Some UK psychological therapists are already directly involved in supporting people in withdrawal from prescribed psychiatric drugs either through working in one of the very few dedicated services (which together cover just three percent of the population8) or as individual therapists working independently.
6.3.1 In dedicated services
Those working in dedicated services receive additional training about withdrawal from prescribed psychiatric drugs, including:
- How to help people prepare to withdraw
- How to engage and achieve the support of the persons’ prescriber
- How to support people during withdrawal including offering relevant information, signposting helpful coping strategies and supporting gradual tapering (although plans should always be overseen by a prescriber)
- How to judge what kinds of therapeutic intervention are helpful at each stage of withdrawal.
First, it is helpful to recognise that under the umbrella of those dependent on prescribed psychiatric drugs there are different groups of patients. Broadly speaking there are those:
a. who are currently unaware they might be dependent and therefore need to be contacted proactively, and
b. those that know they are dependent and need support to withdraw through reactive services they can self-refer to.
The four existing dedicated services in the UK tend to be primarily aligned with one of these two groups:
a. Proactive services
The two small multidisciplinary services which currently cater for patients in the first group are the:
- Prescribed Medication Support Service (PMSS) covering six counties in North Wales, and the
- Bridge ‘Addiction to Medicines’ Programme based in Bradford.
The PMSS
- works alongside local GPs and pharmacists to identify patients taking painkillers or benzodiazepines who are in need of a drug review for a variety of reasons e.g. prescribing is beyond current guidelines, newly pregnant women. Patients can self-refer but not many do.
- Patients are invited in for a holistic assessment of their needs with one of a small number of Prescribed Medication Therapists (a nurse/counsellor hybrid role).
- a plan is developed, usually including a personalised drug reducing regime, which is then signed off by the GP.
- oher appropriate support is drawn from a range of services, including a traditional primary care counselling service.
The above model has been recommended, by the Welsh Government Petitions Committee,10 as one possible model upon which to base the national distribution of similar services.
The Bridge in Bradford operates on a similar basis, and again focuses on painkillers, benzodiazepines and Z-drugs.8
People who are taking antidepressants and antipsychotics, and who are prescribed beyond guidelines, are not currently proactively contacted by either of these services.
b. Reactive services
The other two dedicated services offer support to people within their vicinity who contact them directly for help. They are:
- the Bristol and District Tranquilliser Project
- REST (Mind in Camden), recently taken over by a large substance misuse service provider.*
* It is important to note that whilst there is excellent work being done in substance misuse teams who are often working with people dependent on a mixture of prescribed and non-prescribed drugs, the majority of people who are only dependent on prescribed drugs understandably do not identify themselves as ‘substance misusers’ – they have taken drugs as prescribed by their doctors and so attending a service focused on substance misuse is regarded by them as inappropriate.
Both these services are staffed by a small number of counsellors trained in supporting withdrawal. Given that many people who contact these services report having had poor experiences with their doctors, meetings are offered in non-medical settings. However, it remains important that prescribers are involved in the withdrawal process. Those using services take responsibility for contacting their GP and getting their support for an agreed tapering plan. If the person is a local resident, the service might offer group or one-to-one counselling, with peer-to-peer support offered outside of meetings.
The above dedicated prescribed drug dependence services rely on psychological therapists who have some additional knowledge of withdrawal, but only two services work directly with doctors. The reactive services offer training to local GP surgeries on a request basis, but the people using the service remain responsible for establishing contact with their prescriber. This mirrors the situation generally for psychological therapists who either work in a multi-disciplinary team, or independently of doctors, either in an agency or alone.
6.3.2 In independent practice
A few therapists working independently with prescribed drug dependency and withdrawal have acquired substantial experience through working with this specific client group. They have considerable knowledge of the available literature, to which they may even have contributed via practice-based research. This knowledge is reflected in the ‘combined wisdom’ approach outlined in 6.1.
8. Houghton, P. (2016). Joining the debate around psychiatric medication. Clinical Psychology Forum, 286, 10–14.
10. National Assembly for Wales (2019). Prescription drug depenence and withdrawal: Recognition and support. Report and Welsh Government Response: Available online: http://www.senedd.assembly.wales/ieIssueDetails. aspx?IId=19952&Opt=3 [Viewed 19th June 2019]