Monday 12 May 2014

PTSD is terrifying but speed of UK veterans seeking help is promising

PTSD is terrifying but speed of UK veterans seeking help is promising

It takes on average 13 years before a veteran seeks help for a mental health issue. For Afghanistan it is about 18 months
British soldiers from 2nd Battalion, The Rifles on foot patrol in Helmand province
British soldiers from 2nd Battalion, The Rifles on foot patrol in Helmand province. Those who have served in the infantry tend to make up the biggest proportion of the people who have PTSD. Photograph: Cpl. Timothy L. Solano/PA
The transition to civilian life can be a difficult time, not just for the veterans but for their families as well. Everyone is different, but after being discharged, veterans have to cope with a loss of role and identity.
In service, those things are there, and they are taken care of. They have a sense of who they are. Their whole support and social network is around them, so when they leave, they often have problems adjusting to civilian life. Many of the veterans we see are presenting with depression, or alcohol or drug misuse. They may have lost the support of family or friends; 6% are homeless. They require welfare as well as clinical services to help them get back on track.
Exposure to combat is the biggest risk factor in terms of the significant minority who will be diagnosed with post-traumatic stress disorder.
It tends to be multiple exposures to combat rather than singular events, so those who have served in the infantry tend to make up the biggest proportion of the people who have PTSD.
For those veterans, it's a bit like having a film of something awful that has happened being stuck in your mind. This film may not be on play permanently but if you are walking down a street and see something that looks similar to the traumatic event, it will trigger a memory.
If this is unprocessed trauma memory, there will be a strong physiological response. Your heart rate will increase and you will start sweating and you will feel under threat. It may be something that has happened in the past, but the body responds like it is happening now. The person will be experiencing it in their mind, and it will be terrifying.
For some, delayed-onset PTSD can happen years after they leave the forces. They may seem to have coped very well, and then something will happen 20 years later, such as the loss of a partner or a car crash, and that will trigger PTSD. It will take them back and the memories will be vivid.
In some ways, the big increase in referrals of Afghanistan veterans last year is promising. If you look at the figures across all conflicts, it takes on average about 13 years before a veteran seeks help for a mental healthillness. For Afghanistan, it is about 18 months before they present themselves.
People are coming to us more quickly. It gives us hope that we can try to prevent some of the issues of relationship breakdown and other problems that affect veterans. We would expect the increase in referrals to continue. The troops withdraw from Afghanistan this year and there is a danger that once the conflict is over, veterans will be forgotten.
Dr Nicola Sorfleet is in charge of psychological therapies at Combat Stress's treatment centre in Leatherhead, Surrey

Wednesday 12 March 2014

Self-harm sites and cyberbullying: the threat to children from web's dark side

Self-harm sites and cyberbullying: the threat to children from web's dark side

Suicides linked to websites add to concerns as experts warn NHS is ill-equipped to deal with fallout from 'toxic digital world'
There is a huge gap between what adults see of the online world and their children's experience. Photograph: Ossi Lehtonen/Rex
"Some of the images do scare me, especially if it's my friends. Once my friend cut lines down the side of his face as a 'Chelsea Smile', he put it online and it was the worst thing I had ever seen. He's my friend, I don't want to see him that upset. He got so much hate for it and ended up going into hibernation, nobody heard from him for over a week and we honestly thought he had killed himself."
Frankie* is 15 and lives in the Midlands. For the past year or so she has updated her Tumblr blog most days. On other social networks she uses her real name, but on Tumblr – a blogging platform – she shares her darkest thoughts about depression, anxiety and self-harm anonymously. "The other day I put up a self-harm picture," she says. "I was alone and in a dark place. […] Of course, nobody would help, but posting it boosted my confidence a little; finding it buried in amongst all the other self-harm posts reminded me I'm not alone."
Fears about self-harm sites have been growing since the suicides of two teenagers who, it emerged, were obsessed with self-harm and depression blogs, with mental health campaigners and experts warning that the UK's teens are at risk of becoming a lost generation if parents and adults cannot reach out to them across the digital divide.
Tallulah Wilson, a 15-year-old who killed herself in 2012, was caught up in a "toxic digital world", according to her mother, while the parents ofSasha Steadman, a 16-year-old who died from a suspected drug overdose in January after looking at self-harm sites, said her "impressionable mind" had been filled "with their damning gospel of darkness".
For the uninitiated, self-harm blogs present a surreal world of fantasy and pain. Countless sites dedicated to self-harm and depression are filled with images of bleeding wounds juxtaposed with pixelated gifs, flickering eerily with snippets of Hollywood angst. Helen, who is now 18, visited them regularly, before stopping to help herself move on from self-harming. "You have people asking you how to cut yourself deep enough because their therapist said it wasn't bad enough," she says. "I have had people tell me to kill myself. I think the most traumatic is when you find someone's suicide note online and there is no way to actually get in contact with the person."
Isolated and lonely, she used the blogs because they gave her a sense of belonging. "You want to find people who are similar to you. That is what humans do," she says. "It starts off as trying to help, but then it becomes competitive and dangerous. You get sucked into this world of who can cut the deepest/be the skinniest and avoid notice by the outside world. You end up spending hours a day searching these sites for reassurance, but it just makes it harder."
Keeping children safe online is the "child protection challenge of this generation", according to Peter Wanless, head of the NSPCC. ChildLine, part of the organisation, registered an 87% rise in calls about cyberbullying last year, a 41% increase in calls about self-harm, and a 33% increase in calls about suicide, with the biggest increase among 12- to 15-year-olds.
While the internet provides unprecedented opportunities for young people to communicate and learn, it can be a dangerous place for vulnerable teenagers, says Sue Minto, the head of ChildLine. "Children are communicating in a way we have never seen before – all the time and instantly," she says. "Personally, I think this kind of relentless exposure is the biggest challenge we have ever faced."
Minto notes that while peer pressure and bullying have been around for a long time, the ability to be contacted at all times is new. The cloak of anonymity can lead children to make comments they would shy away from in "real" life, she says. "The pressure on children is immense and very worrying – there is no break for these young people, it is quite relentless. Children who are being bullied tell us there is no point in turning off their phone, because the messages will just be there waiting for them."
recent survey carried out by youth charities ChildLineSelfharm.co.uk,YouthNet and YoungMinds revealed that 61% of the 4,000 young people who responded said they self harmed because they felt alone, while 25% cited bullying. Almost 40% said they had never spoken to anyone in the "real world" about it.
Rachel Welch, director of Selfharm.co.uk, which supports young people affected by self-harm, says there is a huge gap between what adults see of the online world and their children's experience. "So many young people are drifting into a world where they are completely disconnected," she says.
But how dangerous are self-harm sites? Do they simply show teenage angst and creative expression, or highlight a worrying deterioration of teenage mental health?
Mary Hassell, the coroner presiding over the inquest of Tallulah Wilson, was concerned enough to write to Jeremy Hunt, the health secretary, to warn him of a risk of future deaths without a greater understanding of children's online worlds. Although Tallulah was treated by healthcare professionals, they didn't have "a good enough understanding of the evolving way that the internet is used by young people, most particularly in terms of the online life that is quite separate from the rest of life", she wrote.
A study into possible links between suicide and the internet has just been commissioned by the Department of Health and will report in two and a half years: a department spokeswoman said children's mental health was a priority for the government and pointed to the introduction of "family-friendly filters" and internet safety into the national curriculum.
But for Sarah Brennan, chief executive of the youth mental health charity Young Minds, the real issue is ignorance of the scale of the problem, or even denial that the problem exists. The current NHS commissioning of youth mental health services is based on data collected in 2004 – the year Facebook launched.
"It is shocking that the government is allowing NHS commissioners to plan services based on out of date and inaccurate data," Brennan says, adding that a Young Minds freedom of information request recently revealed that 34 out of 51 local authorities in England have reduced the budget for their children and adolescent mental health services since 2010, while a Community Care/BBC investigation this week showed that a growing number of seriously ill children are being admitted to adult psychiatric wards or sent hundreds of miles from home for hospital care.
"We are sitting on a ticking time bomb here," says Brennan. "At the same time that we are seeing an increase in need, youth mental health services are being cut. There is an explosion of bullying online and young people struggling to cope with mental health issues, anxiety, eating disorders. If we don't do something about it we could have a lost generation."
What can be done? Since Tallulah Wilson's suicide, Tumblr has introduced a warning that pops up when users search for terms related to self-harm, directing them towards sites offering support and calling on users to report blogs with "inappropriate content" so they can be taken down. A Tumblr spokeswoman said the site was "deeply committed to protecting our users' freedom of expression", but that it draws lines "around a few categories of content we consider damaging to our community, including blogs that encourage self-harm".
And while there have been calls to shut down certain sites, such as Ask.fm – which allows users to ask anonymous questions and has beenlinked to teen suicides – teenagers and professionals spoken to by the Guardian agreed that simply banning sites or "dangerous" search terms was futile. Regulation can also backfire – recent efforts to impose opt-out "objectionable content filters", backed by the prime minister, have resulted in sites such as ChildLine and Refuge also being blocked.
"We cannot put our head in the sand, simply blame these sites or hope to regulate our way out of this," says Minto. "We are playing catch-up, but we need to take responsibility. You wouldn't let your child cross the road without talking to them about road safety and the same goes for the risks of the internet – if we don't tackle this it's like opening the door and letting them walk through this cyberworld completely unequipped."
Welch at Selfharm.co.uk agrees: "Calling for any type of ban is just missing the point. What we have to do is make sure our young people are emotionally resilient, emotionally aware and they know where to go to get help if they need it."
Others say that while parts of the internet can be dangerous for vulnerable children, it can also provide the means to keep others safe and let them talk about their problems. As many young people contact ChildLine online as call its helpline. Online friends can be a force for good.
Samantha, a 17-year-old who started self-harming when she was 14, says her Tumblr site helped her recover from depression. "I felt like I belonged somewhere, they understood me in a way I felt I had never been understood before," she says. At one point, she was off school with depression and spent all day online, answering 10-15 messages from other troubled teenagers every day. Now she "has a life" again and is online less frequently. "I've been told that I've saved lives and it made me feel good about myself that I was helping other people," she says. "It's really odd – but it works for me."
Frankie, who is still working towards recovery, has mixed emotions. While she recognises that some blogs might encourage self-harmers, or make them feel worse, she still believes they can help. "I think for [people] like myself it can be reassuring just to know there are others out there that do it too [but] what scares me is thinking how many there are, how they are all posting it online, are they all cries for help? If that many people are crying for help then something needs to be done, and fast."
*Names of young people have been changed. If you face any of theissues in this piece, you can call ChildLine on 0800 1111

Monday 27 January 2014

Hundreds of children 'detained in police cells'

Hundreds of children 'detained in police cells'



a young person behind bars
There were more than 300 child detentions in each of the last three years
Hundreds of children in England and Wales have been held under the Mental Health Act and locked in police cells because officers did not have anywhere else to take them, the BBC has learned.
There were 305 detentions of under-18s in the first 11 months of 2013, Radio 4's the World This Weekend found.
Some were detained for more than 24 hours, according to data released under Freedom of Information laws.
Health Minister Norman Lamb said the level of cell use was "unacceptable".
He insisted every area should have arrangements and agreements in place, and police cells should only be used in "very, very exceptional circumstances".
The practice of detaining children suspected of being mentally ill was first uncovered by the BBC in 2012.
Then, the data for 2011 showed there were 385 child detentions.
The latest information revealed that in 2012 there were 317 detentions.
'Shocking'
Some children were detained for long periods of time - including 17-year-olds held for more than 24 hours and 15-year-olds for between eight and 15 hours.
A 10-year-old in Gwent was taken to a cell as no bed was available.
Police have the power under the Mental Health Act to take people they suspect of being mentally disturbed and who could be a danger to themselves or others to a "place of safety" to be assessed by a doctor.
This detention may only last up to 72 hours.
Places of safety will usually mean a hospital, care home or any other suitable place but, in exceptional circumstances, it may also be a police station.

In the case of children, this could mean an adolescent psychiatric unit or a children's home.
Sarah Brennan, chief executive of charity Young Minds, described the situation as "really shocking".
"[Children and young people] need to have appropriate care in the appropriate setting and that should never be a police cell when they have mental health problems."
The fact children were still being held in cells two years after it was first reported was a "terrible indictment", she added.
Mr Lamb insisted it was possible to stop using police cells, saying some parts of the country needed to "step up" to the standards as those areas which do not use them, while proper coordination and collaboration of services was paramount.
"We need to have very clear standards of crisis mental health care," he told the BBC.
The Department of Health also said it was trialling two schemes to tackle the issue.
Under its "street triage" scheme, mental health nurses patrol with the police to identify people who need immediate mental health support.
An extra £25m had been made available for mental health workers to be based in police stations and courts, the department said.
'Got to change'
The Association of Chief Police Officers welcomed the move, but the association's spokesman on mental health said more needed to be done.
"We were in a position where there was every day at least one young person statistically taken to a police cell," said Chief Constable Simon Cole.
"We're now down to less than one person a day as an average. Has it changed quickly enough and significantly enough? No it hasn't, and I want that change to be quicker.
"I'm a father myself and the thought that either of my kids were ill and that they finished up in a police cell, I regard as abhorrent."
So-called places of safety were, in many parts of the country, not equipped to take on young people, he said, adding: "That's just got to change."
Lorraine Khan from the Centre for Mental Health said the figures were "hugely disappointing".
"The government is currently reviewing the code of practice for the Mental Health Act and should look at ways this could help to stop children being placed in police custody when they should be in a safe hospital environment."
Professor Sue Bailey of the Royal College of Psychiatrists welcomed the government's commitment to mental health but said the pace of change needed to quicken.

Thursday 23 January 2014

Mental health: Ysbyty Gwynedd's Hergest Unit could lose beds

Mental health: Ysbyty Gwynedd's Hergest Unit could lose beds


Ysbyty GwyneddStaff at the Hergest Unit at Ysbyty Gwynedd, Bangor, have criticised plans to cut the number of beds

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Some beds at a mental health unit in Bangor could temporarily close to try and deal with concerns over the way patients are treated.
Staff at Ysbyty Gwynedd's Hergest Unit have criticised the plans, blaming problems on managers.
Last year, Healthcare Inspectorate Wales (HIW) identified low staff morale and other issues in a surprise visit.
Betsi Cadwaladr University Health Board (BCUHB) said fewer beds would help it address some of the issues.
Health service regulator HIW made a surprise visit to the 42-bed Hergest Unit at the end of last year.
Its report criticised low staff morale, poor professional relationships, safety issues, concerns over mixing mentally-ill patients with frail elderly ones, and the need for single sex wards.
It said: "Relationships between some responsible clinicians and some nursing staff was very poor with staff not talking to each other.
"In addition, some nursing staff were not talking to other nursing staff. The lack of communication and behaviour amongst professionals is unacceptable and must be resolved."
It also pointed out that there was "a lack of training in some key areas across all wards, specifically fire safety and basic life support".
Another criticism concerned a lack of privacy and dignity for patients.
'Urgent review'
"There are multi-occupancy rooms and the bathrooms are shared between the patients on that ward. There were limited designated male and female facilities," the report said.
"An urgent review of the environment is required."
In response, BCUHB has proposed temporarily reducing the number of beds.
It said the change would "support improved nurse-to-patient ratios, facilitate more appropriate separation of males and females, and also provide for separation of frail older mental health patients and adult mental health patients".
But doctors at the Hergest Unit said the changes would make patients less safe.
They also say it could mean patients being transferred to the mental health unit at Glan Clwyd hospital in Bodelwyddan, Denbighshire, which is currently under police investigation after one ward there was closed last month.
The doctors suggested an extra ward could be opened at the Hergest Unit to deal with the problems instead.
The changes are being discussed at a meeting on Thursday at 10:00 GMT at Wrexham's Maelor hospital.
http://www.bbc.co.uk/news/uk-wales-north-west-wales-25827572

Friday 17 January 2014

So comedians are prone to psychosis? Comedy is more complex than that

So comedians are prone to psychosis? Comedy is more complex than that

Research published on Friday suggests that many comedians display signs of psychosis. This may well be a generalisation of what is a complex, diverse and little understood field – and by that, I mean comedy


North Wales Conwy and Denbighshire Advocacy Service
Overgeneralising the term 'comedian' is misleading, because even clowns could be included. Photograph: Dario Lopez-Mills/AP
I first did stand-up comedy in 2004. I’d always enjoyed making people laugh, which led me to take part in numerous comedy plays and the like in school and university. I never had the nerve to try stand-up though, I simply wasn’t brave enough.
Then I spent 18 months embalming dead people for a medical school, which really does tend to alter your standards when it comes to things you’re able/willing to tolerate, so I opted to give stand-up a go. What was the worst that could happen: I’d end up in a room full of people not laughing at me? I spend every day in a room full of people not laughing at me, at least these ones will still be breathing and have all their organs on the inside.
I signed up to do a brief five-minute set at a local open-mic night in Cardiff. The gig itself was a fun regular night but based in a pub in the rougher side of town with a regular clientele who would probably be given their own definitely-not-exploitative Channel 4 show if a producer had wandered in. I was meant to be the newbie in the middle, but on the night all the other acts cancelled so I was promoted to headliner, which was nice. It went surprisingly well, all things considered. Afterwards, when telling friends and family what I’d done, the most common response was “you must be mad”.
According to research published today, this is true. A study revealed that, when asked to fill in a questionnaire that looks into psychotic characteristics in “healthy” people, comedians scored “significantly higher on all four types of psychotic personality traits” when compared with the scores of actors and “non-creative” occupations. This obviously results in a number of speculations as to how elements of psychosis are useful for the creative process, how elements of madness make it easier to entertain a crowd etc.
It would be easy to critique the report(s) by emphasising how science and psychology are more complicated than that, as is my usual response, but ignoring the potential problems with self-assessment, the fact that psychotic traits can be normally distributed in the population and other issues, I thought it might be useful to critique science’s understanding of comedy for a change. As that rare thing, a neuroscientist/psychiatry lecturer with a decade of stand-up experience, I'm probably well placed to comment.
Most scientific studies into comedy/humour suffer from the fact that the researchers have their own definition of what comedy is, and many would disagree with this definition. Many comedians (myself included) have grumbled about the lumping together of all who do funny things for an audience as “comedians”; it’s an incredibly diverse and varied art form where everyone has their own techniques and style (apart from the gag thieves) and assuming all who do it are the same and therefore comparable does nobody any favours. If a known fan of classical jazz went to a punk concert and complained that the music was crap, their motives and self-awareness would be questioned. But comedians regularly get criticised by people based on nothing more than their own preferences, as if they’re somehow responsible for this. So lumping together 523 comedians together in the study may not be as useful as is implied.
Comedians are also compared to actors, presumably on the grounds that both perform for audiences. But acting and comedy are very different crafts; actors typically have to learn other people’s work, perform very precise actions, and rarely acknowledge the audience. Comedians typically have to write their own material and very much respond to the audience, which requires a different skill set entirely. So it may not be a logical comparison after all, but then no more than the blanket label of “comedian”.
The one individual cited in the report is Spike Milligan, comedy hero andmanic-depressive. But Milligan was a writer/actor/performer, not so much a stand-up, which is what many people think of when you say “comedian”. And as anyone who has read his war diaries could tell you, it’s implied that his depression and mental issues stem from his wounding in WWII, whereas he seems to have been a popular comedic personality before this point.
This also links to questions of cause and effect. The study cites “successful” comedians, presumably focussing on those who at least make a living from performing comedy, so they must be very experienced at it. But as has been pointed out often, doing anything often enough will result in your brain altering as it gets better at this task. Regularly writing jokes and amusing anecdotes that nobody has yet come up with in an increasingly crowded comedy marketplace will probably give rise to a tendency for divergent thinking, something also seen in psychosis. Could it be comedy that gives rise to signs of psychosis, rather than the other way around?
http://www.theguardian.com/science/brain-flapping/2014/jan/16/comedians-psychosis-comedy

Monday 13 January 2014

Bedroom tax loophole could exempt 40,000 wrongly identified as liable

Bedroom tax loophole could exempt 40,000 wrongly identified as liable

Housing benefit experts condemn 'shambles' as it emerges that DWP oversight could mean some actually profit from blunderSocial housing bedroom tax
The bedroom tax loophole applies to working-age social housing tenants who are entitled to housing benefit. Photograph: Graham Turner for the Guardian
Thousands of people have been wrongly identified as liable for thebedroom tax, including some who now face eviction or have been forced to move to a smaller property, as a result of an error by Department of Work and Pensions.
Housing experts believe as many as 40,000 people could be affected by the mistake. The DWP says it believes only a "small number" of tenants are affected, which it estimates number 5,000.
All could be eligible for refunds worth on average at least £640 per claimant and millions in aggregate.
The error affects working age tenants in social housing who have occupied the same home continuously since 1996. An oversight by the Department for Work and Pensions (DWP) when drafting the legislation means that the housing benefit regulations dating from 1996 were not updated when the coalition legislated for the bedroom tax.

Cyberbullying contacts to Childline up by 87%

Cyberbullying contacts to Childline up by 87%

Concerns about online bullying rose by 87% in the year since 2011/12 according to Childline's latest report, while depression and unhappiness have become the most common reason for contacting the charity
Cyberbullying
Counselling for online bullying rose by 87% in 2012/13 according to Childline's latest report. Photograph: Alamy
More than 35,900 young people contacted Childline in 2012/13 aboutdepression and unhappiness, according to the charity's annual report, which also saw a sharp rise in the number of children suffering from cyberbullying.
278,886 children and young people were counselled by Childline in 2012/13, while a further 10,961 young people contacted them with concerns about another child. The charity found that for the first time ever, more counselling took place online, via one to one chats or email (59%) than by telephone (41%).
Depression and unhappiness were the most common reason stipulated by young people contacting the charity. More than half of all contacts about depression and unhappiness came from girls. The issue was also the top reason girls sought help from Childline while for boys bullying and online bullying were the most common cause of concern.