One in six of the population suffer from a mental health problem at any time and for many some form of medication is essential in order to make a recovery. During this difficult period in a person's life it is vital they are involved in choices about treatment and medicines working in partnership with their healthcare professionals.

Ask About Medicines Week [November 3 – 7] is a campaign aimed at ensuring good doctor-patient communication, especially when it comes to mental health issues.

According to a recent survey only 40% of those who have received treatment for a mental definitely had a say in decisions about their medicines. This feeling of disempowerment can lead to some taking their medicine erratically or not at all.

Actively involving a patient in their healthcare choices is a vital part of the recovery process, promoting a feeling that there is at least one aspect of their lives over which they have some control. It can also allay concerns they may have about side effects or fears that they being prescribed inappropriate medicines.

Mental health issues can range between depression and full-blown psychosis, and clear communication with those charged with caring for those in need is key.

Medical campaigner Melinda Letts and Medical Director of the Association of the British Pharmaceutical Industry Dr. Richard Tiner are available in an exclusive Web TV show to address queries you may have.

Melinda Letts and Dr. Richard Tiner join us live online to discuss the subject of mental health.

For more information visit http://www.askaboutmedicines.org/

H: Lis Speight, host
M: Melinda Letts, medical campaigner
R: Dr Richard Tiner, Medical Director, Association British Pharmaceutical Industry

H: Hello and welcome to the Healthcare Show, I'm Lis Speight. Now did you know that one in six of the population suffers from mental health problem at any one time and for many some form of medication is essential in order to make a recovery. Now during this difficult period in a person's life it is vital they are involved in choices about treatment and medicines working in partnership with their healthcare professionals. Well joining me today to discuss this I'm delighted to say we're joined by Melinda Letts, welcome along Melinda, lovely to see you today

M: Thank you

H: And also Dr. Richard Tiner

R: Hello

H: Welcome along doctor, good to see you both. So Melinda there's been this survey done hasn't there, tell us a little bit about it

M: Yes well Ask About Medicine, what we've done is we've pulled together information from a variety of bits of research that have been done, and what we know is that one in six people in this country are suffering from mental health problems at any one time. That's you know a lot of people, and 9 out of 10 of those need to take medicine for their mental health problem

H: So moth people who've got a mental health problem are going to be taking medication?

M: Most people with a mental health problem need to be taking medication. What we also found was the for an awful lot of people, for the large majority of those people, those medicines will cause side effects, and that's natural really because you know medicines are powerful chemical agents and they help people, but at the same time as helping them they do have side effects

H: And what sort of side effects might we be talking about?

M: Well we might be talking about a range of things, ranging from sleep disturbance, perhaps a dry mouth

H: Right

M: Sexual problems, a whole range of things which people find you know quite off-putting sometimes

H: Yes

M: Now what they need to do is to understand really what kind of side effects are likely to happen to them, so that they can perhaps say well I'd rather have a different medicine, or so that they can at least be prepared for it. But we found that most people are actually not getting any information, more than half of the people that we're talking about not getting any information from their doctor about the side effects

H: None at all?

M: That they can expect. They're not getting any written information, and they're perhaps not having the courage or the self-esteem to talk to their doctor and ask, and so you've got people, you know, approaching this really without the information that they need, and not surprisingly then when they find that they've got side effects that they weren't expecting perhaps they stop taking their medicine and that doesn't help them, so really I think my message is that people need to – whatever medicine we're taking – but this week we're particularly focusing on people with mental health problems – we need to ask questions about the medicines that we're being prescribed so that we know what to expect, and then perhaps we'll be less surprised and upset when we get side effects

H: Ok so Richard, whose fault is it that the patients aren't asking questions – is it the doctors, dare I say, or is it the patients?

R: No I think it's a mixture actually, I think some patients are not sure that they can ask questions

H: Yes. It can be a bit daunting can't it, particularly with the mental health problems

R: It is, it is and in my previous life I was a general practitioner so I do understand that can be difficult and of course you know GPs work under considerable stress from the point of view of time as well

H: Well that's right, you're in and out sometime aren't you?

R: Yes well – so it can be quite difficult although I think there is a lot to be gained by spending a little bit of extra time at the beginning with the consultation, that can actually benefit in the longer term, so – and more and more doctors now realise that patients are wanting to have more information. Sometimes they don't know what questions to ask

H: Yes

R: And certainly the Ask About Medicines campaign have helped with that in the production of cards about what sort of questions you might want to ask your doctor, and the sort of questions, sort of issues you might want to find out about. And I think it's really just a question of giving people permission to ask questions, and certainly, certainly that can be very helpful, and certainly from the doctor's point of view it can be very helpful to know that there is someone that the patient actually, or their carer, wants to get more information because that helps – often helps – in the management, in the management of the condition, whatever it is

H: Do you think GPs are open to this though because I know if I go into my GP and I sort of, I've looked on the internet and had a bit of a think – what I think it might be, but then you sort of feel like you're telling them their job don't you?

R: More and more they are, I mean it's – it's much more common now that GPs are getting used to that and the fact that the internet has made a huge difference with that. I mean again it depends, it depends very much on the patient but it certainly isn't unusual to arrive with, with things that they've taken off the internet, and they're confused because – often by that –because, because they've read something on one website and then something completely different on another website, and that just makes people very confused and so they actually do need some help trying to sort, trying to sort this out and to understand what's right and what's – perhaps not correct in that particular situation

H: Yes ok, so don't be frightened to ask your GP then –

R: Not at all

M: No and Richard, you know mentioned the Ask About Medicines questions which we've designed and suggest for people, if I could quickly run through what those are –

H: Yes do

M: We suggest that you know if you're being prescribed a medicine, or even if you're talking in the pharmacy, talking to a pharmacist about a medicine then you should always ask, or make sure you understand what this medicine is, so what is this medicine? Why am I being encouraged to take it? How often should I take it? And how long should I take it for? And are there any side effects? You know are there any other things I need to know? Such as for example take it with or without food –

H: Right yes

M: Or how many you take in a day, that kind of thing and finally where can I go to get more information if I want it? And I think you know those questions we have as Richard said produce them in written form, you can find them on the Ask About Medicines website actually. And they're just a good set of questions, to bear in mind, and get into the habit of always asking the doctor or the pharmacist

H: You can go in with a list if you like can't you –

M: You can

H: Because sometimes when you get into the doctor you sort of forget what –

M: You can, and I think we're talking this week particularly about people with mental health problems. People with mental health problems might need medicines for other things as well. You know someone with a mental health problem might need antibiotics for example, or might have asthma or diabetes or anything else

H: Yes

M: Just because you've got a mental health problem doesn't mean to say you don't get other illnesses, and so I think health professionals who are working with people with mental heath problems you know perhaps need to remember that they might need a little more encouragement. If you're feeling down and depressed then perhaps you know remembering to ask the questions that perhaps you should be asking, about your antibiotics, might not be top of your mind

H: No

M: So a bit of help and encouragement for people with mental health problems

H: Just bear that in mind yes for GPs

M: Yes

H: But we'll move on to some of your questions actually. Richard was just about to jump in there but we've got one in from Sylvia, she says "I often feel intimidated by my doctor they always seem so rushed. What's the best place to ask for further information? Richard what would you say?

R: I think it is worth actually thinking – if – I mean obviously depending on what the doctor has said to you, you sometimes need to ask questions straight away

H: Yes

R: And they come to you at that point, but if you've been, if it's something and you've been seeing the doctor perhaps two or three times with the same condition, if you think of things after you've been to the consultation which is often what happens, the best thing to do then is to write them down at that point and then to have them ready for asking at – next time you use the doctor, if they're still relevant. But –

H: Yes. Could you ring up as well, I mean do they take to that? Some surgeries do –

R: Yes well some surgeries, and even more surgeries now are actually set – happy to accept emails

H: Right that's a good step forward isn't it?

R: So a lot of surgeries have introduced an email service and they're actually – and that actually gives the doctor time because he can actually answer the emails when he's got a few moments

H: Yes

R: Perhaps between patients or whatever

H: In his lunch break

R: Or at the end of a –

H: Overworked aren't they?

R: Yes. At the end of a surgery or whatever. So if that's encouraged by your practice I certainly think the use of email is actually very good, and a lot of doctors use that system now

M: But if I could come in there as well, I would suggest that another place that people can go to ask questions about the medicines is the pharmacy

H: Right

M: And a pharmacist isn't going to know perhaps every – you know they're not going to know as much as the GP does about the individual patient and their case but what often happens, you get your prescription and you go away and then you think oh I didn't really – mm I'm not sure about this, or I think I've heard about this on the internet and I'm not sure and I'm a bit worried, so when you go to get your prescription filled, or even just when you're in the pharmacy any time you can always ask the pharmacist, say can I have a – you know – a quiet word and ask your questions because a –

H: They're very clued up, pharmacists aren't they?

M: Well that's their training, pharmacists are specialists in medicines, I mean that is what their training is. I think a lot of people don't realise that because they sell so many different things

H: Yes that's right

M: You know you pop into the chemists for this or that, and you know a sandwich and a bottle of water and all the rest of it, but actually there is always a pharmacist in there who is an expert in medicines, so can answer people's questions

H: And they may have slightly more time, if you go in when there isn't a long queue

M: Yes I find they're always willing to help actually when I talk to them

R: And another source potentially is if you're involved with the mental health service, in this situation and you have a mental health nurse then they are specifically trained in those areas and often know a great deal about the medication that's being used and can again – can often answer questions or refer the patient to the right person to ask

H: Yes. Ok, well I hope that's been of some help to you. Another question in from Shelley, she says "I've often been quite confused by medication received from my GP. Is it dangerous not to finish a dose of prescribed medicine?" I guess you – it depends what you've been prescribed

M: It's definitely one for the doctor

R: It depends is the answer. Really. In the case of – as we're talking mainly about mental health today, generally speaking it's wise to continue, it's wise to continue with the medication, but if it's causing side effects or problems and using the patient information leaflet which comes in the pack, you don't particularly recognise those side effects as being recognised then it's – you should really seek further advice. Either again from the pharmacist or by going back to the doctor to ask about it. In certain other circumstances it may not be – it may be reasonable not to continue the course, but generally speaking the best thing to do is to carry on with the medication, unless it's making you feel very unwell but to seek further advice

H: Ok, go back to see your doctor then basically

M: And people can always, if it's out of hours they can ring NHS Direct

R: Yes they can

M: You know for a bit of quick advice

H: That's very useful actually NHS Direct isn't it? They come back to you very quickly don't they?

M: Yes it is, I mean I'm not a doctor, Richard is and his answer is obviously much more – you know much more specialised than mine, but I just would add, I want to echo what he says that you know if – you should always look at the patient information leaflet in the pack and find out what are the side effects that you're, you know that you're meant to be getting is what I mean

H: Yes

M: That you could have expected to get, and if you're getting things that aren't that then I would always say to people be very careful, don't just stop it just like that

H: Yes

M: You know, go and find some help from somewhere

H: You could be doing yourself more harm than good by taking it than not taking it

R: Potentially yes

H: Ok. And why is the emphasis of the Ask About Medicine campaign this year- why is it on mental health this year?

M: Well we've been running our campaign for a few years now and we've had various different focuses over the years, but so many people you know do live with mental health problems in this country, and as I said 9 out of 10 of them do depend on you know, need or take medicines. So it's obviously a very big area, and we felt that it was just you know high time that we did focus on this area because of the numbers really of people involved and the extent of potential problems

H: Is there still a real stigma about mental health though, because we should treat it just like any other illness

M: Absolutely

H: But we don't though do we?

M: No, I think that's a very good point actually. I mean there is – I've noticed over the years, and this is just my own personal observation, but I've noticed over the years that people are more willing, you know, to talk and say yes I've been off work with depression, or whatever. But there is a long way to go, and you're absolutely right I feel very strongly that people with mental health problems should be able to talk about them just the same as somebody with physical health problems, and hopefully attitudes are shifting sort of, you know overall in society. But I think it's still the case that people are afraid that an employer might you know not look on them favourably, you know or maybe people who have got mental health problems and who are worried you know whether their children are going to be maybe taken into care or – and I think there are lots of reasons why people feel afraid, as well as just normal social – everyday social stigma, so we've got a long way to go

H: We had a question in that's sort of touched on that actually from Charlie, he says "what constitutes mental health? Are we talking about psychosis?"

R: Well –

H: Huge range I suppose

R: Psychosis is a, is covered in the term mental health but it's – it's much broader than that, so we're talking about – essentially as I see it we're talking about depression, psychosis yes or schizophrenia, orders like bipolar disorder, in common terminology it's called – people may have heard of the term manic depression –

H: Bipolar disorder seems to be a bit more – people know a little bit more about that

R: Yes but it – those are the sort of, those are the diagnoses of sort of a list of potential diagnoses but actually general practitioners in particular will see a lot of people with stress, anxiety and they actually fit into the spectrum of – in my view they fit into the spectrum of mental health – and some of them are more severe than others

H: Is it on the increase would you say then, mental health problems?

R: Schizophrenia for instance affects about 1% of the population

H: That many, that's a lot isn't it?

R: So I mean – and that's a fairly static figure. But yes I mean if you were to talk to most people in the street, most people have felt down, perhaps a bit depressed, low, stressed. I mean particularly at the – you know perhaps now at the moment –

H: The nights are pulling in –

R: Things like the credit crunch and things like that, I mean people are bound to react in different ways to that and so it can vary depending on, depending on circumstances and people find that their lives affect them in different ways and will respond in different ways to the same issues. So – but on the other hand, you know during it's well written up that during war time for instance in second world war, although mental issues did occur they were much less – far less common or appeared to be far less common, so it's – it's a very variable process

M: It's hard to tell isn't it? I do think all the sort of stress though and the pace of life, and the ways in which families are having to live with you know both parents having to work and maybe children developing mental health, or anxieties and parents being very stressed and so forth. I think probably all of that contributes certainly to the what you might call the lesser end of the spectrum, and remember when – you know, we said 9 out of 10 people with mental health problems are taking medicines, that means not everybody with a mental health problem has to take medicines

H: No. Some of it's managed in other ways

M: And I do want to stress that one of the questions in our – that we suggest people ask is, you know, are there any alternatives? Is there anything else I can do, anything different I can do, because there will be some – obviously some cases of severe mental illness where medication is, you know, strongly indicated, and then there'll be at the other end of the spectrum, they'll be a range of things, lifestyle changes and you just mentioned the evenings drawing in, well yes some people use light boxes to sort of, you know, help themselves feel better, and so not everybody with a mental health problem has to take medicine and asking these questions will help people to understand whether there are different things they can do to help themselves

H: Ok well that's useful advice though isn't it? One last question actually, we're nearly out of time. Debbie from Leeds sent one in, she says "what about children with mental health diseases – are medicines suitable for them, and what else might be suitable for them?" General question really that isn't it?

R: Well the answer to – the answer is that some of the medicines that are available are not recommended in children, and it will be very clear – the doctor will know, but also it's very clear in the patient information leaflet as to whether it is recommended for children or not. Some of the medicines used in depression are used in children and used successfully in children, so it depends very much on what the condition is and what the recommended treatment is, but also often just, often for children and also for adults of course, what the term these days "talking therapies" are often very helpful, very useful and there are various other ways in which children can be treated. But if they're very disturbed then in – generally speaking they do need to use medicines as well as all the others and often the treatment is a mixture of those different treatments

M: Well I think we should say thank you to Debbie for raising that point, because it is a very, you know significant area, you know mental health problems in young people, in children and young people, which I think a lot of – you know a lot of people wouldn't kind of necessarily recognise, they wouldn't think that children and young people can suffer from depression and mental health problems, other mental health problems. And they do and you know for young people it can be very difficult to talk about what's going on and they don't know maybe what's normal, so they don't know that actually they're not meant to feel like this

H: Yes, because they haven't got – they don't know what they should be feeling like do they?

M: And nobody else to compare it with, and so – and teenagers you know will be very reluctant to talk about themselves anyway, to share how they're feeling with their parents. So it's a very important area and one that I think adults need to be on the lookout for

H: Ok well Dr Richard Tiner and Melinda Letts thanks very much for coming and giving some good advice there. And if you have a mental health problem you're worried about your mental health at all, then do talk to your GP but you can also go to the website which is askaboutmedicines.org. Well thanks for watching the Healthcare Show and we'll see you next time. Bye bye

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