Atlas 2015 - 4. Interventions for mental health and psychotropic medicines

Key findings

Almost half of the Australian population aged 16 to 85 will experience mental illness at some point in their life. General practitioners prepared more than 950,000 mental health treatment plans in 2013–14. The number of services for the preparation of treatment plans in the area with the highest rate was 21 times that of the area with the lowest rate, and 3.5 times when the highest and lowest areas were excluded. The greatest variation was shown in dispensing of prescriptions for psychotropic medicines for children and young people 17 years and under. More than 500,000 prescriptions for attention deficit hyperactivity disorder (ADHD) medicines were dispensed in Australia in 2013–14. The number of prescriptions in the area with the highest rate was 75 times more than in the area with the lowest rate. New South Wales had the highest average rate of dispensing out of all the states and territories, and had eight of the 12 local areas with the highest rates. Variation in rates of dispensing of antidepressant medicines and antipsychotic medicines to children and young people also varied greatly. Some local areas in New South Wales and Queensland had high dispensing rates across the three medicines for people 17 years and under.

Overall, large numbers of antidepressant medicines were dispensed in Australia. In 2013–14, nearly 15 million Pharmaceutical Benefits Scheme (PBS) prescriptions for antidepressants were dispensed to people aged 18 to 64. In addition, more than 400,000 prescriptions were dispensed to children and young adults, and more than 6.5 million prescriptions were dispensed to people aged 65 and over. Considerable variation is seen from area to area in the dispensing rates for prescriptions for antidepressants. High volumes of anxiolytic and antipsychotic prescriptions were also dispensed to Australian adults, with large variation from area to area. Rates were particularly high for people aged 65 and over, and warrant scrutiny, particularly given the variation in anticholinesterase medicines dispensed for this age group which is highlighted in Chapter 6. More than 900,000 prescriptions for antipsychotic medicines were dispensed for people aged 65 and over. The number of prescriptions was seven times higher in the area with the highest rate compared to the area with the lowest rate, and nearly 2.5 times when the highest and lowest areas were excluded. High and inappropriate prescribing of antipsychotic medicines has been documented in older people.

Recommendations

4a. The Commission refers the atlas findings on dispensing of mental health and psychotropic medications to the National Mental Health Commission for its recommendations on  psychotropic drug prescribing including: i. use of psychotropic drugs in people 17 years and under ii. mechanisms for working with consumer groups to increase awareness of appropriate prescribing of antidepressant and anxiolytic medicines, as well as the benefits of non‑pharmacological treatments.

4b. Clinicians adhere to current guidelines for treating behavioural and psychological symptoms in people with dementia, in particular those on the use of non‑pharmacological strategies, and only prescribing medicines with demonstrated efficacy when necessary. Pharmacological treatment should target only those symptoms or behaviours that respond to medicines.

4c. The Australian Government Department of Health undertakes a national education campaign on the use of antipsychotic medicines for managing  the behavioural and psychological symptoms of dementia. The campaign should ensure that clinicians and patients are aware that excessive or inappropriate use of antipsychotics in people aged 65 years and over has serious adverse effects.

4d. National boards and the Australian Health Practitioner Regulation Agency consider what actions could be taken to ensure relevant registered health practitioners have up‑to‑date knowledge of prescribing guidelines for antipsychotic drugs.

4e. The Australian Government Department of Health conducts an audit of antipsychotic medicines prescribing practices in the high outlier prescribing regions identified in the atlas findings.

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Atlas 2015 - Overview
Atlas 2015 - GP mental health treatment plans
Atlas 2015 - Antidepressant medicines 17 years and under
Atlas 2015 - Antidepressant medicines 18-64 years
Atlas 2015 - Anxiolytic medicines

Data sets