Scotland’s New Mental Health Strategy

Scotland has a new Mental Health Strategy.

The Scottish Government’s strategy for the period 2012 – 2015 was launched earlier this month. There was none of the fanfare that usually accompanies these launches, although that might be due to the timing: mid summer, in a parliamentary recess and post Olympics.

The document was finalised following extensive consultation with user and carer groups, and the Scottish Government is to be commended for producing a strategy that takes on board many of the issues that were raised. User and carer involvement is, quite rightly, at the centre of the strategy, which is very much a working document rather than a lofty statement of ambitions.

The overall tone is of building on successes while recognising that there are also weaknesses to be dealt with. It is realistic, and in times of declining resources it simply had to be. There are no promises of massive new investment in mental health – but then did we really expect there to be?

There is a lot about self management and preventative action, what people can do to improve their own mental health and the challenges that issues like unemployment and poor physical health can play. The recovery approach and anti-stigma work will also continue.

The strategy recognises that measures to improve quality of life can also improve the mental health of many people. It sees that medical treatment is only one part of the fight against mental illness. And it also accepts that government is not the only agency with a role to play here: many of the services that play such important roles are delivered by other public sector bodies and often by the voluntary sector.

The Strategy outlines 36 Commitments from the Government across seven key themes, which emerged from the consultation process. These are:

1. Working more effectively with families and carers;
2. Embedding more peer to peer work and support;
3. Increasing the support for self management and self help approaches;
4. Extending the anti-stigma agenda forward to include further work on discrimination;
5. Focusing on the rights of those with mental illness;
6. Developing the outcomes approach to include personal, social and clinical outcomes; and
7. Ensuring that we use new technology effectively as a mechanism for providing information and delivering evidence based services

So what will we see happening in the world of mental health over the next few years?

The very first Commitment is that the Scottish Government will commission a 10 year on follow up to the 2004 Sandra Grant Report, which reviewed the state of mental health services in Scotland. This will be carried out next year for publication in 2014.

The detail of who will carry out this major review and with what exact remit will come later. This is the strategy after all, and the fine print on how it is implemented is to follow. But we can expect service user and carer involvement in the review, and it will provide another opportunity for us to put forward our perspective.

There is a Commitment to involve families and carers more fully in policy development and service delivery. This is to be welcomed and discussions have already started on how best to progress this work. It is fair to say that many carers’ organisations are not experts in the mental health field and focus primarily on the carers of those with physical illnesses. It is also the case that many partners, parents and friends of those who have mental illnesses would not call themselves carers: they provide support and love but don’t necessarily see themselves as care givers. This all needs to be carefully thought through – but many of the national mental health voluntary organisations offer support to carers as well as to those with mental illness and are therefore well placed to help shape the discussion.

E-health is an area where much progress is being made and the Commitment to develop a Scotland-wide approach to improving mental health through new technology is to be welcomed. There is much that can be done through better use of technology and I look forward to seeing some innovative ideas emerge.

There are several Commitments relating to children and young people, including better support for parenting programmes, developing specialised services for children in care and reducing the number of young people admitted to adult mental health wards. These are all positive developments and the priority given to addressing mental health issues as early as possible is an encouraging step.

And Commitments relating to older people include greater use of psychological therapies and better integration with general adult services. While there is a necessary focus on tackling dementia in service delivery it is good to see a recognition that this is not the only challenge that older people can face.

Work to identify new models of crisis care is an important Commitment. This will involve investigation of home treatment and other service delivery models, recognising that hospital admission should not be the only option available. There are several voluntary organisations that will have an interest in this area of work, and several other European countries already offer a crisis house model.

There are also Commitments relating to specific areas like alcohol and mental health, work in prisons, veterans and also better linkage of mental health services to local government, which is especially important as health and social care systems are integrated.

The final Commitment made is that systems will be put into place to co-ordinate, monitor and performance manage progress against all of the commitments made. This is not to be a document that gathers dust on a shelf, but one which really does drive progress. The method by which this work is carried out, and of course how progress is reported, will be important.

My overall response to the Strategy is a positive one. The commitments on service user and carer involvement and the emphasis on self management are welcome. There is, of course, an important role for primary care services in mental health, but there is also a great deal we can do in communities to reduce the likelihood of hospital admissions.

Mental health issues blight the lives of many people, and can have a big impact on their families and friends too. There is much that can be done to make life better, and many of the positives from this new Strategy involve designing new services that better meet the needs of those affected.

I’m looking forward to seeing a great deal of progress being made over the next few years.

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Financial Crisis Linked To Increased Suicide Rates

It seems fairly obvious that rates of depression and anxiety would rise when the financial crisis hit. Unemployment, or fear of it, added to other financial worries can take their toll.

And now a report in the Lancet has used World Health Organisation data to confirm that the period between 2007 and 2009 saw increased suicide rates among working aged people in nine out of ten European countries studied.

The increases varied between 5% and 17% for under 65s. And this comes after a period of falling suicide rates, The Lancet reported.

Austria was the only country to see its suicide rates fall. This was put down to the country being less exposed to the financial crisis than the others. The UK saw a rise of 10% to 6.75 suicides per 100,000 people, while Greece had the worst record with a 17% increase.

Dr David Stuckler, one of the researchers, said: “There was a complete turnaround. Suicides were falling before the recession, then started rising in nearly all European countries studied. Almost certainly these rises are linked to the financial crisis.”

And Dr Stuckler also reported that that it was possible there would be other health consequences from the economic problems as the impact on heart disease and cancer rates was not likely to be seen for many years.
With unemployment rising added to attacks on terms and conditions and major cuts in many public services it is likely that the UK suicide rate will continue to rise.

Andy Bell, deputy chief executive of the Centre for Mental Health, said: “We know that unemployment and the fear of unemployment are major risk factors for poor mental health.

“This research shows how important it is that we treat the mental health of people who are not just out of work but also in work but fear losing their jobs as a major public health issue”.

Once again this research shows that in difficult times our mental health services need to be protected from public sector cuts. They have more to do, not less, as the recession continues.

And money invested in services that can help those with mental health conditions at an early stage can help to avoid more costly hospital stays in the longer term. There is an economic as well as a human argument for the maintaining of services.

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Zeta Jones Brings Bipolar Into The News

News reports that actress Catherine Zeta Jones is having treatment for bipolar disorder have led to a number of very positive press stories about living with the condition.

Zeta Jones showed considerable courage in making her bipolar diagnosis public, and I wish her well in her treatment. Stresses in her life have affected her mental health, something that I can very much relate to.

There is still considerable stigma relating to mental illness. Many people continue to see it as a sign of weakness – look at some of the recent coverage of the England cricketer Michael Yardy’s battle with depression. And mental illness often features in the media in cases of horrific crimes.

So any opportunity to get the facts behind the condition into the public eye is very much welcomed by those of us non-celebrities who suffer from conditions like bipolar disorder.

Around one in four people will suffer from some sort of mental health condition during their lifetime. That means that pretty much everyone will have some experience from within their own family. And bipolar disorder is estimated to affect at least 1% of the population.

In the Guardian, Alastair Campbell wrote a fine piece suggesting that the media should concentrate more on the millions of “ordinary” people who learn to manage and to live with mental health conditions.

Whatever you might think of Campbell’s politics, he is a good advocate for those with mental health conditions. He understands the issues and puts forward reasoned arguments. He finishes his article by arguing that:

“ ..there are people with the same illness who cannot get the support they need, who still feel they have to lie about their condition to get or keep a job, and who really worry about the impact of government cuts and reforms that will fundamentally change the way mental health services are run. Those issues should be getting an airing regardless of celebrity support or involvement.”

Closer to home the Daily Record and The Herald both ran helpful articles.

In the Record my friend Michelle Howieson was given space to talk about her own battle with bipolar disorder over the past twenty years. She was frank about her battles, but finished on a typically positive note.

“It is a terrible illness to have and coping with it can be difficult but, with the right support, sufferers can come through the other side and lead normal happy lives. I’m a testament to that,” she said.

And The Herald concentrated on the fears of many people that forthcoming changes to welfare benefits could increase stress and exacerbate their conditions. Another friend, Alison Cairns who is Chief Executive of Bipolar Scotland, is quoted.

“People are being assessed as fit for work and later having these decisions overturned on appeal. The process itself has caused anxiety, stress and a worsening of their conditions for many.”

The BBC website also carries stories of those with bipolar disorder and how they can learn to live with the condition while holding down relationships and jobs.

This is the message that we all need to understand. That mental health conditions are serious and may need a variety of treatments including medication and counselling.

But by learning self management techniques and with the support of friends and family we can survive. And with the skills we learn and the strength we gain we can be positive and productive members of society.

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Tackling Depression Amongst Men

It is a myth that depression affects women more frequently than men. The truth is simply that women are far better at seeking treatment.

So how can men be encouraged to come forward in order to receive the help they need? And can GPs do more to make it easier?

These issues will be discussed at a conference to be held in Glasgow in December. The “Men and Depression” conference is being organised jointly by the Men’s Health Forum Scotland and Bipolar Scotland.

Speakers from the health services and the voluntary sector will discuss the reasons behind the situation and a carer will give a female perspective on the issue. There will be a number of workshops before a final plenary discussion, where the results of a survey on the subject will be announced.

Men are just as likely to suffer from mental illness as women but are far more likely to kill themselves: the highest suicide risk group in the UK is now men aged between 40 and 49. And three quarters of those who commit suicide are male.

The current economic situation could well make the situation worse, with job losses and financial pressures adding to the stress that many men already experience.

Men also react differently to depression. While depressed women can turn in on themselves, men suffering from the illness can become animated, aggressive and angry.

Middle-aged men are also far less likely to talk to friends and relatives about their feelings. Real men don’t cry, after all. Many rely heavily on their partner, which can push them towards marital breakdown and further isolation.

Research carried out in England by the mental health charity Mind also concluded that many men see doctors’ surgeries as “feminised” premises where they felt unwelcome.

The growth of well woman clinics and highly successful campaigns on breast and cervical cancer has had beneficial effects on women’s health. But perhaps the down side is that men are now losing out.

The chairman of the Royal College of General Practitioners, Professor Steve Field, has said that doctors are aware of the problems. “I don’t think it is GPs missing the symptoms, as much as people not coming forward, he said.

The “Men and Depression” conference will take place on 9 December in the Radission Blu Hotel on Argyle Street in Glasgow. It should be an interesting and informative day.

For further details, and to register for the conference, go to http://mhfs.org.uk/

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Mental Illness Does Not Mean Violence

The myth: People with a severe mental illness are likely to be violent.

The truth: Those of us who have a mental illness are no more likely to be violent than anyone else.

The stigma associated with conditions like bipolar disorder is, unfortunately, still strong.

81% of people with lived experience of mental ill-health told the Scottish campaign group ‘see me’ that they had experienced stigma. And many people still believe sensationalist reporting that portrays knife wielding maniacs or crazed gunmen as the true face of the mentally ill.

But a new study has confirmed what many of us have always known: the truth is that mental illness does not lead to violent crime.

The research, led by Oxford University’s Department of Psychiatry, examined the lives and behaviour of 3,700 people in Sweden who had been diagnosed with bipolar disorder over three decades.

They compared the experiences of this group with those of 4,000 siblings of people with bipolar disorder and of a control group of 37,000 people selected from the general population.

They found that the rate of violent crime within the bipolar group was no different from that within the general population.

People with mental illnesses who abuse substances were found to have violent crime rates which are six to seven times higher than the general population – as do people with no mental health issues who have similar drink or drugs problems.

Dr Seena Fazel, a clinical senior lecturer in forensic psychiatry and consultant forensic psychiatrist at Oxford University, said, “The relationship between violent crime and serious mental illness can be explained by alcohol and substance abuse. If you take away the substance abuse, the contribution of the illness itself is minimal.”

Dr Fazel also pointed out that you are more at risk of violence outside a pub late at night than outside a mental hospital which is releasing patients.

So there you have it. Proof that mental illness does not inevitably lead to violent behaviour. But the link between violence and substance misuse is shown to be significant once again.

It can be argued that people with a mental illness are more likely to abuse alcohol or drugs. In the case of bipolar disorder it is estimated that the rate of addiction is around ten times higher than that of the general population. And research has shown that this may be partially because of a linked genetic predisposition to addictive behaviour. So it would seem that more support and treatment is required to address these issues.

Once again a myth about mental health has been disproved. If you read of the dangers associated with mental health conditions you will now know that there is no truth behind it.

Changing public attitudes and tackling preconceptions is not an easy thing to do, especially when the tabloid press still seems to frame so many people’s views. But perhaps if we all work together to challenge and to educate we can make a difference over time.

Living with a mental illness is difficult enough without trying to cope with society’s misconceptions as well. Next time you hear someone repeating these myths, I would ask you to point out the facts to them.

You will be doing many of us an enormous favour.

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Adam Ant in Hospital

A friend told me earlier this week that Adam Ant is in hospital. Not because I am a particular fan of his music, but because Mr Ant suffers from the same condition as I do: bipolar disorder.

The eighties star, famous for songs such as Stand and Deliver and Kings of the Wild Frontier, spent many years concentrating on his acting career, but has been working on a new album and recently played his first live shows in several years.

But his health has now led to another hospital stay. Adam Ant was sectioned after displays of bizarre behaviour at a number of public events. Sectioning is a legal process of confinement where a person can be locked up for their own safety.

This is not the first time that the condition has resulted in Ant (real name Stuart Goddard) being hospitalised. And he has also had several brushes with the law over the years.

Bipolar disorder can affect anyone. Around one in every hundred people has the condition – and that would suggest around 600,000 sufferers in the UK alone.

The press, of course, only picks up on the story when someone in the public eye is involved. But many of us battle the condition every day through a combination of drugs and self management techniques.

Major episodes are not inevitable. But when they do strike they can be absolutely devastating. Mania brings excessive energy and a dangerous loss of judgement. In extreme cases it can result in psychosis. I know: I’ve been there.

I don’t have the medical details of Adam Ant’s case. But I do understand the demons he is fighting. So I wish him well in his recovery. Time in hospital can be absolutely the best thing when a manic episode strokes: time out from everyday life to gain strength and to get well once more.

If you want to do something to help, why not send Adam Ant a postcard? I’m sure he would appreciate the support.

Adam Ant c/o 1 Nightingale Place, Mulberry South Ward, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NG.

Get well soon Adam!

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The Myths of Mental Illness

Living with a mental health problem isn’t easy. Indeed, some days it seems downright impossible.

But it is made worse by attitudes that still exist in our society. We are a little better at being tolerant than we used to be, but even in the twenty first century there are still some very nineteenth century views of mental illness out there.

There are many myths about people with mental health issues that can create stigma. Myths that are often incorrect and usually portray a very negative, and totally inaccurate, image.

This can stop people getting help when they need it, or prevent them from talking openly about their problems. It can also make people feel guilty, isolated or ashamed if they become unwell. The reasons for this stigma vary but it seems that a general lack of understanding contributes – many people seem scared by the whole subject of mental illness.

Here are some of the common myths:

Only weak people have mental health problems.

What about Winston Churchill, Theodore Roosevelt or Buzz Aldrin? They all suffered from bipolar disorder and achieved a great deal in their lives.

Psychiatric disorders are not true illnesses like heart disease or cancer; people who have a mental illness are just “crazy.”

Unlike cancer or heart problems, easily detected by simple tests, mental illness has always been an invisible disease. This inability to see what’s wrong may add to the negative public perception, and even fear, of mental illness. But mental illnesses are bona fide medical conditions. They involve complex physiological processes, as well as changes or imbalances in brain chemistry,

Mental health problems are for life.

Not always true. While some people may experience problems over a long period, very many people may experience a single episode of illness. This is as true of schizophrenia as it is of depression. People can and do recover from mental health problems.

You brought it on yourself so pull yourself together.

There are many factors that can contribute to someone becoming unwell and most are outwith an individual’s control. You can no more decide not to have a mental illness that you can decide not to have cancer.

People who have mental health problems are stupid

Totally untrue. Dickens, Byron, Hemingway and Van Gogh all had bipolar disorder. And medical evidence shows that those with the disorder generally have IQs that are well above average.

People with mental health problems are violent

Sensationalist media reporting perpetuates this myth but the sad truth is that people with mental health problems are much more likely to harm themselves than anyone else.

People with mental health problems are weird and different

The majority of Scots say they know someone close to them who has been diagnosed with a mental health problem at some point – that’s an awful lot of weird people!

All people who suffer from depression are suicidal

Suicide is not a mental illness. Not everyone who is depressed will consider suicide. It is as inaccurate as saying that all football fans are hooligans. However it is true to say that individuals experiencing a mental health problem are, generally, associated with a higher risk of suicide.

People are born with mental illness.

Increased risk of mental illnesses can be hereditary; however many people will still develop mental illness even if there is no family history of it. Many factors can cause the onset of a mental illness.

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In Scotland an alliance of five leading mental health organisations runs the ‘see me’ anti-stigma campaign. It aims to tackle stigma and discrimination against those with mental health issues through a programme of public information. You may well have seen adverts in the press or on tv.

For more information about ‘see me’, visit the website at www.seemescotland.org.uk

81% of people with lived experience of mental ill-health told ‘see me’ that they had experienced stigma, and yet nearly half of the public thinks that people with mental health problems have the same rights as anyone else.

Most of us will come across mental illness somewhere in our lives. According to ‘see me’, nearly two thirds (61%) of Scots know someone close to them who has experience of mental ill-health.

Changing attitudes won’t cure the mental health issues that many of us live with. But it can make our lives just that bit easier – and that has to be a good thing!

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Johnny Cash – Hurt

I’m not generally a great fan of cover versions, usually preferring to hear the original artists performing their own music. There are of course a few exceptions: Hendrix’s take on All Along The Watchtower and The Clash’s version of I Fought The Law are two that come immediately to mind.

But this is, in my not so humble opinion, the best cover version of them all.

I first heard Johnny Cash’s Hurt when it was released as a single just a few months after the great man’s death in 2003, and immediately enjoyed his take. It wasn’t until early 2007 though that I really came to appreciate just how good a version of Hurt this really is.

Sometimes a certain track strikes a chord with your life, providing a soundtrack to events or situations you find yourself in at the time. And no matter where you go it seems to be there, almost as if the gods of music are laughing at you.

I was in New York City in March 2007 and Hurt seemed to be playing in every bar I went into. And at that time I went into a lot of bars. The lyrics spoke to me; they seemed to describe the mess that was my life at a time when I was seriously considering ending it. It moved me, almost to tears at times. But that’s another story.

What I didn’t know at the time was that the song had been written by Trent Reznor of Nine Inch Nails, who has both bipolar disorder and an alcohol addiction. No wonder it struck such a chord!

Musically, Cash’s cover is a stark and simple arrangement that fits well with the lyrical themes of pain and regret:

I wear this crown of thorns
upon my liar’s chair
full of broken thoughts
I cannot repair

There is a beautiful simplicity to the chorus, which ends with the lines:

I will let you down
I will make you hurt

The song’s final verse could be interpreted as hopeful, but somehow to me they always seem like a desperate and hopeless cry for redemption, for a second chance that just isn’t going to come.

f I could start again
a million miles away
I would keep myself
I would find a way

 

Johnny Cash’s version of the song, a performance by a man nearing the time of his own death, racked with pain and conscious of his own mortality, is simply stunning. That great voice is raw and laden with emotion, but it still has all of the power and authority of the Man In Black.

The video begins with Cash, dressed in black of course, playing a black acoustic guitar. As it moves on, director Mark Romanek has interspersed with shots from a run-down museum filled with mementoes of Cash’s life with images of a younger Cash, he picks out a simple melody on the piano. And at the end of the song he fades to black, closing the lid on the piano with a finality that speaks of the ultimate conclusion to life.

Raznor himself loves the Cash version. He tells of seeing the video for the first time: “Tears welling, silence, goose-bumps… Wow. I felt like I just lost my girlfriend, because that song isn’t mine anymore… It really made me think about how powerful music is as a medium and art form.”

Raznor is right. Cash didn’t simply cover the song. He reinterpreted it and took ownership of it.

But don’t take just his word for it. Hit the play button and see for yourself.

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Double Trouble – living with bipolar disorder

I wrote this piece almost a year ago – and it seems like a good way to introduce my new blog.

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I’ve called my blog Double Trouble – because that’s exactly what bipolar disorder feels like! The Bipolar Brain causes extreme lows that are awful; as well as extreme mania which can be dangerous. And when both hit you at once …

But let’s step back. What exactly is bipolar disorder?

Well, most people experience different moods with ups and downs, highs and lows. But when these become so extreme that they interfere with ordinary everyday activities this can cause people to behave in very uncharacteristic ways.

Previously known as manic depression, bipolar disorder is basically a chemical imbalance in the brain. No one knows where it comes from, although it appears to be partially genetic. The symptoms vary from person to person in severity, but there are two basic components: mania, which can be a wonderful high, but can hit like a tornado and a lead to dangerous loss of judgement and depression, which can leave you quite literally unable to function in a dark despair. There are drugs that can help to stabilise the condition, but there is no cure.

There is also a strong correlation between bipolar and addiction issues. There is evidence that suggests a weakening in the area of the brain that deals with impulse control may be the culprit. Many people with bipolar also have issues with drugs or alcohol.

This is partly self medication – finding a way to deal with life’s problems by blotting them out. Alcohol was always my drug of choice. And being bipolar is probably with worst condition to have: when feeling down, you have a drink, and when feeling high you want to party.

The key to living with bipolar for me is self management. Basically this is a technique that is used to learn how to recognise personal triggers and early warning signs, which in turn helps to understand how and when to take action to prevent the mood shift from escalating to severe depression or mania.

Another important source of information and understanding come from peer support groups, such as those run by Bipolar Scotland. Who better to learn from than other who are also living with the condition?

So, are there any positives about having bipolar disorder?

There is a strong correlation between bipolar and intelligence. Studies have shown that those with bipolar generally have IQs that are well above average. And there is a link to creativity too, with many famous, artists, writers, musicians, etc, having the condition.

These include Lord Byron, Charles Dickens, Grahame Green, Jimi Hendrix, Ernest Hemingway, Spike Milligan, Sylvia Plath, Edger Allan Poe, Dylan Thomas, Mark Twain, Vincent Van Gogh and Townes Van Zandt, and in more recent times Russell Brand, Kurt Cobain, Francis Ford Coppola, Stephen Fry, Ozzy Osbourne, Axl Rose and Kurt Vonnegut

Others known to have bipolar include Buzz Aldrin, Winston Churchill, Marilyn Munroe, Theodore Roosevelt and Ted Turner.

Quite a list, isn’t it?

So that’s a quick guide to bipolar disorder.

One issue I should touch on in closing is the stigma that is still associated with having a mental illness. Many people, through ignorance, wonder if you might be dangerous. Potential employers are likely to be put off if you mention the illness on an application form. And relationships are difficult, to say the least.

But you have to try to keep a sense of identity outwith the illness. I never say that “I am bipolar”. My condition does not define me. I have bipolar disorder but that’s not who I am.

Much more information on bipolar disorder is available on the excellent website of Bipolar Scotland. See the Links section on the right.

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