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Mental health problems don’t end with age

After years languishing in the dark, mental illness is finally getting its moment in the spotlight. Frustrating political football it may be, but one thing can’t be denied – it’s making headlines more than ever. Focus, largely, has been on young people – crises in child and adolescent mental healthcare and in student populations have been both persistent and significant. But mental illness doesn’t end with reaching adulthood – often, in fact, it doesn’t end at all.

New research from the British Journal of Psychiatry into self-harm in older people puts this into stark perspective. A meta-analysis of 40 studies found that yearly self-harm rates were about 65 per 100,000 people, with risk of repetition and of suicide also higher than average. Self-harm is still seen as a problem among younger demographics; and while that remains true, this data proves that the issue is even more complex and diffuse than we thought.

The findings are not wholly surprising. In 2014, the World Health Organization found that suicide rates were highest in people aged over 70 in almost all regions of the world. The Royal College of Psychiatrists (RCP) also found that 40% of older people in GP clinics experience mental ill-health; this rose to 50% in general hospitals and 60% in care homes. And, as the Mental Health Foundation points out, the UK population is ageing rapidly – since 1974, the number of older people in the UK has grown by 47%. By 2027, the Office for National Statistics predicts, 20.7% of the UK population will be aged 65 or over, compared with 15.9% in 2007. The problem, clearly, is not going away.

Full story: Guardian

Author: Philip Challinor
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Screen time has little effect on teenagers’ wellbeing, says study

Screen time has little effect on the psychological wellbeing of teenagers, regardless of whether they use devices for hours a day or just before bedtime, according to a study by researchers at Oxford University.

The research, based on analysis of the screen use of more than 17,000 teenagers across Ireland, the US and the UK, found use of screens before bedtime was completely unrelated to psychological wellbeing, and screen time more generally had a “minuscule” effect on wellbeing in teenagers when compared with other activities in an adolescent’s life.

The effect was believed to be small enough that adolescents “would need to report 63 hours and 31 minutes’ more of technology use a day in their time-use diaries to decrease their wellbeing” by an amount big enough for them to notice.

The study, published in the journal Psychological Science, is an important data point in the growing debate about whether excessive screen time can damage the mental health of young people.

Full story: Guardian

Author: Philip Challinor
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Opening up about mental health at work

I would rather tell an employer I have excruciating period pain or terrible diarrhoea than say I need to take a day off for my mental health. Despite the mental health awareness days, mindfulness at work courses and stigma-bashing posters, many of us still feel that our bosses are not open to accommodating mental illness – and we may be right.

Andrew Berrie, employer programme manager at the Time to Change campaign, says nine in 10 people who experience mental health problems report facing stigma and discrimination. More than half say they experience that stigma the most at work, meaning many do not feel they can talk openly with their line manager. Things are improving, says Berrie – but the stigma means that, like me, 95% of employees would prefer to call in sick with a made-up reason, rather than reveal the truth about their poor mental health.

Geoff McDonald is co-founder of minds@work, a network of professionals seeking to build psychologically healthy workplaces. He says: “I think there is still a huge disconnect between what senior leaders think the culture and openness is, and what it actually feels like on the frontline, whether or not you can have those conversations.” He tells of a senior executive who walked into a mindfulness class his company was running, surveyed the room and said: “So, these are the people who can’t cope in my business.” The organisation had ticked a box, but not changed the culture of intolerance that fosters judgment of those who struggle. We are making progress, McDonald says, but we are “still at the foothills of climbing Mount Everest”.

It is not just tokenism we are smelling, but fear, too, he says. “There has been a lot of campaigning, awareness-building, encouraging people to talk – but I think there is still this fear of not knowing what to do or say, even at the simplest of levels.” He says line managers often confess that they are fearful of saying the wrong thing, telling him that if someone came to them saying they were suffering from anxiety, they wouldn’t know how to handle it.

Clinical psychologist Dr Beverley Flint, from Camden and Islington NHS Mental Health foundation trust, runs C&I Wellbeing, offering mental health support training for managers and HR staff. She says many businesses and organisations are blind to the reality of what their employees are going through.

When she meets employers who tell her they “don’t have a problem with mental health” in their workplace, she says she raises an eyebrow. “I tell them: ‘But you do, you just don’t know about it. You will have people in the workplace who have a diagnosis – I’d love to see your staff retention data.’ People get annoyed with me when I say that.”

Full story: Guardian

Author: Philip Challinor
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Elephant in the Room: staring down the stigma of black men’s mental health

A couple of years ago, the actor and choreographer Lanre Malaolu was creating a duet about mental health. “I was working with an amazing contortionist dancer,” he remembers. “But for various reasons she had to drop out … I didn’t have time to get anyone else.” He swears under his breath and smiles, before explaining how he sat in his living room and tried to come up with a quick solo performance. “I was like, ‘What’s one of the challenges that I’ve experienced with anxiety, depression? Getting out of bed.’”

The scene Malaolu made “was almost verging on clownish. I was using physical theatre and hip-hop movement to show this guy just wanting to get up.” The performance went down a storm. “People were really affected by it, and were like, ‘You need to tour this around.’ I was like, ‘It’s only 15 minutes!’ But that got me thinking.” Malaolu has expanded that single scene into a full-length show, Elephant in the Room, which now has a three-week run at Camden People’s theatre in London.

“Basically, it’s about a young man’s challenges with his mental health,” he says. “But also how he interacts with different characters that he’s grown up with, and how they influence his perception [of his mental wellbeing].” The piece mixes dance, theatre and spoken word, with Malaolu playing the mostly silent protagonist Michael and the other characters.

Conversations about mental health have become more visible, with the likes of Zayn Malik and Prince Harry openly discussing their struggles. There has been a rise, too, in theatrical work on the subject such as Milly Thomas’s Dust, a look at one young woman’s suicide, and I’m a Phoenix, Bitch, in which performance artist Bryony Kimmings looked at her trauma-related breakdown. Masculinity and the mental health of young men are considered in Barber Shop Chronicles, which is coming to the Roundhouse, London, after two National Theatre runs and an international tour, and Fledgling Theatre’s Neck or Nothing, which is at the Pleasance theatre, London, this month, in partnership with men’s suicide prevention charity Calm.

Full story: Guardian

Author: Philip Challinor
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Under-18s with mental health issues to be asked about social media use

Children and young people with mental health problems will be routinely asked about their use of social media under new guidance being issued to NHS psychiatrists.

Under-18s seeking help with conditions such as anxiety, depression and eating disorders will be questioned to see whether using Facebook, Instagram or other platforms is causing or exacerbating their illness.

As a result, when they first meet young people, psychiatrists will ask if accessing such sites is affecting their sleep, performance at school, mood or eating habits.

They will try, for example, to establish whether troubled young people have spent time on sites that promote self-harm or encourage anorexia.

Parents will also be asked what devices are in their homes, which ones their child uses and how often, and whether their offspring look at screens during meals or while adults are doing chores.

The guidance has been issued by the Royal College of Psychiatrists at a time of growing concern that long hours spent on social media, and some of its content, are damaging young people’s psychological health.

It is the first time the RCP, which represents psychiatrists professionally and sets standards for the profession, has advised members to investigate how much social media has added to young patients’ difficulties.

Full story: Guardian

Author: Philip Challinor
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More than 4,000 women with mental health problems to benefit from Tampon Tax Fund

Women across England and Wales will get vital mental health support as part of a major new programme launched by mental health charity Mind and Agenda, the alliance for women and girls at risk.

The £1.8 million programme, called Women Side by Side, will increase the availability of high quality, community-based peer support for women through around 70 projects delivered by specialist organisations across the country.

The projects will particularly benefit women experiencing multiple disadvantage – for example those experiencing mental health problems, homelessness, drug and alcohol misuse, abuse and violence, family breakdown, offending or a combination of these.

Around one in five (19 per cent) women experience a common mental health problem, such as anxiety or depression. More than one in two women with a mental health problem has experienced some form of violence and abuse.

Five new hubs (four in England and one in Wales), which will act as learning centres supporting every project, are already up and running. The hubs, run by women’s organisations, are using their specialist expertise and links to community organisations to make sure all services understand and respond to women’s specific needs, including their experiences of trauma and abuse. 

Research has shown that peer support – getting support from people who have similar experiences – improves people’s wellbeing and helps them manage their mental health problem, enabling them to choose what kind of support works best for them. Peer support is also a good investment and can help decrease other healthcare costs, for example by reducing hospital admissions by people with mental health problems. 

Full story: National Mind

Author: Philip Challinor
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Strip DWP of responsibility for ill and disabled people, urges thinktank

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

Author: Philip Challinor
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Schizophrenia’s ‘genetic test’ – patients who may be hearing voices might be lied to

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

Author: Philip Challinor
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Abandoned at 18: the young people denied mental health support because they are ‘adults’

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

Author: Philip Challinor
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Individuals continue to be uprooted away from their families for MH care

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

Author: Philip Challinor
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