Friday, 29 August 2014

Mental health and the up-coming general election

Last week saw the publication of what has been titled 'A manifesto for better mental health', jointly written by the Mental Health Foundation, Mental Health Network, Mind, the Royal College of Psychiatrists, Rethink Mental Illness and the Centre for Mental Health. That's a lot of mental health in one paragraph. Hopefully its fruits will be a lot of mental health for society at large.

The paper has been written in advance of next year's general election, in an effort to set out what the next government must do, in the eyes of these thinkers, to improve the lives of people in the United Kingdom labouring under the burden of mental ill health.

Mental health problems, according to the report, carry an economic and social cost of £105 billion annually. They account for almost 25% of the total disease burden - a staggering assertion - while the mental health sector receives only 13% of the NHS budget. Depression and anxiety now exist in what might be considered epidemic proportions - and that's not counting the morbidity that goes unreported. Oh yes, there is a problem.

So, what does the manifesto set out as its desired priorities for government action, be it a coalition or alternative shade of government post-May 2015?

1. More funding - no surprises here, then. A commitment to 'real terms' increases in line with the scale of the problem.

2. Give children a good start in life - by means of providing mental health support before, during and after pregnancy, putting mental health on the national curriculum and running parenting programmes across England.

3. Improve the physical health of people with mental health problems - support for smoking cessation and reducing preventable physical health problems.

4. Improve the lives of people with mental health problems - by supporting anti-stigma campaigns and offering employment support for people who are out of work.

5. Provide better access to support services - reduce waiting times and support mental crisis care in hospitals; work more closely with the police and the courts.

No-one could argue with the first point, though from whence the funds should hail is yet another conundrum. On the second point, on the positive side, at least we see a recognition that mental health outcomes do, indeed, depend upon what happens in the early years, but do we seriously believe that making mental health a subject for academic study - for children - will make any difference?

Then, try for the life of me, I cannot see how helping someone with depression or schizophrenia stop smoking will significantly improve their situation - if my car isn't running, mending a nick in the upholstery is unlikely to greatly advance my cause.

While it's important to sound the clarion call for the government, whichever government, to wake up to the scale of the mental health epidemic, the question is, do these measures get to the root of what's really going on? If they were implemented tomorrow, never mind next May, would they spearhead a reversal in the current worrying trend?

Six mental health authorities solemnly believe this to be the case, but what are your thoughts? Which action points would your manifesto contain? Can we come up with some viable alternatives? Please join in the conversation.

Written by Jacqui Hogan

Friday, 22 August 2014

Don't lose sleep over this...

Having recently shared a twin room with a heavy snorer, I can tell you a thing or two about sleep deprivation. I lasted a total of three nights and, had I sustained the remaining four for which we were booked, I'm convinced I would have gone mad (I paid the extra for a single room).

A new study suggests I'm not far wrong on this -  researchers from the University of Bonn and King's College London have shown that just 24 hours of sleep deprivation can lead to symptoms of schizophrenia (I would have upgraded sooner, had I known).

Twenty-four healthy volunteers aged between 18 and 40 were trialled in the sleep laboratory, in an initial run being allowed to sleep, normally, overnight. A week later, they were kept awake all night, with conversation, games, movies and walks. They were also exposed to a measurement known as 'pre-pulse inhibition' in which a startle response was elicited through headphones as part of the protocol. The following morning, on both occasions, they were asked to record their thoughts and feelings, using a questionnaire format.

After sleep deprivation, there were pronounced attention deficits, as can occur in the case of schizophrenia. The subjects were found to be more sensitive to light, colour and brightness and their sense of smell was altered. They also reported distortions in their perception of time and many had the impression of being able to read others' minds. Professor Ettinger, a psychologist from the University of Bonn, said the team had not expected that symptoms could be so pronounced after one night spent awake.

I can. And I'm relieved to know that sleep deprivation, though apparently inducing schizophrenia-like symptoms is not harmful; the symptoms rapidly disappear after a solid night's sleep. The researchers wonder whether the symptoms might become gradually weaker as one acclimatises to sleep deprivation. Bags not participating in any of their follow-up work!

Written by Jacqui Hogan

Friday, 15 August 2014

First aid for mental health

I've never done a course in first aid, which has always seemed to represent a glaring hole in my CV. You never know, after all, when you might be called upon to apply an emergency tourniquet or, worse still, perform CPR.

But now there's an altogether new species of first aider - the mental health first aider.

Pioneered in Australia, Mental Health First Aid (MHFA) is a programme focusing workplace training in the subject. It's now gaining traction in the UK, where one in four people experiences a mental health problem.

Poppy Jarman is CEO of MHFA England, through which around one thousand instructors have trained over 75,000 people in first aid for mental health since they began operations in 2007. She notes that:
"The fear surrounding mental ill health and the misunderstanding around recovery is one of the biggest barriers for creating mentally fit workplaces. We need to talk about mental health in the same way we do about physical health."
MHFA would like to see every office in the land staffed with somebody trained in mental health first aid and, given the number of people now stepping forward for training, this goal may well be achieved.

Charlotte Walker was once a traditional office first aider, dealing with anything from chest pain to nose bleeds. Today, she gives first aid training in the workplace for the mind, not the body, teaching delegates how to respond to the rising number of mental health episodes.

Anxiety and depression are top of the list of problems they may have to deal with, and psychosis and suicidal crises, though not as common, are also important parts of the training. She says that most workplace mental health problems won't be emergencies and that small acts of compassion by fellow workers are often all that is needed:
"Simple strategies like buddying up for walks in the park or encouraging each other to leave work at a reasonable time can help nip workplace stress in the bud." 
This seems like common sense to me - i.e. to help a colleague battling with stress with practical suggestions. But common sense, it seems, is in increasingly short supply. So, too, is empathy, where the competitive and counter-productive culture of 'me, me, me' (especially in the workplace) can only cause alienation and exacerbate underlying mental health problems.

It is a sad reflection of our times that we need such a thing as mental health first aiders, the locus of 'the battle' now shifting from the physical (material) to the mental (spiritual), which is much harder to grasp and quantify, and much harder to treat. We are, indeed, in difficult times.

What do you think about the MHFA initiative? Is it a positive development? Share your thoughts in the comment box below.

Written by Jacqui Hogan

Friday, 8 August 2014

The high price of funding cuts to North London mental health services

A recent review of mental health services in the Barnet, Enfield and Haringey NHS trust suggests that significant community funding cuts may be on the horizon.

Local NHS commissioners ordered the review, which was carried out by consultancy group Mental Health Strategies - who found that NHS mental health services across the region were 'unsustainable' at current levels. The solution comes down to further investment by the commissioners (you can guess how well that's going to fly) or to cost-cutting measures. Needless to say, my money's on the cost-cutting measures.

A £5.8 million overspend on acute admissions during 2013-14, in response to 'increased acute activity' has clearly spooked the Trust, which sees no change in the trend towards greater numbers of patients for 2014-15. A spokesperson from the trust said:
"The mental health trust is currently under pressure from increased numbers of patients, without the corresponding increases in its funding. It has already made major cost reductions over the last five years, but is unable to keep doing this while still providing safe, high quality care for patients."
So, the number of patients is increasing, and cuts are already in operation - they have been in operation for the last five years. Still, the report says, the situation is unsustainable. It proposes caseloads must be cut by at least 10% and staffing must be reduced to plug a £15 million funding deficit for services.

What does this mean, exactly? Well, you don't have to be a rocket scientist to figure out that with more patients needing mental health treatment and fewer services to meet that need, there will be more mental health patients finding their own way in the community. That's the bottom line here. The sums simply don't add up and guess who's going to pay the price?

The trust spokesperson continued:
"The trust still bears most of the financial risk around increases in the numbers of patients the trust is caring for, which is causing the trust major financial problems this year, as it did last year. This is not sustainable…"
Mark those words 'financial risk' - they are part of the lexicon of the new NHS. To threaten such risk looks set to become the justification for radical withdrawal of services, no matter how many mental health patients end up wandering the streets.

The rising burden of mental health patients is serious cause for concern. And it's not just a problem for them, it's a problem for all of us. Society cannot continue turning a blind eye to the underlying causes of  mental dysfunction - or rather, it can, and sooner or later, the consequences will make themselves felt in ways we can scarcely imagine. Throwing money at the problem was never going to be a sustainable solution in any case, as the number of people just keeps getting bigger. Maybe the withdrawal of services will give us the wake-up call we need.

What are your thoughts? What are the causes and what's the solution? As ever, your comments welcomed.

Written by Jacqui Hogan

Friday, 1 August 2014

Now there's DBT for BPD

Borderline personality disorder (BPD) is characterised by problems with regulating emotions and thoughts, impulsive and reckless behaviour and unstable relationships with other people. Depression, anxiety, self-harm and suicidal behaviours can also be part of the picture. I can't help but think that these symptoms sound remarkably like those of addiction - any addiction - and therein lies the difficulty with classifying mental health with any precision.

But one thing that's certain is that living with BPD (or any addiction, for that matter) is no bed of roses. So it's good to know that a relatively new form of therapy, Dialectical Behavioural Therapy (DBT), is helping people with BPD.

DBT was developed by Marsha Linehan, as an adaption of Cognitive Behavioural Therapy (CBT), to meet the emotional needs of people with BPD. CBT typically focuses on changing behaviour through rationalisation, but DBT brings something new to the process: so-called 'acceptance techniques'.

Acceptance techniques direct the attention to understanding and making sense of one's actions - for example a therapist working with DBT might help the patient to understand how engaging in painful, destructive behaviour of one kind or another made absolute sense in the context of their difficult formative experiences - which ultimately leads to self-acceptance and prepares the ground for CBT-style change techniques.

New UK research suggests that DBT is, indeed, proving successful in treating patients with BPD. Patients were allocated to DBT at two-monthly intervals and others to treatment as usual (TAU). During the 12-month intervention period, significantly fewer patients allocated to DBT than to TAU were hospitalised. A regression analysis showed that the odds of hospitalisation during the intervention period were significantly higher in the TAU than the DBT group and this held true after adjusting for whether patients had been hospitalised in the year prior to intervention.

The positive trend was continued into the 6-month follow-up period and the authors concluded:
"DBT should be considered an effective treatment for keeping self-harming patients with BPD out of hospital and that positive effects on self-harm and hospitalisation are sustained once treatment is over."
Have you worked with DBT? How does it compare with CBT and have you found it helpful for patients? Or perhaps you're a patient who has experienced DBT? Either way, we'd love to hear from you; please leave your comments below.

Written by Jacqui Hogan