Green Health Policy position on "non-drug treatments"

nesf

Specifically this bit:

Moving towards non-drug therapies saves money: where non-drug therapies have been shown to be effective for a particular condition, drugs marketed for that condition should not be reimbursable, if service users have access to alternative treatments.

As well as the mental health specific positioning here:

It is also a goal in mental health to switch treatments from drug therapy - (GPs have tended to rely on medication as treatment) -- towards counselling and psychological services which are often more efficacious and cost-effective.

As someone with bipolar with a large (and potentially expensive if the DPS scheme was changed) drug prescription each month I'd view this with a large degree of scepticism. Counselling etc do not replace medication as a form of treatment and in some cases do nothing for patients. I appreciate that there would be a lot of "horse trading" before anything like this would come into effect but I think ideological positions like "Medication: Bad. Counselling: Good." are really not something politicians should be dabbling in.

Thoughts/Opinions? I'd be interested to hear some medical people's positions on this.


Full details of their policy here: http://www.greenparty.ie/en/policies/health__1

AmcD

I can't see how the Green Party will verify patients' rights to have their meds reimbursed or not. What lengths will they go to to establish if psychology services are available locally? As a GP I prescribe quite a lot of psych meds, often because I have no alternative to offer. Even when I refer patients onwards to the local psychiatric services, I do it knowing that even the psychiatrists have pretty much no access to psychology either. Presumably the Green Party aren't going to insist that private patients must see a private psychologist rather than paying for antidepressants?
I don't think this one has been thought out logistically.

sam34

i have worked in psychiatry for many years, and have worked on and alongside many psychiatric "multi-disciplinary" teams... not one of those teams has ever had a full time psychologist.

there is gross understaffing in terms of psychology services here.

there are a certain group of people who would undoubtably benefit from seeing a psychologist, but, given the unavailability of this, they go the psychiatric route and can end up on meds, usually antidepressants - this is often an attempt to treat what is essentially a reactive depression rather than an endogenous one, but a depression nonetheless, and also, if im being honest, it can be done because one wants to have odne something, to have helped in some way.

however, and it's a big however, teh "talking therapies" have not been shown to be superior, or equal, to medications for the more severe mental illnesses, sucha s severe depression, bipolar disorder and schizophrenia.

there are those with severe and enduring mental illnesses who will require long term meds, end of story. no counselling/psychotherapy will change that.

i didnt read teh whole paper... does it apply to other ilnesses as well - are tehy proposing not to reimburse for antihypertensives as well, because after all, everyone is capable of altering their diet and lifestyle??

nesf

sam34 wrote: »

however, and it's a big however, teh "talking therapies" have not been shown to be superior, or equal, to medications for the more severe mental illnesses, sucha s severe depression, bipolar disorder and schizophrenia.

there are those with severe and enduring mental illnesses who will require long term meds, end of story. no counselling/psychotherapy will change that.

This is my issue. As is, there is no real extra support for those of us with long term mental health problems. We don't fall under the Long Term Illness scheme like those with diabetes do and as such we're out of pocket by circa 1200 Euro a year given that the drugs we are prescribed are expensive and mental health is one of those areas where the generics aren't equivalent to their brand name (still under patent) counterparts.

It would severely effect my life in a negative fashion is some kind of misguided push onto "talking therapies" was tried with respect to mental illness. I fully agree that in many cases talking therapies should be the first option but this doesn't apply to those of us who have more severe and/or long term issues that require medication to manage.

I am biased here though. I'm at the moment on 16 pills a day. These medications have vastly improved my quality of life and I've gone from having serious problems functioning to being able to put my life back on track and lead a mostly normal life. If the DPS scheme wasn't there I'd by out of pocket 400-500 Euro a month instead of just over 100. I've been on medication for the best part of six or seven years and it doesn't look like changing any time soon.

sam34

nesf wrote: »

We don't fall under the Long Term Illness scheme like those with diabetes do and as such we're out of pocket by circa 1200 Euro a year
I'm at the moment on 16 pills a day.
If the DPS scheme wasn't there I'd by out of pocket 400-500 Euro a month instead of just over 100. QUOTE]

:eek::eek:

im in old age psych, so most of my patients have medical cards. it's been a wgile since i did general adult psychiatry, but my understanding/recollection was that if you had bipolar or schizophrenia then you quallified for long term illness/medical card??

jesus, thats rough if you dont. i presume the €100 cost would be too much for a lot of people and would lead to poor/non-compliance, which in turn would lead to more relapses and hospitalisations, so greater cost etc etc.

but then, those that hold the purse strings rarely think long term, do they?

nesf

sam34 wrote: »

im in old age psych, so most of my patients have medical cards. it's been a wgile since i did general adult psychiatry, but my understanding/recollection was that if you had bipolar or schizophrenia then you quallified for long term illness/medical card??

You only qualify for the LTI scheme if you're under 16. If you're in your 20s and have a fairly well paying job (or your husband/wife does) you get neither a medical card nor any extra support.

sam34 wrote: »

jesus, thats rough if you dont. i presume the €100 cost would be too much for a lot of people and would lead to poor/non-compliance, which in turn would lead to more relapses and hospitalisations, so greater cost etc etc.

but then, those that hold the purse strings rarely think long term, do they?

Indeed. The only thing I suppose that is for a single person with severe mental health problems they'll not be able to hold down a full time job so will end up with a medical card. But if you try to support yourself or are the "secondary" earner in a relationship then there's no support for you. There's also a nasty side if you have a seasonal component to your bipolar in that (at least in my case) you can get infection after infection when you're low over the winter/early spring period which means shelling out substantially above what normal people would in doctor's fees over the period.

AmcD

I just want to point out another HSE oddity: patients attending public psychiatry clinics get their meds for free, even without a medical card. This is why some of my patients (understandably) refuse to be discharged from the outpatient clinics. This is only in the greater Dublin area though. It demonstrates nicely how unified and fair the health service is.

JuliusCaesar

sam34 wrote: »

i have worked in psychiatry for many years, and have worked on and alongside many psychiatric "multi-disciplinary" teams... not one of those teams has ever had a full time psychologist.......

This might be becaue Psychology Dept are not actually part of Psyciatry/mental health administratively - where I work, one psychologist is assigned to 2 MH teams, there being about 6 teams.

sam34 wrote: »

there are a certain group of people who would undoubtably benefit from seeing a psychologist, but, given the unavailability of this, they go the psychiatric route and can end up on meds, usually antidepressants .

In some parts of the country, CNSs/ANPs specialise in various forms of therapy - psychoanalysis, CBT, family therapy etc. These are generally part of the teams, but again due to shortage of personnell tend to service more than one team at a time.

sam34 wrote: »

however, and it's a big however, teh "talking therapies" have not been shown to be superior, or equal, to medications for the more severe mental illnesses, sucha s severe depression, bipolar disorder and schizophrenia.

there are those with severe and enduring mental illnesses who will require long term meds, end of story. no counselling/psychotherapy will change that.

Nobody who has worked in MH will dispute that. Psychological therapies can however help with symptom management, compliance, and gererally help improve the quality of life in addition to medication.

DrIndy

Reading through the position paper - i do not think they plan on replacement of mental illness therapy with psychotherapy - they talk of severe mental "distress" not "illness" which makes a difference.

Psychological therapy works on milder affective states and improves function, compliance and rehabilitation in more severe mental illnesses.

Psychological therapy is adjunctive to pharmacotherapy and the two should be used hand in hand with one taking the lead where appropriate. Psychological therapy can NEVER replace pharmacology in more significant mental illness

There is a farcical shortage of clinical psychologists (psychology + DPsych - not CNS) in ireland. In fact I do not believe there is a single one employed in the public adult mental health sector.

sam34

JuliusCaesar wrote: »

This might be becaue Psychology Dept are not actually part of Psyciatry/mental health administratively - where I work, one psychologist is assigned to 2 MH teams, there being about 6 teams.

well, i used the MDT example because that is how the mental health services are delivered in this country. irrespective of how you look at it however, there is still a major shortage of psychologists.

Psychological therapies can however help with symptom management, compliance, and gererally help improve the quality of life in addition to medication.

im not disputing that at all! my point was that at the more severe end of teh mental ilness spectrum they cannot replace drug therapy.

but i see from indy's post above me taht that may not be the intention at all.... fair play for reading teh whole paper indy!

nesf

DrIndy wrote: »

Reading through the position paper - i do not think they plan on replacement of mental illness therapy with psychotherapy - they talk of severe mental "distress" not "illness" which makes a difference.

I sincerely hope so. I'd be deeply worried by a party whose mental health platform consisted of a push towards psych therapy across the board.