Charity warns depression patients getting antidepressants but no referral for psychotherapyIvy Madziva
Charity warns that half of depression patients getting antidepressants but no referral for psychotherapy.
Depression patients given antidepressants first and ‘refused referral for therapy due to long waiting times’
NEARLY half of people prescribed antidepressants in Scotland are not being referred for psychological therapy, in breach of clinical guidelines.
A report today by mental health charity, SAMH, surveyed 281 adults treated for depression in Scotland in the past two years about their experience in the NHS.
They found that while 91 per cent had been prescribed antidepressants, half of these patients (49%) had not been referred for interventions such as counselling or cognitive behavioural therapy.
This contradicts official medical guidelines that antidepressants should be prescribed alongside a psychological therapy in those with moderate to severe depression, with patients experiencing mild to moderate depression offered psychological therapy as a first-line treatment before medication.
A third (32%) of respondents also said they did not feel well-informed about their care, with patients offered antidepressants at the outset feeling “dismissed and not listened to” – particularly if they had sought alternatives.
One respondent said their GP had “refused to put me on the waiting list for counselling as they said with the waiting list in my area there was no point”, while other patients spoke of feeling bewildered by a lack of advice from medical professionals.
One patient, who was considering changing antidepressant type, said their psychiatrist told them “you could stay on the one you’re on or you could try this one, which is a really old-fashioned drug and it has really high rates of overdose and suicide, but it might be better than what you’re on”.
The respondent added: “I need direction from someone. I can’t make that decision.”
There were also complaints from patients saying “doctors never ever mention the side effects”, and that they “never tell you what coming off it’s going to be like”.
It comes after campaigners, including SAMH and the BMA, backed calls for a dedicated helpline to support people with prescription drug dependency who can experience debilitating withdrawal symptoms when they try reducing medication such as antidepressants.
While the report acknowledged that there “could be many reasons for not referring someone to a psychological therapy, including personal preference”, the charity is concerned that medics may be reluctant to refer patients at all over fears they could languish for months on NHS waiting lists.
Carolyn Lochhead, head of public affairs at SAMH, said: “It’s a plausible explanation and we think that must be going on to an extent.
“We certainly saw that happening with CAMHS [child and adolescent mental health services] when we did the audit there, that there was a reluctance to refer because it was so unlikely you’d get anything.
“It wasn’t particularly surprising, but it was disappointing, that almost half the people seeking support weren’t referred for psychological therapy.
“It sounds from what people told us that some of the reasons they weren’t getting access to that was because of long waiting times. People talked about a lack of services.
“Our call is for the Scottish Government to look into this: is there a reluctance to refer because we don’t know how long the waiting time will be?”
The latest waiting times figures for psychological therapy on NHS Scotland will be published today.
The last figures, published in December, showed that 17,697 people began a psychological treatment between July and September 2019. Of these, half had waited no more than five weeks, but one in five had breached the 18 week target.
Of those still on the waiting list as of September 30, however, 10% had already been waiting over a year. This rose to 23% in Highland, 15% in Lothian and 27.5% for the island boards.
Meanwhile, the number of patients prescribed antidepressants has increased by 48%, to 936,000, since 2009/10. Some of the increase is due to new diagnoses of depression, but it also reflects a shift that has seen more people staying on antidepressants longer – sometimes over many years.
Antidepressants can also be prescribed in other conditions, such as migraine, chronic pain and ME.
Ms Lochhead added: “Antidepressants help a lot of people – we would never knock them. They’re a perfectly valid treatment option.
“But there is guidance stating that patients should be getting psychological therapy but not everyone is, and that’s clearly a problem.”
A Scottish Government spokeswoman said: “We are committed to improving access to psychological therapies.
“Nearly eight out of ten patients are seen within 18 weeks and almost half of all people seen started their treatment within five weeks.
“While we’ve seen substantial increases in staffing in this area as a result of increased investment, more people are seeking treatment and support for mental health and we are working to help ensure services reflect these changing needs and demands.
“In the draft Budget, funding for mental health services and autism combined has increased from £88.5 million last year to £120.1 million in 2020-21 – a rise of £31.6 million, or 35.6%.
“GPs use their clinical expertise and judgment to make decisions about a patient’s care and treatment.”
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