I wrote this for the Independent on Sunday on 7/9/08 to go with Nina Lakhani's piece which I will add at the bottom. The scope of the piece left no room for talking about how the label of schizophenia is an unhelpful one but both pieces make some important points nevertheless:

Rufus May, Clinical Psychologist: 'What's the point of guidelines managers and psychiatrists feel free to ignore?'

The Nice guidelines for Schizophrenia are all very ‘nice’ in theory but in reality they are not being put into practice.  Nice recommends choice, lower doses of medication and psychological treatments.  What is the point of guidelines that the many psychiatrists and managers feel free to ignore?

There is very often a cold war between people using mental health services and the professionals paid to help them.  People do not feel listened to by their clinicians and either rebel or become passive shadows of their former selves. The Nice guidelines if implemented would do much to improve this relationship.  But the reality is services do not want to be ‘nice’. Listening to patients achieving a collaborative relationship with them takes time and patience.  It seems more efficient to do things the old-fashioned ‘we know what’s best for you’ way.  However if we did spend more time getting alongside people we would save time and money in the long-term.  This is because would build their capacity for recovery and independence.  Another problem is that most professionals are not trained in the skills needed to implement the Nice guidelines.  Because they are not legally enforceable they are easily ignored.

I get emails from families across the country who are desperate for their son or daughter to get talking therapies and less sedating doses of drug treatment.  Recently I heard of a case where a young man who had been treated for psychosis in hospital was complaining about the side effects of his medication. The psychiatrist doubled the dose of his injection just before he discharged him from hospital.  The young man is now has a bitter attitude towards the services that are supposed to offering him 'care'.  I know of another young man who is being given three times the BNF recommended dose of Olanzapine, a drug known to increase the risk of diabetes and heart disease. 

Will the new guidelines have any more impact on care provision?  I hope so but fear not.  My experience is that Mental Health Trusts are being rewarded not for improving the quality of service patients receive, but more for transforming themselves to the ‘Private business’ model, where abstract figures of patient ‘turn over’ are given much more value.

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Schizophrenia patients denied talking therapies

Mental health services are failing to comply with national guidelines, relying instead on potentially risky drugs

By Nina Lakhani
Sunday, 7 September 2008

Thousands of people with mental health problems are being denied the best and most effective treatments, years after they were approved by the National Institute for Clinical Excellence, according to experts. Proven talking therapies are not offered to people diagnosed with schizophrenia, despite pleas from patients and families for better access. The majority of patients continue to be treated solely with powerful psychiatric drugs and many are denied access to information about serious side effects, according to new research by Rethink, a mental health charity.

The findings are backed up by a Healthcare Commission survey of 14,000 people with mental health problems to be published on Friday, which shows nearly two-thirds have never been offered a talking therapy.

Nice is due to publish updated guidance for schizophrenia next week, which will add to pressure on mental health services to improve access to the most effective treatments. Compliance with Nice guidance will influence the star ratings given to hospitals for the first time this year.

Less than 15 per cent of people diagnosed with schizophrenia have had cognitive behaviour therapy (CBT), according to Rethink's findings. Two-thirds were given no choice about which medication they were prescribed, while one in three did not feel that they were involved in planning their care.

Dr Tim Kendall, a consultant psychiatrist from the Nice guideline development group, said: "There is no doubt that progress in some areas has not been good enough. Access to psychological therapies is the worst area, but we hope government investment in CBT for people with depression and anxiety will filter through for people with schizophrenia in a few years."

More detailed recommendations about where and how patients should receive talking therapy treatment are due next week, despite a widely recognised shortage of trained therapists.

Rethink's survey of 400 people also found the physical needs of mental health patients continue to be sidelined despite the damaging effects of psychiatric medication. People taking medication for schizophrenia die on average 14 years younger than people without a mental illness. One in 10 patients taking the drug Olanzapine – the most commonly prescribed to mental health patients in the UK – develop diabetes.

The new Nice guidance is set to withdraw unconditional support for newer drugs in light of compelling evidence about dangerous side effects. And ways to improve treatment for people from black and ethnic minority groups will be included for the first time.

Jamal Ahmed, 41, from West Yorkshire was diagnosed with schizophrenia five years ago but has never heard of the Nice guidance.

Mr Ahmed said: "I have been on an endless list of medications but my psychiatrist never discusses side effects and he doesn't like me asking questions. In his opinion, he's the doctor and so he knows best. What I think doesn't matter. He asks me the same set of questions and I tell him what he wants to hear. But I'd like him to sit down, listen to what I'm saying and come out of his box."

He added: "I found the Hearing Voices group from a poster, which is great because I get support from others in the same boat. Everyone in the group lies to their doctors because they are afraid what will happen if they are honest. There are no other choices."