Inspectors seek review of high use of sedatives in mental units


Are drugs replacing care in our mental health facilities? | 04/01/2011

CARL O'BRIEN, Chief reporter

MENTAL HEALTH inspectors have expressed concern over the high use of sedatives in psychiatric hospitals and have called for an “urgent review” of drug use in some facilities.

The inspector of Mental Health Services has found in some hospitals that as many as 80 per cent of long-term patients were being prescribed sedatives, also known as benzodiazepines.

Benzodiazepines are prescription drugs used to treat a range of conditions such as anxiety, insomnia and seizures. While they are considered safe for short-term use, the risk of overuse, abuse and dependence has been well documented.

Mental health campaigners also claim the drugs are being used to control the behaviour of vulnerable patients in the absence of access to activities, stimulation or therapeutic intervention.

Inspectors have been collecting detailed information on drug prescription patterns in mental health facilities for the first time. So far they have published reports for one-third of all mental health facilities inspected during 2010.

Of the 22 hospitals or care facilities visited, inspectors expressed concern over sedative use or called for an audit of drug-use in half of them.

Former inspector of mental hospitals Dr Dermot Walsh yesterday said he had long-standing concerns regarding the over-use of these drugs.

“The therapeutic misuse of benzodiazepines in medicine generally is a problem. These drugs are successful for short-term control of anxiety and so on, but should not be used in the medium or long term,” he said.

There are good practice guidelines – issued in 2002 by the Department of Health – but the inspector’s findings raise question marks as to whether they are being adequately implemented.

They state that the need for long-term prescribing should be reviewed regularly. It says “the only clinical justification for continuing use is dependence. Planned withdrawal from patients dependant on benzodiazepines should be considered”.

They also state that “attempts should be made to improve levels of mental stimulation and physical activity on long-stay wards”.

The inspectors’ reports so far show that benzodiazepines and night-time sedation is particularly high across a number of hospitals.

At St Joseph’s Hospital in Limerick, inspectors found 80 per cent of residents had a prescription for a benzodiazepine, many of whom were elderly. Over half were using them on a regular basis, prompting inspectors to recommend an “urgent review” of all drug use.

At An Coillin in Co Mayo, a 29-bed unit, inspectors found 78 per cent of patients on benzodiazepines, while 33 per cent were on more than one.

At St Edmundsbury Hospital, Co Dublin – a private facility – inspectors found high numbers of people on night sedation (82 per cent), as well as on benzodiazepines (73 per cent). Inspectors said these figures were “very high” and noted that medication sheets were of poor quality.

A previous report by the Mental Health Commission in 2009 raised concerns that patients at two psychiatric hospitals in Clonmel, Co Tipperary, were being inappropriately administered sedatives to control their behaviour.

It found a majority of residents at St Michael’s Unit, South Tipperary General Hospital, and St Luke’s Hospital, both in Clonmel, were receiving benzodiazepines on a long-term basis. This, inspectors said, appeared to be the result of a lack of activities and alternative treatment options.

These concerns have since been addressed by the Health Service Executive and no issues have arisen in more recent inspection reports.

John Saunders, director of the Shine support group for people affected by mental ill-health, said the high rate of benzodiazepine use tended to reflect under-staffing.

“Where you don’t have adequate staff, you have this kind of medication, but where there is sufficient staffing, adequate activities, there is far less reliance on medication.”

The Mental Health Commission has declined to comment until it has published all of its inspection reports.

  Mary Maddock, Nuria O Mahony and Orla O Donavan. Nuria O Mahony led the Irish campaign

  'We deserve to know the truth about prescription drugs'. 

 Letter to Joe in response to the above article.

 Dear Joe

While welcoming today's report on the overuse of sedatives in our psychiatric hospitals, MindFreedom Ireland would like to point out this is too little too late, having been common knowledge for decades.  What the report failed to mention was the evidence that SSRI's and neuroleptics are also overused with serious brain damage as a longterm effect. An Oireachtas report of 2006 highlighted the dangers of these drugs but received little media attention at the time.

Frequently the lack of spending on mental health is criticised but in fact when the cost of prescription drugs is taken into consideration, the figure is enormous. The debate should be about diverting this money to more effective and beneficial alternative methods of healing.

If you wish to discuss this matter on air my phone no. is 021 4894303

Yours sincerely,

Mary Maddock, Director, MindFreedom Ireland.