Tuesday, November 13, 2018

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  • May I make two quick points:
    (a) It might be a good idea to listen to the families of mental health patients as well, beginning with this poignant article by a well known author whose son eventually committed suicide, Salmon, T. (2006) My son has schizophrenia: why can’t the system cope? Observer (Focus section), 19 November 2006. Available at- http://observer.guardian.co.uk/focus/story/0,,1951739,00.html.

    (b) Speaking for myself, as a practising psychiatrist, heaven could be defined as a place with NO mental health regulatory statutes requiring the responsible clinician to place a patient under compulsory status if the individual poses a risk to himself/herself, and should the patient subsequently commit suicide/homicide, hauling up the same clinician before a disciplinary tribunal for failing in the duty of care. The remedy for the much maligned ‘psychiatric tyranny’ lies in the legislative domain: do away with all such laws. After all, a patient of diabetes mellitus has the right to refuse insulin even though death would probably result from such refusal.

    D S Goel, MD

  • As a practising psychiatrist, I must plead guilty to prescribing psychotropic medications, usually to the willing but occasionally to those designated ‘compulsory’ status under the relevant regulatory statute, for over half a century. I should also concede that some or many of these medications might have had unintended adverse effects, even though abiding with the basic Hippocratic dictum, ‘primum non nocere’. In balance, however, I believe these interventions possibly did some good to the majority. This belief is strengthened by, inter alia, Jari Tiihonen’s landmark national register based Nordic study [Tiihonenen J, Lonnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A, Haukka J. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009;374:620-7] which indicated that overall mortality (after adjusting for suicides) was lower in patients treated with various antipsychotic medications compared to those not on any medication. Meltzer goes further and asserts that “at least one-third of the approximately 5,000 patients per year with schizophrenia or schizoaffective disorder who commit suicide in the U.S. would not do so had they been treated with clozapine” [Meltzer HY. Clozapine: Balancing Safety with Superior Antipsychotic Efficacy. Clinical Schizophrenia & Related Psychoses 2012: 134-144]. The debate is, unfortunately, clouded by the oft-forgotten fact that the society has ‘outsourced’ risk management to mental health professionals. Be it suicides, or a mentally unwell Andreas Lubitz crashing the German Wings fight killing 150 people, or the mass murderer Anders Behring Breivik seeking refuge in a psychiatric diagnosis, mental health services are invariably accused of having failed in their duty to protect the community. This just highlights that the issues involved cannot be resoled through an either/or binary approach.
    D S Goel, MD