Thank you very much for asking me to submit to you today. As the chair said, I'm presenting for the Psychiatric Medication Awareness Group, which is a web-based information support group for people on psychiatric drugs. I'm also the co-chair of the Canadian Women's Health Network, and have contributed to many Health Canada regulatory hearings, and was a member of the expert advisory panel on the vigilance of health products for five years.
I'm going to bring to the session today my background in working with families, parents, and children in tapering them safely off psychiatric drugs. These are people who have faced a myriad of side effects related to psychiatric drugs, which have increased their mental health and emotional problems. I'll be discussing gaps and barriers in the mental health strategy and proposing some best practices.
I want to talk first about the context in which our mental health services are delivered, and this is really a unique and unprecedented context.
First of all, we have very high stated prevalence rates of mental illness and high diagnostics in many areas of mental health, and these rates are continuing to rise. I think in Canada now we consider that 20% of Canadians may be exposed to a mental illness, and in some cases the rates are much higher. The World Health Organization is now saying that depression will be the major cause of disability globally by 2020. Thirty years ago, depression was considered to affect a very small number of people and to be self limiting.
So in terms of statistics, what does this manifest itself in? We have 6% of boys from 6 to 14 taking psycho-stimulants. We have a quarter of our seniors in our care homes taking antipsychotics, even though they do not have a diagnosis of schizophrenia. We have 20% to 25% of women in middle age and older taking antidepressants. We have a tenfold increase in the number of children who are being prescribed antipsychotics, which are very potent drugs not approved for this group. And we have large numbers of people taking benzodiazepines—15% to 25% in some cases. I was very disturbed to learn that Canada is the third-largest user of antidepressants among 22 comparable OECD countries.
So what does this mean in terms of the individual and their mental health? All psychoactive drugs have side effects. They are very potent drugs that affect the structure of the brain and the neurotransmitters that are the chemical in the brain. All of the drugs can either exacerbate or create new mental health problems or new kinds of emotional problems for the user.
For example, someone taking a tranquillizer like Ativan, which is a very commonly prescribed drug, will eventually become depressed if they take it long enough, and then they will go back to their doctor and say they are depressed, and their doctor will either increase the dosage of benzodiazepines or prescribe an antidepressant to deal with the depression, which is a side effect of the tranquillizer. This kind of pattern is called the prescription cascade, and anyone who's on a psychoactive drug for long enough is going to be taking other drugs to deal with the side effects of the drug they are already taking.
It's the same for antidepressants. Someone on antidepressants may become agitated and develop akathisia, which is a form of restlessness. They may have agitated depression, and so they may be put on a tranquillizer, or they might be put on an antipsychotic to deal with those symptoms.
The point I am making is that we need to take adverse drug reactions from psychiatric drugs very seriously. These drugs not only cause impacts on the sense of mental well-being of patients, but they also cause physical effects. For example, tranquillizers cause dizziness and falls that lead to hip fractures. Antidepressants can lead to suicide or suicide ideation and sexual dysfunction. Antipsychotics can lead to cognitive impairments, memory loss, and issues like that, as well as a predisposition to diabetes and stroke. So we really need to take these things seriously.
I think the other thing that we need to recognize is that if a person stays on a psychoactive or psychiatric drug for a long period of time, their brain is going to adapt to it and they're going to become addicted. I know that's a strong word that we don't like to use in relation to the drugs we prescribe. But it actually is the same mechanism as addiction. When a person tries to reduce their dose or change their dose, they may be affected by an upsurge of symptoms that can be really very unpleasant, including increased anxiety and increased agitation, to the point of hallucinations and irrational violent behaviour. I think in the media we're seeing stories of people engaging in very frightening homicidal or suicidal acts that are associated with prescription drugs. We feel that prescription drugs are definitely a contributor in these cases.
So what do we need to do about it? We need to reassess the degree to which we're prescribing psychiatric drugs. A recent study in the United States is showing that the rate of prescription of psychiatric drugs to children has grown by about 31% in the last decade, yet the children who are prescribed these drugs are ones who are considered to have really moderate issues, whereas children with very severe issues are falling through the cracks. So I think we really need to reassess the degree to which we are prescribing psychiatric drugs. In order to do that we need to provide more supports in the community to families, to women who are pregnant and who are having post-partum difficulties, to young people, to teenagers, to seniors, so that they can address their sense of isolation and find cognitive help that's accessible and reasonable in terms of access. I think a central place to provide these services for families is in the schools, where in the past there were school counsellors and groups that would help parents deal with their family issues and their children.
I also think that we need to really assess people's use of drugs and the impacts these may be having on mental health. We talk about dealing with polypharmacy, but I think anyone who comes in to a health provider with a mental health symptom needs to be assessed in terms of the drugs they are taking. It is not only psychiatric drugs that cause mental health symptoms. There are also common cardiac drugs, antibiotics, the corticosteroids, smoking cessation drugs, and acne treatments. All of these can be associated with mental health issues that the person or physician don't associate with the drug. I would say, too, that we really need physicians and health care providers who are skilled not only in assessing the side effects or the adverse drug reactions caused by psychiatric drugs, but also physicians who understand how to taper the use of these drugs, how to design tapers, how to support people, how to understand what a person is going through on a taper. I've done tapers for dozens of people. It's an arduous job, but it's really miraculous the degree to which people can recover their health. However, it needs skilled health care providers to provide that kind of service.
Finally, I would say that when we consider mental health in general, we need to consider it as a gender issue. Two-thirds of the people who are diagnosed with mental health issues and who receive prescription drugs are women. Women are subject to many stressors related to their role in society and the expectations placed on them. I think we really need to build that back into our assessment of the most effective mental health treatment.
Thank you.