Mental Health News

Jobs, Cleaner Exhaust Fumes May Be Behind Fall in U.K. Suicides By Chantal Britt Feb. 15 (Bloomberg) -- Jobs and less toxic car exhaust fumes may be behind a drop in suicides among young men in the U.K. to the lowest level in 30 years, researchers said in the British Medical Journal. Reductions in antidepressant use among under-18s have not led to an increase in suicidal behavior in youngsters, another study found. Researchers at the University of Bristol set out to explain why suicide rates in young people in England and Wales have declined steadily in the past 10 years after year-on-year increases from the 1970s to the early 1990s. They found that a rise in employment, government efforts to curb suicides, and laws to reduce carbon monoxide in cars may be preventing deaths. ``Favorable changes in several different factors -- levels of employment, substance misuse and antidepressant prescribing as well as policy focus on suicide and vehicle exhaust gas legislation -- may have contributed to the recent reductions, co-author David Gunnell, a professor of epidemiology at the university, wrote. Gunnell explored trends in suicide in young men that showed a decline since 1998, after increases in the 1970s, 1980s, and early 1990s. The overall suicide rate for 15- to 24- year-old men in England and Wales dropped to 8.5 per 100,000 in 2005 from 16.6 per 100,000 people in 1990. While rates for women are also at their lowest levels since 1968, the proportion of those who choose hanging has jumped, the research showed. Antidepressants In a separate study also conducted at the Department of Social Medicine at the University of Bristol in collaboration with the Office for National Statistics and IMS Health, researchers studied effects of the antidepressant restrictions on suicides. They found no evidence that reducing the levels of prescriptions of antidepressants in half led to an increase in deaths from suicide or hospital admissions as a result of self harm. Regulators in 2003 restricted antidepressant prescription to adolescents and children, when trial data raised concern that antidepressants may lead to suicidal thoughts or attempts. Only half of adults and a quarter of adolescents who suffer from depression in the U.S. take antidepressants, and nearly half of all adults discontinue after just a few weeks, Gregory Simmons from the Group Health Cooperative in Seattle, wrote in an accompanying editorial. ``In truth, it would be surprising if antidepressants had any effect -- positive or negative -- on the risk of suicide in the general population, Simmons said. ``Only 3 percent of adolescents dying by suicide in New York City had toxicology data showing recent use of antidepressants." To contact the reporter on this story: Chantal Britt at cbritt@bloomberg.net . Last Updated: February 15, 2008 00:23 EST

Violence In Mental Health Units - UNISON Reaction, UK Article Date: 15 Feb 2008 - 1:00 PST Commenting on the joint Healthcare Commission and Royal College of Psychiatrists report into assaults on nurses working on mental health wards, Gail Adams, UNISON Head of Nursing, said: "The level of violence and aggression towards nurses on mental health wards makes shocking reading. It is clear that more needs to be done to protect staff and risk assessments, training and a good skills mix are the key to achieving that. "It is vital that thorough risk assessments are carried out on each patient. The report misses the importance of the information that carers can provide about any previous history of violence. "Adequate staffing levels and a good skills mix will also encourage an air of calmness on a ward. Where there are staff shortages, or a lot of agency and bank staff, the ward can become more frantic and patients will pick up on that. "It is also important that all staff should also be well trained in the same techniques, so they work together to contain any violence or aggression. "However, we should not stereotype mental health patients as being violent, this is far from the case. If a patient attacks a member of staff, there should be a zero tolerance approach and if found competent, they should be liable to prosecution."

Suicide levels for young men "lowest for 30 years" Suicide levels for young men "lowest for 30 years" Full Story The rate of suicide among young men in England and Wales has fallen to the lowest level for more than 30 years, according to new research. A study by the University of Bristols Department of Social Medicine found the percentage of men aged 15 to 24 who take their own life has almost halved since a peak 18 years ago. In 1990, there were 16.6 suicides for every 100,000 men aged 15-24 but by 2005 the rate had fallen to 8.5 per 100,000, the lowest level since 1974. The study, published in the British Medical Journal, said catalytic converters on cars have reduced the number of lives taken using poisonous exhaust fumes but there has also been a fall in suicides by other methods including hanging - the most common method used by young men. Researchers said factors which create an increased risk of a person committing suicide, such as unemployment and divorce, also decreased during the same period. In men aged 25-34, the rate fell by a third from the peak rate of 27.8 deaths per 100,000 men in 1998 to 15.7 deaths per 100 000 men, the lowest level since 1978. The report, entitled Suicide rates in young men in England and Wales in the 21st century: time trend study, said from 1950 to 1998 rates of suicide in men aged under 45 doubled in England and Wales, while rates in women and older men declined. During the 1990s, suicide accounted for about a fifth of all deaths in young men. Researchers said the suicide rate for young women had been more stable, remaining below four per 100,000 women for most of the period 1968 to 2004 and dropping to just above two per 100,000 by 2004. The method women are most likely to use has changed, however, from self-poisoning to hanging. Release Date 15/02/2008 Source Press Assoiation Country England & Wales

Dail debate for teenagers Dail debate for teenagers Full Story Around 200 teenagers will gather in the Dail today to debate and vote on issues related to education and mental health reform. Dail na nOg is the national youth parliament and is overseen and funded by the Office of the Minister for Children. Delegates are elected by their local Comhairle na nOg throughout the country. Childrens Minister Brendan Smith will address the delegates and a question-and-answer session will be chaired by RTEs Aine Lawlor. The discussion on mental health will focus on suicide, bullying, peer pressure, drugs, alcohol and support services available to teenagers. Education reform talks will centre on reform of the curriculum, assessment and points system, teaching of languages and sports and physical activity. Dail na nOg provides young people with an opportunity to raise their concerns and meets annually. Release Date 15/02/2008 Source Press Association Country Ireland

Government "failing vulnerable older people" Government "failing vulnerable older people" More than one million people aged over-50 feel they are "severely excluded" from society, a report by Age Concern said today. The charity said the Government was "failing" vulnerable older people and called for ministers to make a cross-departmental commitment to help the most disadvantaged. The Out of Sight, Out of Mind report also recommends that councils should carry out a "comprehensive review" of their services under the terms of their agreements with central government. The report said: "Being severely excluded is not just about being poor, feeling lonely or lacking mobility. "It is a complex issue which involves facing multiple hardships and being cut off from the things the rest of society takes for granted." The report found that 400,000 people aged 50 to 64 were severely excluded, 360,000 people aged 65 to 79 and 400,000 aged over 80. Other findings include: :: 50% of severely excluded people over 50 are in poor health; :: 40% of severely excluded people over 50 are lonely; :: People aged 50-64 are eight times more likely to be severely excluded if they rent their home privately rather than own it; :: Over half the homes privately rented by over 50s are considered "non-decent". The report said the Government had done a lot to help old people by introducing pension credit, the winter fuel allowance, improved NHS facilities and concessionary bus travel. But, it said: "Despite this progress, much less has been done to tackle severe social exclusion among older people." Many people have failed to claim benefits they are entitled to or access the service available to them, the report said. Gordon Lishman, Age Concerns director general, said: "It is often said that we should judge the society we live in by the way we treat older people. "How we treat the most excluded older people is even more of a litmus test and one that, sadly, the Government is currently failing. "Without stronger ministerial leadership, and a significant change in the mindset of policy makers and service providers, over a million severely excluded older people will continue to suffer in silence." A Cabinet Office spokesman said: "The Government is fully committed to tackling the social exclusion of older people, which is why since 1997 we have succeeded in lifting over a million pensioners out of poverty. "We want all pensioners to have a decent and secure income, and a pensioner is now less likely to be in poverty than a person of working age. "We are taking action across Government to address the problems faced by older people, including policies to promote greater independence and wellbeing." Release Date 15/02/2008 Source Press Association CountryUnited Kingdom

Study: Boy Babies More Likely To Cause Post-Partum Depression February 14, 2008 8:51 p.m. EST Isabelle Duerme - AHN News Writer Nancy, France (AHN) - A recent study concluded that the births of male babies expose mothers to higher levels of post-partum depression. Experts from the French university Nancy 2 drew their findings from an experiment involving 181 women who had given birth. The scientists measured that one-third of the test subjects had experienced postnatal depression (PND). Of the nine percent that the scientists diagnosed with severe PND, three quarters had given birth to boys, said Times Online. Based on the data gathered from questionnaires asking the subjects about their quality of life in terms of physical functions, bodily pain, mental health, emotional condition, social behavior and general health, experts determined that 70 percent of women who gave birth to male babies reported a lower quality of life, compared to those who gave birth to girls. "Postnatal depression is very common and poses a major public health problem, especially if it is not diagnosed and treated," said Professor Claude de Tychey, study author. "When we launched our research, our main aim was to study the effect that gender has on PND. But the overwhelming finding of the study was the fact that gender appears to play a significant role in reduced quality of life as well as an increased chance of severe PND." The UPI reported that the lower quality of life experienced by the 70 percent of women who gave birth to boys was evident, whether or not they actually suffered from PND. For those with PND, women who had girls had higher quality-of-life scores compared to those who had boys. "Postnatal depression can have a considerable impact on women as it can affect both their physical and mental health," said de Tychey. The study was published in the Journal of Clinical Nursing.

Body-mind Meditation Boosts Performance, Reduces Stress October 9, 2007 Science Daily — A team of researchers from China and the University of Oregon have developed an approach for neuroscientists to study how meditation might provide improvements in a persons attention and response to stress. The study, done in China, randomly assigned college undergraduate students to 40-person experimental or control groups. The experimental group received five days of meditation training using a technique called the integrative body-mind training (IBMT). The control group got five days of relaxation training. Before and after training both groups took tests involving attention and reaction to mental stress. The experimental group showed greater improvement than the control in an attention test designed to measure the subjects abilities to resolve conflict among stimuli. Stress was induced by mental arithmetic. Both groups initially showed elevated release of the stress hormone cortisol following the math task, but after training the experimental group showed less cortisol release, indicating a greater improvement stress regulation. The experimental group also showed lower levels of anxiety, depression, anger and fatigue than was the case in the control group. "This study improves the prospect for examining brain mechanisms involved in the changes in attention and self-regulation that occur following meditation training," said co-author Michael I. Posner, professor emeritus of psychology at the University of Oregon. "The study took only five days, so it was possible to randomly assign the subjects and do a thorough before-and-after analysis of the training effects." The IBMT approach was developed in the 1990s. Its effects have been studied in China since 1995. The technique avoids struggles to control thought, relying instead on a state of restful alertness, allowing for a high degree of body-mind awareness while receiving instructions from a coach, who provides breath-adjustment guidance and mental imagery while soothing music plays in the background. Thought control is achieved gradually through posture, relaxation, body-mind harmony and balanced breathing. The authors noted in the study that IBMT may be effective during short-term application because of its integrative use of these components. IBMT has been found to improve emotional and cognitive performance, as well as social behavior, in people, said lead author Yi-Yuan Tang, a professor in the Institute of Neuroinformatics and Laboratory for Body and Mind at Dalian University of Technology in Dalian, China. Tang currently is a visiting scholar at the University of Oregon, where he is working with Posner on a new and larger study to be conducted in the United States. The current study did not include direct measures of brain changes, although previous studies have suggested alterations have occurred in brain networks. Posner said the planned studies in the United States will include functional magnetic resonance imaging to examine any brain network changes induced by training. In summary, the 11-member team wrote: "IBMT is an easy, effective way for improvement in self-regulation in cognition, emotion and social behavior. Our study is consistent with the idea that attention, affective processes and the quality of moment-to-moment awareness are flexible skills that can be trained." At this point, the findings suggest a measurable benefit that people could achieve through body-mind meditation, especially involving an effective training regimen, but larger studies are needed to fully test the findings of this small, short-term study, Posner said. The findings appear online ahead of publication in the Proceedings of the National Academy of Sciences. Co-authors with Tang and Posner were: Yinghua Ma, Junhong Wang, Yaxin Fan, Shigang Feng, Qilin Lu, Qingbao Yu and Danni Sui, all of the Institute of Neuroinformatics and Laboratory for Body and Mind at Dalian University of Technology, Ming Fan of the Institute of Basic Medical Sciences in Beijing, and Mary K. Rothbart, professor emerita of psychology at the University of Oregon. Tang also is affiliated with the Key Laboratory for Mental Health and Center for Social & Organizational Behavior, both located in the Chinese Academy of Sciences in Beijing. The project was supported by the grants from the National Natural Science Foundation of China, Ministry of Education of China and the UOs Brain, Biology and Machine Initiative. Note: This story has been adapted from material provided by University of Oregon.

Study proves exercise can lift depression October 9, 2007 Exercises benefits are on par with antidepressants Regular exercise could help lift the cloud of major depression as effectively as an antidepressant, research shows. "A lot of people know from their own experience that when they exercise, they feel better," says James A. Blumenthal, a professor of psychology at Duke University and lead author of the study. But anecdotes and gut feelings do not amount to clinical proof. So Mr. Blumenthal conducted a placebo-controlled clinical trial, the first time the gold standard of research has been used to compare exercise with antidepressants for treatment of major depression. He sorted 202 patients into four groups. After 16 weeks, 47 percent of the people who took the antidepressant Zoloft improved . But 45 percent of those who exercised in supervised groups improved, and 40 percent of those who exercised on their own improved, a statistically insignificant difference from the drug group result. About 30 percent of those in the placebo group improved, a finding consistent with the placebo effect. Exercise, Mr. Blumenthal speculates, may increase endorphin or serotonin levels, so-called feel-good brain chemicals. The study was published in the September issue of Psychosomatic Medicine. Los Angeles Times

Mental health assessment for mother who abandoned toddler 09 October 2007 A central Queensland court has been told a woman abandoned her three-year-old daughter at a Rockhampton primary school yesterday after she threw a tantrum. The 25-year-old woman, who cannot be named for legal reasons, has not entered a plea to a charge of endangering a child and has been ordered to face a mental health assessment. Police prosecutor Sean Janes told the court the woman had moved to Rockhampton from Brisbane a week ago and went to the Glenmore State School yesterday morning to ask about enrolling her five-year-old son. Senior constable Janes said when her daughter refused to take her hand she left her in the school grounds, near the busy Bruce Highway. The prosecutor said the toddler had a history of running on to roads. Constable Janes said police found the woman more than 10 hours later, after the story had aired on radio and television news bulletins. She has been released on bail to re-appear in court next month. The toddler and her two siblings are now in the custody of the Family Services Department.

Identifying Mental Illness October 9 2007 There are a lot of myths and misconceptions about persons needing psychiatric help and the role of psychiatrists. Among the many ailments affecting us, mental illness is least understood both by the public and even among doctors. It is a precursor to various ailments, and a lot of expensive tests and unnecessary medication can be avoided if the problem is identified as early as possible. Behaviour Symptomatic of Mental Illness: Mental illness is an ailment which needs to be treated clinically (like diabetes, hypothyroidism). Contrary to popular belief, mental illness cannot be mitigated by yoga, meditation, witchcraft, black magic or prayer. The following abnormal behaviour also constitutes mental illness in varying degrees, such as abusive, short tempered nature, lazy attitude, unable to persist in any work or vocation, unable to succeed in any endeavor. Individuals undergoing multiple consultations, multiple tests - scan, x-ray, blood, master health check-up, taking self-medication for chest pain, stomach pain, neck and low back pain, headache - without an apparent diagnosis of disease. There is also a form of mental illness termed Somatization - Hypochondriasis. Here, the patient needs sympathy from family members. Empathy and scientific treatment from a good physician or psychiatrist does help. - Dr P Anandhan, Psychiatrist Mind care Clinic 93807 96970

Mental health program cuts hospital stays 08/10/2007 A home care program for mentally ill people has seen the amount of time clients spend in hospital drop by more than 90 per cent. Mission Australia runs the program in conjunction with the New South Wales departments of Health and Housing. Over the past year, 24 participants in the scheme spent a combined total of 28 days in hospital compared with more than 350 days the year before. Spokeswoman Bronwyn Howlett says having a normal routine at home helps keep people with mental health problems off the streets. "It assists people in maintaining their accommodation so that they do not become homeless and then fall into that cycle of continuing to be homeless," she said. Ms Howlett says even short hospital visits can be a major setback. "It is about keeping contact with your community and maintaining the normal routines that you would in normal day life, which get interrupted when you get re-admitted back into hospital sometimes," she said. "Even if it is only for a couple of days, it can reduce your confidence in going out and things like that." New South Wales Mental Health Minister Paul Lynch says the scheme will help keep 1,000 people out of hospital this year. "It is good also if you can more effectively use your resources so that you do not have people in hospital that do not need to be there," he said.

Community touch a mental health goal 10/8/07. NEW MENTAL HEALTH LEGISLATION will put the emphasis on greater community treatment. Director of the Psychiatric Hospital Tennyson Springer spoke to the DAILY NATION about mental health yesterday following a church service at the Whitehall Methodist Church to mark the start of Mental Health Week. "We have just had a review of the mental health legislation to make provision for empowering the nurses to function effectively in the community. "We have also increased the number of clinics we do within our primary health care system, as well as our outpatients, so that people can be cared for in the community close to where they live," he said. He added that the global direction was community mental health, because it was recognised that people spending long periods of time in hospital developed a level of institutionalisation which did not help their healing process. Springer said community care was where they wanted to take mental health, but acknowledged it would not occur overnight because of the prevailing view of mental health. He estimated that it would be possible within another ten to 15 years. Springer said progress had also been made with lowering the level of abandonment of the mentally ill. "It is still too high, and for us as a nation on the verge of First World status it is still very high. "What we are trying to do is put more people and more services in the community . . . what we are hoping to establish is day services so that those people can bring their families in the day, have the care provided that is necessary, and take them back home in the evening. "This way everybody wins because they do not get institutionalised," said Springer. During the service Brother Anthony Sobers said adults could influence the lives of young people if as parents, or grandparents and relatives they clearly demonstrated their faith in God. Sobers said that, as leaders, adults needed to appreciate their own faith since it was critical to the development of young people. He said if it was demonstrated in the workplace, home and community, then it would help. The theme of this weeks celebrations is Mental Health In A Changing World:Impact Of Cultural Diversity. (WB)

Free test offered to spot depression OCT. 8, 2007 GREENSBORO — Suicide is among the nations leading causes of death, and depression figures into most suicides. That is why national and local organizations have designated Thursday as National Depression Screening Day. Free screenings for depression will be offered at several sites in Guilford County. Participants also can receive information on depression and how to seek help for themselves or loved one. The need to identify people with depression is clear because 60 percent of all people who commit suicide have depression, said Blair Benson, executive director of the Mental Health Association in Greensboro. But 80 percent to 90 percent of those with depression respond well to treatment, she added. "The same way we expect to be physically healthy, we should also expect to be mentally healthy," she said. "So if you have symptoms of depression, you should get them treated." People also should know what symptoms to look for in friends or family members who might suffer from depression. "Just like diabetes, we would not expect our loved ones to take care of (diseases) on their own," Benson said. "We should not expect (them) to take care of their mental health issues on their own." Failure to address depression can have tragic consequences. Suicide is the fourth-leading cause of death among adults ages 18 to 65, according to the American Foundation for Suicide Prevention. More Americans — about 19 million — have depression than have coronary heart disease, cancer and AIDS combined, the foundation said. About a third of depressed people attempt suicide; half of them succeed. Thursdays screenings are sponsored by the Guilford Countys Mental Health Awareness Coalition, composed of government agencies and nonprofits. Screeners will be clinicians from the Guilford Center, High Point Regional Health System, Moses Cone Behavioral Health, and the UNCG Psychology Clinic. Contact Lex Alexander at 373-7088 or lalexander@news-record.com

At therapys end October 8, 2007 PEOPLE come into Andrew Leuchters office, saying they are better, saying they want to stop. "Oh, gosh, it happens all the time," says Leuchter, a psychiatrist at UCLAs Semel Institute for Neuroscience and Human Behavior. "They say they feel OK, that they do not need drugs or any other help, and that they have recovered. On one hand that is very encouraging, but on the other hand we have to be very careful, because the cost of being wrong -- if they are not ready -- can be very high." These are not drug addicts saying they want to go cold turkey. They are not alcoholics. These are people with depression who want to stop treatment. Nearly 20 million Americans suffer from some form of depression, according to the National Institute of Mental Health. About 14% of adults now take antidepressants -- triple the percentage during the late 1980s -- and most stay on them for at least six months. A study published in this months issue of the Archives of General Psychiatry estimated that mental disorders, largely depression, cost Americans 1.3 billion days of normal activity each year. Many people with such illnesses say they feel hopeless, helpless, unable to face life, unable to find solutions to their problems, and at times think of killing themselves. Some of them do. Depression treatment, such as antidepressant drugs Prozac or some version of talk therapy, can help about two-thirds of sufferers. But as it does, patients start to ask: Am I better? Am I cured? Can I stop my therapy? The answers are not simple. Measuring depression is hampered because there iss no physical marker that indicates whether a patient has it or does not. Information about that comes from behavior, thoughts and feelings, which can not be assessed as easily as, say, blood pressure. Rating scales can show how far symptoms, such as trouble sleeping, have receded, but psychiatrists say they put even more stock in a patients overall mood: whether he or she takes joy from life again and whether the person thinks he or she is back to a pre-depression emotional state. That too can be difficult to determine. Now results from large, long-term studies are beginning to paint a clearer picture of the course of depression and are sharpening decisions about stopping treatment. If a person has had just one episode of depression, the chances of a long-lasting recovery are fairly good. But those chances go down with every subsequent episode. Once people reach their third episode, Leuchter says, "then we need to discuss ongoing maintenance therapy, even if they are feeling better. I do not like to use the phrase lifetime treatment with patients. But, essentially, that is what we are talking about."   A lingering battle One woman, a 41-year-old professional pet sitter who lives in Los Angeles, has been battling depression since she was a child. (She prefers to remain anonymous because, she says, depression is still a taboo subject.) "I lost my dad when I was 10, and I never seemed to be able to get over it," she says. She remembers crying on the school bus, crying a lot. At home, she did not want to get out of bed. Her body ached with a vague pain. She says at times she had to push herself to go to the bathroom. She had trouble seeing herself growing older. There did not seem to be any point. But it was not until she was 22 that she got some help. "I was working as an aide in a pediatricians office, and I was just crying all the time. It was over nothing, but it was uncontrollable," she says. "One day the doctor took me aside. He said, Look, we can not help you here with something like this. But you can get help. And it was the first time somebody used the word depression with me. It was the first time somebody took me seriously." The pediatrician referred her to a psychotherapist and to other doctors who prescribed antidepressants. She saw the therapist for a year and a half, "and I learned coping skills. I learned not to internalize things completely all the time." Medications were a rockier road. "I went through Paxil, and then Wellbutrin," she says. "I would be fine for a time. Then I would go back to being depressed." It is not unusual for patients to try multiple antidepressants and multiple dosages. There is a lot of tinkering, because doctors still do not understand precisely how these medications work. They have theories. The dominant one involves maintaining a balance in the brain of chemicals that seem to be involved in mood and emotions. When Prozac, the granddaddy of modern antidepressants, was approved by the Food and Drug Administration in 1987, it was because taking the drug improved the moods of depressed patients. Doctors then knew the drug made more of the chemical neurotransmitter serotonin available in the brain. They assumed -- and still think -- the two things are connected. Serotonin flows across tiny gaps from one brain cell to the next. Then the cell that originally released the chemical absorbs it again. The process is called reuptake. What Prozac appears to do is block that reuptake, so more serotonin lingers in the gap, ready to be taken up by other brain cells. If depression is indeed caused by low serotonin levels, this method -- while not increasing the absolute amounts of the chemical in the brain -- should leave more serotonin out in the open for more brain cells to use. Some antidepressants, such as Effexor, do the same thing with another mood-regulating brain chemical, norepinephrine. Still, because no one really knows what a low, normal or high level of these neurotransmitters is, there is a lot of trial and error involved in taking the drugs. "We use many different doses and many different drugs because people seem to respond to them differently," says Ellen Frank, a clinical psychologist at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center. She has spent 25 years studying depression treatments. "Once we find something that works for a patient, we tend to stick with it," she says. "The dose that gets you well keeps you well."

Acupuncture - Treat insomnia depression anxiety with acupuncture October 7, 2007 Whilst it is widely known in the western world as an alternative therapy for chronic pain, acupuncture for insomnia depression anxiety is a traditional method for the Chinese. Since acupuncture is an individualised treatment, controlled studies are difficult to execute, but those that have been carried out suggest that acupuncture may, indeed be an effective intervention for the relief of insomnia depression anxiety. Anyone that has a problem such as acute depression, stress or anxiety must need a proper treatment for their problem. A good option for them would be acupuncture for insomnia depression anxiety which will be sure to help them because acupuncture is a holistic means that helps in the integration of body and mind functions to solve all kinds of problems in a natural as well as effective manner. Thus, it is safe to say that acupuncture for insomnia depression anxiety is a far better means of treating insomnia depression anxiety as compared with taking anti-depressant pills, or even drugs for combating anxiety. Elevates a Person’s Mood In fact, acupuncture for insomnia depression anxiety is a great means of elevating a person’s mood and so it pays to know a bit about what acupuncture is before considering it as a viable means to treat insomnia depression anxiety. Acupuncture is a treatment method that involves sticking fine needles into certain parts of the human body which results in relief from pain and also disease. It works in that it balances the life energy also called “Chi” that in turn causes the spiritual as well as physical and also emotional balances to be enhanced. When choosing acupuncture for insomnia depression anxiety as a treatment method, one must realize that there are different techniques used and it could mean getting acupuncture with or without the use of needles. Often, the cause behind a person suffering from migraines and headaches is a lack of proper blood circulation and acupuncture can help restores the blood circulation which makes the mind clear and betters the concentration while also making a person more positive in his or her feeling. Acupuncture for insomnia depression anxiety is probably the best alternative and when a person suffers from insomnia he or she will not be getting enough sleep and with acupuncture you will find that it helps to send complex signals to the brain that induces a person to relax and also get enough sleep thereby curing the disease. Along with insomnia, depression as well as anxiety are other ailments that cause different physical as well as mental diseases for which acupuncture for insomnia depression anxiety is most suitable as it involves inserting needles in the ear cartilage, skin as well as on fingertips and some other meridian points in order to let the energy flow that had been blocked. This new and free flow of energy will cure depression, and also anxiety almost immediately. That is why it is most advisable to opt for acupuncture for insomnia depression anxiety rather than turn to chemically produced drugs.

Post traumatic stress hits kids of cancer patients Sep 26, 2007 By Michael Kahn BARCELONA (Reuters) - Children whose parents have cancer often suffer post-traumatic stress symptoms that adults underestimate, Dutch researchers said on Wednesday. The study, which the researchers said was the first to track post traumatic stress symptoms in adolescents over an extended period of time, found many children of cancer patients suffered telltale signs of the disorder. These symptoms included recurring nightmares, an inability to stop thinking about the disease as well as conscious efforts to avoid hearing or knowing anything about their parents condition, they told the European Cancer Conference. "We thought the symptoms would decline after time but even after one to five years after the diagnosis, the children still had symptoms," said Gee Hazing, a health scientist at the University Medical Centre in Groningen, who led the study. Experts say post traumatic stress disorder symptoms include irritability or outbursts of anger, sleep difficulties, trouble concentrating, extreme vigilance and an exaggerated startle response. A person may initially respond to the trauma with horror or helplessness, then may persistently relive the event. The recently completed study did not actually test whether children had the disorder but rather looked for symptoms of PTSD in 49 youths aged 11 to 18 years old starting during the first year after a parents cancer diagnosis. After first learning a parent had cancer, 29 percent of the children showed post traumatic stress symptoms serious enough to justify psychological help, the researchers said. This number dropped by the end of the first year as kids seemed to adjust to the fact a parent had cancer, especially if the parents health improved, Huizinga said. But surprisingly, as time wore on, another group of children started showing an increase of symptoms, perhaps due to the cancer returning or having the time to think more - and fret - about the disease, she added. "We thought the symptoms would decline over time," Huizinga said. The study also found that girls seemed to have the most problems, perhaps because these children may feel responsible for taking on more duties at home with a sick parent, Huizinga said. The team also suggested that the effect on children whose parents have cancer was bigger than many serious, chronic diseases because dying from cancer was so possible. "We think cancer may have more impact because a parent might die of the disease," Huizinga said. "With a lot of chronic diseases that is often not the case."

Mental health charities in need Thursday, 13 September 2007, Mental health charities are having to spend too much time "begging" for money instead of focusing their time on helping young people, they say. The Mental Health Foundation has called for more funding for the voluntary sector. It pointed out charities often play an invaluable role for children needing help with mental health problems. The call was supported by the childrens tsar for England, Professor Sir Albert Aynsley-Green. Experts said children are often intimidated by state services and instead turn to them for help. One in 10 children aged five to 16 has a mental health problem at any one time. And government figures show 40% of these are not getting specialist NHS help from services such as the Children and Adolescent Mental Health Services. The Mental Health Foundation, in its report Listen Up!, said children often prefer to turn to GPs or the voluntary sector, but charities are struggling to cope with the numbers needing their services. The report said the voluntary sector provides welcoming and accessible services that are attractive to young people. But the charity added for those running the services it is a source of continuous frustration that they need to spend valuable time handing round the begging bowl for funding rather than helping young people on the frontline. Problems Dr Andrew McCulloch, chief executive of the charity, said: "At a time when our young peoples mental health is worsening, they need places to go with their problems where they feel safe and listened to. "Whether we like it or not young people will usually only approach state-run mental health services if theyre pushed because on the whole they find them unapproachable." The childrens commissioner for England, Professor Sir Albert Aynsley-Green. He said: "The voluntary sector has a vital role to play in supporting young people with emotional difficulties and they need continuity of funding to help them fulfil that role." A Department of Health spokesman said: "We are fully committed to making continuous improvements to child and adolescent mental health services." And he added: "The voluntary sector clearly have an invaluable role to play in delivering focused and specialist services to meet the needs of children and young people."

Depression affects more than 6.5 million September 13, 2007 Depression affects more than 6.5 million of the 35 million Americans who are 65 years or older, according to the National Alliance on Mental Illness. But often the symptoms of depression, which can include fatigue, overall sadness and loss of interest in activities, go unidentified or ignored among the elderly, says Veronica Poklemba, a clinical nurse specialist at Levindale Hebrew Geriatric Center and Hospital in Baltimore. Why is it of particular importance to identify and treat depression in the elderly? Depressed people are in a more difficult position in terms of coping with their physical health problems: It is very hard to follow the diet you need to follow if you are diabetic or put energy into rehabilitation after a stroke. Another aspect is that, according to a [National Institutes of Health] study, the elderly have the highest rate of completed suicides. In addition, 20 percent of those who commit suicide have visited their primary care physicians on the day they die. Forty percent have visited the doctor within one week of committing suicide. And 70 percent have visited their primary care doctor within one month. Why does depression among the elderly so often go unidentified? They arent talking about it to their doctors. There is a stigma [about mental health] to many in this generation. And the physicians are in a time crunch. The elderly have many physical problems and so the physical problems are being addressed. But the elderly arent inclined to talk about [mental health] issues. What are some of the symptoms of depression? Key signs are changes in appetite -- it can go up or down. Sleep difficulties are a symptom, including trouble falling asleep, waking up in the middle of the night, waking up very early and not being able to go back to sleep, or excessive sleeping. Other symptoms include having difficulty concentrating, decreased energy, lack of interest in the usual activities. Can depression also cause physical symptoms? Since their viewpoint often becomes negative, the depressed person focuses on various aches and pains. A lot of elderly people spend a lot of time going to doctors thinking there is something to be fixed, but all they can do is focus on health issues that would not seem so huge if they were in a better mood. What causes depression among older people? They often have a lot of reasons for whats called "situational" depression -- which implies that there are things going on in their lives that contribute to depression. Maybe they are moving from their homes of 30 to 40 years; that is a dramatic change. In many cases, they also may be living alone, and their friends may no longer be around. They may be dealing with a serious health issue. ... There may be a period of time during which a person is somewhat depressed after losing a significant other, but you would expect that within a few months they would begin to return to activities or interests. Once diagnosed, how is depression treated? I use cognitive behavioral therapy, which means that you help the person look at how their thinking and behavior influence their moods. If you can look at changing your behavior and thoughts, you can change your mood. Therapy seems to work in about 80 percent of cases. Medication also can be used. Research has tended to show that some people do well with therapy and others do well with medication and even more people do well with both. What steps can an elderly person take to maintain good mental health? Do the opposite of the symptoms: Keep involved, stay active, keep doing the things that you have enjoyed. Exercise is important. Some people think that means joining a gym. It can -- or it can be taking a walk. Exercise increases serotonin, which is a chemical that stabilizes moods. And so does sunlight. ... Another thing to remember is that alcohol is a depressant. If youre a little down, someone might say "maybe you should have a little wine at dinner." You may feel a little lift initially, but ultimately, it is a depressant. What steps can family members take if a loved one seems depressed? Be supportive; invite them out to do things that they have typically enjoyed. Perhaps even point out to the person that they dont seem to be as active as before. ... Get them to talk to a primary care physician. Some people assume that because someone is older or because they have ailments or have suffered a loss, it is natural to be depressed. But you dont have to be depressed just because you are older. Sometimes you just need a little help. What I have found in screening a large number of elderly individuals is that a large majority are coping well and leading satisfying lives. Holly Selby

Honey could reduce effects of ageing London, Sept. 14 (PTI): Worried over ageing? Just start taking a spoonful of honey every day. Yes, according to scientists, honey could help counter the effects of ageing and decrease anxiety, the Daily Mail reported here today. "Diets sweetened with honey may be beneficial in decreasing anxiety and improving memory during ageing," Nicola Starkey of the University of Waikato in New Zealand told the British daily. According to her, this could be due to the antioxidant properties of honey. In fact, Starkey and Lynne Chepulis of the same university came to the conclusion after they conducted their tests on rodents. They raised them on diets of ten per cent honey, eight per cent sucrose or no sugar at all for a year. The rats were two months old at the start of the trial, and were assessed every three months using tests designed to measure anxiety and spatial memory. The honey-fed rats spent almost twice as much time in the open sections of an assessment maze then sucrose-fed rats, suggesting they were less anxious. They were also more likely to enter novel sections of a Y-shaped maze, suggesting they knew where they had been previously and had better spatial memory. It may be mentioned that honey has been used since ancient times as a food, medicine and beauty treatment. It has also been used as an antiseptic therapeutic agent for the treatment of ulcers, burns and wounds. Moreover, honey contains various micro-nutrients said to help prevent some cancers and combat hay-fever.

Most Children With Cancer Are Well-adjusted, Psychologist Reports September 18, 2007 Science Daily — Children under treatment for cancer are generally emotionally well-adjusted and no more depressed or anxious than other children their age, according to researchers at St. Jude Childrens Research Hospital. In studies of depression, anxiety, posttraumatic stress and quality of life, children with cancer do as well as, and often better than their healthy peers. "We see them as a flourishing population that has adapted to the stress of having cancer and undergoing treatment," said Sean Phipps, Ph.D., a member of the St. Jude Division of Behavioral Medicine. "They become quite resilient to the long-and short-term emotional and physical effects of their disease and the treatments." The unexpected finding that children with cancer are emotionally resilient is important because of the dramatic improvement in survival rates of pediatric cancers. "There has been a shift in research toward the concerns of long-term survivors of pediatric cancers," Phipps said. "The ability of these children to cope with the after-effects of cancer is the major issue now. What we are learning from this population might help us learn how to improve the quality of life of children who are not doing so well." Phipps is the author of an article on adaptive styles in children with cancer that appears in the advanced online issue of "Journal of Pediatric Psychology." The article, based on research done by his group and other research teams around the country, was presented at the conference "Psychosocial and Neurocognitive Consequences of Childhood Cancer: A Symposium in Tribute to Raymond K. Mulhern," held at St. Jude in September 2006, in honor of the late Raymond K. Mulhern, Ph.D., a pioneer in psychological research in pediatric oncology at the hospital. The symposiums presentations will also appear in a special December issue of the journal. The low level of depression among children with cancer does not reflect a state of "illusory mental health," Phipps said. That is, these children are not simply clinging to an illusion of mental health by denying distress. Rather, many of them simply have a reduced awareness of emotional distress, and they think of themselves as being well-adjusted and content, a response called a "repressive adaptive style." Children who have a repressive adaptive style have a personality characterized by a positive self-image and avoidance of threat, Phipps said. Such children tend to think of themselves as well-adjusted, self-controlled and content. Only a small percentage of these children experience emotional difficulties that become serious enough to be called pathologic, he said. "The finding that children with cancer are flourishing comes largely from self-report studies in which children discussed their own responses to stresses in their lives," Phipps said. "This is good news that many researchers in the field have been reluctant to embrace. There is a tendency instead to question whether this conclusion is mistaken; whether weve missed something in our studies or have not done the right studies. But the finding has held up over time, and we have not yet found a self-report test that documents in children a high level of difficulty adjusting to their disease." One possible clue to the successful adaptation to cancer and its treatment might be the good care, nurturing and love these children receive, Phipps noted. In addition, they are not confronted with tests in school, bullies or other common stresses their peers face. "A repressive adaptive style appears to provide a pathway to resilience or a route to successful adjustment for these children," he said. "However, it might be only one of several mechanisms that allow them to flourish." The low levels of depression found in children with cancer using self-reporting and other traditional psychological testing led some researchers to believe different tests were needed to study this population, such as tests of posttraumatic stress disorder. Posttraumatic stress disorder is a disorder based on anxiety that follows a terrifying event or ordeal that either harmed or threatened to harm the person. The diagnosis of posttraumatic stress disorder depends on the patient having certain symptoms from several different categories, such as experiencing flashbacks and nightmares; feeling detached; avoiding people or things linked to the trauma; losing interest in activities; and having difficulty sleeping. But investigators found that most children with cancer did not have the full range of symptoms to indicate the disorder. Instead, they had a few of the symptoms that can occur, but not enough of them to qualify for the full diagnosis. This led other investigators to abandon these test and instead look for posttraumatic stress symptoms, even if those symptoms are too few to permit a diagnosis of posttraumatic stress disorder. "Even with this strategy, researchers found that children with cancer appear to have lower levels of stress than do individuals who experienced a natural disaster, serious injury, the death of a parent or another type of major stress," Phipps said. A team led by Phipps examined self-reported somatic symptoms of 120 children with cancer who had finished medical treatment at least six months previously. Somatic symptoms are physical problems such as loss of weight, trouble sleeping and loss of energy. The researchers found no differences between children with cancer and healthy controls in self-reported somatic symptoms. In fact, cancer patients reported slightly lower symptom levels. Phipps and his colleagues are also studying several other factors from the growing field of "positive psychology," such as optimism, benefit-finding, post-traumatic growth and the concept that people facing adversity might actually benefit and become stronger from it in many ways. "Research psychologists have historically focused on searching for problems that need fixing, rather than on a persons strengths," Phipps said. "However, our findings suggest that gaining a better understanding of how children are able to remain so well adjusted in the face of difficult life challenges may provide a more fruitful approach to our research." This work was supported in part by the National Institutes of Health and ALSAC. Note: This story has been adapted from a news release issued by St. Jude Childrens Research Hospital.

Elderly at Highest Risk for Suicide 19th September 2007 Not long after 72-year-old Anne Beale Golsan had retired on disability from her job as a librarian, she put a stack of paid bills out for the mail, hung up a freshly pressed outfit and taped a note to the front of the house. "Dont come in by yourself. Get somebody to come with you. Sorry, Love Beale." Her niece arrived at the house they shared in Baton Rouge, La., to find police already there. Golsan had killed herself with a gunshot to the head. "Every single day it makes me feel like I wish I could have done something," Jane Golsan Ray said, recalling her aunts death eight years ago. "I wish I could turn back the clock and prevent it. It doesnt get any better, it hurts every day." The elderly are the highest risk population in the country for suicide. But few suicide-prevention programs target them — a result, advocates say, of scarce funding and lack of concern for older Americans. And mental heath experts say the number of elderly suicides is likely to climb as baby boomers enter their twilight years. The overall U.S. suicide rate is 11 per 100,000 people. But for those 65 and older, that figure rises to 14 per 100,000, according to the Centers for Disease Control and Prevention, which based its findings on 2004 data, the most recent available. Older adults are less likely to seek help and are more lethal in their suicide attempts. So experts say special care is needed to reach out. Dale Smith, 67, said he might not be alive if not for a suicide-prevention program in Spokane, Wash. Two years ago, he attended a meeting at his retirement complex where everyone filled out a screening form for depression, a key risk factor for suicide. Based on his answers, a caseworker and psychiatrist later visited Smith at his home, where they discussed what turned out to be a lifetime of depression. They developed a plan of medication and therapy that Smith says probably saved his life. "Im not unique. I think theres a lot of individuals out there who do suffer from depression and they have no clue," he said. "They just know theyre not happy. They are tired, they want to pull the covers over their heads and not look at the world, and they dont know what it is." But many older Americans have fewer options for treatment than younger people. "Its a not-so-subtle social-political assignment of resources," said Donna Cohen, a professor in the Department of Aging and Mental Health at the University of South Florida. Ten states passed laws last year intended to curb suicide among children and young adults. But only two — New Jersey and New Mexico — passed laws addressing suicide among the elderly, according to Suicide Prevention Action Network USA, a national advocacy group based in Washington, D.C. Depression is underdetected at all ages, mental health groups say. But much more funding is available for treating younger people, including $82 million in federal money approved in 2004. The situation prompted Sen. Harry Reid of Nevada, who lost his father to suicide, to propose funding more suicide-prevention programs for the elderly and changing a Medicare coverage rule that forces seniors to pay more for outpatient mental health services than other medical care. Some advocates and mental health workers say they also have to battle a prevailing notion that depression is a normal part of aging. "It is not natural and should be treated at all times," said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention. Janice Hodge of Sandy, Ore. said she didnt realize until after her 91-year old father, Anthony Liberto, died that he had been depressed. He was struggling to care for his 85-year-old wife, who suffered from Parkinsons disease. He did not work and he could no longer play golf, his favorite pastime. Friends and family still visited, but they say he spent much of his time lying on the couch and growing frustrated with suggestions that he place his wife of 62 years in a nursing home. Eventually, he shot his wife and killed himself, leaving a note that read: "Sorry we had to leave this way, forgive me. Love, your Dad." Experts say there need to be services tailored to the elderly because they handle depression differently than younger patients. In Spokane, the program that helped Smith, called Elder Services, trains people who come in contact with the elderly — from bank tellers to postal carriers — to notice signs of trouble, such as mail piling up or bills going unpaid. Those people can then notify social workers. In San Francisco, Patrick Arbore founded the Friendship Line in San Francisco in 1973 after seeing the lack of understanding some suicide hot line workers displayed for older people. The line, which lets people call just to talk or get support, now handles more than 3,000 calls a month. About one-quarter of the callers have suicidal thoughts, a staffer said. But most just want a compassionate listener. "Its about reminding people that they are still a part of their community," Arbore said. "Those connections bind us to life."

New mental health court could be operating within two week September 19, 2007 GENESEE COUNTY -- Efforts to launch a special court for mentally ill offenders cleared a major hurdle on Wednesday, and backers say the new court could be operating within two weeks. "At this point, its a go," Chief Genesee Circuit Judge Archie L. Hayman said. "Its very good news because were going to be able to focus on those people who have mental issues and direct them into a position where they can get help. "It should reduce the number of cases coming through the system ... and the county jail. And it should protect the public because they are not out there committing minor crimes." Hayman on Wednesday signed a new administrative order after judges in Flint District Court agreed to a procedural change that will allow the county to implement the new court. The State Court Administrative Office had refused to sign off on the plan unless mental court cases are assigned to the judge who will handle them -- Genesee Probate Judge Jennie E. Barkey. The judges agreed that Barkey can hear the cases while sitting as a district court judge, Hayman said. The new mental health court is the first of its type in Michigan, although similar concepts have been used in other states for years, court officials said. In August, Hayman and other judges signed an order establishing a process to divert mentally ill people who commit crimes into a long-term treatment regimen run by Genesee County Community Mental Health. Under the plan, mentally ill people who commit various misdemeanor and felony crimes would be brought before Barkey and given the option of entering treatment. If they agree, they could avoid a criminal conviction by completing a year-long treatment regimen. But the SCAO said Barkey cant hear the cases unless they are assigned to her. That arrangement concerned the district judges because mental health court diversions would skew caseload numbers used by the state to calculate workload and allocate judges. On Wednesday, all but one of the judges voted to implement the court under an agreement that all cases remain in district court, said Hayman, who also serves a chief judge of Flint District Court. Barkey can hear cases as a district judge because all county judges are cross-assigned, meaning they can sit as judges in other courts. Although he supports the concept, Flint District Judge Herman Marable Jr. wanted a six-month review of the new court, rather than the one year set forth in the order, Hayman said. "All of the judges support the concept of a mental health court," he said. The SCAO also had concerns about the process for identifying who should be allowed to participate in mental health court. But Hayman said the new order addresses all of the SCAOs concerns. For now, the mental health court is limited to cases arising in circuit court and Flint District Court because Central District Court isnt participating. Hayman said judges are still trying to get a drug court off the ground but havent been able to solidify funding. Flint District Judge Ramona M., Roberts has been meeting with community organizations, with the city attorneys office also involved. "We think (a drug court) is very crucial in assisting with a mental health court," he said. "A lot of times people have drug issues along with mental health issues."

Sweating out the stress 19/09/07 WORKING UP A SWEAT Aggies are channeling the stress of college life into daily workout routines. Excercising is just one of the methods experts suggest to ease the stress that goes along with being a college student. Brian Lenz wipes the sweat off his face as he finishes his two-to three hour workout, by doing a "cool down run" to help him think about the things that have occurred in his life that day. Now in his third year at A&T, Lenz believes that being a full time student, working part time and having a social life is stressful. "I try to put my priorities first and put the partying and hanging out second. Being at the gym for a couple of hours helps me clear my mind from everything and be able to think straight about my life." Lenz is among the many students at A & T who works out daily to avoid the stress that college students may feel. According to The New York Times, 80 percent of college campuses in the United States have noted significant increases in serious psychological problems, including severe stress, depression anxiety and panic attacks related to stress. Lenzs workout partner Nick Baylis, a senior, said that he believes professors should be a little easier on students. Lenz disagreed with his friend and said that hard work makes a stronger and better person. Hard work does make a better person, but if the stress is not reduced, that individual can suffer from high blood pressure, obesity, low resistance and inflammatory illnesses, says health experts. "Exercising weekly can help relieve stress," said Dr. Chris Aiken, a University of Virginia and Yale Medical School graduate and now a psychiatrist at A & T. He agreed with Lenz by saying that exercising is a way to relieve stress. But that is just one way. Other ways are eating properly and also getting at least six to eight hours of sleep daily. Aiken believes that college years are very stressful. He said that finding a mate, having real friendships, learning to be independent and having a successful job can put too much pressure on your brain. "That is too much gear shifting for the brain to do all at once," said Aiken. He also pointed out that thinking of more than one thing at once is not what makes you stressed. Being stressed is caused by the hormones in your body that are released and constantly going up and down and putting too much pressure on your brain. According to Aiken, 30 percent of people will develop a mental illness because of stress, such as bipolar disease, depression and even a panic attack. He suggests exercising to students because it can reduce the chances for them or anyone to experience any of the side effects.

Maternal Depression And Controlling Behavior Associated With Increased Stress Response In Infants   20.09.2007 Science Daily — Teenage pregnancy is widely recognized to be a major public health concern. These young mothers face many life challenges and they have an increased risk for becoming depressed. How might the behavior of these young mothers be related to later psychiatric or behavioral problems in some of their offspring? A new study being published in Biological Psychiatry on September 15th suggests an association between a history of depression in the mothers, a particular style of mothering, "maternal overcontrol", and increased stress reactivity of their infants. Azar and colleagues measured the cortisol levels of infants both before and after a brief mild stressor. They found that a lifetime history of major depression in the mother and a maternal pattern of intrusive and overstimulating behavior toward their infant ("maternal overcontrol") were associated with an increased release of the stress hormone, cortisol, in the infants following the mild stress exposure. The infants of mothers with a history of depression had also had lower pre-stress cortisol levels. Also, there was a correlation in the cortisol levels between mothers and their infants. These findings add "to our small but growing body of knowledge on neurobiological differences in stress responses between infants of depressed and non-depressed mothers", noted Dr. Azar. John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, adds, "Teenage mothers and their offspring are both, in their own ways, vulnerable. As a result, teenage pregnancy is thought to be a setting for preventative educational programs that might help teenagers better cope with their upcoming challenges." He also points out that, "We do not yet know the long-term consequences of maternal overcontrol, but should it prove to have negative long-term effects, it is conceivable that this type of behavior might be targeted in preventive educational programs." Dr. Azar concludes, "Practically, the open question is that of the long-term effects: are these infants at increased risk for psychological or physical stress-related illnesses later in life. If so, why? Given that the adrenocortical system is known to be plastic and hence easily influenced in both positive and negative ways, we believe that it is very important to eventually identify which of these babies are more vulnerable to stress." The article is "The Association of Major Depression, Conduct Disorder, and Maternal Overcontrol with a Failure to Show a Cortisol Buffered Response in 4-Month-Old Infants of Teenage Mothers" by Rima Azar, Daniel Paquette, Mark Zoccolillo, Franziska Baltzer and Richard E. Tremblay. Dr. Azar is affiliated with the University Health Network, Womens Health Program, Toronto General Hospital in affiliation with the University of Toronto in Ontario, Canada. Dr. Paquette is with the Department of Psychology at the University of Montreal and the Research Institute for the Social Development of Youth (RISD)-Montreal Youth Center in Quebec, Canada. Dr. Zoccolillo is with the Department of Psychiatry, while Dr. Baltzer is with the Department of Pediatrics, both at McGill University & McGill University Health Centre-Montreal Childrens Hospital in Quebec, Canada. Dr. Tremblay is affiliated with the Research Unit on Childrens Psychosocial Maladjustment at the University of Montreal. This article appears in Biological Psychiatry, Volume 62, Issue 6 (September 15, 2007), published by Elsevier. Note: This story has been adapted from a news release issued by Elsevier.

Chronic Stress Can Steal Years From Caregivers Lifetimes September 20, 2007 Science Daily — The chronic stress that spouses and children develop while caring for Alzheimers disease patients may shorten the caregivers lives by as much as four to eight years, a new study suggests. The research also provides concrete evidence that the effects of chronic stress can be seen both at the genetic and molecular level in chronic caregivers bodies. The findings, reported recently by researchers from Ohio State University and the federal National Institute of Aging, were published in the Journal of Immunology. These are the latest results from a nearly three-decade-long program at Ohio State investigating the links between psychological stress and a weakened immune status. Previous studies have examined medical students, newlyweds, divorced spouses, widows, widowers and long-married couples, in each case, looking for physiological effects caused by psychological stress. In their recent study, Ronald Glaser, a professor of molecular virology, immunology and medical genetics, and Jan Kiecolt-Glaser, a professor of psychology and psychiatry, teamed with Nan-ping Weng and his research group from the National Institute of Aging. Earlier work by other researchers had shown that mothers caring for chronically ill children developed changes in their chromosomes that effectively amounted to several years of additional aging among those caregivers. That work, remarkable as it was, looked only at a broad community of immune cells without identifying the specific immune components responsible for the changes. The Ohio State-NIA team wanted to identify the exact cells involved in the changes, as well as the mechanisms that caused them. They focused on telomeres, areas of genetic material on the ends of a cells chromosomes. Over time, as a cell divides, those telomeres shorten, losing genetic instructions. An enzyme – telomerase – normally works to repair that damage to the chromosome, Glaser said. “Telomeres are like caps on the chromosome,” said Glaser, head of Ohio State s Institute for Behavioral Medicine Research. “Think of it as a frayed rope – if the caps werent there, the rope would unravel. The telomeres insulate and protect the ends of the chromosomes. “As we get older, the telomeres shorten and the activity of the telomerase enzyme lessens,” he said. “Its part of the aging process.” For the study, the researchers turned to a population of Alzheimers disease caregivers they had worked with before, and compared them with an equal number of non-caregivers matched for age, gender and other aspects. They analyzed blood samples from each group, looking for differences in both the telomeres and the enzyme, as well as populations of immune cells. “Caregivers showed the same kind of patterns present in the study of mothers of chronically ill kids,” Glaser said, adding that the changes the Ohio State/NIA team saw amounted to a shortened lifespan of four to eight years. “We believe that the changes in these immune cells represent the whole cell population in the body, suggesting that all the bodys cells have aged that same amount.” The caregivers also differed dramatically with the control group on psychological surveys intended to measure depression, a clear cause of stress. “Those symptoms of depression in caregivers were twice as severe as those apparent among the control group,” Kiecolt-Glaser said. “Caregivers also had fewer lymphocytes,” Glaser said, “a very important component of the immune system. They also showed a higher level of cytokines, molecules key to the inflammation response, than did the control group.” Other experiments showed that the actual telomeres in blood cells of caregivers were shorter than those of the controls, and that the level of the telomerase repair enzyme among caregivers was also lower. Kiecolt-Glaser said that there is ample epidemiological data showing that stressed caregivers die sooner than people not in that role. “Now we have a good biological reason for why this is the case,” she said. “We now have a mechanistic progression that shows why, in fact, stress is bad for you, how it gets into the body and how it gets translated into a bad biological outcome.” Much of the Ohio State work is now shifting to studies on how to intervene with that stress in hopes of slowing the weakening of the immune system in highly stressed people. This research was supported in part by both the National Institute of Aging and the National Institutes of Health. David Beversdorf and Bryon Laskowski, both at Ohio State, and Amanda Damjanovic, Yinhua Yang, Huy Nguyen and Yixiao Zou, all with the National Institute of Aging, worked on this study. Note: This story has been adapted from a news release issued by Ohio State Universit

Depression In Women With Migraine Linked To Childhood Abuse 5th September 2007 Science Daily — Childhood abuse is more common in women with migraine who suffer depression than in women with migraine alone, according to a study published in the September 4, 2007, issue of Neurology®, the medical journal of the American Academy of Neurology "This study confirms adverse experiences, particularly childhood abuse, predispose women to health problems later in life, possibly by altering neurobiological systems," said study author Gretchen Tietjen, MD, with the University of Toledo-Health Science Campus and a member of the American Academy of Neurology. Researchers surveyed 949 women with migraine about their history of abuse, depression and headache characteristics. Forty percent of the women had chronic headache, more than 15 headaches a month, and 72 percent reported very severe headache-related disability. Physical or sexual abuse was reported in 38 percent of the women and 12 percent reported both physical and sexual abuse in the past. These results for abuse are similar to what is been reported in the general population. The association between migraine and depression is well established, but the mechanism is uncertain. The study found women with migraine who had major depression were twice as likely as those with migraine alone to report being sexually abused as a child. If the abuse continued past age 12, the women with migraine were five times more likely to report depression. "The finding that a variety of somatic symptoms were also more common in people with migraine who had a history of abuse suggests that childhood maltreatment may lead to a spectrum of disorders, which have been linked to serotonin dysfunction," said Tietjen. "Our findings contribute to the mounting data that show abuse in childhood has a powerful effect on adult health disorders and the effect intensifies when abuse lasts a long time or continues into adulthood," said Tietjen. "The findings also support research suggesting that sexual abuse may have more impact on health than physical abuse and that childhood sexual abuse victims, in particular, are more likely to be adversely affected." The study also found women with depression and migraine were twice as likely to report multiple types of abuse as a child compared to those without depression, including physical abuse, fear for life, and being in a home with an adult who abused alcohol or drugs. "Despite the high prevalence of abuse and the increased health costs associated with it, few physicians routinely ask migraine patients about abuse history," said Tietjen. "By questioning women about their abuse history we will be able to better identify those women with migraine at increased risk for depression." The study was supported by a grant from the American Headache Society. Note: This story has been adapted from a news release issued by American Academy of Neurology

Study Finds Flaws With How Primary Care Physicians Treat Patients Depression 5th September 2007 By Mary Agnes Carey, CQ HealthBeat Associate Editor Most patients with depression who receive treatment from primary care physicians do not receive care consistent with quality standards, according to a new RAND Corporation study. While most primary care physicians did a good job of diagnosing and beginning treatment for depression, and followed specific treatment guidelines more than 70 percent of the time, the primary care doctors did a poor job of following up with patients, researchers found. Fewer than half of the patients in the study completed the minimal course of treatments for either antidepressant drugs or psychotherapy, and only slightly more than half the depressed patients who were not treated were monitored closely, according to a RAND news release. The lowest quality of care occurred among patients who exhibited the most serious symptoms, including patients who showed evidence of suicide or substance abuse. The study found that among patients who had a previous suicide attempt, just 35 percent were referred to a mental health specialist over the next six months, according to the study, which was published in the September edition of the Annals of Internal Medicine. Physicians had high rates of adherence to just a third of the 20 measures of quality that researchers examined, and had low rates of adherence to nearly half of the treatment recommendations studied, according to the RAND report. “These findings are important for patients since most cases of depression are diagnosed and treated in primary care settings,” said the study’s senior author, Lisa V. Rubenstein, who is also a senior scientist at RAND, a nonprofit research organization. “Right now, primary care physicians don’t have the tools necessary to decide which patients to treat and which to refer to specialized mental health care.” The RAND study, billed as one of the first to assess primary care providers’ adherence to a comprehensive set of treatment guidelines for depression, examined the experiences of 1,131 patients with depression who were treated in 45 primary care practices across 13 states. The study sites ranged from small private practices to large managed care sites, and about 10 percent of the study’s patients were treated by the Department of Veterans’ Affairs medical practices. Researchers examined whether physicians and other health providers followed 20 different measures of quality, as well as analyzing patients’ reports about the status of their depression at 12, 18 and 24 months after starting treatment. Patients who received better-quality care reported fewer symptoms of depression up to two years after the start of treatment.

Speedy Drugs for Depression 5th September 2007 A type of drug has been found that starts working much faster against depression than current medications. Behavioural and molecular tests in rats show that the compounds kick into action in days, rather than weeks. But the drugs — called serotonin receptor agonists — wont be replacing Paxil (paroxetine) soon. None has yet been approved for treating depression in humans, and some have been scrapped because of concerns over side effects. But researchers are still keen to pursue them, because the most popular type of antidepressant, called selective serotonin reuptake inhibitors (SSRI), can take up to two months to start easing symptoms. And for one-third of people with depression, they do not work at all. "This is a very good first step in identifying and potentially having a rapidly acting antidepressant," says Ronald Duman, a drug expert at Yale University in New Haven, Connecticut. "But there is a lot of work to done." Seratonin sponges SSRIs such as Prozac have become a household name over the past three decades, garnering many millions of prescriptions every year in adults, children and even pets. The drugs work by stopping neurons from greedily keeping hold of a neurotransmitter called serotonin, so allowing more of the pleasure-providing molecule to reach protein receptors in nearby brain cells. But in most patients, the drugs take weeks to work, says Guillaume Lucas, who did the work as a graduate student at McGill University in Montreal, Canada. "In major depression you have a real risk of suicide," he says. This lag is caused by specialized proteins called autoreceptors, which sop up the extra serotonin. After several weeks these receptors get used to the extra serotonin and release the molecule, allowing it to spread to where it is needed to lift mood. Super recognition Lucas and his supervisor Guy Debonnel, who died last year, reasoned that serotonins action could be increased by activating the proteins that recognize it, rather than by boosting the amount circulating between neurons. This could circumvent the early counteraction of autoreceptors, and speed up the effect. The team found two compounds that did the job — one from a chemical supply company and the other from an abandoned clinical trial for irritable bowel syndrome. In one test, rats were exposed to stress such as water deprivation, flashing lights and crowding for several weeks, while some received an antidepressant. The researchers then tested them for sugar consumption. Depressed rats, the researchers knew from previous studies, are less likely to partake in sweet treats. The rodents that received an antidepressant were less sugar-shy than controls, and the ones that got the new serotonin receptor agonists regained their sweet tooth a week earlier than those given an SSRI. Two other behavioural tests in rats showed that the drugs were fast-acting, as did several molecular studies. After three days, rats receiving serotonin receptor agonists showed signs of new neuron growth — another indicator of antidepressant action — whereas the SSRI-treated rats did not. The results are reported in Neuron1. Challenges ahead Although the studies were done in rats, the researchers suggest that serotonin receptor agonists might also be speedier than SSRIs in humans. "We can expect therapeutic benefits to appear four to five times more rapidly," says Lucas, who is now at the University of Montreal. Lucas, who has patented the idea of melding serotonin receptor agonists with SSRIs, hopes to see clinical trials start as soon as compounds are found that are safe in humans. Sanofi-Aventis, a pharmaceutical company based in Paris, is testing another serotonin receptor agonist as a treatment for dementia, he says. The study stands out because it looked at several different ways of monitoring depression in rats and found the same answer, says Duman. But he cautions: "It really has to be taken with a grain of salt because these are rodent models, and theyre a long way from what could happen in human studies of depression."

Measuring Depression 5th September 2007 Science Daily — It is hardly surprising that clinically depressed people act differently than healthy people. Quantifying the difference, however, can be difficult. Now a collaboration of physicists and psychiatrists in Japan has found a way to clearly and objectively measure depression. The researchers outfitted both healthy control subjects and depressed patients with accelerometers to continuously measure their motions over 5-day periods. Although activity levels in all of the subjects followed power-law patterns (a type of distribution that often turns up in physics studies of natural systems) the activity levels of depressed patients were clearly distinguished from healthy subjects by a number known as the scaling parameter. For patients with major depression, the scaling parameter is significantly smaller than it is for healthy subjects. It can be a challenge to spot differences in behavior between depressed and healthy individuals via simple observation, and self-reported depression assessments are often unreliable. Applying instrumentation and statistical analyses common in physics research could dramatically improve the reliability and accuracy in measurements of depression, and may help in tailoring appropriate treatments for the debilitating ailment. Authors of the article in Physical Review Letters (forthcoming) are T. Nakamura, K. Kiyono, K. Yoshiuchi, R. Nakahara, Z. R. Struzik, and Y. Yamamoto Note: This story has been adapted from a news release issued by American Physical Society.

Helping To Raise Mental Health Awareness head> 5th September 2007 Mental health funding issues gained prominence in Virginia political and social circles after the April 16 Virginia Tech massacre. Activists, politicians and state residents began asking questions about improving services and appropriating more money for mental health services in the Commonwealth. According to the National Institute of Mental Health, 26.2 percent of adults in the United States suffer from a mental illness, which translates to one in four adults in the nation. One in 17 are diagnosed with a severe mental disorder. "Every extended family has been touched by, or knows someone with, a mental illness," said Wendy Gradison, president and CEO of Falls Church-based PRS, Inc. — formerly Psychiatric Rehabilitation Services. Since 1963, PRS has provided community-based support services and training to people recovering from a mental illness. Aside from its Falls Church headquarters location, PRS also has branches in Mount Vernon and Reston. Karon Cox, vice president and director of resource development at PRS, said the nonprofit serves about 700 clients each year, helping them achieve self-sufficiency in the community. A series of programs, from in-house support to finding employment, help the clients achieve their goals. "As they [the clients] progress through that, we help them become empowered to pursue their own goals in the community," said Cox. PRS and other private and public mental health service providers in the region face problems, said Cox. "The biggest problem, system wide, in Northern Virginia is a lack of resources," she said. Cox added that there is a tremendous need for mental health services in the region, and that donations and contributions are one way of supporting the work of nonprofits and agencies that are tackling mental disorders. Another way to support mental health services providers is to support political candidates who are outspoken in a quest to provide more funding for mental health services in local, state and federal budgets, said Cox. Yet another way to show support for the service providers is to show support to the people receiving the services. "Stigma and prejudice are the number one barriers to recovery from serious mental illness," said Gradison. "Recovery is absolutely possible through right support and training," she said. "WE ARE ALWAYS concerned about the stigma attached to mental illness," said Cox. She said that stigma is the biggest and often most overwhelming obstacle for people suffering from a mental illness on their way to a fulfilling life in the community. "People with mental illness are not unlike you or I," said Cox. She said mental illness is a disease, and right treatment can go a long way to improve the lives of those who are suffering from it. "With treatment they can have a very complete and fulfilling life in the community. They can be successful community participants if they have support services and respect they need and deserve from the community," said Cox. On Thursday, Aug. 9, the Vienna Tysons Regional Chamber of Commerce awarded PRS a check for $4,134. The donation stems from the proceeds of the annual chamber golf tournament. Billy Thompson, the tournament chair, said PRS was selected as the chamber nonprofit beneficiary based on the need for the service it provides in the community. He said he often hears stories of local people suffering from mental illness. "It is so uplifting when you hear how PRS has been able to make them an important part of the community," said Thompson, referring to some of the organization’s clients who have graduated to self-sufficiency and employment in the community. He added that awareness of the existence of mental health service providers could be of assistance to some local residents. "To let people be aware that they don’t have to continue to suffer," said Thompson. Vienna Tysons Chamber chair Joan Fletcher said PRS serves a tremendous need in Northern Virginia. She said awareness and education are key to a better understanding of the needs for mental health services in the community. "We should speak about it more openly and we could come up with better ways to help people living with mental illness," said Fletcher. Cox said every contribution helps PRS and other nonprofits and agencies with similar missions provide mental health services. "We certainly appreciate every donation," she said. She added that through awareness programs the residents of local communities would be more open minded and cognizant of their immediate self perceptions, which would help more people suffering from mental illness and disorders rehabilitate. Local businesses that are willing to hire those recovering from mental illness could serve a major role in helping public and private entities provide mental health services. "Employment is a big part of one’s individuality," said Cox.

Report: Children suffer post traumatic stress more often than soldiers 4th September 2007 Health care professionals are reporting , that one third of children living in violent urban neighborhoods, suffer from "post traumatic stress disorder." Thats nearly "twice the rate" reported for troops, returning from war zones in Iraq. Cleveland has children who are suffering but, they are getting help. Five year old Malaina Johnson is learning how to cope with a tragedy no child should ever have to witness. She watched her father, Edwin Johnson strangle her mother Brandy then put her remains in a bag and set the body on fire. "She died," Malaina said. Malaina and sister Alexandria suffer post traumatic stress. "I get a little scared when I think about it," Malaina said. They are among the 350,000 children nationwide who have watched violent acts committed by family, friends even strangers and suffer the emotional scars. Crime statistics indicate Cleveland Police respond to an average of nine domestic violence complaints each day. Post traumatic stress disorder among children goes largely unreported around the country. Cuyahoga County is aggressively working with parents and kids through the mental health services. Barb Whittenberg understands the cycle of violence. She was raped as a child by her father. Barb spent many years in therapy. They made me understand it was not my fault; it was his fault. These girls need to understand that what happened had nothing to do with them. Grandmother Barb is now mother to Malaina and Alexandria. They are doing much better. Barb has high hopes for their future. "I look for it to be bright and just for them to put all of this tragedy behind them and have a healthy life," Whittenberg said.

Anxiety over pregnancy linked to premature birth ANEW YORK (Reuters Health) - Women who are particularly anxious about their pregnancy may be at increased risk of premature delivery, a new study suggests. Researchers found that among 1,820 pregnant women, those with the greatest concerns about their pregnancy were nearly three times more likely than those with the least anxiety to deliver prematurely. The findings are published in the journal Psychosomatic Medicine. Stress during pregnancy has been linked to a higher risk of complications in some studies, though not all. And those that have identified a link have not suggested any simple solutions to the problem. For the current study, researchers looked specifically at womens worries related to their pregnancy -- including anxiety over labor and delivery, and worries about early pregnancy problems like bleeding and nausea. The goal was to see whether the risk of preterm birth was influenced by the types of anxiety that obstetricians can fairly easily address. For example, a womans fears about labor might be allayed by a thorough discussion with her doctor, according to the study authors, led by Dr. Suezanne T. Orr of East Carolina University in Greenville, North Carolina. For their study, the researchers had 1,820 women complete a questionnaire on pregnancy worries during their first visit for prenatal care. The women were asked whether they were anxious about labor and delivery, the health of the baby, nausea, and pain or bleeding during early pregnancy. They were then given anxiety "scores" ranging from 0 to 6. Overall, Orrs team found, women who scored a 5 or 6 were at greater risk of preterm delivery than those with lower scores. This remained true when the researchers considered factors that could both fuel womens anxiety and raise the risk of preterm birth -- such as a history of problems in past pregnancies, or health problems during the current pregnancy. The findings suggest that excessive anxiety itself may contribute to premature delivery in some women, according to Orr and her colleagues. "If additional research confirms our findings," they write, "then this might suggest an avenue for intervention to reduce spontaneous preterm birth. Anxiety is a treatable condition." anxiety over pregnancy linked to premature birth They point out that pregnancy-related worries, in particular, can be addressed with education. "Pregnant women could receive information from their healthcare providers about the signs and symptoms of a normal pregnancy and the process of labor and delivery to reduce their worries and concerns about pregnancy, and ultimately their risk of spontaneous preterm birth outcomes," the team notes.

Schizophrenia Patients May Benefit from New Experimental 2nd September 2007 According to a recently paper published in the journal Nature Medicine, a new experimental drug, named LY2140023, may have clear benefits for schizophrenia suffering patients. The new drug has shown promise in phase II human trials. The LY2140023 drug targets glutamate receptors in the brain instead of dopamine, which is the traditional way o threat schizophrenia until now. The study is a randomized, double-blind, placebo-controlled clinical trial, Voluneers suffering schizophrenia received in this phase of the study four weeks of treatment. Treatments considered are the new experimental drug LY2140023, olanzapine, or a placebo. One hundred and ninety six people who suffered from schizophrenia were selected to either receive LY2140023 at 40mg twice daily, olanzapine at 15mg daily or a placebo. All volunteers stayed at the hospital before and during the phase II trial. They stopped taking any medicine they were already taking. The study found that LY2140023 and olanzapine improved patients symptoms significantly within one week compared to the placebo, the participants who took LY2140023 did not experience any side effects y associated with modern schizophrenia drugs, and there was no evidence of weight gain or involuntary movements or muscle stiffness. This is certainly good news for schizophrenia patients. However, researchers cautioned about more studies needed for the efficacy, efficiency, and safety of the new drug. Schizophrenia is a debilitating psychological condition frequently characterized by acute episodes of false beliefs that cannot be improved by reasoning (delusions) and hallucinations. Patients generally hear voices which are not there, experience diminished emotion over the long term, lack of interest, and signs and symptoms of depression. It is estimated that 24 million people suffer from schizophrenia globally. The data on this study provide new objective evidence that mGlu2/3 receptor agonists have antipsychotic properties. They may provide a completely new therapeutic approach for treating schizophrenia and, perhaps, other neuropsychiatric disorders. This is certainly an alternative treatment to traditional schizophrenia treating drugs. Longer-term studies are needed to confirm and extend these newly found drug benefits. Source: Sandeep T Patil. 2007. Activation of mGlu2/3 receptors as a new approach to treat schizophrenia: a randomized Phase 2 clinical trial. Nature Medicine Published online: 2 September 2007.

Cradling to right shows stress 29/08/2007 Mothers who cradle their baby on the right side of their body could be showing signs of extreme stress. According to researchers at Durham University, the way mothers hold their baby can show whether they are feeling overwhelmed or becoming depressed. And psychologist Dr Nadja Reissland insisted it did not matter whether women were right or left-handed. It is believed the study results could be used to decide whether new mothers need extra help and support. At least one in 10 women suffers from post-natal depression, yet many go undiagnosed as they are unwilling to ask for help, according to researchers. The study, published in the online version of the Journal Of Child Psychology And Psychiatry, involved 79 new mothers and their babies, who were an average age of seven months. Mental state The mothers were interviewed at home and asked to pick up their baby in their arms. They then completed a survey about their feelings and mental well-being. The study, backed by the Childrens Research Fund, found that of the mothers who expressed no signs of stress or depression in the survey, 86% preferred to hold their babies to the left. Dr Reissland said: "Many mothers dont realise they are suffering from stress, or dont want to admit they are. "The way they interact with their child is usually the best indicator of their inner mental state. "Mums who are stressed often see what their baby does as negative so they may interpret their babys crying as being naughty, when in fact it is normal behaviour. "If this stress develops into depression, then the situation can be even worse."

Thousands of teens sign up to emotional support service 28/08/2007 Around 2,000 teenagers registered for a special text-based emotional support service in its first 48 hours, it emerged today. More than 4,500 have signed-up since its launch by Rehab just over a fortnight ago, which provides confidential information to young adults in the areas of relationships, suicide, teen issues, sexual and mental health. The figure was revealed during a seminar on Suicide and the Internet, held in Killarney, Co Kerry, on the first of a five-day international suicide prevention conference. Rehab’s Collette Ryan said the social support organisation was surprised with the numbers. “Well it was set up during the Leaving Cert results so we did expect a large number, but yes we were surprised,” she said. The free 24-hour service can be accessed by texting the word “Headsup” to 50424. It aims to provide young people with easy access to a range of helplines and support services. Designed for 16-24 year olds, Rehab says it is the first service of its kind in Ireland and highlights the way in which 21st century communication can benefit young people. Today’s seminar focused on both the positive and negative roles that the internet can play in the lives of emotionally troubled young adults. Safety officer with social networking site Bebo, Rachel O’Connell, who attended today’s seminar, said the website was committed to working with various agencies, such as the National Office for Suicide Prevention. This comes after reports linking such sites with suicide attempts by young people. But speakers also emphasised the benefits of using the internet to promote suicide prevention and provide support to youngsters in need. The seminar marked the beginning of the five-day congress, ’Preventing Suicide Across the Lifespan: Dreams and Realities’, which is the first to take place in Ireland. It will be officially launched tonight (Tuesday) and will involve more than 700 delegates from over 45 countries, including Irish and international suicide survivors, care-givers, researchers, policy makers and healthcare professionals. Congress Chairman Dr John Connelly said: “The congress will tackle a broad mix of cross cultural issues, youth and gender suicide, child and adolescent suicide to name but a few. “Attitudes to suicide in Ireland will also be addressed. “The programme was developed to be as comprehensive as possible and address the key issues of suicide and suicide prevention.” Around 500 people die by suicide every year in Ireland, while hospitals record around 11,000 cases of self-harm annually. Ireland experienced one of the fastest rising suicide rates in the world during the 1980s and 1990s and of particular concern to health professionals is the rate of youth suicide, currently the fifth highest in the European Union for 15-24 year olds. Speaking in advance of her address to the congress on Friday, President Mary McAleese said: “The issues surrounding suicide in all their painful, heartbreaking reality have lately become horribly familiar in Ireland. “In particular, the plight of young men, who comprise forty per cent of all suicides here, is striking. For this segment of society, suicide is now the biggest killer. “After them, elderly men living alone comprise the second-highest at-risk group. “The theme of this conference – Suicide Prevention across the Lifespan – could not, therefore, be more apposite to modern Ireland.” The congress’s opening ceremony will take place tomorrow morning and will include addresses from Junior Health Minister Dr Jim Devins, Chief Medical Officer NI Dr Michael McBride, the World Health Organisation’s (WHO) Dr Jose Bertolote and Commissioner Robert Street of the Salvation Army.

Try mental health court instead of jail for 28/08/2007 Ask almost any sheriff in Michigan, and they will tell you where a lot of mentally ill people ended up in the 1990s, when the administration of former Gov. John Engler closed state hospitals. Police swept them off the streets, and the mentally ill ended up in county jails and state prisons, says Bay County Sheriff John E. Miller. For the most part, they do not belong behind bars. Instead, they need help - counseling, and motivation to keep taking the drugs that may help them control their mental disorders. That is why we are interested to see how a pilot program works out down in Flint, in Genesee County courts. There, judges plan to divert at least some mentally ill people who are charged with crimes away from jail and into a program that would supervise their treatment. The suspects would avoid criminal convictions if they complete a yearlong program and stay out of trouble. It is a sane, humane approach to the problem of mentally ill people who may unwittingly break laws. Police do not know what to do with them, so they are taken to jail. They are charged with a crime, and there is nowhere else to lodge the mentally ill, so they stay behind bars. For the most part, lambs among wolves. Sheriff Miller said the shame is that a mentally ill person may come into jail as a relative innocent, but leave for a criminal career after these impressionable people spend time with hard-core offenders. In Genesee County, people with a history of mental illness who are facing misdemeanor and some felony charges are eligible for the alternative program. Those facing some types of charges would need the consent of the prosecutor and victims in order to qualify. They must be able to understand the process they will undertake, and present no danger to the public. People charged with homicide or sex offenses are not eligible. Such an approach makes sense. In the absence of any close monitoring of people with mental illness, such a program to catch them when they fall is needed. Two bills introduced in the Michigan Senate by Sen. Liz Brater, D-Ann Arbor, would offer a similar program statewide. With Genesee County already moving ahead with a program that starts on Sept. 1, senators ought to get that state legislation rolling. It has languished in the Judiciary Committee since its introduction in February. Sure, it will probably cost some extra money, although estimates are not available. Savings, though, should appear elsewhere. If mentally ill people are taking their drugs and doing whatever else they need in order to stay out of jail, that is fewer inmates to house and feed, fewer people that police will arrest, and who knows how many fewer victims of crimes. And many fewer students of crime for the jailhouse tutors. The mentally ill do not belong in prisons and jails. For those accused of nonviolent crimes, this probation-type program makes much more sense. Bay County - and the rest of the state - should give it a try.

Feeling depressed? Try a book 27/08/2007 A growing number of therapists are recommending something surprising for depressed and anxious patients: Read a book. The treatment is called bibliotherapy, and it is gaining force from a spate of research showing that some self-help books can measurably improve mental health. In May alone, the journal Behaviour Research and Therapy published two studies demonstrating the effectiveness of bibliotherapy in patients with depression or other mood disorders. The national health system in Britain this year is prescribing self-help books for tens of thousands of people seeking medical attention for mood disorders. Decades after the emergence of the self-help book, it remains one of publishings hottest categories. This year, U.S. revenue for the category will exceed $600 million, a single-digit jump from 2006, says Simba Information, a market research firm in Stamford, Conn. Yet this category is reminiscent of the market for elixirs, oils and pills before the advent of federal regulation. Despite the growth in research, fewer than 5 percent of the tens of thousands of self-help books on the market have been subjected to randomized clinical trials. And authors with no scientific credentials are just as likely to hit the jackpot as are renowned physicians. "When the book cover announces that its a bestseller, that means nothing," says John Norcross, a University of Scranton professor of psychology and researcher on the effectiveness of self-help books. Now, mental-health professionals in the U.K, the U.S. and elsewhere are determined to distinguish the most proven offerings. The aim is to recommend books that have been shown to be successful in published trials conducted by reputable, independent researchers. Trials are conducted much the way drug research is done, comparing patients depressive symptoms before and after treatment, compared with patients who didnt undergo the treatment. For instance, numerous clinical trials have shown that "Feeling Good: The New Mood Therapy," a 1980 tome by Stanford University psychiatrist David Burns, reduces depressive symptoms in large numbers of readers. In the U.K., where the wait for professional treatment can stretch six months, the national health system has embraced bibliotherapy as the first line of treatment for non-emergency cases. The program varies but in most parts of the country, health officials have approved a list of about 35 books that have been stocked at local libraries. Seekers of nonemergency mental-health services receive a prescription enabling them to check out a book without a library card and for 12 weeks, four times longer than other books. In a small but significant percentage of cases, bibliotherapy reduces symptoms sufficiently that the sufferers no longer seek additional treatment, says Neil Frude, a Cardiff University psychology professor who helped develop the U.K. program. In the U.S., no official list of bibliotherapy treatments exists. But thousands of mental-health professionals have contributed to a self-help manual that Norcross -- co-author himself of a self-help book, "Changing For Good" -- has been updating since 2000. "The Authoritative Guide To Self-Help Resources in Mental Health," available from many commercial booksellers, ranks more than 1,000 self-help books according to their effectiveness, based on clinical trials and on the clinical experience of professionals. Bibliotherapy works best on mild to moderate symptoms, and isnt regarded as a replacement for conventional treatments. A 2003 article in the Journal of Clinical Psychology reviewed the published research on bibliotherapy and concluded that it could successfully treat depression, mild alcohol abuse and anxiety disorders, but was less effective with smoking addiction and severe alcohol abuse. Most research suggests that bibliotherapy is most effective when used in conjunction with conventional therapy or while waiting for conventional therapy to begin.

Fast And Simple Screening Test For Early Diagnosis Of Common Brain Diseases 26/08/2007 Until recently physicians have had to rely on time-consuming and uncertain behavioural examinations to diagnose the onset of brain diseases such as multiple sclerosis, Alzheimers and schizophrenia. Research published in the Institute of Physics Journal of Neural Engineering suggests that we could soon be able to diagnose the onset of many brain diseases by analysing the tiny magnetic fields produced by neuron activity in the brain. This is a significant breakthrough for neurologists and psychiatrists as it could present a fast and simple screening test for brain diseases, while also helping differentiate between different brain diseases that have similar symptoms. A team of investigators from the University of Minnesota Medical School in Minneapolis, US, led by Professor Apostolos P. Georgopoulos, has been analysing the magnetic charges released when neuronal populations in our brains couple. By comparing the patterns of tiny magnetic charges in healthy brains to those afflicted with common diseases such as Alzheimers, the team has been able to identify the patterns commonly associated with these debilitating diseases. A process called magnetoencephalography (MEG), a non-invasive measurement of magnetic fields in the brain, has been used to examine a total of 142 volunteers during tests which last between 45-60 seconds. The team first studied 52 volunteers to find patterns of neural activity that could identify all the different illnesses. They then tested a further 46 patients to see whether the patterns found from the first group could accurately diagnose disease within a second group. Here, many of the predictors found from the first set of participants also correctly diagnosed more than 90% of subjects in the second sample. Professor Georgopoulos said, "We want to continue and acquire data from a large number of subjects - patients and matched controls. The throughput of this MEG test is large so we can continue a high rate of testing and we hope that clinical applications can become a reality in a year or two." Diagnosing illnesses like Alzheimers has always been very difficult, particularly in the early stages. Physicians are forced to rely on conversations with patients, memory tests, physical examinations and, occasionally, brain scans. It is sometimes not until post-mortem or after a biopsy that cause of illness can be confirmed. ---------------------------- Article adapted by Medical News Today from original press release. ---------------------------- Source: Joseph Winters

Psyschologists Study Loneliness And Its Effect On Health 21/08/2007 Psyschologists Study Loneliness And Its Effect On Health Two University of Chicago psychologists, Louise Hawkley and John Cacioppo, have been trying to disentangle social isolation, loneliness, and the physical deterioration and diseases of aging, right down to the cellular level. The researchers suspected that while the toll of loneliness may be mild and unremarkable in early life, it accumulates with time. To test this idea, the scientists studied a group of college-age individuals and continued an annual study of a group of people who joined when they were between 50 and 68 years old. Their findings, reported in the August issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science, are revealing. Consider stress, for example. The more years you live, the more stressful experiences you are going to have: new jobs, marriage and divorce, parenting, financial worries, illness. It is inevitable. However, when the psychologists looked at the lives of the middle-aged and old people in their study, they found that although the lonely ones reported the same number of stressful life events, they identified more sources of chronic stress and recalled more childhood adversity. Moreover, they differed in how they perceived their life experiences. Even when faced with similar challenges, the lonelier people appeared more helpless and threatened. And ironically, they were less apt to actively seek help when they are stressed out. Hawkley and Cacioppo then took urine samples from both the lonely and the more contented volunteers, and found that the lonely ones had more of the hormone epinephrine flowing in their bodies. Epinephrine is one of the bodys "fight or flight" chemicals, and high levels indicate that lonely people go through life in a heightened state of arousal. As with blood pressure, this physiological toll likely becomes more apparent with aging. Since the bodys stress hormones are intricately involved in fighting inflammation and infection, it appears that loneliness contributes to the wear and tear of aging through this pathway as well. There is more bad news. When we experience the depletion caused by stress, our bodies normally rely on restorative processes like sleep to shore us up. But when the researchers monitored the younger volunteers sleep, they found that the lonely nights were disturbed by many "micro awakenings." That is, they appeared to sleep as much as the normal volunteers, but their sleep was of poorer quality. Not surprisingly, the lonelier people reported more daytime dysfunction. Since sleep tends to deteriorate with age anyway, the added hit from loneliness is probably compromising this natural restoration process even more. Loneliness is not the same as solitude. Some people are just fine with being alone, and some even see solitude as an important path to spiritual growth. But for many, social isolation and physical aging make for a toxic cocktail. ---------------------------- Article adapted by Medical News Today from original press release. ---------------------------- Author Contact: Louise Hawkley Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information. Source: Catherine West

Physical Illness And Mental Health: Help Is At Hand In New Booklet 17/08/2007 As soon as I was diagnosed, I felt the depression starting." 46-year-old with breast cancer, Northampton. "After my heart attack I felt really anxious all the time... I was worried that anything strenuous could trigger another attack." Man aged 68, Glasgow. Having a physical illness, and treatment for it, can affect the way we think and feel. A new booklet from the Royal College of Psychiatrists Help is at Hand series explains the emotional effects of having a serious physical illness, and offers advice on how to cope with the mood changes that often accompany ill health. The booklet describes what it is like to be anxious or depressed, and looks at the reasons why these feelings are more likely to occur if someone has a serious illness. Being ill and having treatment are stressful, and people become depressed and anxious when they are stressed for any reason. Some drug treatments, such as steroids, affect the way the brain works and can cause depression and anxiety directly. Factors that may make a person more likely to become anxious or depressed include having experienced these feelings before; not having family or friends to talk to about the illness; having other stresses going on at the same time, such as divorce, or the death of someone close; and being in a lot of pain. The booklet offers advice on when people should seek help, and emphasises that this is not a sign of weakness. Some people try to cope with feelings of anxiety and depression by keeping busy, but overactivity can lead to even more stress and exhaustion. It can be difficult asking for help when we are physically ill because we may feel that our distress in understandable, and therefore there is nothing that can be done about it. Other reasons include not wanting to complain, or believing that the doctors and nurses are more interested in physical problems than emotional ones. Health professionals need to know if a patient with a serous physical illness is depressed, so that they can decide if treatment for anxiety of depression is needed. General practitioners, counsellors, psychotherapists, clinical psychologists and psychiatrists may be able to help. What help is available? Talking treatments allow a person to express their real feelings, and get things in perspective. There are several types of talking treatments, all of which involve a trusting relationship between patient and professional, the opportunity to talk freely about thoughts, feelings and problems, and help in coping. Antidepressant drugs may also be useful, not only in helping a person to feel less anxious and depressed, but also to lessen pain and improve sleep. The booklet offers advice on self-help. Taking care of yourself, healthy eating, exercise and avoiding too much alcohol are all practical things that a person who is physically ill can do to help themselves feel better. Family and friends can also help, by spending time with the person who is ill, offering reassurance that they will get better and encouraging them to accept their treatment.

Army suicides at highest level in 26 years 16/08/2007 WASHINGTON - Repeated and ever-longer war-zone tours are putting increasing pressure on military families, the Army said Thursday, helping push soldier suicides to a record rate. There were 99 Army suicides last year — nearly half of them soldiers who hadn’t reached their 25th birthdays, about a third of them serving in Iraq or Afghanistan. Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general, told a Pentagon press conference that the primary reason for suicide is “failed intimate relationships, failed marriages.” She said that although the military is worried about the stress caused by repeat deployments and tours of duty that have been stretched to 15 months, it has not found a direct relationship between suicides and combat or deployments. “However, we do know that frequent deployments put a real strain on relationships, especially on marriages. So we believe that part of the increase is related to the increased stress in relationships,” she said. “Very often a young soldier gets a ‘Dear John’ or ‘Dear Jane’ e-mail and then takes his weapon and shoots himself,” she said. Lives put on hold The report resonated on Army bases and among war supporters and critics around the nation. “It can get pretty depressing even when you’re not in harm’s way,” said Sgt. Carlene Bishop, a 25-year-old from Reading, Pa., who serves in the 10th Mountain Division and returned from Iraq in May. “You’re away from home, you have to put your life on hold. I know soldiers whose marriages have broken up or who couldn’t pay their bills.” Carol Banks, whose husband is a chaplain for a battalion preparing for another deployment from Fort Hood in Texas later this year, said soldiers are under a tremendous amount of stress — young and suddenly faced with war on top of the regular struggles of finances and family life. “It just piles up, one thing on top of another,” said Banks. “There is help available, but I think a lot of soldiers don’t want to use it.” The 2006 total — the highest rate in 26 years of record-keeping and the largest raw figure in 15 years — came despite Army efforts to set up new programs and strengthen old ones for providing mental health care to a force stretched by the longer-than-expected conflict in Iraq and the global counterterrorism war entering its sixth year. Fighting stigma The Army has sent medical teams annually to the battlefront in Iraq to survey troops, health care providers and chaplains. It has revised training programs and bolstered suicide prevention, is trying to hire more psychiatrists and other mental health professionals and is in the midst of an extensive program to teach all soldiers how to recognize mental health problems in themselves and others — to overcome a culture that attaches a stigma to seeking help. “I am deeply concerned but not surprised” by the new report, said Sen. Patty Murray, D-Wash., a member of the Veterans Affairs Committee. She cited the stresses of longer and repeated tours of duty and her suspicion that many in the military don’t understand how to deal with post-traumatic stress disorder. “I think there is just an inner denial among some that PTSD is ‘you’re just not tough enough,”’ she said. The Army has been working to overcome the stigma associated with getting therapy for mental problems after finding that troops were avoiding counseling out of fear it could harm their careers. Among findings in the new report: Of the 99 suicides, 30 were soldiers serving in Iraq and Afghanistan at the time of their deaths, 27 of them in Iraq. 69 were committed by troops who were not deployed in either war, though there were no figures immediately available on whether they had previously deployed. In a half million-person Army, the toll translated to a rate of 17.3 per 100,000, the highest since the Army started counting in 1980. The rate has fluctuated over the years, with the low being 9.1 per 100,000 in 2001. The Centers for Disease Control and Prevention said the suicide rate for U.S. society overall was about 11 per 100,000 in 2004, the latest year for which the agency has figures. The Army said that when civilian rates are adjusted to cover the same age and gender mix that exists in the Army, the rate is more like 19 to 20 per 100,000. The 99 suicides compare to 87 in 2005 and are the highest total since 102 were reported in 1991, the year of the Persian Gulf War, when there were more soldiers on active duty. Investigations are still pending on two other deaths and if they are confirmed as suicides, the number for last year would rise to 101. About a quarter of those who killed themselves had a history of at least one psychiatric disorder. Of those, about 20 percent had been diagnosed with a mood disorder such as bipolar disorder and-or depression, and about 8 percent had been diagnosed with an anxiety disorder, including post traumatic stress disorder — a signature injury of the conflict in Iraq. Firearms were the most common method of suicide. Those who attempted suicide but did not succeed tended more often to take overdoses and cut themselves. WASHINGTON - Repeated and ever-longer war-zone tours are putting increasing pressure on military families, the Army said Thursday, helping push soldier suicides to a record rate. There were 99 Army suicides last year — nearly half of them soldiers who hadn’t reached their 25th birthdays, about a third of them serving in Iraq or Afghanistan. Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general, told a Pentagon press conference that the primary reason for suicide is “failed intimate relationships, failed marriages.” She said that although the military is worried about the stress caused by repeat deployments and tours of duty that have been stretched to 15 months, it has not found a direct relationship between suicides and combat or deployments. “However, we do know that frequent deployments put a real strain on relationships, especially on marriages. So we believe that part of the increase is related to the increased stress in relationships,” she said. “Very often a young soldier gets a ‘Dear John’ or ‘Dear Jane’ e-mail and then takes his weapon and shoots himself,” she said. Lives put on hold The report resonated on Army bases and among war supporters and critics around the nation. “It can get pretty depressing even when you’re not in harm’s way,” said Sgt. Carlene Bishop, a 25-year-old from Reading, Pa., who serves in the 10th Mountain Division and returned from Iraq in May. “You’re away from home, you have to put your life on hold. I know soldiers whose marriages have broken up or who couldn’t pay their bills.” Carol Banks, whose husband is a chaplain for a battalion preparing for another deployment from Fort Hood in Texas later this year, said soldiers are under a tremendous amount of stress — young and suddenly faced with war on top of the regular struggles of finances and family life. “It just piles up, one thing on top of another,” said Banks. “There is help available, but I think a lot of soldiers don’t want to use it.” The 2006 total — the highest rate in 26 years of record-keeping and the largest raw figure in 15 years — came despite Army efforts to set up new programs and strengthen old ones for providing mental health care to a force stretched by the longer-than-expected conflict in Iraq and the global counterterrorism war entering its sixth year. Fighting stigma The Army has sent medical teams annually to the battlefront in Iraq to survey troops, health care providers and chaplains. It has revised training programs and bolstered suicide prevention, is trying to hire more psychiatrists and other mental health professionals and is in the midst of an extensive program to teach all soldiers how to recognize mental health problems in themselves and others — to overcome a culture that attaches a stigma to seeking help. “I am deeply concerned but not surprised” by the new report, said Sen. Patty Murray, D-Wash., a member of the Veterans Affairs Committee. She cited the stresses of longer and repeated tours of duty and her suspicion that many in the military don’t understand how to deal with post-traumatic stress disorder. “I think there is just an inner denial among some that PTSD is ‘you’re just not tough enough,”’ she said. The Army has been working to overcome the stigma associated with getting therapy for mental problems after finding that troops were avoiding counseling out of fear it could harm their careers. Among findings in the new report: Of the 99 suicides, 30 were soldiers serving in Iraq and Afghanistan at the time of their deaths, 27 of them in Iraq. 69 were committed by troops who were not deployed in either war, though there were no figures immediately available on whether they had previously deployed. In a half million-person Army, the toll translated to a rate of 17.3 per 100,000, the highest since the Army started counting in 1980. The rate has fluctuated over the years, with the low being 9.1 per 100,000 in 2001. The Centers for Disease Control and Prevention said the suicide rate for U.S. society overall was about 11 per 100,000 in 2004, the latest year for which the agency has figures. The Army said that when civilian rates are adjusted to cover the same age and gender mix that exists in the Army, the rate is more like 19 to 20 per 100,000. The 99 suicides compare to 87 in 2005 and are the highest total since 102 were reported in 1991, the year of the Persian Gulf War, when there were more soldiers on active duty. Investigations are still pending on two other deaths and if they are confirmed as suicides, the number for last year would rise to 101. About a quarter of those who killed themselves had a history of at least one psychiatric disorder. Of those, about 20 percent had been diagnosed with a mood disorder such as bipolar disorder and-or depression, and about 8 percent had been diagnosed with an anxiety disorder, including post traumatic stress disorder — a signature injury of the conflict in Iraq. Firearms were the most common method of suicide. Those who attempted suicide but did not succeed tended more often to take overdoses and cut themselves.

Stress And Depression During Pregnancy Leads To Pediatric Sleep Problems, UK Study Finds 31/07/2007 Anxious or depressed mothers-to-be are at increased risk of having children who will experience sleep problems in infancy and toddlerhood, finds a study that published this month in Early Human Development. While this finding presents itself as important news to tired new moms and dads -- for whom a soundly sleeping child spells out well-deserved respite -- it may carry even more value for babies. For them, sleep ranks as one of the most highly regarded indexes of healthy development, and plays a critical role in consolidating memory and facilitating learning, regulating metabolism and appetite, promoting good moods and sustaining both cardiovascular health and a vigorous immune function. "We have long known that childs sleep is vital to his or her growth, but the origins of problems affecting it remained unclear. Now, we have evidence that these patterns may be set early on, perhaps even before birth," said lead author Thomas OConnor, Ph.D., associate professor of Psychiatry at the University of Rochester Medical Center. "This is another piece in the unfolding mystery of just how much the prenatal environment may shape a childs health and development for years to come." The survey-based study, part of the Avon Longitudinal Study of Parents and Children (ALSPAC), assessed pregnant women living in Avon, England, who were due to give birth in a 21-month window. More than 14,000 women -- an estimated 85 to 90 percent of those eligible -- responded to questionnaires that gauged how depressed or anxious they were at multiple points early on in, late in, and after their pregnancy. Later on, the women were then asked to report on their childs sleep habits at 6, 18 and 30 months, detailing how long the child slept (a consolidated daytime and nighttime total), how often the child awoke, and if he or she exhibited any of seven common forms of sleep problems, such as having nightmares, refusing to go to bed or having trouble falling asleep. Surprisingly, babies born to mothers classified as anxious or depressed while pregnant dozed just as long as their unstressed-pregnancy counterparts -- about 12 hours. However, this sleep was less sweet; children born to mothers who were depressed or anxious during pregnancy experienced more sleep problems. For instance, mothers classified as clinically anxious 18 weeks into pregnancy, compared to their non-anxious counterparts, were about 40 percent more likely to have an 18-month-old who refused to go to bed, woke early, and kept crawling out of bed. The childs rocky relationship with sleep often persisted until he or she was 30 months old. A similar effect was found in children born to mothers who were depressed during pregnancy. These prenatal mood disturbances worked as reliable predictors of childrens sleep problems even when investigators controlled data for other factors already linked with poor sleep quality in children, including a mothers level of postnatal anxiety or depression, her smoking habit, or her social class. "This problematic sleep is notable; it may be part of the reason why mood-disturbed pregnancies are linked to childrens behavioral disorders, like depression, hyperactivity and anxiety, later on down the road," OConnor said. "It remains to be seen if the sleep problems we witnessed may play an active, causal role in priming the path for these childrens emotional and cognitive problems in later life, or if both conditions merely fall out of the same stressful pregnancies." Related studies now show that stress, which is associated with increased exposure stress hormones, like cortisol, may disrupt a childs formation of a bundle of nerve cells in the brain -- called the suprachiasmatic nucleus -- which act as a signaling system that tunes bodys internal clock. This signaling system helps to properly regulate daily rhythms of waking, sleeping, even hunger -- that is, if its formation has not been disrupted. This could explain why sound sleep does not come easily to kids whose signaling systems may not be properly calibrated, OConnor said. However, more research is needed to monitor this signaling pathway more closely, watching for biological hints as to why sleep and behavioral disturbances so often crop up together. In the meantime, pregnant women concerned about how their own mood-disturbance may harm their unborn babys sleeping habits, development and emotional health may want to consider psychological treatment, OConnor said. Several evidence-based therapies exist, and unlike medication, none of them are suspect in the least for causing adverse effects to baby. "Given prenatally, psychological interventions could instill a whole host of benefits that may carry-over to the child," OConnor said. "Still, more clinical research is needed to see how we can best promote healthy pregnancies and healthy babies." ---------------------------- Article adapted by Medical News Today from original press release. ---------------------------- The ALSPAC study, part of the WHO-initiated European Longitudinal Study of Pregnancy and Childhood, is funded by the Wellcome Trust, the National Institutes of Health and the United Kingdoms Department of Health, Department of the Environment, and Medical Research Council. Source: Becky Jones University of Rochester Medical Center

Mental Health Bill could be illegal by Matilda MacAttram 5/1/2007 CONCERNS OVER the legality of the 2006 Mental Health Bill are growing as questions over the validity of the REIA (Race Equality Impact Assessment) report have been raised by the National Mental Health Black and Minority Ethnic Network in a letter to the Minister of State for Health, Rosie Winterton. This latest development has comes fast on the heels of Dr Kwame Mckenzie, a government advisor on mental health’s, decision to write to  the Health Minister formally  distancing himself from the REIA late last month.   Anxious to bring to light a number of serious oversights in the REIA report, which he points out, in no way reflects what the government appointed the steering group advised. Mckenzie is keen to make it clear that the report has not followed any of the advice that the expert committee said should be put in place in order to ensure that the new  2006 Mental Health Bill does not exacerbate discrimination in mental health services.   ‘I wasn’t able to see  the REIA report  before it went out so I was not able to check it for accuracy in any way. In light of this I don’t’ want my name associated with it at all.  It was ill considered and the final document is inaccurate and in no way reflects what the committee agreed,’ Dr McKenzie said. implication This turn of events have not only thrown into question the legality of the new 2006 Bill, which is scheduled for Committee Stage in the House of Lord’s  on the 8th, 10th, 15th and 17th of January, but has also shed light on the disregard Department of Health official have shown for Black professionals concern over this issue.   The DH’s shoddy treatment of the expert panel over this process has left a bad feeling among many  professional from the community  who feel they have been used by the process. Published alongside the 2006 Mental Health Bill in November, the  REIA report was presented to the House of Lords with the implication that the National Black and Minority Ethnic Network and other black groups had signed up to the conclusions in the report. ‘The Department of Health have implied that the National BME Mental Health Network complied with the REIA , but this is not the case.  "There isn’t any written report on what the advisory group concluded and now two people from the Network are officially saying that their advice was not taken on board. disappointment "Because they were on the advisory group it is incorrectly claimed by the Department of Health that their consent was given to the REIA,’ professor Suman Fernando of the National BME Network said. Co-chair of the National BME Network, Marcel Vige slammed as inadequate the findings of the REIA. In the letter to the Health Minister he made clear  the Network’s  disappointment over the Government’s report, condemning the findings for the race review of the 2006 Mental Health Act as ‘extremely disappointing’ and ‘painfully inadequate.’ Discrimination within mental health services has had a devastating impact on ethnic minority communities.  Findings from the first national census on inpatient care showed that people from  African Caribbean communities suffer the highest rates of discrimination.  Black people are 44% more likely to be sectioned, 29% more likely to be forcibly restrained and 50% more likely to be put in seclusion than white British people, despite similar rates of mental ill health. The seven area of reform  within the 2006 Mental Health Bill will make this situation worse.  A growing awareness that the crisis in mental health has become one of the most critical issues affecting Black Britons today is leading campaign groups en mass to mobilise support to put pressure on the government avert a further crisis. appalling A groundswell of support among black groups many who are but are keenly aware of the Government’s reluctance to address this crisis in any substantive way has led to a boost in support of the campaign group Black Mental Health UK.  Their online campaign is calling for the appalling treatment of black patients to be made a national priority and believe that calls for a formal inquiry into the REIA could make this happen. ‘The CRE can sanction those who do not produce a proper REIA.  It would appear that the DH have breached the law and the CRE are the only ones who can bring a case.  The Home office has successfully worked with the CRE to produce a  REIA report on the Immigration and nationality Bill, The Charities Bill and the ID Card Bill, this begs the question, why has the Department of Health failed to do this, ’ solicitor and mental health lawyer Chiniyere Inyama said. Following Inyama’s advice, the National Network  are among organisations including Black Mental Health UK who have  written to Professor Kay Hampton the new chair of  CRE (Commission for Racial Equality) to look into the Government’s failings over the REIA. In August last  year the CRE threatened the Department of Health with legal action over it’s repeated failings to consider the needs of ethnic minorities when making policies.   Campaign groups are now keen to see CRE use it’s legal powers to force the government to  ensure any changes to mental health law are in line with both Human Rights and Race Relations law. With changes to the law likely to last for at least another generation campaign groups are keen to see the CRE come out in force to protect the rights of black patients in the run up to their merger with the equalities council next October ‘It would be good for the CRE to look at this work as there have been oversights in the process such as not referring the report back to the steering group that was supposed to be a point of reference for the process. I acknowledge this is one thing that the government isn’t good yet but it is so important to it needs to be got right.’ Dr McKenzie said. About the author Matilda MacAttram is journalist, researcher and founder of  Black Mental Health UK

Women drinkers "depression link" BBC News Wednesday, 3 January 2007, 21:12 GMT The link between binge drinking and depression is stronger in women than men, a study suggests. US and Canadian researchers quizzed 6,009 men and 8,054 women about alcohol intake and their history of depression. They found women who were binge drinkers were more likely to be clinically depressed than men. But moderate drinking was not likely to increase the risk in either sex, the journal, Alcoholism: Clinical and Experimental Research, reported. The study measured alcohol intake for the previous week and the last year, including the frequency of drinking, how much was usually drunk each time and the maximum, overall quantity and whether there were periods of binge drinking. Depression was also measured for the study and defined as whether a person met the criteria for clinical depression, or had experienced recent depressed feelings. The research, carried out by the Centre for Addiction and Mental Health in Canada and the University of North Dakota, said the difference between men and women was noticed only in those suffering from clinical depression. The researchers believe that could be because women suffering major depression drink as a way out of their problems. Vicious circle Professor Sharon Wilsnack, from the University of North Dakota School of Medicine and Health Sciences, said: "This pattern of associations is more consistent with women using alcohol to counteract depression - by high-quantity drinking and intoxication - than with chronic alcohol consumption tending to make women depressed. "However, a vicious circle could possibly begin with drinking in response to depression." She said clinical depression may encourage some women to drink large amounts of alcohol in the hope of numbing depressed feelings, "with risks of alcohol abuse and dependence". And she said doctors had to be aware women may be trying to medicate their moods with alcohol because of this. But researchers said more work was needed on whether drinking leads to depression, depression leads to drinking or whether the relationship is defined by something else. Andy Bell, of the Mental Health Alliance, an umbrella group of charities and health professionals, agreed it was still not clear what came first - the drinking or depression. "We know the link is significant, but it is also complex. People with mental health problems can have drink and drug addictions and often need a multi-disciplinary approach."

Mental illness drug payments call BBC News Wednesday, 3 January 2007, 08:08 GMT Paying people with severe mental illnesses to take medication may encourage some to stick to their drug regime, a team of London doctors says. They have quoted four cases where payments reportedly increased use of medication and cut hospital admissions. But campaigners said the Psychiatric Bulletin study did not offer a "real solution" for improving medication use. Between 20% and 50% of adults being treated by psychiatric services are estimated not to take their medication. It can be very difficult to ensure patients with conditions such as schizophrenia or bipolar disorder take their medication as they should. Particular problems concern patients living in the community - even those under "assertive outreach", where a mental health worker visits patients in their homes. Previous research has shown that financial incentives helped patients being treated for tuberculosis, dental problems, weight loss and people on cocaine abstinence programmes to stick to their treatment regime. "Negative effect" In this study, the researchers sent questionnaires to the managers of 150 assertive outreach teams, asking if financial incentives were used. Just under half responded. None had used financial incentives over the past two years but 10% said they had used food and other indirect incentives to help with "treatment engagement", though not as a direct reward for patients taking their medication. Three quarters of respondents said they had concerns about using financial incentives, most of whom said the practice would be unethical. Individual managers raised concerns about the possibility patients could be coerced into taking medication, and a negative effect on the relationship between the healthcare worker and the patient. But the researchers also studied five patients who were being treated under the assertive outreach programme in East London from the summer of 2003 onwards. Each was offered payments of between £5 and £15 per injection of medication. Four accepted, and were found to be more likely to take their drugs as they should and to stay in independent accommodation. They also had fewer problems with the neighbours and the police than before. Three of the four have had no hospital admissions since entering the scheme. "Unbearable side effects" The team, led by Dr Dirk Claassen of East London Community Mental Health Trust, said: "The results in terms of reduced hospital admissions for the patients who accepted the offer seem beneficial. "There is no harm intended or caused, the service user can revoke the offer at any time, and the treatment is generally available." He added: "Financial incentives might be a treatment option for a high-risk group of non-adherent patients with whom all other interventions to achieve adherence have failed. The researchers accept there are a number of practical questions that need to be addressed if this scheme were to become widespread. However, money for medication may be an effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients. Physical symptoms Mental health charity Rethink chief executive Paul Jenkins told BBC Radio 4s Today programme payments were not a priority for developing services for people with severe mental illness. The key issue was the sometimes "devastating" side-effects of medication, he said. "The research we have done and the calls we get to our advice line report people suffering things like significant weight gain, tiredness, agitation or depression, or physical symptoms like shaking," Mr Jenkins added. "These can affect peoples lives very significantly and have a real impact on their ability to keep to taking their medication." Marjorie Wallace, of the charity Sane, added: "This very small study highlights the desperate situation of people with schizophrenia and bipolar disorder who depend on medication to prevent relapse of their condition. "But we belive that offering what amounts to bribes to take medication that can cause serious side effects is no the answer."

New drive to tackle mental health in work The government has launched a new initiative which aims to encourage employers to improve the way they deal with mental health in the workplace. The three-year initiative, called "Action on Stigma", calls on employers to sign up to a set of anti-stigma principles, such as demonstrating that they have made changes in their work environment and employment practices to ensure that people with mental health problems are treated fairly and equally with others. Health Minister Rosie Winterton launched the initiative to mark World Mental Health Day with the publication of a document detailing the principles and highlighting existing best practice. Although some of the principles are voluntary, the government said that the adoption of them would help public sector organisations, including local councils, government departments and hospitals, meet the requirements of a new duty under the Disability Discrimination Act, which comes into force in December 2006. The government said that many employers who have taken part in projects to make their workplace culture more "mental health friendly" have reported reduced staff turnover and sickness absences. However, only around 20% of people with severe mental health problems are employed, compared to 65% of people with physical health problems and 75% of the whole adult population. Only around half of those suffering from more common types of mental illness, such as depression, are competitively employed. Speaking at a visit to a programme run by Oxleas Mental Health Trust in south east London, Ms Winterton said: "There is no better time than World Mental Health Day to remind people that one in four of us will suffer from a mental health problem at some point in our lives and the cost to business and society is substantial. Ignorance and stigma still surrounds the issue of mental ill-health and when someone does develop a problem, they often do not get the support they need from society to help them recover. "Employers can help by raising awareness of mental health issues amongst staff, supporting those affected and customers. This is good for staff and good for employers, who we know will benefit from reduced staff turnover and sickness absences." (KMcA)

Rethink: Fighting mental health stigma needs both "carrot and stick" approach Tuesday, 10 Oct 2006 08:02 Mental health charity Rethink is today (October 10) calling on the government to use both a ‘carrot and stick’ approach with employers to tackle mental health stigma, following the launch of a national initiative that will provide guidance, advice and support to employers. The Department of Health initiative Action on Stigma, launched today on World Mental Health Day, includes a network of nine regional employment support teams to help support organisations. Paul Corry, Rethink’s Director of Public Affairs, said: “Rethink welcomes this new support for employers to tackle mental health stigma in the workplace. However, government must match legal penalties for workplace discrimination with a powerful, sustained anti-discrimination campaign. “We welcome the focus on tackling stigma in the NHS, because people tell us the attitudes of NHS and social care staff can often be the main cause of stigma. In particular, we need long-term investment in a campaign to tackle the stigma that surrounds severe mental illness. That stigma must be tackled if the Welfare Reform Bill, which is currently going through parliament, is to bring positive changes for people with mental health problems. “Under this Bill, people with mental health problems on benefits will be penalised for not taking steps towards work. They are being asked to go through a locked door - Government must give them the key.” NOTES TO EDITORS: A briefing on mental health, employment and stigma follows below. It includes relevant statistics on suicide, which is the theme of this year’s World Mental Health Day. About Rethink severe mental illness: Rethink, the leading national mental health membership charity, works to help everyone affected by severe mental illness recover a better quality of life. We aim to provide hope and empowerment through effective services and support to all those who need us and campaign for change through greater awareness and understanding. For further information on Rethink’s work, visit: www.rethink.org or call 0845 456 0455. For more information or to request interviews, please contact: Liz Nightingale, Media Volunteers Manager: tel 020 7330 9112, mobile 07870 204583 or Alita Howe, Media Officer: tel 020 7330 9149, mobile 07918 660760 Media briefing: mental health, stigma and employment Research shows that less than 40% of employers would consider employing someone with a mental health problem. Not surprisingly, people with mental health problems have the highest levels of unemployment among any disabled group – yet also have the highest ‘want to work’ rate. Workplace perceptions of mental health Employers can be influenced by false and negative perceptions of mental health issues, which influence their attitude towards both existing and potential staff with mental health problems. Yet by providing a supportive work environment for all staff, not just those with mental health problems, employers can improve productivity and reduce costs. This also helps protect organisations’ reputations and resources from the impact of the cost of breaking the law under the Disability Discrimination Act (DDA). The DDA says there should not be discrimination in recruitment and that reasonable adjustments must be provided. The impact of stigma The government’s report of Mental Health and Social Exclusion, published by the Social Exclusion Unit in 2004, identified stigma and discrimination experienced by people with mental health problems as the biggest barrier to social inclusion, making it difficult for people to work, access health services, participate in their communities, and enjoy family life. 83 percent identified stigma as a key issue; 55 percent identified stigma as a barrier to employment; and 52 percent mentioned negative attitudes towards mental health in the community. Suicide and stigma: the theme of World Mental Health Day Around 5,000 people take their own life each year. There are a range of factors that increase the likelihood of someone taking their own life. These include having a mental health problem and social isolation, which can be linked to unemployment. A review published by the Department of Work and Pensions in September 2006 found that being in work is good for your mental health – while people who are unemployed can have higher suicide rates. Tackling stigma takes resources Changing attitudes and behaviours about mental health issues takes time and resources. Rethink’s own anti-stigma campaign in Norwich in March 2006 shows that measurable results can be achieved when resources are invested in this work. However, New Zealand spends 25 times per head what the UK Government spends on anti-stigma campaigns. Over the two campaigns, the number of people who willing to accept someone with mental illness as a workmate increased from 69% to 79%. We need a powerful, sustained anti-discrimination campaign, like the government funded anti-smoking campaigns, so that people’s understanding of mental health issues is based on facts, not stereotypes. For more information or to request interviews, please contact: Liz Nightingale, Media Volunteers Manager: tel 020 7330 9112, mobile 07870 204583 or Alita Howe, Media Officer: tel 020 7330 9149, mobile 07918 660760 -------------------------------------------------------------------------- Liz Nightingale Media Volunteers Manager Rethink Working together to help everyone affected by severe mental illness recover a better quality of life. Phone 0207 330 9112 Fax 0207 330 9102 Visit www.rethink.org 5th Floor, Royal London House 22-25 Finsbury Square London EC2A 1DX Registered in England Number 1227970. Registered charity no. 271028. Registered Office 28 Castle Street, Kingston upon Thames KT1 1SS. Rethink is the operating name of the National Schizophrenia Fellowship, a company limited by guarantee.

NHS mental health day care axed Almost £10m is to be cut from mental health services in Gloucestershire. NHS day care for mentally ill adults is to be scrapped and in-patient services will be centralised in Gloucester and Cheltenham to make the £9.6m savings. Unions have not ruled out strike action in protest against the announcement by Gloucestershire Partnership NHS Trust. The cuts to mental health provision are in addition to £40m of health savings proposed for a range of services across the county. Staff walked out During the discussion around 30 clinicians and staff walked out saying they had not been listened to. "The walkout was precipitated by a complete lack of consultation on what we feel is the whole issue about the closures that have gone on and just been rail-roaded through without sufficient consultation with staff, service users, carers and the general public," said Jim Stone, Ward Manager, Wotton Lawn Hospital. The NHS Trust will now look at a social enterprise scheme which could see some services kept in the community but with 500 jobs and 240 beds at risk that was not enough to prevent unions considering industrial action. "People are disappointed, very upset and angry and I believe there is a strong possibility there will be some form of industrial action in future," said Francis ORyan, Unison spokesman. Specialist teams The Chief Executive of the Trust said he justified the cuts by putting them into the context of having to save some £9.6m and balancing that with how to best offer care services. "The models of care we used to reshape the services are those that the government, through the Department of Health, commends being good ways of running mental health services," said Jeff James. He added, that by putting more people into specialist teams in the community, services can be offered to people where they want them 24 hours a day, seven days a week. A further round of consultation is now planned before the changes are implemented.

Mental health services "failing" People suffering mental health problems are being failed by poor access to key community services, a watchdog says. The Healthcare Commission review of 174 mental health teams in England found gaps in out-of-hours care, talking therapies and access to information. The watchdog rated one in 10 as excellent, with nearly half just getting a fair grade. Campaigners said the findings were concerning, and NHS bosses said there was room for improvement. The vast majority of people with mental health problems are treated out of hospital by community mental health specialists, including GPs, nurses, counsellors and social workers. " The majority of people who suffer from mental illness receive their treatment in their own community, not in hospital. " Anna Walker Healthcare Commission "The services were not there" The Healthcare Commission, which analysed performance data and patient surveys, found while the majority of local mental health teams had out-of-hours services in their plan, just 49\\% of people with problems had the phone number of someone they could contact after office hours. And 59\\% of the partnerships, known as local implementation teams (LITs), scored poorly when it came to providing access to crisis accommodation out-of-hours. The Healthcare Commission rated 9\\% of LITs as excellent, 45\\% as good, 43\\% as fair and 3\\% as weak. It also found a greater need for access to talking therapies - such as counselling, cognitive behavioural therapy or psychoanalysis. National guidelines say all people with schizophrenia or suspected schizophrenia should be offered appropriate talking therapies. The review found that only half of people questioned had such access and in 20\\% of LIT areas the figure was "significantly lower". Weak It also said the management of medicines for patients with schizophrenia needed to improve - with 84\\% of LITs deemed fair or weak. The watchdog said 89\\% of services had not adequately recorded side effects or how well patients had responded to drugs. Healthcare Commission chief executive Anna Walker said: "The majority of people who suffer from mental illness receive their treatment in their own community, not in hospital. "They want to remain in the community and this helps them get better. But for care in the community to work for the mentally ill, more access is needed to talking therapies and out-of-hours crisis care. "Mental health crises dont keep office hours and the service must be flexible enough to tackle this." Professor Louis Appleby, the national director of mental health, said there were about 1,700 more clinical psychologists, and nearly 1,000 more primary care therapists working in the NHS in recent years. "But in a way these new therapies - cognitive therapy is the main one - are a victim of their success. "There is growing research evidence that they can be used for a whole range of conditions, so of course the demand and the need is much greater, and its far outstripping what we can provide at the moment." Room for improvement Nigel Edwards, of the NHS Confederation, which represents health trusts, said: "Mental health has often been a Cinderella service in the NHS, yet one in four of us will experience a mental health problem every year. " It is disturbing that this strong indictment of out-of-hours community care should come at the very time that mental health budgets are being slashed" Majorie Wallace Sane "So it is reassuring that the review has praised local implementation teams for generally performing well. "Of course, there is always room for improvement and the report presents some serious challenges for mental health trusts and their partners in the services that they provide." Mental health charities have expressed their concern at the commissions findings. Paul Farmer, chief executive of Mind, said: "We are concerned about the large number of people who dont have access to basic treatments, like cognitive behavioural therapy, which is simply not available in many areas of the country." Sanes chief executive Marjorie Wallace said: "This report shows that the community care policy still fails thousands of mentally ill people and their families. "It is disturbing that this strong indictment of out-of-hours community care should come at the very time that mental health budgets are being slashed."

NHS Confederation: Room for improvement in mental health Friday, 29 Sep 2006 10:40 The NHS Confederation has praised health trusts for providing dedicated services to mentally ill people. A review by the Healthcare Commission today finds gaps in care provision, but notes that 77 per cent of mental health service users rated the service as good, very good or excellent. NHS Confederation policy director Nigel Edwards said this was "a tribute to the hard work and dedication of staff, who often work in extremely challenging circumstances". "Mental health has often been a Cinderella service in the NHS, yet one in four of us will experience a mental health problem at some point in our lives," he added. "So it is reassuring that the Healthcare Commission’s review of community adult mental health services has praised local implementation teams for generally performing well." However, he argued there was "always room for improvement", saying today’s review "presents some serious challenges for mental health trusts and their partners in the services that they provide".

Govt: Mental health care is improvin Friday, 29 Sep 2006 09:23 The provision of care for mentally ill people is improving, the Department of Health (DoH) has argued in response to a survey by the Healthcare Commission which finds gaps in the service. Health minister Rosie Winterton said: "More people than ever are getting the right support, at the right time, when they need it, without necessarily going into hospital." Insisting the current funding problems in the NHS are not "disproportionately" affecting mental health services, she admitted community teams had to make "tough financial decisions at the moment". Programmes launched earlier this year "to improve access to psychological therapies" could "provide real, tangible evidence of the effectiveness of investing in talking therapies", she said. Ms Winterton added: "Although we still face many challenges that we must overcome, I am pleased that the information published today shows that community services are generally performing well and that patient satisfaction remains high."

Healthcare Commission: We need more community care Healthcare Commission: We need more community care Friday, 29 Sep 2006 10:01 Community services for the one in six people suffering from mental health problems must improve nationwide, the Healthcare Commission has argued. Chief executive Anna Walker said: "The majority of people who suffer from mental illness receive their treatment in their own community, not in hospital. They want to remain in the community and this helps them get better." However, she stressed that if care in the community was to help mentally ill people recover, more access was needed to talking therapies and out-of-hours crisis care. "Mental health crises dont keep office hours and the service must be flexible enough to tackle this," she added. "This review shows us where in the country the strengths and weaknesses lie. We will be working with the weak performers to improve quality of their services and bring them in line with those who are excellent."

Mind: Basic treatments needed nationally Mind: Basic treatments needed nationally Friday, 29 Sep 2006 09:50 Talking therapies are needed all over the country, the charity Mind has said in the wake of research which finds many people with psychological problems are not getting adequate care. Despite national guidelines which advise that people with schizophrenia or suspected schizophrenia should be offered talking therapies, the Healthcare Commission review says only 50 per cent of people surveyed had access to these services. Paul Farmer, the chief executive of Mind, said: "Its encouraging that most people have a good experience of the community practitioners that they see. "But we are concerned about the large number of people who dont have access to basic treatments, like cognitive behavioural therapy (CBT), which is simply not available in many areas of the country." He urged the government to listen to its own advisers, who have recommended CBT as the first type of treatment for a range of mental health problems.

Rethink: New chief executive pledges to put mental health in the mainstream Rethink: New chief executive pledges to put mental health in the mainstream Wednesday, 27 Sep 2006 09:14 Mental health charity Rethink today (27th September) announced the appointment of Paul Jenkins as its new chief executive. Paul Jenkins is currently Director of Service Development at the NHS Direct Special Health Authority and will join the campaigning mental health membership charity on January 1st 2007. He takes up the post at a crucial period for the country’s largest voluntary sector provider of mental health services and for mental health more generally. Paul Jenkins said that he had four immediate aims: Ensuring continued government support for mental health as a key priority for investment and modernisation Intensifying Rethink’s campaign to raise awareness around mental health and combat the discrimination faced by people with severe mental illness Growing Rethink’s membership amongst people directly affected by mental illness and their carers Securing the charity’s future in a difficult and volatile market for voluntary sector service providers by forging new partnerships and expanding its areas of activities Paul Jenkins said: “Mental health stands at a crossroads. Behind us is a history of crisis and compulsion; long years when millions of people experienced the worst of mental health care – locked away, forgotten, abused. In front us, is a future that is now realisable – where people with mental health problems, however severe, can have real hope of recovering a full and meaningful life. “Close to a decade of major investment in mental health services, advances in our understanding of mental health problems and its successful treatment and an increasingly assertive attitude from ‘consumers’ of mental health services are combining to lay the foundations of a future where recovering a full and meaningful life from mental health problems is the norm rather than the exception. “I am determined that Rethink will play its full part, in partnership with the wider mental health world, in realising that future, and placing mental health in the mainstream of public concern and action.” Outgoing chief executive Cliff Prior said: “Paul is an outstanding choice and I wish him well in what is a hugely demanding but equally rewarding role.” Notes to editors To arrange interviews with Paul Jenkins or for further information, please contact Paul Corry, Director of Public Affairs on 020 7330 9110 / 07775 585178 or Alita Howe, Media Officer on 020 7330 9149 / 07918 660760. A high resolution image of Paul Jenkins is available on request. Rethink’s present chief executive Cliff Prior leaves the charity after nine years on October 18th to become chief executive of UnLtd – the foundation for social entrepreneurs. Rethink has over 8,000 individual members and operates over 350 services in England Northern Ireland. It employs 1,400 staff and works with over 5,000 people with severe mental illness each day. Its turnover in 2005-6 was £43 million. Paul Jenkins – biography Paul Jenkins has over 20 years experience of management and policy-making in central government and the National Health Service. Over the last eight years, he has been responsible for the establishment and development of NHS Direct, the ground breaking telephone and internet based health service. He is currently Director of Service Development for NHS Direct. In June 2002 he was awarded and OBE for his role in setting up NHS Direct. Paul’s previous experience includes leading national policy on long term and continuing care in the NHS. He has been involved in the implementation of a number of major change programmes including the Next Steps Programme, establishing Executive Agencies in Government and the 1993 Community Care reforms. Paul is 43, and is married with two children. His interests include archaeology, hill walking and following the fortunes of the Welsh rugby team. For more information contact: Paul Corry, Director of Public Affairs: tel 020 7330 9110, mobile 07775 585178 Alita Howe, Media Officer: tel 020 7330 9149, mobile 07918 660760 About Rethink severe mental illness Rethink, the leading national mental health membership charity, works to help everyone affected by severe mental illness recover a better quality of life. We aim to provide hope and empowerment through effective services and support to all those who need us and campaign for change through greater awareness and understanding. For further information on the charity and its work, visit: www.rethink.org or call 0845 456 0455

"Living will" proposals revealed Friday, 10 March 2006 Source: BBC News Details of plans to allow people to make a "living will" to determine their medical care in advance of incapacity have been unveiled by the government. Patients with conditions such as Alzheimer s will be able to give "lasting powers of attorney" to a family member or friend. That person would then be able to make decisions about treatment - including whether to withdraw it. Critics fear the plans are a step towards legalising euthanasia. And some doctors have expressed concerns that refusing to comply with the terms of a living will which stipulated that treatment should be withheld could see them criminalised. However, the British Medical Association said it was less concerned. A spokesperson said: "The BMA believes that it would be unlikely that a health professional, who conscientiously objects to fulfilling a patient s advance directive requiring the withdrawal of life-sustaining treatment, but makes a prompt referral to another doctor, would be liable for prosecution. "However, where a health professional deliberately attempted to frustrate the terms of a valid and applicable advance directive, he or she would be acting outside the law and the BMA could not support them." Consultation The draft Code of Practice for implementing the 2004 Mental Capacity Act will now be put out for consultation. Previously the law has only permitted financial matters to be delegated. Ministers say the aim of the legislation is to provide a "broad framework" to protect the two million adults in Britain who at some point become unable to make decisions for themselves due to disability or mental illness. Health Minister Rosie Winterton said: "The Mental Capacity Act is an important step towards empowering vulnerable people who lack mental capacity to make decisions for themselves. "The Code of Practice will ensure that best practice is followed and strict safeguards are in place to protect these most vulnerable people." The guide includes an explanation of what it means when a person lacks capacity to make a decision, and of how to make decisions that are in that person s best interests. It also spells out provisions and safeguards relating to advance decisions to refuse medical treatment in specified circumstances. In addition, it gives details of the duties and responsibilities of healthcare professionals involved in such treatment and the advice and support available to them. A spokesperson for Care Not Killing, an alliance representing 28 organisations promoting palliative care and opposed to euthanasia, said: "We look forward to working with the government and other stakeholders to ensure that the final codes of practice do not leave any loopholes to euthanasia by the back door. "It is essential that doctors are not put in a position where they are forced to abide by advance refusals that they believe are not in their patient s best interests, clinically inappropriate or suicidally motivated."

Dramatic warning about khat misuse Sunday, 5 March 2006 By Jane Elliott BBC News Online health reporter Mahamed Hussien regularly chews khat, a mild stimulant popular with the Somali and Yemeni population. He says the drug, legal in the UK, is an important part of the cultural life of his community, but he is also worried about the effect it is having on some people - particularly the young. Many in the health community want to see the drug banned because of links with mental health problems. It was recently reviewed by the Home Office, who decided against a ban. Mahamed does not want to see the drug banned but does think people should be warned of the dangers caused by excessive use. Now organisers of a play called Khat - Out of Sight, Out of Mind, to be performed at Oxford House in Bethnal Green, London, this month in both Somali and English, hope to educate users about the potential problems. Khat is a stimulant, producing a high when chewed. The main active ingredient is cathinone, which, when broken down in the body, produces chemicals which resemble both amphetamine and the "fight or flight" hormone adrenaline, which readies the body to take dramatic action in times of crisis. "Psychotic" Long-term use been linked to mental illness and heart problems. Dr Eleni Palazidou, a doctor specialising in mental health with a special interest in psychopharmacology, based at the Royal London Hospital, St Clements, east London, said the links with mental health problems were worrying experts. "It is associated with different psychological problems," she said. "When people are using they can become elated and be restless and energetic. They can not sleep and they do not feel like eating. "People can become psychotic and hear voices and become paranoid. "After using people can have the opposite effect they can become tired and depressed and there have been cases of suicides." Dr Palazidou said raising awareness of the problems without seeming to lecture people was vital and she hoped this was what the play s subtle message would do. Oxford House Somali art co-ordinator Ayan Mahamoud agreed. She hopes the play will attract khat users but also a much wider constituency. She told the BBC News website that the play focused on the life of a user, his family and friends. The user s children are so embarrassed by their father s repeated absences that they tell their school he is dead. The play then focuses on how the family reacts to this. Tax Ayan says she wants to see the drug banned, and says even a tax would restrict use. "If you raise a tax on it the use will not be that widespread because people cannot afford it," she said. "Alcohol and cigarettes are expensive because they are harmful so why is the government not taking the same measure with khat?" Mr Hussien would also like to see a tax levied on the popular leaf, which currently costs just £3 a day to fund a habit. "I have not had any health problems myself, I do not use it everyday, but it is really a big problem if you abuse it. "Some people can control their use, I do not use every day. But others, mainly the teenagers, do use it too much. If they put a tax on khat that would help because it would become too expensive. "It could be controlled and not banned because it is an important part of our social life."

"Diet change cured me of depression" Monday, 16 January 2006 Campaigners are claiming diets can play a key role in mental health problems. One man speaks about how he feels cutting out certain foods made a world of difference to his life. Brian Godfrey suffered from chronic depression for about 40 years. He first started having trouble when he was a teenager and over the years tried everything from drugs to psychotherapy. By the 1960s the situation had got so bad that he was thinking about suicide. "It was terrible, I would wake up in the morning with a fuzzy head and just could not get going. I felt tired and depressed. "Some days it would be so bad I would lay in bed crying." Mr Godfrey said it was only when it became clear the advice doctors were giving him was not going to work that he decided to look for something else "I went to the library and found a book about food intolerance." The 71-year-old then cut out wheat and dairy and within three weeks was feeling better. "It was a miracle. I just woke up one morning and my problems had gone." In time, Mr Godfrey, from London, also stopped eating grains, eggs, chocolate, coffee, tea and his favourite drink, Guinness. "I used to love to have a drink of Guinness after a meal, but that had to go. It was hard. "I am very careful what I eat now, especially when I go out for a meal. My main diet is meat, fish, vegetable and fruit and I only eat organic food." And Mr Godfrey, who is now completely free of the severe depression which plagued him during the first half of his life, said other people should consider altering their diets if they are having problems. "It is becoming clear food is linked to mental illness. I would say that the things you most like are what most cause you harm. It is worth trying to cut them out." Source: BBC News

Mental health link to diet change Monday, 16 January 2006 Changes to diets over the last 50 years may be playing a key role in the rise of mental illness, a study says Food campaigners Sustain and the Mental Health Foundation say the way food is now produced has altered the balance of key nutrients people consume. The period has also seen the UK population eating less fresh food and more saturated fats and sugars. They say this is leading to depression and memory problems, but food experts say the research is not conclusive. Dr Andrew McCulloch, chief executive of the Mental Health Foundation, said: "We are well aware of the effect of diet upon our physical health. "But we are only just beginning to understand how the brain as an organ is influenced by the nutrients it derives from the foods we eat and how diets have an impact on our mental health." And he added that addressing mental health problems with changes in diet was showing better results in some cases than using drugs or counselling. The report, Feeding Minds, pointed out the delicate balance of minerals, vitamins and essential fats consumed had changed in the past five decades. Researchers said the proliferation of industrialised farming had introduced pesticides and altered the body fat composition of animals due to the diet they are now fed. For example, the report said chickens reach their slaughter weight twice as fast as they did 30 years ago, increasing the fat content from 2% to 22%. The diet has also altered the balance of vital fatty acids omega-3 and omega-6 in chickens which the brain needs to ensure it functions properly. Fats In contrast, saturated fats, consumption of which has been increasing with the boom in ready meals, act to slow down the brain working process. The report said people were eating 34% less vegetables and two-thirds less fish, the main source of omega3 fatty acids, than they were 50 years ago. Such changes, the study said, could be linked to depression, schizophrenia, attention deficit hyperactivity disorder (ADHD) and Alzheimer disease. The two groups urged people to adopt healthier diets, with more fresh vegetables, fruit and fish, and called on the government to raise awareness about the issue. Report researcher Courtney Van de Weyer said: "The good news is that the diet for a healthy mind is the same as the diet for a healthy body. "The bad news is that, unless there is a radical overhaul of food and farming policies there will not be healthy and nutritious foods available in the future for people to eat." Rebecca Foster, a nutrition scientist at the British Nutrition Foundation, said: "The evidence associating mental health and nutrient intake is in its infancy, this is a very difficult association to research and in many cases results are subjective. "Therefore, it is difficult to draw conclusions about the association between mental illness and dietary intake at this point. "However, the nutrient recommendations outlined in this report are in line with recommendations for good health, which should continue to be advocated by all health professionals." Source: BBC News

Mental health services criticised Published: 11 January 2006 A mental health charity has called for drastic improvements to mental health services in England and Wales after the publication of a damning report into the sector. The report by the Mental Health Act Commission found inpatient mental health services had severe pressure on bedspace, poor levels of security and high numbers of staff leaving. It also found high levels of abuse and a lack of basic humane treatment for patients. The report, based on visits to detained psychiatric patients in all hospitals in England and Wales between 2003 and 2005, also criticised the judicial system for criminalising people with mental health problems rather than offering them the appropriate care. Chris Heginbotham, Chief Executive of the MHAC, said the report highlighted serious concerns about mental healthcare in England and Wales. He said: "Mental Health Act Commissioners find serious abuses of the rights of patients every week - which in 2006 is simply inexcusable. "We are especially worried about complacent and often lax use of the Mental Health Act, some provider attitudes demonstrate a lack of understanding of the significance of depriving a person of their liberty. "We are particularly concerned about the way the criminal justice system works to the detriment of mentally disordered people and call on the government to review the Home Office role in decisions about mentally disordered offenders." Sophie Corlett, Mind Director of Policy called for immediate improvements into the mental healthcare estate. She said: "How many more reports do we need before urgent action is taken to address the continuing appalling state of mental health wards? "Lack of beds, lack of staff, disgusting conditions, abuse of patients, use of coercion - this is what people are compelled to endure, no wonder that patients fear mental health services. "Yet the Government still proposes a draft Mental Health Bill that threatens coercive treatment for far too many, serving only to drive people further away from the help they may so desperately need." Source: www.insidepublic.co.uk

Mental health staff bullying cut Wednesday, 11 January 2006 A report says bullying and harassment at a Devon mental healthcare Trust is in decline. Bullying claims among Devon Partnership Trust staff had reduced from nearly one third in 2003 to 10\% in 2005, the Healthcare Commission (HC) said. Changes at the Trust include a hotline for staff to raise issues directly with the chief executive. The Trust said it was "simply unacceptable" that such a high proportion of staff had felt bullied. "Feel valued" Chief Executive, Iain Tulley, said: "We have more than 2,500 staff - most of whom do a difficult job in stressful and frequently challenging environments. "We are striving to develop a more open and supportive organisation where people can have confidence about speaking up if they feel they have been treated inappropriately and one where showing respect for fellow workers is a fundamental part of the way we all behave." Marcia Fry, head of operational development at the HC, said: "We are pleased to see that the chief executive is leading the way and implementing this ethos throughout the organisation. "It is crucial that staff are made to feel valued and supported and that any allegations of improper behaviour are dealt with quickly and consistently by the trust." Source: BBC News

Mental skills "worse after sleep" Wednesday, 11 January 2006 A person thinking ability may be better after being awake for 24 hours or being drunk than it is following a good night sleep, a study suggests A University of Colorado team found understanding and short-term memory were worse in the minutes after waking. Their finding has implications for workers such as doctors on night-duty, who are awoken and immediately asked to perform important tasks. The study appears in the Journal of the American Medical Association. After the study participants had had six nights of monitored sleep lasting eight hours per night, they were given a performance test that involved adding randomly generated, two-digit numbers. Based on the results of this test, the researchers concluded the subjects exhibited the most severe impairments to their short-term memory, counting skills and cognitive abilities from sleep inertia within the first three minutes after awakening. The most severe effects of sleep inertia generally dissipated within the first 10 minutes, although its effects were often detectable for up to two hours, they added. "At risk" None of the nine study participants had any medical, psychiatric or sleep disorders and were not using alcohol, nicotine, recreational drugs or caffeine. They had also spent several hours each day practising the maths test used to quantify sleep inertia. The study follows other research which has looked at the effects of going without sleep for over 24 hours - and found that has the same effect as being drunk. Professor Kenneth Wright, who led the study, said: "This is the first time anyone has quantified the effects of sleep inertia. "We found the cognitive skills of test subjects were worse upon awakening than after extended sleep deprivation. "For a short period, at least, the effects of sleep inertia may be as bad as or worse than being legally drunk." He said the explanation could be that certain areas of the brain take longer to "wake up". Other research has found the prefrontal cortex - responsible for problem solving, emotion and complex thought - is one of those areas which takes longer to come "on-line" following sleep. Professor Wright said doctors on night shifts, who may get awoken to treat an emergency, or ambulance workers and firefighters who may have to get up and drive to the scene of an incident, could be putting themselves - or others - at risk. He said the study also illuminates the challenges faced by everyday people who are forced to make crucial decisions following abrupt awakening. "If a person is awakened suddenly by a fire alarm, for example, motivation alone may be insufficient to overcome the effects of sleep inertia." He said further research was needed to measure the effects of nap interruption and "recovery sleep" in on-call, sleep-deprived people. "Waking time important" Dr Neil Stanley, of the British Sleep Society, said: "There are a lot of people, like junior doctors, where it is not the number of hours they work that matters, it is when they sleep and how they feel when they wake up. "Nobody should be doing anything really important for 15 to 30 minutes after they wake up." He said people could perform less well than when they had been awake for a long time. "If you are asleep, it is a much bigger transition to go from that to being awake than to stay awake, even for a long time, because then you will be aware you are drowsy." Source: BBC News

Psychiatric care "fails patients" Wednesday, 11 January 2006 Psychiatric wards are unable to provide patients with acceptable levels of security or care, a report warns. The Mental Health Act Commission said there was intense pressure on beds, understaffing and a lack of basic humane treatment. The report was based on visits to detained psychiatric patients in all hospitals in England and Wales between 2003 and 2005. It calls for the government to improve psychiatric inpatient services. The MHAC, which monitors the implementation of the Mental Health Act as it relates to patients detained or liable to be detained, said too many patients are fearful of mental health services. Too many people are also fearful of those with mental health problems, it said. The report found over half of all wards are full or have more patients than beds, with staffing shortages and unpleasant ward environments undermining the therapeutic purpose of in-patient admission. It warned the extension of patient "choice" across health service provision may disadvantage patients unable to exercise choice because of their mental incapacity or because of legal powers of compulsion held over their treatment. The report also said the criminal justice system works to the detriment of people with mental health problems, often treating them as criminals, rather than seeking to offer them appropriate care. It called on the government to review the role of the Home Office in decisions about mentally disordered offenders. Inexcusable problems Chris Heginbotham, MHAC chief executive, said: "Mental Health Act Commissioners find serious abuses of the rights of patients every week - which in 2006 is simply inexcusable. "We are especially worried about complacent and often lax use of the Mental Health Act; some provider attitudes demonstrate a lack of understanding of the significance of depriving a person of their liberty." Professor Kamlesh Patel, MHAC chairman, said: "The NHS should provide reassurance to everybody that they will receive appropriate and dignified care if they fall ill. "But it is in this respect more than any other that mental health services are failing to match the standards of the rest of the NHS." Marjorie Wallace, chief executive of the mental health charity Sane, said: "This report paints a damning picture of psychiatric wards, revealing that some are unable to provide patients with acceptable levels of security or care. "It highlights intense pressures on beds, understaffing, and lack of basic, humane treatment; staff and resources have been siphoned off to the more fashionable community services. "In our own experience, many units are places of squalor and degradation. "There has been an alarming increase in illicit drug taking and violence on wards, leading to an atmosphere of fear where both staff and patients can feel under threat." The report is the second in month to outline problems in NHS psychiatric units. A collective of leading health and social care groups called for radical changes tube made to mental health services in England over the next decade. A Department of Health spokesperson said the reports recommendations would be studied in detail, but stressed the government had already earmarked new funds to improve services. "Improving and updating inpatient care for the small number of people who suffer from acute mental problems is a major priority for the Department of Health. "We have put in place a comprehensive action plan to stamp out inequalities and discrimination in mental health services." Source: BBC News

Cannabis move expected next week Thursday, 5 January 2006 A decision on whether to reclassify cannabis as a more serious drug will be taken in the next few days, Home Secretary Charles Clarke has said. He told BBC Radio 4s Today programme he was "worried" about new studies linking it with mental health problems. Cannabis was downgraded from class B to class C two years ago, but Mr Clarke ordered a review of that last year and said the move had confused the public. Experts and charities are divided over the drug possible reclassification. Dame Ruth Runciman, who chaired the initial inquiry that recommended downgrading cannabis, said reclassification would confuse the public even more. "I think it is very ill-judged thing to do and that it actually puts cannabis where it does not belong in the scale of relative harm," she said. But John Henry, a clinical toxicologist at St Mary Hospital in London, told BBC News there was a "strong link" between cannabis and schizophrenia. "It is probably about four times commoner in people who smoke cannabis regularly," he said. The drug was downgraded under Mr Clarke predecessor, David Blunkett. The maximum penalty for dealing in a class B drug is 14 years in jail, while class C dealing carries a maximum of five years. It was hoped downgrading cannabis would allow the police to focus on tackling harder drugs like heroin and crack. "Since that decision, further medical evidence has been developed about the implications of consumption of cannabis on mental health, which is serious," Mr Clarke told Today. "Concerning" Last March he asked the advisory group to consider the issue again in the light of the latest research. Its report has been presented to the home secretary but not yet made public. "The fact is we still do not know a lot about that relationship [with mental health], as the advisory committee report makes clear, but what we do know is concerning," Mr Clarke said. He told the Times newspaper the committee had strongly recommended a "renewed commitment to public education" about the potential effects of the drug. He said the downgrading had led to public confusion and promised action to alert people to its dangers. Motivation Shadow home secretary David Davis said he welcomed the recognition that "there is new evidence about the dangers of cannabis, particularly with regard to mental health". Liberal Democrat home affairs spokesman Mark Oaten said the government should not base drug policy on "tabloid pressure". "The case for treating drugs in different categories remains very strong and unless the advisory body make a strong argument to change this, the government should resist reclassification." On Wednesday, health charity Rethink urged Mr Clarke to look at the mental health risks of cannabis rather than "fiddle with its legal status". It called on him in a letter to devote resources to reducing the risks of the drug. Source: BBC News

Mental health overhaul demanded Tuesday, 3 January 2006 Radical changes should be made to mental health services in England over the next decade, leading health and social care groups have said. A report published by the Sainsbury Centre for Mental Health says children should be taught about mental health as part of the school curriculum by 2015. It urges a shift in focus from mental ill health to mental well-being, with services better geared to users needs. The government says improvements have been made already and more will follow. The report, which the Sainsbury Centre for Mental Health produced with the Local Government Association (LGA), the NHS Confederation and the Association of Directors of Social Services, said that, over the next decade, mental health should become everybodys business. The key will be to reshape services to ensure that they are primarily geared towards meeting the needs of the people who use them, it said. The report calls for people with severe mental health conditions to have their own budgets for the services they want, including alternatives to hospital. Talking therapies, said the report, should be available as a matter of routine when people need them, along with advice on staying in work and maintaining an ordinary life. People with mental health problems should also be offered an "associate" to help them manage their lives. Big difference It said that well planned and properly resourced public services can make a huge difference to the mental well-being of the whole population and, in particular, to the lives of those who have mental health problems. Sainsbury Centre for Mental Health chief executive Angela Greatley said: "We want public services to make a resolution to work towards this vision of what life could be like 10 years from now. "By investing in good mental health, and offering people who experience mental distress a better service, the £77bn annual cost to society can be reduced and some of our nations starkest inequalities can be redressed." That cost includes health services, lost work days and quality of life. LGA mental health spokesperson David Rogers said up to one in four people would suffer from mental health problems at some point. "It is vital that we challenge the stigma surrounding this issue and create a climate which encourages tolerance, understanding and timely treatment. "This report sets out a challenging but achievable vision of how the overall well-being of our communities can be improved by the health sector and local government working together." Jane Austin, of NHS Confederation, which represents more than 90\% of NHS organisations, said the report set out how health, social care and voluntary organisations could work in partnership to deliver top quality mental health services. "It is only by adopting this kind of holistic approach that all those involved in improving the mental well-being of the whole population will be able to achieve that goal." Government progress National Director for Mental Health Professor Louis Appleby said the National Service Framework for Mental Health had led to big changes over the last five years. "We have seen record increases in investment and staffing, we now have over 700 specialised community mental health teams and we have the lowest suicide rate since records began," she said. "Whilst there is still more work to do, in recent years mental health services have become increasingly responsive to the needs and wishes of the people who use them. "As we enter the second stage of implementing the framework, we face the ambitious task of ensuring the mental well-being of society as a whole." But Marjorie Wallace, chief executive of the mental health charity Sane, said: "While everyone will subscribe to ways of making it easier and pleasanter to obtain treatment, this is a well-rehearsed wish list prescribing a cloud-cuckoo land. "This is likely to remain a utopia because, as the paper itself acknowledges, it is uncertain who will pay or whether it could ever be affordable. Source: BBC News

Mental health rethink Wednesday November 2, 2005 It is welcome news that the government may be rethinking its draft mental health bill, given long-standing concerns about both its content and the lack of resources to implement it properly (Report, October 31). The draft bill, though flawed, contains the seeds of positive legislation. It would be far better for the government to continue to discuss the draft with mental health professionals, service providers and service users than try to force an unworkable piece of legislation through parliament. The Kings Fund is concerned that more time is needed to discuss the proposed conditions for compulsion, to ensure people are not inappropriately placed under compulsion, either in hospital or the community. Our recent report on community-based treatment orders concluded that the Department of Health has underestimated how many people will be placed on these orders and miscalculated the resources that will be needed to support effective community treatment. Simon Lawton-Smith Senior policy adviser, Kings Fund Source: Guardian Unlimited

Getting back into the workplace Thursday November 3, 2005 Polly Toynbee is right to highlight the terrible consequences to the millions on incapacity benefit that result from the exclusion of incapacity in Labours active labour market approach to welfare (A chance to rescue others from lifes dead-end sidings, November 1). This leads to a paradox that two-fifths of IB claimants say they want to work now, yet only 3\% are taking steps towards finding a job. In this context, there is much to be said for compulsory engagement of all IB claimants with the Pathways programme. There is, however, something crucial missing from this debate. Many IB claimants face multiple labour market disadvantages; half have no formal qualifications. The New Deal programmes recognise that, for employers, taking on such workers represents a risk - and they compensate them accordingly. IB reform will be incomplete if the same employer incentives are not extended to its claimants. Meanwhile, the Access to Work scheme, which pays for workplace adjustments when they are necessary to the employment of ill and disabled people and would be unaffordable otherwise, should be expanded based on need, instead of being arbitrarily capped as at present. Any talk of tough action on IB claimants will be irrelevant if those individuals continue to be at disadvantage in the labour market. Ann Rossiter Director, Social Market Foundation Polly Toynbee is right that encouraging people back to work from IB rather than threatening to cut their already meagre incomes is the way forward. But unless you have been forced through the system as a claimant you will never really understand it. The £20-a-week therapeutic earnings rule is complex and demeaning and until I can earn at least £5,000 a year I am trapped. Even then I will not get the working tax credit for the disabled, as this requires you to work at least 16 hours a week. No doubt, given that in this field government thinking is riddled with stereotypes, they can not get their head round the idea that some of us have specialist skills that might earn rather more than the minimum wage an hour. In case you think I am joking, job packs for NHS quangos (which pay under £4,000 a year) state: "If you are disabled and in receipt of benefits you need to be aware that under current regulations a paid public appointment may affect your entitlement." Name and address supplied Polly Toynbee is right to pinpoint the value of the governments Pathways to Work scheme - £167m a year would see Pathways cover one-third of the country. On past success, which has seen the pilot schemes get at least 13,000 claimants back to work, the government would save £50m from the benefits bill for every year these claimants remained in work. Balance this with the £12bn bill to maintain people on incapacity-related benefits, the lost productivity, costs to the health service and the damage wreaked by poverty in our society, then the Pathways scheme looks more like a classic spend-to-save option rather than a luxury item. Bert Massie Chairman, Disability Rights Commission Polly Toynbees defence of proposals to reform IB is timely. The delayed publication of a green paper on the issue points to the tensions in this policy - are people "malingerers" imprisoned by daytime TV, or facing huge hurdles, many of them put in place by this and previous governments? If the former, the kind of "dramatic" cut in benefits suggested by the prime minister might suffice; if the latter the policy will simply condemn people to further poverty. Toynbee notes that 40\% of present claimants are people with mental health problems - she might have added that these people have the highest "want to work" rate of any disability group, but the lowest "at work" rate, or that employers say they would at least consider making the necessary adjustments to support a person with a physical disability to take up a job, but not someone with a mental health problem. People want to work but a combination of inflexible benefits and employer discrimination puts significant barriers in the way. It is these obstacles the government should be addressing, not the tyranny of daytime TV. Paul Corry Rethink Severe Mental Illness Source: Guardian Unlimited

Suicide prevention scheme receives £250,000 boost Scottish ministers announce an extra £250,000 to prevent suicide in the Highlands, yesterday, as part of a national scheme that will see football fans, children and medical professionals join together to raise awareness of the problem. Lewis Macdonald, the deputy health minister, announced the funding at the start of International Suicide Prevention Awareness Week. More than two people in Scotland commit suicide every day, with numbers for young men being particularly high in the Highlands. However, through providing training for workers in the community - from nurses to dinner ladies - publicising helplines and distributing 10,000 "suicide prevention cards" at football matches, it is hoped the problem can be eased. About £200,000 will go towards suicide prevention work in the Highlands, while £50,000 will be given to the Breathing Space helpline to increase its work in the area. Mr Macdonald said the Choose Life strategy, launched in 2002, will get £8.4 million for the next two years, bringing total funding to £20 million. "What we are doing is making investments in order to give people who feel there is no way out a bit of confidence that there are things they can do and services they can access to help them," he said. Source: Scotsman, 06/09/2005

Tsunami survivors in Thailand suffering from mental disorders, risk suicide Nine months after deadly tsunami waves hammered sections of Thailands coastline, hundreds of survivors are still suffering from mental disorders, with dozens at risk of committing suicide and some addicted to drugs, an official said Tuesday. Nearly 12,000 people have visited a mobile mental health clinic set up shortly after the disaster by the Health Ministry in southern Phang Nga provinces Khao Lak village _ the area worst hit by the tsunami, said Health Minister Suchai Charoenratanakul. More than 9,000 of the patients have come from Phang Nga, but others have flocked from the five neighboring provinces also battered by the Dec. 26 waves, he said. "Thousands of patients have undergone rehabilitation and have been cured, but 326 are still suffering severe mental disorders, including 9 percent who are at risk of committing suicide," Suchai said. About 64 of those with severe mental disorders were suffering from hallucinations and nearly 20 of the worst cases have become addicted to narcotic drugs, he said. Suchai made the comments while visiting Phang Nga, where Prime Minister Thaksin Shinawatras Cabinet was holding a special meeting in a bid to restore confidence and encourage visitors to return to the area as the high season for tourism swings into gear next month. Nearly 80 percent of the 5,400 tsunami victims in Thailand perished in Phang Nga. Source: Associated Press, 06/09/2005

Madness of labelling mental illness Scientific advances such as scanners that see into the brain and powerful mind-altering drugs make it tempting to give a diagnosis to things society terms "mental illnesses". But we should resist from using psychiatric labels because there is no clear division between madness and sanity, experts argue. To label someone as schizophrenic, for example, falsely groups people with a wide range of problems together. Followers of psychiatric phenomenology - the study of lived experience in mental illness - say it is time to take a step back. At the turn of the 20th Century, doctors relied as much on what a patient said they were experiencing as they did on piecemeal symptoms to work out what course of action, if any, to take. But now science has outstripped this, meaning doctors look to books containing check lists of symptoms to decide how to classify and treat a given individuals "disorder". Professor Paul Mullen, professor of forensic psychiatry at Monash University, Australia, said: "At some time towards the end of the 19th Century and the beginning of the 20th Century there was a real effort to make sense of the whole domain of madness. "They tried to separate it out into what was meant to be temporary categories so that they would allow more precise development of scientific investigations and treatments. "What has happened in the last 100 years is these concepts became verified and they were turned into themes with operational definitions." So you have a menu that tells you what schizophrenia is, for example. But this does not take account of subtleties and variation from patient to patient, he said. "It has none of the recognition that schizophrenia is not a disorder but a wide range of conditions having a variety of different contributions." Hinckley is wrestled to the ground after firing shots at the president He said going by the rule book was madness and often leads to confusion and problems, including misdiagnosis and incorrect treatment. Professor Mullen said a famous example of confusion was the case of John Hinckley, the man who shot the then US President Ronald Reagan in 1981. When he was tried in court, psychiatrists ran into problems when trying to categorise Mr Hinckleys motivation. It transpired that Mr Hinckley was obsessed with actress Jodie Foster. He believed he could win Miss Fosters attention, and ultimately her affection, by shooting Mr Reagan and hence becoming famous himself. Although Mr Hinckley was found not guilty of attempted murder by reason of insanity, psychiatrists were unable to categorise him as having "erotomania" - a delusional, romantic preoccupation with a stranger, often a public figure - because he did not meet one of the strict diagnostic requirements. He did not believe Ms Foster was deeply in love with him. Professor Richard Bentall, professor in experimental clinical psychology at the University of Manchester, agrees. He said: "The idea that there is a clear division between "mad" and "sane" people, and that distinct psychiatric categories like "schizophrenic" actually exist, is resulting in the mass-application of treatments which, while benefiting some, are very harmful to others. "And because psychiatric patients are seen as having a biological brain illness which affects their rationality, they are not usually allowed a say in the matter." He said that identifying and addressing the problems the sufferer, rather than the psychiatrist, perceives creates an understanding of each persons condition which is far more scientific, humane and effective than a blanket diagnosis. "It also allows us to identify people at risk of psychological breakdown earlier, and keep them out of the traditional cycle of diagnosis and treatment." Even proponents of phenomenology say there is a line to be drawn with this approach. A dilemma arises when the individual has no insight into their psychiatric disturbance and does not think that what they are experiencing or their behaviour is a problem, but others do. A big issue is how to deal with people who are violent. For example, a persons behaviour may threaten their own safety or that of others. On the one hand the individual does not want or think he or she needs treatment. On the other hand their loved ones or society in general thinks or insists that they do need and have to have help. Professor Bill Fulford, professor of philosophy and mental health at the University of Warwick and a consultant psychiatrist in Oxford, said sometimes intervention against a persons wishes may be necessary. Experts will continue the debate surrounding psychiatric phenomenology at the Institute of Psychiatry, London on September 5 and 6, 2005. Source: BBC News Online, 02/09/2005

Next Steps for Mental Health Bill National Institute for Mental Health in England 14 July, 2005 The Government has outlined the next steps for reform of mental health legislation building on the extra investment and work already being undertaken to modernise mental health services. The Mental Health Bill – the biggest reform of mental health legislation since the 1950s – provides improved safeguards for patients and a better legal framework for the treatment of the small minority of people with mental health problems who need to be treated against their will. Formally responding to the report from the Pre-Legislative Scrutiny Committee, Health Minister Rosie Winterton and Home Office Minister Fiona Mactaggart said the Government had accepted in full or in part well over half of the Committees 107 recommendations. They reaffirmed the Governments commitment to ensuring that the Bill provides the right framework to provide treatment to protect people with a mental disorder from harming themselves and others. Among the recommendations the Government has accepted are: The guiding principles will appear on the face of the Bill. This means that those principles will be relevant to all aspects of the Bill provisions. They will help raise awareness and reduce stigma. An exclusion for substance dependency. This tightens the conditions for compulsion, meaning that clinicians will not be able compulsorily to treat people whose sole mental disorder is dependency on drugs or alcohol. Improvements in patient rights, for example, in relation to advance decisions and statements, Tribunal involvement in psychosurgery, patients rights to decide whether advocates can see their records and patients meeting with advocates in private. Improved rights for victims of mentally disordered offenders. More consideration must be given to victims evidence statements when a court or tribunal is considering how to deal with mentally disordered offenders. Rosie Winterton said: "The Bill is designed to provide the right treatment for the right people at the right time. "The Bill sits within the context of the Governments wider programme of reform and developments in mental health services and additional funding, which aims to achieve modern services which help people with a mental disorder early enough so that fewer people reach crisis level. "I thank the Committee for their detailed report, which we have studied carefully. I welcome the Committees support of a number of key features in the draft Bill, in particular the plan to allow compulsion in the community and the introduction of new safeguards for patients such as advocacy services and safeguards for children who are not being treated under compulsion because of their parents consent. "We have accepted in full or in part well over half of their recommendations and I am confident that we have a robust and workable piece of legislation. "Although the majority of mental health patients pose no danger to themselves or others, the Government has a duty to protect people with serious mental health problems from harming themselves or other people. The Bill introduces a number of new safeguards for patients rights and we are confident that the Bills provisions will mean that compulsory treatment will be used only when essential. Compulsion will only be used as a last resort. "For the first time, the legislation will allow people being treated under compulsory powers to be in the community, where there is less of a risk of social exclusion. It also provides a diversion from prison for offenders with mental health problems." Fiona Mactaggart said: "We are determined that the legislation should work to prevent harm. The way to do that is to ensure that people who need treatment can receive it when they need it. That is before they reach crisis and harm themselves or others. "We are determined too that, where people have offended, they should not be excluded from specialist treatment, even where they have been convicted for a serious offence. "Finally, we want practitioners to be able to exchange information needed to prevent tragedies. Building on the Domestic Violence, Crime & Victims Act 2004, we aim to reassure victims of serious offending that their concerns will inform decisions on managing the risk posed by mentally disordered offenders." National Director for Mental Health, Louis Appleby, said: "Since 1999, when the Government published the National Service Framework on Mental Health, the aim has been to develop care from a Cinderella service to one which is first-class. "The Bill goes hand-in-hand with those service improvements. One of its fundamental aims is to help make community care work for the people who need it most. Patients in the community who are ill and vulnerable or at risk will now be able to get the treatment they need." Measures to date to improve mental health include: the National Service Framework on Mental Health published in 1999, which set out for the first time a comprehensive strategy for mental health promotion, assessment, treatment, rehabilitation and care; Investment in mental health services increased by £728 million (19 per cent in real terms) between 1999/2000 and 2002/2003, and targets for numbers of home treatment teams – meaning more treatment in the community – have been exceeded, with 343 such teams now operational.

Would you Adam and Eve it? Telegraph 12/07/2005 Men and women act differently because their brains are built differently, says Chloe Rhodes The physical differences between men and women have long been understood, and can be traced directly to our primeval roles as hunters and child-bearers. But until recently, the many behavioural differences between have perplexed us. So what is it that makes women want to chat about the events of their day while men would rather reflect on theirs in silence? Why do men generally gravitate to computer and sports magazines while women prefer gossip and relationship glossies? And why do men and women often seem to want such different things from their relationships with each other? A new BBC television series, The Science of the Sexes, suggests that the answers may lie in the fundamental differences in our brains - a view backed up by research published last week. Scientists at Bath University have found that men and women feel pain in different ways, with men focusing on how to get through it as quickly as possible, and women becoming so consumed with their emotional response to an injury that they may feel it more intensely. In dealing with the psychological pain of divorce, the sex-divide is just as pronounced, though women are the ones most able to cope. A separate study, for the Yorkshire Building Society, revealed that women were better than men at dealing with all the stages of a break-up, 61 per cent saying that, in the first two years after a divorce, they were happier than before the relationship ended. Only 51 per cent of men felt the same way. Clinical psychologist Dr Frank Tallis, who appears in the BBC series, says that these findings can be explained by significant differences in the brain. "In evolutionary terms, women are designed to be sociable because they were the ones socialising the children," he says. "They have communication skills that men do not have, which allow them talk through their feelings and be comforted by their friends and family. Men are less able to make use of friendship networks and will try to minimise their emotional distress rather than trying to work through it." These natural advantages were found to have played an important role for the women questioned in the Yorkshire study. In the first couple of years after their divorce, they socialised more with friends, spent time with their families and received counselling or therapy. Men were more likely to seek casual sex, drink more and join a dating agency. "You see these techniques a lot in a clinical setting," says Dr Tallis. "After a relationship breakdown, men tend to pursue sex as a solution, seeking a new sexual relationship to restore their self-esteem rather than taking time to reflect on why their marriage has broken down." Similar characteristics determine mens behaviour at the start of relationships, too. Contrary to popular belief, they are far more likely than women to fall head over heels in love, because they are more likely to follow their instinct to pursue a woman they find attractive. "The reason some men end up with “trophy” wives is that they have not been able to see beyond their immediate physical attraction," says Dr Tallis. "Women are much less likely to fall in love in this irrational way because they are programmed by evolution to look for a partner who will look after them and their children financially and emotionally; they will be looking for kindness and generosity as well as physical attractiveness." There is even a scientific explanation for stereotypical male/female behaviour. If you have ever spent an afternoon chatting on the phone while your other half watches sport, you are displaying the classic behavioural patterns of your sex. Experts say the male brain is wired to be systematic and analytical, appreciative of order and detail, while female brains are better tuned in to emotions. But Dr Tallis points out that there are also social pressures that cause us to behave along gender lines. "Men are encouraged to switch off emotionally. This would have been useful for early man, in combat for example, but it is not very useful for forming relationships. Women, on the other hand, are expected to be gentle and nurturing, which makes it easier for them to build bonds with other people, but leaves them needing more verbal reassurance than men." All of this is, of course, a dramatic simplification of the complex workings of the mind. Confusing things still further is the fact that not all women have what scientists now call a "female brain" and not all men have a male one. Some people have "balanced" brains, which have an equal measure of male and female characteristics, and some even have brain types opposite to their gender. There have also been links between the extreme male brain and autism, in which the systemising power of the brain often dominates at the expense of social ability. Understanding the brain in this way is of great benefit to scientists, but even a simplified grasp of the basics may lead us all to a clearer appreciation of why we act in the way that we do - and why we often find our partners so infuriating. Dr Tallis says the differences are just as apparent in healthy relationships as in failing ones, and that they should be embraced and understood. "They are obviously big generalisations, but if something is generally true, it can help to prevent it from seeming personal. If an issue arises in a relationship the man may go quiet, but this does not mean he is being moody or is angry – it is just that his brain works better at trying to solve the problem internally. Likewise, if the woman insists on talking, she is not just nagging for the sake of it: her instinct is telling her to communicate, and to talk about how she feels. If we consider these differences before making demands of each other, we might find that our different brains work perfectly together."

UK Dept of Healh Launches Its New Vision For Older People Mental Health medicalnewstoday.com 11 Jul 2005 A new online publication outlining a vision of how health and social care services should work together to secure better services for older people was launched today by two Department of Health tsars. Mental Health tsar Louis Appleby and Older Peoples tsar Ian Philp, have produced the publication, which marks the start of a new initiative in which their two divisions will join forces for the first time to influence change and improve services. The vision document is a precursor to a service development guide which will be launched by Care Services Minister Liam Byrne in autumn 2005. As part of its commitment to improving services the DH: - Has set up an older peoples mental health programme board, chaired by Antony Sheehan, chair of care services, to ensure the successful delivery of the work programme - Will extend the annual autumn mental health service mapping exercise to include older peoples services Professor Ian Philp, national clinical director for older people said: "This development will help improve the skill and competence of staff in mainstream settings in mental healthcare, spread excellence in mental health services for old age-related needs, and ensure access to services on the basis of need, irrespective of age". Professor Louis Appleby, national clinical director for mental health, said: "Great strides have been made in improving mental health services and I want to ensure that older people benefit from that. I want services for older people to be as good as patients and their carers deserve." The vision document has been tested extensively with stakeholders and is being well supported by the service. Gordon Lishman, Director General, Age Concern England said: "By highlighting the discriminatory regulations that blight older peoples mental health, this report is taking a bold step forward. Older peoples mental health has been a much-neglected area. The new vision will be crucial for helping to combat high levels of depression amongst older people and tackling endemic ageism in older peoples mental health services." Andrew McCulloch, Chief Executive of the Mental Health Foundation says: "The Mental Health Foundation supports the Department of Healths vision of combining forces across older peoples services and mental health services to ensure that older people are no longer neglected. We hope that the implementation of this guidance will not only result in the provision of high quality services, but also demonstrate an understanding of older peoples mental health needs. We welcome the emphasis placed on opening up intermediate care services to people requiring holistic rehabilitation following mental illness, and to those living with mental health problems." Dick Frak, Rethink Director of Quality & Standards, said: "I very much welcome and support the vision for older peoples mental health. I welcome especially the emphasis on skilling further those staff who come into ordinary contact with older people, so services become more attuned to what can be done early to secure better mental health." In the next 10 years, the population of over 65s will increase by 15%, and the population of over 85s by 27%. Dementia affects one person in 20 age over 65 years and one person in 5 over 80. Two thirds of NHS beds are occupied by people age 65 or over and up to two-thirds already have or will develop mental health problems.

Schizophrenia "more common" in West The Age, By Janelle Miles July 12, 2005 Schizophrenia is much more common in the developed world, possibly because people with the mental illness in poorer countries are more likely to recover, an Australian expert says. In the most comprehensive survey of the prevalence of schizophrenia worldwide, John McGrath and colleagues from the Queensland Centre for Mental Health Research, reviewed data from 188 studies published between 1965 and 2002. Their findings are expected to rewrite textbooks on the devastating mental illness characterised by symptoms such as hallucinations, delusions, disorganised communication, poor planning and reduced motivation. Previous research by Professor McGraths team found the number of new cases emerging each year were similar in both Western and developing nations, but the latest survey found the prevalence was "significantly lower" in poorer countries. Although the reasons are still a mystery, Professor McGrath said people with the disorder in the developing world had a better prognosis. "If you get schizophrenia in a place like India, for example, you tend to have a type of illness that recovers," he said in an interview. "If you get schizophrenia in a place like New York or London, you tend to have an illness thatis less likely to respond to treatment. "It is extremely paradoxical. You would think in the developed world like Australia, the UK, Canada and America we would have better treatments so you would be more likely to recover but that is not the case," he said. The survey, published in the US-based journal, Public Library of Science Medicine, also confirmed that schizophrenia is more common in migrants than in native-born people.

UK : MORE CASH, MORE WORKERS, MORE COMMUNITY SUPPORT FOR PATIENTS - KEY TARGETS HIT IN MENTAL HEALTH REFORM PROGRAMME noticias.info Report shows big boost in mental health investment Figures released today in Health Minister Rosie Wintertons speech to the National Mental Health Nursing Conference, show mental health is no longer the "Cinderella service" of the NHS, with record amounts of money getting through to the frontline. A key target was hit for the number of home treatment teams - this means that more people will be treated in their community and kept out of hospital. Three other important service provision targets were also hit. Offenders with mental health needs are also being supported, as six targets were hit relating to their care. These new teams and new ways of providing services have come about because of a hefty cash injection given to mental health. A report published today by the Department of Health shows that investment in mental health services increased by 7% real terms between 2003-4 and 2004-5 - £293 million. This is further evidence of the massive programme of reform and investment in mental health services that has been ongoing since 1999. Health minister Rosie Winterton said: "For too long mental health has been seen as the "Cinderella service" of the health service. But this has changed. Mental health is a key priority for the government. We have invested record amounts of money in the service and I am pleased to see that the money is getting through to the frontline, in the shape of a much needed boost to the mental health workforce. There will now be more people on the ground, in the community, providing help and support to patients where they need it. "We are in the middle of a huge reform of mental health services. The new Mental Health Bill is a key part of this plan to improve life for people with mental health problems and to make treatment more focused on their needs. "In 2004 around one million people were unable to work due to mental health problems. This is now the number one reason for claiming incapacity benefit and costs the British economy billions of pounds. Improving mental health services is a key avenue in reducing the number of people who cannot work because of stress and achieving a healthier population." The National Director for Mental Health, Professor Louis Appleby, said: "In the last five years since the publication of the National Service Framework we have invested over a billion pounds more in mental health services and have put in place many of the improvements that we promised. Much more will be done in the next few years but I am very pleased that we have made such good progress. "Getting these specialist teams in place is an important step forward. Having them working on the ground means that more people will be supported and treated in their own homes rather than admitted to an in-patient ward." The four workforce targets that have been hit are: Crisis Resolution - also known as Home Treatment - teams (target 335, 343 achieved), Early Intervention teams (target 50, 109 achieved), Gateway staff (target 500, 1,520 achieved) and Assertive Outreach teams (target 220, 261 achieved). The investment report, "The 2004/05 National Survey of Investment in Mental Health Services", found that total increased investment between 2001/02 and 2004/05 was £708million or 18.6%. In 2004/05 there was a real terms increase of 7% compared to 2003/04. Notes to editors 1. The four workforce targets were stated in the NHS Plan (2000) - pp118 to 121 - and restated in the PPF (Priorities and Planning Framework) to the PSA 2002. They had a target date of December 2004, except for Assertive Outreach teams which had a target date of December 2003. Three other mental health workforce targets were narrowly missed: Carer Support staff (target 700 - 654 achieved); Graduate workers (target 1,000 - 648 achieved) and the number of people seen by Assertive Outreach teams (target 20,000; 17,500 achieved). 2. Definitions of teams and new staff categories: Local Implementation Teams (LIT) - These are teams set up under the Mental Health National Service Framework to co- ordinate the delivery of mental health services to adults of working age. Crisis Resolution Teams(CRT), also known as Home Treatment Teams A crisis resolution team (sometimes called home treatment) provides intensive support for people in mental health crisis in their own home, or other suitable alternative such as a crisis house. The crisis resolution team will stay involved until the problem is resolved. It is designed to provide prompt and effective home treatment, including medication, in order to prevent hospital admissions and give support to informal carers. It will also act as a gatekeeper to other mental health services such as acute inpatient care. Early Intervention Teams (EIT) - Early intervention in psychosis services provide assessment and care for individuals experiencing a first onset of psychosis, usually under the age of 35. Characteristically they focus on optimising medical control of psychotic symptoms, providing a range of psychological and family interventions and assisting in the personal adjustments necessarily arising from individuall illness. Assertive Outreach Teams (AOT) - Assertive Outreach Teams, known also as assertive community treatment teams, provide intensive support for the severely mentally ill people who are difficult to engage in more traditional services. Many will often have a forensic history and a dual diagnosis. Care and support is offered in their homes or some other community setting, at times suited to them. Workers can be involved in direct delivery of practical support, care co-ordination and advocacy as well as more traditional therapeutic input. The aim of the service is to maintain contact and increase engagement and compliance Graduate Worker - Graduate primary care workers are staff trained in brief therapy techniques of proven effectiveness, employed to help GPs to manage and treat common mental health problems in all age groups, including children. Roles and responsibilities of graduate workers will differ throughout the country and should be decided locally. Gateway Worker - A Gateway Worker is an experienced mental health clinician who works as part of a local clinical health service providing assessment and triage for people presenting in an acute or impending mental health emergency. The aim of the service is to improve speed of access to specialised services. In addition to direct clinical work, Gateway Workers have a role to enhance accessibility of specialist services by developing policies and procedures, providing training for key staff and enhancing the availability of information to potential service users and their carers. Carer Support Worker - Carers support workers have been developed to target the specific needs of carers. 3. The targets on offenders mental healthcare and the healthcare of those with personality disorder are as below: All prisoners with severe mental health illness (SMI) to have a care plan. Target: 5,000 by April 2004; Last survey showed 100% compliance Prison in-reach staff recruited to manage prisoners with SMI. Target: 300 in-reach staff by Dec 2004; 329 achieved Dec 04 - 360 in-reach staff in post Moving patients from High Secure services. Target: move 400 patients by Dec 04; 441 achieved Dec 04. High secure services - expand MH workforce to support secure step-down. Target: Recruit 400 staff by end Dec 04; achieved - 690 new staff Expand capacity to create new secure personality disorder places. Target: create 140 new PD places by Dec 04; achieved - 205 beds open. Will be increased further in June 2005. An additional target on personality disorder was the creation of 75 specialist rehabilitation hostel places by 2004. These 75 places have been achieved 4. Mental Health Strategies analysed data from detailed finance mapping exercises co-ordinated by local implementation teams (LITs). A summary of findings on planned investment in adult mental health services is below. Reported Total Annual increase Total Annualinvestment investment in total investment increase in(£b) (£b) nominal nominal uprated to total upratedprices investment (£m) 2004/05 investmentand % increase price levels (£m) and %increase3.129 3.254 3.8123.489 3.709 457m (14%) 4.195 383m (10.1%)3.910 3.943 234m (6.3%) 4.227 32m (0.8%)4.474 4.520 577m (14.6%) 4.520 293m (6.9%)

Site chosen for new mental health unit Hartlepoolmail.co.uk - 16th June A NEW mental health unit has been earmarked for Hartlepool. The £5m facility could be opened on derelict land at the junction of Lancaster Road and Middleton Road, close to Brougham Primary School. Tees and North East Yorkshire NHS Trust wants to move its adult and older peoples mental health services away from the University Hospital of Hartlepool. Moira Britton, trust chief executive, said: "Our current mental health unit in Hartlepool was never designed to provide the modern mental health services local people deserve, and there just is not the space on the hospital site to build a state-of-the-art facilities we want to offer." The trust has looked at a number of different locations around Hartlepool, but chose the land off Middleton Road and Lancaster Road because of its proximity to the town centre and access to public transport. Last year County Durham and Tees Valley Strategic Health Authority gave the trust £8.4m to build new mental health units in Hartlepool and Stockton, with more than £5m earmarked for the Hartlepool development. The single storey unit will have 16 en suite bedrooms for adults and 16 for older people, as well as courtyard gardens and flexible internal spaces that will be used for a range of recreation activities, treatments and therapies. The site will have car parking for staff and visitors and be surrounded by fencing, trees and bushes. Headteacher at Brougham Primary School, Keith Storey, said: "I do not have a problem with it. If it is properly managed it will be fine and these people need to go somewhere." Subject to Hartlepool Borough Councils planners approving the application, the trust hopes it will be open in 2006. Leaflets are being circulated to everyone living in the Lancaster Road and Middleton Road areas, and are also available at www.peoplelikeus.nhs.uk. The council said the application has been submitted, but said no date for its discussion has been set.

Dirty wards subject to spot checks Daily Mail - 20th June Independent investigators are to be sent into hospitals in a crackdown on dirty wards. Unannounced, random spot checks will be done at 100 acute, community and mental health hospitals in the NHS and independent sectors. The plan was announced by the Healthcare Commission just days before the Government is due to publish latest figures on the MRSA superbug. Further figures are due this summer on the lethal clostridium difficile infection. Commission inspectors will mostly target trusts previously identified as performing badly on cleanliness but they will also visit less dirty hospitals. Wards, outpatient areas and accident and emergency departments will face inspection. Sweeping powers The commission has sweeping powers to gain access to buildings and hospital chief executives were notified on Friday that they may be subject to the random checks. They have been instructed to tell their staff to cooperate with inspectors who will be armed with a 55-point checklist, including the state of floors, sinks and toilets. Healthcare Commission chief executive Anna Walker said: "Patients and the public tell us they are concerned about cleanliness. There is a real danger that this issue could damage confidence in healthcare. "But there is a shortage of facts and this exercise is about getting those facts. "That is why we will be sending in our inspectors over the summer. Our aim is learn from best practice and challenge bad practice." The Government has a target of halving the rate of MRSA by 2008. MRSA kills about 1,000 people a year in the UK, with older people, particularly men, among the most susceptible. The infection does not cause a specific disease but infects wounds and can get into the blood stream, causing blood poisoning and even organ failure. Leslie Ash, agony aunt Claire Rayner, and Tory leader Michael Howards mother-in-law have been some of the high-profile cases of the infection. According to the Health Protection Agency, Britains MRSA blood-poisoning rates are among the highest in Europe. However, in March the Government claimed the battle to beat the killer bug had reached a turning point, with figures reaching their lowest level since mandatory records began in 2001. Independent inquiry Clostridium difficile (CD) is another infection that has caused concern, with Health Secretary Patricia Hewitt recently ordering an independent inquiry into its spread. This month it emerged more than 300 patients at Stoke Mandeville Hospital in Buckinghamshire had been infected with a virulent strain of CD since the end of 2003. It also emerged that 12 patients, whose average age was 85, died from the bug, which causes severe diarrhoea. In the Healthcare Commissions new offensive, hospitals inspected in the summer will be informed of the findings within days so they can set up action plans for improvements. Poor performing hospitals will be checked again as part of a review. In the first year, the commissions review will include focus on acute hospitals. In year two it will move on to primary, community and social care settings and in the final year it will assess how hospitals are performing against the Governments 2008 MRSA targets.

Why society can no longer afford to ignore mental health issues Apr 25 2005 Madeleine Brindley, Western Mail As we move closer to a 24-hour society, the reality for most employees in Wales is longer hours, tighter deadlines and increasing pressure. Work-place stress is now cited as one of the major causes of mental health problems. Even though our attitudes towards mental illness are slowly changing, society has yet to fully help those affected. Health Wales spoke to Welsh charity Gofal Cymru about why we cannot continue to ignore mental health issues... ABSENCE from work caused by stressed-out workers is costing industry an estimated £4bn a year. With stress-related absences accounting for half of all sicknesses from work, stress and related mental health conditions have suddenly been thrown into the limelight. Mental health issues can no longer be ignored, but must be addressed by both the Government and employees - and quickly. Statistics show the chances of individuals signed off through mental health problems returning to work decreases the more time they spend away from the workplace. The likelihood of someone returning to work after six months is only 50\\\\%; after one year, 24\\\\% and after two years, just 5\\\\%. Given these statistics it is imperative that those who suffer from mental health problems are helped back to work as soon as possible to avoid the long-term implications of loss of employment. Better still, prevention is always better than cure, and Gofal Cymru, one of the leading mental health charities in Wales, is the backbone behind a campaign to ensure employees are given every chance to recover from work-related problems with the help of employers. The charity recognises that many people with mental health problems have valuable contributions to make to the workforce. John Mathias, chief executive of Gofal Cymru said, "We recognise that mental health can still be a taboo subject within Wales. For too long society has ignored the needs of people with mental health difficulties." However, the nature of life in the 21st century means more people than ever before are stressed and developing mental health problems. "The negative impact this is having on the Welsh economy means Wales will have to recognise its responsibilities in terms of providing a better framework within which people with mental health problems can be sustained and supported." According to statistics released by the Trades Union Congress, in 2004, three in five workers (58\\\\%) now complain of being stressed at work. The main reasons cited for stress are increased workloads, change at work, staff cuts and bullying. The statistics show the situation to be significantly worse than four years ago, and demonstrates that up until now very little has been done to combat problems of stress in the workplace. Teaching, which is perhaps perceived as one of the most pressured professions, certainly suffers from its fair share of stress. Absences from the classroom are growing as teachers are increasingly worn out by the demands placed on them by pupils, parents and school. A recent survey by the Association of Teachers and Lecturers of 300 secondary school teachers confirmed that abuse at the hands of pupils had left 46\\\\% taking anti-depressants or facing long lay-offs from school from stress. In fact 72\\\\% of the teachers surveyed said they had considered quitting their jobs because of pupils persistent disruptive behaviour. Statistics released at the end of 2004 by Welsh teacher charity, Teacher Support Cymru, support these findings - stress, anxiety and depression accounted for 20\\\\% of total calls made by teachers to the charitys helpline service. The 21-to-35 age group accounted for 29\\\\% of the callers - a serious area of concern considering the current debate about teacher retention. However, a Mental Health Foundation report, released in 2000, found that for people with mental health problems, as well as being the aggravator, work is an important coping mechanism because of the sense of self-worth it brings. Mr Mathias said, "An important balance needs to be struck between keeping people in employment to aid their recovery, but all the while ensuring that employees have access to appropriate support. "This involves educating employers and fellow employees in being sensitive to peoples needs, so they are in a position to offer support to their employees who may be going though a particularly tough period of mental ill-health." The Disability Discrimination Act (1995) goes some way to helping those suffering from mental health problems ensure they are getting the support they require in the workplace. The Act places an obligation on employers - even those with few employees - to make "reasonable adjustments" in order to enable staff to cope. These adjustments include allowing the employee more flexible working hours, coverage during absence and general non-discriminatory practice. Many firms have taken heed of this, and are extremely good at employing and sustaining those with mental health issues. The Employers Disability Forum details companies and employers who have signed up to a positive approach in employing personnel with disabilities, including those with mental health issues. Among those who are judged to display examples of good practice are Marks & Spencer, the Co-op and B&Q. A report from mental health charity Mind - A Practical Guide to Managing and Supporting Mental Health in the Workplace - goes further and suggests many other recommended courses of action for employers, in order that they can successfully employ and retain people with mental health problems. A three-pronged approach is recommended, which uses regular management processes to monitor needs, coping strategies and advance directives. The importance of establishing a relationship of trust between employer and employee is emphasised after a period of employee sickness absence or re-entry to work. This trust enables employers to informally "sound out" how a person is doing without having to take special measures. It also recommends that both parties should establish when the "business as usual" stage has been reached once the employee has returned to work. At this point, the employer should use normal management processes to review an employees performance, needs and work planning. In addition, most individuals are encouraged to develop a coping strategy as part of their care. This often involves noting signs of possible relapse and taking pre-emptive action to avoid it. Some examples include cutting down on work or social activity, being careful about drinking alcohol, taking exercise and finding time to relax. It is important that managers support the employee at this first warning stage. Small and inexpensive adjustments may well prevent a more costly period of illness. The study also found that employees who have developed a coping strategy are often better equipped to deal with pressure than those employees who have never experienced a mental health problem. Some people also find it helpful to draw up an "advance directive" - a statement of how they would like to be treated when they become ill. Sometimes it is helpful to have a version of this that relates to the work place. The directive includes information such as symptoms to look out for, who to contact, and what support is helpful and what is not. If an employee makes the effort to draw this up, it is strongly suggested that employers use this information. There are several projects in the UK, often run by the voluntary sector, which support both employers and employees to help staff retain their jobs. These include Gofal Cymrus employment opportunities project - a three-year project based on the results of an 18-month research inquiry to discover examples of good practice in the UK. The projects primary aim is to improve employment prospects in key areas of South Wales for people with severe and enduring mental health problems. Gofal Cymrus service users are also given the opportunity to gain access to education, training, voluntary work and open employment as well as being offered appropriate support in order to sustain employment. Generally, however, Wales has only recently identified mental health as a serious problem as far as job retention is concerned. Gofal Cymru has organised the first all-Wales mental health conference, next month at the Metropole Hotel, in Llandrindod Wells, to bring these issues to light. The conference will explore the debate surrounding mental health and the workplace and will give delegates the chance to hear key speakers who have had experience in helping those with mental health problems gain and retain employment. Among the speakers are Huw Davies, of Bury Employment and Training, who will be speaking on the work of the Association for Supported Employment, and Miles Rinaldi of St Georges Mental Health NHS Trust, London, who will be speaking about how to develop work projects that work. Mr Mathias said, "What we need in Wales is a co-ordinated, systematic approach to job access and retention for people with mental health problems. "Two years ago only two of Gofal Cymrus service users were in paid employment. Since then Gofal Cymrus employment opportunities project has enabled nearly 30 service users to gain access to paid or voluntary work and 40 people to enter education and training services. "We believe that the climate in Wales is changing and attitudes towards mental health within the workplace are changing from an exclusive to inclusive approach. "However, we still have a long way to go, and it is our hope that with the support of the National Assembly we can make real progress in taking mental health to the top of the health agenda." The Gofal Cymru conference - Employment, Education and Mental Health: Whats Working? - costs £165 for two days, £100 for a single day. For more information contact Dr Colin Palfrey, research and development manager at Gofal Cymru, on 01656 647733.

Mental health sufferers "ignored" 25th April 2005 The needs of 50,000 people with severe mental illness in the UK are still being ignored, campaigners have warned. Mental health charity Rethink has published a report outlining how many patients are denied access to services to tackle their mental, physical and social needs. They also launched a "toolkit" giving practical advice to health workers and carers to help improve the quality of life for this so-called "forgotten generation". Rethink chief executive Cliff Prior said they had probably underestimated the numbers belonging to the forgotten generation who faced the tragedy of long-term severe mental illness without the proper support. "We also probably overestimated what people of the forgotten generation want. First and foremost they want to be remembered, to be seen and heard and to be included in the reforms taking place across health and social care," Mr Prior said. "They want to take greater control over their lives and should be offered real choice and effective involvement in planning their mental health care. "This report and toolkit reveals some very simple ways in which this can be achieved." The report - Action Stations - said that services for people with long-term severe mental illness were often being closed to fund other services. It said that patients could find themselves shunned by services because of strict referral criteria. The report also said that GP practices needed to offer more services to those who are part of the forgotten generation - including physical health checks.

BOOST FOR MENTAL HEALTH SERVICE By Dan Webber, Community Newswire SOCIAL Carers Nottingham, 20/4/2005 Members of Nottingham-based charity The Carers Council were celebrating today after scooping a £9,000 funding boost from the UKs leading grant-making trust. Since 1991, the Carers Council has provided help to individuals supporting people in the East Midlands with mental health issues. Funding from the Lloyds TSB Foundation will pay for information packs for carers and health professionals, the expansion of the charitys quarterly newsletter and a conference to be held later in the year. Carers Council support worker Mary Harrison, said: "Caring for people with mental health difficulties is a demanding job and we are dedicated to providing a comprehensive support service that helps carers cope with every aspect of their jobs. "This very generous grant will allow us to expand our services to offer further support to carers throughout their invaluable work." Gary Beharrell, East Midlands manager for the Lloyds TSB Foundation, said :``We awarded this grant because this charity is providing a service which is supporting carers through the ups-and-downs of their role as well as helping to reduce the stigma associated with mental health." In 2005, the independent Lloyds TSB Foundation for England and Wales will give £22.5 million to registered charities throughout the UK, including more than £1.2 million to charities in the East Midlands. The foundation aims to support under-funded grass-roots charities that enable disadvantaged people to play a fuller role in their community. Visit www.lloydstsbfoundations.org.uk for more information.

How I beat the urge to cut 18/04/05 Jessica Kiddle ON THE surface, Victoria Leatham was a regular woman in her early twenties. In fact, she was more than your average Jane. Those who knew her saw a highly attractive and intelligent brunette, studying for a masters in English at a respected university. But this was not the person Leatham recognised. Overwhelmed by the repeated rejections of an on-off love affair, and struggling with the pressures of academic life, she was in turmoil. For reasons she did not understand, her mind was plagued by images of cutting herself, and one summer’s day she returned to her apartment, picked up a bread knife and did just that. "Gritting my teeth, I put my forearm on the bench and quickly ran the blade across it," she says. "The tension lifted instantly. I felt - and this took me by surprise - exhilarated." What Leatham didn’t know was that this first small cut was to mark the start of a ten-year addiction to self harming. Her experience is far from unique. The Mental Health Foundation estimates that one in 130 people across the UK self-harm - almost half a million people. Women and teenagers are more disposed to this behaviour - 17,000 youngsters aged 15 and 16 are believed to be selfharming in Scotland alone. Alice Sinclair, 18, winner of the television reality show Make Me a Supermodel, openly admitted to cutting herself when questioned on camera about visible scars on her arms. In Bloodletting, Leatham’s newly published book, she charts her decline into self-harm and her journey to recovery. Now aged 35 and a successful publishing executive, it is ten years since Leatham deliberately cut herself, and five years since she had the urge to do so. "I hope that my recovery will give hope to others in a similar position to the one I was in," she says. "Not only is it possible to stop hurting yourself, but it is possible to stop wanting to do it as well." In many ways Leatham’s profile is typical of those who become self-harmers. Born in Australia, she and her brother were raised by middle-class parents . She appeared the model daughter - studying hard, always polite and abiding by her family’s house rule: "Smile before you speak." By the age of 15 she was starving herself, but even anorexia did not stop her going to study English at university in Sydney. As a student she finally rebelled. "My grades slipped, my thighs grew and I didn’t ring home," she writes. "My mother was horrified: ‘Hadn’t they brought me up properly?’" It was aged 20 that she first cut herself, during a low-point in an on-off relationship with an emotionally abusive man. Chatting in her vibrant Sydney accent, she says that she now understands her feelings of self-hatred were tied up with her inability to process emotions. "I’m not sure what made me cut myself for the first time," she says. "There was no one trigger or traumatic event that was haunting me, but numerous factors tied up with a pattern of self-hatred, frustration and depression - a whole range of negative emotions that I was unable to deal with. "I wanted to experience a pain I could deal with. I couldn’t cope with the mess inside me any longer and cutting myself seemed like the best solution. I knew that it would work." Although Leatham was later diagnosed with clinical depression, it is plain that at least part of her problem stemmed from her family environment: "I am very sensitive but come from a family which tends not to discuss emotions. I was also heavily critical of myself. Everything I did was wrong in my head - I spoke to myself in a way I would never speak to anyone else. "Everyone experiences these negative thoughts but mine were magnified a million times. So while my insecurities were not abnormal, the extent to which they affected me and how I punished myself for my shortcomings was." She realised she needed professional help, and her life became a routine of taking antidepressants, visiting no fewer than eight psychiatrists and spells in hospital. The pressure under which Leatham placed herself is evident in the fact that, despite all of this, she completed her degree, and went on to study for a masters - and the cutting did not stop. She frequently moved jobs and flats in a bid to leave her pain behind, but could not. There were good patches, such as the months she spent in Melbourne as an assistant magazine editor, and low periods - during which, unemployed and living alone, she withdrew from friends, completely overwhelmed by her pre-occupation for self-harm. In these phases she would buy razor blades - she never kept them in the house, just in case - return home - "I needed to do it in a controlled environment" - cut herself and then head for the nearest hospital for stitches. While the wound was healing, she could feel physical pain and she could keep her emotions in check. But once her wounds healed, a stressful week at work or a hiccup in a relationship was enough to make her pick up the bread knife again. "I managed to keep up a front for most of the time as I felt ashamed about what I was doing and I didn’t want others to know," she says. "I felt tremendously guilty because I knew I had a lot going for me and should have been happy, but I wasn’t. Because I was intelligent it meant I thought about things a lot and was struggling to live up to high expectations." It was only when she confessed to her doctor that she "felt like driving through a brick wall" that he suggested she try cognitive behavioural therapy. This seeks to change the way in which a person thinks, rather than focusing on what they are thinking about. Although not a conventional treatment for self-harm, it proved to be the key to Leatham’s recovery. She learned to handle her emotions by externalising them and adopting some objectivity. She also developed simple stress-busting techniques, such as going for a walk or discussing her feelings with others. Eventually, she reached a stage where she could resist her desire to cut herself, but it was a further five years before the strongest urges to do so stopped. "Things get harder when you make the decision not to cut yourself any more because you don’t have an outlet for your emotions and have to work through them mentally, instead," she says. "Occasionally I get thoughts that I need to hurt myself but I now recognise those thoughts are reactions to stress. They don’t frighten me and don’t control me anymore." The thoughts may be largely gone, but the scars on her forearms will never disappear. "Maybe that’s no bad thing," says Leatham. "It’s a warning against complacency as well as being a constant reminder of how much better things can be." • Bloodletting: A True Story of Secrets, Self-Harm and Survival, by Victoria Leatham, published in hardback by Allison & Busby at £12.99. • Samaritans: 08457 90 90 90.

Role of social workers set to be changed 11/04/2005 - CareAndHealth.com Months of speculation has ended with publication of the adult social care Green Paper by health secretary John Reid [pictured left]. The role of social workers is set to change and IT provision will increase. Chris Smith reports. John Reid: "Social care should be about helping people maintain their independence, given them real control over their lives and giving them real choice in the services they use. Services must recognise the changing world, our changing attitudes and our ageing population." Social workers are to become ‘care brokers’ for older people as part of a radical overhaul of adult provision. But despite big changes, those tasked with delivering this ambitious agenda will receive no extra money. Months of speculation ended on Monday with the launch by health secretary John Reid of the Department of Health’s adult Green Paper, Independence, Well-being and Choice: our vision for the future of social care for adults in England. Reid said: "Social care should be about helping people maintain their independence, given them real control over their lives and giving them real choice in the services they use. Services must recognise the changing world, our changing attitudes and our ageing population." It focuses on the achievement of seven outcomes for older people, including improving health; quality of life; positive contribution and personal dignity. Social workers look set to become navigators and brokers, pointing people to services rather than providing them, and the Department of Health (DH) was expected to promise initiatives to boost training. The new core models for delivery over the next decade will be: Extra Care – housing complexes that have care facilities included; Homeshare – where older people let spare rooms in their homes to young people in exchange for help. Connected care centres – that use the internet and call centres to improve service provision; Kent County Council is seen as the leader in this area. Assistive technology – heart monitors and other equipment will be used as a way of helping people live in their own homes for longer. In addition, time bank volunteering schemes will also be used to reduce the isolation of older people who have no outside contact. This part of the paper will be linked to plans unveiled last Tuesday by the Social Exclusion Unit. Its report, Excluded Older People, aims to tackle problems such as loneliness and poor transport. Also, pensioner poverty will be addressed in a paper due shortly from the Department for Work and Pensions. Lynne Berry, chief executive of the General Social Care Council, welcomed the emphasis on the role of social work. “It is really exciting that social workers are being highlighted in their new roles as navigators and brokers,” she said. The adult paper will now be discussed at consultation events across the UK and senior figures in social care are expected to highlight problems such as the lack of cash for adult mental health provision.

DEPRESSION NUMBER ONE FOR INCAPACITY BENEFIT CLAIMS Friday, 08 April 2005 BNN: British Nursing News Online Psychiatrists writing in the British Medical Journal, claim that stress and depression have taken over from back pain as the main reasons for workers claiming incapacity benefit. The team from The Kings College London show that in 2003, 176 million working days were lost; up 10 million on the previous year. Each year, £13bn is spent on benefits, and the reduction of long term sick leave is now a top government priority. The team are also calling for more to be done to help people with depression helping them to return to work. The Kings researchers also say that the United Kingdom has very poor provision of occupational physicians (one specialist for every 43,000 workers) compared with the rest of Europe. The team Led by psychiatrist Max Henderson write: "Both employers and patients require a speedier response than is currently delivered, as the longer an individual remains off work, the more difficult a return becomes”. They highlight a successful project in Holland, where work-based psychological therapy improved health and reduced absences. "If the Government is serious about tackling the consequences of common mental disorders then innovative policies... will be required alongside research into the most effective and cost effective methods of delivering service," the researchers add. "This would be a wise investment given the substantial economic and social costs engendered by the current service framework”. A spokesman for the Depression Alliance said employers were often not equipped to recognise the warning signs of stress and mild depression in workers, and so were unable to help them early on in their illness. He added: "Talking therapies and one-to-one support are key to helping someone adjust to a working environment after a period of sickness when self-esteem is probably at an all time low. "Employers also need support to understand the situation and their responsibilities. Unfortunately the necessary resources are scarce. "And the incapacity benefit system itself is simply not designed to deal with the special requirements of people affected by depression. "Service users often tell us that they end up in a vicious circle where they are unable to return to work or are forced back to work too quickly”. Kate Groucutt, a Policy Adviser with the Confederation of British Industries, said: "Nearly two thirds of employers have formal rehabilitation arrangements to assist employees returning to work, including flexible working, counselling, medical treatment and training courses. "And over three-quarters of employers also have arrangements to help employees suffering from stress, including job reorganisation and access to occupational health services, which could help prevent more serious problems”.

91 YEAR OLD PATIENT TREATED ON HOSPITAL FLOOR Thursday, 14 April 2005 BNN: British Nursing News Online Cecil Baker, 91, who suffers from dementia was in the Norfolk and Norwich University Hospital where he was being treated for shingles, was put on a mattress on the floor because the trial period of his bed had expired and the bed had to be returned to the manufacturers. Carole Bedingfield, 48, his daughter, said yesterday: "I was shocked when I saw him. He was just lying on the mattress with absolutely nothing underneath it. "As he has dementia, he was not aware of what was happening around him. "But I was disgusted at the way he was just left on the floor with a single sheet over him. I had to get down on the floor on my hands and knees to speak to him. "I went to ask the nursing sister why he was on the floor and she told me that the lease had expired on his bed. I couldnt believe what I was hearing. It was just so –upsetting”. A hospital statement said: "It is a long-standing and accepted practice in hospitals and nursing homes to nurse patients at high risk of falling or climbing out of bed on a mattress so that they do not cause themselves serious injury. "Mr Baker was admitted to the ward and nursed on a mattress in his single room for two days when a low-rise bed on trial with the hospital became available. "Mr Baker, given his history of dementia and falls, was considered suitable for the bed and he was then put into the low-rise bed in his single room. "However, Mr Baker over the period of a week fell from the low-rise bed on four occasions. "The senior nurses view was that the low-rise bed was not proving suitable for him and Mr Baker was returned to a mattress for 24 hours. "It was then felt that it was becoming difficult to nurse Mr Baker on a mattress and he was moved into a regular hospital bed”.

None of three main parties have mental health policies in election manifestos April 18, 2005 by Angela Hussain None of the three main political parties have drawn up specific mental health policies in their election manifestos. This is despite the Labour governments draft mental health bill sparking controversy and widespread media coverage. The Royal College of Psychiatrists has, nevertheless, drawn up a list of 10 mental health policy questions for people to put to their parliamentary candidates ahead of the May 5 general election. These include questions on how their party is combating the stigma of people having mental health problems, how their party is reducing disability discrimination for people with mental health problems, and how their party would push mental health up the political agenda. On generic health policy the three main parties - as well as the Scottish National Party - are battling it out on issues of hospital cleanliness, patient choice, spending and waiting lists. All parties accept spending across all health services - and by implication mental health services - must grow but they disagree about central control and the private sector. Labour is pressing on with its plans to reform the 1983 mental health act, as outlined in a draft mental health bill. They say new mental health law is needed to better protect the public from violent people with mental health problems. While the Conservatives and Liberal Democrats are critical of many aspects of the bill they have also stated that they would bring in a new mental health act. At a Conservative mental health summit in 2003 the shadow health secretary Dr Liam Fox said that he believes too many people diagnosed with mental illness are being treated inappropriately in the community. He said the care in the community policy - introduced by the Tories - has gone too far and is a threat to patients and the public. Dr Fox said: "Care in the community has been discredited in the public mind by a series of crimes committed by the mentally ill who had fallen between the gaps or come off their medication. "The pendulum has swung too far and too fast. "We need a new balance to be struck which ensures the most appropriate treatment and environment for patients - a balance where those that need treatment in a hospital setting receive it and only those able to cope in the community are placed there." The Liberal Democrats shadow health secretary Paul Burstow has said the draft mental health bill should be "sent back to the drawing board." He said last month: "A new mental health act is desperately needed, but it must be a law to protect and improve services for patients, not a means to demonise those with mental health problems."

Funding for young people with mental health problems announced Mar 8, 2005 Funding of £5 million for young people with mental health problems was announced by Rosie Winterton today, writes Clare Jerrom. The health minister also revealed that £1.5 million of that funding would be given to projects aimed at black and ethnic minority young people with mental health problems. “Racism, discrimination, or inequalities have no place in modern society, and they certainly have no place in the modern NHS,” the minister said. “David Bennett’s death stands as a tragic reminder of what can happen if the service fails to meet the needs of its black and minority ethnic patients. Change might not come overnight, but we are offering a way forward to equity for all in mental health care,” she added. The two largest grants will go to Hillingdon and Camden Councils in London. Funding of £489,000 will be given to Hillingdon to provide mental health support services for unaccompanied asylum seeking children and £475,000 will be spent in Camden supporting refugee or asylum seeking children who are suffering from poor educational performance.

My imaginary friend Should you worry if your child conjures up an invisible companion? Lucy Ward reports Wednesday March 2, 2005 Story from The Guardian They can be male or female, invisible or fully cuddleable; they can live in a castle or in a pocket. Maybe you had one, although you probably lost it when you were little; perhaps your children have created their own. Mine had a place laid next to me at the table and always had his coat buttoned up by my mum, as I did. Oddly, imaginary friends, those little-understood yet strangely powerful occupants of the nursery, are still alive and playing, even in the age of ready-manufactured, highly marketed cartoon characters. In fact, researchers at Manchester University are currently looking into the effect of imaginary companions on childrens language, skills, development and creativity, and the team say that in the course of their work they have been confronted with a motley procession of invented characters, ranging from a whole class of children - all with names - to a 30-year-old adult and a talking toy dog. The children taking part in a series of game-style tests at the universitys school of psychological sciences sometimes bring in their imaginary friends with them, or they explain that they have left them outside in the corridor, or in the castle where they live "because they have so much to do there". "Theres a great range," says researcher Anna Roby. "The children tell me about where their companions live, what sort of friends they have, what they like doing, their names - one was called Pencil and one was called after a line from a Bon Jovi song. "Some live in castles, some are married, some are animals or objects, some are in the form of dolls or stuffed dogs. Some are completely invisible, but are people. One boy even invented two imaginary companions for his little sister." Imaginary friends provoke curiously ambivalent reactions from the grown-up world. Not everyone thinks they are sweet - some parents find them troubling, connecting the fantasy characters with mental disturbance or even something darker. (As it happens The Icarus Girl, the much-lauded debut novel by Helen Oyeyemi, features eight-year-old Jessamy, half Nigerian, half British, whose imaginary friend TillyTilly has sinister powers.) Others are simply concerned that an imaginary friend means the child is shy, introverted or even anti-social, their friendship with the unreal somehow harming their relationships in the real world. Roby, however, believes such fears are baseless."I think the negative stigma come from mental health issues, from the idea of hearing voices and its connection with schizophrenia." Some youngsters, she says, may use their invented friendships to act out issues troubling them at home, in an attempt to make sense of events such as bereavement or divorce. "But I think for the majority it is simply a companionship thing, maybe for when mum and dad are not always there to play with them. We believe imaginative friends are a good, creative thing for children." I am reminded of the comic-book character Calvin and his imaginary tiger, Hobbes. Adults think Hobbes is a tatty old stuffed toy. Calvin, however, sees him as a real, breathing, very dangerous tiger, and they have great adventures together. Of course, both Calvins parents, while witty and urbane, are very busy; its clear Calvin is lonely. Parents can be keen to see imaginary friends vanish as a child gets older, perhaps fearing the child will miss out on "real" social interaction. In practice, says Roby, most invisible friends - typically invented by first-borns or only children - fade away when or soon after a sibling is born or a child goes to school, returning to the shadows in the corner of the playroom. This certainly seems to be the case in my family. Baps, my companion from aged two, together with White Cat (who mainly lived under my nanas chair) and Badger, disappeared when my brother got old enough to be interesting. Meanwhile, my own older daughters invisible friends, Boko, Corky and Cheeky - who once were to be found sharing her bath or coming to nursery - are rarely heard of now that she has started school.

Kids and cannabis: Why dope is much more dangerous than you think 12/02/2005 Last month the Department of Health acknowledged that cannabis is an “important causal factor” in mental illness. It also announced a review of recent research which suggests that cannabis not only precipitates psychosis in some patients with a predisposition to the illness but can cause mental health problems for people who would otherwise be considered low — or no — risk. On top of this, the mental health charity Rethink called last week for an inquiry into the links between cannabis use and mental illness. And this week, a new study in the journal Neurology shows that blood flow to the brain remains altered a month after a joint is smoked. What are parents and teenagers to make of all this news, which must add to the confusion surrounding cannabis since its declassification from a Class B to Class C drug a year ago? For most people, smoking moderate amounts of cannabis causes no problems, says Professor Robin Murray, a leading researcher in the field. But parents are understandably worried. Cannabis is cheap and easy to get hold of; much of it is stronger than it used to be. Some strains contain up to 20 per cent THC (the hallucinogenic ingredient that gets people stoned) compared with less than 5 per cent in the bog-standard stuff. Even the notoriously liberal Dutch Government is now reviewing the legality of cannabis containing high levels of THC. However, many health professionals believe that it’s not so much strength but frequency and length of use that is the issue. Thirty-eight per cent of 15 to 16-year-olds in the UK, compared to an average of 21 per cent in the rest of Europe, have tried cannabis, and some start even younger. That is worrying in the light of recent research from the Institute of Psychiatry in South London, which suggests that adolescents may be particularly vulnerable to long-term damage. Murray, the consultant psychiatrist who coauthored the report, says: “There seems to be consistent evidence that people who start taking cannabis earlier get into more trouble, partly because they are more likely to become dependent. We found that teenagers who were taking cannabis at 15 were 4.5 times more likely to be psychotic by 26, whereas people who started taking it at 18 were only 1.5 times more likely.” He adds: “It’s upsetting that the people with cannabis-related schizophrenia whom I see in my clinic at the Maudsley Hospital, in London, have often been highly successful children — sociable, sporty and intellectually competent — until they got into drug-taking.” Research is also scrutinising the effect that cannabis has on brain development in adolescence. Murray cautions that nothing has been proved yet, but says: “There is speculation that if you smoke a lot of cannabis while the dopamine systems in the brain are still forming, as in adolescence, this might be detrimental. Psychosis is linked to excessive levels of dopamine in the parts of the brain concerned with emotion, and cannabis appears to increase these levels.” The temporary effects of cannabis can be equally worrying, not least because there is considerable evidence that it impairs memory; and unlike alcohol it stays in the body for up to three months. Murray says: “One of the reasons why some young people who smoke cannabis start performing badly at school or university is that they are cognitively impaired by the cannabis lingering in their brain. A young person who smokes cannabis every day, or even three times a week, can be in a state of low-grade intoxication most of the time. However, if you stop, these adverse cognitive effects also stop.” As with alcohol, he says, the important thing is to avoid getting stoned every night. It also reduces risk if young people delay smoking until their late teens. Many health professionals believe that the debate about declassification has blocked the more urgent issue: better education about the risks. At the Royal College of GPs conference last month, Clare Gerada, the head of its substance misuse unit, urged GPs to talk to young people about cannabis. “I am worried about our 15 to 17-year-olds; I feel that we’ve missed the point. OK, they are not taking up smoking, because the Government’s campaign is working. But they ’re getting high on cannabis and alcohol, and the two combined do more short-term damage. We need a public health campaign on reducing the risks of all drugs taken by young people.” Despite the UK’s high rates of cannabis consumption, it lags far behind some other countries — notably Australia — in its provision of services to help users. That may be changing. Rethink is developing a health information campaign with the Department of Health. And in December, HIT, a national drugs information and training centre, launched a website (www.knowcannabis.org.uk) and literature for people who want to cut down or quit. HIT’s director, Andrew Bennett, would like to see other services developed in the style of Australian cannabis quitlines and other cessation services. “At relatively low cost we could probably help a lot of people by developing existing tobacco cessation services and briefing GPs and practice nurses,” he says. One award-winning drugs project in Shrewsbury, aimed at 13 to 18-year-olds, who range from “middle-class school kids to young people living on the streets”, offers a spliff-count workshop. If it’s a cause for concern, the young person is offered a referral to a specialist team, but only with his or her permission. Haroon Riaz, who runs the project, says: “Young people were confused when the law changed so I had to do my own campaign. Cannabis is not a drug to be faffed around with; we need to get on top of it.” For more information, contact Rethink on 0845 4560455; www.rethink.org Story from Timesonline.co.uk

Herbal Remedy as Good as Drug for Depression: Study Fri Feb 11, 2005 LONDON (Reuters) An extract of the herbal remedy St. Johns wort is as effective as a commonly prescribed drug for people with moderate-to-severe depression, researchers reported this week Friday. They compared the extract called WS 5570, which is made by the German company Dr. Willmar Schwabe Pharmaceuticals, and the antidepressant paroxetine sold by GlaxoSmithKline Plc under the brand name Paxil or Seroxat. St. Johns wort is also known as hypericum perforatum. "In the treatment of moderate to severe major depression, hypericum extract WS 5570 is at least as effective as paroxetine and is better tolerated," Professor Armin Szegedi of the Charite-Universitatsmedizin, part of the University of Berlin, said in a report published online by the British Medical Journal. In a study funded by the German company, the researchers compared the treatments in 251 patients, between 18 and 70 years of age, for six weeks. Half of the patients taking the extract reported an improvement, compared with one third taking paroxetine. Patients taking the extract also reported fewer side effects, such as stomach disorders, according to the researchers. Paroxetine belongs to a class of drugs known as selective serotonin re-uptake inhibitors (SSRIs). British and European health authorities have voiced concern that these antidepressants may increase the risk of suicide in young people. "Our results support the use of hypericum extract WS 5570 as an alternative to standard antidepressants in moderate-to-severe depression, especially as it is well tolerated," Szegedi added. St. Johns wort has been called natures alternative to Prozac, but researchers have warned that it can interfere with hormone treatment, antibiotics and chemotherapy. Earlier studies have shown the herbal remedy is also effective for treating patients with mild depression. The researchers called for further studies to confirm their findings. Shire swallows bitter pill as Canada links drug to deaths By Rosie Murray-West (Filed: 11/02/2005) Shire Pharmaceuticals shares slumped 64½ to 577½p yesterday after the companys best-selling drug Adderall was pulled in Canada over safety concerns. The company relies heavily on the drug, a form of amphetamine that is prescribed mainly to children to treat Attention Deficit Hyperactivity Disorder (ADHD). Matt Emmens, Shire chief executive, said yesterday that he "strongly disagreed" with the Canadian health authoritys decision, and added that he was confident that the drug was safe. The withdrawal was made because the Canadian drug regulator was concerned that Adderall had caused 20 deaths. Health Canada said 14 deaths occurred in children, and six deaths in adults. "There were 12 reports of stroke, two of which occurred in children," the regulator added. Analysts said the amount of profit that Shire made from selling the drug in Canada was not statistically significant, and some said the share price fall was overdone. However, others pointed to the companys dependence on the Adderall franchise and the current climate of safety fears in the pharmaceutical industry as a reason to sell the stock. Adderall is not sold in the UK, and its main market is the US. The US regulator, the FDA, said it would not pull the drug and put out a statement saying: "FDA does not feel that any immediate changes are warranted in the FDA labelling or approved use of this drug based upon its preliminary understanding of Health Canadas analyses of adverse event reports and FDAs own knowledge and assessment of the reports received by the agency." Mr Emmens said that he does not expect the FDA to pull the drug, which is labelled in the US as not for use in children with malformed hearts. "I continue to believe this drug is safe and effective," he said.

Chief Nursing Officer announces plans for new framework for mental health nursing 09-02-2005 The review comes in the context of major government reforms such as "Choosing Health", "Delivering Race Equality" and the draft Mental Health Bill. As the largest professional group in mental health services, mental health nurses play an important role in delivering these reforms. Chris Beasley said: "Mental health nurses play a vital role in the NHS. Its extremely important that the profession is supported and has a clear direction and sense of its future role. This is why we are working closely with mental health staff and service users to develop a new strategic framework for the profession as it moves into a new era of mental health care. "The context in which mental health nurses work has changed in recent years as a result of government reforms, lessons from serious incidents and the new professional roles that have grown across the health and social care system. The time is right to take stock of what these mean for the profession and to provide mental health nurses with a new direction and clear future role in order to deliver government reforms such as the Mental Health Bill, personalised care and choice. "As mental health nursing improves, service users will see the benefits." Professor Louis Appleby, National Director of Mental Health, said: "Mental health nursing is an essential component in our plans to continue to improve mental health services. The CNO Review will provide an excellent opportunity to look at how nursing can best contribute in the context of changing roles and developing priorities. I am very keen that mental health nurses are able to make the most of any opportunities available to develop their roles and improve outcomes for service users." The Review will consider how mental health nurses can best contribute to priorities such as: Delivering Race Equality Health promotion Child protection Developing non-medical prescribing The review will report by the end of the year. Notes for editors 1. Format of the Review - Formation of a Reference Group to advise CNO. This will include representatives of professional organisations and service users - A broad consultation process to gather the views of service users, mental health nurses and other stakeholders - Following the consultation, a document will be produced by the end of the year. - Dr Neil Brimblecombe, Director of Mental Health Nursing, National Institute of Mental Health in England ( NIMHE ) will be coordinating the Review process. The consultation will include: running open forums, having direct meetings with key organisations and a consultation document asking views about key issues. We are planning to commission a review of published literature to contribute to the review. 2. Mental health nurses are the largest professional group in mental health services with nearly 45,000 qualified nurses working in the NHS in England, and another 30,000 support staff working with them. 3. For media enquiries only please contact Victoria MacCallum at the DH media centre on 7210 5229. Issued by : DOH Press Office, UK story from i-newswire.com

Queen promises mental health reform, UK 25 Nov 2004 The Queen has outlined UK Government plans to reform the UKs current legislation on mental health. The Queens speech to Parliament outlined the reforms proposed in a new draft Bill aimed at improving mental health services. The Mental Capacity Bill hopes to give patients more choice in their treatment by introducing extra-safeguards and increasing sentences for those found guilty of ill-treating people with dementia or severe learning disabilities. The legislation proposes the introduction of so-called "living wills" that would allow patients to refuse treatment as well as a clear assessment for judging whether a person lacks the mental capacity to take a particular decision at a particular time. The bill will also allow those suffering from illnesses such as Alzheimers disease to appoint a relative or friend to take medical decisions on their behalf once their condition worsens. However, some critics have raised concerns that the Bill could be providing the foundation for legalised euthanasia.

Tears before bedtime 29/11/04 by Margaret McCartney Controlled crying aims to turn babies who are poor sleepers into good ones. But a new book suggests that the technique can be dangerous I SPENT THE first year of my first child’s life holding him. If I put him down, he cried. I was irritable and exhausted. I bought all the books and eventually, out of frustration and fatigue, I turned to controlled crying. This, as described in Dr Christopher Green’s Babies!, aims to turn poor sleepers into good ones by leaving your crying child for increasing periods. “The aim is to let them cry for a short period of time, but not long enough to let them get upset or hysterical,” Green writes. But I simply couldn’t do it. My boy seemed to be instantly upset when I left the room, and letting him cry when I could easily have comforted him seemed cruel. He cried, I cried. It felt deeply wrong to have my baby wailing for me yet not respond to him. Yet when all the “Gina” babies I knew were sleeping through for eight hours at a time, I was convinced that, as a mother, I was failing. So I secretly took my baby back into my own bed, accepted that this was how things were, and planned my life around that instead. And, almost imperceptibly, things slowly got better. As a GP I see lots of women who are having a hard time getting their babies to sleep and have resorted, as I did, to the controlled-crying technique. It has become apparent to me that for every controlled-crying success story, there are also lots of parents who admit that they have found it too distressing and given up. And maybe we were right to feel uncomfortable. The Definitive Child Rearing Book, by Margot Sunderland, is based on more than 700 scientific papers, and claims that the technique of controlled crying can be danger- ous. If you persistently leave a child uncomforted, ignoring their distress, Sunderland writes, it can result in brain changes that end up creating a neurotic or emotionally disordered adult. Sunderland has been working with children and their families as a child psychotherapist for 20 years and is now director of training at the Centre for Child Mental Health in London. She feels strongly that we should be working with our parenting instincts more. “For many years we have assumed that the child’s brain is robust. It isn’t,” she says. “Key chemical systems are not yet established after birth — and continued stress can damage, even shrink, part of the brain, the corpus callosum. Magnetic Resonance Scans show a direct relationship between early stress and these brain changes. We don’t yet know how much this will impact on a child in terms of emotional difficulties, but we do know that persistent, uncomforted emotional stress — including smacking — can make these structural brain changes.” The scope of damage that Sunderland believes can be caused by this level of uncomforted distress is marked. She writes that “one in five UK children has or will have a mental health problem; 40,000 children and young people are taking antidepressants; 170,000 people a year, mainly teenagers, harm themselves in despair”. She feels that persistent distress as a child is a major cause. “The key is cell death,” Sunderland says. “Persistent child distress can lead to enduring changes in the autonomic nervous system and alters the responsiveness of the child to stress in the future. Using controlled-crying techniques might seem to work, but we know that around the age of one, children start to be able to ‘bottle up’ their distress. I’m not saying don’t use these techniques, but I am saying that parents need to be aware of the cost. And there is a cost.” While it isn’t possible to extrapolate some of the research that she cites — for example, the effects of stress on Romanian orphans, or studies of maternal separation in infant rats — to the controlled crying of well-cared-for children, it does raise questions about the technique. Sunderland thinks that we should be more responsive and instinctive to our children: “Other mammals don’t want to separate from their children as we do. There are huge benefits from physical touch, which releases our natural opioids and oxytocin. These are key response systems.” But what if the parents are exhausted and controlled crying is the only thing that seems to give them a break? Is this so wrong — can the “damage” become irreparable? “It is only persistent uncomforted distress that seems to be hazardous for brain development. However, there is biochemical repair if you pick up a child and soothe them.” It is normal for babies to cry, says Asha Phillips, a child psychotherapist, lecturer at the Tavistock Clinic and author of Saying No — Why it’s Important for You and Your Child. “They need to cry from time to time,” she says. “But don’t let a baby cry for hours. The problem with controlled crying is that it is not always responsive to what the baby can manage. It is externally imposed by an ‘expert’ and not tailored to your baby. For some it works, for others it distresses them too much.” Phillips doesn’t believe that babies cry because they are “trying it on” or because they are spoilt. “They are expressing the way they feel. It is crucial to listen to what the baby is saying. Crying is one of the ways he communicates. There is no single answer to the different cries. I believe that in certain circumstances it is OK to let a baby express himself by crying. Sometimes it can be his way of dealing with overstimulation, especially at the end of the day, the colicky time. His nervous system is raw and can be overloaded. Crying may be how he lets it all go, almost in a cathartic way. It can be his way of settling himself and self-comforting. At those times, parents trying to rock him or speak to him may increase his difficulties by overstimulating him and interfering with his attempts to recover. A crying baby is not a terrible thing, but an unresponsive parent can be damaging.” Gina Ford goes further: “Babies should really cry only seldom or not at all. That is the whole point of my book — using a routine means that babies do not get into the situation where eating and feeding habits have gone so far wrong that you have to use controlled crying. Even then, I would advise controlled crying only as a last resort and where medical professionals have advised it. I don’t think that parents should be panicked by this research. If controlled crying works for you, that’s fine — it doesn’t make you bad parents.” There are lifelong positive effects on emotional development from children reared with tender loving care, says Professor Jaak Panksepp, a psychobiologist at the Falk Centre for Molecular Therapeutics at Northwestern University and author of Affective Neuroscience (Oxford University Press). However, he does not think the latest research means that parents who have used some controlled crying should panic. “A few good cries within a loving environment seems unlikely to harm or permanently modify the develop- ing brain,” he says, “and perhaps it might even facilitate emotional intelligence, as long as the child is comforted soon after real distress begins with a brief period of holding, understanding and loving words, as opposed to ‘stiff-upper-lip-type’ advice.” I know what it is like to endure motherhood as an exhausted, paranoid hell, and I would hate to think that this latest book was going to add to the stress of parenting. The key is to get in touch with our instincts. My children are now 4 and 2 and, it has to be said, join me under the duvet every night by midnight. But it feels instinctively right for me. One of the best lessons I was taught at medical school was simple: if a mother is worried about her child, you should be, too. Doctors are taught that for a reason. The maternal instinct is potent and protective and we should use it, not ignore it. The Definitive Child Rearing Book, by Margot Sunderland, will be published in the new year.

Sexual encounters among patients in UK psychiatric wards are common News-Medical in Healthcare News Monday, 4-Oct-2004 Healthcare providers in psychiatric wards are faced with two conflicting ideas when assessing the incidence of sexual activity. The European Convention on Human Rights emphasizes the individuals "right to respect for the private life," which is generally interpreted as the right for two consenting adults to express themselves sexually. They are also responsible for protecting their vulnerable patients from sexual exploitation and unwanted disease and conception. Dr James Warner of Imperial College London explores the issue in the October issue of the Journal of the Royal Society of Medicine. Previous staff-based reports suggest sexual encounters among patients in UK psychiatric wards is common, but no earlier formal study has been undertaken to provide patient input. Dr Warner and colleagues studied eleven wards at three psychiatric units across West London through patient questionnaires. Ward staff also answered a separate questionnaire about their opinion on likely sexual activity among their patients. The studys findings reveal a "remarkably high" amount of sexual activity on the wards. Dr Warner reports "no relation between length of stay, diagnosis or ward type and levels of invitation," leading to the conclusion that "all patients may be vulnerable to sexual exploitation." He writes, "Although all sexual intercourse was rated as consensual by respondents, some sexual activity was non-consensual." In spite of the no-sex policy instituted on all the wards surveyed, the study found that a variety of sexual acts had been carried out in all eleven wards. Of 100 respondents, ten reported having sexual intercourse, eight without contraception. Six respondents "said the sexual intercourse took place within a long-term relationship established on the ward," and three respondents reported it on more than five occasions. Patients had sexual intercourse in the bedroom, dayroom, toilet and in stairwells and gardens. "No respondents reported having sex with staff members," the author writes. The study concluded that there were 12 incidences of unwanted invitations or actual sexual activities reported, none of them ending in sexual intercourse. "Although this is a relatively small study, it highlights an important ethical and clinical dilemma,” says Dr Warner. He adds, "We were surprised by the high rates of sexual activity reported by patients" and stresses that this "demands attention." For patients that are unable to consent to sexual activity and those detained under the Mental Health Act 1983, sexual activity may be illegal. "Health care providers have an obligation to protect them from sexual exploitation," the article claims. However, for patients who are able to consent, "any attempt at policing sexual activity might violate the European Convention on Human Rights. The problem is that an individual with mental illness may fluctuate in their ability to consent to sexual activity." In addition to these conflicting pressures, "health care trusts may be held responsible if a patient under their care becomes pregnant or develops a sexually transmitted disease." Dr Warner acknowledges the "near-impossible task in balancing the issues" and advises hospitals to revise their policies and "ensure that condoms and contraceptive advice is available."

Hospital autism detention From BBC news The European Court of Human Rights has ruled his detention was wrong The detention of a man with autism under common law was a breach of his human rights, the European Court of Human Rights has ruled. The decision could have implications for people with dementia and learning disabilities who have been admitted to care under similar circumstances. The man was detained at a Surrey hospital in 1997 after he was deemed incapable of consenting to treatment. He had no right to appeal, unlike if he had been held under the Mental Health Act. This ruling says it is wrong and denies a person their liberty Solicitor Robert Robinson The common law allows a single doctor to recommend the detention of patients incapable of consenting to treatment if it is in their best interests. Under the Mental Health Act, patients are entitled to appeal to a tribunal for release. Detention But no such entitlement exists for the thousands of people admitted to hospitals and nursing homes under common law. As the man, known as HL, cannot speak, his legal team argued he was incapable of resisting detention and it was against his right to liberty under the European Convention of Human Rights. Mr Ls solicitor Robert Robinson said the decision could have "huge implications" for the UK. "When people are admitted to hospital under common law, doctors will have to consider whether people are being detained. "The key is whether they are actually detained rather than just admitted under the common law. "If they are detained, this ruling says it is wrong and denies a person their liberty." It is more costly and time consuming to admit people under the Mental Health Act and some families prefer patients to be treated under common law because of the stigma associated with detention on mental health grounds. Behaviour Mr Robinson said the carers, a family who have looked after Mr L since 1994, were delighted at the decision. "It has taken a long time and been heard by four different courts, the family are obviously pleased at the result." No damages were awarded. Mr L was admitted to Bournewood hospital in July 1997 after staff at a day centre became worried about his behaviour. He was released after nearly five months following a Court of Appeal challenge by his carers. The court ruled his detention was unlawful but the House of Lords overturned the decision in 1998. In 2001, the Health Service Ombudsman found there was no justification for detaining Mr L.

Seroxat and Prozac ****Sarah Boseley, health editor Tuesday September 21, 2004 The Guardian**** +++Doctor who found suicide risk says experts ignoring danger+++ Evidence that antidepressant drugs like Seroxat and Prozac could make people homicidal is being ignored by the body responsible for regulating medicines in the UK, a leading expert said yesterday. The charge came from David Healy, an expert on psychiatric drugs from north Wales whose warnings that the drugs could cause suicide prompted a major inquiry. That investigation, by an expert working group of the Medicines and Healthcare Products Regulatory Authority, led to the entire class of drugs except Prozac being banned last year from use in children. The expert working group has gone on to look at suicides in adults taking any of the drugs known as SSRIs (selective serotonin reuptake inhibitors). But Dr Healy says that they are overlooking very important data relating to a set of further dangerous side-effects. Dr Healy, director of the north Wales department of psychological medicine, says he has seen data from the clinical trials that show even some healthy volunteers - people with no illness at all volunteering to take part in the earliest safety trials of the drugs - became unaccountably aggressive. Their reaction is coded as "hostile" which can include homicidal behaviour and serious aggression. "I think there is very clear evidence for all of the SSRI group of drugs that in addition to making people suicidal, they can make people homicidal or seriously aggressive and the data have been sitting in the MHRAs files on this issue," he said. "It is there for children across a range of different problems, it is there for healthy volunteers and a range of adults and the MHRA has paid no heed to this." Advertiser links Internaxx, International Investing Internaxx offshore broker. Real-time access to major stock... internaxx.lu Trade Your Own Foreign Currency Account Invest in the global foreign exchange markets with Gci. Try... gcitrading.com Welcome to ING Direct Our hassle free, no catches savings account offers everyone... ingdirect.co.uk The healthy volunteer trials of the British drug Seroxat took place in the late 1980s or early 1990s. Of the 271 fit and well individuals, three became hostile, compared with none on an inactive placebo - a rate of 1.1\%, which although small could translate to very many cases among the 50m worldwide who have taken Seroxat over the last 15 years. The signal from the healthy volunteer trials is supported by data from trials in children on Seroxat for obsessive compulsive disorder (OCD), depression and social phobia. Children taking part amounted to 738 on Seroxat and 647 on placebo. Of those, there were 27 hostile events on Seroxat and only four on placebo. Taking the children with OCD alone, those on the drug were 17 times more likely to become aggressive than those on placebo. Trials of Seroxat (known generically as paroxetine) for women with pre-menstrual syndrome show a similar pattern, with five hostile acts on the drug and none on placebo. But, says Dr Healy, the MHRA officials appear not to have picked up the signals from all the separate trials and are failing to see the whole picture. A number of cases where people have argued their aggressive acts were due to one of the SSRI antidepressants have come to court. In the most dramatic, a US jury in 2001 found that GlaxoSmithKlines drug was partly responsible for the murders committed by Donald Schell. After two days on Paxil (as Seroxat is named in the USA), Schell killed his wife, his daughter and his baby granddaughter before shooting himself dead. GlaxoSmithKline was ordered to pay $8m (£4.5m) to the remaining family members. GlaxoSmithKline last night denied that its drug caused adults to become hostile, although it acknowledged there had been a problem in the childrens trials. "There is no compelling evidence from our clinical trials that Seroxat causes hostile behaviour in adults. When you put the results from all the clinical trials together there is no difference between the rates of hostility for adult patients taking Seroxat and the patients taking placebo, or dummy pill. This data has been shared with regulators including the MHRA," said a spokesman. The MHRA said yesterday that the working group had looked at the data on events coded as "hostility" in its analysis of the childrens trials and that it had acted to prevent the use of most SSRIs in children as a result of all the data, including that on hostility. "The review of adult data is ongoing," it said.

RCGP response to "Doctors could spot murderers" story, UK 24 Sep 2004 Dr Alan Cohen, Royal College of General Practitioners (RCGP), UK, mental health spokesperson, said: “The RCGP would encourage GPs who have concerns about the suicidal or homicidal risks of patients to seek the advice of specialist mental health services and where appropriate have a Mental Act Assessment undertaken. It is extremely difficult to predict whether patients with serious mental health problems are at risk of committing homicide or even suicide. We do not support the idea of informing the police immediately.” For more information please contact Heather Whitney at the RCGP press office on 020 7344 3137 or Dan Stern on 020 7344 3136 or email press@rcgp.org.uk. Out of hours contact number 07885 958632.

Britain: dramatic increase in self-harm by children By Liz Smith 23 September 2004 A new report shows the rate of self-harm in Britain has increased over the past decade and is among the highest in Europe. The First Interim Inquiry Report into Young People and Self Harm in the UK being conducted by the Mental Health Foundation (MHF) and the Camelot Foundation is based on evidence submitted by young people and parents/carers with experience of self-harm, as well as professionals working in mental health, researchers and academics, etc. The inquiry is ongoing so that those working in the field of young people’s services may submit evidence to further inform the inquiry over the next 18 months. The interim report describes a wide range of things that people do to themselves in a deliberate and usually hidden way that are damaging, but focuses on three main areas: * Cutting behaviours * Other forms of self-harm (e.g., burning, scalding, banging, hair pulling) * Self-poisoning It states, “More than 24,000 teenagers are admitted to hospital in the UK each year after deliberately harming themselves. Most have taken overdoses or cut themselves. Additional figures from the same study estimate that 1 in 10 teenagers self-harm.” The report makes clear that statistics on self-harm are unreliable for a number of reasons: “Firstly, many incidents of self-harm will be treated at home and will not reach the attention of services or professionals. Secondly, the incidents that do reach [accident and emergency] services are predominantly cases of self-poisoning and therefore only account for a small sub-population of young people who self-harm. Finally, figures on self-harm are confusing as the definitions of self-harm used vary across the different research.” ChildLine, which provides a free, confidential, 24-hour telephone helpline for any child or young person with a problem has also just released its latest findings on self-harm. Last year, 3,345 (3,032 girls, 313 boys) children and young people talked to ChildLine about self-harming. Of these, 80 percent talked about other problems in their lives. Forty percent spoke about tensions within their family—for example, separation or divorce, or maltreatment—and 14 percent said they were experiencing symptoms of depression or had other mental health problems. ChildLine also receives calls from children and adults who are concerned about a young person they know. In 2002/2003, nearly 800 people (children and adults) contacted ChildLine because they were worried about a child they suspected or knew to be self-harming. Over the last 10 years, the number of children disclosing self-harm to ChildLine’s counsellors has increased steadily, but has dramatically increased by around 65 percent in the last two years. The report points out that this increase can be attributed in part to recognition of the problem, self-diagnosis by young people and better identification. But even given this, there are clear indications of worsening mental ill-health caused by the pressures that young people face. Since ChildLine was established, it normally hears from 4 times as many girls as boys. However, the gender ratio shifts considerably when self-harm is disclosed: 12 times as many girls as boys are counselled about self-harm. The picture is similar when taking into account those who contact ChildLine for their friends. Of the 70 percent of those who disclosed their age to a counsellor about all problems, a quarter were 5-11 years old, just over 60 percent were 12-15 years old, and the remaining 17 percent were 16-18 years old. Of the majority who talked about self-harm, 62 percent were aged 12-15 years old. Cutting is the most common form of self-harm disclosed by young people calling ChildLine. In the personal testimonies given, two main themes emerged. Callers often disclose anger and frustration at their situation, with self-harm providing their only outlet for this emotion. As with other mental health problems (e.g., eating disorders, depression, and suicidal thoughts), children who self-harm also talk about a loss of control over their lives, and state that by inflicting injury and pain on their bodies they gain a sense of control and personal ownership. Callers often disclose a “trigger” or circumstance that led them to begin self-harming. In some cases this is prompted by bullying, or other incidences connected to education or schooling. But the majority of callers raise family relationships as their main trigger. Experiences such as pressure from parents to do well in exams and marital breakdowns were cited as some of the reasons given to counsellors. Others spoke about grief, family crises and sexual abuse. Some of the young people acknowledged their parents were aware of the cutting. But the young people who are self-harming not only see this as a coping mechanism, but as an alternative to seeking support and advice from professionals. This aspect was highlighted by Dr. Carole Easton, chief executive of ChildLine, who said, “The experiences of ChildLine’s callers highlight the need for directly accessible, widely available and well-resourced child and adolescent mental health services.” The report makes clear that the trigger factors alone should be seen in context, because clearly not all teenagers deal with pressures in the same way. Based on previous reports the initial inquiry shows that young people who self-harm are more likely to come from “certain sub-populations that have a much higher likelihood of having direct experience of self-harm compared to the general population.” For example: * Young women, who are three to four times more likely to self-harm than young men * Young people in prisons, in particular young women * Young Asian females * Individuals in other institutional settings such as inpatient psychiatric units. Within all of the literature previewed, only one paper specifically investigates self-harm within the inquiry’s age range of 11-25 years. The vast majority of the literature spans late adolescence through to middle adulthood (i.e., 16+ years). The report cautions that whilst there has been an expansion in Child and Adolescent Mental Health Services in recent years, there has also been an increase in the voluntary sector and the use of untrained staff. It warns that “there is a tendency to believe that any kind of counselling/therapy, even from an untrained worker, is better than none. For ‘talking therapies’ to be beneficial to the young people with experience of self-harm it must be carried out by appropriately trained staff, and must be focused on the problems or issues that the young people want to address. There is a need for staff to be knowledgeable and trained in the issues around self-harm specifically and to be engaged with the young person about what else is going on in their lives when addressing their self-harming behaviour.” Additionally, the report points out that if the young person attends hospital, which they do only if they need treatment, the majority of interventions are carried out from a medical and not a psychosocial standpoint. Thus far, the young people who have submitted evidence to the inquiry have spoken about the negative experiences when they engaged with services for support.

Voluntary Work "Can Ease Stress and Depression" By Community Newswire reporter Doing voluntary work could help the 12 million people in the UK who suffer from mental health problems to combat stress and depression, campaigners have claimed today. A survey for Community Service Volunteers (CSV), a leading volunteering and training organisation, found that half of those who had volunteered for more than two years (48%) said it made them feel less depressed. The poll of more than 600 volunteers also found that 63% of 25 to 34-year-olds and 62% of over-65s said volunteering reduced stress levels. The research came ahead of CSV Make A Difference Day on Saturday, October 30, when around 100,000 people are expected to give their time to help improve their local communities. CSV said that volunteering had also been shown to have a big impact on work-related stress, which affects around five million adults in the UK and costs society an estimated £3.7 billion a year. The poll also found that 71% of volunteers who offered their professional skills and experience said volunteering helped combat depression. Almost a third (31%) of 18 to 24-year-olds also said they had taken less time off work since starting to volunteer. TV health pundit Dr Hilary Jones, a supporter of the CSV campaign, said: “Nearly half of regular volunteers say that volunteering makes them feel less depressed. “It’s clear that keeping physically and mentally active can often improve your state of mind. “The research indicates that volunteering might help achieve this, especially if it’s done on a regular basis.” Earlier findings released in the summer showed that volunteering also helped improve health and fitness, particularly among young people. More information about CSV Make A Difference Day is available at www.csv.org.uk/difference.

Report reveals mental health abuse ----Sep 7 2004---- A climate of fear, harassment and abuse exists on many mental health wards in England and Wales, a new report claims. Many patients are still forced to stay in mixed-sex wards, despite Government pledges to phase them out, adding to their sense of unease, according to the Ward Watch report by Mind. The mental health charity today launched a campaign to improve conditions in hospital for such patients, delivering their message direct to Downing Street. Some 38,000 people in England and Wales will spend time in hospital with mental health problems every year. For their report, Mind asked more than 400 current and recent mental health patients about their experiences of the hospital environment. They found that almost a quarter - 23% - had been in mixed-sex accommodation, despite Government reassurances two years ago that such wards would be eliminated. The report said that those patients in mixed-sex wards had greater concerns about their safety and said it compromised their privacy and dignity. Over a quarter of those questioned (27%) said they rarely felt safe while in hospital, and only one in five said they felt they were treated with respect and dignity by staff. Almost a quarter of patients said they had been physically or verbally threatened during their stay in hospital, with 20% reporting a physical assault. And 7% of patients said they had been harassed or assaulted by staff. More than half of patients said the hospital surroundings had not helped them recover, and a third thought they had made their health worse.

Mental until proven innocent ---by Ken McLaughlin--- The UK governments draft Mental Health Bill is the latest attempt to reform mental health legislation (1). A previous version of the Bill was published in 2002, and attracted widespread criticism from psychiatrists, service users, campaign groups and civil libertarians. The government claims that it has addressed many of the concerns about the previous draft, with health minister Rosie Winterton saying that "Patients in the community who are ill and vulnerable or at risk will now be able to get the treatment they need" (2). Two proposals attracted most criticism in 2002, with the recent modifications unlikely to appease critics: plans to allow compulsory community treatment orders, and measures that would allow those with a personality disorder who are considered dangerous to be detained indefinitely, even if they had not committed a crime. According to Winterton, the aim is to ensure that "The small minority of people with mental health problems who need to be treated against their wishes...will get the right treatment at the right time" (3) - something that the government believes the present Mental Health Act (MHA) is failing to do. Under the present Act, patients can be given medication against their will if they are detained under the Act in hospital. However, once discharged they regain the same right to refuse medical treatment that most of us take for granted. And given the often severe side-effects anti-psychotic medication can cause, many patients unsurprisingly exercise this right and stop taking their medication. It is argued that patients failure to continue with medication allows them to become ill again and commit acts of violence. The new Bill will grant professionals powers to ensure "non-resident" patients take their medication after discharge from hospital. Prolonged involuntary detention in hospital, as the law currently stands, requires that the patients mental disorder is deemed "treatable". Many psychiatrists view personality disorder as untreatable, the patient being "bad" rather than "mad" and therefore unresponsive to medical input. According to the government this "loophole" leaves dangerously disordered people free to roam the streets committing random acts of violence and homicide. The case of Michael Stone, jailed for the murder of Lyn and Megan Russell, is often cited. Considered dangerous and severely personality disordered but untreatable, Stone fell outside of the remit of the current MHA. The new Bill will close this loophole with a masterstroke of New Labour speak. Rather than the patients mental disorder being deemed "treatable", professionals need only think it "clinically appropriate" to instigate proceedings allowing indefinite detention. Not surprisingly, such moves have sparked fierce criticism from service users and mental health campaign groups. But many psychiatrists are also hostile to the new Bill. According to the president of the Royal College of Psychiatrists: "the Bill will extend use of compulsory powers to a wider group of patients than is medically necessary, thus putting pressure on psychiatric services, and infringing human rights." (4) The Law Society shares these concerns about human rights, and is also worried that the definition of mental disorder in the new Bill is too broad, containing as it does the potential for epilepsy or even being drunk to be counted as mental disorders (5). Angela Gregory of the Sainsbury Centre for Mental Health believes that mental health professionals were being put under pressure to "detain many more people and compel them to take treatments that do not benefit them" (6). The human rights and civil liberty implications of the new Bill are concerning. Take indeterminate detention. While convicted murderers are already subject to an indeterminate "life" sentence, it is an entirely different matter to impose such a sentence on someone merely on the basis that mental health professionals think they will offend at some point in the future. The proposal would allow people to be locked up indefinitely, not for what they have done but for what they might do - not for treatment but because it is deemed "clinically appropriate". With risk assessment and the prediction of dangerousness notoriously unreliable, how many people who may never harm anyone need to be detained to ensure one Michael Stone is caught? And if people are considered well enough to be discharged from hospital, surely they are well enough to make decisions as to what, if any, medical treatment they receive? As I have pointed out previously on spiked, a diagnosis of major mental disorder is less of a predictor of violence than being young, male, substance abusing or substance dependent - and non-compliance with medication is over-emphasised as a contributory factor in acts of homicide (7). Nevertheless, the government seems set to push through the mental health equivalent of the pre-emptive strike. With so much opposition to the plans, and so little evidence that the measures will work, it is worth questioning how such a situation has arisen. The government is responding, at least in part, to several high-profile tragedies involving ex-patients. Campaigning groups such as the Zito Trust, set up by Jayne Zito after her husband was killed by a psychiatric patient, have lobbied extensively over what they perceive to be the failings of care in the community. Given the current high status accorded to victims today, the government finds itself under increasing pressure to respond. However, the governments ability to push through legislation that would have been unthinkable 10 or 15 years ago is also partly due to those groups campaigning against the current proposals. It is groups such as the Mental Health Foundation and MIND that have exaggerated the extent of mental health problems - arguing for a broader range of issues to be seen as psychological problems, and opening up our personal lives to professional scrutiny and intervention. And while mental health organisations may abhor its more extreme manifestations, they have played a major part in extending psychiatric control from the hospital to the community. Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University. He writes here in a personal capacity.

Reforms pledged on mental health of children ****John Carvel and Rebecca Smithers Tuesday September 14, 2004 The Guardian **** The government last night pledged fundamental reform of childrens mental health services after the Guardian published evidence of a sharp increase in emotional and behavioural problems among teenagers. The health secretary, John Reid, will tomorrow announce plans to provide 24-hour access to psychiatric services for the seriously disturbed and more help for troubled children through schools and local authorities. The Children and Adolescent Mental Health Service (CAMHS) will be instructed to include 16 and 17-year-olds, who have previously been treated as adults, and hospitals will be told that it is no longer acceptable to admit young people to adult wards. The initiative comes in response to mounting concern about the deterioration of teenagers mental health over the past 25 years. A study due to be published in the Journal of Child Psychology and Psychiatry in November - reported in the Guardian yesterday - said the proportion of 15-year-olds with behavioural problems had doubled in Britain over the past 25 years. The proportion with emotional problems such as anxiety and depression has increased by 70% over the same period. The scientific study appeared to confirm the experience of charities working with troubled children. Last week the Mental Health Foundation reported that more than 24,000 teenagers a year are admitted to hospital in the UK after deliberately harming themselves. The charity ChildLine said the number of children disclosing self-harm to its counsellors had increased by 65% in the last two years. Advertiser links Use Your Car to Get a Loan Simple, fast loans from LogBookLoans. Unlock the money in... logbookloans.co.uk Auto Loans - Dial4Aloan Borrow from £2,000 to £250,000. Competitive secured loan... dial4aloan.com Any Purpose Loans for UK Homeowners Borrow £5,000 to £100,000 at rates from 6.9% Apr. Instant... loansdirect.org.uk Louis Appleby, the governments mental health tsar, said the childrens mental health budget would increase by £300m over the three years to 2005-06, mostly through extra local authority services. Although the government was cautious about the figures in the latest research, it accepted there was a consensus among academics that adolescents mental health was deteriorating. Mr Appleby said about 2% of 11-15-year-olds were depressed and 5% had emotional problems such as anxiety and phobias. About 3% of girls and 8% of boys in this age group have conduct problems, such as aggressive behaviour. The Association of Directors of Social Services said it was concerned that the CAMHS service was not available until children had severe symptoms needing intensive psychiatric care. The document expected to be published tomorrow will establish new guidelines for the NHS, local authorities, schools and training providers to work closely together to refer children to where they can get the most appropriate help. The emphasis will be on training everyone involved with children to recognise mental health problems but refer only a minority to specialist mental health services. Education experts yesterday pointed to a link with the pressure heaped on youngsters as a result of tests and exams. A spokesman for the Department for Education and Skills said: "All examinations are designed to be appropriately challenging for candidates. Exams can be stressful for some students, but teachers will use their professional judgment to counsel and advise their students."

New agreement between NHS and voluntary sector, UK 20 Sep 2004 ----Charities and the voluntary sector will play a bigger role in delivering NHS and social services as the result of a pioneering agreement signed today. The sector will supplement an already expanding NHS capacity. Under the new Strategic Agreement between the Department of Health, the NHS and the voluntary and community sector (VCS) will have an even more central role in supporting and providing NHS services. Increasing the role of the voluntary sector will both increase capacity and give patients and others a wider choice of services to meet their individual needs. Launching the Strategic Agreement, Health Secretary John Reid said: "This agreement makes it easier for the voluntary and community sector to provide services for the expanding NHS. The NHS is expanding more quickly than ever before and today’s agreement helps further supplement that expansion. The value of the voluntary and community sector to the work of health and social care services cannot be underestimated and thats why this Agreement is so important. It adds to the diversity of provision. It is a major building block in how we deliver our commitment to personalise NHS and said care services to meet the differing needs of every individual." A National Strategic Partnership Forum will have responsibility for reviewing how the Agreement is working, supporting local partnerships in lowering barriers between the NHS and the VCS and it will pull together best practice and innovation from across England and help disseminate it throughout the health and social services. Current best practices include: -- the British Red Cross working with the NHS to support patients leaving hospital to help them settle quickly when they get home, -- NHS Direct working with the Coalition for Cancer Information to "kitemark" for quality information being made available to patients, -- Local social services working with Age Concern and the Help the Aged to help service users make the most of direct payments which allow them to purchase the services they know best suit their needs. -- Brent Primary Care Trusts Patient Advice and Liaison Service working with Brent Association for Disabled People. A PALS officer holds information and advice surgeries with the help of a British Sign Language interpreter to improve access to the local deaf community. -- Turning Points crisis services in Manchester work with local health and social services to help people with mental health problems stay out of hospital. Sir Nicholas Young, Chair of the Making Partnership Work and Chief Executive of the British Red Cross, said: "This welcome agreement is a landmark step towards a real working partnership between the voluntary sector and health and social care commissioners. It is recognition of the hard work of the voluntary sector and of our potential contribution at the heart of service planning and provision. It will help us all work better together. "In the UK the Red Cross currently has some 200 health and social care contracts. Organisations like ours are able to respond flexibly and innovatively to users needs. This agreement recognises the unique added value voluntary organisations bring to the mix of modern service provision in local communities. "I commend this agreement to every agency that has a stake in health and social care provision, and I urge them to support the work of the new Forum that will oversee its implementation. It is vital that the Forum be an influential body that encourages good working relations at a local level." Lord Victor Adebowale, Chief Executive of Turning Point, said: "This is a vital step in enabling the not for profit sector to play its full role in providing health and social care services. It is in line with the growing reality of a professional, vibrant £20 billion sector that is tackling some of the most difficult health issues across the UK. "This agreement will give us a powerful voice in shaping health and social care policy, and a formal way of alerting the NHS to gaps in their services or problem areas affecting the most vulnerable. Crucially, it will allow us to start to standardise contracts and partnership arrangements, freeing up time and money that will be better spent on delivering effective services to the people who need them most." Chief Nursing Officer Sarah Mullally said: "Making Partnership Work for Patients, Carers and Service Users signalled a joint commitment with the NHS and voluntary sector leaders to work constructively together to optimise the voluntary sector contribution to a genuinely patient-centred health service. Through the development of the Strategic Agreement between the Department of Health, the NHS and the Voluntary and Community Service we will strive to promote and support joint working with the voluntary and community sector at local level through progressive, dynamic and innovative partnership." Notes to editor 1 The National Strategic Partnership will be in place in by November 2004. 2 The Strategic Agreement is designed to complement the Compact and its Codes of good Practice at all levels of partnership work. 3 Copies of the Strategic Agreement are available from the link provided. Press Office For further information please contact Department of Health media centre on the number provided: Contact Press office Phone Media centre (UK) 020 7210 5231

Hostels plan for high-risk paedophiles faces storm (Sandra Laville Friday September 10, 2004 The Guardian) --------Attempts to build treatment hostels for 100 high-risk paedophiles in England and Wales could be countered by years of protests, the government was warned yesterday. The Home Office has begun identifying sites for up to five residential units for the most dangerous child sex offenders in the community, it was announced yesterday. Ray Wyre, an expert who works with sex offenders, said it would be incredibly difficult for the centres to be built. "Intellectually they [government officials] will try and persuade a community of the benefits, but emotionally they will have big problems. I think there will be huge opposition, long running judicial reviews and it will be very difficult." Two years ago the only residential treatment centre in the country, Wolvercote in Epsom, Surrey, closed after a vigorous campaign. An attempt to open a similar one at Silverlands near Chertsey, Surrey, was defeated after £2.4m had been spent on the project. In a bid to avoid confrontations it is understood that the government is planning to build the first of the units, which will treat up to 25 paedophiles, in the grounds of Rampton high security hospital, Nottinghamshire. The strategy is the result of years of debate and planning after the outcry in the late 1990s at the release of notorious paedophiles such as Sidney Cook, and concern at the numbers of sex offenders in probation hostels. Sex offenders are estimated to account for 40\\\% of the 2,500 people in the 101 hostels in England and Wales. Advertiser links NatWest E-Savings Account Looking for attractive interest rates and instant access to... natwest.com Sainsbury's Bank Direct Saver Account Make the most of your hard earned savings with tiered rates... sainsburysbank.co.uk Welcome to ING Direct Our hassle free, no catches savings account offers everyone... ingdirect.co.uk Paul Goggins, the prisons minister, promised that the government would work with local communities and be open about the location of units. "We face a dilemma," he said. "We know that local communities are afraid ... but we know that we can reduce reconviction rates and therefore make our society a safer place." Childline, the charity which works with victims of child abuse, welcomed the plans. "Work at Wolvercote clinic showed that treatment of convicted sex offenders is effective in significantly reducing the risk that offenders pose," said Natasha Finlayson, its director of policy and communications. "Sensitive siting of any new treatment centre is vital and every measure must be put in place to ensure that the safety of children is paramount." But Phoenix Survivors, a group which offers counselling, support and advice for child victims and their families, called for the government to put as much effort and money into treatment centres for victims of child sex abuse. The group has been refused funding by the Home Office for a specialist centre and is struggling to continue its work. "We should be opening five treatment centres for victims and five for perpetrators," said Shy Keenan, who runs Phoenix Survivors. Mr Wyre backed her view. He said the government had to convince the victims of the benefits of its plans. It would be astute to fund a model treatment centre for survivors of abuse alongside the plans for units for offenders. A spokesman for the Home Office said the government was putting money into schemes for victims. Last April it announced that £4m from recovered proceeds of crime, would be directed towards community-based groups supporting victims of sex crimes. "We have to do both things: stop reoffending, so there are fewer victims, and support those people who are victims."

Attention disorder has physical cause (By Charles Arthur 09 September 2004)------ Children with attention deficit hyperactivity disorder are four times more likely than average to suffer mental problems in later life, researchers have found. They said ADHD was a physical disease and there was a difference between the disorder and ordinary bad behaviour. Professor Eric Taylor of the Institute of Psychiatry in London told the British Association of Science that not enough children with the disorder were being medicated. He said 1.4 per cent of British children - about 70,000 - had acute or "hyperkinetic" ADHD, which should be treated with drugs such as Ritalin. Only one-third of them were receiving the drug, which improved their ability to concentrate, he said. In the US up to 6 per cent of children are receiving it. A further 3.4 per cent of British children, 180,000, had a milder form of ADHD, which could be treated with psychiatric methods, he said. His studies found that bad parenting was not the cause of ADHD, although a "chaotic" lifestyle could be a trigger for the pattern of bad behaviour typifying ADHD, which Professor Taylor described as being "impulsive, inattentive, disorganised and [emotionally] volatile". Ignoring the problem could have serious repercussions, he said. ADHD sufferers were four times more likely to suffer mental illness, including manic depression, and engage in antisocial behaviour. "Brain scans show that people with ADHD have less development of the right frontal lobe, parts of the cerebellum, and the basal ganglia. Its not a problem that depends on the society; the Chinese and South Africans have reported it." ADHD was not a purely negative condition, Professor Taylor added. "Billy Connolly has identified himself as having it, so has Robin Williams."

Alcohol Abuse May Follow Onset of Eating Disorder (Thu 9 September, 2004 16:23 By Amy Norton NEW YORK (Reuters Health))-------- Its known that women with eating disorders often abuse alcohol, but new research shows that its typically the eating disorder that arises first -- and that women with certain personality traits may be prone to having both problems. Researchers found that among 672 women who had ever suffered an eating disorder, 253 had abused alcohol at some point in their lives. Only one-third had developed their drinking problems prior to the eating disorder. Understanding such "patterns of onset" is important in the treatment of eating disorders and alcohol abuse, according to lead study author Dr. Cynthia M. Bulik, of the University of North Carolina at Chapel Hill. For example, she noted, eating disorder treatment programs may need to pay more attention to the risk of a patient having an alcohol problem. The study, reported in the Journal of Clinical Psychiatry, also found that certain personality traits -- including impulsivity and perfectionism -- were associated with the odds of having both an eating disorder and an alcohol problem. Past research has noted a high prevalence of alcohol abuse among women with bulimia, an eating disorder marked by bouts of binge eating followed by purging, fasting or excessive exercise. Likewise, Bulik and her colleagues found that women with bulimia or anorexia with bulimia-like bingeing were much more likely to abuse alcohol than were women with classic anorexia. Overall, 46 percent of bulimics in the study had abused or been dependent on alcohol at some point in their lives. That figure was nearly 38 percent among women with anorexia marked by binge eating. Using standard tests of personality, Bulik and her colleagues found that women who abused alcohol had a tendency toward impulsive behavior, but also perfectionism; they showed more concern over their mistakes, and perceived more criticism and higher expectations from their parents than women without alcohol problems did. According to the study authors, these findings "mirror the clinical observation of both overcontrol and dyscontrol" often seen in patients with both eating disorders and drinking problems.> Women who abused alcohol were also at greater risk of anxiety disorders and depression. Anxiety commonly goes hand-in-hand with eating disorders, and its possible, according to Buliks team, that for some women, alcohol provides an additional way -- besides food restriction -- to deal with that anxiety. Bulik noted that the personality traits pinpointed in this study could prove useful in identifying eating disorder patients at risk of alcohol problems. "When you see a patient who is particularly anxious or impulsive, your antennae should be on higher alert for the presence of alcohol use disorders," she said. SOURCE: Journal of Clinical Psychiatry, July 2004.

Edinburgh schizophrenia breakthrough Using imaging software, doctors at the Royal Edinburgh Hospital and Edinburgh University have identified changes in the brain that predispose people to develop schizophrenia later in life. The development is being hailed as a breakthrough in the early detection of schizophrenia that could lead to far more effective treatments, and possibly even prevention of the condition. It’s been known for years that there is a heavy genetic component in at least half of all cases of schizophrenia. As in some cases of cancer, a number of genes in combination with environmental factors are likely to be responsible. It has also been known for some time that relatives of schizophrenia sufferers are statistically more likely to develop the condition themselves. Full story in bjhc&im Sept 2004 (570 words)

Study links schizophrenia to stress (By Amanda Dunn Health Reporter September 9, 2004)~~~~~~~~~ Stress hormones may be responsible for brain changes in people with schizophrenia, Melbourne research has shown. In a world-first study of 18 to 24-year-olds at high risk of developing a psychotic illness, researchers at the Melbourne Neuropsychiatry Centre and Orygen Research Centre have found that those who develop schizophrenia have a larger pituitary gland at the base of their brains than those who do not develop the illness. This was also true for those who developed psychotic depression. Psychotic disorders such as schizophrenia are more likely to become apparent in early adulthood than at any other stage of life. Melbourne University neuropsychiatry professor Christos Pantelis said the hormone cortisol, which is active in response to stress, could damage the brain. "If its sustained (cortisol) for a long period, or if it (the brain) is sensitive to its effects, then it may be damaging to the brain," he said. Earlier work by the group, using magnetic resonance imaging, and published in The Lancet in 2002, showed that changes to the hippocampal region, a part of the brain important in memory, emotion and behaviour, occurred in young people in the early stages of schizophrenia. Professor Pantelis said an enlarged pituitary gland, releasing high levels of cortisol when symptoms of the illness first appeared, might explain why those changes occurred. The hippocampal region has also been shown to be affected in major depression. Depression did affect those with psychotic illnesses and "cortisol has been linked to depression for a long time", Professor Pantelis said. He released the findings yesterday at the opening of the Melbourne Neuropsychiatry Centre at the Royal Melbourne Hospital. While it was not yet clear if the enlarged pituitary gland was a cause or an effect of the brain changes observed, Professor Pantelis said the onset of psychotic conditions was highly stressful for young people and "they may be more vulnerable to the effects of the stress". I like the notion of the integration of the psychological (stress) and the biological (pituitary gland). DAVID CASTLE, researcherIf the findings on the pituitary gland are confirmed it may be possible to inhibit the production of cortisol and stop its damaging effects. Professor Pantelis hopes the changes seen in the earlier MRI work will also enable researchers to detect changes in the brain at the earliest onset of the condition. David Castle of the Mental Health Research Institute said the initial findings of the team on the changes to the hippocampus were very important. "I think all these things are pushing back the frontiers, really, and I like the notion of the integration of the psychological (stress) and the biological (pituitary gland)," he said. Professor Castle said there was still much to be learnt about schizophrenia, saying the unknown outweighed the known. Professor Pantelis group, with Orygen, is now planning to look at brain changes that might occur earlier in life in those at high risk of psychotic illness.

Depression: Drug v. Talk Therapy (WebMD)~~~~~~~~ Whether its talk therapy or drug therapy, getting help for depression or anxiety helps, Americans say. But one appears to work faster, while the other may be more effective. The survey is a snapshot of the common Americans experience with mental health therapy — and the second such survey published by Consumer Reports. The 1995 report "has been cited in textbooks and is considered a landmark study with worldwide impact," said Joel Gurin, Consumer Reports executive vice president, in a news teleconference Tuesday. "We think this newest study is just as important," he added. "We hope our study will call attention to the need for further research of a large-selling category of drugs, one that millions of people are taking." Gurin said. "Depression, anxiety, and other mental health problems can be as debilitating as any serious physical illness. But there really is not enough information about the risks and benefits of different treatments." During the past decade, "the biggest change ... has been the dramatic shift from talk therapy to drug therapy for mental health problems," he noted. "In 1995, less than half of people getting mental health treatment — 40 percent — got drug therapy. Now 68 percent get drug treatment, and 80 percent of those treated for depression or anxiety get drug treatment." However, the drugs "have some serious side effects ... that seem to be much more common than people realize ... much more common than you might think from seeing drug ads and from reports on drug studies," Gurin said. The link between antidepressants and suicide rates among children and adolescents is "a very serious issue" that both Congress and the FDA are investigating in hearings, he noted. An FDA panel is meeting next week to determine if there is an increase in suicide and suicidal thoughts among kids taking antidepressants. The agency sent out a warning to doctors last year to be on the lookout for worsening depression or suicidal thoughts in these kids. Another problem: "Many managed care programs limit mental health treatment to 10 sessions... which may deprive people of the treatment they need." Drug Therapy vs. Talk Therapy Researchers based the report on surveys completed by more than 3,000 Consumer Reports readers, and is published in the magazines October issue. Specifically, it shows that: A combination of talk therapy and drugs worked best for treatment of depression and anxiety. But those whose treatment consisted of mostly talk therapy did almost as well if they had 13 or more visits with the therapist. Treatment consisting of mostly drug treatment was also effective for many people. Drugs had a quicker impact on symptoms than talk therapy, but it often took trial and error to find a drug that worked without undesirable side effects. More than 50 percent of survey respondents who took antidepressants tried two or more drugs; 10 percent tried five or more. "It really does have to be a process of trial and error ... because theres no predicting peoples response to [antidepressants]," says Nancy Metcalf, a Consumer Reports senior editor and author of the survey. Side effects were much more common than noted on the medications package information: 40 percent said they experienced a loss of sexual interest or performance, and almost 20 percent said they gained weight. Why the discrepancy? In clinical trials, people are not asked specifically about certain side effects, Metcalf tells WebMD. "They were expected to volunteer the information, and they may not be as willing to do that." Treatment from primary care doctors was effective for people with mild problems, but less so for people with more severe ones. Treatment by mental health specialists yielded significantly better results for people who started out in poor shape. Health insurance plan limits on therapy visits and costs kept some people from getting the best treatment. Consumers who did their own research and monitored their own care reported better results. More than 80 percent of survey respondents said they found treatment that helped. Another finding: Nearly one in five people said their health plans dont cover mental health. "Thats an odd statistic to us, because we know that almost all employer-provided health care plans have mental health coverage," says Metcalf. "Either people were too shy to seek reimbursement or were having trouble accessing it." Many Routes to Good Care "What comes through overall — there are many routes to good care, but it takes flexibility and persistence to get there," says Metcalf. "The more committed to your own care, the better off you will be — whether that means finding a different therapist, cutting through red tape with your mental health coverage, or applying what you learn in therapy to your life." "Some companies do whats called a "carve-out" mental health coverage, which means they contract it over to another company," she tells WebMD. "If you call the 800 number on your health plan card, you may get someone who does not know very much about your mental health coverage. Thats where persistence pays off. You really need not give up until you find someone who knows about your health plan. Mental health coverage is often very different from health coverage." Important note: Under the Americans With Disabilities Act, an employer cannot discriminate against an employee getting mental health care, Metcalf adds. "There are also restrictions as far as how much information your therapist can turn over. Your health care plan knows about drugs you are taking, and very generally about your condition. But they do not have access to personal notes made by your doctor — the most private information. That is legally protected." Also encouraging is "there has been a lot of effort in the last five or 10 years to bring primary care doctors up to speed about depression, and either treat [patients] or refer them to a mental health professional," Metcalf says. "The most important point is to get help somewhere ... and get it promptly." Many types of mental health professionals can provide excellent therapy, she notes. The survey showed that whether they saw a psychiatrist, a psychologist, or a social worker, patients had equally good results. How to choose your therapist? "Its largely personal preference," Metcalf tells WebMD. "Just keep in mind, if you go to see a psychiatrist, you are much more likely to get medication. Psychologists and social workers provide talk therapy ... and they can be more cost-effective if you pay out of pocket, which many of our respondents did." "Many insurers refuse to allow psychiatrists to do anything but prescribe drugs, except for the most severely ill patients," notes Bruce Schwartz, MD, in the report. He is associate professor of clinical psychiatry at Albert Einstein College of Medicine in New York City and one of two consultants who helped design the survey and interpret the results. From CBSNews.com

AZ hit by drug-induced depression (Simon Bowers Friday September 10, 2004 The Guardian)~~~~~~~ Shares in AstraZeneca fell 109p to £25.10 yesterday on news that its potential blockbuster drug offering stroke prevention, Exanta, might face delays in getting American approval. Clinical trial results are being scrutinised by the US food and drug administration, which is due to make a decision this year. A panel of doctors and scientists will quiz AstraZeneca officials about the drug today, on behalf of the FDA. The agenda for the meeting was put on the regulators website yesterday and revealed that FDA staff have highlighted safety and effectiveness issues with the drug. It has potentially negative effects on the liver and the FDA staff highlighted a possible risk of increased heart attacks. Exanta has potential as a blockbuster because the standard drug used now, warfarin, is complicated and has unpleasant side effects. Analysts had been upgrading the stock ahead of an ex pected approval of Exanta. Research out on Wednesday from Lehman Brothers analyst Stewart Adkins warned that the approval of Exanta was already taken into account in the share price, yet there were outstanding safety concerns that might delay FDA approval. In letters to the Lancet journal in February, a succession of scientists questioned the effectiveness of the drug and the design of AstraZenecas clinical trials. Meanwhile, the FTSE 100 index was down 20.4 points at 4538, with much of the drag coming after a profit warning from Compass wiped more than a quarter off its share value. The drop put an end to a three-week rally that took the index from 4300 to four-month peak at 4570 on Wednesday. Elsewhere among blue chip stocks, Bhs boss Philip Greens name was once again linked to J Sainsbury. Persistent rumours of a link with the man who tried and failed to take over Safeway last year came as Sainsburys shares rose 7.75p to close at 277p. This despite a stinging report from credit rating agency Standard & Poors describing Sainsburys as having "strong pressure on market share ... lesser operating efficiency [than rivals] and inadequate price positioning". Among smaller stocks, Eldridge Pope announced it was in discussions with SDA, a company controlled by Michael Cannon, more than a year after the acquisitive pub entrepreneur began building a stake in the Dorset-based firm. A year ago, the then chairman of Eldridge Pope, Christopher Pope, was apopleptic at the tender offer through which Mr Cannon was taking an interest in the troubled business. Nevertheless, the unwelcome entrepreneur obtained a 22\% holding. A year on, and Mr Pope has been replaced by Miles Templeman, the former Whitbread man brought in last year by West Country cider maker HP Bulmer to run that family-controlled business. Months later he had brokered a sale to Scottish & Newcastle. The founding family at Eldridge Pope controls about 30\% of shares and is remaining tight lipped. Nevertheless, relations between Mr Templeman and Mr Cannon, are believed to be friendly. Yesterday, shares in Eldridge Pope were up 15.5p at 168.5p. Mr Cannon last bought at 171p. Avesco, which supplies video screens for pop concerts, corporate and sporting events, including the Olympics, was up 10.5p at 75p. Its chairman, Ian Martin, told a shareholder meeting yesterday that the group had enjoyed "an excellent start to the year". "Both our revenue and profit figures ... [for the first half] were ahead ... and considerably better than our expectations at the start of the year," he said. In July Mr Martin bought 50,000 shares at 51p. Metnor, the Tyneside metal galvanizing business, was down 38.5p at 171.5p. It blamed a lumpy pipeline of contracts for a dismal first-half performance, insisting several contract completions had fallen into the final six months of 2004. Nevertheless, profits will be down on last year by the year-end and below expectations, the company said. Aga Foodservice Group was up 2.25p at 227.5p after the company announced it had acquired the three factories and stock from bankrupt French bakery oven maker Pavailler for €2.5m (£1.7m). The operations acquired achieved a turnover of €32m and came close to breaking even in 2003. Pavailler will be integrated into Agas existing French business, Bongard, the market leader, with the loss of 60 jobs. However, there are persistent reports of unrest among French unions, some of which have suggested workers will strike should Aga take control of Pavailler. Aga said yesterday its offer had been the only one on the table and the deal had been approved by a workers council vote. Some 220 jobs have been retained and Aga "plans to grow the business", a spokeswoman said. Biocompatibles gained 8.5p at 190p after it accompanied in-line interim losses with news that the food and drug administration had cut the level of testing it requires on the companys main product, Bead Block, a cancer therapy. Ebookers in sale talks Ebookers jumped 45.25p to 230p after the online travel group said it was in talks with a umber of potential suitors that might lead to sale of the business. Shares have struggled to recover from a 30\% slump in July after the group, which specialises in mid- and long-haul destinations, announced it would miss its profits target this year. Last year, US media baron Barry Diller, who controls rival website Expedia as well as Hotels.com and Ticketmaster, was said to have shown an interest in both Ebookers and Lastminute.com.

Gene linked to both alcoholism and depression (By CHERYL WITTENAUER Associated Press Thursday, September 9, 2004)~~~~~~~~ Scientists say they have identified a gene that appears to be linked to both alcoholism and depression, a finding that may one day help identify those at higher risk for the diseases and guide new treatments for them. Previous studies of twins and adopted siblings have suggested there likely are genes in common underlying alcoholism and depression, and that the two disorders seem to run in families. But the lead researcher of the new study says this is the first report of a specific gene that seems to increase risk for both disorders. "Clinicians have observed a connection between these two disorders for years, so we are excited to have found what could be a molecular underpinning for that association," said Alison Goate, the Washington University School of Medicine researcher who led the study. Follow-up research might help reveal the underlying biology that makes some people susceptible to alcoholism, others to depression, some to both diseases and others to neither. Dr. Goate said a variation or alteration of the gene, known as CHRM2, influences those four separate conditions. The study is published in the September issue of the journal Human Molecular Genetics. "What you want is to see someone obtain the same results in an independent study," said Dr. Goate, a psychiatric geneticist. She said the researchers will know soon whether they can replicate the finding from another group of people they are studying. Peter McGuffin, a psychiatric geneticist at the Institute of Psychiatry at Kings College in London, said it is the first time this particular gene has been implicated. He said probably multiple genes are involved in these two disorders. Dr. Goates team analyzed DNA from 2,310 people from 262 families in which at least three members were alcoholic. Some individuals in these families were also depressed alcoholics. Both groups had similar distinguishing characteristics in their DNA in a region on Chromosome 7. Participants with both maladies were most likely to have the genetic similarity. Within that region of the chromosome, researchers isolated the CHRM2 gene, which is involved in attention, learning, memory and cognition. from Globeandmail.com

So, if not MMR, what is causing a fourfold rise in autism? (ALISON HARDIE -Scotsman.com)~~~~~~~~ JABS to protect against measles, mumps and rubella were a health milestone for every infant in Britain until 1998 when Dr Andrew Wakefield dropped his bombshell. His controversial finding that the triple MMR vaccine was directly linked to autism, bowel disease and other neurological disorders sent shockwaves through families and the scientific community. At the height of the scare in Scotland, the take-up of MMR dropped to an all-time low of only 70 per cent - a significant fall from the World Health Organisation recommended level of 95 per cent. Even now, vaccination is still below the level needed to avoid potentially fatal epidemics of measles and mumps. In Scotland, reported cases of mumps and measles are rising sharply. According to the Scottish Centre for Infection and Environmental Health, reported cases of mumps had risen to 1,367 by July - compared with only 85 for the same period last year. But the anxiety of parents over the MMR jab is all too understandable. The latest figures estimate the number of autistic children at pre-school and schools in Scotland has risen fourfold in the last decade to 3,400. Today - six years after it reported Dr Wakefield’s original findings - the medical journal The Lancet publishes a major study which appears to debunk the very results which in 1998 created such a wave of consternation. The new research, funded by the Medical Research Council, concludes that they could find no "convincing" evidence of a link between autism and MMR. The authors say: "No significant association has been found in rigorous studies in a range of different settings. "These are severe diseases for which very little is known about causation, and this absence of knowledge itself might have contributed to the misplaced emphasis on MMR as a cause. Research into the real origins of autism is urgently needed." Various studies have so far failed to find any evidence of a link between MMR and autism and attempted to discredit Dr Wakefield’s own research. However, his view that the triple vaccine is unsafe has held sway, despite his resignation from the NHS. The issue has become a political hot potato, embroiling Tony and Cherie Blair with almost constant demands - all unmet - that they reveal whether or not they have had their youngest son, Leo, inoculated. But the medical establishment, which has attempted unsuccessfully to persuade parents that MMR is safe, will be hoping this report - the biggest so far - will finally debunk Dr Wakefield’s opinion. The study looked at the vaccination records of 1,294 children diagnosed with autism or other pervasive development disorders (PDDs) between 1987 and 2001 in England and Wales. These youngsters were compared with a control group of 4,469 children of the same sex and similar age who were registered with the same practices but did not have a recorded diagnosis of autism. The researchers, from the prestigious London School of Hygiene and Tropical Medicine, say they were unable to find evidence to support an association between MMR and autism or other PDDs. The team, led by Dr Liam Smeeth, went on to look in more depth at the records, looking only at children who had MMR before their third birthday - autism is not normally diagnosed before the age of three. They also looked at children vaccinated in the period before reporting of the theory that MMR might be linked with autism. The researchers finally compared children who joined practices before their first birthday with those joining after this age. Again, their conclusion was that there was no link between MMR and autism. They then reviewed previously reported studies that examined the possibility of a link, but none of these showed any increased risk of autism associated with MMR. The researchers concluded that their combined results increased the strength of the assessment, also held by the Department of Health and medical experts, that there was no evidence of a link between the combined vaccination and autism. Dr Smeeth said he hoped their findings would help boost confidence in the vaccination. "We hope the results of this study, the most robust and comprehensive undertaken to date, will reassure parents that MMR is not associated with an increased risk of developing autism. Our findings are consistent with evidence from a growing body of high-quality scientific studies. "It is now time to move on and focus on research into other potential causes of autism which is urgently needed." The conclusions reached by Dr Smeeth and his team were not enough to convince Dr Wakefield, who continues to stand by his research. Dr Wakefield was in the US yesterday and said he was unable to give the paper published by The Lancet his full consideration. In a statement to The Scotsman, he said: "The government has chosen to rely on a series of epidemiological studies that, when subject to re-analysis, have been comprehensively criticised. "For example, readers should consider the two papers recently published in the Journal of American Physicians and Surgeons, one by Dr Goldman and one by Dr Scott. "These papers demonstrated the unreliability of the recent Danish study which was also heralded by the authorities as demonstrating the safety of the MMR vaccine. "It has been shown repeatedly that epidemiology proves to be a very unsatisfactory method for investigating complex disorders such as autism." The outline findings have done little to encourage Bill Welsh, of the Scottish charity Action Against Autism. He said: "This kind of study gives me and people like me not the slightest glimmer of hope. "These people do not actually look at the kids - they just look at the numbers. That’s why we will ask the same two questions of this report that we ask of every study into links between MMR and autism. "We need to know how many children they examined and, of that number, how many autistic children did they examine. "The answer is usually none and I’m confident that it will be the same in this case. The medical establishment has arrogantly refused to medically examine just one autistic child to clearly confirm what the underlying causes of this epidemic, and that is what it is, are." Mr Welsh added: "We are heartily sick of this epidemiological studies. To get to the root of this problem we need to examine these seriously ill children." He also picked holes in the wording of the report’s conclusions, claiming the authors had used "clever language" to mask their failure to dismiss conclusively the link between autism and the triple vaccine. Mr Welsh said: "They may have found evidence, but they decided it was not convincing. It is just clever language and we have heard enough of it." That view was echoed yesterday by Jackie Fletcher, the founder of Jabs, a support group whose aims are justice, awareness and basic support for families with autistic children. Mrs Fletcher, who blames her son’s autism on the MMR vaccine, said: "I am very concerned that this is a study which is presenting the vaccine as safe without convincingly proving the reliability of the data they used." Parents who claim vaccine damage say their child appeared to regress and become autistic, after developing normally up to the point of immunisation. Many also developed bowel trouble. The injection is given when a child is two, about the same age as symptoms of autism emerge, and government experts have repeatedly said it is a coincidence that autism is being diagnosed after the jab. The1998 study by Dr Wakefield, formerly of London’s Royal Free Hospital, suggested MMR was causing a "perceived increase" in incidence of the severe neurological disorder. A Department of Health spokeswoman said: "This study shows that having MMR is not a risk factor for autism. "The study is in full agreement with other international studies carried out in different ways, by different researchers, in different countries." A spokeswoman for the British Medication Association (Scotland) said: "We stand by what we have been saying which is that the overwhelming evidence to date has proven the safety of the MMR vaccine and one paper in associating a link to autism has done so much unnecessary damage." However, the spokeswoman conceded that this latest report in The Lancet would be unlikely to be enough to debunk completely the suggestion of any link between the triple vaccine and autism. She said: "I do not think that one report alone will ease the fears many parents have because of stories they have read. The disquiet in the population over these claims has undoubtedly worried parents unnecessarily. "What is needed now is a extensive programme to rebuild public trust and ensure the population is protected against diseases that can kill." SINGLE MEASLES VACCINE IS CHOICE FOR A MOTHER WHO WANTS CLEAR PROOF THAT THE MMR JAB IS SAFE HEATHER McLean had her 13-month-old daughter, Mairi, vaccinated with the single measles vaccine yesterday. She said: "I suppose my decision to have a single vaccine has been prompted by the scares surrounding MMR. What concerns me more is that the government or the experts don’t seem to be able to give clear information about whether there is a link or not without a shadow of a doubt." Mrs McLean, a 37-year-old occupational therapist, added that in the course of her work she had been on courses about autism and it did seem to be on the rise, though there were obviously genetic factors involved, too. She said: "I think as a parent you worry about your children all the time and if you think you can minimise any risk of something happening, then you will make the decision to have the single vaccination. I’m not convinced there is a link, but the information given by the government hasn’t convinced me there is no link. "I’ve read the information given to me here, but I think it’s difficult for parents to get the appropriate information. If they go on to the internet there is no way of knowing if the information is reliable." Despite concerns surrounding the issue, Mrs McLean’s own family doctor backed the official government line that there is nothing to link the MMR vaccine with autism. But she insisted: "Until there is a study which can definitely show there is no link, then parents will continue to want single vaccination. Even if this study has looked at enough patients and can prove conclusively that there is no link, the problem is that doubts have already been raised." Asked if she felt that the government was slow to provide evidence backing the vaccine, she said: "I don’t think public confidence in politicians is very high in general, and I would tend to trust medical or scientific evidence more." According to Dr Carole McAlister, a GP who runs the vaccination service at the private clinic GP-Plus, their attitude on the issue is all about providing choice: "GP-Plus is pro-vaccination, and at the end of the day all we are doing is providing choice for parents who, for whatever reason, don’t feel comfortable about MMR vaccination. "Often the reasons given for choosing single vaccines are not related to the much-debated possible link with autistic spectrum disorder, but are mainly to do with reducing a perceived risk associated with vaccination." Frtom the Scotsman.com

Study finds no link between MMR and autism - but doubts remain (ALISON HARDIE POLITICAL CORRESPONDENT - Scotman.com)~~~~~~~ A MAJOR new scientific study has found no evidence that the controversial MMR vaccine causes autism in children. The research, published today in the Lancet, debunks the claim made in the same journal six years ago that led thousands of parents to opt for single vaccines against mumps, measles and rubella or to avoid inoculating their children altogether. In Scotland, the take-up of the triple vaccine slumped to 70 per cent - the World Health Organisation’s recommended safe level is 95 per cent - leaving swathes of the population at risk of contracting the potentially deadly diseases. In Scotland, reported cases of mumps rose to 1,367 by July this year - compared with only 85 for the same period last year. The authors of the report - sponsored by the Medical Research Council and by far the biggest British study to date - today conclude that they could find no "convincing" evidence of a link between autism and MMR. And they argue that research into the real origins of autism is "urgently needed", claiming it was the lack of knowledge of the condition that might have "contributed to the misplaced emphasis on MMR as a cause". Dr Andrew Wakefield provoked huge controversy in 1998 when he suggested in a Lancet article a link between the MMR vaccine and autism. Despite assurances by the Department of Health and the British Medical Association, parents deserted the jab in their droves. However, last night it appeared that the new research in Britain’s most prestigious medical journal, which comprehensively overturns Dr Wakefield’s findings, would not be nearly enough to convince campaign groups and charities which remain sceptical about the safety of MMR. Bill Welsh, of the Scottish charity Action Against Autism, said the authors of the report had employed "clever language" to reach their findings. He said: "They may have found evidence that did show a link, but they did not find it convincing. It is just clever language and we have had enough of it. "What parents want to know is what causes autism, not what does not cause it." Mr Welsh also strongly criticised the report’s authors for failing to examine children with symptoms, but instead relying on data from GPs which critics claim is an unsatisfactory method for investigating complex disorders such as autism. Dr Wakefield is now a leading member of Visceral, a charity investigating links between childhood vaccines and autism. Last night he was also critical of the report. He told The Scotsman in a statement from the United States: "It has been shown repeatedly that epidemiology [statistical disease research] proves to be a very unsatisfactory method for investigating complex disorders such as autism. "We have sent the paper to a number of expert epidemiologists on both sides of the Atlantic and once their detailed comments have been received, the board of Visceral will issue a full statement." The latest study looked at the vaccination records of 1,294 children diagnosed with autism or other pervasive development disorders (PDDs) between 1987 and 2001 in England and Wales. These youngsters were compared with a control group of 4,469 children of the same sex and similar age who were registered with the same practices but did not have a recorded diagnosis of autism. The researchers, from the London School of Hygiene and Tropical Medicine, were unable to find evidence to support an association between MMR and autism or other PDDs. The team went on to look in more depth at the records, looking only at children who had MMR before their third birthday - autism is not normally diagnosed before the age of three. They also looked at children vaccinated before it was reported that MMR might be linked with autism. The researchers finally compared children who joined practices before their first birthday with those joining after this age. Again their conclusion was that there was no link between MMR and autism. The researchers concluded that their combined results increased the strength of the view, also held by the Department of Health and medical experts, that there was no evidence of a link between the combined vaccination and autism. From the Scotsman.com

Scotland can talk itself out of suicide (MARGO MacDONALD - The Independent voice of Scotland)~~~~~ IT’S shocking that more young Scottish men now end their own lives than are killed in road accidents. Why? It’s not complacent to admit that since time immemorial, suicide rates have always been higher in the cold, hard countries of northern Europe. The months of short days and long, dark nights bore down on the souls of the Vikings, Celts and the other peoples who settled near to, or inside, the Arctic Circle. Suicide must have appeared the better alternative to earlier communities and tribes who, in addition to light deprivation, had to cope with near starvation and abject boredom. No wonder the peoples of the cold countries took to finding oblivion in strong spirits. And that’s the common clay from which we’re moulded . . . wealthy Scandinavian and skint Scot alike. The rigours faced by our forebears are woven into our identities. So does that mean it’s a lost cause for the Scottish Executive to Choose Life . . . its new campaign to improve mental health that, as a by-product, should reduce the 600 or so suicides each year? Not at all. Although the evidence points either to a genetic predisposition to suicide or a deeply embedded cultural trait, medical and agricultural science, building technology, etc, have provided the means to combat a tragic end result. All that’s needed is for politicians to put enough money into medical services that prevent and treat the sort of depression responsible for our cave-dwelling ancestors’ suicides. Well, not exactly. Our consumerist, pill-popping lifestyles can induce abject feelings of inadequacy in some people for whom the Western liberal dream becomes a nightmare. Yet, a generation ago, many of the men aged between 16 and 24 who ended their own lives wouldn’t have even been aware of such levels of despair. Yesterday’s generation of potentially-depressive, dour Scots had a structure and purpose to their lives based on their work and the money they earned. Poverty depresses people. The poverty trap can be sprung by employment being available as and when and, if possible, where recovering alcoholics, drug abusers and people battling depression can attempt to break the vicious circle of addiction. People unable to take up work for whatever reason need support that can only be paid for by all of us. So, if the Scottish Executive doles out the necessary dosh, will there be fewer suicides? Maybe. But there’s another social trend just getting into cruising gear . . . the ageing population. Many more elderly people will decide to end their own lives because being poor and old is depressing. Many oldies, while they’re still in their golden period, are making living wills. They don’t want to run the risk of being miserable at the end of life. So far from simply being shocked by the findings of the suicides inquiry, the Executive must have a public debate on the different reasons why people end their lives. Going private not the answer to health woes JACK McCONNELL’S done a U-turn on cutting jobs in the public sector . . . or so the headlines in this week’s newspapers would have you believe. The First Minister stands accused of kowtowing to Tony Blair’s backroom boys, who announced a few months ago that New Labour would reduce the number of civil servants by at least 70,000 across the UK. When this was being punted by the policy wonks at No 10 Downing Street, the Scottish Executive let it be known that it wasn’t too much bothered by the very high percentage of Scots employed in the public sector. In fact, Health Minister Malcolm Chisholm and Education Minister Peter Peacock were quite frank about their intentions to recruit and employ more nursing and medical staff, from overseas if necessary, and more teachers and classroom assistants. Apart from a collective spasm of conscience about recruiting nurses and doctors from countries with even greater healthcare needs than our own, few people in Scotland disagreed with the Executive’s policy. But over the summer, we continuously heard about the far greater amounts of money spent by Scottish health boards than their English counterparts. We also heard that the Government’s policy is to blitz the bureaucracy and put the money saved on the wages of administrators into "frontline" services . . . nurses, doctors, social workers, for example. When he announces that the public sector is too big in Scotland and that the Executive’s looking for an annual saving of two per cent on expenditure on health and education, for example, it’s difficult not to believe Jack McConnell has fallen into line with his colleagues south of the Border. With a Westminster election expected next year, is anyone surprised? Is this not just Jack’s way of strengthening Labour’s defences against accusations of a cross-border split? If I’m wrong, and Jack’s a convert to the ideology that believes private investment and private companies deliver public services better than public authorities, before badly-needed social workers are laid off, or their posts not filled when they leave, local MSPs should demand an audit of their jobs be carried out . . . and the Executive should pay for it. If we’ve the worst suicide rate in Europe (see above), if our life spans are about the shortest in Europe, if our teeth are the most rotted in Europe because we eat so much sugar without cleaning our teeth afterwards, if our teenage pregnancy figure is higher then any other developed country, isn’t that an indication of our need for properly trained, and rewarded, public sector workers?

Q & A: Mental Health Laws The government has re-drafted plans to change mental health laws after criticisms about earlier proposals for the enforced treatment of potentially dangerous mental health patients. BBC News Online looks at what is in the new Bill. What are the main changes being proposed by the government? Doctors treating patients in the community who they believe should be forced to undergo treatment will be able to obtain a Mental Health Act Order. The Act removes the need for patients to be sectioned - confined to hospital - in order to make them take their medication. A new broader definition of mental disorder includes people with severe personality disorders. This will make it easier to force them to undergo treatment or to detain them, whether or not they have committed a crime, if theres a substantial risk that they will be a danger to themselves or to others. But doctors would have to be able to justify that the pla