Tag Archives: mental health

Anti-exorcism

rosaryAn article in the Telegraph today interviews Dr Gallagher, a psychiatrist based in the US, all about how he thinks demonic possession is real and exorcism can be helpful.

The article doesn’t give any alternative point of view, or ask Dr Gallagher any particularly challenging questions, so it’s possible to read it and think it’s not that controversial.

The practice of exorcism is worse than controversial though. It’s not a neutral thing to do that might not work but doesn’t cause harm. It’s often frightening for the person and may prevent them from being able to access treatment that can be helpful. It often involves being restrained. The few exorcisms I have heard described to me have been been confusing and frightening at best and brutal and sad at worst. 

The way the psychiatrist in the Telegraph article talks about exorcism uses examples where a person has requested it themselves. This is by no means always the case however. Often the use of exorcism is instigated by families of young people who are experiencing significant mental health problems, for instance psychotic experiences such as hearing voices or seeing things other people can’t see. Whilst people are entitled to make sense of experiences through different frameworks of understanding, if the framework leads to the use of a ritual that is frightening and involves labelling a person as possessed or bad then this is not ok.

Exorcism is also be used when no mental health problems are present, but for some reason the child has still been scapegoated as possessed or evil.

Whether or not a child is experiencing their own mental health difficulties at the time, these scenarios are all abusive, and the London Safeguarding Board has clear guidelines about why this is unacceptable. The guidelines talk about how to work respectfully with faith communities engaging in this, whilst removing risk to the child.

Adults can be vulnerable too, and use of exorcism with adults against their will is just as abusive.

Use of exorcism with freely consenting adults presents more of a complex dilemma: we are all free to make decisions about what we want, but exorcism remains problematic in my view, in the way it offers false hope and possibly delays access to other more evidence-based help for whatever is making someone want to request an exorcism. It also often involves restraint even if it has been requested, which I think has huge potential to be traumatic.

The psychiatrist interviewed in the Telegraph offers “discernment” assessments to say whether or not he recommends exorcism. He is clear that he doesn’t think priests should charge for exorcisms, but he doesn’t state whether he charges for these assessments.  I would be very surprised if these are also free of charge, although I don’t know for sure, and the book on discernment that Dr Gallagher has coming out soon certainly isn’t.

 

Advertisements

Cuts and knives

knife“This is a complex crime and you cannot arrest your way out of it,” said Amber Rudd this morning on Radio 4’s Today programme, as she talked about the rise in knife crime in young people in London.

I couldn’t agree more that arresting our way out of this is not the answer. But then what is? The rise of violent crime in London’s youth is complex, although sadly not surprising.

The impact of the policy of austerity on young people should not be under-estimated. Cuts to services have been brutal and chronic. Cuts to education maintenance allowance, to social service provision, to youth services such as career advice centres and voluntary sector project groups, to mentoring schemes, to child and adolescent mental health services…  the list is long. These cuts have accompanied the reductions in police numbers which are more highly reported, yet not necessarily more important.

The context that we are raising young people in is one where there are fewer and fewer resources to help them with their education, wellbeing, safety, and emotional understanding, and at the same time one where more and more is being expected of them. More frequent exams, negotiation of digital social landscapes, employment hunting in a world with fewer jobs and more expensive university fees… The environment we have created is one where there is not enough to go round, where there is huge pressure on the individual, and one in which the backdrop of “adult” discussion on the news is routinely of war and violence.

Subsequent discussion on radio 4 this morning mooted the usual suspects: the idea that we could blame knife crime on violent lyrics, or on social media. I’m surprised video games didn’t get a bit of a look in too. Of course it isn’t this simple, and of course we have more responsibility.

In the clinical settings I have worked in the violence I have witnessed has often been related to fear: a fear of being hurt, of not knowing what will happen next, of being out of control, of not knowing who to trust. Training on managing situations where someone is likely to be violent included making sure that they had a way out of the room: that they didn’t feel trapped.

What ways out are we giving young people? How are we helping them with the people and things that they are afraid of?

This problem is complex, and there is also lots more we could be doing to unpick it. The under-funding of key services mean we are raising a generation with fewer opportunities and under greater pressure. It is hard to statistically model the effects of all of the different ingredients of this cocktail, although it’s important to try, but in the absence of a clear cause of rising youth violence, I think we could be doing more to call out the common sense explanations and to do something about these. Looking at police capacity to be present is one thing, and likely important, but we can go much further than this – and look at how to increase the numbers of youth workers, youth services and youth opportunities that are available. 

Not enough mental health services to go round for young people

nspccOver 100,000 children referred to local mental health services in England have been rejected for treatment in the last two years. Figures requested from NHS Trusts by the NSPCC, released today, show that an average of 150 referrals a day are turned away from NHS children’s mental health services, despite Childline reporting record numbers of calls. From a total of 652,023 cases referred to child and adolescent mental health services (CAMHS), 109,613 children were turned away. The NSPCC has called on Government to focus on early intervention to reduce numbers who reach crisis point.

These figures are very concerning, and reflect the chronic levels of underfunding which mental health services, and in particular child and adolescent mental health services, have experienced. With ever-shrinking and unprotected budgets for child and adolescent mental health and social care, services are sometimes pushed to raise the threshold for access higher in order to prioritise high-risk and crisis cases. It is mad that a system there to help young people should have to wait until they are in crisis before it can.

Not every assessment should necessarily result in access to a service – some referrals aren’t appropriate and some young people could be better helped in other ways, but these sky-high numbers suggest that the need for mental health services for young people is much greater than the provision. In addition the care received in different geographical areas of England differs, so waiting lists and access to services depends on where you live. This data is only for England but we know other areas of the UK and Ireland are also affected by stretched services, with Wales in particular suffering from having very little access to evidence-based talking therapies for children and adults.

It’s important these figures don’t become yet another stick to bash the NHS with.The data shows a greater need than there is capacity for, which is different from showing that the services themselves aren’t good. There is simply not enough service to go round, which is not OK.

What might help? Several things:

  • Ring-fence current funding and increase it. There has been a huge amount of rhetoric about parity of esteem between mental health and physical health problems, but until there is parity of funding it is hard to believe this. Child and adolescent mental health funding in particular has had such a chronic lack of under-funding for so long that it needs even more growth in funding to be able to provide the care that young people want and that professionals want to be able to give.
  • Getting in there early. Providing good services early on before mental health problems become severe and enduring is crucial. This doesn’t mean cutting back on specialist services – we still need them – but it does mean also making sure there is enough funding for early intervention to try to nip problems in the bud and also enough funding for the education and social care supports that need to go alongside.
  • As well as early intervention we can think about prevention: putting more effort in even earlier, perhaps in school settings, to help young people understand and negotiate powerful emotions and have the emotional literacy they need to talk about their feelings, might help head off some of these problems before they begin.
  • Thinking about why these young people are so distressed. The rise in numbers of reported mental health problems in children may be partly to do with increased knowledge of mental health issues and increased ability to speak up, but it’s also likely to have much to do with the huge pressures young people are under. There are more exams than ever before, there are new social media pressures to encounter, it’s really hard to be a young person in our society today and we should be addressing that.

50% of adult mental health problems are already present at the age 14. If we could help young people avoid this we might set them off on a different trajectory for their adult lives.

World Mental Health Day

blueprint coverToday is World Mental Health Day. I haven’t written on this blog for ages – I’m sorry for the radio silence – but World Mental Health Day has got me back on here. I have been working on a couple of other things which are available or nearly available to read if you’re interested. I’ve written a piece for The Guardian on trauma which you can see here. I’ve also been working on a bigger project this last year or so – a book about child development – all the juicy experiments and theories that I think would be really useful for everyone to know about – and it’s coming out in March. It’s called Blueprint: How Our Childhood Makes Us Who We Are and it’s available for pre-order on Amazon which is both exciting and terrifying.

nest

World Mental Health day is a great opportunity to pause and think about whether there are ways we could be boosting our own or other people’s mental wellbeing.

It’s easy for simple things that we know are helpful to drift when we’re busy: things like eating well, sleeping enough and being kind to ourselves. It’s easy when we’re stressed and pressurised to forget to ask how others are doing too, and to really listen to what they say when they reply.

Sometimes it can feel overwhelming if someone tells you they’re not feeling ok, and it might leave you feeling helpless – unsure of what to do to help them feel better. But sometimes just the act of asking and listening carefully to the reply is enough. I love this cartoon from Robot Hugs which captures that feeling that someone has really tried to get alongside, not got frustrated by things not getting better immediately. 

The focus of World Mental Health Day this year is mental health in the workplace. Stress at work can be a major problem, in all sorts of professions, and trying to create kinder and more compassionate workplaces is a really important thing that we can all do. It starts with making sure we’re taking care of ourselves, so I hope if you’re reading this it encourages you to think of a kindness you can do for yourself today, as well as something you might be able to do to make a colleague’s life a little easier.

cup

Is living in the city bad for our state of mind?

app picture mechelliMental health problems are more common amongst city dwellers – but why? Is it the stress? The noise? The lack of green spaces? A study involving scientists from King’s College London, architects from J & L Gibbons, artists from Nomad Projects and design experts from the Van Alen Institute, is trying to find out how the urban landscape affects how we feel.

To take part, download their free app, called Urban Mind, which will prompt you at random, seven times a day for seven days, to answer questions about how you feel and where you are. The app gathers geotagging data, and if you choose to you can also upload images and sound files, to give a full sensory picture of your location.

The geotagging – which says where you are – can then be used to compare with existing mapping data to see whether you are in a deprived or affluent area, whether there are many trees or rivers nearby, and even what levels of pollution there are.

Dr Andrea Mechelli, Reader in Early Intervention at the Institute of Psychiatry, Psychology & Neuroscience and lead investigator on the project, hopes the app will enable a rich dataset to be collected.

“This has been developed to look at how the built urban evironment affects our mental wellbeing, Dr Mechelli said. “It’s important because within the area of urban planning and design a lot of decisions are made without much scientific evidence. The longterm aim of the study is to design some policy guidelines in this area.”

Dr Mechelli’s usual area of research is psychosis, and he sees the Urban Mind project as highly relevant to mental illness as well as mental wellbeing. Whilst some people may be genetically more vulnerable to developing certain mental illnesses, environmental stress can be a major trigger to make this more likely.

“Although we’re not looking at mental illness directly we’re looking at something that’s related,” said Dr Mechelli. “We’re all on a continuum, some of us tend to be more anxious, some less so… some may have slight psychotic symptoms that are much more common than we tend to think…. By understanding how the general population responds to the environment we’ll also understand how the environment becomes a risk factor. Longer term the study might reveal how the environment may contribute to the development of mental illness.”

Dr Mechelli, who grew up in a small village but now lives in London, thinks living in the city has many effects, socially, physically and culturally. “There are certainly aspects of urban living that are not very healthy but there are also aspects that can be very positive,” he said. “For example social networks, less risk of social isolation.”

Previous studies have shown downsides to urban life, Mechelli explained: “some aspects of city living are not good for us, for example increased sensitivity to stress and increased vulnerability to many mental disorders.”

Whether we find the city exciting or stressful might depend a lot on our individual characteristics, so Urban Mind asks some initial questions about what we are like and where we grew up to try to understand how this interacts with environmental factors.

Mechelli is excited about the project which he described as a “true cross-sector collaboration” between science, architecture and art. Anyone can download Urban Mind and participate, and Mechelli thinks using the app might make us appreciate the effects of our environment more.

To download the app check out the Urban Mind website. Images from the pilot data are available from the project-related Instagram and will be on exhibition at This Public Life – Festival of Landscape Architecture to be held in Melbourne, Australia, 15-18 October 2015.

For more on how where we are affects how we feel try these pieces on whether green spaces make us more creativehow natural light can make us feel more awake and how hospital architecture can make us feel better or worse.

This piece is cross-posted on Huffington Post UK

How do we look when we are sad? Time to Change’s campaign against head-clutching.

A campaign launched by Time to Change in Spring of this year aims to get rid of “headclutcher” pictures in articles about mental health. The campaign was started as a response to the wealth of images accompanying articles about mental illness which have someone sat with their head in their hands, as highlighted by twitter users with the #headclutcher hashtag.

It’s a challenge to represent emotions that are often private in a way that can be understood quickly, but the photos of people with their head in their hands tend to be stereotypical and fairly hopeless. They also make it seem like it’s easy to spot someone who is really distressed, when actually we know that isn’t the case. If it were then it would be much easier to offer help to people who need it, but who aren’t necessarily showing this in any obvious way.

I asked comedian Jo Brand, who used to be a psychiatric nurse, what she thought about the headclutcher campaign. She said: ‘I have always thought that portrayals of individuals with mental health issues in the popular press are really inappropriate. Either you get the terrifying, out of control, wild eyed maniac or someone that looks like a pauper out of a Dickens novel who has their head in their hands in a darkened room with the curtains drawn.”

Brand agreed with the importance of showing mental health in a more ‘normal’ way: “I think it is absolutely essential that mental health issues are portrayed by people who look completely ordinary, because it is something that happens to ordinary people. It has to be said that many library photos used in newspapers of ‘families’, ‘schoolchildren’, or ‘workers’ are somewhat ridiculous, but portrayals of those suffering from poor mental health are always at the more bizarre end of the spectrum. In this day and age, one might have hoped we’d have moved on a bit.”

What should we be using instead? The campaign has come up with a whole stockpile of photos that journalists can download for free. But the campaign made me think of an image by Quentin Blake, from a brilliant book I’ve used a lot with children and young people in my clinical psychology job.

Image reproduced with kind permission from AP Watt at United Agents on behalf of Quentin Blake

Michael Rosen’s Sad Book describes feelings of deep sadness with beautiful simplicity. One image which often resonates with young people I have worked with illustrates the contrast between how we might look on the outside and how we feel inside. The picture is accompanied by the text “This is me being sad. Maybe you think I’m being happy in this picture. Really I’m being sad but pretending I’m being happy.”

How often have any of us said “I’m fine” and put a brave face on things when we’re not really? Feeling sad often makes us withdraw or lash out at others just when we need them most. I hope the headclutcher campaign makes us think about how we represent mental health in the media, but I also hope it helps us think about how we show other people what we are feeling, and how much we presume that what other people are showing us is the full story.

UK Government’s Child Mental Health Taskforce Publishes Report

Screen Shot 2015-03-22 at 14.57.06Last week the UK Government’s Child Mental Health Taskforce published a report: Future In Mind – Promoting, protecting and improving our children and young people’s mental health and wellbeing.

As a clinician working for part of my week in an NHS acute psychiatric ward for 12-18 year olds, I welcome this focus on children and young people’s mental health, but I can’t help but feel a sense of unease about some of the recommendations.

The key themes the report outlines are:

  1. Promoting resilience, prevention and early intervention
  2. Improving access to effective support – a system without tiers
  3. Care for the most vulnerable
  4. Accountability and transparency
  5. Developing the workforce

Nothing to argue with there – some might say, but reading the report I had three main worries:

1. The vagueness, in parts (not all) of the report, in specifying how these goals are going to be achieved when designing services which need to be clear in their purpose and coherent in the way they fit with other services. There are some helpful ideas e.g. suggestions for commissioner training, and building on existing good practice in terms of coordinating young people’s care. There are also areas where there is a lack of attempt to crystallise ideas into more practical suggestions for coherent service structure, with nebulous “transformation plans” and other jargon referred to.

2. The lack of consideration of why a ‘tiered’ system exists – namely that different young people present to services with different severity of problems, and need different environments and treatment to manage this care. We need to respond differently to different levels of clinical risk and a tiered system allows us to do this more effectively and more safely.

3. The total lack of acknowledgement of cuts to outpatient child and adolescent mental health services (CAMHS), and to social care services responsible for children and young people’s well-being. These funding restrictions have contributed to the difficulties which the remaining CAMHS and social care teams face in meeting targets relating to waiting times. The report refers to government money spent on inpatient beds, Children and Young People’s Improving Access to Psychological Therapies programmes (CYP-IAPT), and MindEd resources. It is great that these are receiving funding, but simultaneous devastating staff cuts in other CAMHS services are also happening. The language around this report talks about CAMHS needing a “culture shift” and an “overhaul”, but to remove funding and then criticise CAMHS for not meeting targets or not embodying patient-centred care as much as it should feels nonsensical.

I’ll be watching developments with interest, and hoping that my concerns prove unwarranted.