PETER CAMPBELL

The starting point for this paper is the belief that people active in service user/survivor action have not yet developed a clear position on psychiatric drugs - unlike the situation regarding ECT, where a defined, although not unanimous, position has been made clear.

Service user/survivor activists are assumed to be anti-psychiatric drugs by many people in mental health services but such opposition has not often been well-defined. Contributing factors may have been, on the one hand, widespread "non-compliance" among all recipients of psychiatric drugs, and on the other hand, continuing use and valuing of psychiatric drugs by many involved in action (regardless of episodes of "non-compliance").

I believe it is vital to define what our opposition amounts to, particularly as we are faced by promotion of new anti-psychotics and new anti-depressants as better and "cleaner" drugs and calls by a number of organisations for people with a mental illness diagnosis for a right to the treatment they are assessed as needing.

I hope people will use the key points below as a basis for discussion, agreement, disagreement and above all as a way of moving us towards a clearer and more effectively promoted position on psychiatric drugs.

This is not the same as No Compulsory Treatment but is fundamental. People can only exercise choice and a realistic right to treatment if mental health service providers create the space for drug-free approaches. This is essential both for new entrants to services and long-term recipients. (Commitment to regular drug-free holidays.)

The right to care and treatment is ineffective unless a proactive effort is made to educate service providers into creating this drug-free space. MIND etc are not going far enough by soft-pedalling or omitting this demand. Also promotion of alternatives to drugs (like Mental Health Foundation's "Strategies for Living") will not have maximum impact unless combined with robust criticism of drug treatments.

I would argue that some medications are clearly useful in crisis situations and their use could be supported over a few days in crisis resolution. Long-term use should be given less support and be a greater focus of opposition.

(These can be placed under the umbrella of informed choice.)

This would include opening up of safety- testing and safety-approval of these drugs. It would include not only recipients of drug treatments and prescribers/purveyors of drugs but also the general public so that the latter are in better position to appreciate the real advantages and disadvantages of psychiatric drugs.

1. Recognition of central importance of informed consent/ what constitutes informed consent/training and education of drug. prescribers and purveyors. .
2. Definition of amount and quality of information to be given at time of prescription. Definition of need for follow-up information giving throughout use of drug.
3. Information created with full involvement of service users/survivors -this should apply to standard information supplied with drugs and to information given out to supplement manufacturers' information at time of prescription and afterwards.
4. Information on dosages and relationship of those dosages to BNF limits to be given to all recipients.
5. Information on dosages and relationship to known therapeutic dosages to be given to all recipients
6. Information in written and oral form to be given/ to be available on demand at all stages of care and treatment.

To include offer of information even if not requested by recipient.

This should include deconstruction of ideas about compliance - links with general non-compliance of population when taking drugs for "chronic" conditions, links with ideas of lack of insight and psychosis. Promotion of reality that psychiatric drug users regularly assess their best interests regarding drugs in a rational way even if not starting from same assumptions as service providers etc.

1. "Drugging out" in times of crisis
2. Prescribing without informed consent
3. High dosages
4. Polypharmacy - use of a number of psychiatric drugs at the same time
5. Use of above therapeutic dosages.

See elsewhere, in particular "Strategies for Living" (Faulkner, 2000, Faulkner & Nicholls, this volume), recent workshops by Jim Read (Read, this volume).

Including questions about how effective drugs are in securing better outcomes and questions about:

• lack of research on outcomes of those who appear to have successfully withdrawn.
• lack of proper facilities, support for people wanting to withdraw or reduce dosage

How to work effectively on this?

I believe there is a way to promote a position of opposition to the use of psychiatric medication without denying the freedom of choice of individuals to use psychiatric drugs. This needs a statement that we believe that there are better ways and an explanation of how real freedom of choice is denied. Psychiatric drugs are powerful and often toxic substances and the way they are being used increases the problems.

I believe that service users and survivors acting for positive change need to consider and debate the above concerns. It remains a vital area that is not being addressed very effectively by organisations or individuals. .

This is a paper to stimulate further debate. Please photocopy or pass on to interested others. But please recognise authorship and that it is only the view of one individual.