A bad place to have schizophrenia? Budgetary concerns in the British National Health Service have led to doctors ‘rationing the best mental health drugs’ in a way that even U.S. “managed care” has not succeeded in doing. The newer atypical antipsychotic medications (clozapine, risperidone, olanzapine and quetiapine) are such an improvement over conventional antipsychotics for the treatment of schizophrenia and related conditions that they have made the older conventional antipsychotic medications all but obsolete in North America and the rest of Europe. They are effective against a broader range of the symptoms with which afflicted patients are beset, and they are far safer and more tolerable. Consultants advise that all patients requiring antipsychotic treatment in the UK receive these atypical medications as well, but in fact fewer than one in eight do. The official NHS position is that there have not been enough trials to establish the superiority of the newer drugs, although this flies in the face of the experience of every clinician treating psychotic disorders.
The real concern is that these newer medications are vastly more expensive — sometimes approaching a hundred times the cost of the older, side-effect-riddled medications, which are often available in generic form. “But if you compare with the cost of long term
treatments for other conditions like diabetes
the atypicals aren’t that expensive,” said a spokesperson for the British National Schizophrenia Fellowship; not to mention the costs of recurrent hospitalization when patients are not compliant with the older less desireable medications. Critics suggest that the
reluctance to pay for newer treatments is a
form of discrimination against people with a
mental illness.
“Part of the problem is that it’s difficult to
measure things like quality of life, but if you
look at other areas of health care, when a new
drug comes along with much fewer
side-effects, then the old treatments are
unceremoniously dumped even if they are
cheaper.” BBC
