The UK's opioids 'timebomb'
30 March 2018 - Having gone under the radar for some time, recent media coverage has brought the UK’s growing opioids addiction crisis centre stage. Some alarming statistics: use of painkillers up 80% in 10 years (23.8m prescriptions for aggressively marketed opioids like Tramadol. OxyContin and Fentanyl in 2017); cost to the taxpayer £263m; about 200,000 UK problem users; hospital admissions for overdoses doubled over 10 years; over 16,000 people died from overdoses in the US in 2016 and UK numbers are growing; opioids culpable in celebrities’ difficulties (eg Ant McPartlin, Tiger Woods) and overdose deaths (Prince, Tom Petty and Cranberries’ Dolores O’Riordan).
In response to the massive crisis in the US, President Trump has announced tough penalties for drug dealers, though the problem didn’t start with them and it could be argued this is too little too late. Having trusted their doctors’ advice, patients have found themselves gradually caught in a downward spiral, upping their doses and often suffering severe side-effects, due to taking prescribed painkillers for severe pain, for example after an accident or surgery. It’s a very different journey from the more usual addiction pattern, so people don’t see themselves as addicts and may not seek help. People can appear to be functioning normally for some time before friends, colleagues and families become concerned about their behaviour.
Some very worrying facts: GPs under pressure are overprescribing these extremely strong painkillers (and prescribing is not monitored) for chronic pain and for longer, when it’s known they are for acute pain over short timescales; they actually know opioids are unlikely to be effective for chronic pain but continue prescribing, faced with distressed patients; these substances are extremely addictive but this is NOT mentioned on the packets and patient information leaflets (which governing body, the Medicines and Healthcare Products Regulatory Agency is fully aware of); while the NHS has allowed this crisis to grow under its nose, there is no widely recognised treatment (so far very few forays into such disciplines as mindfulness for pain, for example); many patients are losing huge amounts of money, jobs and relationships to this addiction; there are next to no NHS resources for rehab and recovery, prompting some into expensive private sector facilities (if they can afford it).
So what’s to be done? Public Health England has announced a Prescription Drug Addiction Review but this won’t report until 2019. We surely can’t afford to wait that long for anything to change. It only takes 3 days to become addicted to morphine and Fentanyl is 100 times more potent. We need a major rethink of how different kinds of pain are managed, clear medication labelling, marketing by large pharma companies investigated, monitoring of prescription practices, effective NHS treatment services and counselling offered to those affected.
(If you decide to seek private sector rehab and/or counselling for yourself or someone else, do check out their suitability, for example ensuring the therapist is properly qualified (you can do this using accredited registers such as BACP’s). Check out the website here.
Older people - not ready to be written off!
17 January 2017 - Older people have recently been in the news, because of the social care crisis but also promising new initiatives to increase their enjoyment of later life. These include experiments involving cross generational interaction, like regularly taking young children into a retirement home. Enjoyment of life is closely related to mental health, yet this group has often been overlooked when it comes to treatment for anxiety and depression, etc, a BACP (British Association for Counselling & Psychotherapy)survey worryingly showed, even though 68% said they would be open to therapy. With 3 million older people in the UK living with a mental health problem, and that's a lot of people's parents, grandparents, aunts and uncles, it's timely that BACP has now appointed a new Older People Lead to take forward the strategy of extending access to talking treatments. BACP has already held a meeting with other relevant organisations, including Cruse and the British Geriatrics Society, so let's hope this leads to more equitable allocation of therapy and more fulfilling later lives.
Image source: Nordic Co-operation website (norden.org) Licensed under Creative Commons Attribution 2.5 Denmark
Rising demand for mental health services
7 December 2016 - Could the longstanding 'one in four' (said to be experiencing a mental health problem) now be more like one in three? Yes, according to a report from NHS Digital, which found 37% of adults in England were getting treatment for anxiety and depression. And that's only counting those who seek help. Only 12% were having psychological therapy, with 31% 'treating the symptoms' with medication. The medication route is initially easier for GPs but as only symptoms, not the root cause, are being addressed it's arguably a false economy. You can read the report here.
Worryingly, as antidepressant prescriptions have risen so rapidly in recent years, a new review of published studies finds that taking antidepressants doubles the risk of suicide and violence, even among healthy adults with no symptoms of mental ill health. Until recently it was accepted that these medications pose this risk in children and teenagers, but we now have to accept the very real possibility that medication adults, too, expect to help them feel better, at least temporarily, could be unsafe.
So what's the solution? These are not easy to come by in today's cash-strapped NHS but we need much more NHS provision of talking therapies, treatment of choice rather than just the CBT still offered as a sole option by many areas. And many more skilled practitioners including from the existing workforce of counsellors and therapists need to be recruited to facilitate patients' choice and reduce long waiting lists. At least the NHS England's GP Forward View report has promised 'every GP practice access to a dedicated therapist', and in my view it would work much better to return to the system of having counsellors actually based in surgeries rather than hived off to IAPT teams. Let's see what happens. In the meantime many are accessing therapy privately to ensure their choice of treatment and therapist and avoid waiting lists. If you decide to do this it's a good idea to check out their qualifications, level of experience and whether they're registered and/or accredited by one of the main professional bodies. Read more about the review here.
Loneliness - the last taboo?
27 September 2017 - In Victorian times sex was taboo, the 20th century (and still) death and the 21st century it's loneliness: who wants to admit to it? Yet it's been shown many are feeling lonely on a regular basis and that's not just older people. Many factors contribute to this, including friends and families scattered or relationships become strained or even severed, the ageing population now often facing later years minus their partner and especially with younger people increased online and social media use, which gives the illusion but not the actuality of connecting.
Staying connected (eg with friends, family and neighbours) or making new connections (however transitory eg at the bus stop, in the cafe queue) has long been recognised as a principle of mental wellbeing, but many may struggle with this. It's encouraging that this social issue is now more recognised and occupying the energies of policymakers and organisations like the Jo Cox Commission and The Silver Line. Although loneliness is often associated with older people it's now clear that it's experienced at any age. What's perhaps most helpful is a combination of organisations which work to tackle this problem, which is known to shorten life, plus our own efforts to get ourselves 'out there', for example by joining a club, fitness group or a choir - anything that brings people together. See this BBC piece. Mind produces a useful booklet.
What progress in mental health?
6 March 2017 - NHS England has published a report reviewing progress over the past year towards achieving the commitments made in Implementing the Five year forward view for mental health.
It covers 7 areas: children and young people's mental health; perinatal mental health; adult mental health; health and justice; suicide prevention; testing new approaches; harnessing digital delivery and infrastructure and hard-wiring the system.
While some encouraging progress has been made it's clear that mental health service provision 'on the ground', as experienced by patients, leaves much to be desired. A huge elephant in the room is surely the postcode lotteries produced by having 200 Clinical Commissioning Groups covering England alone, with different policies and levels of adherence to planning guidance. One aspect of this postcode lottery situation is that even when funding has been agreed, for example for children and young people's services, not all these CCGs ringfence it so it gets diverted into the general expenditure.
It's a tough one, as demand for services is clearly rising but at the same time, short-termism in many policy areas in the UK mean that longer term, effective solutions, which may be costlier in the short term, are not used. Psychological therapy is a good example of this - it's often not helpful and it's costlier overall that many are offered very little choice of treatment in primary care, of short duration, only to have to return to the GP further down the line to ask for more help. As one commissioner said at a conference earlier today, we need to fundamentally rethink how we run health services, to incorporate both mental and physical healthcare, without the all too common ineffective and expensive separation. Read about it here.
Why might this affect you? You or a family member, partner or friend may need such services at some point and getting NHS treatment in your area will depend on how your local CCG manages its funds and whether (for example in the case of the 4 new mother and baby units) your area is thought to have 'greater need'. Otherwise it could be a choice of going without appropriate help or going privately, which of course not everyone can do. You might find it interesting and helpful to keep up with what your local commissioners, patient groups and Healthwatch are doing - GP surgeries and libraries should have details of these.
Risks of prescription drugs for anxiety and insomnia
23 October 2016 - News that doctors' leaders are calling for the urgent introduction of a UK-wide 24-hour helpline for prescription drug dependence begs major questions about the potentially damaging policy of issuing too many prescriptions (many of these long term eg decades) for Benzodiazepines - taken for severe anxiety, insomnia and sometimes pain relief. 10m prescriptions were issued in England in 2015 and the British Medical Association (BMA) says there should be more support for people coming off the drugs. Such a helpline may well be helpful but surely it doesn't get to the root of the problem. Many patients are not being offered a choice of treatments (required by the NHS Constitution) and are often prescribed medication without even being told about talking therapies. These therapies are much more likely to get to the root cause of the patient's difficulties because although medication can be helpful in some circumstances, it can be too often used as sticking plaster: simply controlling symptoms (regardless of the side-effects and that medications often lose some efficacy after a while) doesn't allow for the issues to be explored and understood. Even when patients are recommended talking therapy, NHS waiting lists are long and BACP research has shown too many services still aren't offering the full range of NICE approved therapies, mainly just Cognitive Behavioural Therapy (CBT). Read about the research here.
Many people are seeking help via the charitable sector or private counsellors because they can then choose their therapist and the way they want to work. If you decide to do this it's a good idea to check out the level of qualification achieved and with which professional body they qualified. Besides internet searching there are several reputable directories of counsellors and therapists including the British Association for Counselling and Therapy's It's Good to Talk, which also offers useful information on different approaches to this work. You can view it here.
On 23 October BBC Radio 5 live broadcast Prescription Drug Addiction. Listen here or download the podcast.
Thanks to the BBC for the image used in this post.
Post EU referendum fallout
6 July - In the wake of the referendum there as been a widespread feeling that axes have shifted and tectonic plates moved: things are no longer the same, leaving many feeling shaken and profoundly unsettled. Meanwhile the drama and clashes of titanic egos continue unabated, preventing or at least hindering adjustment to this new reality. Counselling and therapy encourage development of capacity to deal with uncertainty, one of the life tasks of mature adults. But what if this huge uncertainty seems never-ending and events in the external world coincide with inner uncertainty?
We could feel even more alone with such challenges because the 'grownups' paid to run the country seem more interested in fighting each other than looking after their 'children'. Such a feeling will especially resonate with those whose early experience included neglect and warring families, undermining our sense of psychological safety.
So what can we do to help ourselves tolerate the continuing uncertainty? Since there's a limit to what we can change in the external world we need to concentrate on ourselves, shoring up our mental wellbeing and resilience by caring for our physical health and practising wellbeing principles. These include staying active, making connections (strangers as well as friends), keeping learning and 'noticing', for example through mindfulness or meditation, all of which can help us feel less disempowered when chaos seems to reign around us.
It's official - nature is good for our mental wellbeing
May 6 - It's long been felt that being close to nature and experiencing green spaces is good for both physical and mental health and now further research reinforces it. The study was conducted by the University of Derby and The Wildlife Trusts to try and measure the impact of last year’s "30 Days Wild" campaign, run by the charity.
“Nature isn’t a miracle cure for diseases,” said campaign manager Lucy McRobert, “But by interacting with it, spending time in it, experiencing it and appreciating it we can reap the benefits of feeling happier and healthier as a result.”
What will you do and where might you go? This time of year is perfect for a bluebell walk. Find out more about the research here.
What if Christmas isn’t merry?
21 December 2015 - Advertising generally perpetuates the idea of a jolly family Christmas and the perceived need for
compulsory merriment can be reinforced by social media eg ‘Facebook envy’. It’s not helpful for our self-esteem to
compare ourselves with others but it’s as if we’re programmed to do this, leading to automatic pilot. So it can involve
conscious effort to interrupt the pattern and make our own choices.
There could be many reasons why you feel less than joyous about the festive season. You may be without a partner and/or family, you may have lost someone or have memories of previous losses re-invoked, you may be feeling lonely or you may have just had a difficult year one way or another. This could be aggravated by a sense of shame that you’re not enjoying it when everyone else apparently is.
The first inroads into the myth of the universally happy Christmas and New Year seemed to be made a few years ago, some admitting they ‘hate’ New Year’s Eve. Now it’s now not unusual to find people, in confidential settings like therapy, admitting to fearing, hating or dreading Christmas itself.
There are numerous useful blogs and articles offering tips for coping with Christmas, focusing on looking after yourself, not going overboard eg with alcohol and normalising difficult feelings. As part of practising vital self-care (not always as easy as it sounds) some of the mental wellbeing principles can be especially helpful at this time of year:
•Connect (avoid isolation by keeping in contact with friends and family and acknowledging people we don’t know, eg in a café queue, at the bus stop)
•Stay active (exercise doesn’t have to feel hard work – a brisk walk or swim, bike ride or yoga session can help tackle lethargy)
•Take notice (slowing down as in observing nature around you, meditation or mindfulness facilitates being in the moment and reducing rumination)
•Help others (altruism is good to aim for anyway and research shows ‘doing good does you good’).
It’s worth making the effort with these even if you don’t feel like it. If Christmas can’t be merry perhaps it can at least be tolerable and even restorative...See below for sources of support.
Sources of support over Christmas and New Year
21 December 2015 - If you need support when the usual sources may be unavailable here are some details of helpful organisations – not all offer a helpline but have downloadable information on their websites.
Samaritans – long established 24/7 helpline offering emotional support.
Tel: 116 123 (freephone)
CALM (Campaign Against Living Miserably) – awareness raising on men’s mental health and suicide prevention.
Phone line and webchat.
Helpline: 0808 802 58 58 (London)
The campaigning organisations listed below don’t have a helpline as such but all aim at tackling mental health stigma and have very helpful information on a range of mental health issues. Single copies can be downloaded from their websites.
Mind - http://www.mind.org.uk/information-support/
Mental Health Foundation - http://www.mentalhealth.org.uk/
Rethink - https://www.rethink.org/home (see Free Factsheets page)
Royal College of Psychiatrists - http://www.rcpsych.ac.uk/expertadvice.aspx
Time to Change - http://www.time-to-change.org.uk/
Other information providers include ISMA –International Stress Management Association (www.isma.org.uk)- has information on how to spot stress and stress busting tips, etc.
Another boost for talking therapies
24 June 2015 - You may have heard in the news recently about the International Choosing Wisely campaign, to prevent unnecessary medical interventions and prescriptions being issued. Medical procedures seemed to gain more media attention but it's encouraging to see that this is expected to extend to anti-depressants for mild depression, for which there is less evidence.
In recent years prescriptions for anti-depressants have risen markedly, and although of course there will be instances where they are necessary and helpful, the dramatic rise suggests it could be due to doctors coming under pressure from patients. Commenting on this, Professor Maureen Baker, Chair of the Royal College of General Practitioners, states that non-medical approaches could be equally effective. 'For example, mindfulness and talking therapies have been shown to have positive effects in some patients with recurring depression and anxiety, as opposed to taking antidepressants'. Such approaches are also clearly recommended in the NICE guidelines.
It will be interesting to see how this plays out in terms of prescription statistics.
And let's not forget fathers...
23 August 2015 - When a baby's on the way or after the birth it's maybe understandable that much attention focuses on mother and baby, but this can leave some fathers feeling marginalised and alone with their own worries. Recent research by the NCT shows that more than 1 in 3 new fathers (38%)* are concerned about their own mental health and 73% were worried about their partner's. Fathers can experience Postnatal Depression too and it's important they get the chance to talk and the support they need. The NCT offers information here and has useful advice including sharing feelings with people you trust (family or friends, a health professional or a counsellor) and being sure to take some time for yourself eg hobbies, exercise and social life.
It's very good news that the Dads Matter UK (click here) website offers education and support. On Twitter you can follow @DadsMatter and the #PNDchat forum has been an excellent source of support for those with perinatal mental health problems, recently nominated for a TalkTalk Digital Heroes award.
Mental health during pregnancy and following childbirth
4 August 2015 - The parlous state of perinatal (meaning the period covering pregnancy and up to a year following childbirth) mental health service provision in the UK has been highlighted in recent months, partly thanks to the Centre for Mental Health report – Falling through the gaps (March 2015) More here. Calling for urgent investment, the author found that up to 20% of women have experienced difficulties during this time, such as anxiety, depression and post-partum psychosis, but specialized services such as Mother and Baby Units are few and far between. Problems include GPs and other health professionals failing to identify these needs, leading to appropriate treatment not being offered; treatment still mainly being via anti-depressants rather than talking therapies; mental ill-health stigma exacerbated by social and clinical expectations that this is a joyous time for all; and the fear that admitting to being unable to cope could result in the baby being taken away.
So what’s being done about this? The Government has granted an additional £75m for service improvement over the next five years, there’s more media coverage and social media activity, helping to raise awareness, and the Royal College of Psychiatrists has just issued recommendations for these services. Read them here. These seem very sensible, ranging from every health region having a perinatal mental health strategy to psychological therapy services ensuring that they can offer this specialised treatment. A key point is training for primary care practitioners, to make sure difficulties are spotted and treated early on. It’s very important this momentum isn’t lost and that Clinical Commissioning Groups also step up to ensure services are available in every area.
What are the effects of loneliness?
1 May 2015 - A new report from the Campaign to End Loneliness and the University of Kent suggests that 'maps' indicating loneliness would more clearly show which areas need which kinds of help so service providers can better target their efforts. Why does this matter? Is loneliness not just a personal thing? Well, no: loneliness and isolation are thought as harmful to our long-term health as smoking 15 cigarettes a day. It can also put people at risk of developing dementia, high blood pressure and depression. There's a public cost implication because people experiencing severe loneliness may in turn put a strain on the NHS and loved ones, as they are more likely to visit their GP more often, and enter residential care earlier. One of the key wellbeing principles is 'Connect', so it makes sense that the opposite, avoiding contact, leading to isolation, is unhelpful for wellbeing.
I think it's important to remember, though: first, loneliness isn't the same as being alone (and often the two are conflated); second, it's not only elderly people affected - many of us can feel lonely, even in a crowd; and third, besides expecting services to tackle loneliness, we also have a responsibility to ourselves to help reduce our own isolation and that of others. If you regularly feel lonely it may be worth discussing it with a qualified counsellor, to explore what could be contributing to it.
Read about it here.
A third of bereaved people don't get support at work
16 July - A report by the National Bereavement Council and others, Life after death: six steps to improve support in bereavement shows that a third of people bereaved during the last five years haven't felt their employers treated them with compassion. It's difficult enough coping with bereavement, so having an unempathic employer, who perhaps expects you to pick up the reins very soon after your loss, is very unhelpful and is likely to lead to you being less productive overall. There's no statutory paid bereavement leave and employers are only asked to give 'reasonable' unpaid time off. Quite rightly the report calls for all employers to have an up-to-date bereavement policy, which could include support such as counselling, and for the Government to review employment practice, leading perhaps to a minimum amount of leave and helping identify good practice.
It seems there's such a wide variation in employers' approaches that some Government time could do with being spent on an issue which can affect us all.
Counselling can help you come to terms with loss: if you're thinking of going privately for counselling a reminder that it's advisable to check out their professional qualifications.