Since 2014, when it was identified in the Five Year Forward View, improving mental health care has been a key part of NHS England strategy.
As the prescribing of medicines remains the most frequent therapeutic intervention in the NHS, across England during the period from October to December 2023, 23 million antidepressant items were issued to an estimated 6.8 million patients. Over that same quarter, prescribing of hypnotics and anxiolytics increased to 3.4 million items, with medicines used to treat psychoses increasing by 1.3% to 3.4 million also. Medicines are an important therapeutic tool in the care pathways of many mental disorders.
In the UK, 1 in 4 people experience a mental health problem: 1 in 11 having dementia, 1 in 100 having schizophrenia, and 1 in 50 having bipolar affective disorder. Below are links to resources which you may find useful when supporting patients with mental ill health, from the more severe to the more common mental illnesses.
Medicines used (typically) in Severe Mental Disorder
Medicine safety for Lithium:
• NICE CKS Lithium
• Information for patients: Lithium: a medicine to treat mood disorders such as mania and bipolar disorder - NHS
Medicine safety for sodium valproate (for any use):
• Medication Safety :: NHS Hampshire and Isle of Wight (icb.nhs.uk)
• Valproate | Prescribing information | Bipolar disorder | CKS | NICE
• Information for patients (sodium valproate): Sodium valproate: medicine to treat epilepsy and bipolar disorder - NHS
• Information for patients (valproic acid): Valproic acid: medicine used for bipolar disorder, epilepsy and migraine - NHS
Medicines information for antipsychotics and high dose antipsychotics: (HDAT):
• Physical health monitoring for psychotropic medication (Southern Health)
• Medication safety information: clozapine
• Antipsychotics | Prescribing information | Bipolar disorder | CKS | NICE
• Lamotrigine | Prescribing information | Bipolar disorder | CKS | NICE
• Information for patients (lamotrigine): Lamotrigine: medicine to treat epilepsy and bipolar disorder - NHS
Medicines used for bipolar disorder:
• Recommendations | Bipolar disorder: assessment and management | Guidance | NICE
Links to Physical Health SMI health check information:
• HIOW Population Health Platform (formerly Healtheintent)
Medicines for common mental disorders
Medicines in anxiety and depression:
• Management | Depression | CKS | NICE
• Generalised anxiety disorder | Health topics A to Z | CKS | NICE
• Royal College of Psychiatrists: Stopping antidepressants
• Specialist Pharmacy Service (SPS): Deprescribing of antidepressants for depression and anxiety (requires free registration)
Medicines used in the dementias:
• Dementia | Health topics A to Z | CKS | NICE
• Information for patients: This is me | Alzheimer's Society (alzheimers.org.uk)
ADHD medications
• Shared Care :: NHS Hampshire and Isle of Wight (icb.nhs.uk)
• Prescribing available medicines to treat ADHD - SPS - The first stop for professional medicines advice
• NHS Choice Framework - what choices are available to you in your NHS care - GOV.UK
Medicines for addiction (alcohol and drugs)
• Homepage - Inclusion
Links to special consideration in children and young people:
• Mental health support for children and young people: NHS
• YoungMinds
• Papyrus
• The Mix
• SHOUT
Broader support as part of holistic care:
• HIOW social prescribing network
Links to walking groups, centres, young carer group, and other local groups which may be of benefit to people with mental ill health:
• Solent Mind: Thrive Inside
Tips, support and services to help people live well with positive mental health, including sleep toolkit and self-care ideas.
Local non-pharmacological therapy services:
- NHS Talking Therapies - Hampshire
- Steps 2 Wellbeing (Southampton)
- Talking Therapies Portsmouth – Homepage
- Isle of Wight NHS Trust - NHS Talking Therapies
Links to Toxicology advice (overdose):
• SPS Medicines Advice Service
• Asksps.nhs@sps.direct or call 0300 770 8564
• Login (toxbase.org)
Links to signpost patients to for medication and other MH/dementia research
Dementia and Mild Cognitive Disorders Research:
• Memory Assessment & Research Centre (MARC) (marctrials.org)
Learning and development for clinicians
• Health Innovation Wessex polypharmacy masterclass: Antipsychotics in dementia (duration 1 hour 30 minutes)
• Health Innovation Wessex polypharmacy masterclass: Antidepressants in older people (duration 1 hour 30 minutes)
• Health Innovation Wessex polypharmacy masterclass: Stopping antidepressants safely (duration 1 hour 50 minutes)
Further resources and useful reading
• Royal College of Psychiatrists
• The Maudsley Prescribing Guidelines in Psychiatry (David M. Taylor)
• The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (Mark Horowitz, David M. Taylor)
STOMP (Stopping Over Medication of People with a Learning Disability, Autism or Both)
We all need to make it a priority to reduce and stop the use of inappropriate drugs, to reduce adverse side effects and potential drug interactions. This is vital to the person’s safety and their quality of care. Read more about the programme here.
The former West Hampshire CCG worked with WidgetHealth to develop an easy read prompt for people with a learning disability and their carers to complete before their medication review or annual health check. You can read or download it here.