Mental Health: Your concerns answered

In October 2007, BBC Radio Norfolk’s breakfast show explored the issue of mental health in a series called Head First. Maggie Wheeler, chair of the Norfolk And Waveney Mental Health Trust answers your questions.
Q: How long have you worked in mental health?
A: I’ve been chair of the trust for about four and a half years but I’ve spent the last 30 years or so working as a social worker and social care manager.
Q: According to national figures, Norfolk has a high rate of prescribing anti-depressants. Why is this?
A: Nobody is quite sure why. One possibility is that there are more people with mental health problems in Norfolk, though there’s no particluar reason why there should be. There is another argument that people are getting good access to their GP and that the GPs are responding to that. Anti-depressants are not the only answer. But it’s not an ‘either or’ with medication and other kinds of therapy, I think sometimes you need both. There’s not a ‘one size fits all’.
Q: Some people have said that their doctors were not well prepared for people with mental health problems. What should people do if they are not happy with the service they recieve from their GP?
A: One of the things they can do when they see their dcotor is ask if they can see a link worker. Link workers are people who are trained in mental health, with a nursing or social care background who can work with the individual and also help the GPs to know what more is available out there.
Q: Do you think there’s enough care in the community? Some people have suggested that there should be more help outside the hospital environment.
A: I think the whole future is about caring for people in their communities. I think the phrase ‘care in the community’ has become devalued over the years. What we know is that most people want to carry on living their lives in their own home, carry on working if they can, carry on being a student, a mother, a father…whatever it is that you and I would characterise as being our unique lives. It’s about finding a way to carry on with that while you’re recovering from mental illness, or while living with mental ill-health.
Q: What would you say to someone who’s worried about becoming dependent on anti-depressants?
A: If people are concerned about that, it’s really important they go back to see their doctor. I think most GPs, when they’re prescribing anti-depressants, are asking people to come back regularly to be reviewed. Certainly anti-depressants isn’t something you should suddenly stop taking.
Q: There seems to be a lot of help available for people who live in Norwich – what about those in rural areas? How can you reassure people about the way care in the community is going to develop here in Norfolk over the next few years?
A: One of the reasons it’s important to enable people to have care in their own homes is that the further you live away from a centre the harder it can be to access services. So the more we can do to avoid people having to come to Norwich, or wherever it might be, the more money we can invest in the teams that will go out and treat people in their own homes. We have the same challenge that every agency in Norfolk has, of providing equal services across a huge geographical area. I think our services are good right across the county, but they will feel different in different places.
Q: What’s the future for mental health services in Norfolk?
A: One of the things we’ve done quite considerably is changed the way people are treated. People now spend much less time in hospital, which means that we need fewer hospital beds, so we can invest the money back in the community teams. I can’t quote you an exact figure off the top of my head, but we’re having to have a long hard look at the very best way to spend the money we have.

Source: BBC Website

Mental Health: Your concerns answered

In October 2007, BBC Radio Norfolk’s breakfast show explored the issue of mental health in a series called Head First. Maggie Wheeler, chair of the Norfolk And Waveney Mental Health Trust answers your questions.
Q: How long have you worked in mental health?
A: I’ve been chair of the trust for about four and a half years but I’ve spent the last 30 years or so working as a social worker and social care manager.
Q: According to national figures, Norfolk has a high rate of prescribing anti-depressants. Why is this?
A: Nobody is quite sure why. One possibility is that there are more people with mental health problems in Norfolk, though there’s no particluar reason why there should be. There is another argument that people are getting good access to their GP and that the GPs are responding to that. Anti-depressants are not the only answer. But it’s not an ‘either or’ with medication and other kinds of therapy, I think sometimes you need both. There’s not a ‘one size fits all’.
Q: Some people have said that their doctors were not well prepared for people with mental health problems. What should people do if they are not happy with the service they recieve from their GP?
A: One of the things they can do when they see their dcotor is ask if they can see a link worker. Link workers are people who are trained in mental health, with a nursing or social care background who can work with the individual and also help the GPs to know what more is available out there.
Q: Do you think there’s enough care in the community? Some people have suggested that there should be more help outside the hospital environment.
A: I think the whole future is about caring for people in their communities. I think the phrase ‘care in the community’ has become devalued over the years. What we know is that most people want to carry on living their lives in their own home, carry on working if they can, carry on being a student, a mother, a father…whatever it is that you and I would characterise as being our unique lives. It’s about finding a way to carry on with that while you’re recovering from mental illness, or while living with mental ill-health.
Q: What would you say to someone who’s worried about becoming dependent on anti-depressants?
A: If people are concerned about that, it’s really important they go back to see their doctor. I think most GPs, when they’re prescribing anti-depressants, are asking people to come back regularly to be reviewed. Certainly anti-depressants isn’t something you should suddenly stop taking.
Q: There seems to be a lot of help available for people who live in Norwich – what about those in rural areas? How can you reassure people about the way care in the community is going to develop here in Norfolk over the next few years?
A: One of the reasons it’s important to enable people to have care in their own homes is that the further you live away from a centre the harder it can be to access services. So the more we can do to avoid people having to come to Norwich, or wherever it might be, the more money we can invest in the teams that will go out and treat people in their own homes. We have the same challenge that every agency in Norfolk has, of providing equal services across a huge geographical area. I think our services are good right across the county, but they will feel different in different places.
Q: What’s the future for mental health services in Norfolk?
A: One of the things we’ve done quite considerably is changed the way people are treated. People now spend much less time in hospital, which means that we need fewer hospital beds, so we can invest the money back in the community teams. I can’t quote you an exact figure off the top of my head, but we’re having to have a long hard look at the very best way to spend the money we have.

When does your mental health become a problem?

People often feel sad during difficult life events

Continue reading the main story

What is depression?
Can CBT really change our brains?
One in four people are expected to experience a mental health problem, yet stigma and discrimination are still very common. Myths such as assuming mental illness is somehow down to a ‘personal weakness’ still exist.

How do we define mental health?

A person who is considered ‘mentally healthy’ is someone who can cope with the normal stresses of life and carry out the usual activities they need to in order to look after themselves; can realise their potential; and make a contribution to their community. However, your mental health or sense of ‘wellbeing’ doesn’t always stay the same and can change in response to circumstances and stages of life.

Everyone will go through periods when they feel emotions such as stress and grief, but symptoms of mental illnesses last longer than normal and are often not a reaction to daily events. When these symptoms become severe enough to interfere with a person’s ability to function, they may be considered to have a significant psychological or mental illness.

Someone with clinical depression, for example, will feel persistent and intense sadness, making them withdrawn and unmotivated. These symptoms usually develop over several weeks or months, although occasionally can come on much more rapidly.

Mental health problems are defined and classified to help experts refer people for the right care and treatment. The symptoms are grouped in two broad categories – neurotic and psychotic.

Neurotic conditions are extreme forms of ‘normal’ emotional experiences such as depression, anxiety or obsessive compulsive disorder (OCD). Around one person in 10 experiences these mood disorders at any one time. Psychotic symptoms affect around one in 100 and these interfere with a person’s perception of reality, impairing their thoughts and judgments. Conditions include schizophrenia and bipolar disorder.

Mental illness is common but fortunately most people recover or learn to live with the problem, especially if diagnosed early.

What causes mental illness?

Continue reading the main story
How common are mental illnesses in the UK?

Anxiety will affect 10% of the population
Bipolar disorder will affect one in 100
One in every 150 15-year-old girls will get anorexia, and one in every 1000 15-year-old boys
20% of people will become depressed at some point in their lives
OCD will affect 2%
Personality disorder will affect one in 10, though for some it won’t be severe
Schizophrenia will affect one in 100
Source: Royal College of Psychiatrists

The exact cause of most mental illnesses is not known but a combination of physical, psychological and environmental factors are thought to play a role.

Many mental illnesses such as bipolar disorder can run in families, which suggests a genetic link. Experts believe many mental illnesses are linked to abnormalities in several genes that predispose people to problems, but don’t on their own directly cause them. So a person can inherit a susceptibility to a condition but may not go on to develop it.

Psychological risk factors that make a person more vulnerable include suffering, neglect, loss of a parent, or experiencing abuse.

Difficult life events can then trigger a mental illness in a person who is susceptible. These stressors include illness, divorce, death of a loved one, losing a job, substance abuse, social expectations and a dysfunctional family life.

When is someone thought to be mentally ill?

A mental illness can not be ‘tested’ by checking blood or body fluids. Instead it is diagnosed, usually by an experienced psychiatrist or clinical psychologist, after studying a patient’s symptoms and monitoring them over a period of time.

Continue reading the main story
How ICD-10 classifies bipolar affective disorder:

‘A disorder characterized by two or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). ‘

Many different mental illnesses can have overlapping symptoms, so it can be difficult to tell the conditions apart.

To diagnose a mental health condition, psychiatrists in the UK may refer to the World Health Organisation’s International Classification of Diseases (ICD) system. This lists known mental health problems and their symptoms under various sub-categories. It is updated around every 15 years.

Some experts argue that the current system relies too strongly on medical approaches for mental health problems. They say it implies the roots of emotional distress are simply in brain abnormalities and underplay the social and psychological causes of distress.

They argue that this leads to a reliance on anti-depressants and anti-psychotic drugs despite known significant side-effects and poor evidence of their effectiveness.

For symptoms and more information, visit NHS Choices

Source: BBC Website

England’s Mental Health Services ‘in Crisis’

England’s mental health services ‘in crisis’
By Michael Buchanan
BBC News

Care Minister Norman Lamb; “I know there are problems and I am absolutely determined that we address them”Continue reading the main story

The mental health service in England is in crisis and unsafe, says one of the country’s leading psychiatrists.

Dr Martin Baggaley, medical director of the South London and Maudsley NHS Trust, spoke out as an investigation by BBC News and Community Care magazine reveals more than 1,500 mental health beds have closed in recent years.

Many trusts have all their beds filled.

Care Minister Norman Lamb said the current situation was “unacceptable” and provision must improve.

While there was a drive to treat more people in the community, he said beds must be available when patients needed them.

System ‘inefficient, unsafe’
Freedom of Information requests were sent to 53 of England’s 58 mental health trusts, by BBC News and Community Care, and 46 trusts replied.

The figures show that a minimum of 1,711 mental health beds have been closed since April 2011, including 277 between April and August 2013.

This represents a 9% reduction in the total number of mental health beds – 18,924 – available in 2011/12.

Three quarters of the bed closures were in acute adult wards, older people’s wards and psychiatric intensive care units.

Northumberland, Tyne and Wear NHS Trust has cut its inpatient beds by 157, while St George’s and South West London has removed 155 beds.

Behind the statistics lie the consequences for staff and patients.

On the morning Dr Baggaley spoke to the BBC, he said a severely distressed patient had been transferred from Croydon to Hertfordshire as there were no beds in London.

He has 50 patients in beds outside his trust, some as far away as Somerset.

He said: “We are in a real crisis at the moment. I think currently the system is inefficient, unsafe.

“We’re certainly feeling it on the front line, it’s very pressured, and we spend a lot of our time struggling to find beds, sending people across the country which is really not what I want to do.”

Increased demand

Lucy Bowden sought voluntary psychiatric help, and was told no beds were available
Lucy Bowden ended up in the back of a police van due to a lack of beds after voluntarily seeking help.

The 33-year-old, who self-harms, was left wandering around the grounds of her local accident and emergency unit after being told there were no psychiatric beds available after she’d been treated following an episode.

Eventually the police were called, who had to section her to force her local psychiatric hospital to provide her with care.

She recalls: “They couldn’t find anywhere so they were saying I’d have to go in to police custody, in a police station which would mean I’d have to go into a cell. Eventually they found a bed and I had to go into the back of a police van, in the cage in the back. It was horrible.”

The bed closures are only part of the problem.

There is also increasing demand for mental health services, according to Dr Baggaley.

Dr Martin Baggaley: “There seems to be a genuine increase in demand”
“There seems to be a genuine increase in demand,” he said. “That’s partly explained by a reduction in beds, by resources coming out of the health system, the squeeze on social services budgets, and by the general economic situation.”

Average occupancy levels in acute adult and psychiatric beds are running at 100% according to the FOI figures from 28 trusts.

Half of these trusts had levels of more than 100%; all of them had occupancy rates above the 85% recommended by the Royal College of Psychiatrists.

The problems of running at capacity are highlighted by the tragic case of Mandy Peck. The 39-year-old told psychiatric staff she was feeling suicidal but her local mental health service centre said they had no beds available. A day later she jumped to her death from a multi-storey car park. A subsequent investigation found that a bed had actually been available.

Care Minister Norman Lamb said: “Current levels of access to mental health treatment are unacceptable. There is an institutional bias in the NHS against mental health and I am determined to end this.

“More people are being treated in the right settings for them, including fewer people needing to go into hospitals. It is essential that people get the treatment they need early and in the community but beds must be available if patients need them.”

Dr Geraldine Strathdee, National Clinical Director for Mental Health from NHS England, said the key was to strike the right balance between providing sufficient hospital beds and helping patients to be treated at home, or in the community.

“We need to make sure the people who are commissioning services have the information they need about the level of need in their area. We have to get this right for people.”

Marjorie Wallace, chief executive of the charity SANE, said: “It is all too easy to find the cuts demanded by NHS efficiency savings in mental health.

“If a patient has heart failure or is in a coma, a bed has to be found. But for a person in mental distress, this is not seen to be as necessary.

“Being turned away when seeking help only reinforces patients’ feelings of rejection and hopelessness and can in our experience drive them to suicide.”

http://www.bbc.com/news/health-24537304