In March and June this year, Associate Professor David Menkes (University of Auckland) and Andrea Bates (Wellbeing Wellington) contributed to a number of presentations that furthered the message of Equally Well about the contribution of psychotropic drugs to the early mortality of people who access mental health and/or addiction services, and how improved prescribing conversations can reduce the risk of harm. David and Andrea reflect on these presentations.
Treatment-resistant depression and anxiety
At the Goodfellow Symposium in March, we presented two workshops titled ‘Treatment-resistant depression and anxiety’ where we discussed the negative impacts of naming someone’s experience as resistant to treatment and the importance of addressing a person’s history in a broad formulation, and supporting the person to consider non-drug approaches in conjunction with any prescribed options.
The value in these discussions was presenting to a broad range of primary healthcare workers that the consumer and psychiatrist viewpoint can work in the same direction, while respectfully diverging based on each person’s experiential learning.
Demonstrating the key message of working together, which would equate with supported decision making in a clinical setting, showed our audiences that good things come through talking with each other.
Psychotropic medication, friend or foe?
Later in the day, we were joined by Professor Bruce Arroll, director of the Goodfellow Unit, to continue the discussion they started at the Royal New Zealand College of General Practitioners congress in 2017 with their presentation ‘Psychotropic medication, friend or foe?’.
In this presentation, which featured in NZ Doctor a few months ago, we discussed this unfortunately divisive issue and worked our way through our diverse experiences to the conclusion that psychotropic drugs are a tool that a person may use to support the life they want to live, and that this is best done with a well-informed prescriber(s) who values therapeutic relationships.
In June we presented ‘Psychotropic medication, friend or foe’ at the Royal Australian and New Zealand College of Psychiatrists (RANZCP) congress.
We set out the experiential basis of our positions on the subject by introducing each other, and so establishing our expertise in the area, and our ongoing professional friendship. We conducted a sometimes challenging, often playful 20-minute conversation in front of an audience of 40.
A variety of topics were touched upon, but we returned repeatedly to the fundamental importance of open and honest communication between prescriber and consumer, acknowledging inevitable differences in perspective. In addition to a number of provocative and thoughtful responses from the audience, this feedback was received subsequently by email from a community psychiatrist:
Obviously many of our patients disagree with us when it comes to medications, but it’s unusual that a psychiatrist will show his patient such deep respect the way you did, acknowledge that her point of view is just as important and that of us professionals and stand on the same stage with her in front of his peers.
“I am writing to let you know how much I enjoyed your presentation at the Congress with Andrea.
"Obviously many of our patients disagree with us when it comes to medications, but it’s unusual that a psychiatrist will show his patient such deep respect the way you did, acknowledge that her point of view is just as important and that of us professionals and stand on the same stage with her in front of his peers.
"I appreciate what you’ve done with Andrea and I wish more of us were as open to our patients’ points of view as yourself.”
Several of the other congress sessions were of direct relevance to Equally Well. These included:
Preventing and managing the life-threatening adverse effects of antipsychotics
‘Preventing and managing the life-threatening adverse effects of antipsychotics’, a symposium organised by Wellington psychiatrist Susanna Every-Palmer. Drugs of this class are vital and can be life-saving.
As was described in detail by the presenters, use of these drugs can also result in serious, sometimes fatal, adverse effects. These include drug actions on the gastrointestinal system (Susanna Every-Palmer), the neurological system (Paul Glue), heart (Chris Kenedi), and metabolism (David Menkes).
Despite the sometimes alarming details of what can ensue, the presenters generally agreed that these drugs have an essential role to play in modern healthcare.
Knowledge of their adverse effects allows these to be monitored and treatments optimised.
Benefits, harms and ethical implications of sponsored education in psychiatry
‘Benefits, harms and ethical implications of sponsored education in psychiatry’ was a multidisciplinary symposium organised and chaired by David.
In what has become a controversial topic, this session challenged traditional RANZCP policy which allows pharmaceutical industry sponsorship of congress.
A panel of ten experts, including Andrea, from diverse backgrounds (clinical and academic psychiatry, nursing, psychology, sociology and law) considered the issue and responded to comments and questions from the audience.
The symposium emphasised the use of best evidence to inform treatment options, and the now widely recognised distortion of evidence that often results when commercial interests deliver or otherwise influence professional education.
Panellists also pointed out that the College runs a reputational risk, among consumers and the public at large, by continuing to engage with industry in this way.
Later in June we presented ‘Psychotropic medication, friend or foe’ at the New Zealand Medical Association (NZMA) general practice conference and medical exhibition, in Rotorua with Bruce.
During two workshops we used role plays and audience questions to show how good prescribing conversations can work.
There was a focus on how a transparent relationship between a consumer and their GP and psychiatrist, can support both no or minimal prescribing, and also reduction and withdrawal from psychotropic drug use.
Another key issue discussed was time, and while we all acknowledged that time is always an issue in healthcare, good planning such as rebooking for a longer appointment for a later time, will lead to best outcomes for the relationship and each party’s wellbeing.
Next up for our travelling roadshow with Bruce is the NZMA South general practice conference and medical exhibition, in Christchurch later this year!