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.
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.
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.
How are your relationships?
7 May 2016 - This Mental Health Awareness Week (16-22 May) organisers the Mental Health Foundation is focusing on relationships. Connections with family, friends and community are one of the most important aspects of our lives. This was recognised by 'making connections' being one of the mental wellbeing principles forged by the New Economic Foundation a few years back.
We can all do something to improve our relationships and, in doing so, improve our mental health. MHF is asking us to make a relationships resolution and they're interested to know how we all get on. What will you do? Find out how to take part here.
To mark #MHAW2016 NHS Maudsley staff and volunteers will be joining a walk from Victoria to Waterloo stations at 12 on Wednesday 18th May, and at Waterloo setting up our usual information stall. See you there, maybe...!
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.
Feeling stressed at work?
4 October 2015 – It’s likely you’ve been back at work some time and your summer holiday could feel a distant memory. Are you feeling stressed at work? It wouldn’t be surprising if you were, since recent research by Mind found that 26% of employees had developed anxiety from workplace stress, partly induced by feeling unable to speak out about their mental health. NICE (National Institute for Health and Care Excellence), found that over 1m people in the UK experience a work-related illness and, in its new workplace health guidelines, says that employers and managers must do more to tackle these issues including irregular hours, unhelpful (toxic in some cases) cultures and discrimination. NICE highlights staff/management relationships as key to developing a healthy work setting but finds only 1 in 10 businesses provide mental health training for managers See more here. . Elsewhere it was found that few organisations have a mental health policy, though staff need to be able to share their difficulties and get help to prevent things getting worse, which can then lead to long-term sick leave. See more here.
So what can be done? NHS England is walking the talk by a drive to improve the mental health of health service staff (more here) and, noting that more than two fifths of employers have seen a rise in empoyees with mental health issues, the Chartered Institute of Personnel and Development (CIPD) reminds employers of their obligations under the 2010 Equality Act and what helpful measures can be introduced eg adjusted hours and line managers being more aware (see more here). Mental health campaigning body Time to Change has set up a champion scheme, whereby employers sign a pledge to create a setting free from stigma and discrimination. Employee Champions challenge stigma and work towards increasing understanding of mental health in their workplaces (Find out more here. ).
Workplace stress is often multifactoral, several issues contributing to a problematic situation. Besides workplace cultures and aspects of the physical environment there can also be our own unresolved and often unrecognised difficulties, which can then 'bump into' those of colleagues and managers. If you regularly find yourself in such situations, which could mean it's not just that particular workplace, it could be worth be worth talking to a counsellor, either through a workplace scheme if they have one or an independent practitioner. Whatever you decide to do, it's helpful to see that you're not alone, and as these different research and policy initiatives show, workplace stress has been increasingly acknowledged though there is more work to do.
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.
Has your local council got a mental health champion yet?
4 January - Linked to this is local authorities' responsibility (since April 2013) for public health and this includes mental wellbeing. BACP produced a report The role of counselling and psychotherapy in improving the public's health and wellbeing and is part of a campaign to make sure authorities don't neglect this important area. They're urged to appoint a mental health champion and 13 councils already have. You could check with your local council to see if they're rising to the challenge.More information here.
Happiness for people who can't stand positive thinking
30 May - That's the subtitle of a very thought-provoking book I want to recommend - The antidote, by Oliver Burkeman (Canongate Books, £8.99 paperback, but you could borrow it from the library). The author suggests that the various and relentless ways people chase after certainty and happiness are illusory and that this pursuit could paradoxically bring about dissatisfaction and unhappiness. One of the revelations was learning that the Yale University study widely quoted by self-help gurus (the one where it was 'proved' that people who wrote down their goals years ago were far more successful than those who'd not done so) never actually took place. Well worth reading, especially given the author's own research, including attending a silent Buddhist retreat.