‘Tens of thousands of children’

Hole Ousia

On the front page, and over several pages inside, the Times newspaper reported on prescribing rates of antidepressants:

The Times considered the prescribing of antidepressants to both young and old:

And confirmed that:

Dr James Davies was quoted:

This was the view of the Times Editor:

One of the potential drivers of over-medicalisation is the involvement of industry in both research and marketing. In the UK, the pharmaceutical industry spends over £40 million a year on doctors and academics who market their products to appear somewhere as part of “approved Continuing Medical Education”.

The Royal College of Psychiatrists, in a response to a formal complaint, offered this statement of 8th June 2018:

However it is the case that the Royal College of Psychiatrists has no single, searchable register that records all payments to its Members. It is therefore impossible to determine the scale of any potential payments that have been…

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How much NHS Scotland money is going to ‘Quality Improvement Partners’?

Hole Ousia

Unfortunately this question cannot be answered as the information is not publicly available, this despite the fact that public money has been going to the Institute for Healthcare Improvement since 2007 and has since  become an “expanded partnership.”

I was copied into a FOI request (dated 24 July 2018) to Audit Scotland that sought to clarify how much public money was going to “Quality Improvement Partners” such as the Institute for Healthcare Improvement, Boston, USA.

The first FOI question asked for:
“All the information that Audit Scotland holds relating to financial dealings and the total amount of money paid to the organisation the Institute for Healthcare Improvement since the inception of the first engagement of their services by the Scottish Government and the Scottish NHS up until the present day.”

This was the response:
We have reviewed our audit records for both the Scottish Government and NHS audits where Audit…

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The President of my College

Hole Ousia

I was recently asked by a friend what I made of some of the responses by the President of the Royal College of Psychiatrists on the potential for antidepressants to cause dependence and withdrawal.

I replied that I was somewhat uncertain what to make of the responses that I had come across.  I am not on social media and I am always wary of gauging anyone without really knowing them.

So these were some of my thoughts, which may, or may not, add up to something:

• Based on my experience of colleagues around me in psychiatry, Professor Wendy Burn is saying what I generally hear: that the prevailing view is that SSRIs are generally not harmful, have few long term side effects, and that dependence and withdrawal are issues confined to relatively few. I noted that one commentator said: “If, as Wendy suggests, it’s taken Twitter to open her eyes…

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Reflections on being a black client & black therapist: PART 1 Mind the Gap


For about three years now, I have been holding a private psychotherapy and psychology practice where I see almost exclusively women and non-binary people of colour; in one to ones, in groups and in the community. This is one of my most cherished personal and professional accomplishments.

I have carved my practice out of my struggles and hopes as I continue to battle through the whiteness of clinical psychology and of psychotherapy. A whiteness I felt all the more sharply because as an inner-city child, I have grown up within communities of colour and, because the bulk of my clinical experience pre-doctorate was supporting black people and other communities of colour.

I have carved my practice out of my struggles and hopes as I continue to resist and exist within a society that still does not know how to treat people who look like me equally and decently regardless of…

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President of the British Association for Psychopharmacology

Hole Ousia

On Monday, 23rd July 2018, the Presidency of the British Association for Psychopharmacology (BAP) was handed over to Professor Allan Young.

Professor Allan Young was the Chair of the Royal College of Psychiatrists’ Psychopharmacology Committee before the current Chair, Professor David Baldwin.

Above photographs are from the BAP 2018 Summer Conference

This short post considers Professor Allan Young and transparency of competing financial interests. I have heard Professor Allan Young described as “the most influential key opinion leader in British psychiatry”. I would agree with this, certainly in terms of his “educational” role in prescribing of psychiatric medications for mood disorders.

This is one comment from an attendee at a BAP course: “Excellent course. All useful info which will help me in day to day prescribing.”

Previous Hole Ousia posts that may include Professor Allan Young can be read here.

I wish to repeat that my interest is in transparency…

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“Objectivity” does not come in a title

Hole Ousia

On the 17 July 2018 Professor Roy Perlis shared the publication of this paper in which he was lead author:

Professor Perlis who is Director, Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital did so with this introductory statement:

“Papers suggesting that antidepressants are associated with adverse birth outcomes get published in JAMA and hyped on NPR and BBC. Think this one, suggesting the same for psychotherapy, will get noticed? Confounding by indication is the point, of course.”

Two senior Scottish Psychiatrists shared this. One was Professor Keith Mathews and the other was Dr David Christmas, both of whom work for NHS Tayside.

In a post that I wrote in April 2018 I considered another recent paper by Professor Perlis, “Anxiety about Antidepressants” , where he considered “the cognitive and affective biases that may prevent effective treatment“. In this paper Professor Perlis referred to the recent publication…

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Hole Ousia

This post is not about Donald Trump.

I first communicated with Professor Sir Simon Wessely not long after he had been elected as President of the Royal College of Psychiatrists. In his e-mail of introduction to me he asked me to call [him] “just Simon”. I appreciated this to be nothing but an act of extraordinary kindness. I was wowed that the President of my college was on level with me.

At this time my uncle, Dr Guy Scott, was President of Zambia.

My uncle’s Presidency of Zambia was short lived.

Professor Sir Simon Wessely has since moved on from President of the Royal College of Psychiatrists to be elected as President of the Royal Society of Medicine.

I have never met Professor Sir Simon Wessely, however he did walk by me when I protested outside the RCPsych International Congress in Edinburgh, 2017. I noted that he arrived with a carefree…

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Transparency: Revision of NICE guidance on Depression

Hole Ousia

In a recent post I shared a letter that I had sent to the BMJ that was not published. It was based on correspondence with Professor Sir Simon Wessely who is one of the members of a stakeholder group who requested a revision of the Draft NICE Guidelines on Depression in Adults: Recognition and Management

In correspondence with Professor Sir Simon Wessely he suggested that I make a Freedom of Information request to NICE. I followed this advice and have received the following four documents (shared here below as received).

I also share here, to provide open and transparent context, the correspondence that I had with Professor Sir Simon Wessely. I will let the reader decide on whether this is the correct thing for me to do. I have concerns that such a powerful and influential UK medical leader should confuse transparency about a matter of public interest with me as…

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‘Flight of Ideas’

Hole Ousia

One of the current clinical definitions of “flight of ideas” is: “a rapid flow of thought, manifested by accelerated speech with abrupt changes from topic to topic: a symptom of some mental illnesses, especially manic disorder.”

I have never experienced mania and reckon that I never will. I am naturally of a quiet temperament and may be inclined to think a little more negatively than positively.  However I have found that “flight of ideas”, as a psychiatric concept, can be misapplied and misused. I have two personal examples.

First example:

In the early days of my writing on mental health I wrote a reply to a paper on the renaming of “schizophrenia”. I shared my reply with a psychiatrist colleague who sent me his perspective on it:

“There are two types of comments I want to make, one relating to the theme, and one to the way you put your…

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Healthcare Improvement Scotland and Realistic Medicine

Hole Ousia

Last week I sent an open letter to the Chair of Healthcare Improvement Scotland on Realistic Medicine in NHS Scotland. I have received this prompt reply:

I am sure that we all welcome the initiatives that Dame Denise Coia has outlined. I certainly do. However, it is the case that the improvement work undertaken by Healthcare Improvement Scotland is based on IHI methodology – a reductionist approach that was developed in the engineering industry. It remains to be seen whether this approach can be used as a universal model for healthcare and whether it delivers the outcomes that really matter to people.

I note that Dame Denise Coia has not responded to my open question on allocation of resources to the Institute for Healthcare Improvement, Boston, USA.

If anybody has any thoughts on realistic medicine I would welcome them. Please add as comments below.


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