§ Mr. Christopher Priceasked the Secretary of State for Social Services what safeguards exist for psychiatric patients against the indiscriminate use in their treatment of those psychotropic drugs which cause permanent personality change.
§ Dr. OwenThere is no evidence that the great majority of psychotropic drugs cause permanent personality change. Indeed, they are often used to treat conditions which themselves are liable to cause personality change. The responsible clinician would almost invariably be a fully trained and accredited consultant psychiatrist, and where he believed that the medication or other aspect of a patient's treatment raised difficulty, he would normally seek a second opinion from a fellow consultant.
432WNo general guidance has been given on the general question of consent to treatment of psychiatric patients but the advice of the Department's legal advisers, in broadly the following terms, has been given in answer to inquiries.
No treatment involving any special risk, however slight, should be administered to an informal patient over 16 years of age who is capable of appreciating and agreeing to what is proposed unless the patient gives his or her specific consent in writing. In the case of an informal patient over 16 who is incapable of giving an effective consent it seems that no one else can legally give such consent on his behalf.
Where treatment is necessary to preserve the life or health including mental health of the patient is it thought that the administration of such treatment would be unlikely to be questioned and the more so if the consent of the nearest relative had previously been obtained.
In the case of informal patients under the age of 16 the consent of the parent or guardian to treatment would probably be held to be effective in law.
In the case of a patient detained for treatment under the Mental Health Act it is thought that any recognised form of treatment considered necessary for the mental disorder from which he is suffering may lawfully be administered irrespective of his wishes or those of his relatives whose interests may conflict with his. However, in the case of treatment involving any risk it is desirable that the patient, if he is capable of understanding and the nearest relative should be told what is proposed and the consent of both should if possible be obtained.
This whole question of consent to treatment of psychiatric patients is being considered in the light of the recommendations of the Committee on Mentally Abnormal Offenders. I understand that in practice is form of treatment involving ing any special risk is not administered if the patient or his nearest relative objects.
§ Mr. Christopher Priceasked the Secretary of State for Social Services what tests she has made of the effectiveness and value to patients in mental hospitals of psychotropic drugs.
433W
§ Dr. OwenThe real test of the effectiveness and value to patients of psycho-tropic drugs lies in the clinical assessment of the effects of these drugs on the progress of the patients illness. This is constantly being monitored by practising clinicians who treat patients in mental hospitals. In addition my Department has recently sponsored a study at the Institute of Psychiatry under the arrangements for Locally Organised Research. The results are still awaited. I understand that the Medical Research Council has supported clinical trials in various psychiatric disorders including schizophrenia and the neuroses, some of which are still ongoing.
I have already announced that psycho-tropic drugs will be one of the early categories of medicines to be reviewed. The Committee on Review of Medicine has already established a Sub-Committee on
Date of increase 9.11.70 1.10.71 7.1.74 2.9.74 16.7.75 Largactil Ampoules—1.0% 10mg/ml 10 x 5ml 42 — 57 64 80 2.5% 25mg/ml 10 x 1ml 24 — 34 40 50 10 x 2ml 36 — 47 52 64 50 x 2ml 160 — 204 224 280 Suppositories 100mg 5 24 — — — 30 50 194 — — — 242 Syrup 25mg/5ml 125ml 16 — 18 22 28 1L 100 — — — 124 2L 190 — — — 236 Tablet 10mg 50 12 — — 16 20 500 86 — — 104 130 25mg 50 18 — — 22 28 500 142 — — 170 212 50mg 50 32 — — 40 50 500 270 — — 324 404 100mg 50 62 — — 76 96 500 498 — — 600 750 Largactil Forte Suspension* 5ml 150ml — 80 — — 100 1L — 433 — — 542 Date of increase 1.1.71 1.12.72 2.7.73 1.6.74 1.1.76 Modecate Ampoules 0.5ml 5 325 — — 366 439 1ml 10† — — 1,130 1,271 1,525 2ml 5‡ — 975 — 1,097 1,316 Vial 10ml 1 940 — — 1,058 1,270 Disposable syringe 1ml 5 587 — — 660 792 * Introduced in October 1971. † Introduced in December 1972. ‡ Introduced in July 1973.