Intended for healthcare professionals

News Roundup [abridged Versions Appear In The Paper Journal]

Mentally ill people denied choice of drugs

BMJ 2000; 321 doi: (Published 09 December 2000) Cite this as: BMJ 2000;321:1432
  1. Jason O'Neale Roach
  1. BMJ

    Sixty two per cent of people with mental health problems are denied a choice of drug treatment, said a new report published yesterday by the National Schizophrenia Fellowship. The report is based on a survey of 2600 people carried out by the Manic Depression Fellowship and Mind.

    Although 73% of doctors discussed treatment, only 38% offered a choice, and only 54% offered written information about side effects. The fellowship's chief executive, Cliff Prior, said: “People must be able to exercise an informed choice about the drugs they are expected to take. That demands an end to rationing.”

    Atypical antipsychotics such as olanzapine, clozapine, and risperidone were among the drugs rated best by patients. Conversely, the three worst rated medicines were the typical antipsychotics haloperidol, chlorpromazine, and trifluoperazine. Those taking typical antipsychotics were significantly more likely to experience very bad muscle spasms, muscle shaking, and tremor; 43% of respondents said that side effects of prescribed medicines had badly affected their everyday life.

    The difference in annual cost between olanzapine and the most frequently prescribed typical antipsychotic can be over £2700 per patient, and there is now a 10-fold variation in atypical spending across health authorities. Mr Prior said: “There is a real challenge here for the National Institute for Clinical Excellence because it has just announced a review of drug treatments for schizophrenia.”

    The survey used direct mail questionnaires targeted at mentally ill people (85%) and informal carers (15%). Information from 10 focus groups was also included in the results. The frequency of non-medical interventions varied between 19% for herbal medicine and 56% for “talking therapy.” However, those who received these non-medical interventions found them helpful (61% and 79% respectively). The study concluded that positive outcomes are increased if people are informed about their choices and allowed to choose.

    A Question of Choicecan be accessed at

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