News

Every year, over 800,000 people die from suicide; this roughly corresponds to one death every 40 seconds. This is shockingly high and something which we can all help to change. Three words lie at the heart of suicide prevention : connect, communicate and care; find out more about this and world suicide prevention day  by clicking here.

 

When people ask me about my job, I tell them that I use my lived experience of mental health to help other people recover. They smile and nod, but I wonder, should I give them a flavour of what that really means? They see me with my name badge on and I get a sense they assume I'm 'cured' or 'better' or 'recovered'; so I think it's important for me to reflect on what 'recovery' means to me and to think about how I can share the magic as a peer support worker with service users.

I'm 18 months past my last section and an inpatient alcohol detox. I’m also in full time employment and was ticking along quite nicely, until one April morning, let me take you to that day........

I drove to work as usual and sat in the office reading the handover notes. Only, something wasn't quite right. I couldn't read the words on the page; it was if I was looking at a foreign language. I got up and walked onto the ward. I stood there, and a cavernous voice was shouting in my head, I remember looking round and a patient asked me if I was ok.

Fast forward a day, and I'm under the care of the home treatment team. They were coming in twice a day, bringing me medication, talking to me, encouraging me to wash and dress and open the curtains. I also received support from a Peer support worker, someone who I could be incredibly honest with, and someone who would just sit with me in my distress.

Fast forward another five days and the strong medication had silenced the turmoil in my head, and I could bear to have the TV on, up to that point, background noise was unbearable. At this point, I began to think about recovery. I felt I had failed. How could I ever support other people when I was no more than a page ahead?! What was recovery? How could I think I had recovered? For a short moment I felt a failure, I even felt I could no longer work as a peer support worker……. until someone said to me 'Clare what better person to help someone in distress than someone who not only has lived experience but RECENT lived experience?!"

So, as I began to stand back up on my feet, and grow strong again, I realised my perception of recovery had changed. It's not a linear journey; well not for me anyway, it's full of twists and turns. I began to tell myself that it was ok to fall back……….as long as I got back on track. This is my recovery, my journey and I remembered how passionate I was about using my lived experience to help others recover.

I returned to work, and quickly felt able to fully function in my role. It helped me having a great support network and a team of people who I work with who just accept me as part of the team and who support me unquestioningly. But what really helped me, was not allowing my view of recovery to remain fixed. Allowing my definition to change allowed me to change and grow, and learn. It allowed me to return to the peer support work that I am so passionate about. It allowed me to story share with patients, to let them know that I too struggle, and that it’s ok. They take strength from seeing me at work, supporting them, knowing that I too am vulnerable.

Being a peer support worker helps me to stay well, but I am not infallible as that brief interlude in April showed me. I have no idea what lies ahead for my recovery journey, but peer support has taught me that its ok, and that recovery is there for us all……………..

  Clare is an accredited peer support worker based in Worcestershire, a passionate coach, mentor, cat owner and lover of kindness..NHS champion..survivor....expert by experience. You can follow her on Twitter @knightonstar

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This year the blog has had over 6,830 views from 47 countries and we have you to thank! We would also like to thank our wonderful contributors who have allowed us to cover diverse topics such as prejudice in mental health, brain stimulation,  academic/creative writing, peer support, schizophrenia and the media , creative practise and many others.

We have no new content this week, but there's plenty of fantastic posts from the last few years which we would invite you to browse through. As always we would welcome some new material so please do get in touch.

 
 
 

Typically, my point of view on the matter of alternative medicine or treatments, is pretty simple. If it has a prefix before medicine, it is not medicine. Medicine, is a science, and as a science it should be susceptible to intense scrutiny and review, open to change, and open for criticism. Many of the prefixed ‘Medicines’ do not pass this standard.

Many people with mental health issues are looking for new treatments, therapies or drugs, and during this search may come across things like hemp oil, colour therapy, aromatherapy, acupuncture and magnetotherapy (not to be confused with magnetic stimulation).

Sadly, not everyone has had the benefit of learning about empiricism, control groups, and placebo effects; nor is everyone aware of pseudo-science ‘wooisms’ that are aimed at tricking you into thinking that it is scientific.

So, when considering some form of alternative treatment ask yourself, and/or the other person trying to sell it to you (yes, they will try to sell it to you) these things:

1:  Ask how it works This is probably the best question. Ask how it works, and if you get an arm-wavy, exoteric, angelic answer, it is probably something you should avoid. Also be aware of the ‘bait and switch’, where something may work for one tiny aspect, and practitioners will try to extended to everything. One interesting example is Yoga. Many practitioners make claim about the benefits for mind and body, and suggest that doing specific routines can heal your anxiety, or cure your depression.  However, any of the benefits that people have from doing yoga are exercise related and not yoga specific. This rose in a field of daisies  effect can also be seen in media coverage surrounding the Medicine Nobel Prize in 2015, where Artemisinin a traditional Chinese Medicine, was scientifically tested and found to be an effective anti-malaria compound. Despite the original compound being marketed quite differently and not originally considered to have anti-malarial properties, the finding of some effectiveness gave way to a barrage of vindication articles about alternative medicine.

Here’s a list of ‘alternative’ therapies and how they work. Notice that many of the explanations given are either based on some esoteric, mystical explanation, or on pseudo-science that defies logic:

• Homeopathy: giving patients medicines that contain no medicine whatsoever. You fight the illness with a diluted version of a substance that can cause your ailment. This is because water retains ‘shape memory’ of previous substances that were diluted in it will act as some form of inoculation. By this logic, we are all drinking poop water.
• Reiki: Literal arm waving above someone’s body whereby you transfer some form of energy (or remove it?) and you cure someone of their pain or condition.
• Angelic Reiki: as above, but angels power you up, like a videogame bonus.
• Aromatherapy: smelling certain smells will treat specific things, and make you feel better.
• Colour therapy: as above but with colours, possibly auras have something to do with this too, the website is not very clear. You can also buy a colour making machine for a reasonable price at the end of the page.
• Acupuncture:  So this one is a controversial issue, because there are some good studies that show that it may work for back pain. However, there are no biological mechanisms offered to explain the effects and the studies are rarely double blind. But the original explanation for this treatment is that all sorts of pain, psychological or physical, lead to Qi blockages (life force -you know what it is if you ever watched any Japanese Anime). By placing needles in these specific blockages you break them down and restore the life force flow, thereby feeling better.

2: Are the [insert treatment/therapy] results’ published in any reputable medical/psychological journal? Many times alternative therapies only refer to old books, or in-house conducted studies. This is highly dubious because they are not peer-reviewed. Peer review is, perhaps, the most important ‘bullshit’ detector that there is in science; if the study or idea does not hold up to the scrutiny of academic peers then it is no good. Peer-review usually works by having experts in the field carefully read the contents of a report and identify any flaws in the experimental design, statistics and interpretation of results. The author will receive numerous comments on their manuscript to which they have to answer to the satisfaction of the reviewers.  This creates an exchange between the author and reviewers which aims to raise the scientific quality of the report. The author of said report may disagree with the comments of the reviewer and reply with added evidence in the manuscript. Or, they could simply just directly address the reviewer's concerns by doing an extra experiment, or doing the data analysis a different way. A little caveat to this is, if you send a study about colour therapy to Journal of Alternative and Complementary Medicine, the peers reviewing it may have a vested interest in publishing the report, even if it does not survive the highest scientific standards. Therefore, extra care should be taken when reading about the results and interpretations.

3: Is the study for the [insert treatment/therapy] double blinded? This is important! Having a controlled, double blind study, where both the researcher and/or subject are unaware of the experimental condition, is the gold standard of good science. If you cannot find research for the treatment, or the ‘expert’ cannot answer it is probably best just to ‘#forgetaboutit’.

An excellent example of the importance of the double blind design was highlighted in a study [1] published in the journal Nature. In this study it was found that white blood cells release histamine (which is very important for the immune system) when exposed to a very diluted solution of specific antibodies (1X10129 dilution factor, which technically it is not a solution because at this factor there would be no actual molecules of compound left ). This release was observed via microscopy and with staining techniques which change the colour of the cells, and allowed researchers to count those which had reacted to the solution. Sir John Maddox, then editor of the journal, published this article on the condition that Dr. Jacques Benveniste, open their lab for a close examination and allowed the study to be replicated [2]. Part of the team, and surprising everyone, was James Randi a professional magician, and master of all tricks, who was invited to detect any subterfuge. The team sent by Maddox accurately pointed out that, when counting the number of blood cells that supposedly reacted to the homeopathic solution, the experimenters were not appropriately blind to which condition they were counting for [2,3]. In the end of the counting, when they saw that the control group did not have an appropriate count, the experimenter thought ‘this is not right’ and would recount. This lead to an obvious experimental bias where the results that fit with the experimenters’ expectations were more likely to be accepted. Having found this, the investigating team asked the experimenters to repeat the study, using a stricter blind procedure:

One person codes the samples, these are given to another who is unaware of the initial coding and re-codes them again, then another experimenter does the counting.

The above procedure was the one mentioned in the study, but typically one person codes the samples or conditions, and gives to another experimenter who does not know code and s/he does the analysis. After repeating the statistics, no significant differences were found between blood cells which has been exposed to homeopathic solutions and those which had not.  This highlights the importance of the double blind procedure. Human brains are easily tricked into bias, and perceiving  patterns where they do not exist, therefore make sure you look for the double blind design.

Deciphering the science based treatments from those which are not can be tricky, particularly with the continuous arrival of new alternative therapies. However, these 3 questions are probably sufficient for you to start developing your own bullshit detector, and focus on those treatments that actually improve your well-being.

Miguel is a PhD student in Cognitive Neuroscience, and currently is working on Brain responses to body abnormalities. This email address is being protected from spambots. You need JavaScript enabled to view it. ……………………………………………………………………………………………………………………

References:  [1] Davenas, E., Beauvais, F., Amara, J., Oberbaum, M., Robinzon, B., Miadonnai, A., ... & Sainte-Laudy, J. (1988). Human basophil degranulation triggered by very dilute antiserum against IgE. Nature, 333(6176), 816-818.

[2] Maddox, J. (1988). Waves caused by extreme dilution. Nature, 335, 760-763.

[3]Maddox, J., Randi, J., & Stewart, W. W. (1988). " High-dilution" experiments a delusion. Nature, 334, 287-290.

   

'The challenge facing individuals with experiences of mental ill-health is to retain, or rebuild, a meaningful and valued life and like everyone else, to grow and develop within and beyond the limits imposed by their cognitive and emotional difficulties' [1].

My passion to Raise Awareness of Mental Health in Higher Education began from my interaction with students who had experiences of mental ill-health. It broke my heart to watch, listen and hear them cry. They cried and I cried because there was very little that I could do at the time. Following this experience I was motivated to write a blog piece discussing the importance of mental health awareness in higher education.

Soon after, I started the Raising Awareness of Mental Health in Higher Education campaign, after receiving a successful ESRC PGR grant to host an event. Nothing was more important than to host an event on mental health in higher education. An event that will bring a diverse group of people together to dialogue on the issue of mental health in higher education. Therefore, the Raising Awareness of Mental Health in Higher Education (RAMHHE) conference will be on the 10th October 2016 at the University of Nottingham. The conference is open to staff and student at the University of Nottingham, Warwick and Birmingham. It is also open to service providers and speakers from all over the UK.

The objective of the RAMHHE conference is to promote an anti-stigma and inclusive day, where people can express their views and perceptions of mental health and recovery through collective dialogue. In order to meet this objective, RAMHHE aims to provide a social learning space.

'Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems' [2].

'Recovery is not about ‘getting rid’ of problems, it is about seeing the individual beyond their mental ill-health experiences, their abilities, possibilities, interests and dreams' [1].

There will be inspirational and motivational speakers with lived experiences of mental ill-health and recovery, mental health service providers with information on mental health and wellbeing and mental health practitioners to answer any questions that attendees may have. Information from the conference will provide an interdisciplinary insight into how to raise awareness of mental health in higher education.

I have also developed the RAMHHE16 selfie post card, so that people can handwrite or print, snap and tweet to #RAMHHE16.

I believe in the power of many, so in addition to the conference and RAMHHE selfie post card campaign, a petition had been submitted and we require 10,000 signatures before the government will respond to the call to debate the issue of mental ill-health in higher education. Please click the link or scan the QR Code to sign the petition. Please remember to check your email and click the link from the house of parliament to sign the petition.

Thank you to all of the people who have shown tremendous support by signing the petition and tweeting their selfie post cards to #RAMHHE16. It is my hope that with the combination of the three campaign strategies and other supporting efforts, we will collectively make enough noise to sensitise the government about the prevalence and incidence of mental ill-health in higher education.

 Josephine NwaAmaka Bardi is a Registered Mental Health Nurse, and an Economic and Social Research Council PhD student on the mental health and wellbeing pathway.  Contact: This email address is being protected from spambots. You need JavaScript enabled to view it.
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For more information and sources of support:
StudentMinds
UoN Counselling Services
NightLine
UMHAN
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References
[1]  Repper, J. and Carter, T. (2011) 'A review of the literature on peer support in mental health services', Journal of Mental Health, 20(4), pp. 392-411.

[2] Shepherd, G., Boardman, J. and Slade, M. (2008) Making recovery a reality. Citeseer.

Dear reader,

Do you have something to say about mental health, integrated health care or wellbeing? Are there any issues that you feel passionately about and would like to communicate to a wider audience?

Well good news….we are looking for content and would love your input! We would welcome any content broadly related to mental health and health care. This could be anything from personal accounts to discussions about recent research, current affairs or interesting books (and everything else in between!).

The blog really does depend on your kind contributions and support and we would really love to hear from you, so please don't hesitate to get in touch with any ideas you may have.

Kat Dyke, PhD Student, Psychology (This email address is being protected from spambots. You need JavaScript enabled to view it.)

Charlotte Horn, Medical School (This email address is being protected from spambots. You need JavaScript enabled to view it.)

 

Recent research I carried out has brought home to me how difficult it is for students to be honest about their mental health. I am a mental health nurse currently doing a PhD in mental health and wellbeing. A couple of months ago, I decided to conduct participatory action research on mental health, to give students a voice and opportunity to participate in a mental health research project. However most of the students that I invited refused to participate.

But who can blame this student? With the stigma, shame and social isolation associated with mental health, it is no wonder that higher education students want to be seen as “normal”.

As a mental health nurse, I am very aware of what the Nursing and Midwifery Council (NMC) Code of Conduct says about my responsibility and accountability to patients. However, there is no code on my responsibilities to vulnerable students who do not have a diagnosis of mental illness, neither is there a code for the ones with a diagnosis who refuse to disclose.

The question is why mental health education is not a significant part of university student inductions, health promotion campaigns and mental health awareness initiatives? It is not enough to put up A4 posters, leaflets and sign with messages like “confidential counselling team”, “feeling stressed about your exams, want to talk it?”  Stigma, shame and social isolation seems to ring through the information leaflets.

Experiences of mental health among higher education students are not limited to the student alone, but friends and family members may also have a diagnosis of mental health. This is huge mental responsibility for any student, in addition to studying to achieve academically.

Higher education authorities must recognise the importance of the student voice in facilitating help-seeking behaviour among higher education students with experiences of mental ill-health. The time has come to prioritise the voice, opinions and experiences of mental health among higher education students, so as to provide a platform for students to express their views on their mental health without the fear of stigma, shame and social isolation.

  Josephine NwaAmaka Bardi is a Registered Mental Health Nurse and an Economic and Social Research Council PhD student on the mental health and wellbeing pathway. Contact: This email address is being protected from spambots. You need JavaScript enabled to view it.

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For more information and sources of support:

Graduate School advice about mental health Mind

Eliminating eating disorders and investigating the roots of these issues is a passion of mine. While I have never struggled with an eating disorder myself, I have personally experienced dear friends both die from and overcome these disorders.  It is a serious issue that impacts many.  As a scientist investigating eating disorders, I hesitate to share that I am also a former fashion professional.  However, being a part of these two unique worlds of science and fashion, hopefully gives me experience and insight.

Eating disorders take more lives than all the other mental illnesses [1], and is a growing epidemic in children through to adults, effecting both males and females.  Recently, in the United Kingdom alone, the hospitalisations in one year (2012/13) for eating disorders rose 8% overall, and these types of hospitalisations often result in longer periods of hospitalisation than for all other admissions [2].  Sadly, eating disorders take the lives of females ages 15-24 years, 12 times more than all other causes of death [3].  The underlying roots which propel these disordered eating behaviours forward into dangerous and life-taking habits and illness are still unclear, including the role and impact of body image.

Much of the main focus regarding eating disorders seems to be on anorexia nervosa and the ideals of attaining an emaciated body, which is often blamed on the influence of the fashion and entertainment industry.  Interestingly, the most suffered eating disorder for women and men combined is currently binge eating disorder (BED), which affects nearly half of all eating disorder sufferers[1].  BED is characterised by overeating several times a week for over three months with distress. Whilst eating disorders continue taking the lives of people of all shapes and sizes, genders and ethnicities, and both malnutrition and obesity put an incredible strain on the body and lives, the main message has been to understandably eliminate “thin-ideal” and also to embrace the “real” larger body-types, for women in particular.

Within the fashion industry body-size is also a delicate subject, and many who enter the fashion model profession have naturally slimmer frames.  Whilst it is necessary to develop some type of guidelines and laws to protect fashion models (in many aspects of their profession), a Body Mass Index limit to avoid unhealthily thin models from gaining employment may also strip the means of earning a living for those who are not able to gain weight easily (in their natural state).  Just as some people naturally have a more overweight tendency and body shape, there are others who naturally have the opposite issue.

I will never forget a female fashion model from South America in tears sharing with me the frequent rude comments made about her body size face-to-face, and under her social media photos.  Perhaps many felt justified to tear down what they assumed was her goal and the “thin-ideal”, not realising that not everyone is trying to lose weight or desires the “thin-ideal”.  This particular model shared that she always struggled to gain more weight, as she came from a culture where curvy is the ideal body type for women, and was brutally bullied growing up as a very slim person.  Now this bullying continued, even in a new country, again, for not having a curvier, more voluptuous body type, and it was painful.  Seeing many struggle in many ways, brought personal awareness of the importance to consider all different shapes and sizes, in our attitudes, comments, and in how to protect anyone from being bullied for their size.  A larger, curvier body, as well as a very slim body does not make someone more or less a "real" woman.  Also, women of all shapes and sizes suffer from eating disorders.  Assumptions, rude comments, and bullying, should not acceptable whether someone is underweight or overweight or average weight.  There is a danger when working with those struggling with an eating disorder to demonise those with body size closer to the unhealthy goals the person may hold. While this may be done with the hope that these goals will be dropped, bringing health and healing, we may be more effective if we each contribute to reducing a spirit of competitiveness, and the “us” and “them” messages, even pertaining to outer appearance.  Messages that someone is not "enough", "real", or "worthy" because of their size and shape - should never be acceptable.  It may be that instead of labeling the “thin-ideal” as the evil to avoid, we all may work to develop an embracing society, which cheers on others beauty (of all sizes), gifts and talents, while also cheering on our own.

It is also important to research the facts behind these issues, so that we may develop the most effective safeguards.  My current research focus is investigating these underlying roots.  My hope is to help develop more effective prevention and treatments with the goal of saving more lives, whilst supporting more inclusive body messages which reduce victimisation and stigmatisation for all people.


Christina Ralph-Nearman is a former fashion professional, who has an MSc in Neuroimaging and Neuro-Clinical Psychology, and is currently completing a PhD using neuroimaging techniques to research the implicit underlying mechanisms of eating disorders.  Contact: This email address is being protected from spambots. You need JavaScript enabled to view it. Twitter: @CRalphNearman

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For more information and sources of support:

 Mind

B-eat

Eating Disorder Support Service

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References

[1] NICE (National Institute for Clinical Excellence) (2004) Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders, Great Britain: The British Psychological Society and Gaskell.

[2] Health & Social Care Information Centre (HSCIC). (2014). Eating disorders: Hospital admissions up 8 per cent in a year.  Retrieved on May 1^st, 2014, at: http://www.hscic.gov.uk/article/3880/Eating-disorders-Hospital-admissions-up-by-8-per-cent-in-a-year
[3] Sullivan, F., 1995, Mortality in anorexia nervosa.  American Journal of Psychiatry, 152(7), 1073-4.

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The 16-22th May 2016 has not been like any other week. It has been Mental Health Awareness Week; a much needed occasion designed to raise awareness and tackle the stigma still attached to mental health. This is something I’ve always been passionate about, but in all honesty I am not always as open about my own struggles as I could be. The thing is that as much as I encourage others to share their experiences, I still have apprehensions about discussing things so openly, and I’m not alone.

We live in a time where an estimated one in five of us will experience depression at some point in our lives, but despite this we are still not particularly good at talking about it. Understandably, talking about mental health with a friend or family member who is unwell can be difficult and it can be hard to know what to say, but this doesn’t mean that silence is the answer.

The focus of this week’s campaign is relationships; the wonderful connections that we all make (and all too often take for granted) which are so important in maintaining good health and well-being.  Relationships are fluid and during times of illness these dynamics can change. I’m hoping that by sharing a few of my own experiences I can shed some light onto how depression can impact relationships, and how they can also be key to recovery.

My personal experiences have taught me two key things. Firstly, that even good strong relationships can be strained by issues like depression. Caring for someone who is ill can be difficult at the best of times, and when this illness has invisible causes it can be particularly challenging. Secondly, and most importantly, good relationships are invaluable to recovery and to maintaining good mental health.

I’ll start with the first more gloomy point. One of the things I discovered during the depths of a depressive episode was that I was unable to fully appreciate the kindness of my friends and family. During that period my thinking and self-esteem were disorganized and negative and as a result there were many instances when I felt that I deserved to be isolated and alone. I’ve come to think that this is one of the most cunning tricks of depression and also one of the reasons that small acts of kindness are so important in supporting someone who is unwell. Although at times I felt undeserving, I also felt various other emotions (albeit slightly muted). During this time things like receiving post, borrowing lecture notes or being cooked for were invaluable. These small things gave me the chance to feel valued and normal, and although these feelings didn’t always last long, they provided glimmers of light in what was otherwise a dark place.

Another cruel trick of depression was to make me exhausted and apathetic, which meant that the things I would usually do to repay kind favours went out the window. This put a strain on my close relationships as things became very one-sided, and eventually led to unhelpful but understandable comments from those around me. In a moment of exacerbation someone incredibly close to me once said ‘I just don’t understand why you can’t be happy’. This was heart breaking as I really didn’t know. I knew the answers to many questions, but that one was, and remains out of my grasp. Although everyone’s experiences of depression will be different, it’s important to remember that no one chooses this and given the option we would all surely chose health and happiness.

Fortunately, in spite of all the challenges my wonderful friends and family stuck around to help me crawl slowly back to health and happiness and as my thinking became clearer I was increasingly grateful to those around me. I also came to realise that sometimes we need to refocus and really appreciate what we have. It’s clichéd, but when it comes down to it the most valuable thing you will ever have is the love and support of others. Be kind to yourself, give yourself time and above all value those close to you. And if you ever notice a friend who seems down, don’t be afraid to ask ‘are you ok?’ and then to listen patiently for an honest answer.

Kat Dyke (@kat_s_dyke) is a PhD student within the School of Psychology. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

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If you need someone to talk to Samaritans are available round-the-clock (and free to contact) on 116 123 (UK & ROI)

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This week is Mental Health Awareness Week.  Find out more here:

Recently this wonderful blog was nominated for a Knowledge Exchange and Impact Award 2016, in the media category. Sadly we didn’t win, but we did have the opportunity to attend the awards night, and what a fantastic night it was.

The awards celebrate some of the University's biggest achievements across all departments and campuses, including China and Malaysia. This makes it a really inspiration place to be and we felt very honoured to be able to be part of it. Of course this would not be possible without our readers and contributors, and for that we are hugely grateful to you all. We really do value all the contributions we receive and are proud of what we post.

Thank you to all those who have joined the conversation so far. Here’s to even more conversations to come...

Kat and Emma (IMH Blog Editors)

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‘Improving Lives’ (IL) (formerly Integritas) is a small, independent charity that delivers both one to one case support and advocacy services to adults with complex health and social needs within the city of Nottingham. The service was formed as a community interest company in November 2006 and became a registered charity in February 2012.  IL is led by a Board of Trustees, which is made up of a mixture of mental health service users and professionals. Working for the charity are five support-workers (including two social workers), highly committed to providing person-centred, compassionate support.

Their message and aim is clear: to provide free one-to-one support for some of the most vulnerable adults across the city of Nottingham and work towards current policy aims to reduce health inequality. All of the people whom Improving Lives work with have mental health issues or learning difficulties, often undiagnosed, and come to attention either due to repeated calls to emergency services or through instances of anti-social behaviour.

Fundamentally, Improving Lives promotes individualised, wide-ranging case support and services for people, in order to promote a more effective way to empower individuals and the problems they face in society. In recognition of the complex and fluctuating nature of mental health issues and complex needs, the charity has a broad focus and is striving to promote this model of pragmatic support in the community in order to bridge the gap (and catch those who fall in) between ‘single-issue’ service provision and individualised services.



I volunteer for Improving Lives one afternoon a week, as a befriender to an individual (let’s call him ‘Keith’) living in Nottingham who has a recent diagnosis of autism, complex social and personal needs, no family and no one to help with day-to-day activities that he sometimes finds challenging. We usually grab a cup of tea and talk about 1950’s rockabilly music – a valued weekly step away from PhD writing to see how Keith is (and what’s going on in the outside world generally). However, for the people working all day every day to keep the charity afloat, raise awareness, as well as provide support services, things are tough, and largely unpredictable. The service is small and relatively low profile (although some publicity has been achieved with a recent spot on BBC East Midlands today and in the Nottingham Post ), with insecure funding. Improving Lives is not big enough to dedicate resources to fundraising, and in the past some charitable funders have refused support since the work undertaken and services offered are considered to be in need of delivery or funding by statutory services. The majority of costs for the last two years have come from a combination of NHS and Nottinghamshire Police Commissioner resources. It’s not yet certain where, or if, further funding will come from to take the charity into 2017. There’s a lot of work to do, and potential for collaboration across sectors.

In keeping good to their word being tenacious and determined, independent and person-centred, Improving Lives undertook their own research with their clients to get their take on the value and impact the service has on their lives. They have run focus groups within their offices, as well as undertaken telephone surveys to assess client satisfaction with services, and their general wellbeing. The outcomes of this qualitative research largely reinforces Improving Lives as an integral source of advocacy, advice, and support with anything from paperwork, debt management, benefits, teaching new skills (e.g. IT) and befriending to help combat isolation. However clients feel that more can be done to improve socialising opportunities, and to improve staff knowledge of different physical and mental health conditions. These perceived gaps in the service are not met with surprise. This organisation has limited resources and strives to provide individualised, one-to-one support for people from potentially any background. Therefore it is an on-going challenge to meet both individual and broadly collective needs.

This research is important, and helps third sector services find out ‘what works’ for them and the community. However the dissemination of findings to academic audiences is challenging, particularly where fundamental ethical codes of informed consent, safely and securely handling data, and protecting participants from harm have undoubtedly been adhered to, but a formal application to a research ethics committee (REC) has not been made, either because of lack of resources to write applications or due to time constraints. The fact that included participants would have a current or background of mental illness or learning disability would be flagged in a research ethics committee application, as a vulnerable population group requiring additional protection and safeguards to research practices and potential power conflicts (which can take this blog post into an entirely different discussion, but for those interested see Bracken-Roche et al., 2016).

Academic research has been known to be retracted from publication due to lack of ethical approval, and the BMJ, for example, states that research submissions will not be considered for publication unless a statement is made that ‘the study obtained ethics approval (or a statement that it was not required), including the name of the ethics committee(s) or institutional review board(s), the number/ID of the approval(s), and a statement that participants gave informed consent before taking part’. There is an expectation to obtain ethical approval when undertaking any type of research with human participants, even if it’s not considered overly intrusive, and this principle rests on those laid out by the lynchpin of ethical guidelines, the Declaration of Helsinki, the principles of which are implemented into domestic legislation and policy (for us, the upcoming EU Clinical Trials Regulation ), as well as regional research ethical guidance, including the Economic and Social Research Council (ESRC) Framework, and more locally, the University of Nottingham’s inter-faculty research ethics committees.

For third sector organisations, the ethical rules are a bit more ambiguous, with some guidance available online, but no formal way of ensuring that research output is driven towards influencing policy. Collaboration is key in this circumstance; the Nottingham Community and Voluntary Service (NCVS) in which Improving Lives is based, has previously published a report showing a contribution of £227m of the voluntary and community sector to Nottingham’s economy, as well as the equivalence of £14m in wages through non-paid volunteers working the equivalent of 649 full-time jobs.

For small charities like Improving Lives, there is constant need and expectation to justify their purpose, and research is one way to do it; cut-backs in funding have been exponential over the past decade (more than £3.8bn) and it doesn’t look like things are going to improve any time soon. This current structure in research capability, however, puts third sector organisations at a disadvantage, and serves to keep academic research in the ivory tower. In our current age of tackling social and income inequality, shouldn’t academia be more concerned with engaging with the not-for-profit services (particularly those that offer support to people with mental health difficulties [13]) in order to investigate their challenges, successes and their overall effectiveness? It is undoubtedly the third sector that holds much expertise and insight that is capable of shaping the way in which services are delivered in the community to improve lives.

What clients have said:
“They offered to escort me to appointments. They took me to my PIP court hearing. I don’t think I would have gone without her”
“I was able to speak to my worker about some personal issues. I had no one to discuss it with. I was able to get over that stage. He gave advice and encouragement and helped me to be open. I had no one else to speak to.”
“I was absolutely suicidal when I first came here.”
“If it wasn’t for something like this I don’t know what I would have done when my wife died. I would have turned to drink or drugs, I would have committed suicide.”

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You can find the Improving Lives offices on the first floor of the Nottingham Community and Volunteer Service (NCVS) building, 7 Mansfield Road, Nottingham, NG1 3FB

Website: http://www.improvinglivesnotts.org.uk
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Stephanie Sampson (@steph_samp) is an Associate Fellow of the Institute of Mental Health and PhD candidate (Mental Health and Wellbeing) in the School of Law (This email address is being protected from spambots. You need JavaScript enabled to view it.)
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Kate E. Pickett, Richard G. Wilkinson (2010) Inequality: an under-acknowledged source of mental illness and distress, The British Journal of Psychiatry, 197 (6) 426-428; DOI: 10.1192/bjp.bp.109.072066
 

Having found hope in dark places, having experienced the power of Peer-support for myself, I have returned to the world of employment.

Can I ask you to let that sentence just sink in? I felt I had lost everything and would never work again. Here I am, fully employed as a Peer-support worker.

So my recovery journey has taken an unexpected path. I work full time on an acute ward. I have a pass for the ward, after years of trying to escape these places; I now have the responsibility that comes with being a member of staff! I’ve gone from utter despair to now believing that things will be ok, that I’m ok. I feel so lucky that the team I now work with have made me so welcome.  Not only that, they value my opinion and can see the key role that Peer-support plays in a ward environment.

However this is not a fairy story, I still have my dark days, and dark moments, but I have a reason to get up in the morning again, a reason to carry on and these thoughts alone prevent a lot of my previous self-destructive behaviours.

The other affirmation I kept saying to myself was that I am trained! Not only do I have my own lived experience, I am now an accredited Peer support worker. The IMH peer support training gave me a great foundation around principles of recovery. Learning how to apply these in a very acute environment can be hard. I have to remind myself that there will be steps backward as well as forward for both me and the patients! The feedback I get from patients is amazing, they are often really encouraged by the fact that I have returned to employment, and it often gives them hope that it’s possible for them too.

Some of the patients I work with haven’t even heard of the word recovery, and they are often unaware of the mutual benefit I get from talking with them, sharing stories and ideas, validating their experiences and providing them space to hear their story. They are all helping my recovery and I will always be grateful to patients for the mutuality of peer support that I get.

I work with a great team of people. They genuinely care so much about helping, and now, as a member of staff, I get to see just how busy everyone is, how many parts to the jigsaw of an inpatient admission there are. Peer support is a now a part of that jigsaw and I feel valued by everyone. They look out for me, and have welcomed me as part of the team. I will always be grateful to my colleagues on the ward who no matter how busy they are, they are always there for me too. Peer support works!

Clare Knighton

Peer Support worker, Worcestershire

This article was co-written by Emma Nielsen, a researcher in the Self-Harm Research Group at the University of Nottingham and Sophie, a mental health worker with lived experience of bereavement by suicide.  Sophie’s words are quoted throughout.  ……………………………………………………………………………………………………………………

Sometimes it feels like the world is full of a lot of rules:  don’t walk on the grass, eat five portions of fruit and veg a day, double space after a period if (and only if) that full stop marks the end of the sentence in APA formatting.  Sometimes this guidance feels trivial and rules feel restrictive and pedantic.  The guidelines for the media reporting of suicide probably fall under this category for some people.  Perhaps at first glance they seem overly prescriptive and counter to creative expression or editorial judgement.  But despite first impressions some rules really matter.  The guidelines for media reporting have been put in place for a specific reason and by people that really understand.

I am the first to admit that I don’t always like being told what to do.  It is not simply a case of stubborn independence or wanting to do things my own way all the time.  It is more than that.  It is the, ‘but why?’  Rules are hard when they aren’t understood.  You need the why.  Often it is not a commandment that is frustrating but being asked to adhere to something when you don’t know how it makes a difference.  It is far easier to tolerate the green wavy lines of grammatical corrections when you appreciated that double-spacing post-period is not mere convention, it is recommended to increase reading comprehension.  Similarly, it is perhaps easier to see the importance of media guidelines when you appreciate why they were created - and there are big whys behind these guidelines.  They are there to keep people safer.  They are there to keep people alive. Often it is in listening to people’s experiences that we understand the truths of a situation.  Perhaps by feeling the impact of reporting which doesn’t adhere to the guidelines we can start to appreciate how, why and the extent to which these codes of practice really do matter.

“When a close friend died by suicide* my world shattered. Aged 21 and living in a close knit university community meant the grief rocked everyone around us. But for me, and I imagine her other close friends, the pain was unbearable. The depth of emotion I felt, including the shock, horror and the forever unanswered questions have reduced in intensity now, five years on, but they still linger under the surface. The immediate aftermath of shock, sadness, guilt and confusion are still vivid in my mind when I recall it. I don’t remember how I found out about the first newspaper article that was published. It was the first in a number published by many different newspapers. I can recollect vividly, however, how much the pieces magnified the pain I was in. Looking back, the papers broke almost every suicide reporting guideline: they commented extensively on the method she used, showed pictures of the place she died and described the act with unnecessarily sensationalised language. The articles speculated on reasons, or lack thereof, she might have had to kill herself, and erroneously linked the tragedy to two other (unrelated) deaths, one of which was also a suicide, that had occurred that term.”

In the reporting of suicide, it is important to think about both what is said and also how it is said.  Discussions around suicide are of paramount importance.  Conversations need to be encouraged but they also need to be constructive, accurate and educated.  The media hold a privileged position. Good coverage can be a catalyst for encouraging a better understanding of the topic, in wide audiences.  Indeed, research evidence suggests that responsible media reporting can have a suicide-protective effect – the Papageno effect - especially if reports consider aspects of positive coping in difficult circumstances [1].  Conversely, irresponsible and negative messages carry scope to make just as big an impact.  This is dangerous.  There is robust evidence that media reporting of suicidal behavior can lead to modelling and contagion - the Werther effect [2]. This is what the current media guidelines set out to prevent [3]. To borrow a catchphrase from Spiderman, with great power comes great responsibility. It is vital that those producing media content not only think carefully about the content they are creating but also take responsibility for the way in which these pieces are presented and how people are encouraged to interact with and respond to them.  Education matters and so does compassion.  Opening forums which permit unmoderated comments is perhaps unhelpful in this instance, particularly given the potential for eliciting comments which magnify distress.

“Worse still were many of the comments left by readers, a number of which were nothing less than horrific.  Most exacerbated the extreme distress myself and friends were already experiencing.  Seeing the worst of them ‘upvoted’ by other readers did nothing to help this matter.”

For a journalist, the piece they write may be just another story.  For those bereaved it will always be an important story.  It matters that media producers understand the lifelong impact of being bereaved by suicide.  People who are grieving are vulnerable to experiencing suicidal thoughts themselves and need support.  It is not uncommon for those bereaved by suicide to report having been distressed by media coverage [3]. It is vital to consider the distress surrounding suicide and, if writing a piece, use it as a platform to help others and to signpost them to sources of support.  It is a matter of responsibility and respect.  We need to be considerate.  We need to be hopeful.  These are people’s lives we are considering and people’s futures that we are being hopeful for.

“Losing a loved one, particularly to suicide, is a pain that may reduce in intensity over time but never really goes away.  Apart from her Facebook page, these articles are among the only tangible online records of the tragically short life of a dear friend.  She should be remembered as the vibrant, gifted, articulate, hilarious woman she was, not as someone portrayed as selfish who couldn’t cope with her studies.”

There is a role for us all. While those producing media undoubtedly have a big role to play, we, as an audience, also hold power.  We shouldn’t be passive recipients. We need to challenge irresponsible and dangerous coverage. If we see reporting that we aren’t comfortable with, or that we know may be difficult for other people, we can politely challenge it and direct people to the guidelines. Worldwide, someone makes a suicide attempt every 3 seconds. Someone dies by suicide every 40 seconds [4].  Anyone can be affected and each year thousands more are.  We need to create safer spaces for us all..

“It is our collective duty to take action and effect change. Insensitive reporting causes avoidable distress for those experiencing some of the most difficult periods of their lives.  For the sake of vulnerable people and the bereaved, I implore journalists to use their powerful positions to help, not hinder, the grieving process.”

Emma Nielsen (@EmmaLNielsen) is an Associate Fellow of the Institute of Mental Health and PhD student in the School of Psychology (Lpxen@nottingham.ac.uk)  Sophie wished to write this piece anonymously. However, she would be glad to hear of any comments. These can be left on the blog or e-mailed, via Emma.   ……………………………………………………………………………………………………………………

*Note: I have not used the word ‘committed’ here - see Emma Nielsen’s excellent blog on the reasons why

 Interested to learn more? Information and great advice for media reporting of suicide is available from the Samaritans, Mindframe and the World Health Organisation . These codes of practice acknowledge that not everyone is an expert in suicide prevention. They don’t have to be – those with expertise have done, and continue to do, the leg work.  The research evidence is there, the guidelines are outlined on this basis and there are even people there to provide advice. The Samaritans’ Press Office is available 24 hours a day for consultation on any media enquiry or sources of support:

• +44 (0)20 8394 8300 (during working hours)
• +44 (0)7943 809162 (out of hours contact)

They are also able to provide up-to-date statistics and advice around their interpretation.

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If you need someone to talk to, Samaritans are available round-the-clock (and free to contact) on 116 123 (UK & ROI)

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[1] Niederkrotenthaler, T., Voracek, M., Herberth, A., Till, B., Strauss, M., Etzersdorfer, E., ... & Sonneck, G. (2010). Role of media reports in completed and prevented suicide: Werther v. Papageno effects. The British Journal of Psychiatry, 197(3), 234-243.

[2] Pirkis, J., Blood, R. W., Beautrais, A., Burgess, P., & Skehan, J. (2006). Media guidelines on the reporting of suicide. Crisis, 27(2), 82-87.

[3] Chapple, A., Ziebland, S., Simkin, S., & Hawton, K. (2013). How people bereaved by suicide perceive newspaper reporting: qualitative study. The British Journal of Psychiatry, 203(3), 228-232.

[4] World Health Organization. (2000). Preventing suicide: A resource for primary health care workers.

 

 

Gilles de la Tourette syndrome (TS) is a neurological condition which affects approximately 1% of the school age population. To put that into perspective, if Wembley stadium were full that would be 900 people, which makes TS far more common than most people believe.

People with Tourette’s syndrome have ‘tics’, which are involuntary and difficult to control. Tics can involve movements (motor tics) or sounds (vocal tics), and are highly varied. For example, a tic could be a simple action like an eye blink, or it could be a sequence of complex movements and/or sounds. Some people are able to suppress their tics for a short amount of time, however, this can be uncomfortable (like trying not to blink, or hold in a sneeze). Suppressing tics can require a large amount of effort, which can make it difficult to concentrate on other things; it can also lead to a feeling of tics building up and may result in more occurring later on in the day. This can be particularly difficult for school aged children, and is one of the key reasons why raising awareness and understanding of TS is so important. It’s a myth that people with TS can just stop their tics, although some people with TS can supress them for a short amount of time this does not make them go away. However, for about 70-80% of people with TS their tics will naturally decrease as they get older [1].

Causes of Tourette’s syndrome

The exact cause of TS is not yet fully understood, but it does seem to run in families [2]. Most people with TS will have a close relative who also currently experiences tics, or has done so in the past. There are also specific regions of the brain which seem to be slightly different in people with TS [3], and there are differences in some types of chemical messengers known as neurotransmitters [4].

Finding the cause of TS is a difficult task, which is made more complicated by the fact that TS is a disorder which is often accompanied by other conditions. In fact up to 88% of people with TS will also have at least one other diagnosis such as Obsessive Compulsive Disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD) [5]. Despite this advances in science (like improved brain scanning techniques) are helping us to understand how TS develops. Discovering the neurological basis of TS has been hugely important in disproving some previous myths about the condition, for example, that people with TS have unresolved underlying psychological conflicts or are possessed. Both of which are clearly untrue!

Tourette’s syndrome and swearing

A common misconception about TS is that it involves swearing or making inappropriate comments. While Coprolalia (the use of obscene or unacceptable language) is a type of tic associated with Tourette’s syndrome, only 10% of people with TS have it. Due to some of the media coverage of TS, and the distinctiveness of this type of tic, many people think that it is much more common.

Are tics serious?

Tics can seem humorous, but to someone with TS they are often a source of embarrassment and unwanted attention. It’s important to remember that tics are not intentional actions. They are involuntary and can be surprising, even to the person with TS. Tics can also be physically painful; this is because some tics may involve repetitive actions or self-abusive behaviours such as hitting or scratching. The majority of people with TS typically prefer their tics to be ignored; but there can be times when it’s ok to laugh. This will depend on the person and your relationship to them, but if in doubt ask what they are comfortable with. For an insight into the humorous and creative side of tics I strongly recommend exploring the world of Tourette’s Hero (Jessica Thom) and following her on twitter for insightful commentary about living the TS and for ‘daily outbursts’ like "Al Murray wants your vote more than he wants a tortoise".
TS is a complex and multi-dimensional disorder which effects people worldwide. It can have a significant impact on quality of life in a number of areas, including in educational and social settings. These are areas in which a little understanding could go a long way in reducing stigma and misconceptions, and that can only be a good thing.

Kat Dyke (@kat_s_dyke) is a PhD student within the School of Psychology. (This email address is being protected from spambots. You need JavaScript enabled to view it.)

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If you’d like to find out more about TS please explore the following websites.

Tourette’s action: http://www.tourettes-action.org.uk/
NHS: http://www.nhs.uk/Conditions/Tourette-syndrome/Pages/Introduction.aspx

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[1] Bagheri, M. M., Kerbeshian, J. A. C. O. B., & Burd, L. A. R. R. Y. (1999). Recognition and management of Tourette's syndrome and tic disorders.American family physician, 59(8), 2263-72.

[2] Lennington, J. B., Coppola, G., & Fernandez, T. V. (2015). Genetics of Tourette Syndrome. In Movement Disorder Genetics (pp. 169-189). Springer International Publishing.

[3] Felling, R. J., & Singer, H. S. (2011). Neurobiology of Tourette syndrome: current status and need for further investigation. The Journal of Neuroscience, 31(35), 12387-12395.

[4] Jackson, G. M., Draper, A., Dyke, K., Pépés, S. E., & Jackson, S. R. (2015). Inhibition, Disinhibition, and the Control of Action in Tourette Syndrome. Trends in cognitive sciences, 19(11), 655-665.

[5] Freeman, R. D., Fast, D. K., Burd, L., Kerbeshian, J., Robertson, M. M., & Sandor, P. (2000). An international perspective on Tourette syndrome: selected findings from 3500 individuals in 22 countries. Developmental Medicine & Child Neurology, 42(7), 436-447.

After reading her IMH Blog Mind your 'C' and 'S's, the charity Rethink got in touch with our editor Emma Nielsen and asked her to write a contribution for their blog to mark Self Injury Awareness Day 2016 (#SIAD).

We are delighted that Emma took up the invite - check out her piece for Rethink here.

Emma Nielsen (@EmmaLNielsen) is an Associate Fellow of the Institute of Mental Health and PhD student in the School of Psychology (This email address is being protected from spambots. You need JavaScript enabled to view it.) …………………………………………………………………………………………………………………… If you need someone to talk to, Samaritans are available round-the-clock (and free to contact) on 116 123 (UK & ROI)

Self Injury Awareness Day, 1st March 2016
For most people reading this blog, the notion that mental illness is stigmatised will not be new. You may be one of many who are fighting to end the stigma – particularly if you have lived experience of mental illness, work in a sensitive field, or both. Yet stigma continues to be a pressing issue for those affected by self-harm. Service users have identified stigma as a barrier to help-seeking as well as a problem with services themselves [1]. CAMHS staff report that stigma continues to hinder their working ability [2] and the relatives of those who self-harm highlight stigma as a key concern for the future of their families [3]. So why, if it is so widely acknowledged and with many working tirelessly and passionately to eradicate it, is stigma around self-harm still present?

Firstly, although societal discussion regarding mental health has increased over previous decades, self-harm does not seem to be receiving sufficient attention relative to the number it affects. Recently there have been some well-received television shows aired regarding suicide, such as the BBC’s documentaries Suicide and Me and Life After Suicide. However, coverage of self-harm without suicidal intent, or with ambivalence towards suicide, remains lacking. Mental health is not a compulsory part of schools’ curricula, despite the number of young people experiencing psychological distress themselves or supporting friends and family members facing difficulties. While estimates vary, research suggests that one in every two to ten adolescents [4-7] has self-harmed and those who self-harm are most likely to seek support from friends, not professionals [8]. Insufficient discourse regarding self-harm is detrimental for a variety of reasons: it reduces the opportunities to debunk myths; it can increase feelings of isolation for those who self-harm and it can lead to those who hear disclosures of self-harm feeling unequipped to provide effective support. The restricted discussion about self-harm also means that messages of hope and recovery are limited, which is particularly detrimental as such messages could make a huge difference.

Even when self-harm is publicly discussed, inappropriate language and irresponsible media reporting is rife. Terms such as “commit suicide” remain common on mainstream television even though this carries criminal connotations. Guidelines for how newspapers should report suicides have been established but are rarely followed [9], even though poor media reporting increases the likelihood of more people taking their lives [10]. Even lived experience testimonies can be stigmatising and divisive if not delivered carefully; although many pieces are sensitive and insightful, some assert that self-harm and related issues are “like this”, rather than “like this for me”. Everyone’s experiences are unique and deserve to be treated as such. The omission of a few simple words has the potential to shape preconceptions, while including them can increase understanding by empowering people to ask what someone else’s world is like. Language is complex, but careless use does far more damage than may first be thought – especially when research has shown that conversations about self-harm can alter a person’s self-perception [11].

Media is not the only agency through which stigmatisation of self-harm is facilitated. Those in other positions of authority have a role in shaping and maintaining ideas and, although many in authority are helping to end stigma, research suggests that some individuals still hold stigmatising beliefs. For instance, a study of youth justice staff found that some hold dismissive attitudes towards self-harm which they considered to be socially-motivated [12]. Nurses too have been found to hold more stigmatising attitudes towards those who self-harm than those treated for other reasons, such as for eating disorders [13]. Negative attitudes towards self-harm are also common amongst Accident and Emergency staff [14].

So what is the way forward? How can we get further on in our efforts to end stigma?

Ending stigma lies in helping people to understand self-harm and talk openly about it. Big changes may be required to address stigma in some areas, particularly those at an organisational or political level. However, there are small steps that we can all take, which I believe can have just as important an impact:

• Be brave enough to askTalking can be therapeutic and talking about self-harm/suicide does not increase the risk of someone hurting themselves. If you’re concerned about someone, don’t be afraid to ask them how they’re feeling and – if you both wish – to talk to them about their experiences. A listening ear can make all the difference.

• Refuse to accept inappropriate languageExplain why a term is inappropriate, write a complaint letter, correct yourself (we all make mistakes).

• Remember the personSelf-harm is a behaviour. Don’t lose sight of everything else that makes the person who they are. Just as it can be beneficial to talk about self-harm, it can be positive to spend time together focusing on other things too.

• Look after yourselfIt may be cliché but it is true. Understanding your own mental health can help in understanding others. If you feel you’d like support, remember that you deserve it as much as anyone else. Show the same compassion to yourself that you’d show others and be as open about your experiences as you can, whilst still feeling comfortable.

Mental illness stigmatisation is beginning to be reduced. With enough effort and time, it will be eradicated - not only from self-harm, but from distress in all forms.

Katherine Brown (@Kat_E_Brown) is an MSci student and Research Intern in the Self-Harm Research Group, School of Psychology (This email address is being protected from spambots. You need JavaScript enabled to view it.)
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If you need someone to talk to, Samaritans are available round-the-clock (and free to contact) on 116 123 (UK & ROI)

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[1] Plaistow, J., Masson, K., Koch, D., Wilson, J., Stark, R., Jones, P. & Lennox, B. (2014). Young people's views of UK mental health services. Early Intervention in Psychiatry, 8(1), 12-23.

[2] Hay, A., Majumder, P., Fosker, H., Karim, K. & O'Reilly, M. (2015). The views and opinions of CAMHS professionals on their role and the role of others in attending to children who self-harm. Clinical Child Psychology and Psychiatry, 20(2), 289-303.

[3] Ferrey, A., Hughes, N., Simkin, S., Locock, L., Stewart, A., Kapur, N., Gunnell, D. & Hawton, K. (2016). The impact of self-harm by young people on parents and families: A qualitative study. BMJ Open, 6(1), e009631.

[4] Edwards, S. D., & Hewitt, J. (2011). Can supervising self-harm be part of ethical nursing practice? Nursing Ethics, 18(1), 79–87.

[5] Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self harm in adolescents: self report survey in schools in England. BMJ (Clinical Research Ed.), 325(7374), 1207–1211.

[6] Madge, N., Hewitt, A., Hawton, K., Wilde, E. J. De, Corcoran, P., Fekete, S., … Ystgaard, M. (2008). Deliberate self-harm within an international community sample of young people: Comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 49(6), 667–677.

[7] Calvete, E., Orue, I., Aizpuru, L. & Brotherton, H. (2015). Prevalence and functions of non-suicidal self-injury in Spanish adolescents. Psicothema, 27(3), 223-228.

[8] Armiento, J., Hamza, C. & Willoughby, T. (2014). An Examination of Disclosure of Nonsuicidal Self-injury among university students. Journal of Community & Applied Social Psychology, 24(6), 518-533.

[9] Schafer, M. & Quiring, O. (2015). The Press Coverage of Celebrity Suicide and the Development of Suicide Frequencies in Germany. Health Communication, 30(11), 1149-1158.

[10] Notredame, C., Pauwels, N., Walter, M., Danel, T. & Vaiva, G. (2015). Media coverage of suicide: From the epidemiological observations to prevention avenues. Presse Medicale, 44(12), 1243-1250.

[11] Gregory, R. & Mustata, G. (2012). Magical thinking in narratives of adolescent cutters. Journal of Adolescence, 35(4), 1045-1051.

[12] Knowles, S., Townsend, E. & Anderson, M. P. (2013). 'In two minds' - socially motivated self-harm is perceived as less serious than internally motivated: A qualitative study of youth justice staff. Journal of Health Psychology, 18(9), 1187-1198.

[13] Emerson, A. (2010). A brief insight into how nurses perceive patients who self-harm. British Journal of Nursing, 19(13), 840-3.

[14] Timson, D., Priest, H. & Clark-Carter, D. (2012). Adolescents who self-harm: Professional staff knowledge, attitudes and training needs. Journal of Adolescence, 35(5), 1307-1314.

Eating Disorders Awareness Week, 22-28 February 2016

At work I found a copy of the book Naturally Thin on a shelf of what I assumed to be donations. I skimmed through the pages expecting to get a few giggles, but was sorely disappointed. The only thing about the experience that evoked anything reminiscent of enjoyment was the fact that someone decided that this book was trash and kicked it out of their possession. A book like that belongs nowhere better than the bin. What accomplishments can this author boast? Furthering a vitriolic empire that makes its money off of desperate people? Name-branding and endorsing eating disorders as a lifestyle choice? Posing in a bikini three weeks after giving birth? Trash. Books like these are trash. Unfortunately, they are not a rarity either. In fact, they help to compose a billion-pound industry that permeates nearly all of the modern landscape. It's as simple as turning on the TV, walking outside, standing in line at the supermarket, or sitting in a GP surgery to suddenly become privy to the world's obsession with dieting.

This particular book claims that a "naturally" skinny girl is hiding inside of every female. What is cleverly veiled behind cheap rhetoric, is that this girl requires unnatural methods to be unleashed. Likewise, a chiseled, virile, strong man with post-Photoshop abs is sulking inside of every male. He too is waiting and growing impatient with his own slovenliness. The diet industry does not discriminate by gender; it merely changes its face. It is our self-contempt that makes us malleable, and our desperation that sharpens its teeth. Failure to attain the ideal is not only expected by the diet industry, it is depended upon. If we do not see our own weakness and fallibility, then we would not need to turn to anyone else for their hallowed advice. Our failure has been preordained.

Difficulty arises when you attempt to disassociate yourself from a culture, an industry which everyone seems to be a part of. I made the false assumption that returning to the Real World (read: outside of hospitals and waiting rooms) would mean severing my connections from that part of my life. Reintegrating into what I thought to be the Real World made me realise my history, my past exists in every single person I meet - albeit in diluted forms. Parities of failing to attain the ideal vs. the expected exist and manifest in so many different ways. Yet still, I begrudgingly eat, remorseful for every morsel as I hear people talking about their diets, their weight loss. Of course, I’m aware not everyone develops a life-threatening eating disorder, but I am mindful. Mindful of how much emphasis and value, often moral value, we place on the very act that sustains us, our being.

I find it hard not to associate abstinence with peace and a twisted type of pleasure. Eating disorders exist because they serve a function, they fill a void, they address a need. I cannot say that this illness did not do anything for me, because that would be a lie. But I can tell you that these are the words of a psyche still under siege. I am however acutely aware relapsing will eventually kill me, so I maintain this functional state of being. Eating enough to survive, not quite enough to live. It is not ideal; it is not where I want to be. I hold out for hope that I will be able to make further progress, and get to a better mental state of being.

I will be happy when we begin to invest less money on the diet industry and more money into mental health. I will be happy when there are more options for psychiatric treatment than there are for weight-loss aids. I will be happy when eating disorder rates stop exponentiating. I will be happy when the guilt stops. I will be happy when our collective death-drive either loses its allure or succeeds. The only thing some people gain from this war is an indent of their broken bodies in a hospital bed. Some day, that is all that will be left.

Not every body is the same but every body is an efficient machine that requires and deserves help and health. A well-intentioned diet can easily become disordered. If you plan on altering your diet, do not take it in your own hands but consult with a qualified dietician or doctor. If you are concerned that you or someone else has an eating disorder, do not hesitate to get help. There is a solution out there, but early intervention and continued stable support is key. As hard as it may be to unconditionally love yourself or your body, understand your inherent worth and learn to protect it.

Shaista

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For more information and sources of support:

 Mind

B-eat

Eating Disorder Support Service

Men Get Eating Disorders Too

Mental Health Foundation

 
 
 
 
 

There is a growing concern among professionals in regards to increased use of ADHD prescription drugs. In this case I will not discuss the recreational use of such stimulants, rather discuss the increase rate of prescription for children and adolescents diagnosed with Attention-deficit hyperactivity disorder (ADHD).

ADHD is a neurodevelopmental disorder, characterized by deficits in attention, hyperactivity and/or impulsiveness that is not age appropriate. In May 2011 a journal article was published in Acta Psychiatrica Scandinavica entitled: The use of ADHD drugs in the Nordic countries: a population-based comparison study. In this specific article the authors demonstrated that Iceland (my home country) had five-fold higher prevalence rate of medication prescription for ADHD per 1000 inhabitants compared to Sweden, for example. These results were consistent with recent news reports from Iceland, notifying the public of a substantial increase in medication prescription for children diagnosed with the disorder. For such a small nation, the rate of prescription is too high. Another similar study from Iceland demonstrated that approximately 8% of children between the ages of 9-12 were treated with ADHD medication. To put into perspective, a class of 25 students would include at least 2 who are prescribed ADHD medication. The stimulant treatment is also detrimental to their academic performance, in comparison with their peers. Interestingly, BBC news reported in August 2013 a similar situation in the UK. According to the Care Quality Commission between 2011 and 2012 an 11% rise had been observed in the prescription of ADHD medication. This rise is considered too steep and should be reviewed carefully by physicians. Thus, the question must be, aren’t there any other remedies?

The NHS lists, on its website, other possible forms of treatment to control ADHD symptoms. These remedies include psychoeducation, cognitive behavioural therapy and a change in diet. With all of these alternatives being more favourable than medication, the website does not recommend exercise as a possible therapy. A myriad of evidence suggests that exercise is quite powerful in controlling ADHD symptoms. Several scientists propose that physical exercise could be an effective treatment for the paediatric ADHD population. In particular, two recent studies showed that a moderate-to-vigorous exercise programs resulted in improvements in motor performance, social and behavioural functioning, information processing and response inhibition (Smith, et al. 2011; Verret, et al. 2012).

Moreover, the studies reported improvement in behaviours of interruption and unintentional aggression, results that can be traced back to improvement in response inhibition. Physical exercise has also been shown to reduce stress, negative affect, anxiety and depression, as well as self-destructive behaviour (Archer and Kostrzewa, 2012). Despite few study limitations such as small sample sizes and short study duration, these results should be of interest since most participants had been treated with high doses of stimulants from a young age. Similar results have also been reported in other neurodevelopmental disorders where a high aerobic exercise resulted in a significant decrease in reaction times on cognitive tasks.

Lastly, looking at the most decorated Olympian of all time the effect of exercise minimizing symptoms of ADHD can be seen. Michael Phelps was diagnosed with ADHD at the age of 9. According to his mother, Michael suffered from a lack of concentration that affected his performance in school severely. Being physically active helped Michael to overcome his symptoms and quit taking medication.

Despite further research needed on the effect of exercise, it would be interesting to see exercise being recommended by physicians as a form of treatment of children and adolescents with ADHD.

Hilmar Sigurðsson (This email address is being protected from spambots. You need JavaScript enabled to view it.) PhD Student, School of Psychology

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References

Archer,
T.
 & Kostrzewa, 
R.
M.
(2012).
Physical
 exercise
 alleviates
 ADHD 
symptoms:
 Regional
 deficits
 and
 developmental 
trajectory.
 Neurotoxicity 
research,
 21, 
195‐ 209.

Smith, A. L., Hoza, B., Linnea, K., Mcquade, J. D., Tomb, M., Vaughn, A. J., et al. (2011). Pilot physical activity intervention reduces severity of ADHD symptoms in young children. Journal of attention disorders, 1-13.

Verret, C., Guay, M-C., Berthiaume, C., Gardiner, P., & Beliveau, L. (2012). A physical activity program improves behavior and cognitive functions in children with ADHD: An exploratory study. Journal of attention disorders, 16, 71-80.

       

In March 2003 I attended an event on novelists in conversation with psychologists for trainees and supervisors from the Leicester University DClinPSy training course in which the writers AS Byatt, Nick Hornby and Pat Barker were interviewed by psychologists Steven Frosch, Simon Thomas and Caroline Garland about their work. I was keen to attend, not only as a reader, but because I had just reduced my working hours as a clinical psychologist to four days a week in order to make time for the writing that had been an interest since childhood. With four degree theses/dissertations under my belt, and a clutch of papers in academic journals, I knew how to write for publication and thought it wouldn’t be long before I too could call myself a novelist. As it turned out, although I did manage to publish several short stories in the meantime, it was another twelve years or so before the launch of my first novel.



So what went wrong? Well, nothing really, except that it takes an exceedingly long time to learn to write fiction, even for those experienced in other types of writing. I’d like to share my reflections on the similarities and differences between clinical/academic writing and fiction, some of which will also apply to creative non-fiction.

Structure

The classical structure of the experimental report works extremely well for all kinds of academic writing, but is of little help when it comes to writing a novel. While quest novels follow the eight-point arc familiar to us from fairy tales, the writer of literary fiction as to create a fresh structure for each project. This was the area I found most difficult in writing my novel, partly because the story has a secret at its heart. I eventually found my structure for Sugar and Snails, by starting at a crisis point and moving and forth in time with the secret revealed around midway.

Subjectivity

Although, with the increasing recognition of qualitative research methods, this is changing, academic writing has traditionally favoured an objective stance. Clinical report writing is a little more subjective, yet still concealing the individual behind the professional stance. With creative writing mostly about character, subjectivity is of prime importance. Yet, as with structure, the writer needs to play around with different possibilities . Which character is best placed to tell the story? Do we need one or several points of view? How close to zoom in on how that character thinks and feels?

Readers are often curious about how much of the writer’s own personality and experience has gone into their characters. I’m also fascinated by the question of what makes some writers turn to fiction and others to memoir. But I don’t think clinicians and academics are immune from putting themselves into their work. The motivation may be unconscious, but I think we’re drawn to fields that reflect something about our inner worlds.

Research

Whenever anyone asks me about the research I undertook for my novel, my mind flips first to the randomised controlled trial to which I was first introduced as an undergraduate. But, of course, that’s not what they mean. What passes for research in the creative writing world is the fact-finding that would constitute the literature review for the scientist, although novelists can be just as scrupulous as academics in reading around their subject.

Sometimes, that subject is the research endeavour itself, exploring the experience and ethics of the academic life. Although it wasn’t my original intention, the narrator of my novel is an academic psychologist who revisits her PhD research twenty years on.

Evidence

While clinicians are guided by both evidence and professional standards, novelists are free to make things up as they go along. Yet, although unlikely to construe it as evidence, fiction writers need nevertheless to demonstrate the events and emotions that constitute their story. It’s not sufficient to write “this happened and then that happened” or “she felt this and then she felt that”, but the skilled writer must show these events and emotions through dialogue, description, metaphor etc that enables readers to experience the story as if it were unfolding before their eyes.

Economy and precision

I once submitted a 7000 word paper to a journal that had a 5000 word limit on articles, and was a little put out that they asked me to cut and resubmit! Now I write 99-stories and was delighted that, in conjunction with my editor, I was able to cut 10,000 words from my novel before sending it out into the world.

Similarly, although I used to pride myself on the standard of my writing, my knowledge of grammar and punctuation has definitely improved since I turned to fiction. When writing is your main job, there’s an extra expectation to do it well. We are the people who obsess about the placement of commas and are offended by the aisles in the supermarket for “ten items or less”. (Of course, I’ve left myself wide open to criticism if you come across errors in this post.)

Publication and peer review

To be published in an academic journal, a paper is subjected to peer review. The parallel within creative writing occurs at different points in the process, with the actual editing undertaken in-house by a small number of editors. Long before this stage, most writers will have received feedback on previous drafts from a small group of trusted readers. Post-publication reviews are crucial, with book bloggers becoming increasingly influential in spreading the word.

Emotional depth

Like mental health workers, writers of literary fiction need to be highly emotionally literate as it’s through this depth of emotion that the story unfolds. Alongside my background in clinical psychology, I’ve found my psychoanalytic studies extremely useful preparation for drawing my own emotional experience on my writing. A degree of vulnerability, that can be awkward at times as a mental health practitioner, can be a source of strength when it comes to composing engage in fiction.

Standing on each other’s shoulders

Like academics, fiction writers do not develop their ideas in a vacuum, but draw on the work of others. Because this occurs in a diffuse manner, it can be more difficult to map this debt in creative writing than in academia, although the acknowledgements page is one way in which novelists attempt to do so. However, plagiarism is frowned upon as much in the world of fiction as it is in academia.

What similarities and differences have you observed between clinical/academic and creative writing?
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Anne Goodwin is a former clinical psychologist at Nottinghamshire Healthcare NHS Trust. She will be discussing and reading from her debut novel, Sugar and Snails, which explores issues of mental health and self-esteem, at Five Leaves Bookshop on 17 February 2016.

Connect with Anne via on her website: annethology or on Twitter @Annecdotist.