NHS antidepressant prescribing—what do we get for £266 million per year?

Derek Summerfield, writing in the Opinion section of the British Medical Journal (February 2018), says:

“… our epidemic of antidepressant prescribing: 64.7 million in 2016, up from around 9 million in the 1990s? Antidepressants cost the NHS £266 million in 2016, and these are only the direct costs. In an age of medicalisation no diagnostic category is more indiscriminately applied than ‘depression.'”

“The Royal College of Psychiatrists and the media routinely state that there is an ‘epidemic’ of mental disorder—1 in 4 people in the UK, with 3 in 4 said not to get the treatment they need. These disease-mongering assertions have been recycled for so long that they have become unexamined societal truisms. We are apparently wading knee deep in ‘mental disorder,’ yet psychiatry has not confronted the philosophical problem of defining just what we mean by ‘mental disorder.’

Barring categories arising directly from physical disease (for example, dementia), there is no conceptual agreement about when a person ‘really’ has a mental disorder, only the constructed agreement inherent in the methodologies that psychiatry has adopted. [1] If there are sufficient phenomena, at sufficient threshold, a mental disorder is declared to exist. This is a kind of alchemy. If to have a mental disorder is to have some measure of incapacity, how could 1 in 4 UK citizens be thus afflicted and society still keep going as it does? [2] The psychiatric field is making knowledge claims it cannot justify. I am not talking about a minority with undoubtedly severe or recurrent psychiatric problems, often needing inpatient care.

When the medicalisation of everyday life and the commodification of ‘mind’ is professionally endorsed and taken up by wider culture, the language of psychological deficit is inserted into the public imagination. People come to see themselves not as normally stressed, but as ‘ill’, with negative emotion recast as a mental health problem. [3] As more resources for mental health services are called for and provided, more are perceived to be needed, an apparently circular process, a dog chasing its tail. It was clear when I was an occupational psychiatrist that the psychiatrisation of the problems of living frequently perpetuated them.[4] …”

Read more here.

References:

  1. Ingleby D. Understanding ‘Mental Illness’. In: Ingleby D. ed. Critical psychiatry. The politics of mental health. London: Free Association Press 2004. 23-45.
  2. Summerfield D. Proposals for massive expansion of psychological therapies would be counter-productive across society. Brit J Psychiatry 2008:192(5);326-330.
  3. Summerfield D. Cross-cultural Perspectives on the Medicalization of Human Suffering. In: Rosen G. ed. Posttraumatic Stress Disorder. Issues and Controversies. Chichester: John Wiley 2004: 233-45.
  4. Summerfield D. Metropolitan Police Blues: protracted sickness absence, ill-health retirement, and the occupational psychiatrist. BMJ 2011;342:d2127.
NHS antidepressant prescribing—what do we get for £266 million per year?
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