Editor's Note: This blog entry marked the first stirrings of an idea which eventually grew into SOAR. It reflects founder Josh Berger-Viflanzoff's concerns about the over-prescription of psychiatric medications within society in general. In his next blog entry, Josh looks more narrowly at issues of over-prescription within vulnerable groups.
There are several reasons why the prescription of psychiatric drugs needs reforms. The first reason is the shifting definition of mental illnesses and the fact that mental illnesses can’t be diagnosed the same way physical illnesses are diagnosed. Physical illnesses can be diagnosed by the doctor observing the patient and by using objective tests. For example, if I went to the dentist for a toothache, the dentist would need to examine my teeth to see if there was a cavity. Objective tests such as X-rays might be performed to confirm the diagnosis. This is not the case for diagnosing mental illnesses; here, the patient reports the condition to the psychiatrist and, based largely on this self-report, the psychiatrist determines what kind of mental illness they have (if they are diagnosed with one at all). When a diagnostic process relies primarily on patient self-report, room for error is increased.
Children face special issues in diagnosis and treatment. When a young child is examined it is the parents who typically report their perceptions to the doctor. This may at times lead to an inaccurate diagnosis, which could negatively affect the child and could continue to affect them into their adult life. Finally, it must be noted that in many cases children are prescribed psychiatric medication because their parents and teachers want them to act a certain way and not to benefit their health.
Even assuming a correct diagnosis, the prescription of psychiatric medications should be approached with caution. These drugs can have limited effectiveness and may have serious side effects. Since these drugs are potentially dangerous, they should only be prescribed as an absolute last resort if other measures fail. Ideally, in order to get a prescription for any kind of psychiatric drug some conditions should be met. The first condition is that the person has a long-term mental health condition that causes them extreme discomfort, or causes them to be a risk to the safety of themselves or others. The second condition is that all other forms of treatment have failed and medication is the only option. The third condition is that instead of using “guidelines” for prescribing psychiatric drugs and letting doctors prescribe them at their own discretion, there should be explicitly stated rules for prescribing psychiatric drugs. With the exception of the German Autobahn, the speed limit is a law and not a guideline, the use of force by police officers is a law and not a guideline and there are many other examples I could note, but I can’t think of them off the top of my head. However, I will conclude that if something has very serious consequences it must be regulated tightly by laws and not just suggested by guidelines.
A final reason why there needs to be more serious restriction on the prescription of psychiatric drugs is that in some cases, such prescriptions appear to violate the section on comprehensiveness of the Canada Health Act, which defines comprehensiveness as broadly, to include “medically necessary services for the purpose of maintaining health, preventing disease, or diagnosing or treating an injury, illness or disability.” Psychiatric drugs may certainly help in certain cases, but in many other cases they may have harmful side effects that may not be worth the risk. In order to determine medical necessity it must be determined if there is an absolute need for a person to receive psychiatric medication and it must be proven that other methods will not help. When psychiatric drugs are prescribed for minor issues or issues that can be resolved by other means, it appears that the Canada Health Act is being violated, since these prescriptions are not medically necessary. In such cases, more effort must be made to explore available alternative forms of treatment.