Merry Christmas from all at 96 Harley Psychotherapy

Well, we're almost at the back door of another year - another ending, no less. Those of us who have been on the wrong side (or perhaps the right?) of the archetypal therapist's tissue-topped coffee table know all too well what this can mean - anything from melt-down to the quiet joy of recognising that we can actually sustain ourselves emotionally without need of professional help - at least for the holidays!

So how has 2013 been for you, psychologically speaking? Do you feel like you're growing? Or perhaps regressing? Ultimately, whichever one, it is (arguably) all in the service of deepening your experience of life. If things have got worse, it's because they're on their way to getting better and if they've got better, congratulations, you're no doubt experiencing the fruits of being in the flow of life!

At 96 Harley Psychotherapy, we like to encourage good 'psychological hygiene' at this time of year, in the form of taking stock of all that has worked and not worked, succeeded and failed, been gained and lost over the course of the last 12 months. Such processing really does help de-clutter the mind and make way for the coming year. Even taking simple steps, like clearing your desktop of all those errant screen grabs and loner files, sorting through your in-tray and packing away your summer clothes (if you haven't already) can lead to a sense of marking completion and paving the way for the exciting, new and unimagined.

May we, at number 96, take this opportunity to say THANK YOU to all those with whom we have connected during 2013 and to wish you all a Merry Christmas and a happy, healthy 2014. Expect more of our disarmingly candid psychological commentary in the New Year!

Written by Jacqui Hogan

'Tis the season to be jolly - what's the role of antidepressants?

It's Christmas, that wonderful time of year when we deck the halls, gather together in community and sing carols to herald the arrival of the newborn Christ-child - right?

Maybe not. For many people, the festive season is now, not only devoid of any spiritual significance, but also associated with the consequences of widespread family breakdown and the socio-economic sleight-of-hand that is currently making paupers out of the middle classes. Thankfully, many of us still find reason to be cheerful, but for those who struggle with depression, this can be the worst time of year to navigate.

A new information resource for people with depression, hailing from research conducted by Oxford University and the University of Nottingham, provides identification and comfort in the form of a series of video interviews, conducted among depression sufferers from all around the country. You can watch these interviews at healthtalkonline.org.

What's striking about this piece of work is the honesty of the 30 people interviewed and the broad range of experiences reported across this relatively small cohort (that, and the rather perplexing appearance of Alastair Campbell introducing the work - what, may I ask, does he have to do with any of this?).

A common observation made by interviewees was that the response to antidepressant medication could be as diverse as the number of people being medicated - in other words, each individual appears to respond differently.

Several refer to the reality of side-effects, such as anxiety, feeling detached, dizziness and suicidal feelings, as being an important consideration in the decision to proceed or not. One participant commented "Some of [the side-effects] are not bearable… [so] if you're mildly depressed it may not be worth it." It took some people several years to find an antidepressant that worked for them, usually accompanied by adding in strategies such as talking therapy. A proportion said they had never found an effective treatment.

In contrast, one man, an eighty-four year old, had been prescribed valium for depression since his early thirties and a few years ago was prescribed an SSRI. In his words "the black clouds lifted."

If there's one thing that can be said with certainty - no response can be predicted with certainty, which is what makes this video footage so very interesting. If nothing else. it will provide those who are trying to make a decision about whether to go on medication a realistic impression of what it may mean to take the plunge. Fore-warned is fore-armed and given the massive increase in antidepressant prescriptions in the UK in recent years, this must be considered an important resource.

Along with the reality of the true Christmas message - that love has now entered the world.


Written by Jacqui Hogan

Mental health and casual sex. What sort of bedfellows?

I have no doubt there are those who would argue for the benefits of sex, sex and more sex. Loosening us up, chilling us out, opening us up to creativity - why, it's a surprise there are not more of us putting it about. Perhaps such lines of thinking can be traced back to Sigmund Freud, or perhaps less salubriously to good old sex addiction which, arguably, now exists in epidemic proportions in our culture.

Unfortunately, a recent piece of research rather puts paid to this notion - at least when it comes to teens and young adults. A new study conducted within the Department of Human Sciences at the Ohio State University shows a clear association between poor mental health and casual sex, with both variables having a causative effect. In other words, casual sex leads to poor mental health and poor mental health leads to casual sex - there's no way of cutting this one to make it work for the sex-obsessed.

The longitudinal study involved 1,000 participants, who were interviewed as adolescents (from about 12 to 16 years of age) and then again when 18 to 26. Each was asked about sexual relationship experiences, such as "just having sex" (i.e. casual sex) or "having sex with partner while dating" as well as mental health experiences, such as "depressive symptoms" and "serious thoughts of suicide".

The results showed that teens who reported depressive symptoms and serious thoughts of suicide were significantly more likely to report having casual sex encounters as young adults (between 18 and 26) and each additional casual encounter increased the chances of suicidal thoughts by 18%. Which begs the question, what happens inside the heads of those who have more than five casual encounters? (And let's face it, you wouldn't have to look to hard to find a few of those.)

Sara Sandberg-Thoma, lead author and doctoral student commented: "This study provides evidence that poor mental health can lead to casual sex, but also that casual sex leads to additional declines in mental health", which waves the red flag across both conditions.

How much more evidence do we need to believe that sex is a gift that can not be deployed outside a committed context without incurring serious consequences? For the sake of future generations, let's help support our young and depressed understand the meaning of love.

Written by Jacqui Hogan

Schizophrenia Awareness Week, November 11-17, 2013

R.D. Laing

And so it is upon us - Schizophrenia Awareness Week 2013, now with just two days to go until the closing gong. So here I am doing my bit, in the hope that my small action here will help to de-stigmatise what must be an incredibly difficult condition to live with.

I have not had much personal exposure to schizophrenia, though I do hold the view that diagnostic labels can often be more dangerous than the conditions which they describe. In that sense, I have some sympathy with the thoughts of R.D Laing (1927 -1981), a Scottish Psychiatrist and a controversial figure, who believed that schizophrenia was "a theory not a fact". He rejected that schizophrenia was genetically inherited - a prominent model of the time - which was also rejected by leading contemporary medical geneticists.

Laing's views were greatly informed by existential philosophy and he believed that the feelings and experiences expressed by the person with schizophrenia were valid descriptions of the lived experience, from which there was much of therapeutic value to be gleaned. In fact, he rejected the notion of an underlying biological model of mental illness more generally - according to Laing, diagnosis of mental illness did not follow a traditional medical model and this led him to question the use of medication, such as anti-psychotics, for those diagnosed with schizophrenia.

Rather, he saw 'schizophrenics' as somehow luminary, people who were expressing fundamental truths about their lives and the world around us, and whose difficulties were merely a reflection and expression of unresolved aspects of their lives. A passage from one of his books, The Politics of Experience, reads:

"If our human race survives, future men will, I suspect, look back on our enlightened epoch as a veritable age of Darkness. They will presumably be able to savour the irony of the situation with more amusement than we can extract from it. The laugh's on us. They will see that what we call 'schizophrenia' was one of the forms in which, often through quite ordinary people, the light began to break through the cracks in our all-too-closed minds."  

From this, we observe the respect he has for those who suffer from schizophrenia, whom he sees as shining beacons in the darkness of our 'enlightened epoch'. Frankly, I'm with Laing, who was effectively blowing wide open preconceptions and misconceptions about the condition.

A year ago, in November 2012, the independent Schizophrenia Commission published its report The Abandoned Illness which found that significant change is urgently required in the NHS (and beyond) to ensure that people affected by schizophrenia, and their families, get the support they need. Following its publication, Rethink Mental Illness Innovation Network has been working with the NHS and independent providers to turn the report's recommendations into nationwide change. The focus has been on providing therapeutic inpatient care, supporting people into employment and improving physical health outcomes.

Whether you hold with Laing's views or a more biological basis for the condition, it's clear that people with schizophrenia need understanding and they need help. Let's hope that awareness-raising, along with government-sponsored and private action, will deliver positive change.

Written by Jacqui Hogan

Good news for paedophiles

The computer generated image of ‘Sweetie’ (Picture: EPA/Terres des Hommes)

The American Psychiatric Association (APA) has recently re-classified paedophilia in their Diagnostic and Statistical Manual of Mental Disorders, mark five (DSM-V).

In a move towards destigmatising the disorder, the organisation has changed their terminology to describe paedophilia as a 'sexual orientation', thereby opening the door to paedophiles arguing that their behaviour (as per the precedent set with homosexual declassification) is not only acceptable conduct, but a civil right. Paedophiles the world over will be rubbing their hands (and God knows what else) together with glee at this highly disturbing development.

And if you're in any doubt as to a hidden agenda, let's just take a look at the way the APA has made changes to the diagnostic category of paedophilia (or pedophilia in the American spelling) over the years:

• In DSM-III, the APA said that one who acted upon one's sexual attraction to children was a 'pedophile'
• In DSM-IV, the APA changed its criteria, stating that 'pedophilia' was only a disorder if it caused 'clinically significant distress or impairment in social, occupational or other important areas of functioning' (how's that for woolly?)
• In DSM-V now, 'pedophilia' has been changed to a 'sexual orientation', leading to public outcry for the reasons outlined above. In reply, the APA has stated that this 'error' will be corrected in the next printing of the manual and - get this - that 'sexual orientation' will be changed to 'sexual interest'

Am I reading right here? Because if I am, then paedophilia is set to become, at best, simply an orientation (like being gay, which of course is now enshrined in law) and at worst, an interest, much like stamp collecting or go-cart racing. To say we are on a slippery slope is to understate the utter desperation of the situation and to be putting our childen in terrible danger.

This is how chilling laws are born - a so-called authoritative body justifies what is clearly indefensible behaviour and then people argue that the behaviour is, not only acceptable conduct, but a civil right. The next step, of course, is for those with a vested interest to claim that anyone who speaks out against their behaviour is in breach of their human rights. That's when the party begins.

Oh yes, people, we are sleep-walking here if we sit back and let this continue. All it takes is for a few good men to remain silent.

All this comes in the same week that more than 20,000 paedophiles were caught red-handed when an anti-child-abuse group in Holland (Terre des Hommes) created a computer-generated 10 year-old Fillipina girl called Sweetie and floated her in the chatrooms. She was bombarded with offers to perform sex acts on a web-cam from (predominantly) men from all over the world. Project Director Hans Guyt commented:

"If we don't intervene soon, this sinister phenomenon will totally run out of control. The child predators doing this now feel that the law doesn't apply to them."

UN figures suggest that up to 750,000 paedophiles (or should I say people with 'sexual interest' in children) are online at any one time - you know, just a regular bunch of guys who share a common interest and just want to have a little fun. "No harm done. It's all remote anyway, so what's the problem? You gonna tell me theres something wrong with me, just because I happen to enjoy the company of children?" According to the APA, this is exactly what we can expect - now that paedophilia has ceased to exist as a disorder.

I don't know where we take this, but if this story disturbs you as much as it does me, try Liberty News, whose tagline 'Report Truth. Take action.' seems like a sensible imperative here. And maybe spread the word by tweeting this article.

Written by Jacqui Hogan

A therapy that makes good horse sense

Just lately, I've been hearing reports from a friend about her experience of equine psychotherapy. Once a week, she boards a train and heads for the hills, so to speak, to meet with her four-legged chestnut therapist (who, for the purposes of this post, is just out of view munching on turf in the scene above!).

By all accounts, she's galloping ahead with this form of therapy, learning from her (increasingly less tentative) interactions with the  horse, whose behavioural responses often reflect the dynamics she uses with friends and family. As someone in treatment for  childhood trauma, her weekly sessions seem to yield strong, bodily-felt awarenesses about how she initiates and responds in relationship, which is doing her the power of good.

Equine psychotherapy, also known as 'hippotherapy' (from the Greek word hippos, meaning horse) involves using horses to engender growth and emotional healing in people suffering from all sorts of psychological conditions and wounding. The basic principle stems from the fact that horses, by and large, are natural co-operators and conciliators who demonstrate similar social behaviours to humans, just without all the complications.

Collaboration in a herd of horses happens as a matter of course, with members instinctively looking out for each other. Unlike the typical dog-eat-dog mentality that dominates human society, horses are natural peacemakers and when people (such as my friend) start to operate in an environment in which they are being worked with, rather than against, remarkable healing can happen. Horses don't lie or cheat or manipulate - they simply respond authentically, with a natural predisposition towards fostering relational harmony. Horses are basically honest and kind.

Working with horses and equine therapists, people discover new ways of dealing with their problems, often ingrained over a lifetime. A relationship with a horse can help build confidence, compassion and trust, and flag up ways of being which run counter to the natural flow of life. Of course, the therapist's role in the process is specialised and crucial, with horse whispering credentials being every bit as important as those accredited by the British Association of Counselling and Pychotherapy..

If my friend's experience is anything to go by, hippotherapy is well worth exploring. At the very worst, it's a session out in the soft earth and fresh air, with a majestically appointed creature, whose main interest is in getting to know you simply for who you are.

Written by Jacqui Hogan

Who's got OCD? Obsessive treatment of OCD on TV screens this week

People seem to be returning to the subject of Obsessive Compulsive Disorder (OCD) rather a lot lately (boom-boom). And is it any wonder. Almost half of the UK adult population believe themselves to be suffering from mild to severe OCD, a recent study reveals.

The study, conducted by Benenden Health in partnership with OCD UK, was released to mark the start of OCD Awareness week on 14 November 2013. Problematic behaviours include obsessive checking of locks, frequent hand-washing, hoarding, frequent checking of appliances, excessive cleanliness, preoccupation with symmetry and intrusive repeating thoughts.

This week promises to be a bumper week on the OCD calendar with an almost obsessive treatment of the subject on our television screens - no less than three programmes dedicated to its exposition and exploration in as many days.

Tonight (28 October) we start with OCD Ward (9:00pm, ITV1), which focuses the treatment of OCD at the Springfield University Hospital in South London. OCD Ward will address the impact of  the condition on patients and their family relationships, as well as the difficulties involved in treating it.

Then, tomorrow night on Channel 4, stay tuned for Obsessive Compulsive Cleaners which starts at 8:00pm and, as the name suggests, focuses obsessive behaviour around cleanliness. As much as some of us may feel that a small dose of this particular malaise wouldn't go astray in our lives, this is a serious illness with painful consequences.

Bedlam, on Channel 4, constitutes an OCD triple-whammy. This new four-part series challenges misconceptions about mental illness through unprecedented access to the patients and staff of the South London and Maudsley (SLaM), the world's first and oldest psychiatric hospital, it promises to make absorbing, if somewhat heartbreaking viewing. The first episode starts this Thursday (31 October) at 9:00pm and will feature OCD and other anxiety-related conditions being treated at the Anxiety Disorders Residential Unit.

So if there's any week to discover the facts about OCD this is it - just go easy on the replays.

Written by Jacqui Hogan

It's standing room only in English mental health facilities

In this post-modern era (and I never have been entirely sure what that means) it's difficult to know, at least from the outside, what's going on with mental health services in the NHS. In recent weeks I've written about a friend of mine who has lately been confined to a secure unit in North London and is having a lovely time by all accounts, reporting that "it's just like being in a hotel". Then, on the other hand, we hear in the media this week that mental health services are in a state of crisis - what's one to believe?

Just to give you the heads up on this week's report in The Guardian, an investigation has revealed that over 1700 mental health beds in England have been closed since April 2011 (representing a 9% reduction). Care minister Norman Lamb has described the situation as "unacceptable" - provision must improve, he says (earnestly).

The investigation protocol involved BBC News and Community Care magazine sending out 'freedom of information' reports to 53 out of England's 58 mental health Trusts. A substantial 87% of those to whom the report was sent (and that's a very high proportion so they were obviously motivated) replied.

The findings reveal that 75% of bed closures were in acute adult and geriatric wards and psychiatric intensive care units. Average ward occupancy levels were running at 100% and total (as opposed to average) occupancy levels were over the 85% limit recommended by the Royal College of Psychiatrists, with some at over 100%. Which begs the question - where were all those patients being stashed?

Whichever way you look at it, this can't be good, particularly considering the demographic of ward closures. Adult, geriatric and psychiatric patients in intensive care - not exactly the thick end of the wedge, shall we say.

"We're certainly feeling it on the front line, it's very pressured and we spend a lot of our time struggling to find beds, sending people across the country which is really not what I want to do" said Dr Martin Baggaly, Medical Director of the South London and Maudsley NHS Trust. He said that he had recently directed 50 patients in need to beds outside the Trust, all to facilities outside of London and some as far away as Somerset.

Let's face it folks, if you or a member of your family were in need of an acute bed for a mental health admission, the last thing you'd want is to be removed from your geographical support network or worse still, be given no bed at all. What becomes of the non-admissions?

Not to worry though. Norman Lamb, further to his observations on the state of play with bed closures, has said "There is an institutional bias in the NHS against mental health and I am determined to end this." Fine words, but can he deliver?

You can hold him to account by attending the New Savoy Partnership conference at the end of next month where the success of the government's massively increased funding to mental health services over the last few years will be examined. Are we getting value for money, do you think? If not, where is the slack? Where is all that money going?

Written by Jacqui Hogan

Conference alert: Psychological Therapies in the NHS

In 2007, the government issued its first ever commitment to enable universal access for anyone with depression and anxiety to NHS-funded psychological therapies. The then Health Secretary, Alan Johnson, announced funding for a national programme, which has since been well underway.

So how has the government investment in the mental health of our nation fared? Have we seen improved access? To whom and for what conditions? What have been the measurable outcomes?

Such questions will set the agenda for the annual New Savoy Partnership Conference, entitled Psychological Therapies in the NHS: Re-thinking Psychological Therapies in the new NHS.to be held at the Mermaid Conference Centre in London on Thursday 28 and Friday 29 November.

British Psychological Society Fellow, Professor Michael Barkham, will present the results of the Second National Audit of Psychological Therapies with Professor Mike Crawford and Dr Lorna Farquharson in the conference's opening keynote. Other speakers will include Norman Lamb, the Health Minister and the NHS England's National Clinical Director for Mental Health, Dr Geraldine Strathdee.

The New Savoy Partnership is a group of organisations whose aim is to bring psychological therapies to the NHS and improve access to those who need them in a timely and appropriate manner. Its annual conference aims to break new ground in policy development and present the latest findings and ongoing developments in evidence-based mental health practice.

This year's presentation of top line results from the Second National Audit promises to provide an invaluable insight into the health of NHS service provision and shed further light on the positive trends seen in the First National Audit. An excerpt from the conference promotional programme reads:

"If this event has gained a reputation for anything, it is for giving delegates the opportunity to challenge and engage with ministers, policy makers and decision-makers so they know directly from the people on the front line what doesn't work."

Fighting words then. If you'd like to have your say or find out more about the event, you can book your place and/or download the programme here.

Written by Jacqui Hogan

Asda, Halloween and who's the mental patient?

Yesterday, Asda was criticised for launching a Halloween costume for online sale, labelled 'Mental patient fancy dress costume'. As you can just make out from the screen shot of the offending item, the model is covered in blood and wields a meat cleaver - charming.

Amidst all the hoo-ha surrounding the offence being done to mental health patients because of this, what I find interesting is that no-one has raised so much as an eyebrow at what seems to me even more disturbing - the alarming spectacle of violence referenced by this, at best tasteless, party costume. I repeat, 'covered in blood' and 'wields a meat cleaver' - can anyone hear that or have we become so numb to such grotesque ideas and images that nothing disturbs our serenity (or should I say denial).

I contend that the increasing incidence of images, items and concepts like these in our everyday lives is a reflection of something we should be far more concerned about - such visions ultimately make mental patients of us all by inuring us to images of the obscene and violent, normalising them and even turning them into a so-called laugh.

Here's an idea - why don't we market Al Shabab outfits and sell them for Halloween in the wake of the recent Kenyan shopping mall atrocity - you know, just for a bit of fun? Given that Halloween is now a popular date in children's diaries, the need to recognise what we're doing is all the more stark. Or perhaps we should wait until the meat cleaving and blood letting starts among our young adults (and we've already seen it on the streets of South London), then introduce education around it into the school curriculum?

On a similar theme, a recent article by James Delingpole on the shocking reality of the content of the new Grand Theft Auto V game, gives a horrifying insight into this brave new world of explicit and gratuitous images of human suffering and violence. Horrifying, that is, to those who are still able to be shocked by the depravity routinely touted as entertainment in these times. I urge you, for the sake of our common humanity, to take a look at James' article.

Written by Jacqui Hogan

Neurocognitive impairment or just bad memories?

Just recently, there have been a few occasions on which I've had cause to wonder whether I'm headed squarely for dementia - being absolutely certain I'd forgotten my keys and then being surprised to find I had remembered them after all (better than the other way round), and the increasingly common disappearance of a word or thought that had, two seconds previously, been top of mind. Know the feeling? I know I'm not the only one, because just last night I was talking to a friend who also confided she's concerned she's on the same slippery slope, citing similar faux pas.

New research from Cornell University doesn't totally allay our fears, but it does move us closer to identifying reliable methods for evaluating whether such lapses are on the 'healthy age-related memory loss' spectrum or the 'Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD)' spectrum. The results hold promise for detecting neurocognitive impairment early and implementing prophylactic strategies.

CJ Brainerd et al. in the paper 'Dual-retrieval models and neurocognitive impairment' showed that declines in reconstructive memory (that is, recalling a word or event by associating it with clues about its meaning, for example recalling that 'carrots' was presented in a word list by first remembering that the list was associated with food shopping) were associated with cognitive impairment of the type described by MCI and AD, but not with healthy ageing. The type of impairment associated with healthy ageing was recollective memory - that is, an increasing inability to recall a word or event precisely.

So, decline in reconstructive, as opposed to recollective, memory is the all-important distinction and, over a period of 1.5 to 6 years, declines in reconstructive memory were a reliable predictor of of future progression to neurocognitive impairment (either MCI or AD). Of great significance is the finding that loss of recollective memory is a better predictive marker of MCI or AD than the best available genetic markers of such diseases.

So, where was I? The bottom line is, that forgetting the odd word or thought (or keys) here and there is a perfectly normal part of ageing. 'Thingummyjigs' and 'What's-his-names' are just fine. And hopefully this research will lead to greater leverage of the predictive value of reconstructive memory and foster earlier and more effective treatment of neurocognitive morbidity.

Written by Jacqui Hogan

A crisis of character in the Western world

I have a friend who has recently been 'committed'. In the psychiatric sense. To a mental hospital. Perhaps rather arrogantly, I didn't imagine I would ever be in this position - how could anyone I would befriend ever be locked away for mental illness?

I discovered this just a few days ago. She called from hospital to let me know what had happened. She sounded fine - no, not just fine, but positively chipper. "It's just like being in a hotel" she confided, chirpily. When I asked her what had happened, she said it started with her flooding their block of flats by leaving a bath running, then progressed to the fire brigade attending, followed by the police. For reasons unexplained to me, she resisted the police, who apparently handcuffed her to try to restrain her. Rather than oblige, she continued resisting and wound up banged up at said 'hotel' up the road. It sounded like she was thoroughly enjoying herself, and the prospect of a six-month mandatory stay didn't seem to phase her a bit.

One part of her story which raised a red flag for me, was when she described how she had behaved in response to the flooding incident. She said that (rather than going downstairs and checking to see what damage had been done) she chose to hide in her kitchen. The fire brigade thereby ended up having to break down her door to get in.

This small cameo speaks volumes to me and gives a clue as to what might really be going on for my friend - is she really bipolar, as she tells me she's now been diagnosed (like most of the population now, it seems) or are we witnessing a crisis of character - the unwillingness to take responsibility for one's behaviour.

According to experts only a handful of clinical conditions can potentially render a person not fully responsible for their behaviour. For example, people with delusional psychosis can commit heinous acts because their brains are not functioning properly. In such cases, an individual can lack the capacity to judge right from wrong.

But my friend is not in this position. She has never been diagnosed with delusional psychosis or any other condition that exonerates her from responsibility for her actions. But what I do notice, looking back, is that she has actively denied taking responsibility at crucial points in her life.

For example, when she was diagnosed with a serious physical condition which was subsequently retracted by her doctor as her health improved, she asked if he would keep the revised diagnosis a secret, to which he (remarkably) agreed. This entitled her to the full slew of sickness benefits and relieved her of the burden of ever having to take responsibility for her work life again. (The flats I mentioned are council of course, so any responsibility for rectifying the considerable damage caused by the flooding falls to the council).

When I delicately raised this matter with her some years later, she had totally forgotten that particular game-changing conversation with her GP, and I do recall thinking at the time - she has genuinely purged her mind of that truth. I wondered, at the time, what happens to the minds of people who choose to live in a state of denial. Perhaps now I am witnessing the answer.

A recent article by Dr George Simon PhD entitled 'Mental disorders and accountability: is everyone a victim?' speaks to the increasing shift in Western culture towards a 'he couldn't help it - he has a mental disorder' attitude, when in fact he does have a choice about whether or not to engage in responsible social behaviour. He refers to this as a crisis of character in the people of our Western nations:

"Not only has the character crisis being witnessed by the industrialised world over the past several decades reached epidemic proportions, but we have become so desensitised to it (or are in such enormous denial about it) and have grown so accustomed to claims that various mental disorders are really to blame for willful misconduct, that the very notion of personal responsibility for behaviour is in jeopardy of becoming extinct."

I agree with him that 'character is has always been key to responsible social functioning' and we are now entering a brave new world where virtues of character are the exception rather than the norm.

As to my friend, in many ways, being committed may be her preferred next step along the pathway to total relinquishment of any responsibility for her life whatsoever - reversion to a perennial childhood. Perhaps, to her, being committed is not such a high price for total relief from the adult challenge of character formation.

Written by Jacqui Hogan

A good kind of crossing boundaries

Those of you who are therapists and/or patients of therapists will likely be aware that, in the normal course of things, it's not a great idea to cross boundaries - as in, slap someone without permission (violating a physical boundary) or engage in emotional blackmail (violating an emotional boundary). But this month, the Mental Health Foundation is launching a new paper, front cover pictured above, entitled Crossing Boundaries: Improving integrated care for people with mental health problems which, it has to be hoped, represents a good kind of crossing boundaries.

The report sets out the findings of an inquiry which ran between April 2012 and June 2013, whose aim was to identify good practice, generate discussion and draw up key messages on integrated healthcare for people with mental health problems.

One of the key findings of the report is that the quality of the leaders involved in delivering mental healthcare services is vital - it is particularly important they understand that an integrated approach is needed. To achieve effective patient outcomes requires the co-operation of many professional disciplines and focus on major social influences such as education, unemployment, housing and poverty. Support based simply on medical diagnosis of mental illness is insufficient in and of itself - medical support is obviously critical, but adverse social factors for example, may mitigate against any positive effect.

This 'crossing of boundaries', the report finds, needs to be underpinned by a number of structural and organisational improvements, among the most important being integrated IT systems within and across different care and social organisations, the ability to pool funds from different funding streams into a single budget and shared protocol and partnership agreements.

But most important of all, the report cites, is the involvement of 'staff who understand the holistic nature of health care and have no professional defensiveness about working closely with colleagues in other disciplines...'. Hmmm. One has to wonder - would a little psychotherapy be in order?

Written by Jacqui Hogan