Ill-Informed Consent in Psychiatry

For years I have moaned about ill-informed consent in psychiatry which, if attempted at all, typically relies on RTC (randomized controlled trial) evidence.  The deception in this is shown clearly when, instead, evidence draws on NNT (numbers needed to treat) data.  NNT data tells us how many people must be exposed to a particular drug to get one positive outcome.  For antidepressants, the number is 8.  For antipsychotics it is 6.  This means that you have a 7/8 chance of being pointlessly harmed by your antidepressant, and a 5/6 chance of being harmed by your antipsychotic.  Faced with this evidence how many patients would agree to being prescribed anything.  So much for informed consent.

It is even more troubling in jurisdictions such as British Columbia where the mental health legislation allows psychiatrists to assume consent of those incarcerated in mental hospital by virtue of their admission, even when it is against the patient’s will.

See the following document, “Operating in Darkness“, for a very clear account of why operating without the checks and balances of requiring proper consent is important, and what can happen when a jurisdiction operates without checks and balances.  Also see Robert Whitaker’s excellent article on the value of NNT evidence and dangers of that derived from RTC”s.

‘Operating in Darkness’, BC’s Mental Health Act Detention System.  November 2017 (Community Legal Assistance Society)

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