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Archive March 2019

The Department for Work and Pensions should be stripped of its responsibility for providing social security benefits and job support to ill and disabled people, a thinktank has urged.

A scathing report by Demos says public trust in the DWP has been shattered by a series of botched reforms to disability benefits, and the imposition of a brutal sanctions regime that has left many vulnerable claimants stressed and in poverty.

The department is risk averse, defensive and seen as hostile to claimants, it says. “With its current configuration, culture and reputation, it is impossible for the DWP to engage meaningfully with ill and disabled people,” it concludes.

Benefits such as the employment and support allowance (ESA) and personal independence payment (Pip) should be instead handled by devolved governments, while job support could be run by councils, the NHS and charities, it says.

“After years of failings, ill and disabled people have lost all faith in the DWP. This demands a radical rethink of the department’s responsibilities,” said the report’s author, the Demos researcher Ben Glover.

The call comes amid concern over what critics say is the DWP’s punitive and insensitive benefits policy and contemptuous treatment of some claimants. Last year the chair of the charity Scope, the former top civil servant Andrew McDonald, who receives Pip because he has Parkinson’s and terminal cancer, called the disability benefits system a “hostile environment”.

The DWP’s reputation has been battered in recent years over its handling of disability benefits, including its widely distrusted fit for work tests, its Pip assessments, and its plans to migrate of hundreds of thousands of existing ESA claimants on to the much-derided universal credit benefit over the next three years.

Full story: Guardian

An elite band of doctors has now come up with a solution to their recurrent occupational hazard. They say a genetic test for schizophrenia should be made available on the NHS. “It can help people understand that they have an illness like any other, just like epilepsy or diabetes, and may also mean that they and their families are more comfortable with the idea of them taking medication,” Professor Kam Bhui explained in the respected British Journal of Psychiatry.

Professor Bhui edits the journal, published on behalf of the Royal College of Psychiatrists, and has long been an influential commentator. His latest suggestion has already been backed by his Queen Mary University colleagues Professor David Curtis and Dr Katherine Adlington. They say the NHS should make the test available “as a matter of urgency.”

There is just one small ethical problem. Schizophrenia has never been shown to be caused by genetics, either wholly or in part. The trio of psychiatrists appear comfortable in advocating that this moral inconvenience should not stand in the way of it being held up as an explainer to patients and families. “We can do a simple genetic test on a patient and, for example, tell them that they have a small piece of chromosome 22 missing and that this is probably the reason why they’ve developed schizophrenia,” Professor Curtis has excitedly argued.

This particular chromosome correlation has been observed in just one percent of patients with schizophrenia, and those without schizophrenia have also been seen to exhibit it, the Royal College of Psychiatrists has told Mental Health Today. Schizophrenia can not currently be genetically explained in the same way as, say, Down’s Syndrome can (where children are born with a third copy of chromosome 21).

If genetic testing becomes routine on all patients diagnosed with schizophrenia, then perhaps in time a commonality will be discovered. If patients are being given a false reason for taking a (currently hollow) test, does the end justify the means?

Let’s start by making a comparison with Down’s Syndrome once again. Since diagnostic testing has become more reliable and less invasive for pregnant mothers, abortions have increased. Parents should not be denied their reproductive rights of course, but campaigners living with the condition have expressed their fears at where that statistical trend will end up, or how such knowledge could be abused by eugenicists.

Just this month Japan agreed to pay compensation to thousands of individuals with mental health conditions, intellectual disabilities and physical disabilities who were sterilised over five decades until 1996. 25,000 people were sterilised under the so-called Eugenics Protection Law. Almost half gave their consent to the procedure.

Professor Peter Kinderman, a clinical psychologist, is dismayed at psychiatry’s latest approach to confronting conversations about schizophrenia. “Biological explanations of mental illness appear to offer people the suggestion that they are not to blame for their difficulties. But in truth the history of both psychology and psychiatry is littered with the debris of eugenics, where biological and genetic explanations are used as justification for harsh, discriminatory, and sometimes even lethal treatment,” he says. “Even if we did have a genetic test for so-called schizophrenia, we should be extremely reluctant to roll out its use. But in truth the notion is scientific fantasy anyway.”

Full story: Mental Health Today

When does a child become an adult? The answer to this question is in many ways muddier than it was. Over the last decades, the traditional landmarks of adulthood in the west – a job, a marriage, a home of one’s own and a child – have been delayed or have disappeared. Legally, though, the answer is still clearcut: 18.

Jessica, 19, lives in south Wales and hopes to go to college to study childcare. She likes to spend her time chatting with friends in Costa or on the phone; she loves dancing and singing, and she plays the ukulele. She used to enjoy hanging out at her local youth club, having pizza and playing games, but since turning 18, she has had to leave. At times, her voice is soft and playful and she sounds younger than her age; at others, her tone has an edge of irony and she sounds far older. She has spent the past few years in mental health services, and says of her experiences: “You’re in a sea of your own because you’re so young and naive.”

The story Jessica tells is heartbreaking. After some traumatic experiences at the age of 13, she began self-harming, she says, because she felt she could control that physical pain, unlike the emotional agony in which she was drowning. She had panic attacks and was referred to Child and Adolescent Mental Health Services (CAMHS) in her mid-teens; at 17, she had two admissions of a few weeks each to a CAMHS psychiatric unit. When she was discharged, she became a patient with the CAMHS intensive treatment team, whom she saw three times a week for therapy, activities and supportive chats. It was working: her self-harm reduced, she felt safer, and she was making progress towards recovery.

Then she turned 18.

The CAMHS team continued caring for her for a further three months, to bridge the waiting time until she could be seen by Adult Mental Health Services (AMHS), who told her (against the recommendations of her previous clinicians) that her care would be reduced from three times a week to once. She had an introductory session and was told she would be phoned back, but the call never came. Her mother chased it up, and was told that the clinician she had seen once had moved on, so Jessica was put on another waiting list and told to expect a delay of “six to 18 months”, she says.

All the painstaking progress she had made was undone in an instant. “It all just fell apart. I had gone from having help three times a week from people who know me, whom I trusted, to nothing at all. It felt as if the world had been ripped from underneath my feet, and I was falling into a deep hole. My self-harming behaviours increased, and I attempted suicide. I felt helpless, alone and scared of what I was going to do to myself.” After less than a month with no treatment, Jessica was sectioned on an adult psychiatric ward, where she was the youngest patient by 10 years. She stayed there for five months.

Eighteen. Is there a more tumultuous period in a person’s life? It is a time of such tremendous change: the end of school and the structure it provides, the beginning of work or university or whatever comes next, of adult life and the freedom it promises; the fears and exhilaration of leaving home or the fears and disappointment of being left behind. The loss of people and places, the coming of the new and unknown. A moment of such volatility and vulnerability that it is comparable to infancy.

For a healthy 18-year-old, this change can bring uncertainty and anxiety, yes, but also excitement. For an 18-year-old with severe mental health problems, it can mean deterioration and danger. If you had to pick the worst moment in a troubled young person’s life to withdraw the help they have been receiving and to thrust them into an unfamiliar system where they do not know when or even if they will get the help they need, the age of 18 may well be it.

Yet that is exactly how most mental health services are structured.

Full story: Guardian

The number of people being sent hundreds of miles away from their families for mental health treatment rather than cared for locally has increased over the last twelve months.

In April 2016, the government said within four years it would eliminate the practice of uprooting individuals due to local bed shortages, which is generally thought to impede or delay recovery.

Some 7,655 new mental health “out of area” placements (OAPs) occurred last year. 96 percent of these occurred not because specialist care was available elsewhere, but because of a lack of local provision.

Vicki Nash, Head of Policy and Campaigns at Mind, said: “The NHS has promised to completely eradicate inappropriate out of area placements, and yet we can see that the number of these placements between September and December last year increased from the same period the year before. This is disturbing. We are nearing the NHS’s own target of zero out of area placements by 2020/21, but the figures are going in the opposite direction. There is a huge amount of work still to do to get the numbers down.”

“Too many people with mental health problems are being forced to travel hundreds of kilometres from their friends and family to receive the treatment they need. This can worsen people’s chances of recovery, as well as being expensive for the NHS and the taxpayer. In December 2018 alone, 250 people were sent 300km or more away from home to get help. We urgently need to see investment in mental health services reaching the frontline, so that people can get the treatment they need, when they need it, close to home.”

“The NHS has rightly made ambitious commitments for improving mental health care. But while we are waiting for these to be delivered, thousands of people continue to face the traumatic experience of being sent away from home and separated from their support network to get the help they need. This is a crucial year and the urgency of the NHS delivering on its promises cannot be overstated. It must do far better for the people with mental health problems in its care right now.”

Out of area placements cost, rather than save, the NHS money. On average, the health service pays £545 / day for each relocated individual. This amounted to a figure in excess of £100m in 2018.

Source: Mental Health Today

Social media addiction should be considered a disease, MPs have said, in a sign of the pressures facing technology companies and the growing concern over the impact social networks are having on users’ mental health.

The politicians called for further research on the effects of social media but said a report suggested there was good reason to believe sites such as Facebook, Instagram and Twitter – which are constantly competing for users to spend more time on their platforms – could be having a corrosive effect on children.

“It is paramount that we protect young people to ensure they are kept safe and healthy when they are online,” said the MPs, who believe the government should urgently fund long-term studies to see whether a clinical definition for social media addiction should be introduced.

The report was compiled by the all-party parliamentary group on social media and young people’s mental health and wellbeing, made up of MPs who have an interest in the topic. The report was written with the assistance of the Royal Society for Public Health (RSPH) charity, which endorsed its findings following a series of evidence hearings.

Full story: Guardian

People with a gambling problem are 15 times more likely to take their own life, according to the largest study of its kind, prompting calls for swifter action by the government to tackle betting addiction.

Academics at Lund University, Sweden, monitored more than 2,000 people with gambling disorders, finding a significantly elevated risk of suicide among participants compared with the general population over an 11-year period.

The study found that suicide rates increased 19-fold among men between the ages of 20 and 49 if they had a gambling problem and by 15 times among men and women of all ages.

The authors of the research said that while the causes of suicide were complex and likely to involve more than one factor, their work indicated gambling disorders were associated with far higher than average rates of suicide.

Campaigners said that if the same results were applied to the UK, the Swedish study would indicate around 550 suicides a year in which gambling played a part, or more than 10 per week.

“This research confirms the high number of gambling-related suicides that Gambling with Lives families brought to public attention after the deaths of our children,” said Charles and Liz Ritchie, who founded the charity after their son Jack took his own life aged 24 following a gambling addiction.

“The lack of recognition of the scale of this problem has been shocking and we call on the government to take immediate action to save lives.”

There is just one specialist problem gambling clinic in the UK, although a second is due to open in Leeds after the government promised greater funding for treatment as part of a 10-year plan for the NHS.

Full story: Guardian

A new report from NHS Providers, Mental health services: addressing the care deficit, looks at the levels of demand for mental health services reported by frontline leaders and the reasons behind the growing pressures.

The report identifies widespread concerns about benefits cuts and the impact of universal credit. It also indicates that loneliness, homelessness and financial hardship are adding to pressures on NHS mental health services.

Responding to this, Mind’s chief executive Paul Farmer said:

“Changes to the benefits system in recent years, and austerity generally, have had a devastating impact on the lives of many people with mental health problems. It’s clear that difficult life circumstances and mental health problems are closely linked, yet the relationship between them isn’t taken into account enough. If you have a mental health problem you are more likely to need support from the benefits system, experience poor housing and may struggle to stay in work without the right support, while the enormous challenges of dealing with difficult life events and trying access support can take a huge toll on mental health.

“The punitive, complicated benefits system in particular is making people unwell. People tell us they are treated with suspicion about the nature of their health problem and how it affects them, by someone who lacks expertise, knowledge or sensitivity when it comes to mental health. They are then having their support cut when they’re not able to do the things that are asked of them.

“Unsurprisingly, demand for NHS mental health services has gone up and while we welcome the long-term plan and the funding attached to it, this should be seen as the start, as a down payment for future investment, and as only one part of the solution. We need a cross-governmental plan for mental health that looks at all aspects of people’s lives and recognises the part that all government departments can play in helping people live mentally healthy lives.”

Source: National Mind