Each week we publish blog posts on a whole range of topics, relating in some way to mental health — written by Mind staff, service users and health and policy professionals. Some blog posts may not reflect official Mind policy.
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.
I am keen to attend this event as I am passionate about promoting excellent crisis care. The quality of crisis care interventions, services and resources are inconsistent and they are also underfunded. This situation is made worse by government spending cuts which are a costly false economy both in financial and human terms.
13 CommentsMind's CEO Paul Farmer welcomes a landmark Supreme Court judgement, which promises greater protection for people with mental health problems who admit themselves to hospital voluntarily.
29 CommentsA timely and supportive response to a person in crisis can make all the difference. As part of our acute and crisis care campaign, Krishna writes about his passage through services. He's currently an inpatient.
The arcane world of psychiatry is a scary one but please take heed when I say it is not to be feared.
When I began to experience mental health problems, I was quick to disagree with my family about being ill and suffering symptoms of an illness.
1 CommentGuest post from Glen, on the difference one caring mental health professional can make.
In 2009 I moved to London and to the care of a new support worker at the local Community Mental Health Team (CMHT). Annie was my third support worker that year, but she was amazing from the start.
33 CommentsThe future of the NHS is all over the media. Stung by criticism from politicians, health professionals and the public, in April the Government announced a pause in its reforms and set up a 'listening exercise'.
The group overseeing the listening exercise, charged with investigating people’s concerns and recommending changes to the proposals, was the NHS Future Forum. I was asked to be on the panel of this group, and for the last few weeks have worked to ensure that the concerns and needs of people who use mental health service are represented on the panel. While it’s clear that many people hugely value the NHS and the way it supports mental health service users, it would certainly be wrong to assume that nothing needs to be changed (perhaps the impression created by some media coverage).
5 CommentsMind’s Chief Executive Paul Farmer met with David Cameron, Nick Clegg, Andrew Lansley and other voluntary sector representatives last week to discuss the Government’s 'pause' in reforming the health system.
8 CommentsOriginally posted on the Frontline First blog.
Mind supports the RCN’s Frontline First campaign because of the vital mental health care provided by nurses.
8 CommentsThere’s much talk at the moment of the future of mental health services. Is NHS funding really protected? What does the move to GP commissioning mean for mental health? Yet there’s a need to focus attention on the current state of services too, which is what Mind is doing through our new Care in crisis campaign.
9 CommentsAfter the Lib Dem's conference, the team headed off to Manchester for the Labour event. As Decca Aitkenhead analysed in The Guardian, the early days felt extremely quiet and flat. But Ed Milliband's speech brought the Conference to its feet, and suddenly it felt like the Opposition were ready to get stuck in.
32 CommentsA guest post by Marion Janner, founder of the Star Wards project
Despite enormous progressive changes over the last decade, there continues to be ill-informed prejudice and perplexing stigma, inferring or conferring inferiority on those associated with it. My immunity to this stigma for the seven long years that I’ve been severely mentally ill has recently collapsed and I am using this opportunity to bravely come out in public. [Clears throat, extends herself to the full available 4’9” and announces:]
I go to a day centre. A day centre for mentally ill people. A morning a week, sanity permitting.
When I’ve told friends about this, all but one have laughed merrily and started to make requests for baskets for their picnics, pets or poker sets. I asked the dissident why she didn’t regard me going to a day centre as being a bad move, and she replied: “Why wouldn’t I be enthusiastic about you volunteering at a day centre?” When I cleared up the misunderstanding, she laughed merrily but stopped short at placing a basket order.
I have to confess that I was also a bit iffy about day centres before I started going to one. I knew that the relatively few that have survived changes in fashion and funding don’t actually have hundreds of people sitting at assembly benches, in gloomy light, bunging widgets into tiny plastic bags. But I did have lurking doubts about whether there was something – er, inadequate about these services and even perhaps the people that use them. There had to be, really. Progressive services don’t ‘congregate’ people who happen to share a label. My approach was Marxist: I didn’t want to belong to a club that accepts people like me as members, just like Groucho didn’t.
And then I went to a meeting with some of the big-wigs at Jewish Care to discuss Star Wards. It ended rather inconclusively in relation to work, but with me deeply enthusiastic about starting to go to one of their ‘well-being centres’. And two months later, I’m benefiting way beyond what I’d hoped for by going to Kadimah, their Hackney centre. Kadimah is Hebrew for ‘forwards’, usually slightly shouted in a “Let’s go”, or “Onwards” sort of way. It’s also the name of the centrist, liberal party in Israel. I like it that my centre is similarly inclusive and accessible to such a diversity of people, located in one of the heartlands of the ultra-orthodox community, Stamford Hill, but happily embracing everyone from the traditionally garbed to those adorned with tattoos, self-harming scars, bling…. Black, white, old, young, train-spotters and trainee potters.
The staff are wonderful - expert, warm, funny, human/normal/friendly. And completely accessible. Unlike so many services where we have to gear ourselves up to knock on the office door expecting to be told to come back in x minutes, the Kadimah staff are constantly around in the lounge, schmoozing with us.
There are rules, but mainly along the lines of we must feel able to come as frequently or occasionally as we want, take part only in the activities that we’d like to do that day etc. (Of course, eating lots, telling jokes and overstating the achievements of the kids in our life are core expectations.)
The groups are very enjoyable, from a mellowly therapy-lite women's group to the Jewishish film group where everyone's talking at the same time and there's no shortage of opinions. And brace yourselves for this one! We’re welcome to take part in the activities of the day centre for elderly people in which Kadimah is based. Not only do I not find it peculiar or let alone stigmatising being based, lunching and hanging out with ancient Jews, but it feels inclusive and heimisch (homely). And the elders have great guest speakers, music sessions and nice sweets in the bags dangling from their wheelchairs.
Kadimah’s magazine, Shemesh (sun) is remarkable. Edited by the award-winning, geniusly witty and creative member, David Filabon, its 32+ pages are full of articles I feel motivated rather than obliged to read, are a visual pleasure and another regular boost to my patchy morale. Star Wards is hoping to have the honour of publishing Shemesh on our website. (A few more high-calorie enticements for David and team and I hope to have clinched the deal.)
I’m lucky to be well-endowed with social and psychiatric support, but Kadimah combines the best of all these and is now an essential part of my life. Friends have stopped the basket jokes and several are openly envious of my being able to go whenever I want to what feels more club than centre, where I can relax with interesting, friendly, supportive people, enjoy the activities and recharge. With a continuous supply of food and jokes.
Marion Janner
Marion was awarded an OBE for services to mental health care in the New Year Honours list 2010.
6 CommentsGuest post from Zarathustra of Mental Nurse
A friend of mine recently phoned me up in a panic, “My GP's sending me to a psychiatrist! I'm so scared. I think they're going to section me.”
After she calmed down, it turned out to be a routine referral to the Community Mental Health Team (CMHT), as the GP felt that the antidepressants he'd prescribed her weren't helping. I reassured her that this didn't mean she was about to be sectioned, that these referrals happen all the time, and it wasn't anything to be scared of.
I ended by giving her a note of caution, “You don't need to worry about being whisked away. You'll probably wind up more pissed off about how little they'll do than how much they'll do.”
A few weeks later, I spoke to her again. Her previous fear had turned to annoyance and anger. “I had an assessment with a CPN and a social worker.They suggested I might get CBT and an appointment with the psychiatrist to look at my medication options. Then a few days later I got a letter saying they weren't going to offer me a service, and I should just go back to the GP.” She felt dismissed, humiliated and let down.
I've seen this pattern quite a few times. Somebody is referred to a CMHT with little explanation of what it's for and why. When they arrive at the CMHT, they still aren't given any explanation, and at times are given false expectations. The result is that people are left oscillating between fear about what might happen to them, and disappointment from hoping for a service that doesn't materialise.
At worst, this can resemble a squalid exercise in buck-passing. The GP has tried a couple of antidepressants. They didn't work, so he's washing his hands of the patient and packing them off to the CMHT. The CMHT fill out their assessment, then write back to the GP and tell him they're not taking the patient, and he should try another medication. Like a bureaucratic exercise in mental health pass-the-parcel.
In all fairness, there are often good reasons why so many CMHT assessments end with a referral back to the GP. Mental health services are notoriously under-resourced, and when somebody gets offered a service by the CMHT they often remain with them for a long time. For that reason the CMHTs insist they need to have a high benchmark for offering someone a service, so that they can concentrate on complex conditions such as bipolar disorder and schizophrenia. They also point out that they often have little to offer people with depression and anxiety that can't be offered by a GP. For that reason, they take the view that people with mild-to-moderate mental health problems should remain at the GP level, leaving the CMHT to focus on people with severe and enduring mental illnesses.
In addition, they also argue that some referrals are genuinely inappropriate. Sometimes a GP hasn't done as much as he or she could have done before referring the patient on. At other times the person being referred can be signposted on to other, more suitable services for their needs – for example a bereaved relative who might be better off seeing Cruse rather than a mental health service.
These arguments are valid and I don't dispute them. But what I would suggest is that there needs to be clear communication so that people have realistic expectations of what is and is not likely to happen to them. If a GP is referring somebody to the CMHT, then that GP needs to explain what a CMHT is, why they are referring them, and what will happen as a result. GPs need to remember that, although the stigma of mental illness is much reduced these days, being asked to see a psychiatric service is still a deeply frightening prospect for many people. Above all, GPs need to avoid giving people the impression that they're getting rid of them, and need to advise patients that the follow-up from the assessment could be either from the CMHT or back with the GP.
Just as GPs need to communicate clearly, so too do CMHTs. It's all too easy to promise somebody this or that when they're sitting in front of you in in an assessment, then discuss it in the team meeting the next day, decide you're not going to do anything, and then write the patient a letter that can be summarised as “bugger off”. People shouldn't leave the assessment having been given a set of false promises, and then be left devastated when the letter arrives. Just as GPs need to tell people that a CMHT assessment can often wind up as no more than an assessment, so too do the CMHTs need to give the same message, and give it clearly.
Ultimately, the brutal truth is that NHS resources are limited, and not everyone can be offered a service. But if that's the case then clinicians need to be open and honest about that, to avoid further distress to an already-troubled person.
Zarathustra blogs at Mental Nurse.
7 CommentsGet involved
•Ask your MP and parliamentary candidates how they are going to improve access to talking therapies
•Tell us about your experiences of talking therapies
Regular visitors to our news and blog pages will know that we’ve recently celebrated the manifesto hat-trick scored by the We Need to Talk campaign. All three major political parties have used their manifestos to pledge to improve the provision of psychological therapies. As Paul Farmer’s latest blog post argues, we should definitely see these commitments as a great step forward – we’ve achieved a consensus from all the main parties that access to psychological therapies needs to get better.
You could therefore forgive me for choking on my breakfast cereal this morning as I turned to page 13 of The Times and read this. According to this article, 40 mental health foundation trusts have been singled out for bigger cuts than any other area – the cuts equate to a reduction of an extra £50 million!
Although we all have to appreciate that funds are tight and savings will need to be made in the NHS, it is unjust that yet again mental health services are seen as an easy target when it should be thought of as anything but. As we know, one in four people experience mental distress throughout their lives and there is no reason why they should accept a reduced service any more than those needing physical health services.
These proposed cuts show more clearly than ever that a pledge alone is not enough – we need action. Although I remain encouraged by the parties’ commitments to improve access to psychological therapies, we must keep up the pressure to ensure that words turn into deeds. You can help us achieve this by getting involved in our election campaign. When candidates come to your door, ask a mental health question – just what would they do to improve access to psychological therapies in your area? And don’t forget to take our survey on your experiences. Only by working together can we consign treating mental health services as a “soft option” for cuts to the waste bucket of history.
Mariam Kemple is a Policy and Campaigns Officer at Mind
2 CommentsTo 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
5 CommentsI’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
››Attend our free conference on men and mental health.
››Tell us your thoughts on how the mental health needs of men can be met.
Start the discussionA 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