The only ‘parity’ for mental health is that it is being cut and privatised as well

Peter Beresford writes:

Mental health services are amongst the hardest hit by cuts and privatisation. A new Charter suggests how people can build alliances and fight back. 

Image: Phil Hamer

This government has promised that mental health will at last be given ‘parity of esteem’ with physical health.

We need it. We have a psychiatric system still rooted in nineteenth century notions of medicine and ‘science’. Successive governments have failed to drag it into the twenty first century. Psychiatric policy is underpinned by a narrow medical model which service users report is damaging, unhelpful and stigmatising. It is far too reliant on drug treatments which are repeatedly shown to be of limited effectiveness, have problematic ‘side’ effects and give an undue influence and responsibility to ‘big pharma’. ­­

But what is mental health actually getting from government?

Not any new funds – mental health continues to be grossly underfunded.

The latest funding changes have imposed a 20% higher cut on payments to mental health services, than to acute hospitals. Mental health patients are being discharged into B&Bs to free up mental health beds, it was reported this week. And three quarters of local NHS Clinical Commissioning Groups have just announced cuts to already overstretched mental health funds for young people.

In recent years only forensic and compulsory ‘treatment’ have had funding increases – and even this now appears to have been reversed.

Nor does ‘parity of esteem’ seem to mean more ‘person-centred’ care.

Service users call for person-centred support, flexibility and non-medicalised services. They call for user-led out of hours, crisis and peer support provision.

But both councils and the NHS are instead cutting day care, social work, occupational therapy and other valued help. Posts remain unfilled, increasing caseloads for mental health staff.

In fact, the only way in which the Coalition is being even-handed with mental health is in its commitment to privatisation – as strong with mental health as with the rest of the NHS.

Psychiatric services are being outsourced at an accelerating rate. Capita, Virgin Care, Accenture, Reed, G4S and Serco are lining up for lucrative contracts despite a minimal track record in this difficult area. The growing presence of big private sector providers is diverting scarce NHS resources away from frontline support and into corporate profits.

The increasingly privatised services emphasise ‘throughput’ – people receiving short care help rather than long term support. Short term provision and drug interventions are prioritised over longer term talking treatments and the kind of family and social support valued by service users and carers. New managerialist techniques ignore calls from service users and instead talk of ‘care pathways’ and ‘payment by results’ (PbR).

Support is seen as only needed temporarily, until ‘normality’ is restored – ignoring the reality of many people’s situation. Mental health conditions often fluctuate, and people need ongoing help and support to maintain progress.

At the heart of new developments in mental health lies the bright, new, cosy-sounding idea of ‘recovery’. This has been welcomed by some service users. It suggests they will no longer be written off as ‘hopeless cases’, doomed to be damaged – and perhaps damaging – for the rest of their lives. Instead they are offered hope that their problems can be helpfully addressed and they can ‘get their life back’.

But increasingly service users find the officials dealing with them, under pressure from above, are using ‘recovery’ and related terms like ‘reablement’ to mean simply getting people off benefits and into employment – any kind of employment.

As the high profile Campaign to Save Mental Health Services in Norfolk and Suffolk points out, the impact of all of this is devastating.

People in crisis are waiting up to eight hours for an ambulance. Because of cuts in local beds, mental health service users are being sent all over the country, sometimes to costly private hospitals. People are not receiving their personal budgets, a flagship government policy, because of cuts in services. Patients who had remained well with outreach services are now coming back in need of help because these have been cut back.

As local MP and Care Minister Norman Lamb was launching a ‘Mental Health Crisis Care Concordat’ the campaign was highlighting that over a period of five months in 2013, there were 22 unexpected deaths among mental health service users.

It is because of this enduring crisis in mental health services, that the Social Work Action Network (SWAN) has launched its Charter for Mental Health this month at its international conference in Durham

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Borderline Personality Disorder – a feminist critique

Quinn Capes-Ivy wrote in 11/06/10 for the f-word blog:

Among my many diagnoses, I have what is known in the UK as Emotionally Unstable Personality Disorder (Of The Borderline Type), known elsewhere as Borderline Personality Disorder. BPD is described by Wikipedia as “a prolonged disturbance of personality function … characterized by depth and variability of moods.” It manifests in many ways, including rapid cycling mood swings, ‘self-destructive behaviour’, black and white thinking, disassociation and extreme fear of abandonment.

BPD is a serious mental illness and is difficult to diagnose. Unfortunately it is also well-known as being used by psychiatrists and mental health professionals as a way of labelling ‘difficult’ or ‘problem’ patients – I know at least one woman who was threatened with a diagnosis of BPD by a mental health professional because she wouldn’t do as she was told.

Three-quarters of patients diagnosed with BPD are female. I’ve spent some time since my diagnosis wondering why that is, when one would expect the split to be roughly 50/50.

My first thought is that the diagnostic criteria cover much of what is considered to be “stereotypically feminine” behaviour, but to a more extreme level. For example, one of the diagnostic criteria, “Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).” – well, women are supposed to be overly emotional people anyway, right? Another of the criteria is “Frantic efforts to avoid real or imagined abandonment.” We’ve all heard the stereotyped stories of bunny boilers, of women who get pregnant to ‘trap their man’, of women who are controlling and possessive and who are terrified of being alone. Women are supposed to be flighty, unable to control their emotions, and to have trouble navigating their interpersonal relationships.

The second thing I’ve been thinking about is that it’s possible that women get the diagnosis of BPD because some of the diagnostic criteria include things which are considered ‘normal’ for men, but ‘abnormal’ for women. For example, if a woman behaves in an ‘unfeminine’ way, say by expressing extreme anger (another of the diagnostic criteria is “Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)”), the label of BPD is slapped on her by the psychiatrist…

To read the rest of the article, and the interesting comments on it, follow this link

 If you found this article interesting, make sure you take part in The Big Mad Experience (@BigMadTweeter)’s weekly #BigMadChat on Tuesday 29th April 2014 8pmBST/3pmEDT, when we’ll be discussing the social politics of the Borderline Personality Disorder diagnosis!

Dispelling the nightmares of post-traumatic stress disorder

Daniel Freeman and Jason Freeman post for The Guardian Blog:

Treatment for post-traumatic stress disorder can take months, but an intense course may relieve symptoms in just a week

In post-traumatic stress disorder or PTSD, patients repeatedly relive the traumatic event. Photograph: Azhar Rahim/EPA

On Wednesday morning we woke to the news that a passenger ferry had sunk off the coast of South Korea, with at least four people confirmed dead and 280 unaccounted for. Meanwhile, though the search has continued for the missing Malaysia Airlines plane, relatives’ hopes of a safe landing have long since been extinguished.

Human tragedies like these are the stuff of daily news, but we rarely hear about the long-term psychological effects on survivors and the bereaved, who may experience the symptoms of post-traumatic stress disorder for years after their experience.

Although most people have heard of PTSD, few will have a clear idea of what it entails. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) defines a traumatic event as one in which a person “experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others”. PTSD is marked by four types of responses to the trauma. First, patients repeatedly relive the event, either in the form of nightmares or flashbacks. Second, they seek to avoid any reminder of the traumatic event. Third, they feel constantly on edge. Fourth, they are plagued with negative thoughts and low mood.

According to one estimate, almost 8% of people will develop PTSD during their lifetime. Clearly trauma (and PTSD) can strike anyone, but the risks of developing the condition are not equally distributed. Rates are higher in socially disadvantaged areas, for instance. Women may be twice as likely to develop PTSD as men. This is partly because women are at greater risk of the kinds of trauma that commonly produce PTSD (rape, for example). Nevertheless – and for unknown reasons – when exposed to the same type of trauma, women are more susceptible to PTSD than men.

What causes it? In one sense, the answer is obvious: a specific trauma. Yet this is only part of the story, because not everyone who is raped or badly beaten up develops PTSD. Of the contemporary psychological attempts to answer that question, the most influential is the one formulated by the clinical psychologists Anke Ehlers and David Clark at the University of Oxford.

They argue that PTSD develops when the person believes they are still seriously threatened by the trauma they have experienced. Why should someone assume they are still endangered by an event that happened months or even years previously? Ehlers and Clark identify two factors.

First is a negative interpretation of the trauma and the normal feelings that follow, for example believing that “nowhere is safe”, “I attract disaster”, or “I can’t cope with stress”. These interpretations can make the person feel in danger physically (the world seems unsafe), or psychologically (their self-confidence and sense of well-being feel irreparably damaged).

Second are problems with the memory of the trauma. Partly because of the way the person experiences the event, the memory somehow fails to acquire a properly developed context and meaning. As a result, it constantly intrudes. Ehlers and Clark liken the traumatic memory to “a cupboard in which many things have been thrown in quickly and in a disorganised fashion, so it is impossible to fully close the door and things fall out at unpredictable times”…

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Student Expelled From King’s College London University ‘For Failing To Prove She Was Depressed’

File picture | Johner Images via Getty Images

Indigo Ellis writes for The Huffington Post UK:

A former student at King’s College London has claimed she was expelled for not being able to provide sufficient evidence she was depressed after falling behind with her work.

Jane* says the university “failed and humiliated” her and spoke out to criticise the lack of support and insensitivity she suffered through a period of depression which she says eventually led to her expulsion in 2012.

The former student highlighted King’s inability to support her pastorally, and felt let down by her personal tutor and university counsellors – the support systems in place for incidents of this type.

Having being severely depressed prior to and after a serious operation, Jane failed an assignment by a single mark. Her place on her course was terminated and appeals denied after the written evidence of her illness was deemed “inappropriate”. The university claimed the letters she provided from her GP and counsellor were insufficient in explaining the failure of the assignment as they covered the wrong dates.

Jane visited a university counsellor but says they did not provide any help, simply telling her she came from a “dysfunctional family”. Her personal tutor, another supposed point of support for students pastorally, was similarly unhelpful.

The former student told The Huffington Post UK she had finally found the confidence to speak out about her experience, saying KCL failed to give her the “key ingredient to success – support”.

“In 2012, I underwent a very serious operation which left me distraught and depressed,” she said. “Unaware as to the extent of my mental illness, I fell behind with one assignment and my place on the course was terminated. It was too late to prove my mental health issues once I had been kicked to the curb; they requested evidence to ‘prove’ that I had had depression, they said that the evidence that I had provided was ‘not enough’…

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*Jane’s name has been changed to protect her anonymity.

‘Suicide Prevention Sheds a Longstanding Taboo: Talking About Attempts’ – The New York Times

Dese’Rae L. Stage, a photographer and writer living in Brooklyn, tried to kill herself in 2006. She has since created an online photo exhibit of people who have also survived suicide attempts and is among the dozens whose stories are becoming known on Internet forums and through social media.

Benedict Carey writes for The New York Times:

The relationship had become intolerably abusive, and after a stinging phone call one night, it seemed there was only one way to end the pain. Enough wine and pills should do the job — and would have, except that paramedics barged through the door, alerted by her lover.

“I very rarely tell the story in detail publicly, it’s so triggering and sensational,” said Dese’Rae L. Stage, 30, a photographer and writer living in Brooklyn who tried to kill herself in 2006. “I talk about what led up to it, how helpless I felt — and what came after.”

The nation’s oldest suicide prevention organization, the American Association of Suicidology, decided in a vote by its board last week to recognize a vast but historically invisible portion of its membership: people, like Ms. Stage, who tried to kill themselves but survived. About a million American adults a year make a failed attempt at suicide, surveys suggest, far outnumbering the 38,000 who succeed, and in the past few years, scores of them have come together on social media and in other forums to demand a bigger voice in prevention efforts.

Plans for speakers bureaus of survivors willing to tell their stories are well underway, as is research to measure the effect of such testimony on audiences. For decades, mental health organizations have featured speakers with schizophrenia, bipolar disorder and depression. But until now, suicide has been virtually taboo, because of not only shame and stigma, but also fears that talking about the act could give others ideas about how to do it.

“This is a real shift you’re seeing,” said Heidi Bryan, 56, of Neenah, Wis., who has been speaking for years about suicide attempts she made in the 1990s. “For people working in suicide prevention, they always told us not to talk about our own experience, like they were afraid to tip us over the edge or something. Honestly, we’re the ones who know what works and what doesn’t.”…

To continue reading this article, follow this link.

‘Suicide Prevention Sheds a Longstanding Taboo: Talking About Attempts’ – The New York Times

Dese’Rae L. Stage, a photographer and writer living in Brooklyn, tried to kill herself in 2006. She has since created an online photo exhibit of people who have also survived suicide attempts and is among the dozens whose stories are becoming known on Internet forums and through social media.

Benedict Carey writes for The New York Times:

The relationship had become intolerably abusive, and after a stinging phone call one night, it seemed there was only one way to end the pain. Enough wine and pills should do the job — and would have, except that paramedics barged through the door, alerted by her lover.

“I very rarely tell the story in detail publicly, it’s so triggering and sensational,” said Dese’Rae L. Stage, 30, a photographer and writer living in Brooklyn who tried to kill herself in 2006. “I talk about what led up to it, how helpless I felt — and what came after.”

The nation’s oldest suicide prevention organization, the American Association of Suicidology, decided in a vote by its board last week to recognize a vast but historically invisible portion of its membership: people, like Ms. Stage, who tried to kill themselves but survived. About a million American adults a year make a failed attempt at suicide, surveys suggest, far outnumbering the 38,000 who succeed, and in the past few years, scores of them have come together on social media and in other forums to demand a bigger voice in prevention efforts.

Plans for speakers bureaus of survivors willing to tell their stories are well underway, as is research to measure the effect of such testimony on audiences. For decades, mental health organizations have featured speakers with schizophrenia, bipolar disorder and depression. But until now, suicide has been virtually taboo, because of not only shame and stigma, but also fears that talking about the act could give others ideas about how to do it.

“This is a real shift you’re seeing,” said Heidi Bryan, 56, of Neenah, Wis., who has been speaking for years about suicide attempts she made in the 1990s. “For people working in suicide prevention, they always told us not to talk about our own experience, like they were afraid to tip us over the edge or something. Honestly, we’re the ones who know what works and what doesn’t.”…

To continue reading this article, follow this link.

Are we using antidepressants to paper over the cracks of a fractured society?

Frankie Mullin writes for The Guardian:

Use of antidepressant drugs has become more common than ever before. Perhaps it’s time that we looked at the wider causes of this trend

More than 50m prescriptions for antidepressants are written in the UK every year. Photograph: Alamy

 

The chances are that you know someone who takes antidepressants. Or maybe you take them yourself. If so, you are in good company. More than 50m prescriptions for antidepressants are written in the UK every year and, although the not all of the pills will be swallowed – taking into account repeat prescriptions and failure to collect from pharmacies – the figure is still staggeringly high.

There’s a positive side to the 50m statistic, though. It suggests that as the stigma has decreased, people have become more willing to ask for help. And, for many, antidepressants work. However, while professionals are quick to acknowledge the benefits – which can be life-saving – many express concern about our growing dependence.

“Prescription levels have gone through the roof,” says Dr Matthijs Muijen, head of mental health at WHO Europe. “On the demand side, people know antidepressants work. I would even argue there’s a degree of fashion about antidepressants. On the supply side, antidepressants have become cheaper and more easily available. Doctors now know it’s easy and ‘good’ to prescribe.”

Key to arguments around antidepressant use are questions about what constitutes “normal” sadness and where the boundary lies between this and clinical depression. There is no cut-and-dried answer, and this ambivalence around the use of antidepressants seems to be characteristic of those taking them. “It’s not ideal, but I just make use of the resources available,” is a characteristic response.

Lisa Cunningham, 45, was signed off on sick leave and prescribed Prozac after suffering problems at work. Soon afterwards, she was attacked, leaving her with facial injuries and even deeper depression. For nearly 11 years, Lisa remained on medication, becoming steadily more withdrawn, until she barely left the house.

Cunningham’s story has a positive outcome: after being referred to a volunteering scheme by her GP she got involved in a gardening project which led to a full-time job. She then felt able to stop taking her medication. “Antidepressants did a vital job and I definitely think I had clinical depression,” Cunningham says. “But I was a nervous, anxious child.” She explains that while growing up, she was subjected to physical aggression from people close to her, “so it was almost inevitable I’d get depression. Looking back, it would probably have been better if I’d had some sort of psychotherapy in school.”…

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Ketamine ‘exciting’ depression therapy

The illegal party drug ketamine is an “exciting” and “dramatic” new treatment for depression, say doctors who have conducted the first trial in the UK.

Ketamine offers an avenue of research into a field that has struggled to find new treatments for depression

James Gallagher reports for BBC News:

Some patients who have faced incurable depression for decades have had symptoms disappear within hours of taking low doses of the drug.

The small trial on 28 people, reported in the Journal of Psychopharmacology, shows the benefits can last months.

Experts said the findings opened up a whole new avenue of research.

Depression is common and affects one-in-10 people at some point in their lives.

Antidepressants, such as prozac, and behavioural therapies help some patients, but a significant proportion remain resistant to any form of treatment.

A team at Oxford Health NHS Foundation Trust gave patients doses of ketamine over 40 minutes on up to six occasions.

Eight showed improvements in reported levels of depression, with four of them improving so much they were no longer classed as depressed.

Some responded within six hours of the first infusion of ketamine.

Lead researcher Dr Rupert McShane said: “It really is dramatic for some people, it’s the sort of thing really that makes it worth doing psychiatry, it’s a really wonderful thing to see.

He added: “[The patients] say ‘ah this is how I used to think’ and the relatives say ‘we’ve got x back’.”

Dr McShane said this included patients who had lived with depression for 20 years…

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Has cognitive behavioural therapy for psychosis been oversold?

CBT is a recommended treatment for schizophrenia in the UK, but how strong is the evidence that it works? Keith Laws suggests it’s not as strong as we might hope.

The evidence for cognitive behavioural therapy to treat psychosis is not as strong as guidelines might make you think, according to Keith Laws. Photograph: Alamy

In 1952, the same year that chlorpromazine was introduced as the first effective drug treatment for schizophrenia, Aaron Beck first employed a form of cognitive-based talk therapy to treat delusional thinking. While chlorpromazine inaugurated the era of drug treatments in psychiatry, Beck’s psychological alternative was a slow-burner. Cognitive Therapy or Cognitive Behavioural Therapy (CBT), as we now know it, became part of the mainstream treatment for psychosis in the UK in 2002 when the National Institute of Clinical Excellence (NICE) endorsed it; and again in 2009, they further recommended that CBT be offered “to all people with psychosis or schizophrenia.” Despite repeated endorsements by this Government agency, is it possible that CBT for psychosis has been oversold?

NICE, along with almost everyone else nowadays, ‘takes stock’ of the results of clinical trials by using the quantitative technique of meta-analysis. This allows findings of different trials to be mathematically summed, giving more weight to larger (and usually methodologically more rigorous) trials. Notably the dozen meta-analyses of trials investigating CBT for schizophrenia document the shrinking evidence for its effectiveness on symptoms. Although initial meta-analyses optimistically suggested that around 50% of patients showed significant symptom reduction following CBT, more recent meta-analyses estimate that just 5% benefit significantly when compared to controls…

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Thich Nhat Hanh: is mindfulness being corrupted by business and finance?

The Zen master discusses his advice for Google and other tech giants on being a force for good in the world

Jo Confino writes for The Guardian:

Mindfulness has become an increasingly popular topic among business leaders, with several key executives speaking publicly in recent months about how it helps them improve the bottom line.

Intermix CEO Khajak Keledjian last week shared his secrets to inner peace with The Wall Street Journal. Arianna Huffington, editor in chief of the Huffington Post, discussed mindfulness in Thrive, her new book released this week. Other business leaders who meditate include Aetna CEO Mark Bertolini, Salesforce.com CEO Marc Benioff and Zappos.com CEO Tony Hsieh, to name just a few.

In a blog post last month, Huffington wrote that “there’s nothing touchy-feely about increased profits. This is a tough economy. … Stress-reduction and mindfulness don’t just make us happier and healthier, they’re a proven competitive advantage for any business that wants one.”

But by focusing on the bottom-line benefits of mindfulness, are business leaders corrupting the core Buddhist practice?

Thich Nhat Hanh, the 87-year-old Zen master considered by many to be the father of mindfulness in the west, says as long as business leaders practice “true” mindfulness, it does not matter if the original intention is triggered by wanting to be more effective at work or to make bigger profits. That is because the practice will fundamentally change their perspective on life as it naturally opens hearts to greater compassion and develops the desire to end the suffering of others.

Sitting in a lotus position on the floor of his monastery at Plum Village near Bordeaux, France, Thay tells the Guardian: “If you know how to practice mindfulness you can generate peace and joy right here, right now. And you’ll appreciate that and it will change you. In the beginning, you believe that if you cannot become number one, you cannot be happy, but if you practice mindfulness you will readily release that kind of idea. We need not fear that mindfulness might become only a means and not an end because in mindfulness the means and the end are the same thing. There is no way to happiness; happiness is the way.”

But Thay, as the Zen master is known to his hundreds of thousands of followers around the world, points out that if executives are in the practice for selfish reasons, then they are experiencing a mere pale shadow of mindfulness.

“If you consider mindfulness as a means of having a lot of money, then you have not touched its true purpose,” he says. “It may look like the practise of mindfulness but inside there’s no peace, no joy, no happiness produced. It’s just an imitation. If you don’t feel the energy of brotherhood, of sisterhood, radiating from your work, that is not mindfulness.”….

To read the rest of this article for The Guardian, follow this link