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Dublin: 12 °C Friday 16 November, 2018

'We spend €400 million each year on drugs while only €10 million is spent on counselling'

Expanding the availability of CBT in Ireland at primary care level, would provide better outcomes for many patients, writes Sean Byrne.

Sean Byrne Economist

ON 26 APRIL 2018 the Oireachtas Health Committee launched a report on mental health services in Ireland which recommended an increased use of counselling. The report pointed out that in Ireland €400 million is spent each year on drugs by the mental health services while only €10 million is spent on counselling.

Benzodiazepines, one of the commonest anti-depressants, is widely prescribed as a “cure all” for several mental disorders. This was highlighted in a television documentary entitled Benzodiazepine: Medical Disaster broadcast in October 2016.

Painful and debilitating

In the documentary Shane Kenny told how he had been prescribed benzodiazepine-based drugs (which include valium, xanax and atavan) as a treatment for Meniere’s disease which causes severe tinnitus, vertigo and vomiting.

The valium prescribed to Shane Kenny initially relieved his symptoms but produced side effects so painful and debilitating that he considered ending his life in the Swiss assisted suicide clinic, Dignitas.

While the more severe effects of the benzodiazepines, which were wrongly prescribed for Shane Kenny’s illness, diminished after he stopped taking them, he still suffers some of them and made the documentary to raise awareness of the devastating effects of the over-prescribing of these drugs.

Reducing symptoms

Until the 1950s when anti-psychotic and anti-depressant drugs were discovered, there were no effective drugs treatments for those disorders. Psychoanalysis was effective for many patients but because of its cost it was available only to a small minority of the mentally ill.

The new drugs significantly reduced the symptoms of psychosis and depression resulting in a dramatic reduction in the numbers of patients in mental hospitals as most of them could now be treated as outpatients. But the new drugs did not cure any mental illness, they merely controlled the symptoms.

While benzodiazepines may relieve depression in the short-term it has been known since the 1970s that they are addictive and to often lead to worse anxiety, cognitive impairment and functional decline. Anti-psychotic medications are mostly powerful tranquilisers.

They do not “treat” the illness in the way that antibiotics treat (and mostly cure) infections. Only 25% of people receiving maintenance treatment with anti-psychotic drugs after an acute psychotic episode report a satisfactory quality of life.


The anti-psychotic and anti-depressant drugs proved immensely profitable for the pharmaceutical companies who went to great lengths to ensure that doctors would prescribe them and find more conditions for which to prescribe them. In some cases the drug companies promoted the drugs for uses for which they were not approved.

In 2012 Abbott was fined €1.5 billion for promoting the use of the drug depakote for the control of aggression and agitation in elderly people suffering from dementia despite there being no evidence that the drug was safe or effective for this purpose. Several nursing homes in Ireland have been found by HIQA to use anti-psychotic drugs to “manage” patients with dementia.

In the UK over a million children, some as young as three, are taking Ritalin, which has been described as a “chemical cosh”, for hyperactivity. The British Psychological Society has pointed out that Ritalin is so widely prescribed because the drug is cheaper than psychotherapy, which would be more effective in treating hyperactivity.

Poorly funded

Mental health services in Ireland are very poorly funded, receiving only 6% of the total health budget. Most of the funds are spent on expensive medications, the most widely prescribed of which are benzodiazepine-based drugs.

The number of medical card patients being prescribed benzodiazepine based anti-depressants increased by 50,000 between 2011 and 2016. The provision of care for those suffering mental distress, from anxiety to psychosis is dominated by the “medical model” promulgated by psychiatrists, most of whom offer only drug-based therapy.

In other EU countries including the UK, mental health services provide many patients suffering from anxiety and depression, with Cognitive Behaviour Therapy (CBT) administered by clinical psychologists, in community health centres. CBT has been shown in many trials to be more effective than medication for depression and anxiety.

Expanding the availability of CBT in Ireland at primary care level, would provide better outcomes for many patients and be a more effective use of the public spending on mental health than the present drug-based system.

Sean Byrne is Emeritus Lecturer in Economics at Dublin Institute of Technology.


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Sean Byrne  / Economist

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