Got+a+problem?+Take+a+pill

Name: Robert Gardener Student number: n7177992 Tutor: Jacinda Wilson

= Cultural Artefact  =



Society has been showing a worrying trend in the reliance of medications to treat many mental and behavioural problems. This cartoon depicts the dependence on antidepressant medication by society and was created by Andy Marlette of the Pensacola News Journal in 2007. This same cartoon was also displayed in an article about the effectiveness of antidepressants on the Science-ology website (2010).

= Public Health Issue  = In 2003, mental illness was among the ten leading diseases burdening the health care system in Australia and accounted for 13% of the total burden of disease (AIHW 2006). It is reported that these figures have further risen over the years so it is therefore imperative to examine how well the Australian health care system supports individuals suffering from mental illness in 2011. More specifically research is required to enable future breakthroughs in antidepressant and antipsychotic drugs. This includes the prescription, administration and relative effectiveness when compared to counseling and placebo trials as well as the reliance or dependence on antidepressant and antipsychotic medications.

= Literature Review  =

Mental illness and mental health problems are among the greatest causes of reduced productivity, diminished quality of life and disability in Australians. People who are affected by mental health problems often have high levels of morbidity and mortality, experiencing poorer general health and higher rates of death from a range of causes, most commonly suicide (AIHW 2006). These conditions are significant in terms of disease burden and prevalence, and have far reaching impacts for families, carers and others in the community.

In 2004-05 the National Health Survey was conducted and found that 11% of all people reported they currently have a long-term mental or behavioural problem. Of that 11%, 19% of adults reported that they had used some form of medication, whether it is pharmaceutical medications, vitamins, mineral or herbal treatments, for their mental wellbeing in the past fortnight prior to the National Health Survey (ABS 2006). The survey found that of those using medications for mental wellbeing, 27% reported using antidepressants, 23% used sleeping tablets and 10% used medications for anxiety or nerves.

From the survey it was discovered that 26% of young people up to 24 years had a mental disorder in the previous year which is approximately 671,000 young people (ABS 2010). The rates of people with mental disorders living in private housing decreased from 26% in the 16-24 years age group to 22% in the 45-54 years age group, after which the numbers declines much more rapidly down to 6% of those aged 75-85 years (ABS 2010). Around one quarter of people who have a mental disorder in all age categories experienced a severe level of impairment associated with their disorder, with the others only experiencing mild or moderate levels of impairment.

Advancements in antipsychotic medications led to atypical antipsychotics such as clozapine, risperidone and olanzapine to name a few. A study conducted by Swanson, Swartz & Elbogen in 2004 looked at the effectiveness of atypical antipsychotics in reducing the occurrence of violent bahaviour amongst patients with schizophrenia. They discovered that these newer drugs were found to significantly reduce the risk of violent behaviour amongst patients with schizophrenia when compared to the more traditional neuroleptics over the one year period (Swanson et. al. 2004).

A recent study by Hougaard in 2010 comparing antidepressants with placebo trials and psychotherapy has shown larger improvements in placebo groups in antidepressant randomized controlled tests. There have been a few theories as to the reasoning behind this; these consist of patient recruitment methods, diagnostic tools and lesser symptomatic severity among patients in newer studies (Hougaard 2010). However none of these theories have been tested nor confirmed. In a meta-analysis of 8 placebo andomized controlled tests comprising of 3063 participants lasting at least 12 weeks, 79% of placebo responders remained well and did not relapse (Khan et. al. 2008). Thus, the placebo response was enduring even though it was less than the antidepressant response of 93% of responders which remained well.

The costs for treatment of mental disease and mental illness are of great concern as these issues are quite prevalent inAustralia. A study done by Dobson et al. in 2008 found that psychotherapy costs were roughly $2,000 per patient during the acute treatment phase (average 20 sessions per patient), over that same interval medication costs were roughly $1,000 (about $125 per month) (Dobson et. al. 2008). These dollar values relate only to treatment costs and do not even begin to consider the cost of decreased productivity in the work place and the impact on the family unit (Jarrell 2002).

When we look at the prevalence of mental health in the community and the cost to society it cannot be questioned that further research into medications is required. As with all drugs there are side effects and antidepressants and antipsychotics are no different. Side effects include: vomiting, dizziness, headache, irritability, sleep disturbance, nightmares, seizures, hypertension, abnormal heart rhythms, anxiety and sexual dysfunction (Harper & Austin 2011). The previous list of side effects are only the mild ones and antidepressants and antipsychotics can also provoke psychosis, suicidal thoughts and behaviour disorders which are the very problems they are meant to prevent. So evidently society is in need of drug companies to continue to develop new break throughs in medications for mental health disorders.

Fortunately the government has identified the immense impact mental health has on society as well as the individual and their family and has allocated a larger proportion of the budget to mental health. The majority of antipsychotic and antidepressant drugs are government subsidised therefore reducing the impact the cost has on the family budget. Unfortunately there still remains a stigma regarding mental illness which may prevent individuals seeking assistance but with on going education, developments by drug companies and growth in support services Australians will hopefully be better equipped to deal with life’s difficulties.

= Social and Cultural Analysis  =

According to the National Health Surveys from 1995-2004/5 there has been in increase in the proportion of people reporting long term mental or behavioural problems. In the 1995 survey 5.9% reported a mental or behavioural problem however in 2001 the incidence increased to 9.6% and in 2004/5 it was reportedly 11% of the population with long term mental issues. (ABS 2006). The 2004-5 survey found that 7% of people aged 0-17 years reported they suffer from mental or behavioural problems. Since a large proportion of this age group cannot convey whether or not they suffer from any such problems it is fair to say that 7% is a markedly lower estimate than the true proportion of 0-17 year olds suffering. These statistics are alarming as this young population will struggle to become productive adults. The prevalence of mental or behavioural problems was higher amongst young females than young males in the previous year with 30% compared to 23% respectively (ABS 2010). Young females were also found to be roughly twice as likely than young men to have an affective disorder (8% compared with 4%) or an anxiety disorder (22% compared with 9%) (ABS 2010). Overall it was found that medication use was higher among females than males with 24% and 14% respectively (ABS 2006). Jerrell et. al. 2002 conducted a multiple comparison study of groups of suffers taking various medications and revealed that those prescribed olanzapine and risperidone had significantly higher total mental health treatment costs on average over the course of the study when compared to the conventional group. This is not surprising though as newer drugs on the market claim higher prices until generic varieties become available. Researchers discovered that the total cost of mental health treatment changed significantly over time, increasing between the baseline trials and the 3 month follow up. A study conducted by Dobson et. al. in 2008 comparing costs of psychotherapy and medication costs over the acute treatment phase determined that psychotherapy costs were roughly $2,000 per patient for an average of 20 sessions. Over the same time interval medication costs were roughly $1,000 per patient ($125 per month), with around half of the cost going to pay for physician time- on average 12 sessions per patient at $75 per session (Dobson et. al. 2008). Both the direct cost of medications and treatment as well as the indirect costs such as lost productivity make it imperative that on going research continues into mental health treatment. Advancements in internet technology and availability of other resources have made researching symptoms and self diagnosis a much more frequent occurrence. This has led to increases in people going to doctors with their own diagnosis instead of relying upon the doctor to assess the symptoms and their severity as well as prescribe the right medications. This abundance of knowledge has also led to people going from doctor to doctor until they find one who agrees with their home diagnosis instead of relying upon the professional knowledge and expertise of the medical profession. It is an interesting phenomenon whereby doctors continue to seek second opinions on diagnosis and treatment from specialists in the specific fields yet the average person believes that they can not only obtain all the necessary information but have the ability to accurately interpret this information.

= Analysis of Cultural Artefact  =

The cartoon drawn by Andy Marlette depicts Uncle Sam consuming copious amounts of antidepressants thereby demonstrating a worryingly relaxed view regarding the role of medications in our life and in particular antidepressants. Using Uncle Sam who represents not only leadership but was instrumental in recruitment provides impact to any statement. Therefore the fact that Uncle Sam is the one depicted as consuming the medication implies to most Americans that this is accepted practice when the use of medications should only be used under strict medical supervision. The label on the bottle clearly states “top drug in US” which tragically implies that either the rates of depression have increased dramatically or the incidences being reported have increased over that past decades. The relaxed attitude depicted in the facial expression demonstrates a relaxed attitude towards medications. The picture on this artifact seems to imply that if something is wrong just take a few pills and everything will be alright. Tragically this view is further enhanced by the caption “The pursuit of happiness”. The stigma associated with mental illness is slowly being erased with increased education and massive media campaigns increasing public awareness. These initiatives have encouraged people with mental or behavioural problems to be more confident to seek aid as well as offer support to their significant others. With the government subsidizing the cost of medications as well as the cost of a variety therapies assistance is available to all socioeconomic groups. This is obviously important as mental illness shows no distinct cultural boundaries. This assessment piece has highlighted to me the non discriminate number of people suffering from mental or behavioral issues and the desperate need for ongoing research and support in the mental health field. While there are continual advancements in treatments including medications there is still no guaranteed cure for the issues affecting the lifestyles of many individuals. Researching this topic increased my understanding of how many people suffered with mental and behavioural problems inAustraliaand enlightened me with regards to the distribution within age groups. I sincerely hope that drug companies continue to create new, more effective medications with less side effects and that the government continues to subsidize medications and other treatments so sufferers can experience a rewardingly high quality of life and be productive members of society.

= Reference List  =

Marlette, A. (2007). The Pursuit of Happiness cartoon. Retrieved October 29, 2011 from: []

Australian Institute of Health and Welfare 2006, **Australia****'s Health 2006**, AIHW Cat. No. AUS 73, AIHW,Canberra.

Australian Bureau of Statistics 2006, **National Health Survey: Summary of Results, Australia, 2004-05**, cat. no. 4364.0, ABS,Canberra.

Australian Bureau of Statistics 2010, ** Mental Health of Young People, 2007, ** cat. No. 4840.0.55.001, ABS,Canberra.

Swanson, J. W., Swartz, M. S., & Elbogen, E. B. (2004). Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. //Schizophrenia Bulletin//, 30(1), 3-20. Retrieved from EBSCO//host//.

Khan, A., Redding, N. & Brown, W. A. (2008). The persistence of the placebo response in antidepressant clinical trials. //Journal of Psychiatric Research//, //42//, 791–796.

Harper, J. & Austin, J. (2011). //How to get off psychoactive drugs safely// .USA: Createspace.

Hougaard, E. (2010). Placebo and antidepressant treatment for major depression: Is there a lesson to be learned for psychotherapy?. //Nordic Psychology//, 62(2), 7-26. doi:10.1027/1901-2276/a000008

Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., & ... Jacobson, N. S. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. //Journal of Consulting and Clinical Psychology//, 76(3), 468-477. doi:10.1037/0022-006X.76.3.468

Jerrell, J. M. (2002). Cost-effectiveness of risperidone, olanzapine, and conventional antipsychotic medications. //Schizophrenia Bulletin//, 28(4), 589-605. Retrieved from EBSCO//host//.

HelpGuide, 2011, //Antidepressants What You Need to Know About Antidepressant Medication//. Retrieved: []

= Reflections  = Doctors and Patients - Are We From Different Planets

Lucinda Appleton

I found this article depicting the need for cultural competency extremely interesting. Previously doctors had exclusive power over patients and with changes in technology patients have become empowered and are demanding more of the health care system. It is interesting to note that it is the ethnic minorities revealing greater dissatisfaction then those born in Australia. Perhaps Australians are not questioning the power of doctors as much as those from other countries. Extremely interesting.

Australia is in a Global Mental Health Desert

Suzie Walker

It was scary to realize that 85% of the 105,000 people who are homeless are suffering from mental illness. Given that only a third of sufferers are seeking treatment it raises the question of how many homeless people are actually being treated. Great work.