Marked rise in mental health prescribing
The number of people receiving psychopharmaceuticals in England increased between 2015/16 and 2019/20, according to data released in September by the NHS Business Services Authority.
Of the five groups of psychopharmaceuticals assessed in the data, only prescriptions for hypnotics and anxiolytics fell – down by 8.2 per cent since 2015/16.
The number of patients receiving hypnotics or anxiolytics was 10.9 per cent lower compared with the peak in 2016-17, yet 14.6 million items were dispensed in 2019-20 and 2.1 million patients received at least one hypnotic or anxiolytic.
In the other groups, the number of prescriptions and people receiving psychopharmaceuticals rose. Depression emerged as the most common mental health condition and selective serotonin reuptake inhibitors (SSRIs) were the most widely used psychopharmaceutical. In England, 7.79 million patients received at least one prescription item for antidepressants during 2019-20, an increase of 13.9 per cent from 2015-16.
The number of patients prescribed SSRIs increased to 4.93 million in 2019/20 (a 16.4 per cent rise), while those receiving at least one other antidepressant increased by 35.5 per cent to 1.64 million.
More females than males received prescriptions for four of the classes. For example, 65.6 per cent of those prescribed antidepressants, 61.4 per cent prescribed a hypnotic or anxiolytic, and 61.2 per cent prescribed a dementia drug during 2019/20 were female.
These proportions have remained broadly similar since 2015/16 but almost three times as many males as females (73.6 and 26.4 per cent respectively) were prescribed central nervous system stimulants and drugs for attention deficit hyperactivity disorder (ADHD).
People living in socioeconomically deprived areas were most likely to receive all five groups of psychopharmaceutical.
People of all ages receive psychopharmaceuticals but the pattern of use varies. Prescribing of stimulants and ADHD drugs was most common among people aged 24 years and younger. In 2019/20, 153,000 patients received at least one prescription item for stimulants and ADHD drugs, a 44.6 per cent increase from 2015-16.
The number of children aged 10-14 years using hypnotics and anxiolytics increased by 62.9 per cent, in marked contrast to the overall trend of declining use. Antidepressant prescribing in children increased by 4.89 per cent since 2015-16, compared with a 14.2 per cent rise among adults, but this still means some 69,000 children in England use antidepressants.
Prescribing of hypnotics and anxiolytics, drugs for psychoses and related disorders, and antidepressants peaked among people aged 40-65 years. Not surprisingly, prescribing of dementia drugs was most widespread among people aged 60 years and older. Just over half the people prescribed dementia drugs were in their 80s. People aged 70-74 years showed the greatest increase in antidepressant use, a rise of 25.0 per cent.
Exclusions skew figures
Some psychopharmaceuticals are prescribed for other conditions (e.g. antidepressants for chronic pain), which complicates the analysis, and while the data covers drugs prescribed in primary care and dispensed in the community, it excludes secondary care, private prescribers and prisons.
A recent paper, for instance, enrolled 338 males and 131 females from 13 prisons. Of these, 43.5 per cent of males and 62.6 per cent of females had previous contact with mental health services in prison or the community, which, the authors remark, is “much higher” than among the general population. Mental health problems were common: 51.8 per cent of males and 73.2 per cent of females reported a history of mood disorders, 20.0 and 7.3 per cent reported ADHD, and 20.0 and 35.4 per cent had personality disorder.
In addition, the figures do not include people accessing other sources of support. During 2019/20, there were 1.69 million referrals to Improving Access to Psychological Therapies in England, up 5.7 per cent from 2018-19. Of these, 35.7 per cent of those referred completed a treatment course and 51.1 per cent of those referred recovered.
Psychiatric illness is often hidden and everyone’s experience of mental illness differs. Only time will tell how devastating Covid-19 and the lockdown restrictions will have been on future figures.