Britain's child victims of the chemical cosh

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Powerful anti-psychotic drugs designed for adults are being used to treat

children, including those with learning difficulties. Brian Brady and Nina

Lakhani report

 

Sunday, 15 June 2008

 

The number of powerful psychiatric drugs prescribed to England's children has

risen by more than half in four years, government figures have revealed.

 

 

GPs in England are handing out prescriptions for anti-psychotic drugs for

children as young as seven at the rate of 250 a day, according to figures

obtained by The Independent on Sunday.

 

Latest data compiled for the NHS show that tranquillisers designed to treat

serious conditions including schizophrenia in adults were prescribed to young

people 57,000 times in 2003. But the total had risen to more than 90,000 by 2006

- a 59 per cent rise in three years. The figures do not include drugs dispensed

in hospitals. Experts believe the increase is partly down to early detection and

treatment of serious mental health problems in children, but there is also

concern they are being used inappropriately to treat psychological and learning

difficulties. Shortage of staff and resources are further factors.

 

The drugs, which are designed to treat symptoms such as visual hallucinations,

hearing voices and delusional thoughts, have serious side effects including

weight gain, tiredness, sexual dysfunction and lactation. The safety and

effectiveness of these drugs, which were designed for adults, have not been

fully tested on children.

 

Official guidelines say they should be used only as part of a wider treatment

package, but there are concerns GPs are relying on them too heavily because

other treatments are unavailable. Some GPs, however, stand accused of ignoring

or being ignorant of the guidelines.

 

England's mental health chief, Louis Appleby, said, " We are aware that

anti-psychotic drugs are sometimes used as a last resort by clinicians dealing

with highly disturbed behaviours in young people, and we are now considering how

to prepare clinical guidance on this area of practice. "

 

Psychiatrists and mental health charities have warned against using

anti-psychotic drugs on developing minds. Paul Corry, director of public affairs

for the mental health charity Rethink, said: " It is worrying that these very

powerful drugs designed for adults are being given in such high numbers to

children before their brains are fully developed.

 

" If the increase is because previously undiagnosed teenagers are now getting

treatment, then that is positive. But it is difficult to justify the widespread

use of these drugs in younger children because it is actually unlikely they will

have schizophrenia at such a young age. "

 

Anti-psychotics are commonly used to treat conditions including schizophrenia,

mania and delusional disorder by blocking the chemical dopamine in the brain.

But they have also been widely used for their " calming " effects in other

conditions, such as autism and hyperactivity.

 

MPs and pressure groups have already complained about the use of anti-psychotic

drugs in care homes to manage people with dementia - often to treat " behaviour

that is neither distressing nor threatening, such as restlessness or being

vocal " .

 

But experts have raised further concerns about their growing use on young

people. A study by the University of London's School of Pharmacy last month

found that the prescription of the drugs to children almost doubled between 1992

and 2005 - with the greatest increase among children aged seven to 12.

 

Figures provided for the IoS from the NHS Prescription Cost Analysis (PCA)

system prove that the trend has continued to rise dramatically. The increase in

costs can be partly explained by the move towards prescribing newer or atypical

drugs, which are more expensive but generally have fewer and less severe side

effects.

 

But mental health campaigners are outraged by the number of older, typical drugs

such as chlorpromazine and haloperidol still being prescribed. There were more

than 7,000 prescriptions for these two drugs, widely known as a " chemical cosh " ,

in 2006, which means nearly 20 prescriptions every day.

 

According to Rethink, there is no excuse for prescribing these powerful drugs

and they should have been phased out. Mr Corry said: " The use of these older

drugs is just wrong. There is no excuse at all. They may be cheaper but they are

associated with some of the most debilitating and stigmatising mental healthcare

from the 20th century, which led to people behaving like zombies. "

 

Guidelines from the National Institute for Clinical Excellence (Nice) state that

atypical anti-psychotics should be the first choice for treatment for young

people, who should be given all necessary information to make an informed choice

about treatment. Many young people complain they are not warned about the side

effects.

 

When Elaine Hewis's teenage daughter was admitted to a psychiatric hospital in

2004, she assumed the treatment would be far removed from that she herself had

received. But Mrs Hewis, 43, was wrong. She said: " The doctors had prescribed

her anti-psychotics within days. But despite my pleas they refused to tell her

about the side effects because they were worried she wouldn't take them if she

knew.

 

" When she came to me distressed because her breasts were leaking milk, I told

her this had happened to me and again tried to get the doctors to be honest with

her. They then tried to remove me as her nearest relative because they felt I

was a bad influence. "

 

New teams have been brought in to catch cases early. Psychiatrists and nurses

would work closely with teachers, youth workers, school nurses, family

therapists, social workers and psychologists. While progress has been made, the

reality is that many of these teams have few resources and the emphasis is often

on drug treatments.

 

Mr Corry said: " It is a crying shame because early intervention is one of the

rare parts of mental health with an evidence base. If we get to people early and

treat them with a combination of psychological, social and medical intervention,

then their chances of a full recovery increase dramatically. But you need to do

all of these things, not just the medication. "

 

Clinical psychologist Rufus May was treated with anti-psychotics as a teenager.

He believes the drugs stop a young person from understanding their symptoms and

from learning skills to manage difficult experiences by trying to block them

out. He said: " The early intervention movement has turned into the early

drugging movement. These very powerful drugs can affect the emotional and

cognitive development of a young person as well as sapping them of their

confidence and motivation. "

 

But psychiatrists argue the rise in prescribing to children represents a

success. Young people are being treated earlier.

 

Professor Sue Bailey from the Royal College of Psychiatrists said: " This

increase reflects the development of better adolescent mental health services,

which means ill children are being identified earlier, and we are going in more

assertively with a treatment package that includes medication.

 

" Early identification and treatment lead to better outcomes. The real difficulty

we face is convincing young people to take the medication and stay compliant. "

 

'No one ever talked about side effects with me, not once'

 

Lucy Bennett, 19, from Exeter, lives with her seven-month-old son Harvey. For a

year she lived in psychiatric hospitals with medication the only option.

 

" By the time I was 15 I had every problem you can imagine. I was into drugs,

alcohol, boys, and had stopped going to school. After years of growing up with

my mum's mental illness and alcohol problems, I was on a road to

self-destruction. I finally told a psychiatrist in A & E I was hearing voices

after which I was admitted to hospital straight away.

 

" I felt terrible. I was all over the place, so when the doctors and nurses told

me the medication would make me feel better, I took them. In some ways I did

feel a bit better. I was a complete zombie and sleeping all the time which meant

I didn't care about the voices any more, but they were still there.

 

" Within days I had started leaking milk from my breast. It was awful. I swapped

medication and within three months I had put on three stone. I was so depressed

at being a size 16 I started making myself sick. I ended up with bulimia as

well.

 

" As soon as I decided I didn't want to take the drugs I was sectioned and

forcibly injected. I ended pretending the voices had gone just so I could get

out. Drugs were the only option. I had a psychology session for an hour a week

and a few family therapy sessions but that was it. No one ever talked about side

effects with me, not once. I ended up having to get information from my mum and

other patients.

 

" Three years later I am medication free and learning new ways to cope with my

voices. I have a great community psychiatric nurse, who lets me keep some

medication for emergencies, but I'm in control now. There is no way I could look

after my son if I was still on the medication. I know they can help some people

but they didn't help me. I should have been given the choice. "

 

Nina Lakhani

 

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