Concerning children's mental health

A recent government task-force review sheds some rather disturbing light on the state of child mental health services in England. The review focuses on concerns highlighted by a survey of Clinical Psychologists working across 43 separate specialist Child and Adolescent Mental Health Services (CAMHS) in 2014.

According to the Psychologists, in the last three years some 62% of services have decreased their staffing levels, with a bias towards the loss of more highly skilled professionals. In addition, further cuts are being planned for 42% of services.

Other findings showed that:

• 71% of services have tightened their acceptance criteria and raised severity thresholds for being seen
• 54% of respondents were concerned about the deterioration in provision for young people in crisis
• 66% of services reported a decrease in the quality of treatment provision
• 56% said the availability of psychological therapies had decreased in the last three years
• 53% had noticed a more medicalised approach to treatment

On this last point, Professor Jamie Hacker-Hughes, President-Elect of the British Psychological Society commented:

"We are seriously concerned that over half the respondents reported a move to more diagnosis-led, medicalised approaches given the significant weight of evidence in favour of psychological interventions for the majority of child mental health issues."

He has a point. There is a substantial and growing body of outcome research from the UK and abroad demonstrating the efficacy of child and adolescent psychotherapy, which is one of the reasons why the National Institute of Clinical Excellence (NICE) clearly recommends it. And while medical treatment has its place, it would be a tragedy to see it become the mainstay of treatment for conditions such as childhood depression.

Corroborating the survey findings, figures released last month showed that NHS spending on children's mental health services in England has fallen, in real terms. by 6% since 2010. The charity Young Minds has also recently found that over half the councils in England cut or froze budgets for child and adolescent mental health spending between 2010-2011 and 2014-2015.

These are troubling times for mental health services in general, but it is especially upsetting to think that our children, who are our future, are being let down in the critical area of mental health service provision. And as the culture around them becomes increasingly dysfunctional, we can only expect the crisis to deepen.

Do you have thoughts on this important topic? If so, we'd love to hear them.


Written by Jacqui Hogan

Bedlam now on open display

This week, I heard the story of a mother whose son had been conscripted to Afghanistan with the Territorial Army. One of her anecdotes which particularly touched me was that of her son asking her to send, along with protein bars and practical sundries, a colouring-in book. She told of how, in a quiet moment, his commanding officer had given him advice about how to stay within the lines - a wonderful cameo of simplicity and humanity in a world gone mad around them.

Perhaps this incident gives a clue as to the potential role of making art, no matter how rudimentary, for those trapped in a mental war zone.

This week, a new £4m gallery and museum, Bethlem Museum of the Mind, opened up at the Bethlem Royal Hospital in South London (pictured above), the world's oldest psychiatric institution. Formerly known as Bedlam, Bethlem has been treating patients with mental illness for almost eight hundred years.

Over that time, it has acquired a large collection of art and artefacts, many of them created by patients, and it is this body of work which has just gone on display. The collection itself dates back to the sixteenth century, making it the oldest archive of objects related to mental health in the world.

As one of the former patients acknowledges in a short promotional video put together by the BBC, creating art helped him to express the darkness he felt inside, while at the same time providing liberation from the strictures and disciplines of being in the clinical environment. He speaks of how the experience helped him to communicate what was happening for him and the great extent to which it contributed to his recovery.

The collection now on display is significant, bringing together the work of patients from Bethlem, The Maudsley and other psychiatric institutions.

Some artists, such as Richard Dadd, who was painting during the reign of Queen Victoria, have achieved international acclaim, while some of the exhibits, such as a pair of seventeenth century statues entitled 'Raving and Melancholy Madness' by an artist named Caius Cibber are of historical significance as former major London landmarks.

Victoria Northwood, Head of Archives and Museum, hopes that the current exhibition will help stimulate debate among visitors and lead to a better understanding of the lives of those living with mental illness. We echo that aspiration. And if you decide to visit, you'll be able to enjoy world class works of art and learn more about the history of mental health through the museum's unique archive.

Do you have experience of working with art in patients with mental illness? Or have you, perhaps, been helped by art in making a recovery from mental illness? We welcome all contributions on this fascinating topic. And do consider visiting Bedlam.


Written by Jacqui Hogan

Valentine's Day Special

I've been trying to figure out the connection between the original St Valentine, a Roman priest who was beheaded under Claudius II on 14 February in the year 270 AD, and the restaurant-and-rose-fest we practice every year in his name. Maybe it has something to do with him sheltering Christians from persecution and, in losing his life for their sake, demonstrating perfect love.

Now, I'm not sure how many of the couples in candlelit restaurant windows on Valentine's night would lay down their lives for their paramours; with the wind behind them, they won't have to. They will simply be able to bask in the bliss of the rather more comfortable derivative passed down by St Valentine - that is, romantic love.

But what is romantic love and how does it impact our mental health?

It would appear that romantic love is certainly good for overall health. This was demonstrated by a study of 3,000 people, aged between 57 and 85, who reported that being in a satisfying romantic relationship improved their sense of wellbeing. Participants in close relationships were more likely to report that they were in "excellent" or "very good" health than merely "good" or "poor" health.

Such positive thinking, according to the Mayo clinic, has all sorts of positive knock-on effects for objective measures of physical and emotional health, including reducing the risk of depression and protecting against the common cold.

And indeed, it's hard to argue against the affective pleasures of being in a good romantic relationship (whatever exactly that is!).

But is all romantic love good for your mental health?

Show up at any 12-Step meeting catering to the needs of people suffering from love addiction and I'm sure you'll get a different response to the one you'd get from diners in the hypothetical restaurant above.

Because what passes for love in this case is usually neurotic attachment, in which things can go horribly wrong. When the reason for being with another is to assuage unconscious feelings of discomfort or inadequacy (which usually hail from the family of origin), life is not all beer and skittles.

The typical love addiction cycle waxes with periods of intense engagement (usually pleasurable, at least on the face of it), then wanes with one or both partners entering into avoidance. It's a roller coaster ride that can get very messy, especially when the object of attachment (i.e. one's partner) is removed from the scene, as happens in a break-up.

Which leads on to the question how do people fare in the mental health stakes when there is no romantic love? Should singletons gaze through that restaurant window with sadness and longing?

Not necessarily! According to the NHS, having a healthy network of friends can have many of the same positive benefits as being in a romantic relationship. And reported on the same platform, a longitudinal study of almost 700 older nuns found that many are keeping fit and mentally agile well into their 90s and past 100!

Which brings us back to St Valentine. He clearly understood that love is not a feeling but an action (or perhaps a committed set of actions). As M Scott Peck in his classic book 'The Road Less Travelled' writes 'Love is the willingness to extend oneself for the purpose of nurturing one's own or another's spiritual growth'. I do like that definition.

Happy Valentines!


Written by Jacqui Hogan

Getting up close and personalised

You may not have noticed it, but personalised medicine is about to be all the rage. It's one of the biggest trends in modern medicine and what it may mean to the average punter is fewer side effects on medication. The idea is that the drug you will be prescribed will be tailored to your own personal genetic profile, thereby avoiding pesky side effects that may apply to the broader gene pool. Sounds good in theory, doesn't it? And maybe it will be.

There's a new initiative reported on the starting blocks this week which aims at using personalised medicine to reduce the side effects of medication in people with mental illness. Potentially this could be a winner, given the well known problems with side effects on antidepressants and other mental health prescriptions.

Geneticists at the University of Pittsburgh Graduate School of Public Health in Pennsylvania are to implement the research project which will be conducted over 28 months. According to Dietrich Stephan, PhD, Professor and Chair of the Department of Human Genetics at the School of Public Health:

"An individual's genetic makeup defines how many common drugs are processed by the body and who is at risk for an adverse reaction from such therapies. Individuals can suffer immensely from the very drugs that are meant to improve their health if given drugs they cannot tolerate, often resulting in increased emergency room visits and elevated healthcare costs."

Participants will be selected from a pool of adults with mental illnesses who are currently prescribed, or who will be prescribed, at least one psychotropic medication during the study period. Participation will be voluntary and oversight provided by a senior counsellor and a recognised ethicist in the Pennsylvania region.

Now, as someone who, this very week, experienced an adverse reaction to an anaesthetic, I can assure you the idea of personalised medicine is sounding mighty appealing. In my case, the doctors were utterly perplexed by my reaction and, in what could have been a television advertisement for personalised medicine, exclaimed things like 'we've never seen this before' and 'never say never in medicine'.

So if it's sounding like a relief to me, how much more of a relief will it be to those prescribed a cocktail of drugs with no insight into their genetic susceptibilities, perhaps triggering interactions and symptoms which might be misdiagnosed as part of their symptom profile?

All too often, the vulnerable, the mentally ill and the elderly, obediently (and sometimes not so obediently) imbibe drugs with a side effect list the length of your arm, based on best guesses as to their problem, only to feel even worse for the treatment.

Personalised medicine, especially in the area of mental health, seems to me to be a step forward, so let's hope this US study yields some positive results.

Written by Jacqui Hogan

Depressed? Try popping an aspirin.

It's a sad reality that depression is now being diagnosed in epidemic proportions, and equally sad that we seem so relatively helpless to treat it. According to popular figures, more than 50% of those who suffer from major depression do not respond to treatment.

That's why the latest piece of research from the Centre for Addiction and Mental Health (CAMH) in Canada is bound to attract interest from those who suffer from depression and those who treat it.

Published in JAMA Psychiatry this week, the study found that the measure of brain inflammation in people with clinical depression was much greater than for those without depression. Where previous studies have shown a correlation between depression and the level of inflammatory markers in the blood, this is the first study to show a definitive link with markers in the brain itself.

The team conducted brain scans on 20 patients with clinical depression and 20 non-depressed control participants, using a technique called Positron Emission Tomography (PET). Using this method, rates of brain inflammation were shown to be elevated by a remarkable 30% among the depressed patients, and were highest among those with severe depression.

Senior author Dr Jeffrey Myer of CAMH's Campbell Family Mental Health Research Institute rightly observes:

"This discovery has important implications for the development of new treatments for a significant group of people who suffer from depression. It provides a potential new target to either reverse brain inflammation or shift to a more positive repair role, with the idea that it would alleviate the symptoms."

Imagine that. Good old aspirin as a possible solution to (or perhaps a reliever of) depression. Is there anything the humble son of willow bark (for aspirin is a natural derivative of willow bark) cannot turn its hand to?

Now I'm making a leap here, of course, but wouldn't it be wonderful if aspirin, known for its anti-inflammatory effects from the time of the ancient Greeks, were to give us a very real solution to one of the most significant and intractable diseases of our modern time?

Perhaps we would be well advised to look to the past for solutions to depression - and yes, I mean that in more ways than one.


Written by Jacqui Hogan

STOP PRESS: Men and women are different!

We live in confusing times. So much so, that sometimes we lose track of the obvious. New research from the University of Basel is reassuringly supportive of something we women instinctively know to be true - that women experience a more potent response to emotional stimuli than men.

This large scale study, the results of which will be published in the latest issue of the Journal of Neuroscience, set about establishing the gender-dependent relationship between emotions, brain activity and memory performance.

While it is generally known that women consider emotional events to be more impactful than men, research supporting this and linking it to gender-based recall has been relatively thin on the ground.

Almost 3,400 male and female subjects were asked to rate emotionally charged content, some positive and some negative, for the size of the emotional reaction they evoked.

Women rated the content (especially the negative) as being more emotionally impacting than their male counterparts and, in a subsequent memory test, women could freely recall more of the images than men. Women demonstrated particular facility with recalling positive images.

Dr. Annette Milnik, leader of the team from the University of Basel's Molecular and Cognitive Neurosciences Transfaculty Research Platform noted:

"This would suggest that gender-dependent differences in emotional processing and memory [i.e. the difference between men and women when it comes to emotional processing and memory], are due to different mechanisms."

To further probe the findings, MRI data from almost 700 of the subjects showed that womens' stronger reaction to negative emotional content is linked to increased activity in the motor regions of the brain, supporting the common observation that women are more emotionally expressive than men.

Now, I don't know about you, but I would have been surprised by any other result. Logic tells me that women have babies and, biologically, that makes a difference. As the bearers of children we are fundamentally programmed for nurture, which, of course, has a profound effect on both our biology and our psychology. How could it be otherwise?

That's not to say that men are not moved by emotional stimuli; nor to say that some male individuals do not emote in the same way that women do (or some women do!). It is simply to say that, as a general rule, emotional processing and memory of emotional content occur differently for women and men.

Do you have any thoughts on this topic? If so, we'd love to hear from you, men and women alike!

Written by Jacqui Hogan

Of mice and men (and empathy)

Anyone who has trained in counselling knows that empathy is one of the most basic tenets of the therapeutic relationship. Psychologist Carl Rogers identified empathy and two other principles, congruence and unconditional positive regard, as the three essential pillars of his client-centred approach to psychotherapy.

Empathy has recently been enjoying a relative resurgence of interest among researchers and clinicians, owing to its known relationship with disorders such as autism and those on the psychopathic spectrum.

A new study published this week in the journal Current Biology digs down deeper into the conditions under which empathy arises and reveals some interesting findings about the role of 'strangers'.

Student participants were asked to immerse one arm in ice cold water and rate their level of discomfort. These scores remained exactly the same when the task was performed sitting opposite a stranger who was also performing the task. However, when sitting opposite a friend, participants' pain ratings increased, suggesting that familiarity was having a bearing on the results. One of the authors commented:

"It would seem like more pain in the presence of a friend would be bad news, but it's in fact a sign of a strong bond of empathy between individuals - they are indeed feeling each others' pain."

Funnily enough, such findings have already been demonstrated in mice, who experience more pain from a stimulus when being stimulated with 'cage mates' than when being stimulated alone.

Going back to the study at hand, to test the validity of the initial findings, student participants were then paired up with strangers and given the opportunity to play a video game together in advance of the ice water pain stimulus. After just 15 minutes of playing together, the strangers demonstrated empathy towards each other when subjected to the original stimulus.

Aside from the fascinating observation that empathy appears to operate in the same way in both mice and men, this study makes for very interesting psychosocial speculation.

Knowing that the inability to feel empathy is linked to various psychological disorders, we can ask the question: could such findings be used to treat these (often intractable) conditions? Could stimulating friendships and social interaction (in autism, for example) be used as a formal treatment or as part of a treatment approach? Is it even possible to stimulate friendship or must therapeutically valuable friendships arise organically?

At the societal level, does the melting pot of strangers created by open border policy have a dumbing down effect on our collective capacity for empathy? If so (and common sense, if nothing else, tells you there must be something to this), how do we reach out to others and form bonds of friendship in ways that increase our empathy?

Ah, so many questions, so little time. Perhaps you have experience of working with cultivating empathy, either in the one-to-one clinical environment or in the group setting. As ever, we'd welcome your feedback.

Written by Jacqui Hogan