gave several workshops to people in the health and welfare fields and to Local Government staff responsible for municipal child development programs before heading off to Canberra to speak to high level officers in the corresponding Commonwealth government departments. The message was very clear. Money spent on pre-school child development makes a profound difference to the whole life progress of individuals. Accumulated over thousands of children, this means that the whole society is enriched. The investment is repaid many times over.
This is not just the opinion of an enthusiastic kindergarten teacher. It is the conclusion of solid scientific evidence comparing the progress of children who have been in the program with those who have not. The basis of the program is good quality three and four year old kindergarten teaching delivered locally with family social support, integrated where necessary with child care for working parents. This ensures that children have maximum opportunity for language and cognitive stimulation in a supportive healthy environment at a
critical stage in their development. It also emphasises family support in terms of improved parenting and measures to overcome poverty and unemployment.
Research shows a clear link between poverty and poor progress. Not-so- bright children of supportive families make generally better progress at school and later employment than talented children of impoverished families as a group. The best way of overcoming poverty is through employment. The Sure Start program is strongly committed to the social development of the adults in the family as well as to the wellbeing of the children.
So convincing is the evidence that the British government has embarked upon a five year plan to build 3500 Sure Start centres in local communities throughout the UK. The expenditure on the program this year alone will be three and a half thousand million pounds sterling (A$7.8 billion). What a marvellous commitment!
If only we could have something similar in Australia. In coming months MHYF Vic will be exploring ways in which we can lobby for such incredibly important programs here. If you have an interest in helping this, please send us an email.
Allan Mawdsley

Antidepressants Under Attack

Two articles published in the Melbourne Age recently argued that antidepressants are being over prescribed. The article Drugged to the Max was a review of two books –
Selling Sickness: How Companies Are Turning Us All Into Patients by Ray Moynihan & Alan Cassels
Quarterly Essay 18: The Worried Well: The Depression Epidemic and the Medicalisation of Our Sorrows by Gail Bell. (The Age 3/7/2005).

The main argument of Moynihan and Cassels, according to reviewer Cameron Woodhead, is that drug companies, through aggressive marketing, are now medicalising “ordinary tribulations of human existence”. Mental health problems were included with the implication that disorders such as ADHD and major depression have largely been manufactured to create a market for treatment by drugs.

The Worried Well article focussed on antidepressants with author Gail Bell, who is a pharmacist, arguing that they are over prescribed. This essay was reprinted in an edited extract in The Age Good Weekend magazine on 25 June 2005. She admits that antidepressants are necessary for those who are seriously depressed but believes that the high number of prescriptions is due to patients self diagnosing.
There are obviously some important criticisms of the role that pharmaceutical companies play in our health care and their pursuit of profit at all costs. However, neither of these articles deal with issues relating to other treatments for mental health conditions. Unfortunately both articles perpetuate myths about depression and help to reinforce the stigma against mental illness.
For example, Cameron Woodhead argues that only serious depression requires drug treatment. He writes: “And whether minor depression, the kind of transient sadness that affects us all – should be a medical condition at all is highly debatable.” He has misunderstood the nature of clinical depression by confusing it with a passing mood. His negative opinion of those suffering mental illness is reinforced by referring to the depressed as “marginal sad-sacks” and that we have a “culture of depression in Australia”.
The accompanying graphic in the Good Weekend article features a number of pills. Most are blue with sad faces with two yellow pills with a happy face. The introductory blurb refers to antidepressants as “happy pills” (a term the author herself uses) and the essay is entitled “Joy in a Jar”.
This image reinforces the false idea that antidepressants are mood enhancers or “uppers” and that taking an antidepressant will make you feel not just happy but euphoric.
Gail Bell also writes that “Australians bought into depression (called misery- chic in the 1990s)”. She also advocates such traditional depression cures as being “drunk el fresco with friends while wearing new clean clothes on a sunny day” which to a person who has experienced depression seems insulting and ridiculous.
Unfortunately, for those who are prescribed antidepressants, there is the widespread community opinion that there is something wrong with treating a condition such as depression with drugs. Articles such as these do little to increase understanding about antidepressants and reinforce the stigma towards the mentally ill.
Suzanne Robson