By Ron Unger
At least here and there, mental health authorities are recognizing that it is a problem that people in the public mental health system are dying 25 years earlier than the average person, and they are starting to talk about it. (For more information on these death rates, see this power point presentation) But while they are often willing to talk about how to reduce death by improving medical care or reducing smoking, they are often much less likely to discuss the role of neuroleptic (”anti-psychotic”) medication in causing many of the deaths, or how to reduce that impact.
Below is a list of suggestions that if followed could really reduce deaths from neuroleptics, by attempting as much as possible to safely reduce their use, and substitute alternatives wherever possible. You might take this list to your local mental health administrator.
Let consumers know that we want to collaborate with them in safely minimizing the use of neuroleptics. Let them know that our success in this will partly depend on their willingness to use alternatives and to learn more about other ways of managing their issues.
Make sure consumers are fully informed about the risks to their health from taking neuroleptics, so they are more likely to be interested in working to reduce their use, and so they don’t end up being exposed to risks from neuroleptics without informed consent. (This means not just telling them once, but making sure they really “get it” about the risks.)
Provide groups to educate consumers in how to shift to relying more on alternatives to medications, so they will experience less need for medications.
Provide written material that educates consumers on how to shift to relying more on alternatives to medications.
Attempt to identify types of clients who are currently getting started on neuroleptics, but where alternative approaches that are available in the community might work if tried. Figure out how to encourage trying these alternatives and giving them a reasonable chance to work before neuroleptics are tried.
Identify clients who may have needed a certain level of neuroleptics in the past, but who now might possibly do well with less or no neuroleptics. Work out with them a process of weaning off, which would include assistance in handling withdrawal reactions and with gradually shifting to alternate forms of coping. Have a good relapse plan in place which includes the possibility of resuming higher levels of medication as one option, if necessary.
Specifically avoid using forms of psychoeducation that imply that certain forms of mental problems can only be handled by medication, as these discourage attempts to handle the problems in other ways. Instead, always frame medication as a possibly temporary measure, which could become unnecessary in the future if other forms of coping become more successful.
Make sure consumers are informed about the likelihood of withdrawal effects when neuroleptics are discontinued abruptly (the fact that relapse is 3-5 times more likely in abrubt withdrawal.) This will help consumers avoid mistaking withdrawal effects for a need to constantly maintain medication.
Make sure alternative treatments are as available in the community as possible. For example, make sure that clinicians are available who are trained in psychological approaches to psychosis, so they don’t just see “more medication” as the only option when a client experiences a psychotic symptom.
Rather than just focus on the risk to clients of reducing or getting off neuroleptic medications, acknowledge that risks of reducing or getting off must be weighed against the possibly life threatening consequences of staying on the medications, and acknowledge that the balance of risk is different for each person, and varies as well over time. For example, trying a reduction may be too risky at one point in time, but may make good sense later.
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