Welcome to Mind's blog
Each week we'll be posting items on a whole range of topics relating in some way to mental health. We hope to stimulate debate and get you thinking about mental health and Mind's work in a new way.
We welcome comments and questions on our posts, but have a few ground rules to keep the site welcoming and interesting to every body. The first rule is the most important: be respectful of other commenters and bloggers. Read the rest of our comments policy.
Please note that some blog posts may not reflect official Mind policy.
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19 February 2010
Do TV hospital dramas reflect reality?To what extent do TV hospital dramas reflect reality? Not much, according to Antony Sumara from Mid-Staffordshire NHS Foundation Trust. He particularly targets BBC dramas, but I doubt they are alone in ignoring good practice, patient confidentiality and attention to hygiene in the search for a gripping storyline, as he claims. Perhaps writers don’t feel that an episode of someone waiting for treatment or extolling the virtues of hand washing will draw those viewers in.
How well versed are you in what you can expect from your hospital stay? Every local NHS organisation is expected to produce a guide to local services and deliver that to all households in their area. This one is from Milton Keynes (PDF).
Have you read the NHS Constitution so you know which waiting times have been enshrined within it – no longer than four hours in A&E, for example? The constitution says that you have a right to be treated with a professional standard of care, though to be fair it doesn’t explicitly say that staff shouldn’t be sorting out their love life in corridors when they’re not treating you.
Bridget O'Connell, Head of Information
4 Comments -
17 February 2010
Services for servicemenI’m angry. I’ve just finished reading another article on the armed forces. In this one, the story revolves around the "fact" that women are "more likely to suffer mental problems" than their male colleagues. After spending over a year working on Mind’s Men and Mental Health campaign, I’m smarting at this statement.
›› Attend our free conference on men and mental health.
›› Tell us your thoughts on how the mental health needs of men can be met.It’s not that men are less likely than women to experience mental distress; it’s that men are much less likely to seek help for it. It’s just this kind of approach – only looking at the figures and not the reasons behind them – that leads to services not adequately meeting the needs of its users.
But that’s not all that I’m angry about. Whatever your political point of view, I imagine that we can all agree that the human cost to our servicemen and women as a result of the wars in Iraq and Afghanistan has been devastating. At time of writing, the wars have taken the lives of 440 UK troops and left many more injured. But this is not the half of it. What about the injuries that aren’t so visible? Taking into account the stress they are put under, it’s unsurprising that many servicemen and women experience some form of mental distress, post-traumatic stress disorder in particular.
And so we come to the source of my frustration. Despite the mental trauma military personnel experience, there is only one main specialist mental health organisation in the whole of the UK for ex-services personnel - Combat Stress. In 2008 alone they worked with 2,500 ex-services personnel, of which 1,160 were new cases. And figures from the charity suggest that the rate of mental distress among veterans is rising.
Although Combat Stress provides an amazing amount of support to a large number of people, they cannot and should not be responsible for all ex-services personnel. But other services just aren’t always available.
Things are so bad that even some of the Army’s brightest starts have criticised the government’s treatment of ex-soldiers. Last year, Lance Corporal Johnson Beharry, the most decorated soldier in the British Army, spoke out last year about the “disgraceful” treatment of soldiers experiencing mental distress. And only last week another ex-soldier came forward to denounce the ‘complacent attitude’ shown to veterans that end up in the prison system.
Things may be about to change. In January, the Government announced plans to improve NHS care for veterans and said that this would include mental health services. Perhaps this is only lip service. But, even if something is delivered, steps to improve treatment for veterans will only succeed if the particular needs of soldiers – and the needs of men (the majority of ex-services personnel are male) – are properly taken into account. Without such consideration, these plans really could be too little, too late.
Mariam Kemple, Policy and Campaigns Officer
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12 February 2010
Is the medical model really so evil?A guest post by Zarathustra of the Mental Nurse blog.
Before I became a mental health nurse, I spent a few years as an over-educated, unemployable humanities graduate - hey, I'm not knocking that; being an over-educated, unemployable humanities graduate can be a lot of fun.
I also had quite firm views on psychiatry. I was a huge fan of RD Laing, the radical 60s psychiatrist. I'd tell anyone who would listen that psychiatric diagnoses are a subjective construct, that drugs aren't the answer, and that the medical model of mental illness is irredeemably reductionist (yes, I was the kind of humanities graduate for whom "reductionist" is the ultimate word of abuse).
Comparing these views with what I think now, I get the impression my younger self would be rather disappointed in me. Admittedly I haven't changed my views entirely. I still think there are problems with some forms of psychiatric diagnoses, and these problems are inevitable due to their subjective nature. I still regard the psychosocial aspects of mental health as absolutely vital, and I still regard the drug reps as servants of Beelzebub.Even so, I also now think the medical model has its merits as well as its flaws. Diagnostic categories do seem to have some usefulness and validity, and psychiatric medication can at times work wonders. The twentysomething, BA-educated version of me would shake his head in sorrow.
So, what's changed my mind on the medical model? Well, the most obvious answer would be that I went into the belly of the beast and trained as a mental health nurse. Certainly cold, hard clinical experience has had a lot to do with it. I can't swan around saying that the drugs don't work, because all too frequently they do work. Admittedly the meds work haphazardly, and sadly all too often with unpleasant side effects, but the bottom line is I've seen too many people benefit from medication to be able to dismiss those benefits.
Crucially though, the people who've most effectively challenged my previous hostility to the medical model have been patients rather than doctors.I have a friend with bipolar disorder who's also a very intelligent, independent-minded lady. Not the sort to be brainwashed by an evil cabal of shrinks and Big Pharma. She's tried yoga, mindfulness, CBT, person-centred counselling...all of which have had some benefit, but she's also learned to her cost that, unless she takes the meds, all those benefits are immediately cancelled out. Her response to anti-psychiatry is to angrily insist, "Look, I don't have a problem in living, or a social construct, or an existential crisis. I have an illness which is called bipolar disorder, for which I take medication."
"Your diagnosis is this, and we're going to treat it like this" is an explanation that works for a lot of a people. Those people shouldn't be hectored on how they're dupes of the medico-pharmaceutical complex simply for finding the medical model helpful.While much has been written on how psychiatric diagnosis can label and stigmatise people, you can also demean, belittle and patronise people by telling them they don't have an illness, and that it's all just a social construct/problem in living/spiritual crisis.
Of the anti-psychiatric authors, Thomas Szasz in particular writes with an unpleasant moralistic tone that reeks of, "You could just snap out of it and pull yourself together if you really wanted to."
Ultimately though, any argument about, say, "medical model" versus "psychosocial model" shouldn't be an either/or issue. It's perfectly possible to make use of diagnosis and medication while also taking into account psychological and social issues. And yes, while also being aware of the political and philosophical controversies that psychiatry generates.Any model of psychiatry, be it medical, psychosocial, existential, social contructivist etc, describes an aspect of the truth from one particular angle. We need to be able to move between the models as and when they become useful, rather than loudly privilege one model while denouncing the others.
Speaking of models, a consultant psychiatrist I know has a fondness for saying that we follow an "ecobiopsychosocial model". I'm gagging for him to say it to me so I can quip back, "That's easy for you to say."Zarathustra
45 Comments -
25 January 2010
Why I love being an inpatientA guest post by Marion Janner, founder of the Star Wards project
Hmm. Perhaps the only uncontroversial words in the heading are those with a character count below 4. That’s 3 of them (I’ve just started ‘tweeting’ on Twitter and am now obsessed with character count as each tweet has to be haiku-like petite, under 140 characters. I usually find it hard to express myself in under 140 minutes).
Anyway, returning to my own character, it’s been totally fucked over in the last seven years by the explosion of borderline personality disorder. BPD is actually as common as schizophrenia but most people have never heard of it. I hadn’t until many months after I became inexplicably hyper-depressed and started, completely bewilderingly, self-harming as a way of managing extreme plunges in mood (I go on and on about this in my website Mentalising). And when my partner of 20 years walked out on me, a month after our civil partnership ceremony and having forgotten to mention her plans to me, the suicidality started.
You might be familiar with OCD-type compulsions – hand-washing, germ-avoidance, safety rituals. My compulsion to kill myself is broadly similar. Although obviously with the opposite intention in terms of life preservation. It’s pretty exhausting (not least for my extensive team of therapists) trying to contain this force and all gets very messy when I decide to take an overdose as a way of flirting with death and simultaneously gaining a sense of being able to control my destiny when I sheepishly land in A&E to get the overdose reversed.
So. The chance of a break from having to internally manage my self-demolition urges is irresistible. Butlins is great, what with all the entertainment, slot machines and good grub, but it’s a lot to ask them to manage my suicidality. Whereas my lovely local, St Ann’s in Tottenham, may not have the slot machines, but they do lock me in and remove all tolerable methods of disposing of myself. Such a relief.
I’m a bit of a regular at St Ann’s, and the familiar staff team greet me with hugs and welcomes, perhaps temporarily forgetting that I’m a nightmare patient for them. For example. I’m 4’9” so not very tall, but while being ‘specialed’ via 1:1 staff with me 24/7, I’ve still managed to unscrew a lightbulb from the ceiling and use it to self-harm. All very David Blaine and presumably infuriating for staff. Yet they manage to respond to my relentless self-destructiveness with patience, understanding, non-judgementalness (?) and to use an old-fashioned term – compassion.
I love it there. I don’t need to worry about work or my weird eating nonsense or looking after my foster sons or (not) answering the phone or writing blogs or going to meetings or acting cheerful. I know from my work running the Star Wards project that St Ann’s is scarcely in the Premier League of hospitals, indeed it’s going to be knocked down and replaced. But it has exactly what I need, and what my friends and family need, to keep me safe and provide a little break from the overwhelming task of keeping it all together. There are very few days when I’d rather be at home than in hospital.
Marion Janner
Marion was awarded an OBE for services to mental health care in the New Year Honours list 2010.
20 Comments -
14 January 2010
Are antidepressants helpful for only severe depression?Making the news in the USA is research that indicates that mild and moderate depression are not lifted by antidepressants, which are only useful for severe depression (though the research methodology has come in for some critcism).
The research concludes that if a person experiences mild or moderate depression then medication should be just one of the options available.
This side of the pond, National Institute for Health and Clinical Excellence (NICE) guidelines already states that antidepressants should not be the first choice in treating mild depression but may be of use for people with a past history of moderate or severe depression.
Of course guidance and practice aren’t always in step and it was reported last year that prescriptions for antidepressants are on the rise and recently that GPs prescribe antidepressants even if they feel another treatment might be more beneficial as that treatment is not as readily accessible.
The government had pledged £173 million towards mental health care. The Improving Access to Psychological Therapies (IAPT) scheme is designed to combat the reliance on prescribing medication for mental distress by offering accessible alternatives. There is some uncertainty over how the scheme is faring, with reports late last year that it has experienced difficulties, including only 400 of the required 3,600 therapists trained, although IAPT disputes this figure and other aspects of the article.
With any luck headlines about the best treatment options for depression and will strengthen the government’s resolve to keep supporting a wide range of treatment options for the millions who experience depression and other mental health problems.
Bridget O'Connell, Head of Information
3 Comments -
18 November 2009
Social care: saving the state moneyOver the past month I've been interviewing people about their experiences of social care services, to inform Mind's response to the social care Green Paper.
It's really opened my eyes to how vital these services are to supporting people with mental health problems to stay well and live independently in the community, and to preventing crises.
But at the moment far too few people with experience of mental distress are entitled to access social care. Those who do receive services often find they are not flexible enough to fit round their needs, or they are not offered a choice of services, due to pressures on the public purse.
One person I spoke to was refused an art therapy evening class costing just £80 for the whole term, because she was already doing a vocational training course for two days a week, and her social worker said she could only have one thing at once.
To me, this approach is misguided. We all know that because of the recession there are greater pressures on public spending than ever before. But investing in preventive social care services now will save the state money in the long run, helping people with mental health problems towards recovery and reducing the need for expensive crisis care interventions. A smart Government will take this forward in its proposals for a future social care system.
Amy Whitelock, Policy and Campaigns Officer
Read more on Mind's response to the Green Paper
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5 October 2009
The elderly are the happiest...but badly servedThe Telegraph recently reported that the elderly are generally mentally healthier than younger people. This is apparently explained in part by their living for the present and not worrying about the future. In a past worklife, I worked for Help the Aged and we spent a lot of our time trying to publicise the fact that many people can and do have a very active, fulfilling and happy later life.
However, the images of a 'silver surfer' generation living in retirement bliss - relaxed happiness with a yacht here and a Spanish villa there - do not hold true for the entire elderly population. In stark contrast, one in four older people have symptoms of depression severe enough to warrant intervention. But even more worrying is the fact that people over 75 are sixteen times - sixteen! - less likely to be asked about suicidal thoughts than young adults.
Why the shocking disparity? Ageism clearly plays a large part, with many wrongly believing that depression is a natural part of the ageing process. A survey by the British Geriatric Society found that over half of respondents believed the NHS is institutionally ageist. The fact that this came from doctors specialising in the treatment of older people makes the findings all the more upsetting - they really know what they're talking about.
The consequences of older people not getting proper care can be fatal. In particular, suicide rates for older men are very high. This is often blamed on the isolation that many older men experience. Around 500,000 older men live alone and, sadly, one in five people with an elderly father is not in contact with him. Mind's Men and Mental Health campaign highlights the need to make mental health services more male friendly.
Something needs to change. Services need to take the needs of older people into account and not pass their symptoms off as 'old age'. Who knows, perhaps universal 'retirement bliss' - Spanish villa included - could become a reality for the future!
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Mariam Kemple, Policy and Campaigns Officer -
22 September 2009
Gordon - keep your prescription promise!As the country begins to gear up for the Labour Party Conference, it's a good time to look back at what's happened since the last conference in 2008. Exactly one year ago, Gordon Brown vowed to scrap prescription charges for all people with long term conditions. This was received as a great step forward.
For years, charities, pressure groups and service users have been calling for this very thing. With the prescription charge constantly rising, many people find their burden just too much. In fact, around 800,000 people a year fail to collect their prescriptions simply because of the cost. As one Mind supporter says:
I've often had to stretch out medications or self-medicate because I can't afford another prescription. Or I don't take medications designed to off-set the adverse effect of other medications because I can only afford one prescription.
Obviously, medication is not the best treatment for everyone, but when a person does feel it will be beneficial it is simply unjust that they can be prevented from doing so because of the cost. That's why Mind is part of the Prescription Charges Coalition that is calling on prescription charges for all those with long term conditions to be eliminated as a matter of urgency.
A whole year has already gone by and the hundreds of thousands of people with long term conditions still have to pay an ever rising prescription charge. Visit Prescription Promise website today to sign our petition asking Gordon Brown to keep his promise.
Find our more on this issue by visiting our Prescription charges page.
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Mariam Kemple, Policy and Campaigns Officer -
22 September 2009
The Bournemouth effect?The party conference season traditionally kicks off with the Lib Dems, this year in Bournemouth. This is a good conference venue - sea air, pleasant walks and friendly people. Or so we thought....
The Time to Change roadshow was in town talking mental health to conference delegates and members of the public, in the main shopping area just outside Debenhams. Many people the team spoke to were happy to see us. But some just scowled, and a few came up to the stand to tell us why there isn't enough discrimination against people with mental health problems. If ever we needed a reminder why we have to stand up for mental health, and the work still to do, here it was.
Inside the Conference, we had a friendlier welcome. This year, all parties are preparing for a General Election, and our job is to ensure that mental health gets a high profile as manifestos get written. The Lib Dems have a good understanding, and their Shadow Health Secretary is a terrific advocate for mental health. Norman Lamb is also a rock music impresario-he mortgaged his house to invest in his son's music business, and they've now signed up cool grime artist Tinchy Stryder. Norman is now seen as an unlikely equivalent of Simon Cowell and disappeared after our meeting to review Mika's new album.
But there's a catch - there's no money. Even Vince Cable, Britain's most trusted politician and hot favourite for Strictly Come Dancing 2010, warned in his speech that some of the issues he's campaigned for, including mental health, may have to wait for new investment.
So the word of the Conference is reprioritisation. We (and others) will have to make a strong case for the prioritisation of mental health over other issues. So where do we start - Trident, ID cards, other parts of the NHS? Your thoughts are welcome-it's going to be a bumpy ride....
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Paul Farmer, Chief Executive -
17 September 2009
Why the wellbeing of NHS staff is so importantSo, NHS staff take the more sick days than anywhere else in the public sector? Anyone who has had any experience with the day to day running of NHS services can't be that shocked by this.
Growing up in a household of medic parents, I know the stress that these professions can entail. I imagine that if I told my mum that a quarter of NHS staff go off sick due to stress, depression and anxiety, she would simply look a bit baffled and reply "Surely stress, depression and anxiety are part of the job?!"
Speaking with people who use NHS mental health services over the last few months, as we consult on the Department of Health's plans for New Horizons, the next 10 year strategy for mental health, the issue of NHS staff wellbeing keeps cropping up.
The general opinion is that there are some great people working in mental health services but too many of them just aren't treated properly. Instead, they can be overworked and left with little support of their own. The resulting absenteeism then goes on to have a very negative effect on clients who, even in a crisis, are told that their psychiatrist isn't available or that their community psychiatric nurse will be changing for the umpteenth time. In fact, more than 80 per cent of NHS staff questioned admitted that their health affected the quality of care they gave to patients.
Users of NHS services deserve better continuity with mental health professionals who are well enough to provide the right care, and mental health professionals deserve a better working environment that practices what it preaches.
As the Department of Health begins to draw up plans to improve wellbeing across the whole population, let's hope they remember the needs of their own. You can have your say on the Department of Health's plans for New Horizons.
Mariam Kemple, Policy and Campaigns Officer
3 Comments -
28 August 2009
Can pets improve your mental health?Conversations about cats seem to be all the rage at Mind at the moment. No, we're not expanding our remit; staff and volunteers who are proud pet owners are discussing the latest in pet psychology books.
From my point of view, it is animals or pets as therapy for either physical or mental health issues that is the topic, whether it be the option to get a dog in Lewisham using your individual budget care allowance or swimming with dolphins to cure depression.
Read a little closer, and of course the questions start coming. A review of studies into dolphin-assisted therapy found that the studies were methodologically flawed and also failed to investigate any long term benefits. Another review of the link between pet ownership and health found that research this decade found no reduced risk of cardiovascular disease, no decrease in the use of primary care and no psychological or physical benefits to older people living in the community associated with pet ownership.
Kruger and Serpell writing in Handbook on animal-assisted therapy "Despite their long history and the unequivocally positive media attention they typically receive, animal-assisted interventions are currently best described as a category of promising complementary practices that are still struggling to demonstrate their effectiveness and validity" (p.21).
Even recent research looking at therapy using farm animals failed to adequately control for effects of working outdoors or increased socialisation opportunities as being part of the research and not the control group. Then there is the need to consider the impact on the animals being used for therapy.
If this sort of therapy option gets positive media attention then researchers should harness that interest to plan and fund robust research to investigate the effectiveness of what could be a relatively safe, inexpensive and non-invasive treatment option.
Bridget O'Connell, Head of Information
8 Comments -
11 August 2009
Rise in antidepressant prescriptions...and prescription chargesThe Evening Standard tells us that the recession has resulted in a dramatic rise in the prescription of antidepressants. This is no great surprise. The link between recession and mental health is well documented. But what I would like to know is just how many of these prescriptions for antidepressants have been collected.
This April, the prescription charge rose yet again. It now costs £7.20 per item. So, the more ill you are, and the more prescriptions you need, the more you have to pay! I can’t help thinking that for those who have lost their jobs and subsequently experienced depression, the burden of prescription charges is the last thing they want (unemployment does not necessarily exempt people from prescription charges). Although Mind doesn't believe that medication is a good treatment option for all, when someone feels that medication really will help it is unjust that the poorer they are the less likely it is that they will get treatment.
Mind is part of the Prescription Charges Coalition that is calling on Gordon Brown to keep the promise he made last year to eliminate prescription charges for all those with long term conditions. Please go to the Coalition's website to find out more and take action. With the number of those experiencing depression very likely to increase throughout the rest of this year, eliminating prescription charges for those in distress is now more important than ever.
Mariam Kemple, Policy and Campaigns Officer
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