Two years ago, almost to the day, I attended a Cross Party Group on Mental Health and Older People at the Scottish Parliament. I found it a difficult meeting for a number of reasons and I feel it is now the right time to share these.
The Principal Medical Officer for the Scottish Government, who led on the Ten Year Vision, presented first and gave a useful summary. He said that it was “an ambitious vision with generous thinking about the future”. The Principal Medical Officer acknowledged several times evidence that those with chronic mental health disorders living in Scotland die 15-20 years earlier than those who do not. He said this is a “huge finding, a universal finding, a huge inequity”. He was asked (not by me) if one significant reason for this might be the harmful long-term effects of psychiatric medications? He replied that Ministers could not advise doctors what to prescribe. In reply I said “but we allow the pharmaceutical industry to educate doctors”. I went on to express concern that ‘Realistic medicine’ did not feature in the ten year vision, and was surprised by this given growing concerns about over-diagnosis and over-treatment.
The calm and dignified Hunter Watson asked important questions on human rights. The Principal Medical Officer said he could not talk about legislation as that was “up to ministers”.
Two speakers shared their lived of experience of poor mental health as they have got older. They explained how the healthcare system in Scotland had become focused on cognition rather than their overall well-being. They were also of the view that this focus (based on targets for early diagnosis) had left the system so stretched that they no longer got the support they needed. This has been termed as “inverse care”.
A representative from Action in Mind talked with clarity and genuine concern about what she termed as “institutional discrimination”.
The meeting ended with a senior NHS Psychiatrist and Government advisor talking about depression in older age. He outlined that there have been far fewer studies on antidepressants in those over 65 years than in younger adults. He then went on to question the validity of ‘non-biological approaches’ for depression.
This senior NHS Psychiatrist, who has been an advisor to the Scottish Government, stated unequivocally that “depression is under-recognised across all age groups” and that “there is good evidence that long-term antidepressant treatment has a good risk-benefit ratio” [please note in talking about this he used the term “maintenance treatment”]. I replied that there is no evidence to support this statement and that we do not even know the actual views of patients on long-term antidepressants. The expert (who does not know me) replied “Peter does not accept the evidence that other professionals follow”. I noticed that the Convener of the Cross Party Group, an MSP, smirked at this. Feeling ridiculed I quietly walked out of the meeting before its conclusion.
On my way home I could not stop thinking, that if as a doctor I struggle to be considered “credible” by colleagues, then those who are not doctors may find it even harder. I really did not sleep well that night.