The quagmire of mental health treatment

If only I shared Marjorie Wallace's optimism about the latest guidelines from the National Institute of Clinical Excellence, or "Nice", concerning the treatment of mental health patients. Ms Wallace, chief executive of Sane, the mental health charity, welcomes Nice's recommendation that the 170,000 patients, mainly young people, who present themselves at hospital accident and emergency departments last year with self-inflicted wounds, should be treated with sympathy and respect by the medical profession and not, as is usually the case, dismissed as time-wasting whingers trying to draw attention to themselves.

If only I shared Marjorie Wallace's optimism about the latest guidelines from the National Institute of Clinical Excellence, or "Nice", concerning the treatment of mental health patients. Ms Wallace, chief executive of Sane, the mental health charity, welcomes Nice's recommendation that the 170,000 patients, mainly young people, who present themselves at hospital accident and emergency departments last year with self-inflicted wounds, should be treated with sympathy and respect by the medical profession and not, as is usually the case, dismissed as time-wasting whingers trying to draw attention to themselves.

Miss Wallace whose helpline responds to more than 1,000 calls a week from people suffering from schizophrenia, depression, paranoia and other acute psychological conditions, said: "Doctors seem to feel that they should somehow be punished for their antisocial behaviour. Clearly the medical profession has no understanding of a mental condition that prompts people to resort to such drastic measures. Let us hope that these new Nice guidelines will encourage the medical fraternity to change its unsympathetic attitude towards this kind of mental illness."

As chief executive of a national charity with both kudos and clout, I suppose she has to be optimistic. As the mother of a 24-year-old son who has been seriously mentally ill for three years, diagnosed as a paranoid schizophrenic and sectioned under the Mental Health Act twice, requiring detention in a locked hospital ward for up to six months, I don't have to pretend. Unlike many self-harmers who slash their wrists or eat iron filings, he has never tried to wound himself physically, although he has attempted suicide twice by taking overdoses.

His first psychotic episode, as it's called in medical terms, was triggered by smoking a particularly powerful strain of cannabis called skunk. Since then he has been on anti-psychotic medication more or less regularly. I say "more or less" because last March, three months before he was due to sit his finals at London University, he had a glitch. He complained that his medication was making him feel like a zombie - "like something out of One Flew Over the Cuckoo's Nest" were his actual words. He said he couldn't concentrate, felt depressed, and that there was absolutely no way he would be able to sit 12 hours of exams. So I relented. I said he could stop taking it until he'd finished his last paper at the end of May.

The reason I'm banging on about medication is that, 18 months ago, Nice came up with another set of regulations concerning anti-psychotic drugs. National Health doctors, it advised, were not keeping abreast of the new improved generation of antipsychotic drugs specifically directed at schizophrenics whose condition had proved resistant to conventional drugs such as Risperidone, which my son has been prescribed. The one that has proved to be the most successful, with the least adverse side-effects, is Clozapine, often referred to as the gold standard anti-psychotic drug and one that clearly impressed my son's last but one NHS consultant. I've lost count of how many he's had.

So how many British psychiatrists have responded to that last Nice directive? I asked Miss Wallace. Not a lot, she admitted, particularly where Clozapine is concerned, which seems odd considering its tried and tested success rate.

I don't think it's odd, I think it's pretty much par for the course as far as mental health treatment in this country goes. I'm not knocking the NHS, by the way. If we had spent thousands sending my son to a private clinic (the Priory is the one most people have heard of) I don't think he would have been any better off. There seems to be an inbuilt reluctance on the part of psychiatrists here, to go out on a limb, to try something new.

Their other inbuilt reluctance is to offer patients any form of counselling. All of us who listen to the psychiatrist Dr Raj Persaud's brilliant radio series All In The Mind know very well that the most effective treatment for mental illness is a combination of medication and psychotherapy. I subscribe to the Tablets Are Good But Talking Is Better school of medicine. Last September, Sane canvassed the opinions of 19,000 self-harmers who had called their helpline. Only a quarter of them had received any form of counselling.

Since my son took (and, I'm glad to say, passed) his finals, he has refused to go back on medication. This, to put it mildly, has caused him and his family a lot of grief, and legions of doctors, psychiatrists, social workers, lawyers, police - and, in the final stages of our domestic drama, a helicopter with searchlights - a lot of time and trouble.

He has been back in hospital now for three weeks, during which time he has not had any formal counselling. He's also back on Risperadone, the drug that made him feel like a zombie. I'm all for doctors following the latest Nice guidelines and being more sympathetic to psychiatric patients. I'd be even happier if they'd backtrack a bit and take note of the last recommendations. It might be quite nice for Nice too.