End ‘Chemical Cosh’ for the "Mentally Ill”  Article published in The Big Issue ion Nov 08

by Daisy Greenwell

The quick-fix drugs solutions to her brother’s illness caused his early death, says Ana Galvin.

When north Londoner Daniel Galvin died of a heart attack, he was six stone overweight, his legs trembled uncontrollably, he suffered epileptic fits and his hair had begun to fall out. He was 29 years old.
According to his family, his symptoms and untimely death this August were caused by the anti-psychotic drugs he was required to take for 14 years following a diagnosis of schizophrenia.
“I truly believe that if Daniel had been given the right treatment in terms of an intensely supportive environment he could have come through it. As it was, the damage was done to my brother very early on,” says his 28-year-old sister Ana.
Like many patients who take anti-psychotic drugs, Daniel reacted severely to the medication. Within hours he deteriorated rapidly, developing many of their possible side effects. His limbs began jerking involuntarily, and he became temporarily paralyzed. The first time the tablets were prescribed to him aged fifteen he was sectioned within a few hours. The next fourteen years of his life were spent in and out of St Ann’s Psychiatric Hospital in Tottenham, north London.
“Drugs are the first resort of treatment, and they should be the last,” said Ana, who – alongside psychologists and mental health workers – is campaigning for the “chemical cosh” approach to mental health treatment to be reformed.
Galvin is just one of the many thousands of people in the UK who the family believe are being damaged by the NHS drug-focused approach to mental health. They are calling for a more holistic treatment, which patients have greater control over and which incorporates psychological therapies with exercise, creative activities and self-help groups.
NHS treatment of schizophrenia currently centres on anti-psychotic drugs, which stifle the symptoms of auditory hallucinations, delusions and disorganised thinking, but do not ‘cure’.
In the short term, their adverse side effects can range from sedation to excessive weight gain, diabetes, seizures and involuntary movements of the lips, tongue and limbs. In the long term, people taking medication for schizophrenia die on average 14 years earlier than people without mental illness.
Around 60 per cent of patients who try to come off anti-psychotic drugs do so because of the side effects they experience. Thirty per cent have been forcibly medicated under the Mental Health Act, and 52 per cent felt they had to take the drugs otherwise they would be forced take them, according to research in 2005 by mental health charity MIND.
This apparent lack of choice over the use of anti-psychotic drugs is made more controversial in the light of evidence from the World Health Organisation. Multiple international surveys have shown the outcome for people diagnosed with schizophrenia in non-Western countries, where they do not receive comprehensive drug treatment, is, on average better than for people in the West.
National Institute for Clinical Excellence (NICE), suggest in their guidelines that the illness should treated alongside cognitive behavioural therapy – a form of therapy that aims to influence problematic emotions and behaviours. They also recommend that an occupational therapist is used to help in the development of skills for day-to-day living, and, through family intervention, the patient’s loved ones should be taught how to deal with the illness – a technique proven to reduce relapse in schizophrenic patients.
However, in a recent survey of 14,000 mentally ill people by the Healthcare Commission, almost two thirds have never been offered these, or similar therapies.
Clinical psychologist Dr Rufus May, who is campaigning with Ana was himself diagnosed with paranoid schizophrenia aged 18. He effectively ‘cured’ himself without medication, and now believes that at the heart of the problem lies the question of whether people’s ‘madness’ is meaningful, or whether it is something to be suppressed with drugs.
He said: “There is huge pharmaceutical company propaganda around mental illness being a chemical imbalance, and not being meaningful. I believe madness is a creative way of dealing with pain. For example I believed I was a spy, which was essentially symbolic. Rather than seeing myself in a boring job with no friends, I started to imagine I was really important.”
As someone who questions the very existence of schizophrenia as a medical diagnosis, Dr May is calling for alternatives to the current medical model. His unorthodox approach pulls society’s impression of the mentally ill inside out; changing the current ‘them and us’ view of madness and instead someone’s place in it as as part of a spectrum. He believes self-help groups, creative activities and exercise should be the norm.
It is an approach met with derision from many in the field who point to the lack of scientific evidence supporting such treatments. Implementation, they say, would not be cost-effective, and results would not necessarily be quantifiable in the short-term.
“People say ‘we don’t want medication, we want something else’, with the assumption there is something else that really is going to be useful,” explains Dr Jacqueline Atkinson, professor of mental health policy at Glasgow University. “At one level, you want to say, ‘if we really did have something that cured schizophrenia, do you not think it would be being used?’”
The NHS spends an estimated £2.2 billion per year treating schizophrenia in England, the majority of which goes towards hospital inpatient care. The use of anti-psychotic drugs helps to minimise government spending, allowing patient’s acute symptoms to be controlled meaning they can live safely in the community.
“It’s a very fear-based, risk-management approach,” says Dr May, “In the short term it seems cheaper for the government. In the long term it’s more expensive because these people aren’t able to contribute to society. Trying to get a debate about this is very difficult because of the influence of the pharmaceutical companies. Both the Royal College of Psychiatry and the government still take drug company money.”
It is an allegation backed up by Britain’s largest mental health charity MIND. Senior campaigns manager Alison Cobb said:
“There is a lot of pharmaceutical funding for research, and what gets published as well as the promotion to doctors and so on. It is important to be alert to it.”
Although it is too late for her brother, Ana Galvin remains resolute that the current trend for using anti-psychotics has to change. Alongside a small group of psychologists and psychiatrists, Dr May believes that things are slowly shifting. He describes the issue as the ‘next civil rights movement’, and has developed a dedicated following. He also hopes to set up a resource centre that could work outside the NHS in more imaginative ways. “Over the last twenty to thirty years we have seen the beginnings of a recovery movement that aims to raise awareness that people’s madness is meaningful and that recovery is possible if we as communities all work together holistically,” he says, “With the growth of authoritarian government and the power of pharmaceutical industry and professional self interest we have along way to go. But certainly something exciting is happening.”