The proven benefits of growing old gracefully

If it's true you're as old as you feel, then it would seem, from a recent piece of research, that you're also as depressed as others think you should feel for your age.

New research from the Yale School of Public Health in the USA suggests that older people who see growing old in a negative light are significantly more prone to mental health disorders than those who view the ageing process as being positive.

Researchers surveyed over 2,000 American veterans, aged 55 or older, from the National Health and Resilience in Veterans Study, a nationally representative cohort of nine million return soldiers. Participants' attitudes, markers of mental health and social activity were measured and assessed. The results were striking.

Among those with more positive attitudes to ageing, only 2% expressed symptoms of post-traumatic stress disorder (PTSD) versus 19% with a negative attitude, 5% had suicidal thoughts compared to 30% with a negative attitude, and 4% had anxiety disorder compared to 35% with a negative attitude. A stark contrast, indeed.

Lead author, Becca Levy, Associate Professor and Director of the Social and Behavioural Sciences Division at Yale says that, in her experience, negative age stereotypes can generate stress in older people which, in turn, raises the risk of psychiatric disorders later in life. She comments:

"These results suggest that reducing the negative age stereotypes that are present in media, marketing and everyday conversations could have mental health benefits." 

Well said. While the chances of the media and marketing machine which dominates the culture is unlikely to do an about-face in projecting images which glorify youth and suggest that life on earth is about inexorable decline, we can, at least, do something in our own lives (i.e. 'everyday conversations') to recognise the intrinsic value of the ageing process in moving us towards greater maturity and wisdom.

I believe this is a significant piece of research, because it suggests that the more older people who succumb to the prevailing dogma of ageing as being negative, the more we can expect to see a rising tide of depression and suicidal tendencies among older members of our community. What a great tragedy this would be.

I recently sent a birthday card to an elderly relative which read 'It isn't an ageing process, it's a perfecting process', which sums it all up, to me. A cheerful veteran of World War II, he bears his various aches and pains with good humour, fortitude and dignity. He's a great gift to our family and we are profoundly grateful for the example, wisdom and guidance he continues to provide, especially for younger members coming up the line.

The value of a positive attitude towards ageing cannot be underestimated - nor the necessity to defy the negative age stereotypes becoming so pervasive in this post-modern world.

Have you witnessed the contrast between the mental health consequences of  negative and positive attitudes to ageing? If so, we'd love to hear from you. Either way, we'd value your thoughts.


Written by Jacqui Hogan

Get to the art of mental health

There's nothing more satisfying than allowing that inner child to let rip with a fist full of crayons and a blank sheet of paper. That's my opinion, anyway. And members of the York community seem to be of a similar mind. They've decided to set up a new art and crafts group specifically for people with mental health problems, which will meet from 11 September.

Sarah-Jane McKenzie and her art teacher sister, Helen, are masterminding the project and their aim is for the artworks created to be sold on a stall in the refurbished York market, once a month.

Sarah-Jane knows, from personal experience, just how isolating mental health difficulties can be. She hopes to create a forum in which people can reach out to others and come to understand that they are not the only ones who suffer. She explains:

"Because the group is aimed at people with mental health problems (or people who have in the past experienced them) we won't feel any need to pretend or put on an act, or hide the details of problems we've had..."

She maintains that encouraging participants to make art and craft will, itself, prove therapeutic and promote renewed inspiration and motivation for those whose lives have been disrupted by mental ill health.

Some formal instruction will be given, but participants will be encouraged to bring their own projects and ideas and to shape the direction the group takes. Any money made on the York market stall will be ploughed back into funding for more materials, and any excess over and above this will be shared among the group. (More detail and contact information here.)

There has been growing interest in arts-in-health initiatives where 'the creative process' is seen to have therapeutic value in promoting wellbeing. The UK Mental Health Foundation claims on its website:

"International and UK research has found that many people with mental health problems find arts therapies helpful, either on their own or as part of a range of therapies, which may include medication and talking treatments."

Have you worked with arts-in-health initiatives? How successful have they been? Whether you're a therapist or someone with experience as a patient, do post your comments - we'd love to hear from you.

Written by Jacqui Hogan

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

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

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

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

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