Two years after the investigation of the Kauhajoki [school shooting] there is not yet a common practice for prescribing psychiatric drugs to young people. Experts disagree whether it is worth it.
After the school shooting in Kauhajoki the investigating Commission in February 2010 issued a recommendation that treatment with psychiatric medications should not only start for young people under 23 years without having been examined by a psychiatrist or specialist in the area.
Since then, the Arms Act tightened, new security policies for schools developed and national programs and strategies for children's health presented in accordance with the report. The law on health care states that mental health services for under 23 year olds should be arranged so that care starts within three months of the care needs identified, but no restrictions on prescription of psychiatric medication for young people have been made.
Meanwhile, the use of depression medications in Finland increases steadily each year and results from David Gyllenberg recently completed doctoral dissertation, University of Helsinki, shows that approximately 15 percent of Finns born in 1981 started taking some form of psychiatric medication before age 25. Eighty percent of these drugs are anti-depressant drugs, and many of the drugs should also alleviate various types of anxiety.
Associate Professor Mirjam Kalland, chairman of the Mannerheim Foundation for Child Welfare, was a member of the Investigation Commission and says that the background of the recommendation were fears that more young people get medications without a diagnosis.
- The risk is if you can not see a specialist doctor or a doctor at all. The wrong kind of drugs can make the patient impulsive, then chances are that you do things you would not otherwise do, she says.
Kalland feels there is a broad consensus in Finland that the current system where doctors at health centers and even nurses can prescribe psych drugs to young people is not an adequate solution to the problems of young people.
Even Development Director Kristian Wahlbeck Association for Mental Health in Finland endorses the recommendations contained in the report. Wahlbeck has worked as a research professor of mental health issues at the Institute for Health and Welfare, THL, and according to him, the increased medication may be associated with local governments inability to provide adequate counseling in primary care.
- Prescription of psychiatric drugs to young people must be very carefully considered, because research is not clear about whether they are beneficial or detrimental. There is also data indicating that the processing times of the drugs should be longer. I personally think that medication with psychotropic drugs should always be linked to monitoring and counseling.
Although the use of medications increases, the statistics don't show there are more diagnosed cases. More people are looking for help and new medications are heavily marketed, says Wahlbeck.
- There is an increased awareness of depression in the community and it's more acceptable to seek help than before.
The Commission based their conclusion on recommendations by a consensus opinion from the Medical Association Duodecim from the same time. But the purpose of the Medical Association's report was not to ban the prescription of drugs at health centers, but rather to emphasize that the treatment of children and adolescents with psychiatric medications require special expertise in medical field, says Professor Mauri Marttunen , director of mental health and substance abuse department of THL, who chaired the report meeting.
- I think that the report is adhered to relatively well in psychiatry in Finland. Children and teenagers are getting almost all their medications only after having met with a specialist, and the doctors who accept people under 22 years in primary care are often familiar with this type of diagnosis.
The problem according to Marttunen is that there are not enough specialists in psychiatry in Finland that the recommendation would be feasible.
- We want the young people's problems to be addressed as early as possible and it is increasingly more common for primary care physicians to consult psychiatrists. School physician and researcher in psychiatry David Gyllenberg doesn't believe the situation would benefit from prohibiting doctors in a certain position or certain health facilities to prescribe psychiatric medications.
- However, it is important to spread information about the need to consult with other physicians, and that there are alternative forms of care.
He does not think that anyone should stare themselves blind at the age category, the evaluation of a patient needs to be on a case by case basis, as people of all ages are affected differently by the medication. It is also the physician's responsibility to make sure the medication is followed up by contact with the patient.
- Monitoring is especially important for young patients, since there are indications that some psychiatric medications can increase impulsive and self destructive behavior.
The problems of the youth?
Stay healthy folks!