With a third of the population in some areas of NI on antidepressants how do we deal with our massive drug over prescribing rates?

It was when a clinical psychiatrist expressed her concern at the number of people prescribed antidepressants that I realised it wasn’t just me.   She too thought the good people of West Belfast especially unhappy as the data was telling us some 30% of  the local adult population are on “happy pills”.   You might ask how did we get here and should it be acceptable that a third of any population are taking medicines to improve their mental health?

When I expressed these concerns at a public meeting I was quickly admonished by a  community worker.  Barely unable to hide his contempt he asked if I hadn’t noticed we had just come through “The Troubles; 30 years of conflict and this is the legacy of that”!

Sadly, for him at least, there is little evidence that “the conflict” had a direct negative impact on the mental health of a large number of people: certain individuals off course have suffered intolerable anguish and are still suffering.  But it is ironic that a study in the 1980s, at the height of the conflict, failed to show a higher usage of Diazepam-like medicines in N. Ireland compared to other UK cities including Glasgow. Social deprivation it seems is a greater predictor of poor mental health and psychiatric medicine use.   In times of conflict communities bond, people see a higher purpose and mental health improves.

Post-conflict is a different matter.   The continuing impact of social deprivation – a considerable problem in all parts of Belfast – is certainly a factor in defining the mental health of a population. But what has happened is cultural rather than medical.   Feeling low, feeling down, feeling fed-up is not  a medical problem rather it is  part of the human condition.  Finding an inner resilience is easier for some but can be developed by most. If anything we are failing as a society to support individuals to help themselves and we have opted for a medical solution to get us through.

We have too much medicine in N. Ireland and not enough health and wellbeing. We have been trapped into a medicalization myth: a pill for ever ill and for every ill a pill.   This has led us to a point where our population  is overdosed and its telling with medicines the fourth most common cause of death.   We use 40% more medicines per head of population compared to England.  We use 22% more medicines per head of population compared to  Scotland.  Do we get respectively  40% and 22% better health than these populations.   You bet we don’t .

But there is something about our antidepressant medicine use that screams this cannot be right.  For a start there’s every likelihood antidepressants don’t work.  They are only as effective as sugar-pills when it comes to treating mild and moderate depression but we don’t know as the  drug companies, up to now, refuse to release all the clinical trial data.

Antidepressants are designed to rectify “a chemical imbalance” in the brain but again there is little evidence that “a chemical imbalance” is the cause of depression or if antidepressants fix it.  Antidepressants certainly affect the brain and this is evident in the withdrawal experienced by those who wish to come off.  These unpleasant effects are similar to the low mood experience initially so the patient prefers to stay on the medicines.  I would not be stretching things too far to call these drugs addictive.

If this is so why do so many GPs choose to prescribe them?   Many GPs practise defensive medicine when it comes to patients reporting signs and symptoms of mild and moderate depression.   To do nothing, to watch and wait, which is the recommendation of  the Government body the National Institute of Clinical and Healthcare Excellence (NICE), GPs start prescribing fearing censure should a patient attempt suicide for example.  And off course it’s easier to be depressed now than it was 10 years ago.  The diagnostic criteria – the level of symptoms needed to issue a prescription – sets the bar so low it would catch most of us on a bad day.

There is a way out.   The Public Health Agency in its Take 5 campaign gives us the means to improve our own mental health;(1) connect with others, (2) learn a new skill, (3) exercise, (4) give of our time and, if we have it, money (5) be curious about our big exciting world. Yes, I  agree this take some personal effort.

If you can’t do it yourself, there is the Mental Health Hub now operational across Belfast supporting individuals to create their own resilience and develop more positive thinking patterns using methods such as Cognitive Behavioural Therapy (CBT).  The talking therapies are more expensive than cheap-as-chips pills so we will have to invest.

So there it is.  West Belfast people are not especially unhappy it’s a medical conspiracy; we have medicalised feeling down, produced medicine to treat it, altered the diagnostic criteria so most people fit and we have thrown the problem at GPs and given them few real alternatives.

Terry Maguire is a pharmacist in West Belfast

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  • Korhomme

    ” In times of conflict communities bond, people see a higher purpose and mental health improves.”

    This was very apparent in Britain in WW2; there was a clearly identified common enemy and a common purpose.

  • Old Mortality

    This is an admirably forthright piece by someone whose business lies within the area under consideration, not to mention the potential loss of business if local GPs practised less ‘defensive medicine’.
    The profligate prescribing habits of our GPs in general demonstrate a total indifference to the financial health of the NHS.
    I recently visited my GP about a persistent but minor muscular pain and was horrified to be prescribed paracetamol which I could have bought over the counter in any shop.

  • Brian O’Neill

    Just to let you know BBC talkback will be covering our story in today’s show. Make sure to tune in.

  • AHGMS

    I am not an expert in the issue, but, with all due respect to the author, I think the piece above lacks the pondering needed when you deal with a sensitive topic like that. I have been taking anti-depressants for ten years now, always with regular medical accompaniment. The treatment has had a very positive impact on me. It has been, to sum up, a life changing experience; and I doubt that I am the only case. I do believe that doctors in general may commit excesses in prescribing anti-depressants. I do believe that the pharmaceutical industry is probably not the most ethical economic sector in the world. Those problems should be addressed. However, I also believe that scientific research can lead us to options, products, medicines, that can improve individual lives and life in society if used in the correct way. Labeling anti-depressants a “medical conspiracy” is not helpful for people who have been benefiting from them and not helpful when we consider people who may need them.

  • Heather Richardson

    I’m not sure that it’s helpful to be so dismissive of depression or the medical treatments available. There’s a world of difference between “Feeling low, feeling down, feeling fed-up” and clinical depression. From what I’ve read in the media, North and West Belfast have higher than average suicide rates. I don’t think people take their own lives because they’re feeling fed-up.

    I’d guess one of the reasons modern anti-depressants are prescribed freely is because they have good results with comparatively minimal side-effects compared to older drugs. Are they doled out too liberally by hard-pressed GPs? I don’t know, but I imagine when a GP is faced with a patient in real mental anguish it would be a bit thrawn of them to withhold treatment that could help.

    The suggestions in the Take 5 Campaign are great for recuperation once recovery is underway, and also for keeping someone well and protecting against a recurrence, but they’re not a treatment in themselves – not for someone in the grip of a depressive episode.

    I have to declare a personal interest – having ‘soldiered on’ through depressive episodes since my teens (and religiously done the ‘take exercise, eat sensibly, be connected’ stuff) I finally went to my GP when I got into a mental bad place I couldn’t get out of. He prescribed anti-depressants, and for me they were life changing. They’re not ‘happy pills’. The best way I can describe it is that they gave me a sort of shelter from the storm. I knew the storm was still outside, but the drugs allowed me to recuperate and build up my mental strength until I was fit to venture out again. I only needed them for a few months, but knowing that there’s an effective treatment available should I need it again is immensely reassuring.

  • CP

    It’s hard to properly analyse the real impact of depression in post-conflict Northern Ireland on the basis of this article. The reason is that this article displays an alarming level of ignorance (even more staggering given that it comes from a pharmacist) of depression and its causes and effects. In other words, the ‘analysis’ is rendered worthless by the inaccurate and disrespectful manner with which the author treats depression and people dealing with it.

    “The diagnostic criteria […] set the bar so low it would catch most of us on a bad day.”

    Even if that were true – which is HIGHLY debatable – it completely misses the point. What may be a bad day for most people is in fact a normal day (at best) for a person dealing with depression. Much of the time, depression means feeling nothing at all for days on end. Alternatively, it means feeling nothing but despair, hopelessness and helplessness under a black cloud which never seems to lift. Sometimes it lasts so long that the black cloud becomes so familiar that you almost don’t want it to lift because you can’t remember what life was like before and the very thought of it seems more terrifying than the black cloud itself.

    Does that sounds like just a bad day? Nope, didn’t think so.

    Having depression is far worse than having “a bad day” and that’s why the glib assertion that “we have medicalised feeling down” is so inaccurate and indeed offensive to those of us who deal with these issues at times in our lives.

    I’m not suggesting that medication is the only response to depression and I fully agree that it has to be complemented with other initiatives, such as the good examples the article cites from the Take 5 campaign (although he seriously underestimates just how much effort these can require). All I’m saying is that any conversation on this issue, either in general or in the specific context of post-conflict Northern Ireland, needs to begin with a proper understanding of what depression is and how it really affects people. This article is not it.

  • Brian O’Neill

    No one is arguing that depression is a very real and debilitating condition.

    The article is making two key points:
    GP’s are to quick to prescribe antidepressants
    Patients are looking for a magic bullet solution to life’s problems

    I talk with GP’s a lot to research these posts and they will tell you they get patients coming to them with lots of non medical problems. Here are some examples:

    Dealing with grief
    Dealing with job loss

    Grief is part of life. Are we really saying we should medicalise every knock we get in life?

  • Reader

    CP: What may be a bad day for most people is in fact a normal day (at best) for a person dealing with depression. Much of the time, depression means feeling nothing at all for days on end. Alternatively, it means feeling nothing but despair, hopelessness and helplessness under a black cloud which never seems to lift.
    Do you really, truly, believe that 30% of the adult population of West Belfast are in that situation?

  • Dan

    Are all these antidepressants a convenient route to enable the DLA claims to look good?

  • Granni Trixie

    I question the education of GPs as relevant to dealng with the spectrum of mental health conditions. For example, recently at two seminars I attended I noted a pattern of complaints in each about the ignorance of GPs in respect of eating disorders and fibromyalgia. Commonly, the link to cognitive functioning and mental health and these conditions is not recognised. But I think that expectations that GPs are more informed as they can access pathways of help, is reasonable.

    My understanding is that in their forth year trainee doctors can opt to learn about various conditions but this is hardly satisfactory.

  • barnshee

    “Social deprivation it seems is a greater predictor of poor mental health and psychiatric medicine use.”

    And there you would appear to have it —focus on the causes and effects and cure or at least ameliorate the causes and effects of social deprivation and you might make a difference.

  • Heather Richardson

    The key points that stood out for me were the claims “there’s every likelihood antidepressants don’t work” and “I would not be stretching things too far to call these drugs addictive.” That’s what I’m taking issue with.

    And I don’t think the real and debilitating nature of depression is being recognised by saying “And off course it’s easier to be depressed now than it was 10 years ago. The diagnostic criteria – the level of symptoms needed to issue a prescription – sets the bar so low it would catch most of us on a bad day.”

    This sort of attitude makes many sufferers reluctant to ask for help – of any kind.

  • Ben De Hellenbacque

    “Until we have a see-change (sic)” and by that you rightly imply the electorate. You raise a very valid point about the toxicity of our polity.
    This is some interesting reading: http://scholar.harvard.edu/files/hckelman/files/Reconciliation_as_Identity_Change_2004.pdf
    And on the subject of mediation: http://www.mediate.com/articles/cloke7.cfm
    It is troubling that the ‘profound psychological change’ required for both the process of conflict resolution and the outcome of resolution has been largely overlooked in NI. The process has to be started and the outcome has to be achieved.
    The 2 tribes here do more than disagree; they antagonise the other and our unthinking media then give community & political reps the often underchallenged opportunity to legitimise this with some dishonest posturing. The depth to which many of us identify as one tribe or the other along with our need to believe lies could be seen as a mental health problem in its own right. After all, how sustainable is this in the long term? Why do we continue inventing new delusions to sustain our fictions? Einstein’s definition of madness runs through us like ‘Brighton’ in a stick of rock. We gain nothing from it in any real sense yet we don’t see it. Does this present a ticking mental health time bomb?
    As with all mental health problems, treating depression is complex and the individual has to be understood for the treatment to be appropriate and effective. The treatment has to address the social conditions that caused it as well as the individual’s response to that environment i.e. psychology & thought processes. That involves the patient’s participation as much as that of the therapist.
    GPs overprescribing antidepressants is debatable. However, specific locations in NI do have an alarmingly high rate of mental health problems with worryingly high rates of suicide. Terry mentions CBT which involves challenging thoughts and thought processes as well as facing some uncomfortable truths. This requires the patient/client to play an active role in their own recovery including challenging their own beliefs and ways of thinking.

  • Old Mortality

    ‘The best way I can describe it is that they gave me a sort of shelter from the storm. I knew the storm was still outside, but the drugs allowed me to recuperate and build up my mental strength until I was fit to venture out again. I only needed them for a few months’

    I think the difference is that you were willing to check whether the storm was past instead of remaining in shelter indefinitely. If the 30% in West Belfast were all using the drugs for just a few months, there wouldn’t be much reason for concern
    I would have thought that any responsible GP would seek some alternative form of treatment rather than let the patient languish indefinitely on anti-depressants.

  • Old Mortality

    It might be difficult to claim DLA for mental infirmity if you were not being prescribed drugs of this type. In fact, a suitable prescription is probably all you need.

  • Toben

    I think you have raised an important issue here. There is much evidence now that use of psychotropic medications (and particularly antidepressants) in NI are higher than other countries.

    The impact of the conflict should not be underestimated. It is now, in our post-conflict society, that the further impact of the troubles is being seen. Mental disorders such as PTSD (typically associated with conflict) in NI are among the highest in the world. So it is not entirely surprising that our use of psychiatric medications is also high. Those who have experienced trauma, including that related to the conflict, are more likely to be taking psychotropic medication. This association remains even after accounting for other factors such as deprivation. Yes, social deprivation is undoubtedly an important factor and the research I am doing points to a high use of psychiatric medication in the most deprived areas. Yet when other factors (such as experience of the troubles etc.) are taken into consideration, the impact of deprivation is reduced. The thedetail.tv Script Report also found ‘The relationship between deprivation and antidepressant prescription rates is significantly stronger in Northern Ireland than in both England and Wales. But even in Northern Ireland the relationship was too weak to reliably indicate a relationship.’.

    Yes, there are likely individuals using these medications without needing to. And yes this may be higher than in other countries. And we need to understand how or why this is happening. Is it due to individuals/patients, GPs, or simply a lack of available alternatives? We need more research before we can answer these questions and ‘blame’ anyone. In saying that, in the grand scheme of things the evidence suggests that most people in NI taking antidepressants probably need them (though if you doubt the whole premise of depression, chemical imbalance, and antidepressants you will probably disagree with this).

  • kalista63

    I’ve mentioned before that my partner is a CPN in E Belfast and they’re snowed under plus, she’s told me, the service they refer acute cases to has closed it books, so to speak, meaning that they are having to give continued care to vunerable people who they would normally refer on. She’s a massive fan of talk therapies but that option is now limited.

    As a general point, she tells me that a fair amount of her patients are having post conflict issues but not all historical, many being related to the thuggery going on there that the media seems to neglect.

    Then from my own point of view, I’m aware of the issues in Rathcoole and the surrounding areas, especially among the youth and even those nearer my age. Kids on theor teens, with their developing brains, are doing bongs on a daily or very frequent basis and abusing ‘Blues’ as well as legal highs and other cheap crap. Anything positive is frowned upon, manifesting in acts such as the ongoing attacks on the community centre and building bonfires on pitches. I’m sure we’re all aware enough to realise the damage that would be done by the time these kids hit their 20’s.

    NI is being massively mismanaged, youth services being regarded as a luxury and the indulgence loyalists that’s stopping the police doing their jobs is haveing inevitable consequences.

  • kalista63

    In England and Wales they have the infamous sink estates and areas of massive deprivation but they also have massive issues with illegal drugs and alcohol abuse, self medicating in other words.

  • CP

    No I don’t but that’s not even remotely what I said. Try reading again…

    “All I’m saying is that any conversation on this issue, either in general or in the specific context of post-conflict Northern Ireland, needs to begin with a proper understanding of what depression is and how it really affects people. This article is not it.”

    What I was saying was that I don’t know and that I have no way of knowing but then again neither does the author, especially given his glib description of a serious condition, which I sought to correct. The difference is that I’m not judging anybody or assuming they’re looking for ‘happy pills’ because they’re having ‘a bad day’.

  • CP

    “No one is arguing that depression is a very real and debilitating condition.”

    That’s exactly what the author did:
    “it’s easier to be depressed now than it was 10 years ago. The diagnostic criteria […] sets the bar so low it would catch most of us on a bad day.”

    Do you really think those sentences portray a ‘real and debilitating condition’? Catch yourself on.

  • Kevin Breslin

    I have Asperger’s Syndrome and was in a very hostile workplace environment in my opinion. CBT and the Take 5 campaign would’ve been very poor substitutes for antidepressants. This isn’t my self-diagnosis, I have been advised by medical professionals that CBT was not the answers, even when I asked for it. Take 5 seems like CBT-light, but doesn’t reflect the humiliation I had to endure to state several grievances I had to deal with,

    I was depressed, I didn’t feel sad, I didn’t feel helpless, I wasn’t lonely or deprived from educational challenge or distraction, most of all I should not have been forced to feel happy, I was kept away from my girlfriend for this stupid job that was regressive and was driven through abusive personality and no one who tried to help me or intervene did anything but make my situation worse. I got my way out of that situation by myself with the help of anti-depressants.

    I stayed there until I could obtain different employment rather than the alternative which was being forced unto benefits and having no work to get to better work from.

    The alternative would’ve been for the rest of the company to radically change their personalities to tolerate or be patient with mine, and it was made clear everyday that that wasn’t going to happen.

  • notimetoshine

    Over use of Antidepressants are as much a symptom of a modern health service that doesn’t care and is unable or unwilling to seriously deal with mental health. It’s not just here, over the water is as bad, when a senior police officer has to take to twitter to complain about holding a minor in a jail cell because there were no beds in an appropriate facility, you know something is wrong.

    I suffered and I suppose still do suffer from pretty debilitating depression and anxiety and have done since I was in my teens. My most recent bout was particularly nasty and I went to my gp. First thing first script for anti depressants and then eventually a referral to mental health services. Five months later a letter arrives giving me an appointment with a specialist and an assessment in two and a half months. So 7 months to see someone about talking therapy. Counselling of whatever form it takes is the best way out. But to wait for 7 months? Bloody disgrace. Thankfully I was able to afford to see someone privately but for many this is not an option. Dope you up and send you on your way seems to be the preferred option.

    If I had waited those 7 months I might not have been here now. I was not well. And our health service simply couldn’t or wouldn’t help. God knows how many people die waiting for treatment or end up in a debilitating and dangerous state of mental health. It would be a national scandal if it were any other illness.

  • Brian O’Neill

    If it is not to intrusive to ask did you find the therapy helpful? Was it CBT?

  • notimetoshine

    No not intrusive at all.

    Yes immensely. It was a combination of cbt, talking therapy and its hard to explain but a sort of lifesytle guidance programme with an exercise and diet plan.

  • Brian O’Neill

    I did ask terry that very question. He said that used to be the case but they have tightened up a lot recently on DLA, but personally I can see it being a factor alright.

  • Brian O’Neill

    There is people on Valium etc from the 60’s.

  • Brian O’Neill

    How interesting. If you ever fancy writing about your experience send me an email to brian@sluggerotoole.com it may help other people in the same boat.

  • Brian O’Neill

    Terry specifically states “They are only as effective as sugar-pills when it comes to treating mild and moderate depression”.

    Depression is real but this post it about the ethnics of giving drugs with massive side effects to people who are dealing with life’s normal challenges.

  • Reader

    CP : No I don’t but that’s not even remotely what I said. Try reading again…
    So that’s what I did. The article suggests that anti-depressants are being over-prescribed. Hence: “The diagnostic criteria […] set the bar so low”. I can see that you are offended by this, and I also saw your moving description of severe depression. But neither of those contradicts the original argument that anti-depressants are being over prescribed.

  • Turgon

    There are a number of problems with this blog.

    One of the most important problems in mental health is getting a correct diagnosis. Antidepressants are likely to be prescribed too frequently because they are prescribed in people who in actual fact do not have depression.

    Being down or feeling depressed is as some have noted above very, very different from the colloquial term “depression”. For depression in a true medical sense antidepressants although not perfect (no treatment is) are highly effective. Both my wife and I (thankfully spared the illness ourselves) have relatives with recurrent bad depression and they have responded extremely well to antidepressants: some have remained on them long herm; some shorter term.

    The problem here is that depression is best diagnosed by a doctor: either a GP or ideally a psychiatrist if the illness is bad. Clinical psychologists etc. are actually not the best people to make the diagnosis and pharmacists I am afraid most assuredly are not.

    Antidepressants are probably over prescribed and GPs may over prescribe them but this blog makes a number of dangerous assertions about antidepressants which are inaccurate.

    Furthermore Brian explains he has spoken to GPs to research the posts: well maybe he should try talking to psychiatrists as well.

    Next he talks about “valium” which is the trade name of diazepam. This is not an antidepressant but a sedative and anxiolytic: different things. The fact that Brian does not understand the difference demonstrates a worrying lack of understanding of psychotropic medication and suggests the research has been rather poor. Any GP or pharmacist could have explained the difference.

    Finally the pharmacist is wrong. Antidepressants are not addictive: sedatives such as diazepam are but that is comparing different sorts of drugs. Antidepressants are not addictive. However, proper clinical depression is often a life long disease and if one stops the medications treating it unsurprisingly frequently the illness recurs.

    This blog unfortunately perpetuates multiple misconceptions about depression; is poorly thought out and poorly written.

    There is a very real issue about over use of antidepressants (and other medications) in NI but this blog is not so much an opportunity wasted but rather makes the situation worse by adding to misunderstandings.

  • Brian O’Neill

    I did not write this post terry did.

    My comments about GPs were general and not related to this post.

    I know fine well the difference between Valium and antidepressants. I only mentioned it in the context of the comment about long term prescription addiction.

  • Turgon

    You mentioned valium in reply to a discussion about antidepressants. If you know the difference you might be wise not to discuss the two different things at the one time. If you know about the issue you should know that many people confuse the different drugs. You have added to the confusion and getting irritable with me is not helping.

    You were wrong about this.

    Turning to the blog as a whole: You have allowed a pharmacist to make comments about diagnosis of mental health problems on a leading blog. The specific diagnosis of mental health problems is something completely outwith his sphere of expertise.

    Your blog has done a dangerous disservice both to people with depression and those attempting to address the problem of over prescription of medications.

    You need to think rather more clearly and carefully before posting about health matters. We have already had you making unsubstantiated claims about other health personal. It would also help to take proper expert advice on each topic rather than let people with opinions but not necessarily the expertise to analyse the issue fully loose to make inaccurate generalisations.

    By all means let a pharmacist note the high rate of prescription of these medications but allowing him to comment on diagnosis etc. is highly inappropriate. That you fail to understand this is worrisome.

    Your analyses of complex problems in healthcare is superficial and all too often inaccurate. You add heat not light to these debates.

  • hurdy gurdy man

    On what do you base your claim that Clinical Psychologists are not the best people to make a diagnosis of depression?

  • Turgon

    The fact that mental health diagnosis is best made by psychiatrists: just as say a heart diagnosis is best made by a cardiologist. Doctors make the diagnoses. Psychologists are extremely useful in treatment but the actual responsibility for diagnosis resides with the medical doctor: in this case ideally a Consultant Psychiatrist.

    Psychologists may well be able to help with and even make a diagnosis. However, the best person to make such a diagnosis will be a psychiatrist. Pharmacists, however, are assuredly not the best people to make such diagnoses.

  • Turgon

    And Terry is in a poor place to comment on this: being as he is a pharmacist and not a doctor let alone a psychiatrist.

    Your blog and defence of it are unravelling. I am worried that you are defending the inaccuracies: even more so that you comment supposedly authoritatively on health matters on NI’s leading blog when in actual fact you seem to have little grasp on those very health matters.

  • Surveyor

    People with mental health problems face enough prejudice without pharmacists now casting aspersions upon them. If I were in need of antidepressants I’d think twice about going to this pharmacy to get them dispensed least I’d be judged. Need I also remind Terry about the high rate of suicides in the North, a fact he has completely ignored in his piece.

  • Heather Richardson

    What are the “massive side effects”, and what proportion of users will experience them?

  • chrisjones2

    (5) be curious about our big exciting world

    So abolishing Stormont will have positive mental health benefits for all

  • chrisjones2

    So many addicts get their mammy granny etc to claim the drugs for them?

  • chrisjones2

    “And Terry is in a poor place to comment on this: being as he is a pharmacist and not a doctor let alone a psychiatrist.”

    ….. and you dared to say what you thought and disagree with Turgon by not showing the nth degree of precision in every phrase.

    Feeling depressed now? Well ……..

  • Old Mortality

    Chris
    Back in the day when free prescriptions were confined to children and OAPs this appears to have been a common practice. I remember my wife being shocked when asked in the local chemist if she’d like a prescription for her own use to be made out in the name of one of the children as the item in question was commonly prescribed for children as well.

  • Sharpie

    I remember a research piece highlighting how top civil servants with a very poor lifestyle still had much greater life expectancy than civil servants with impeccable lifestyles at the bottom. The explanation attributed to the gap was autonomy – the ability to make a decision and act on it.

    The population of Northern Ireland seems to suffer from a lack of autonomy. Our society is governed by norms and social mores that are choking, archaic, and depressive. From religious attitudes, to tribal differences, to political stagnation, and economic despondency – there is precious little to look forward to unless you protect yourself with your family and close knit friends – even that is a type of rear guard action.

    This is in contrast to an open tolerant society where aspirations and ambitions can be housed, accommodated and fulfilled; where a population can much better cope with life events. In such places there is more “redundancy” in people’s coping skills so that when a knock comes the coping is better. Lets call it resilience.

    Unfortunately in Northern Ireland the resilience is lacking – old society bonds are breaking down despite a desperate clinging on by some, and there is not a positive, inspiring, aspirational tone at a large.

    There are sub sets of society where people have broken through that – mainly in middle class communities – geographical and interest based. They are doing fine, but while they are ok, society at large is sick – as individuals and as communities.

  • Kevin Breslin

    Autonomy? Surely you’d think top civil servants are the most constrained and controlled of people…budgets, ministerial orders, buck stops with them, delegating tasks to an entire staff and hoping they don’t undermine your power and control and being responsible for managing the biggest problems the region has to manage.

    Perhaps it’s the cognitive challenge and all the added adrenaline that’s keeping these senior civil servants alive. That or they suck young blood.

  • Brian O’Neill

    Terry plans to write about suicide in a future post.

  • Ben De Hellenbacque

    It is more complicated. Social deprivation and poor mental health do go hand in hand. However, a further question crops up. The debilitating effects of long term poor mental health cause some people to move to poorer areas due to reduced income. Classic vicious circle stuff and very hard to break.

  • james

    If so perhaps it’s the lack of ability to choose their own political representatives that causes the black cloud. I’d suggest that many there would be fearful of being seen to not vote SF, despite the lack of representation in return.

  • Cosmo

    Sharpie’s observations on lack of autonomy, choking religion and traditions and defeated despondency in NI, are apt. We could look beyond British Isles for context, as France also has a high level of medication, with 1:3 on pyschotropic medication – according to France 24 report (2014-05-20). (This of course, could be to do with the ‘push’ by big pharma, but according to GP friends there, is a great deal of ‘pull’ by the patients, as well.)
    France has a doctrinaire culture and style of education – in which (unless for a very thin layer of educational elite) in reality there is very little actual social movement, or sense or appetite for change. Once you have a job, whether as a waiter but especially as a functionnaire, you stay with it, despite boredom, ennui and frustration. And just drive very fast and recklessly as you go home for lunch! The French attitude to the State is actually a very Catholic worldview. It is maybe worth comparing to parts of NI population. Like the ‘God’ of the Church – the State is both to be feared and yet totally relied on, like a child. Hated and criticised, yet viewed with a defeated sense of frustration and blame, and the sense that there is no point in trying to innovate, be productive or enterprising.

  • Cosmo

    Thank you for these insights.

  • Brian O’Neill

    France is notorious as a nation of hypochondriacs:
    http://www.theguardian.com/world/2003/jul/17/france.jonhenley

    Curiously they also love shoving things up their bottoms:
    “The French take more suppositories than the rest of Europe combined. In
    2006, they shoved 235 tonnes of pharmaceuticals up themselves.”

    http://www.telegraph.co.uk/news/features/3634345/30-reasons-why-we-hate-the-French.html

  • Brian O’Neill

    You are right, lack of control is considered a key cause of stress:
    http://www.admin.cam.ac.uk/offices/hr/policy/stress/causes.html

  • Cosmo

    Actually, I wasn’t just wanting to do French-bashing a la Telegraph. (After all, they seem to have superior ‘rules’ and outcomes when it comes to nutrition and the public behaviour of young children!!)
    How is a culture and education geared up to make its people unafraid to adapt and change? What are the real underlying cultural reasons for stagnation and personal defeat, one symptom of which might be drug usage. Not to forget, our faltered economy.
    It is also surely worth looking at NI in a broader context, than just these two islands.

  • aquifer

    The Gang of Four called it:
    All this talk of blood and iron, is the cause of all my shaking

    The fatherland’s no place to die for
    It makes me want to run out shouting
    I hear some talk of guns and butter
    That’s something I can do without
    If men are only blood and iron
    O doctor doctor, what’s in my shirt?
    Just keep quiet no room for doubt

  • Turgon

    Since pharmacists are not trained in diagnosis etc. nor are they specifically trained in suicide prevention (apart from tying to avoid people obtaining enough medication to take dangerous overdoses) it is unlikely that Terry will be able to provide much in the way of professional insight into this issue. He may have expertise through routes other than his profession but if that is so it might have been useful to reference them previously.

    The way forward if you want to do blogs on health (or any other subject touching a given profession’s area of expertise) is to involve the appropriate professionals. This is pretty elementary journalism: actually it is elementary common sense if one wants to run an authoritative website.

    My overriding concern here Brian is that you have a very limited grasp on what different health professionals do in their work and an equally limited insight into your own lack of understanding.

  • Robbi McMillen

    I was on and off many anti-depressants. The main issue I had is that doctors prescribed them without working out which would be the best. I went through one after another. I am lucky to have family and friends around me who keep me busy so that I am tired out by the time I’m getting into bed.

    When you go into a GP’s room you’ll see bold and underlined posters saying that your appointment lasts 10 minutes. It is a deeply off-putting message to see as you walk into a room to share your physical and mental illness with a professional. Most doctors behave in a way that you’re out in 3 or 4 minutes. Doctors work unbelievably hard, but they have to start listening to patients. Their unwillingness to listen and enquire leads to very bad personal results for some of their patients.

    And probably an unpopular point, doctors and surgeries’ administrative teams need to be trained to deal with people with severe anxiety.

    We simply cannot move away from our over-prescribing rates without doctors and their teams being part of the debate and without them, and the rest of us, owning up to failures, and accepting that new systems have to be found.

  • Cosmo

    I am very sorry to hear about your illness, and you make very good points. The rushed 10-minute consultation ‘rule’ is inhumane for doctor and patient, and in terms of care, surely ultimately inefficient. Surely, those GP’s who can survive working with such a constraint, will have to steel themselves to simply not care. Isn’t there a crisis in retaining GP’s? Isn’t this a reason?