At the DRA (Dunbar Residents' Association) Annual General Meeting in December of 2006, MLA Colin Hansen authoritatively reassured 400 residents that nowadays there are better medicines for the treatment of severe mental illnesses.
Is Colin Hansen's claim correct? That the newer atypical antipsychotics are better, more long term effective in treating schizophrenia than the older drugs, like HaloperidolPr?
There is ample, peer reviewed published evidence readily available at the time of Colin Hansen's claim which shows that the newer antipsychotic pills are not any better than the old ones.
It is shocking that it took over 20 years for mental health experts' conventional wisdom to be put to the test. Here's what the Canadian Medical Journal says:
"The National Insititutes of Health and UK trials of schizophrenia treatment Clinical Antipsychotic Trials of Intervention Effectiveness [CATIE] 1, Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study [CUtLASS] 2 both found that the newer atypical antipsychotics offer little advantage over the first generation [older] antipsychotic [drugs], results so shocking that an editorial about them was titled, "CATIE and CUtLASS: Can we [mental health professionals] handle the truth?" 3
At best, there has been only minimal improvement in the effectiveness of medications in the treatment of schizophrenia over the past 40 years, contrary to what the mental health experts have been telling you for the last 20 years.
The current reality in the treatment of severe mental illness is:
"The scarcity of high-quality evidence for mental health care is striking." This statement was written in the Canadian Medical Journal in May 2008. 4
"Mental health practitioners often cannot obtain useful information to guide their clinical decisions, a situation that the director of the US National Institutes of Mental Health described as the 'unfortunate current state in psychiatry' where too many research studies have little immediate relevance to practice and too little practice is based on research evidence." Written in 2008. 5
"In the current state of limited or missing evidence, mental health professionals can only guess at best treatments." Written in 2008. 6
So when the experts are proposing a 30, 50, 100 bed supportive housing for mentally ill drug addicts or the severely mentally ill with their "addictions in check" remember: there is a significant knowledge deficit in the treatment of mental illness, yet the mental health experts claim "solutions."
It takes real courage and intregrity to expose your own profession's lack of evidence base. Drs. Shuchman and Hébert should be applauded for their candor and for their quest to demand that mental health treatments be proven effective and safe by long term, large-scale randomized trials in Psychiatry similar to CATIE and CUtLASS.
To make any progress you have to measure clinically significant outcomes. All other areas of medicine are now doing so, it's time mental health and addictions do it. This is why NIABY wants all supportive housing to be monitored and measured for meaningful long term outcomes and is opposed to large supportive housing facilities for mentally ill drug addicts in residential areas where treatments are merely guesses to what might be effective and no monitoring for effectiveness is contemplated.
In the meantime, mental health and addictions experts should be candid with the public about the large knowledge deficits in effective treatments for mental illness, rather than continue to make claims of solutions without a robust evidence base.
2006: "The ministry [of Health] has increased the budget for mental health and addiction services by 28% over the past 4 years. The ministry provides over $1 Billion for mental health and addiction services." 7
Current policy appears to be based on "Spray and Pray". Spray the money. Pray it works.
And MLA Colin Hansen? He was probably advised by local mental health experts when he unwittingly misinformed the residents of Dunbar that there are newer better antipsychotics available today for the treatment of schizophrenia.
Let's hope mental health professionals start being candid with our politicians and tax payers. Or we can expect more millions of dollars spent on ineffective, unproven programs that have the potential to put communities at risk.
Published August 27, 2008.