Please note that this edition contains reference to a suicide and other potentially difficult subjects.

Reading through articles when I was supposed to be working this week, it struck me that a central theme emerging from a number of pieces has been awareness, or rather the distressing lack of it, in relation to mental health issues. First off, a YouGov poll has revealed, some 800,000 adults in Scotland do not know where to turn for support. In these times of economic austerity, one would have thought that the cost of not dealing with these issues – apparently £10,7bn a year – would motivate the powers that be into action.

Thankfully there has been a small boost to awareness raising in one field at least, in the form of a new initiative from the UK Government sponsored employment relations body Acas. Balancing the experience of mental illness with ongoing employment can of course be a real challenge, as many readers can testify. While there are personal costs to the individual of fighting this good fight, the Acas study points to the high costs to employers of failing to manage conditions in a way that supports the individual and consequently reduces negative impacts on productivity.

…[I]t is estimated that around five million employed people struggle with depression at the moment.

John Taylor, chief executive of Acas, urged managers to do more to break down the “taboo” of such illnesses.

“There needs to be a willingness to discuss mental health and a culture where employers understand it and try to help their employees recover from mental illness,” he noted.

Intrigued, I must admit that I looked into this one a little more closely, and it appears that Acas have developed training materials to help employers manage employees encountering mental health issues more appropriately. Check here for more, if you’re interested.

“Not before time,” many might say. There’s a long way to go. Some employers certainly don’t have what one might deem an exemplary track record on this. The the US Army is one well known case in point. Securing appropriate mental health treatment for service personnel, a review commissioned by that organisation suggests, has not, perhaps, been the priority it ought to have been. The review, which will look at cases dating as far back as 2001, will seek to determine whether soldiers suffering mental health conditions have been denied help that is suited to them.

The move by Army Secretary John McHugh and Gen. Raymond Odierno, Army chief of staff, comes after findings this year that several post-traumatic stress disorder diagnoses at a base near Seattle were wrongfully reduced to lesser illnesses during medical retirement evaluations.

“We owe it to every soldier to ensure that he or she receives the care they need and deserve,” McHugh said in a statement, adding that the military “must ensure that our processes and procedures are thorough, fair and conducted in accordance with appropriate, consistent medical standards.”

Inadequacies of care are, sadly, nothing new, and continue to have deadly consequences. Another entry in that particular catalogue is the tragic death of a woman in south Tyneside who was meant to be under appropriate supervision, but wasn’t.

A CORONER has slammed the “systematic failure” of a South Tyneside mental health unit after a blind woman was found dead in her room.

Terence Carney criticised the Bede Wing psychiatric ward after Nicola Lilley was discovered collapsed in the bathroom of her room last May with a plastic bag over her head and a cord wrapped around her neck.

The 39-year-old’s death came little more than a month after she was admitted to the unit, within the grounds of South Tyneside District Hospital in Harton Lane, South Shields.

An inquest into the death of the former Barclays Bank telephonist revealed that staff had failed to check on her for 35 minutes, despite doctors stating she should be observed every quarter of an hour.

In news that will be shocking to absolutely no-one, it appears that the economic pressures of the day have prompted an increase in calls to mental health helplines.

Paul Farmer, chief executive of Mind, said people’s mental wellbeing was being affected by factors like job security, working conditions and financial security.

Marjorie Wallace, SANE’s chief executive, said: “There has been a disturbing increase in the number of people with depression and anxiety due to financial uncertainty contacting our helpline for information and emotional support.”

If current events are one factor leading to a high incidence of illness, these cannot be seen in isolation. One suggestion, indeed, is that we ought to look more closely at factors way back towards the beginning of our lives.

A large new study found a statistically significant peak of schizophrenia in individuals born in January.

The season of birth may affect everything from eyesight and eating habits to birth defects and personality later in life. Past research has also hinted the season one is born in might affect mental health, with scientists suggesting a number of reasons for this apparent effect.

The study seems to suggest that prenatal and postnatal effects associated with time of year bear closer investigation.

Whether we take cognisance of such suggestions or not, in bleak times such as these, some naturally turn to thoughts of effective treatment. But what is effective? According to one psychologist, we’ve not been thinking ‘outside the box’. There is a need, it is argued, to consider the potential benefits of homeopathy. According to Dr Vengalis Zafeiriou:

“In psychiatry there aren’t any medicines designed to be curative, rather these relieve symptoms. Homeopathy can treat all kinds of disorders from anxiety and phobias to depression and schizophrenia. In mental hospitals, homoeopathy can treat patients with severe mental disorders, contributing considerably to the therapeutic outcome of conventional psychiatric treatment.”

Certainly, more conventional forms of treatment are not without their critics. A new study demonstrates the need for an awareness of bias in the presentation of industry sponsored trials of psychiatric drugs. The study analysed presentations given at two recent meetings of the American Psychiatric Association.

Of the industry-supported studies, 97.4 percent reported results that were positive toward the medicine that the study was designed to test, and 2.6 percent reported mixed results. No industry-sponsored studies with negative results were found.

In contrast, when industry was not the source of funding, 68.7 percent of the presentations were positive, and 24.1 percent contained mixed results, while 7.2 percent contained negative results.

Remaining on the subject of treatment, how about those awful silences between patient and therapist I’ve read so much about? Well, would you believe it? There’s an app for that. Well, sort of. The web application, known as Buddy, is a diary of sorts apparently.

“Buddy helped me communicate better with my therapist, and it helped me to spot patterns and see what I was doing or not doing,” says Sarah, 36. “Buddy really felt like a friend checking up on me at the end of the day. Sometimes it was the only contact I would have throughout the day. It’s something that helped point me in the direction of change, and which I then felt better able to act on.”

Well, this has all been rather heavy, hasn’t it? It’s not all bad news, let me try to assure you. Attitudes are changing – uncomfortably slowly, perhaps, but changing nonetheless. To take an example, it appears that press coverage of mental health issues in Ireland is improving.

Analysis of over 20,000 Irish print media articles found that the portrayal of suicide and mental health was 50% more positive than in 2011 than in 2010.

Negative depictions of mental health and suicide have decreased by 24.38%. However more than have of the negative articles were reported by Irish daily tabloids.

That’s good to hear, though in the crusade to bust stigma, there is no room for complacency.

In summing up, it’s time to turn to this week’s wildcard. This one’s in honour of Pandora, who has procured for herself an iPhone 4S. I hope the first question she’ll be asking ubiquitous digital assistant Siri will not be as below – moreover, I hope Siri isn’t quite as determined to see the back of Pan as this person’s mobile aide was of them!

;

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Published earlier due to a particularly uncooperative WordPress client. Sorry, good people!

 Zarathustra: How do you juggle editing the magazine with your own mental health difficulties?

Mark: I think that one of the secret or not so secret stories of One in Four is me the editor as someone with mental health difficulties. The question of how I juggle editing the magazine and my own mental health difficulty is actually the story of how I juggle editing the magazine, doing the rest of my job and having a mental health difficulty.

The answer is, I suppose, intimately bound up with mindfulness and the fine tightrope between giving yourself kindness and hating yourself for self indulgence.

Being someone who is basically the boss with my co-director of Social Spider CIC (our social enterprise that publishes One in Four) allows me a lot of latitude in terms of reasonable adjustments in terms of working hours and the like. This means that I can adapt my working practices around my condition. That isn’t to say that I don’t fuck up sometimes. There is, after all, only so long you can go being present at work in body but not in spirit and periodically things get on top of me.

For a long time I pursued the idea that there would be a secret amulet somewhere that I could find and if I was to put it on I would suddenly become an ultra-professional well organised go-getter, some trick of organisation or some self imposed rule. In reality, I do what everyone else does, I bumble along and make the best out of what I have.

The further you take yourself into the world of ideas and fighting for some ideas over others, the more you have to fend off periods of self doubt. What I find is that every new challenge is like a potentially damaging act of stretching. When it goes okay you end up slightly more supple and mobile, but if it’s too intense or too harsh you end up in pain for a bit and out of shape or immobilised. You tend to get back to normal eventually.

I think what I’ve learned is that I need longer to recover after taxing times and longer to process the meaning and implication of things that have happened. I suppose, like a lot of people with mental health difficulties, I’m operating at a deficit that others are not. If it’s taken you three hours to get as far as the train station in the morning, you tend to arrive at work more tired than your colleague who springs out of bed and is at work in twenty minutes, pillow to desk.

I also found that getting stuff done while you’re not too well requires a level of intimacy with your colleagues that seems odd to some. It makes it more difficult, I think, to completely divide your private life and your work life, as the totality of your life often impacts on your mental health and in turn on your work life.

There’s been a few times where I thought ‘Fuck, that’s torn it’, that palpable sense of having pushed myself too far, trying to get too much done, like the feeling of being a kid at the beach and getting knocked down by a wave, then knocked back down by another one while you’re getting up, then another, then another.

In juggling a mental health difficulty you need to marry a level of fearlessness (“I’m going to take this on and lick it!) with a level of self knowledge (“Do I feel I’m able to do this right now?) with the ability to apologise and draw upon alternative arrangements (“I’m really sorry I can’t do this right now, but I’m sure my colleague can help.”)

You need to actively consider yourself as a resource to be look after, and to plan accordingly knowing your own limitations and potential areas where your mental health might cause you additional challenges over and above the challenging nature of the things that you do.

I think the message that I have for people with mental health difficulties in employment is that mental health difficulties absolutely are disabilities rather than personal failings and that knowing that means you have to first accept them and then second work to minimise or offset their effect on your work. Sadly, we’re only really at the start of that thinking about mental health and work. I’m relatively successful in my present situation because in a lot of respects I made up the rules for that situation, so the level to which I am disabled may not be obvious. Were I to move into a situation with less flexibility, I think those disabilities would become more apparent.

This is what people sometimes don’t grasp about the challenges that we as people with mental health difficulties face in employment. in most situations, it isn’t us that controls the levels of adaptation that are available in our working life but our bosses and what ever the professional guidance is at that point in time and in that profession. I can achieve because my colleagues and I can work with the grain of my condition, but that isn’t often an opportunities that is afforded to other people.

What never works for me is pretending to myself, just because I’m having a few good weeks, that my mental health difficulty doesn’t exist or will never come back.

I’m not a person who has ‘overcome my mental health difficulties to become the editor of a magazine’ I’m a person with mental health difficulties who has found a way to do things that works around my mental health difficulties.

The Q&As continue on Thursday, when I ask Mark about mental health and stigma.

As some of you may have noticed, Pandora and I have been increasing the content of the site, so it’s now more than just a repository for blog and news round-ups. Let’s have another discussion about where we should be going. In presenting my own thoughts, I’m going to talk about the past, present and future of the blog.

The Past

The This Week in Mentalists blog round-ups started up on the Mental Nurse site, until it went down the tubes in March 2011, partly as a consequence of some-of-you-know-what, although also due to a cock-up with the domain name renewal. It was initially just me doing them, and then it became a collaborative effort, with different bloggers taking it in turns to present their favourite blog posts from that week.

After Mental Nurse went down, I initially set up a new website, Madosphere.com, and the TWIM round-ups continued there. But some-of-you-know-what was still going on, and causing me enormous stress. In June 2011 I deleted the Madosphere site and decided to quit blogging. I knew that TWIM was something that was valued in the Madosphere, so wanted to hand that over.

At this stage, Pandora agreed to pick up the baton and set up this dedicated home for the TWIM round-ups (with a brief interlude where TWIM was hosted on UselessCPN’s site for a week while Pandora was setting up the site). Pandora then added the TNIM news round-up as a mid-week feature.

Around October 2011, it became increasingly clear that the person who was trying to cause problems for various people (including me!) in meatspace was not going to succeed. I started tentatively blogging again – initially under the new username of Veruca Salt (apologies to those of you who thought I was a woman!), then back to being Zarathustra. I agreed to set up a new blog, The Not So Big Society, along with Ermintrude2, a social worker with a keen interest in the politics of health and social care. Ermintrude and I were then joined by other bloggers in a new collaborative effort.

In December 2011, back at the TWIM blog, Pandora was organising the annual TWIM awards. Unfortunately some oddities in the voting put her in an uncomfortable position, which meant difficult decisions had to be made. At this point we agreed for me to come back on board as a co-editor for TWIM, initially in order to help out with the awards.

In April, we had a discussion about the way the blog should go in future. Although this discussion eventually got a bit “spirited”, there were good ideas that were worth playing around with. Afterwards, Pandora and I exchanged some e-mails about how to take those ideas forward.

The Present

Since April, we’ve been working on expanding the blog format from its initial base as a bi-weekly producer of blog and news round-ups. We’ve re-blogged archived posts from authors such as Mental Health Cop. We’ve also sought out and published original content, for example CosmicClive, Terry Mace, UselessCPN and Sanabitur Anima Mea. Just in the past week, I’ve started posting a series of conversations with One in Four Magazine editor Mark Brown, which will cover such topics as mental health, stigma, politics and the media.

The Future

In my conversations with Mark Brown, there’s a comment by him that I think is worth quoting.

I actually took my lead from the madosphere circa 2006 / 2007 because what I saw was people who had got to the end of writing about how their condition or experiences felt and were taking on the questions of what their condition meant and what it meant to live their life with it. This naturally moves from discussing mental health difficulty as if it exists situated only within yourself and begins to see it as something situated somewhere between how you are and how the world around you is. The late lamented Mental Nurse was also a great inspiration for One in Four. There was something about seeing mental health professionals and people who experience mental health difficulty rubbing along together as people who, in essence, are involved in the same day to day mental health industry that appealed to me greatly and influenced the pragmatic stance of One in Four,

I think this describes quite well the value of the madosphere. It also describes the ethos of Mental Nurse before it got scattered to the winds by some-of-you-know-what.

It also gives a good description of what we should try to get back.

I propose that the TWIM Blog be expanded into something equivalent to a sort of Mental Nurse the Second, or possibly a kind of mental health Huffington Post. A safe, respectful place where all those involved mental health – patient, professional, carer, academic, whatever – can come together to talk about the issues that matter to them. A place where original blog content is posted, as well as re-posting selected, high quality content from other blogs.

At some point we’ll need to change the name of the blog, as calling it This Week in Mentalists would increasingly be a misnomer. I did think about This World in Mentalists, but that might confuse people on abbreviations. Or maybe Mental Matters, but that sounds a bit plain. Possibly we could have a renaming competition.

Obviously the domain name will have to be kept or people would get lost. Possibly at some a second domain name could be set up that directs to the same site.

I plan to continue with the Not So Big Society. It’s a different ethos to this site – more political, more “professional” in tone. In some instances, any articles I write that are relevant to both blogs might get cross-posted. I’ve already started doing this.

There was some debate previously as to whether to add a forum to the site, though as some people rightly pointed out, the Mental Nurse forum never got used all that much. I’d welcome people’s thoughts on this. Possibly we could just add one and see if it gets used.

Hosting debates is something that Pan and I have pondered upon. Maybe have a motion where one person does a “for” post and then somebody else does an “against” post.

So, the question I’d like ask now is, What do you lot want? What would you like to see develop on this site? Over to you.

Mental Health Cop has written a series of guides on detention under S136 of the Mental health Act and removal to a place of safety. Useful for not just Police Officers, but Mental Health staff, and service users to have a clear understanding of their rights.

Julie’s Mum talks about a downturn in mood

Warning – moods can go down as well as up, and your heart may be repossessed if you don’t keep up your spirits.

When I posted my lastpost I had a superstitious presentiment that it would lead to a downturn!  And sure enough, the very next morning I had to drive Julie over to the clinic to get a fresh cut dressed.  We’ve been in the doldrums pretty much ever since.

I am glad that you and Julie seem to be getting more support from the hospital.

Sanabituranima has a post about the consequences of dismissing the effects of ME

M.E. is an extremely painful neurological illness with multiple severe symptoms – the main ones being constant exhaustion, severe muscle and joint pain, over-sensitivity to light and noise, nausea, vomiting, impaired mobility (ranging from mild difficulty walking to complete inability to even turn over in bed, depending on severity) incontinence, muscle spasms, headaches, permanent sore throat and fever. People can die from it - here is the story of one woman named Sophia Mirza, who did. The refusal of doctors to believe that she was physically ill contributed to her death – yet her autopsy showed severe inflammation in her spinal chord. Emily Collins was another woman who died of M.E. Before she died, she wrote a book about living with severe M.E. There is also a letter she wrote very shortly before her death, published here, which I will re-post. It is rather a harrowing read, but people must realise that M.E. is real:

Though not strictly MH related I felt this was an important post to highlight, as ME is one of those conditions that is so often ignored and misunderstood.

Stuart Sorensen has been ripping off other people’s ideas

My newest project is a blatant rip off. The materials are my own but ther format is very definitely inspired by two bloggers and tweeters whom I admire so much I intend to emulate them. They do say (whoever ‘they’ might be) that imitation is the sincerest form of flattery.

Recently Twitter’s excellent @nurse_w_glasses who is responsible for the immensely popular 20 commendments for mental health workers and the ’20 commandments’ blog has seen her 1 page summary of the commandments posted in nurses’ stations all across the globe. It’s such a good format.

Even more recently a Leicestershire police inspector @MentalHealthCop who hosts his own extremely popular blog has begun posting ‘quick guides’ for serving police officers who may need fast access to pithy information as situations arise.

My project is based upon a combination of both these ideas. I plan to create relatively brief ‘quick guide’ summaries of mental health and social care principles that can either be used for quick online reference (like Mental Health Cop’s guides) or posted in staff rooms and offices (like Margreeth’s 20 commandments). I’m essentially ripping off two basic formats to create my own hybrid. Fortunately neither Margreeth nor Mental Health Cop seem to object. After all – we’re all chasing the same thing – information getting ‘out there’ to the people on the fromt line.

Fantastic idea. I have given Margreeth’s 20 commandments to my students and told them to keep them close by their side and refer to them often.

Katieinwonderlandx wonders if cats can get anorexia

Winston (my cat) is currently perched on the end of my bed, at half one in the morning staring at himself in the mirror. He has been doing so for at least ten minutes. Unflinching. Just staring. And I cant help but notice the sullen, contemplative look on his face. I am concerned that I may have passed on my insecurities to him. I tell him every day what a pretty boy he is. But he’s staring in that mirror looking very distressed by his reflection. Like he’s saying ‘Mum, am I fat?’ Perhaps he is cat-orexic. He is not a big eater, so its really hard to tell.

I’m not sure cat’s have a sense of body image, but most of them are surely on the autistic spectrum

What it takes to be me has returned from a trip to Sweden

I feel that this trip has really helped to reset my brain. I feel so much happier than I have in the past several months, and although I am still having flashbacks it’s nowhere near as bad as it was, pre-trip.

So pleased you are feeling happier.

And finally, the wildcard. I don’t LIKE to take pleasure in other people’s misfortune, but if anyone deserves it:

Rebekah Brooks charged with conspiracy to pervert the course of justice

There simply isn’t going to be such a thing as mental health social work within a multidisciplinary team.  Upset personally, terrified politically.  This Biopsychosocial model we’d all worked towards collectively, the idea that a person existed within a socio-political context, that a person was created from events as well as biological material, the knowledge of different social roles, power-differentials within caring relationships, the question of meaning and identity, all of these are lost.  While nursing staff have some training in these ideas, necessarily it is not the bread-and-butter of their training, nor should it be.  No professional can be completely holistic in the true sense.  That is why the multidisciplinary approach was conceived, and has been the backbone of Community Mental Health for over forty years.  It has now been undone in a matter of months and there appears to be no reverse gear.

This chimes in a nasty way with the sort of thing I’ve been noticing in my own neck of the woods.

Last month I blogged,

Relations between CAMHS and social services have historically been fairly poor. As the gulf widens, this relationship can only get worse. The risk is that it can turn into a game of pass-the-parcel with children. As soon as one service accepts responsibility for a child, the other service steps back…This isn’t spoken out loud, but there’s a sense if this trend continues we could move closer to an assumption that if a child is seeing CAMHS, they can’t have a social worker. And if they’re under the care of social services, they can’t have a service from CAMHS.

This certainly seems to be continuing. All the social workers in our CAMHS team are being pulled out, just like the ones in the blog post I read today. It seems to be pretty much unofficial policy in both health and social care camps that we are not working together to safeguard children.

Years of good practice about joined-up working between health and social care is being undone at a fast rate of knots, crushed beneath a merciless drive to control budgets. Health is now something that happens in one place, and social care somewhere else, and never the twain shall meet. It’s appalling.

These Q&As will form a series of posts. To start off, we talked about the magazine itself.

Zarathustra: Congratulations on four years of One in Four. Did you expect it to last this long?

Mark: Doing a magazine is a funny business. In some respects it’s a bit like having a child. You nurture it, you look after it, you try to give it everything it needs to succeed in life, then you launch it into the world and hope that you’ve prepared it well enough to stand on its own two feet.

When I originally hatched the idea for it I didn’t really have any idea of it getting further than the pilot issue. Looking back, it amazes me just how much intellectual ground we covered in coming up with the thinking behind it. It surprises me how strong the emphasis was even early on that the magazine wasn’t a ‘service user magazine’ and how little it focused on services as the point of prime interest for people with mental health difficulties.

The idea of providing hope and peer guidance was also there right at the start.

What surprised me, and continues to surprise me, is that people often had a difficulty getting their head around the idea of a journalism for people with mental health difficulties and how that differed from journalism about mental health. The idea of doing a magazine for people who shared experiences of mental health difficulty but which did not focus on those mental health difficulties or the services provided to help with them seemed to baffle a number of people.

I actually took my lead from the madosphere circa 2006 / 2007 because what I saw was people who had got to the end of writing about how their condition or experiences felt and were taking on the questions of what their condition meant and what it meant to live their life with it. This naturally moves from discussing mental health difficulty as if it exists situated only within yourself and begins to see it as something situated somewhere between how you are and how the world around you is. The late lamented Mental Nurse was also a great inspiration for One in Four. There was something about seeing mental health professionals and people who experience mental health difficulty rubbing along together as people who, in essence, are involved in the same day to day mental health industry that appealed to me greatly and influenced the pragmatic stance of One in Four,

The reality of the magazine trade is that you are in business for as long as you can keep paying your print bill and can keep paying your contributors. I don’t think you enter the act of doing a magazine thinking ‘brilliant, I’ll be happy if I can sell twenty copies’. We set out with One in Four as a determinedly mainstream publication, not something for enthusiasts, so initially we had hugely optimistic ideas about how many of each copy we might shift.

In fact, we initially conceived the magazine as something that a grant funder or the NHS would fund in its entirety so that it could be given out for free. This model lasted up until we’d completed the pilot and people had liked it and we went to try to raise funds for the first regular issue.

No one was interested in funding a magazine! Really. Funders saw magazines as a risk or as money down the drain. The wisdom was that no one read magazines, especially not ‘service user’ magazines and that they all well intentioned projects of interest only to those writing them.

We had a couple of funders interested but both waiting for each other to commit so we did something fateful – we launched the first regular issue of the magazine ourselves. With our own companies money and with the model that as we weren’t going to be able to raise all the money we needed to do the magazine from funders, we’d have to charge people for the magazine.
If we hadn’t put our own company money in, the money that we use to pay ourselves a salary, the magazine wouldn’t have happened. We’d still be wandering about touting increasing tatty copies of out of date business plans every time a new funding opportunity opened up.

We wanted it to happen so we took a risk. Without that risk, there wouldn’t be a One in Four.

This was before Time to Change, before New Horizons, before ‘Nothing About Us Without Us’ remember. What service user magazine there were were shutting up shop or running to a stop when their initial funding ran to an end. I suppose that we arrived on the scene just when the previous wave of activism around the amendment of the Mental Health Act was finishing, which looking back may have shaped some of the early responses to the magazine from more established campaigners and activists. They’d been embroiled in high level political campaigning and lobbying and then we turned up and seemed to be saying ‘that’s not important, here’s a magazine about going on holiday and sorting out your relationship with your GP’.

The model we came to at that point was that organisations had funds, the NHS had funds, therefore it made sense to ask them to purchase the magazine on behalf of people who use their service. So that what we tried to sell: Bulk subscriptions – ‘buy a box, give them to your clients or members. It’s an awesome magazine and it’s doing something no one else is.’

Even trying to transfer the costs of production to service providers, people still accused us of profiteering from the plight of people with mental health difficulties and assuming that, because we erred toward inspiring hope and saying life with a mental health difficulty doesn’t have to be unremitting shit, we we somehow a massive media conglomerate looking to asset strip poor people with mental health difficulties and serve vested service provider interests.

We did manage to make some big sales to the NHS and to organisations like libraries, despite the fact that as anyone involved in non-NHS mental health work will tell you, it is a nightmare trying to sell services or goods to the NHS if it isn’t actively procuring them.

Then the credit crunch happened. And we started to get thinner and hungrier. But more focused. So the answer is I’m surprised that we manage to keep going!

Zarathustra: What are you most proud of in your time as editor?

Mark: I’m proud of the whole thing really. I’m proud that we’ve paid people with mental health difficulties to write and have published good writing and got it in front of people. I’m proud that, in a small way, we might have contributed to a shift from seeing people with mental health difficulties as some strange other species to people with challenges getting on with stuff.

I’m proud that we haven’t fallen into the trap of assuming all people with mental health difficulties are unemployed and unemployable. I’m proud that we haven’t fallen into the ‘them and us’ of seeing all mental health services as the enemy.

I’m also proud of the fact that we’ve pushed for a journalism by people with mental health difficulties that escapes from asking people to reiterate their own personal story over and over. I’d like to think that we’ve shown the way for some people to see that their own experience of mental health difficulty might provide the fire and the animus to do things, change things, write things and be interested in things, but that it doesn’t have to be simply a story about yourself you tell over and over.

I’m also proud that we, I, haven’t lost sight of the importance of hope and slide into the role of Cassandra, wailing at the side lines about how everything is literally turning to shit for people with mental health difficulties.

I’ll also let you into a secret. When we cooked up the idea for One in Four, I never saw myself as actually doing the editing. I thought I’d be the figure head ‘person with mental health difficulties’ while my colleague did the proper professional work, hence the ‘Editor in Chief’ at the bottom of my editorials in early issues. In essence, I’d only seen my role as a person with mental health difficulties like a service user consultation! That’s how little faith I had in my own abilities. What actually happened is that I actually did end up the editor ad did end up leading our mental health work.

So every month I do One in Four is a step further into the limelight for someone didn’t even see themselves as someone who should even be in the limelight!

And I’m proud that we’ve kept One in Four going, publishing good stuff written by people with mental health difficulties when, on a purely business case, it would have been sensible to stop.

And I’m proud that it’s not shit.

Part Two of this series will be posted on Monday, when I ask Mark how he juggles his role as editor with his own mental health difficulties.

Please be warned that this post discusses some potentially distressing police restraint techniques.

On Thursday, The Telegraph reported the harrowing story of a man with Alzheimer’s who was tasered by police as they sectioned him:

An Alzheimer’s sufferer, Peter Russell, was shot by police with a Taser during a struggle because he refused to go into care, it has emerged.

The 59-year-old farmer was shot several times with the stun gun after struggling with three officers who were trying to help section him under the Mental Health Act.

In response to this, Mark Brown from One in Four magazine writes about the need for UK police to have better training in sectioning people with mental health problems:

The case of Peter Russell [...] was horrifying. It’s hard to imagine how it would feel looking on as a loved one was acted against in that way, but beyond the shock, it is always worth asking: what could be done instead? Why, in 2012, is our treatment of people with severe mental health or cognitive difficulties still so entwined with the apparatus of policing? The answer, from the point of view of mental health services at least, seems simply to be “it’s a dirty job and someone else is going to do it”. But this doesn’t go far enough.

Sectioning, or taking away someone’s right to freedom so he or she can be taken for treatment or assessment, is one of the most challenging areas in mental health. To be physically restrained at a time of great personal disorder, desperation or distress is never going to be a good experience, and as such it requires a sensitive and thoughtful approach.

Another aspect of mental health treatment that’s often considered to be distressing is electroconvulsive therapy. However, in The Guardian Lucy Tallon shares her very different experience of ECT:

What happened to Carrie Mathison in the final episode of Homelandwasn’t real. I’m not referring to yet another plot twist. Or even to the broadly admirable portrayal of an intelligent woman with bipolar disorder. I’m talking about the traumatic electroconvulsive therapy (ECT) scene. It’s actually not a big deal. And I should know – I’ve had it several times.

Staying on the subject of treatment, The Guardian also discusses the government’s plans to tackle postnatal depression by reforming perinatal care:

Mothers will receive one-to-one care from a named midwife during labour and birth as part of government plans to combat postnatal depression.

Women who have a miscarriage or stillbirth and parents who are forced to cope with the death of a baby will also be offered increased support from the NHS.

Meanwhile, in Australia, new research shows that mental health carers – many of whom are under 16 – are struggling to cope. ABC News reports:

A survey has found a high number of children under the age of 16 are caring for relatives with mental health problems, and many of them are struggling to cope with the burden.

More than 1,000 Australians were interviewed for the Wesley Mission report, which found 90 per cent of relatives of people with a mental illness are suffering physically, mentally and financially.

Three quarters of respondents said their role as caregivers had adversely affected their relationships with family and friends, and 57 per cent said their financial situation had deteriorated.

Similarly, in the UK, government cuts are having a devastating effect on carers, as The Guardian shows:

As politicians shrink the state, Rose Fernandes’s life choices dwindle. Her day is sandwiched between caring for her autistic 25-year-old daughter Crystal and her 83-year-old mother, Maria, who suffers from dementia. But since 2010, she has been caught in a whirlwind of cuts, reducing her life to a series of arguments – in and out of lawyers’ offices – to preserve her way of life.

The Independent reports that over a third of people with autism have been bullied or discriminated against at work:

Meanwhile, 43 per cent said they had left or lost a job because of their autism, the poll by the National Autistic Society (NAS) concluded.

The NAS said the findings highlight the lack of support for people with autism in the workplace, and the lack of awareness of the condition among employers and colleagues. The poll, released for the charity’s 50th birthday this week, found just 10 per cent of adults with autism in paid employment receive support from their employers, despite 53 per cent saying they would like it.

If the last three stories have driven you to despair, here’s one that might give you some faith in humanity. The Guardian writes about how music and dance are helping people with dementia in Germany:

At the Dance Cafe Wilhelmine in the south-eastern Berlin district of Kreuzberg about 20 elderly people – the oldest is 98 – have been brought together to escape for a few hours the dementia that shapes their lives, trapping them in a sequenceless limbo.

“Music is like a silver bullet for those with dementia,” says Christa Matter, psychologist and manager of Berlin’s Alzheimer’s Society, which hosts the dances every month. “People with dementia are constantly being told they can’t do this, they’re doing that wrong, but when they’re dancing they can suddenly move with much more confidence, they know the steps, the music triggers something in them. They might not remember the names of their spouses or children any more, but they haven’t forgotten how to dance.”

Finally, still on the topic of dementia, the US government has pledged more funding for Alzheimer’s research, BBC News reports:

The US says it will seek an effective treatment for Alzheimer’s by 2025, as it faces an ageing population and spiralling health costs.

Health Secretary Kathleen Sebelius announced the goal as part of the first National Alzheimer’s Plan.

An additional $50m will be added to research funding during 2012.

This week’s wildcard is for those who are feeling the pinch of the cuts, or otherwise struggling financially. Have a cat?* Need extra cash? Look no further than WeBuyAnyCat.com.

* No cats were harmed in the writing of this blog post.

I am a 32 year old man with a long history of mental ill health, stretching back from early adolescence through to the present day. I have been a psychiatric ward inpatient, had numerous Accident and Emergency admissions, and many years of prescribed treatment. I recently began to receive counselling, which has finally enabled me to control my depression and disassociative disorder. I write my own blog, based on my experiences called Madman No More

I want to re-open a  the debate about the merits of  personal and professional perspectives of mental health, found in a number of recent blogs.

An excellent starting point is the20 Commandments for Mental Health workers, as written by Nurse with Glasses. This is currently going viral, and with good reason; both patients and professionals are given a clear set of expectations which it is reasonable for any service to achieve. The concepts are so simple, yet do not match everyone’s own experience of interaction in mental health, regardless of the side of the fence they are on at any given time. They are quoted in full here:

Inside Mental Health is a newly started blog, but opens an important debate with regard to linking both the patient and professional experience:

“I am a mental health nurse. This is a job I am very passionate about and a job that I absolutely adore. Of course there are days when I would rather stay on bed than head to work but I’m pretty sure that’s true of any job. Being a mental health nurse wasn’t a lifelong ambition of mine, it literally happened to be the only course which still had places on it when I decided I wanted to go to university. That being said, the minute I walked onto the ward (the ward I still work on) on placement I knew that this was where I wanted to work.

I work on an acute assessment ward. Which is where people are admitted when they are acutely unwell, often under a section of the Mental Health Act, but also informally. It can be a scary, intimidating place, not just for the service users who are admitted but for workers and visitors. The ward can be volatile in nature and can change in minutes from a calm, quiet environment to absolute chaos.

In blogging about my experiences as a nurse in this field I’m trying to get the nurses viewpoint across. The mental health nurse is seen by many people as an enemy, when in my experience nurses are there to help and generally nurse in the least restrictive way possible. Obviously everyone’s experiences of mental health services will differ, everyone is different, and in fact every admission is different, but I’m hoping that in hearing others views on their experiences I can become a better nurse.”

A patient experience is currently being blogged by the host of Talk Out, under the title “Its Okay To Talk” and is worthy of note for two reasons. Firstly, the author writes with a refreshing honesty, and each entry gives a sense of striving towards recovery. Secondly, the author has successfully tapped into a predominantly young group of twitter users, and has been immensely successful in a short space of time in empowering people to speak openly about their mental health and feelings.

“The power of social media is well documented. Unfortunately it’s often highlighted for it’s negatives, not it’s positives. This is greatly frustrating but tonight we are proud. We are proud because a topic that started a little over a month ago in my mind has developed into a much larger project. We aim to talk to people, to support people, to let people know that talking about feelings, talking about mental health is not something to be scared of or ashamed of. Tonight we launched the hashtag #TalkOut where we wanted people to talk about their experiences of mental health and their feelings. The response was brilliant, with many people joining in. Some of the responses can be seen here: http://storify.com/Time4Recovery/talk-out-an-individual-and-collective-rise-above-m“

Patient accounts of course do not just relate to doctors or nursing staff. Nineteen Plus Seven has described the experience of accessing CBT, and the relationship between client and counsellor, in amusing fashion:

“There are many reasons why it [CBT] didn’t work out, not least the fact that my therapist (let’s call her T) and I just didn’t hit it off.  But I like to blame it on hot cross buns, partly because it makes for a catchy blog title.  Hot Cross Buns are, for the uninitiated, not the all-butter fruit n’spice bun forever immortalised in nursery rhyme.  They are homework sheets that you have to complete to chart how your mind and body react to bad or intrusive thoughts.  This handy key should help you differentiate:

Hot Cross Bun

Not Much Fun

It turned out that the act of recording my negative thoughts and actions, then analysing them with someone with whom I had zero rapport was not entirely conducive to better mental health. Couple this with my notoriously poor handwriting skills and you come out with hours’ worth of exchanges that went something like this:

T: So you’ve written here….what does this say?
19: Oh, um, yeah that says ‘clawing at my face’.
T:  Clawing at your face….mmmm.  OK.  And do you think that was productive?
19: Um…well, no but…
T:  No.  So what could you have done instead of that…that clawing, mmm?  Can you think of anything you could have done?  That could have been more productive?
19: Um…

And so on.”

Paul Brook  highlights an important area of working life, which can have such a detrimental effect on mental health, applicable to both patient and professional in the field of mental health:

“The ‘extra mile’ of which they speak is that heroic extra effort, that additional, metaphorical distance that is travelled by keen, conscientious or ambitious people up and down the land as they strive to meet and exceed expectations and targets, to make money, or to impress and please people. It often achieves these things. But then what? What happens next? Well, it’s time to go another extra mile – the extra, extra mile perhaps – either for the same person or purpose, or for another one. And it happens again and again and again.

The sad thing that happens if you carry on going the extra mile is that you run out of extra miles and fall off the edge of the map (my own new nugget of business waffle – like it?). You then discover that getting back onto the map involves going more extra miles than you’ve ever gone before.”

Hot off the press, and rated by Alistair Campbell no less, is the latest blog entry from Beauty from Pain, in support of International Nurses Day :

I have been very lucky to have a really amazing CPN who, quite simply, I am certain that I would not be here without. I could babble on about how great she’s been, the things she has done for me, how much she has cared, how awesome she has been…. No doubt, that would lead you to perhaps ask ‘what’s to say that this CPN isn’t just one really wonderful person?’ I believe, however, that:

Community psychiatric nurses are the backbone of mental health care.

 And so to this weeks Wildcard.

When I was aged 9, having school dinners, my primary concern was always to attempt to sweet talk the dinner ladies into giving me extra chips. And less cabbage. However, one remarkably resourceful 9 year old girl in Argyll was not so lucky and has set up her own blog to alert the wider world to the poor state of her school’s meal provision.

The aptly titled “ Never Seconds” has been an internet success, and Jamie Oliver has also added his support in a tweet to the girl. If by now, you have also looked at the photographic evidence of her appalling lunches, you may want to also click on her site!!

Back in the 18th century, people used to amuse themselves by paying a penny to take a tour round Bedlam, pointing and laughing at the lunatics incarcerated there. Nowadays, we save the penny and use the internet instead, as evidenced this week by the parading of a You Tube clip of a woman called Jane Svoboda unleashing an incoherent rant against gay people at a hearing into LGBT protection measures in Lincoln Nebraska.

As a one time psychiatric nurse, it took me less than thirty seconds to work out that this woman was experiencing some kind of psychotic episode. It was, sadly, so obvious, anyone half awake could’ve realised what was going on. But still, she was dragged round the internet and made an object of hatred/mockery, including by friends of mine on Facebook who I would’ve thought had more sense or sensitivity. What was even sadder was that some of them continued to yock it up even when clear evidence emerged that she was mentally ill.

Is this what we’ve come to? I’ve been doing a bit of thinking about this recently. I remember being shocked during the first series of Big Brother when Mel emerged from the house after 57 days immurement to boos and catcalls from the eviction night crowd; by the last series, I was shouting in the same way at the telly screen and wishing I could be in the baying mob so I could chuck something nasty at the winner. Reality TV has allowed us to view our fellow humans as circus animals, to be disposed of once they stop being entertaining.

What’s more, despite the wonderful plethora of ways in which we can communicate these days, we live in a more anonymised society, hiding behind usernames (like I am here!), distanced from the impact of the things we say and somewhat blind to the emotion contained within a tweet or a post on a blog or a comment on a webpage because we can’t see the face of the human making it. The more we connect, the more we seem to disconnect. Cruelty has become recreational once more and there seems to be little chance of putting that particular genie back in the bottle.

But then, those 18th century Bedlam visitors eventually dried up, society and mental health care moved on, and while humankind has never been particularly kind, that specific cruelty disappeared. Probably, in time, the internet too will change and become less of a bear pit than it is right now. I live in hope.

Peace and love

I hereby disclaim any formatting disasters and typographical errors, and will bat them in the direction of the “service” provided by Virgin Media.

I’m not actually going to quote a passage from the following link as it’s full of spoilers, but if you’ve been watching the US drama Homeland, this article from The Guardian is quite a good analysis of how the main protagonist’s bipolar disorder is presented. As the piece states, unlike a lot in the media, the Homeland depiction (whilst, of course, imperfect) is relatively sensitive and broadly accurate.

The Guardian also reports on how a centre in Bristol is trying to tackle men’s mental health difficulties.

[Dave] Martin has been addressing men’s mental health since Wellspring secured around £20,000 a year from two charitable trusts in 2009. “At first, we were seeing people one to one, referred by GPs and other health professionals. Then I thought of having a group – there were groups for women and children but nothing here for men,” he says.

For those who turn up on Tuesday afternoons to gossip, cook, play Wii games – whatever they fancy – it is the weekly highlight. The first-floor kitchen at Wellspring is alive with the sound of banter. Slices of pizza are shared out. One or two work on an intricate balsa wood model aeroplane, others play cards.

“Sometimes, we just sit down and rant and rave,” says Martin, who sees around 17 men a week. “Once every six weeks we go out on a trip. Over 12 weeks we put a life plan together and help to build their confidence so the men can start building up a social network outside the group.”

The Yorkshire Evening Post also examines mental health from a local perspective (as you might reasonably expect, I suppose). In this case, they report on recent research demonstrating that – unsurprisingly – mental health problems are more common in areas of social deprivation.

Analysts from NHS Leeds found the more deprived areas all have higher than average incidences.

They also highlight the link between unemployment and mental health, saying that the recession is having an impact right across the city.

The city also has higher levels of psychotic disorders than would be expected and there is some evidence that overall, mental health problems are growing.

Now health and political leaders say the new information must be used to improve the wellbeing of residents.

NHS experts are calling for more work to be done in the communities with the most mental health issues.

They say services should be based around responding to people’s needs, with more focus on tackling unemployment and cutting the overall inequalities between the richest and the poorest.

You may have heard that US President Barack Obama today (or yesterday, if you wish to be technical) stated that he is in support of gay marriage (or, y’know, marriage). The LA Times has a story on how the legalisation of gay marriage is good for public (mental) health.

But studies show there’s another reason to favor gay marriage – it’s good for public health.

…

Mental health improved as well, according to the study. The number of visits to the clinic related to a mental health issue dropped from 3.35 per patient, on average, to 2.93, while mental healthcare costs fell from $331.08 to $283.59.

Overall, the number of visits to the clinic fell by 13% after gay marriage was legalized – and both partnered and single gay men benefited, the researchers found.

“One mechanism that may explain these findings is a reduction in the amount and frequency of status-based stressors that sexual minority men experience when institutionalized forms of stigma are eliminated,” they wrote.

BBC Wales reports on how services for veterans with PTSD should be organised.

Military personnel should have their medical care overseen by a network of armed forces’ forums set up across Wales, a report has recommended.

Healthcare Inspectorate Wales (HIW) also wants a veterans’ mental health clinical network because of significant needs among ex-servicemen and women.

The recommendations come following a survey of serving former staff and charities such as Combat Stress.

The Welsh government has pledged to improve support to military families.

When someone is being bullied, is it just that someone whose mental health deteriorates? Apparently not, Market Watch tells us. Bystanders witnessing an act of bullying may also develop mental health issues – not surprising in itself, but some of the specifics might be.

Research has documented a number of mental health effects for both bullies and bullying victims, however, witnesses to bullying may also suffer similar mental health consequences. Just like witnessing an act of violence, seeing someone being bullied can be a traumatic experience, or can remind a person of other personally traumatic experiences. Additionally, many bystanders feel a sense of guilt or regret for not intervening on behalf of a bullying victim.

A 2009 study in the United Kingdom surveyed 2,000 students and found that nearly two-thirds of the students had witnessed bullying, 20 percent admitted they had been a bully themselves, and 34 percent indicated they had been a victim of bullying. Witnesses were more likely to exhibit the same mental health issues as bullies and victims, such as depression and interpersonal sensitivity, and were more likely than victims to engage in substance abuse.

“Bullying impacts all of us, whether we’re actively participating or simply witnessing a bullying event,” said Gary Henschen, M.D., chief medical officer for behavioral health at Magellan. “We have to be mindful that people who witness bullying might be hurting, too, or may have difficulty dealing with the emotions of what they have experienced. It’s more important than ever that we establish rules of respect and tolerance within our communities and online. When bullying happens, we all lose.”

Finally, a slightly less conventional exploration of psychology from Medical News Today, who advise us that melting into that compelling novel could have interesting consequences on our thoughts and behaviour…

When you “lose yourself” inside the world of a fictional character while reading a story, you may actually end up changing your own behavior and thoughts to match that of the character, a new study suggests.

Researchers at Ohio State University examined what happened to people who, while reading a fictional story, found themselves feeling the emotions, thoughts, beliefs and internal responses of one of the characters as if they were their own – a phenomenon the researchers call “experience-taking.” They found that, in the right situations, experience-taking may lead to real changes, if only temporary, in the lives of readers.

In one experiment, for example, the researchers found that people who strongly identified with a fictional character who overcame obstacles to vote were significantly more likely to vote in a real election several days later.

I’m an Adrian Mole fan, and I’m as inept and cynical as him, so I know this to be true. But on the other hand, I’m also an A Clockwork Orange fan…hmm. Oh dear.

Nothing special for the wildcard because of my limited access to the lifeline of the world wide web, but in the wake of the Queen’s Speech to Parliament today(/yesterday), here’s a few mildly amusing parodies of Liz, courtesy of Dead Ringers.

Enjoy the rest of your week folks x