How should you give your clients a say in the design of mental health services?

CQC guidance should inspire providers to change their ways, but it’s easy to overlook the real needs of service users

The Care Quality Commission’s recent statement, Putting people first, tells us how it will increase the involvement of service users in the design of its services. Mental health care providers could use the CQC’s statement to inform their own involvement strategies, provided the gaps between policy and practice are bridged.

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Parity of esteem for mental health is essential

Mental illness accounts for nearly half of disease among under-65s but only 26% of adults with problems receive care

The case for much greater focus on mental health is articulated in an LSE report – How Mental Illness Loses Out In The NHS – published in June 2012. It showed that, among people under 65, nearly half of all ill health is mental ill health: 17% of adults and 10% of children experience mental health problems. The report also shows that mental health problems are generally more debilitating than most chronic physical conditions. For example, on average, a person with depression is at least 50% more disabled than someone with angina, arthritis, asthma or diabetes. Mental illness also accounts for nearly 40% of disease – morbidity – compared to 6% for cardiovascular disease; 3% for cancer; and 2% for diabetes. This chimes with other evidence, including mental distress accounting for nearly half of all absenteeism at work and nearly half of all incapacity benefit. In looking at mortality we talk much these days of the malign impact of smoking and obesity – the two modern-day killers – but mental health problems have the same effect on life expectancy as smoking and a much higher impact than obesity.

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Eating disorders can affect people of any age and from any background

“11th February marked the start of Eating Disorder Awareness week organised by eating disorder charity B-eat.  This year’s theme “Everybody knows somebody “ aimed to increase awareness of eating disorders which affect some one and a half million people in the UK, as well as to counter stereotypes that eating disorders only affect young girls.

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Sick cities: why urban living can be bad for your mental health

…a group of researchers at Hammersmith hospital, in London, are among many who believe that dopamine could hold the answer. Dopamine is a neurotransmitter with many functions, one of which is to infuse your brain when something important – good or bad – is happening. It might be that you are tasting an ice cream and your body wants you to eat the lot while you can, or it might be that a volcano is erupting and your body wants you to find your car keys nice and promptly. Dopamine levels are often very high in parts of schizophrenic peoples’ brains.

“How we explain that at the moment,” says one of the researchers, Michael Bloomfield, “is If there’s just a car going past your house, normally your dopamine cells wouldn’t fire, because it’s just a car. But if your dopamine cells are firing, your brain will try and make sense of it. It will seem to say there’s something very important about that car, then your brain will try to process that and, depending on your experience and your culture, it might jump to the conclusion that it was MI5 following you around.”

Cities, the theory goes, might be part of the reason why a person’s dopamine production starts to go wrong in the first place. Repeated stress is thought to lead to this problem in some people, so if high social density combined with social isolation could be shown to do so, and thus to alter the dopamine system, we might have the first rough sketches of a map from city living all the way to schizophrenia, and perhaps other things.

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Should we be mindful of mindfulness?

It has been prescribed by the NHS for depression since 2004 but recently mindfulness has spawned a whole industry of evening classes and smartphone apps. What is the evidence that the practice – part meditation, part CBT – works?

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“A lot of people think it will cure everything. But we know there is nothing that cures everything. There is some interesting work in psychosis, bipolar disorder and schizophrenia but it’s in its early days. There’s a lot of hype around mindfulness and we need to be cautious because it doesn’t serve our science or patients well if we’re overenthusiastic. We have to make sure the science catches up with the enthusiasm.” – Professor Mark Williams

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WITHOUT YOU THERE IS NO ME: An interpersonal framing of psychosis

The general aim of this thesis was to explore experiences of interpersonal relationships of individuals with psychotic disorders and to explore patients’ understanding of their symptoms. The four studies covered different aspects and perspectives relevant to understanding the interpersonal context and its possible associations with psychosis. The aim of Study I was to explore how individuals with psychosis experience their early relationships with caregivers and how they describe themselves as children. The study was based on interviews with 7 men and 5 women (aged 29 to 63 years). Caregivers were portrayed as sexually, physically, and/or emotionally abusive, often in combination with a non-abusive caregiver described as resigned and passive. The childhood strategies such as daydreaming and ‘trying to become invisible’ that emerged resemble recognized childhood signs of psychotic disorders. In Study II, the aim was to explore how individuals with psychosis make sense of the content of their psychotic symptoms. The study was based on the same interviews used in Study I. A consistent theme in the participants’ understanding of the content of their psychotic symptoms was either an absence of interpersonal relationships or relationships described as abusive or intrusive. The aims of Study III were to compare the distribution of attachment styles in patients with psychosis with that in the general population and to investigate the relations between attachment and symptoms in the psychosis group. The study group consisted of 47 individuals (30 males and 17 females) with a mean age of 43.02 years. As expected, the secure attachment style was underrepresented in the study group compared with the general population group, and dismissing and fearful attachment styles were overrepresented in the clinical sample. The results also showed significant positive correlations between preoccupied attachment and severity of symptoms. In Study IV, the aim was to explore mental health professionals’ perceptions of parents of patients with psychosis. Participant observations were conducted during team meetings at a psychiatric care unit specializing in patients with psychosis. In the analysis, a complex and multifaceted image emerged of parents as seen by mental health professionals. Some parents were described as a helpful resource, but others were thought to hinder treatment, or to cause the patient emotional pain. Other parents were described as neglectful or abusive. In sum, this thesis shows that knowledge of interpersonal relationships could be valuable for understanding the early signs and adult symptoms of psychosis. These findings may be important to consider both in individual treatment and in treatment focusing on family interventions.

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Psychotic traits in young linked to changing schools

Children who have repeatedly moved schools may be more likely to develop psychotic-like symptoms as young teenagers, a study has found.

Researchers said children that had moved schools three times or more before the age of 12 were 60% more likely to develop at least one psychotic symptom as young teenagers.

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Our brains: predictably irrational – TED playlist

The 3 pounds of jelly in our skulls allow us to reflect on our own consciousness — and to make counterintuitive, irrational decisions. These talks explore why.

TED has curated a playlist of 11 talks exploring “irrational” decisions.  They are:

  1. Michael Shermer: Why people believe weird things
  2. Dan Ariely: Beware conflicts of interest
  3. Barry Schwartz: The paradox of choice
  4. Dan Dennett: The illusion of consciousness
  5. Dan Ariely: Are we in control of our own decisions?
  6. Tali Sharot: The optimism bias
  7. Daniel Kahneman: The riddle of experience vs. memory
  8. Peter Donnelly: How juries are fooled by statistics
  9. Daniel Goldstein: The battle between your present and future self
  10. Sheena Iyengar: The art of choosing
  11. James Randi: Homeopathy, quackery and fraud

To watch any or all of these talks, follow this link