I say ‘the End’ in the title, as this will obviously be my last post in this series before the big day tomorrow when we head to the polls; however, in the interests of equity, I will at some point look at what the main parties in the Republic of Ireland have to say on the provision of mental health services. The health service in the Republic is quite different from here in the North, but I’ll address that in the post in question. I’m not saying I will necessarily write this anytime soon, but I’ll get to it eventually.

Anyway, it’s the eve of the election and I’m simultaneously excited and anxious. I’m excited because I’m a total politics nerd, and I always get a thrill out of exercising my democratic right to vote. I’m anxious because I am worried that Gordon Brown will end up back in 10 Downing Street; I pathologically detest the man. I hate Cameron too, mind you, but nowhere near as much as Brown. Like so many people, I now am a fervent supporter of a Liberal Democrat win. I don’t think we’ll get it – not this election – but fingers crossed for the future.

Anyway, it’s kind of moot because I can’t vote for any of those three parties (unless you count the strange alliance between the Tories and the Ulster Unionists). We’ve already looked at both the Unionist and Nationalist parties…but are there any other options, and if so, what do they offer to the Mental Vote?

Well, the answer is that there are other options: here we are with the ‘Others’, the parties often forgotten in coverage of Northern Irish politics. Two of them – the Alliance and the Green Party – are not along the normal Northern Irish sectarian lines. The third – The Traditional Unionist Voice – clearly is. Of course, there are a number of other smaller parties in existence in our wee country; however, mostly they are not running in this general election. Some are – mostly independents – and you can see their details here. However, I am not exploring their positions on mental health provisions, for the simple reason that they are unlikely to have any, being mainly one person parties. Even if they do have something to say on the subject, their chances of election are minimal*, and even if they were elected, as single candidates in Westminster they would need to vote with bigger parties to have any influence whatsoever.

(* With the possible exception of Sylvia Hermon, as she is also the outgoing MP for South Down and has been considered fairly popular in her constituency).

So we’re left with the Alliance, the Greens and the TUV. what if anything do they have to say on mental health services provision?

The Alliance Party and Mental Health Service Provision

Ideologically, the Alliance Party are my preferred party, as they were the first Northern Ireland-specific party to embrace cross-community unity, rather than organising themselves along the usual tribal lines. It turns out, too, that there’s a lot to be grateful about in terms of their mental health policies.

Navigate your way over to here, a page on the Alliance’s website. An entire policy on mental health issues, rivalled only in my investigations by the DUP’s (which was shockingly comprehensive, and about which I wrote the other day).

Unfortunately the page presents some alarming statistics; apparently, there are 20% more mentally ill individuals in Northern Ireland than in the rest of the United Kingdom (which tallies with other material I’ve read attributing this greater incidence to Troubles-related PTSD and depression), yet simultaneously we are the least resourced region to tackle this group of health conditions. Well, what a surprise.

The Alliance Party propose to tackle this sorry state of affairs in the following ways:

• [by] tackling segregation – addressing the exclusion of those with mental health and mental health issues;
• [by] re-balancing the economy – addressing the costs to businesses and the loss of GDP that arises from mental health and learning disability, and allowing people to develop to their full potential; and
• [by] providing of sustainable public services – delivery of a modern system of properly funded services.

All sounds grand to me. Of course, the difficulty with this is that it means fiscal resources will have to be allocated to mental health service provision instead of other areas of importance. I’m only speaking for myself here, but I would genuinely be happy to be more highly taxed/National Insurance-d if psychological and psychiatric resources were improved and developed. Furthermore, if some capital has to be removed from other (non-urgent) areas of the health service to accommodate the Alliance’s proposals, then I could quite easily live with that too. I admit that I am seriously biased here, but don’t forget the old statistic that at least one in four people will be directly affected by mental or emotional illness at some point in their lives. Some lobbyists are arguing now that the figure is one in three. The Alliance also point out that:

Over 19% of the total burden of disease in Western European Countries is attributable to mental illness compared to 17% for cardiovascular disease and 16% for cancer (WHO 2004)

It is sobering to know that mental illness affects more people than the openly-discussed ailments of heart disease and cancer in Western Europe – yet how often have you seen it mentioned in the media, at least without Sun-style sensationalism of ‘Schizo Freak Murders Fluffy Kitten!!!1!1!!!!eleven!!!’?

Moving on from what could easily become a rant, the Alliance Party at least do move on to tackle the fundamental issue of funding. One of the primary failing of political pledges, in my view, is that there is endless rhetorical sentiments expressed, without any substantive explanations of how the pledges can be achieved. At least here we have an awareness that achieving what is desirable will not an automatic development; it’s something that requires compromise and hard bloody work.

The party then move on to discuss what they term ‘Key Issues and Principles’, which (conveniently, a cynic might say) are right in line with the perennial Bamford Review.

The lines that interested me most was these ones: ‘Services should be needs-led‘ and ‘[we need] increased access [to] psychological therapies‘. Sounds obvious, doesn’t it? Yet as my own case underlines, that’s not the way it is in the current NHS in this region (and in the country in general in many cases), oh no. Access to psychological therapy and services in general are resources-led:

Therapist: I’m dealing with a really mental bird at the minute, she has about 403 different diagnoses and she needs long-term psychotherapy.

Manager: Throw a few weeks more at her, then kick her out, we can’t afford her.

Therapist: But what if she’s not better?

Manager: Oh my poor dear man, you’re new here, aren’t you? That’s not how it works!

The above was, of course, an entirely hypothetical scenario. *whistles innocently*

The Alliance also draw attention to the need to tackle stigma head on, and in a particularly commendable move address the issue of greater focus on the needs of carers for the mentally ill. They are the only party that have also pointed out that the recommendations of Bamford are not always fully transparent and, indeed, fully achievable.

Finally, they point out that the current situation regarding the Mental Health Act in Northern Ireland. Apparently, two major revisions were due to this legislation as it applies here in both 2011 and again in 2014. Sound fucking stupid to have two modifications? Well, the Alliance concur. In a demonstration of the fact that they can make a difference in this policy area, after their lobbying of Michael McGimpsey, the Health Minister, it has been agreed that – in principle at least – one modification will incorporate all the proposed statutory changes.

Result.

The Northern Ireland Green Party and Mental Health Service Provision

I’ve been wittering on in this series of posts about how we in Northern Ireland are not afforded the right to vote for the ‘mainland’ parties, but I suppose this kind of contradicts that a little. The Green Party are, of course, a national force – national in both the sense of the UK and Ireland.

Their widespread nature means that someone, somewhere, will inevitably have had to bring up the issue of mental health. In Northern Ireland, it seems primarily to be student Karly Green. Ms Green is heavily involved in developing a cross-party youth initiative on mental health, and that’s not to mention her considerable involvement in lobbying current politicians for better care for mental illness in our wee country.

(An aside – Ms Green’s hard work makes me wish I’d taken a more active role in politics at university. I was involved heavily in student politics – the running and management of the Students’ Union – but never in actual, meaningful party politics. I feel like I wasted my youth when I could have been out there making a fucking difference).

To get more details on the Greens’ position on this matter, however, we need to look at their policy South of the border. This has, quite obviously, questionable relevance to a Westminster election, but their UK health policy is surprisingly and disappointingly silent on the issue of mental illness.

As with the Alliance, the Greens argue that mental health is an area that is ‘greatly neglected,’ and interestingly, they’re the only party of the lot that I’ve looked at that has made more than a passing reference to preventative medicine and its relation to mental illness, which is to be applauded.

Of course, with this document focusing so heavily on the Republic, the contents are not always 100% applicable to those of us in the North; for example, they discuss how many patents with mental health difficulties are seen only under their GP. This is actually true up here too – the CMHTs generally only manage more serious cases – but in the Republic, the whole system is different, meaning that some people do not even have the primary care of a GP (something that is rarely true in Northern Ireland). Clearly this is an appalling state of affairs, and I would hope that the main parties down South are looking at this deficit too.

One point that applies to this jurisdiction is that they want to emphasis the need for psychological treatments, rather than an over-reliance on drugs. Remember this moment, readers, because it is possibly the only time you will see the Green Party agree with the DUP (see somewhere or other in the Unionist post).

Alarmingly, the Greens point out in this policy that apparently Irish mental health spending is less than half what it was 20 years ago. I suppose the rationale was along the usual lines that people were severely traumatised by the violence of the Troubles (any flippancy is to do with the fact that the Troubles existed at all; I don’t for a second see how anyone could not be traumatised by so much of what happened). Whatever the case, the fact that this party want to see at least 12% of the health budget devoted to this area is a worthwhile aim.

I particularly like their pledge to offer more post-graduate positions for the training of clinical psychologists. It rather seems to me that we could do with some of that up here too.

A few of the parties I’ve looked at in the course of this series have alluded very briefly to the human rights of the mentally ill (the UUP were the main ones that I mentioned, if memory serves me correctly). The Greens, however, have their own page as part of their general mental health policy devoted to this. Although their point is indeed commendable, unfortunately they miss the opportunity to fully address what could and should actually be done about the difficulties faced by many individuals on involuntary detentions. At least the UUP had the clear viewpoint that they would support amendment to legislation that shifted the legal onus on hospital release from the patient to their assessing tribunal.

In essence, in the area of mental health provision, the Green Party want to see greater staffing, greater funding and greater community, non-institutional care. I don’t think any of us would agree with these fundamental aims, but the approach sadly feels a little lacking in substance and discussion in how these aims could be achieved.

The Traditional Unionist Voice and Mental Health Service Provision

Hahahahahahahaha. I’m not even going to waste the energy it takes to type anything vaguely related to this non-entity of a vicious, nasty little scumfuck of a so-called political party. Well, except this rant of course. Just read their manifestoss (no spelling error). Nothing on mental health, scant on health in general, scant on education except their hate-filled bile, scant on sanity. I guess I’ll see Jim Allister in the bin.

Conclusion – Alliance, Greens or TUV

I don’t think you’ll be stunned to hear that the TUV are very instantly ruled out, and indeed it wouldn’t be a huge leap of faith for you to think I’m siding with Alliance as the victorious party amongst the so-called ‘Others’. The aims of the Green Party are certainly admirable, but they fail to fully articulate how they hope to achieve them, and cannot exemplify any occasions in which they’ve made a difference in this arena in the past. Furthermore, there is very little information on their exact position in this specific region.

The Alliance Party, on the other hand, have set out a number of very clear mental health objectives, and fully recognise the challenges of achieving these – yet they can articulate with some authority how they would achieve them. They can even cite an example of when their lobbying of a minister has previously made a difference to mental health issues.

I was not surprised to find that they had a mental health policy, but I was most gratified by its comprehensiveness and the fact that their aims are not all pie-in-the-sky-ness, but real, obtainable goals.

OVERALL CONCLUSION

So, here we find ourselves at 11pm on the eve of the election, having investigated the policies on mental health of the main UK parties, the NI Unionists, the NI Nationalists and, finally, this, the NI nebulously-named ‘Others’. Who’s getting my vote?

It’s important to note that I am not, nor should I be, a single issue voter. I have a view on the economy, on Iraq, on crime, education, etc etc etc.

Most of all I have a view on the tribalism that Northern Irish politics has traditionally presented. To that end, I have almost always supported the Alliance Party, and my enthusiasm about their mental health manifesto above was surely palpable. I was undecided as to whether to vote tactically tomorrow but this has been the final deciding factor: the Alliance Party will, once more, get my vote tomorrow. They won’t win, but I aim to be a conscience voter, and the things that they strive for (not just in terms of mental health) are things that, for the most part, I want.

In terms of this series of posts, I still think Alliance have trumped the other parties, but the mental health policies of Sinn Fein and the DUP were actually surprisingly impressive, even if I don’t trust either of those parties as far as I spit out my own shite. I was very disappointed by the UUP and the SDLP, parties that I otherwise don’t mind. It was hard work finding anything on the UUP at all, and whilst the SDLP had a little more substance, ultimately they seemed to be trying to echo points already laid out by SF.

It’s time mental health was an issue taken seriously by all political parties; just like I did at the bottom of the first post, I would again urge you to sign Rethink’s petition for the next government.

In conclusion – please, whatever you do, don’t be apathetic tomorrow. In some ways it doesn’t matter who you vote for, as long as you give enough of a shit to go out and put one ‘x’ on one bit of paper. This is a democracy. We have the right to vote here. Not everyone has that right, so please exercise yours.

Happy voting, darling readers.

So, last time we had a look at the mental health issues in the manifestos of the two main unionist parties in Northern Ireland. Today it’s the turn of the two main nationalist parties, Sinn Féin (SF) and the Social Democratic and Labour Party (SDLP).

There is a certain curiosity in the potential influence of both of these parties. SF, perhaps unsurprisingly, may take a certain amount of interest in the politics of the Irish Republic, discussed mainly in its Parliament, the Dáil. In that regard, their policies might not necessarily fit a similar pattern to those of the other Northern Ireland parties, which are more likely to be influenced by their colleagues in Westminster. More surprising is the fact that, despite their status as supporters of a United Ireland, it’s quite possible that the SDLP are influenced similarly to the Unionist parties. They are, in fact, Northern Ireland pseudo-surrogates of the UK Labour party.

There has often been arguments from many voters here, me included, that because we don’t have any of the three main UK parties (or, indeed, Dáil parties) that our voice is not heard in Westminster (or Dublin). The Labour party try to get around this by citing their loose association with the SDLP – but, at least as far as many unionists perhaps unfairly see it, the SDLP only represent the nationalist side of the community, and therefore are not a party that can convey their needs and views. Of course, the Ulster Unionist Party are now allied with the UK Conservatives – but the SDLP shoe still fits, simply in a different way; not many nationalists see the UUP as a party that can represent them. The Liberal Democrats briefly mooted the possibility of setting up their own branch here, but to the best of my knowledge, that never came to proper fruition.

To that frustrating end, it might seem favourable that the SDLP have some alliance in London; the problem often is, however, that they seem to take the Labour whip without due regard for their actual constituents (to be fair, this is a problem in many, if not all, seats). I’d always thought of them as a good constituency party until last week when I watched the Northern Ireland party leaders’ debate, and Margaret Ritchie of the SDLP admitted that her MPs voted with the Labour party more often than not.

Still, they take their seats, unlike SF. To be fair, the SF rationale is that – as Irish Republicans – they do not wish to swear allegiance to the UK monarch. I really do understand that issue of principle, but the difficulty is that it complicates the party’s ability to lobby the Westminster executive. SF contend that Westminster is becoming decreasingly relevant to Northern Ireland, what with our devolved government at Stormont. In some ways that is true, as we decide on the allocation of fiscal resources. On the other hand, the overall source of those fiscal resources is, ultimately, still London.

So, how would each of these two parties allocate this capital? Will they consider mntal health provision as a priority?

Sinn Fein (SF) and Mental Health Service Provision

My first reaction to what I see of SF’s mental health policies is one of encouragement. I suppose one should expect reasonable discussion on matters like these from a party that is, broadly speaking, socialist in nature, but it’s still nice to see it in black and white.

The first article of interest to me was this one from the West Tyrone branch of the party. Here SF discuss the provisions – or, maybe more accurately, the lack thereof – for forensic patients.

Anyone who knows me will know that crime is one issue on which I am relatively right-of-centre. I believe in retribution, and public protection, at least for the most serious crimes. However, I do make an excepton for individuals with serious mental ilnesses who are clearly not fully cognisant of the folly or danger of their actions. I resent people simply claiming mental illnss as some sort of excuse, but in genuine cases, the personnel concerned need to be treated as patients to be rehabilitated and treated, and not as criminals. I don’t have the statistics to hand, but I understand that in most prisons in the UK and Ireland, at least a significant minority of prisoners have serious mental health trouble. Would these people really present a danger to society if their illnesses were adequately managed and treated? How can incarceration lead to their recovery?

SF clearly concur that services for forensic patients are wholly inadequate. As councilor Declan McAleer says:

Rather than treating these people as patients in need of care and support, they are frequently treated as ‘felons’ and find themselves being shuffled between court appearances, case conferences and confinement.

This lack of a proper joined up approach… prolongs the day when they are restored to full health.

Councillor McAleer then points out that, with the recent devolution of justice and policing to the Northern Ireland assembly, hopefully there will be increased communication between the health service and criminal justice service here. Since the devolution only took place last month (April) it is of course far too soon to say whether or not there has been much progress in this regard, but it is a situation that I will continue to monitor.

The document further contends that a high security unit is a necessity here in the province; it is claimed that 78% of males and 50% of females in our prisons have personality disorders. We only have one medium security unit; any patients/prisoners requiring high security are presently sent to Great Britian. I should imagine that sending them to a unit far from their home, friends and family would be a serious inhibition to their recovery.

Moving on from forensic matters, SF have what I feel is a very positive message about mental health service provision, as published in this page of Republican newspaper An Phoblacht. They detail four key mental health issues that they intend to address, specifically as part of their 2010 General Election manifesto:

• Implement proposals of the Bamford Review and raise awareness about mental health issues
• Pursue implementation of an all-Ireland suicide prevention strategy
• Support the ‘card before you leave’ system to provide vulnerable patients at Accident and Emergency units with advice, contact numbers and follow up appointment details
• A new system to provide dedicated perinatal mental health services on an all-Ireland basis, ensuring that pre-natal and post-natal patients can be cared for with their new-borns when this is required

Four objectives don’t sound like an awful lot – but (a) they are four sensible, achievable goals and (b) although other parties do have positions on mental health service provision, as far as I have seen none of them have directly detailed their policies in this area for the 2010 election.

Finally on Sinn Fein, I’d like to draw your attention to this article. This relates specifically to the Republic of Ireland, but is nevertheless relevant to voters in Northern Ireland, as it shows SF’s position on mental illness and privisions for same. In essence, this piece discusses “savage” cuts from the local health Trust, meaning the closure of an acute unit and a day unit. The SF Dáil leader and spokesman on health in Eire, Caoimhghín Ó Caoláin, expresses his concern and anger at the prospect in this article, and details how he has lobbied the Republic’s health minister to seek assurances that the closures will not take place as planned. In particular, Ó Caoláin is concerned with the closure of the day unit in question, as it helps to prevent institutionalisation, something the Republic has sought to minimise through various initiatives. All in all, SF’s protests at these cuts seem encouraging.

The Social Democratic and Labour Party (SDLP) and Mental Health Service Provision

Apparently

The SDLP believes that good mental health is imperative to an individual’s general well being.

Such insight!

To be fair, like SF, they do lay out objectives which, whilst small in number, are potentially achieveable and not some sort of spin doctored pipedream. This booklet was written as their manifesto for the 2007 Northern Ireland Assembly elections, but I cannot imagine that the points therein are no longer normative; particularly with the ongoing discussion of the Bamford Review in mental health, these points are surely still relevant. The positive message of them is unlikely to be something on which the party would renege.

Essentially the SDLP would also seek to deliver an all-Ireland suicide prevention strategy, seek to build a cross-border forum on mental health issues and address “as a matter of urgency” what they call the chronic lack of services in both child and adult psychiatry and mental health in general. In part this would be achieved through full implementation of the recommendations by Bamford. I note that their comments here are essentially an elaboration of their 2005 General Election manifesto, thus giving further weight to the idea that their policies will remain broadly similar now. For what it’s worth, here is their 2010 manifesto – but it is disappointly sparse in its discussion of mental health issues.

The document also fixates on human rights for those that are mentally unwell. Although it does not specifiy the current infringements, we all know that this is a big issue for the mentally ill – in particular in regards to involuntary hospitalisation. The party also note that mental health service provision for adolescents is particularly crap, and claim that this would be a key point for them to address.

On that note, I was really pleased to see this piece on the SDLP Youth site discussing how a delegation of young people from not only the SDLP but all the other main parties plus the Alliance and the Greens launched their very own mental health strategy in Belfast in April last year. It makes a wonderful change to see the typical boundaries transgressed in the name of unity on such an important issue, and is to the credit of all the youth branches, not just that of the SDLP.

And…well, that’s about it really.

Conclusion – SF or the SDLP?

Although their siding with Labour at Westminster does annoy me (despite my earlier whinging that we need representatives from here in the main UK parties), I have always had respect for the SDLP. I don’t agree with them on every issue, of course, but their relative lack of fixation on the whole Ireland/UK debate was refreshesing from a party who were still intrinsically linked to that mode of thinking.

However, I must report that I am rather underwhelmed by their policies on mental health service provision. I’m not a one-issue voter by any means, but this is clearly an arena of much importance to me, and I would have thought a socialist party who would seem to be all for the NHS system would have had more to say on conditions that will, at any given time, affect one in four of us.

I’ve never been Sinn Fein’s biggest fan because their primary aim has always been the unification of this island. I don’t object to that per se, but it’s similar to the beef I have with their unionist counterparts, the DUP – there are so many more important issues than where the fucking border lies. However, I must admit that I am really rather impressed with the time they’ve taken to outline their position on mental health issues and, in particular, that the goals that they’ve set are not just there to look good – I believe that their manifesto aims in this area are actually quite obtainable, and they have given more space to writing about mental illness and provision therefore than any of the other parties other than, shockingly, the DUP.

But having said that, as with all articles from political parties, one has to ask oneself how much of it is rhetorical and how much of it they would really implement. My current thinking is that they are probably fairly well-intentioned in making all these pledges – but how much of it gets lost in the big pile of bureacratic shite that our politicans have to deal with? It remains to be seen.

Based on the literature, though, as far as the provision of mental health services goes, SF beat their nationalist rivals hands down.

—

Next time: a look at the Alliance Party and some of the smaller parties that are running for office, plus my conclusions on which party is offering the most to us Norn Iron mentalists.

Northern Ireland politics is, in the main, a load of divisive nonsense (in my view, anyhow).  It infuriates me that I cannot vote for either the Westminster nor the Dáil parties; we have to have our own little set of philistines, and they are built – by and large – upon sectarian, bigoted lines.  You have to be, broadly speaking, a unionist (favouring the union with Britain) or a nationalist (in support of a united Ireland).  By and large, unionism is supported by members of Protestant faiths and nationalism by Roman Catholics, though there are occasional ‘anomalies’.

I come from a unionist background, but am a very disaffected member of the breed.  I prefer Sinn Fein to the Democratic Unionists, even though it must be said that I don’t like Sinn Fein that terribly much.  I don’t particularly dislike either the Social and Democratic Labour Party nor the Ulster Unionist Party, who are more moderate parties still built on the nationalist/unionist issue, but I find it sad that politicans who have a serious chance of making a difference here still have to be ‘on one side or the other’.

Arguably, it’s not that different in Britain: Labour, working class / Tories, middle and upper classes.  It’s still a case of ‘sides’.  Except that it’s not, because both of those parties essentially stand for the same things now, what with the coming of New Labour and the so-called third way, and a subtle Tory shift to the centre-left.  Whilst there are, of course, still plenty of left-wing Labour MPs, and plenty of right-wing Tories, the two partys’ front benches – and other areas in which political difference is mad – consist of a bunch of sychophantic, power-hungry irritants who mirror each other in significant numbers of ways.

The folks on the hill at Stormont are also ‘sycophantic, power-hungry irritants’ (perhaps in some cases more so than the Brits) – but each side is still very different.  Aside from the obvious UK/Ireland debate, the DUP, for example, are religious (Free Presbyterian, mainly) reactionaries, whereas their power-sharing partners Sinn Fein are socialists who supposedly do not let religion impact upon their politics (though they are almost exclusively Catholics, whether that’s just in name or in actual practice).

Anyway, this is turning into a rant about the status of politics here, and that’s not what it’s intended to be.  I want to see what the various parties have to say on mental health.  In true Norn Iron style, let’s look at it along divisive lines.  Today I bring you TEH UNIONISTZ.

The Democratic Unionist Party (DUP) and Mental Health Provision

The DUP should have a view on this issue, as recently one of their former MPs/MLAs and the wife of the leader – after revelations about her financial dealings and private life – was undergoing intensive psychiatric treatment.  Iris Robinson had also claimed, well before the private life issues were made public, that she struggled with mental illness.  But…can we really expect some tolerance and compassion from a party like this?

Well, I have to say – on the face of it at least, they are taking this issue rather more seriously than I expected.  They have an entire agenda on Northern Irish mental health provision published here.  (Perhaps rather regrettably for the DUP, a few pictures of an apparently sane Iris are splattered all over the document, harking back to the days when she was ((publically)) just a bigoted wingnut, rather than a mental, bigoted wingnut).

Overall the document is surprisingly encouraging.  They consistently press the need for larger and more specialist community services, crucially (in my case) including the necessity for services for personality disorders (which as regular readers will know is something with which I have recently taken much issue).  They point out that research is needed to establish just how prevalent personality disorders are in the province, something I would welcome as currently the Trusts seem to get away with saying they won’t treat you as they don’t have the facilities.  Demonstrating the levels of PD would surely put an end to this – or at least would allow services to be developed in the geographical areas in which PD is most prevalent.

Other areas requiring more developed services here, according to this document, are eating disorders, addictions, learning disability and autism, and CAHMS services.  I cannot disagree with any of this.

In terms of therapy, they slam the current waiting times, though recognise that changing this could take years.  I note with interest that they feel “sustained” therapy changes lives.  Perhaps I should ask C if he votes for them.

One thing that irritated me was that they are very critical of medication and hospitalisation.  In terms of medication, I take their point that treating PTSD and depression related to the Troubles would generally be best managed by psychological treatment; however, this belies the truth – in my mind, anyway – that the medical model is really not that bad.  Yes, therapy should be offered and sustained – however, if drugs ease suffering thus helping to enable productive discussion in therapy, then I fail to see what is so wrong with them.

As far as hospital goes, the DUP have put great emphasis on community services.  That’s fine; no one wants to have to go to the bin, and if the remit of the various CMHTs can be increased, then bring it on.  However, there are times when hospitalisation is a necessary evil – and I know of no one who liked it exactly, but I do know of people whose lives it saved and, furthermore, whose lives it ultimately improved (though, for the sake of balance, I do know of individuals whose lives it ruined too).

At one point the DUP assert that beds are being used ‘inefficiently’ in both acute and long-term psychiatric wards; I have no idea as to the accuracy of this statement, but surely that judgement should be in the hands of a consultant, and not a politican?  They contend that in these cases patients are more than capable of living in the community – but, again, I question how they can reach that conclusion.  From what I understand, if someone is well enough to leave hospital, then they leave hospital.  The DUP’s fixation with discharging people seems at best misguided, at worst dangerous.

Overall – ostensibly speaking, I’m more impressed than I expected to be.  I expected to have to wade through dozens of articles just to get a snippet of information, and yet here they have a reasonable sized policy devoted to this niche area.  It’s not faultness, and as ever the danger is that it’s founded entirely upon rhetoric, but it’s a start.  Can we say the same for the Ulster Unionist Party?

The Ulster Unionist Party (UUP) and Mental Health Provision

The UUP have become the little surrogates of the British Conservative party in recent months.  Originally calling themselves ‘Unionists and Conservatives – New Force’ (WTF?), they have now mostly downgraded this simply to ‘Conservatives and Unionists’.  Theoretically, therefore, were the UUP the main NI party in Westminster, we (as constituents represented in Parliament) might expect to have more political influence than we presently do.  However, even if the UUP won every NI seat (which would clearly never happen), it would only be in the tightest of votes in which 18 people could make a difference.  And in any case, I bet they have policies that diverge from that of their new parent party.

Like the DUP, you’d expect the Ulster Unionists to have something significant to say about mental health; Michael McGimpsey, one of their MLAs, is the Health Minister at Stormont.  Yet I can find surprisingly little information on their outlook on this subject.  There are plenty of search results, and a number of news stories and whatnot, yet there does not appear to be a specific policy or mental health agenda developed by the party.

One of the first results that seems of interest is, hilariously, from the DUP (and more hilariously again, it’s specifically from good ol’ Iris, who before her political demise served on a health committee at Stormont).  But let’s just try to ignore the source for a minute and see what is said.

The most alarming assertion in the article is that, during Mr McGimpsey’s time as Minister, only 5% of health service spending has been devoted to mental health.  Given the severity of many mental illnesses and, in particular given that it will affect 25% of people at some point, this is an incredible statistic.  Five per cent.  Five.  5% to deal with, potentially, 25% of people.

Mrs Robbo continues by pointing out that the DHSSPS is “committed to” the development of community mental health services, but notes that this will require a fundamental overhaul of services as they presently exist.  She contends that little effort has been made in this regard.

Regardless of her view that nothing of worth is happening vis a vis this ‘overhaul’, I would query how such changes could possibly be made when mental health services are allocated such a meagre income from the Department, if the 5% statistic quoted is in fact correct.  I wonder how it is even possible to take care of the most severely ill people on such a figure.  OK, so I can’t comment on the actual figure – 5% of what, exactly? – but I know that the entire NHS both here and in Britian struggles on the billions it’s allocated, so throwing such a tiny minority of money into this necessary sector of it suggests to me that financial management is inevitably going to present difficulties.

A second link describes how Mr McGimpsey attended the opening of a new inpatient facility for adolescents in South Belfast in February this year.  £9million was invested in this ward, and a children’s ward is due to open next month.

It is difficult to say whether or not these two wards were impacted to any significant degree by the UUP’s own policies.  Given that they both opened/will open in the first half of 2010, it’s probable that they were planned well in advance of the current Assembly, which has been in place since 2007.  Ergo McGimpsey and the UUP could well have little to nothing to do with this.

Additionally, the creation of two hospital wards for those under 18 seems at odds with the Departmental policy of promoting community care.  Of course they will and indeed ought to still accept that there are occasions during which hospitalisations are necessary, but millions of pounds spent on new ones when others exist does strike me as somewhat curious.  Why not use those funds in developing a better CAHMS service and improving already-existing in-patient facilities?

And what about us adults?

A more encouraing perspective comes from a transcript of Hansard from the House of Lords, which chronicles a debate on an amendment to the Mental Health (NI) Order 2004.  During the debate, it is noted by a number of NI Lords that mental health services here are, even in comparison to the rest of the UK, pretty shit.  Lord Rogan, representing the Ulster Unionists, proclaims that he welcomes the Order, which – in essence – deals with human rights during involuntary detentions.  Specifically, the Order seeks to move the burden of proof from the patient having to prove they are well enough to be released, to the tribunal having to prove that the patient is ill enough to remain sectioned.

Lord Rogan, of course, throws a bit of a spanner in the works in that he raises a number of questions as to how this legal change would operate in practice.  However, far from being outraged by this, I think this is a sensible course of action.  It seems evident that Rogan and other Lords agree in principle with the Order, but it would be remiss not to consider certain legal and logistical practicalities that accompany such a profound modification to mental health law.  Asking for clarification on the potential issues suggests to me a considered approach to the implementation of the Order, hopefully meaning that it would be a more secure law when finally passed.  Ignoring potential difficulties and then having to deal with them as they arose would have been irresponsible.

Finally, although there is little detail here, an interesting meeting was recently had between the sectarian-neutral Alliance Party and the UUP.  Alliance leader David Ford commented that his party’s stance on mental health provision was broadly similar to that of the UUP.  Both parties were apparently alarmed at cuts to the health budget from the DUP (thanks to the Department of Finance and Personnel’s budgetry allocations), and (as above) note that mental health services here are inadequate in comparison to those in Great Britain.  Having found “common ground”, the UUP and Alliance want to work together (and with other parties, too) to improve matters.

Conclusion – DUP or UUP?

Ostensibly the DUP seem to have more directly immersed themselves in a policy for mental health services than the UUP.  I was surprised to find their document directly discussing the issue, and was subsequently disappointed to not find similar from the UUP.  On the face of it, the DUP’s position seems considerably more favourable, and – rhetoric or otherwise – I was impressed by the time they invested in their document.

However.  The DUP are, in my view, an insidious party.  They might be very good as constituency MPs (and to be fair I understand that, for all sides of the community, they are), but my instinct is not to trust them on basically anything that happens in a wider arena, including NHS provisions.  If, as the Alliance and UUP claim, Peter Robinson (formerly the Finance Minister) has made health budget cuts – then we should be alarmed, regardless of what his party says in some nice little booklet.  Plus – there’s no way I could bring myself to vote for these people, unless they gave me a personal, written guarantee of indefinitely continued mental health care.  I’d vote for anyone who did that, but it ain’t going to happen.

But the UUP aren’t exactly wonderful in this subject either.  The broad support of and assurance-seeking on the Mental Health Order was vaguely encouraging, but I was incredibly troubled by the 5% statistic.  OK, OK – that came from a press release from Iris fucking Robinson.  Salt and pinches of it, I know.  But I doubt even Iris would have the balls to make up such a statistic; having served as the Chair of the Stormont Health Committee, she would have been bound to have been able to back this up with evidence.

In short – I don’t believe in the DUP, and I’m underwhelmed by the UUP who could have done so much more, and didn’t.  So something of a fail all round.

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Next time: we meet the nationalist parties.  Do Sinn Fein and the SDLP care about our mental health?

I haven’t written an AotW for some weeks, mainly as I’ve been too mental to actually read anything that I think is worthy of inclusion here.  I’m not particularly less mental at the minute, as Monday’s post will presumably attest; however, coverage of the matter that I intend to discuss is hard to miss at the best of times, and especially so when one is a complete current affairs junky.  Yes, my dears, that can only mean one thing.  I present to you:  The Epic Serial Insomniacal Journey into UK Politics and the 2010 Election.

I’m addicted to politics.  It drives me round the bend, but I’m addicted to it nevertheless.  I received an ‘A’ in my ‘A’ Level in it, and very, very nearly studied at university (the subject that I ended up studying is strongly impacted by it too).  I watch Question Time (and scream at the TV) and This Week most weeks, and now that I am a dolescum tend to be hooked on The Daily Politics as well.  I watch about three news programmes in a row, at least twice a day, mainly to see what the twats in Westminster, the Dáil and that Godforsaken shithole that is Stormont are doing.  I invariably find myself enraged, but always strangely excited at the same time.

Anyway, I’m not going to subject you to a full discussion of the parties and the rhetoric and lies that we can expect from each of them; there’s hundreds of blogs and websites (probably thousands) that will do that for you much more ably than I can.  Nevertheless, I’d like to zoom in on a couple of things – specifically, party policies on mental health provision and in particular views from Northern Ireland on same.  I was going to do it all in one post, but to my surprise it turns out that it would too big for that.  Therefore, today I will bring you…

Mental Health Provision in the Manifestos of Parties in Great Britain

Note that the heading says ‘Great Britain’, and not ‘the UK’.  The two are distinct, and (annoyingly for me) that is reflected in the division of political parties.  For those not conversant with the bizarre and uncodified constitution of the United Kingdom, ‘Great Britain’ refers to England, Scotland and Wales.  These countries – and, let’s face it, in particular England – house the ‘main’ parties of the Liberal Democrats, Conservatives and Labour.  Scotland also have the Scottish Nationalist Party, and Wales have Plaid Cymru.

I’m not going to get into a major discussion of any of these parties, mainly as it’s been done elsewhere.  Moreover, in some ways what happens in Westminster only tangentially affects us in Northern Ireland – on the other hand, though, they’re still responsible for how much money our Department of Finance receives to spend in whatever way, so in that sense they still have a lot of political clout.

Anyway, Mental Nurse have run a very entertaining and interesting series, known as This Election in Mentalists, exploring the mental health policies (or lack thereof) of the main parties (the title of which as you can see I have stolen).  You may notice that I’ve not commented at all in any of the posts, despite being a relative regular over at Mental Nurse; I was scared that I’d get into a fight, to be honest, as I tend to be quite…ahem…’direct’ in my expression of political views.  Nothing gets heads rolling more than politics.

So that’s the first article I’d like to mention, but on a similar theme, I was highly dismayed to note in Thursday’s electoral debate between the leaders of the three main parties that – in discussion of the NHS – not one of the three mentioned services for mental illness.  Two things struck me about this.  Firstly, to ignore this group of conditions in such a blatant and public way is to further distance it from physical illness, which in turn surely adds further fuel to the cruel fire of stigma.  Secondly, stigmatised or not, mental illness will affect at least one in four people at some point in their lifetime.  That is bound to have a lot of impact on NHS spending and other resources, and on other macro issues such as the economy (owing to days lost to sick leave and whatnot).  The parties must surely have a view on this matter.

Well, mercifully, one of them does – and it seems to be a more encouraging outlook than the apparent silence of the others.  Unfortunately, despite his current surge in popularity, this man is still the one least likely to end up as the occupant of Number 10 on 7 May.  He is Nick Clegg, leader of the Liberal Democrats.

Now, this article, from politics.co.uk, is slightly out of date, being published as it was in September last year.  Nevertheless, everyone knew at that point that a General Election would be called for early May, so it seems reasonable to assume that this information can be included as part of Clegg’s policy concern in the unlikely event that his party forms the next government.  (Side note: as things stand, there is a very real possibility of a hung parliament, meaning that although Clegg is unlikely to become PM, the Lib Dems could still form a coalition government with one of the other two parties.  That may mean their policies having more weight in Westminster after all, even if still not quite up to the level of a single governing party).

Anyhow, to get to the point (finally), Clegg has pledged to protect mental health services on the NHS from budget cuts specifically related to the recession.  It’s a shame that the pledge carries that caveat – shouldn’t we be protecting mental health services from all budget cuts – but nevertheless, it’s a public act of solidarity for those of us using these services, which to the best of my knowledge is a lot more than can be said for David Cameron and Gordon Brown.

As this article points out:

[The NHS area of] Mental health receives only a fraction of the funding awarded to other health conditions such as cancer, even though one in four people will experience mental health problems at some point in their lives.

I find this reality unsurprising, of course, but utterly outrageous all the same.  One could argue that cancer is, or at least can be, a fatal disease.  Mental illness, in and of itself they might say, is not thus deadly.  But is that really true?  I don’t have any statistics to hand, but I know the suicide rate in this country is not as low as it should be.  If left untreated – or if inadequately treated – suicide is often the natural progression of some of the more severe mental illnesses.  So yes, my dears, mental illness certainly is oftentimes deadly.

What is most troubling to my mind is that many suicides could probably have been prevented had there been adequate intervention and/or treatment (as to whether or not suicide is a right, and I actually happen to believe that it is – well, that’s a post for another day).  Oh, but the person didn’t seek that help! Quite often this is true, but (a) seeking treatment for mental illness is still horribly and unfairly stigmatised, something that I would like to expect the next government would seek to eradicate through proper investment and (b) I know from bitter experience, and know from the bitter experiences of others, that asking for help – no matter how desperately – does not always (or even often) get you it.  Surely these issues are directly correlated with resources invested (or rather not) in mental health services.

As Nick Clegg comments, “It is a false economy not to invest in mental health services.”

Finally for now, I’d like to draw your attention to Rethink’s General Election Campaign.  As you may know, Rethink is one of Britain’s largest mental health related charities (sadly they recently demerged from their Northern Ireland branch, now known as Mindwise, but they are probably still the most influential lobby group for this demographic in Westminster and therefore still deserve the attention of those of us over here).  The election campaign includes a petition that they intend to forward to the next government, that demands better access to services, the tackling of stigma and discrimination, and fairer treatment to prisoners with mental health difficulties.  Please go and sign the petition; we really need the new government to take notice.

An excellent suggestion that Rethink make is that if you are ‘doorstepped’ by your local candidates, please ask them what their party’s (and indeed their own individual) policy on mental health provision is.

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Tomorrow we move into the murky realms of Northern Ireland politics and ask what the the Unionist parties – the Democratic Unionists and Ulster Unionists – are doing for the mental vote.

Given the kind of material I’ve been writing about recently, I thought I’d make note of these stories that I found on the website Child Abuse Effects.  None of the three are exactly revelatory, but they do highlight issues I’ve had in my own experiences, and they acutely remind one that one is not alone in this situation.

This story details the victim’s experience of abuse when she was a child, and the fact that most of it was dissociated until well into her adulthood – her 40s, in fact.  It was only at this juncture that memories of the abuse began to return with clarity, thus exemplifying the effect of repressed memories pretty well.  Perhaps I do not have False Memory Syndrome after all; dissociative amnesia in circumstances like these is a very real psychological phenomenon indeed. 

This one details one woman’s experience of sexual abuse at the hands of her brother when she was nine.  What I found most ‘interesting’ about this was the sad fact that the girl’s parents both refused to believe her, thus adding to her trauma.  Clearly parental denial is not uncommon either, then.  The author details a path of destruction that she found herself on, all thanks to abuse and the fact that no one trusted her to have told the truth.

Finally, this article discusses the victim’s three abusers, including her GP.  What is telling about this terrible story is how manipulative molesters can be, and how they can mould their prey into doing exactly what they want.

The above stories are very sad to read, and – I’ll warn you – potentially triggering.  Nevertheless, the website is a good resource as it provides reassurances to those that post there, and reminds the rest of us that we’re not alone.  I hope it draws attention to the fact that child abuse is sadly very widespread.

The following article from the excellent Psychology Today asks just what is a mental disorder.  As far as I can tell, “normal” mental health and severe mental illness exist at far ends of a continuum; we all have foibles, idiosyncrasies, bad days, stressful experiences – it’s just a case of measuring at which point those things stray away from the path of general societal norms.

The central tenet of the argument in this piece, written by Dr Stephen Diamond, is the severity of clinical impairments caused by mental illness.  He does acknowledge, though, that those experiencing some conditions may not be suffering themselves – but the chances are someone in their life is.  I suppose one example is someone in a manic or other psychotic episode who thinks they’re the Messiah or suchlike – I’ve never experienced anything like this, but I’d imagine the euphoria you feel is pretty significant.  Your family and friends are highly likely to be stressed by this, however.

The argument makes sense; however, I find myself wondering if this is universally applicable.  Someone with Schizoid PD, for example, is clearly outside the usual interpretations of social normality – yet, because he or she is genuinely uninterested in relationships, does anyone really suffer owing to this disorder?  On the other hand, because SPD is quite uncommon in clinical settings, it maybe hard to determine the answer to that.

Normalcy, Neurosis and Psychosis: What is a Mental Disorder?

It’s either a famine or a feast in writing AotW; last week I found nothing of interest, this week there was loads.  However, I’m sure the above is enough to be getting on with.

Most of my regular readers probably saw my disgusted rant yesterday about the recent BBC documentary, Why Did You Kill My Dad?.  Most of those with whom I communicate online regarding mental health have very strong views against this programme, which is unsurprising as – forgive my repetition – it was biased, unfair and stigma-inducing.  To that end, it was excellent to see a clarification of just how ordinary the vast majority of people with mental illness are in the hallowed pages of The Guardian.  (I suspect the Daily Hate Mail has spouted a load of bile in support of the documentary, but I can’t bring myself to check).

This article is fairly straightforward, but more than adequately covers all the salient points: violence and mental illness are not correlated; alcohol and drug abuse are, in the ill and ‘well’ alike, associated with higher rates of violence; the NHS is far from faultless in the care of those with severe mental illness; that sad cases such as those of Phillip Hendy represent only a tiny number of recorded murders per year (though the author of course acknowledges that any death is one too many).

She ended the article with what I thought was a very good point:

How many viewers watching this film will realise they’re in more danger from their partner beside them on the sofa than from a stranger with schizophrenia in the street?

Since the documentary, this piece has done the rounds on Twitter and probably Facebook et al as well, but if you haven’t happened upon it yet, it’s worth a read.  There’s some lively debate and interesting points made in the comments section too (though there are a few inevitable naysayers criticising the author).

Violence is Not a Symptom of Mental Illness

I came across the following article whilst Wiki-surfing the other day.  As Bippidee has discussed, the San Francisco authorities are planning to erect huge nets under the Golden Gate Bridge to deter potential suicides from jumping off it.  Which is a shame, as the bridge is beautiful (I’ve seen it with my own eyes, and have been on it), and it’s at an extortionate cost that would be better spent, surely, in mental health services.  Anyhow, as things presently stand, the Golden Gate is still the most popular suicide site in the world.

The New Yorker goes into fascinating, if morbid detail, as to why this may be.  It discusses in detail the perceived romanticism of jumping from the bridge and the experiences of the few survivors.  Apparently, some that survived the immense, four second jump have claimed afterwards that as soon as they fell, they realised that they didn’t, in fact, want to die after all.  The article also states that these survivors almost exclusively entered the water feet-down and at an angle; most others were probably killed instantly, as hitting water from that height has been demonstrated to be equivalent to hitting concrete.  The rare few that did survive the fall but later died usually drowned, as they ‘dived’ so deeply into San Francisco Bay.

There is a discussion of previous attempts to erect anti-suicide measures, and reasoning for their failures (usually cost or aesthetics).  One of the most intriguing, if horrific, parts of the article details exactly the kind of injuries a person can expect to sustain should they choose to jump from the Golden Gate – and it ain’t pretty at all.  Apparently it’s as if “someone took an eggbeater to the organs of the body.”

Random fact of which I was completely unaware: the most common phobia amongst the San Francisco populace is the fear of crossing bridges.  Who knew?

This is long and morbid, and really rather outdated too coming as it does from 2003, but it’s still a compelling and engaging read.

Jumpers: The Fatal Grandeur of the Golden Gate Bridge

If you’re feeling particularly interested in investigating popular suicide spots (!), you might ‘enjoy’ the following article discussing the macabre popularity of the Aokigahara forest at the bottom of Mount Fuji, Japan.  The article, at the Providentia blog, claims that this forest is the world’s third most popular place to kill oneself, with Toronto’s Prince Edward Viaduct taking second.  However, Wikipedia claims that since the viaduct has erected its “luminous veil” (essentially a high barrier preventing jumps), Aokigahara has overtaken it.

The Suicide Forest

I always have to get an article about psychotherapy into these posts, don’t I?  This is from Psych Central, and discusses what side-effects one might expect from the therapeutic process.  It isn’t a very long article – though there’s a couple of interesting comments following it – and it focuses on a few specific types of disorders, but it still makes for interesting reading.

One point of interest is that when practicing exposure-based therapy with an agoraphobic client, relaxation techniques and breathing exercises can actually lead to a worsening of a panic.  The study discussed is not denigrating the use of such techniques in general, however; it is merely suggesting that they should not be taught simultaneously with exposure exercises.

Harmful Side Effects of Psychotherapy

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As ever, there were half a million other articles that I found interesting, but for this week these were either my favourites, or the ones I felt most pertinent to other parts of my blog.

Enjoy…if you have the same sinister, grim capacity I do to enjoy stuff like this.

The first article I’d like to look at this week is from the excellent After Silence blog, which is about regaining one’s confidence, hope, life – one’s voice – after rape or sexual assault.  This particular entry discusses the physiological effects of post-traumatic stress disorder, which in the author’s case was of course caused by her own rape, but which is applicable to PTSD brought on by any type of trauma.

The author, Kimberley, discusses an article on the phenomenon from Pandora’s Project, which is a support site for those effected by sexual abuse (interestingly, ‘Pandora’ is the name currently leading my poll on what I should be ‘called’).  Firstly, Kimberley discusses the symptoms that are commonly seen in this illness, such as hypervigilance, flashbacks, severe anxiety and dissociation, though she then moves on to outline the biological research undertaken into PTSD.

The bottom line is this: PTSD is not just a psychological illness, but a physical one too.  Trauma does not just damage our psyche, it can actually change the physiology of our brains.  In particular, traumatic events seem to affect the hippocampus (a part of the brain that has responsibility for a lot of memory functions) and the medial prefrontal cortex (responsible for cognitive functions such as personality expression and decision-making).

I have come across information like this before, but Kimberley’s analysis of the Pandora article is worthy of particular note for her eloquence and understanding of this subject.

PTSD and Your Brain

Now, this I like.  Anyone who has followed this blog in the long-term knows about my complete disdain about all forms of cognitive behavioural therapy.  I think it’s the biggest pile of toss in the history of psychology, at least for people like me.  To say that I have faith in the psychodynamic and analytical schools of therapy would be false, because I am not sure that I really believe any form of psychotherapy works entirely.  Nevertheless, I hold the latter in much higher regard than the ‘newer’, in-vogue, supposedly cost-efficient therapies.

The problem in this position in the last few years has been that the psychodynamic schools have lacked empirically-based evidence for their effectiveness, whereas (surprisingly for me) CBT and its kindreds are backed by a myriad of studies supposedly supporting their effectiveness in treating various forms of mental illness and distress.

Well, finally it seems the psychoanalyst types have sought to prove the efficiency of their practice.  This article from Scientific American (reported prolifically elsewhere too) discusses a recently published journal article apparently demonstrating that psychoanalysis and psychodynamic therapy not only work, but keep working after cessation of treatment.

The piece claims that psychodynamic therapy has been shown in controlled trials to effectively treat anxiety, depression, eating disorders and, crucially for yours truly who is in psychodynamic therapy, personality disorders.  According to the author of the original journal article, this type of therapy enables patients to develop tools to better function in the “real world”, increases self-confidence and decreases the symptoms of their illness(es).  A key ingredient in achieving this is, of course, the therapeutic relationship.

Like the preceding article above on PTSD, there’s a wee bit of neuroscience thrown in here; current research seemingly suggests that psychodynamic therapy can produce changes in the prefrontal cortex of the brain, as patients begin regulate emotional health.

Naturally this isn’t a faultless paper; for one thing, the studies therein simply aren’t numerous enough in number.  But, not unsurprisingly in my view, most of the main detractors of the article’s findings are CBT devotees, who complain that this study is across various mental disorders, rather than focusing on just one.  Fair enough, but the analytic schools had to start somewhere (and admittedly should have done so sooner), and ‘somewhere’ is proving to be a promising start.

Talk Therapy: Off the Couch and Into the Lab

A few other articles of interest came up this week, but I think I’ve drivelled on enough.  Enjoy.  *coughs*

C is off tomorrow   So I shall report on last week’s session then, hopefully.

The madosphere is still jumping with news and views on the first published draft of the DSM-5, about which I wrote briefly last week.  Mental Nurse comment on the implications of new and modified paediatric diagnoses, including the interesting medicalisation of temper tantrums (Temper Dysregulation Disorder with Dysphoria, apparently); Psych Central review the good, bad and ugly of the tome; and Psychiatric Times just bloody hate the thing.

For my part, having read about my particular diagnoses in much more detail now than when I posted last week, I’ve modified my views somewhat.  I was relatively favourable towards the proposed revisions then, but I’m not sure if I still agree with that.  One change that I do like is the potential that mixed states can be incorporated into bipolar II, rather than just I, but as far as the BPD and PD changes in general go, I’m not sure I still hold to my view that the dimensional scaling therein is a good thing.  I like it in theory, I think, but there are some very negative traits being included, and as Lost in Mental Health pointed out to me, there is a potential danger than if you don’t ‘score’ that highly, that you will be disregarded as someone without a serious illness.  This is in some ways applicable to the mood disorders too.

I think the problem for me right now is that the PD section in particular is so ludicrously convoluted, that it’s easy to get lost in it.  I do ‘get’ what they’re trying to achieve, I think, but that doesn’t keep the whole thing from being a quagmire with many different strands of which a clinican must be perpetually mindful.

Anyway.  Up until yesterday I had found the sum total of no articles that I thought were of great interest.  But it’s either a famine or a feast; yesterday I was totally inundated with them.  I really can’t be arsed to make this a definitive directory of internet psychology, so I’m just going to single out a few links.

Two Australian academics have, however, sought to make their website the definitive directory on the internet of philosophical and psychological articles on consciousness.  I haven’t been through many of these papers yet, but this is truly a mind-blowing resource that you should definitely check out if you are interested in this subject and indeed philosophy or psychology in general.

Online Papers on Consciousness

A couple on therapy, of course.

Psych Central ask what you’re meant to do if you run into your therapist in public.  This is something about which I have always wondered; a difficult social encounter, to be sure.  It is postulated in this article that the therapist will generally take the lead from the client, though the author does state that some shrinks of the analytic persuasions will often feel it better not to acknowledge the client at all.  This, to me, seems even weirder than running into each other in the first place.

What if I Run into my Therapist in Public?

Regular readers will be aware that last week, I questioned what the very point of psychotherapy was.  The author of the perennially interesting Kellevision blog seeks to find the answer – and it is not to make us clients always happy-go-lucky.  The author quite rightly acknowledges that real therapy should be hard, hard work.

Therapy is Not to Make You Happy

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As ever, please feel free to contact me if you have anything you’d like to see included in AotW.

I couldn’t possibly write this week’s AotW without mention of the first public consultation on the DSM-V, which was unveiled today.  The American Psychiatric Association has put its proposals on existing and new mental disorders up at www.dsm5.org, for the delectation of professionals and the public at large.  Comments are invited.

I’ve had a rudimentary gander through the pages on BPD and bipolar II.  The latter seems largely unchanged, though the section on personality disorders has a distinctly new feel.  I noted with interest that they want to change the term ‘borderline personality disorder’ to ‘borderline type’.  What the fuck does that even mean?  As one of my Twitter followers said, the borderline type of what exactly?  (It’s the borderline type of personality, I think, which makes the new designation no different from the old one as far as I can see).  I know there have been many calls to change the name of BPD (I don’t share the hatred of the name myself, though I agree that the disorder is unfairly stigmatised), but why change it to something so meaningless, that still incorporates the supposedly offensive word?  I can’t see any sense in it, I’m afraid.

One thing that is, I think, a positive move, is the APA’s decision to introduce rating scales to assess the severity of traits in the personality disorders (though assessing ‘severity’ as a more general concept still seems rather vague).  As far as I can see, the present methods of establishing just how bad someone’s PD is are nebulous and arbitary.  If the new ratings are adopted as the current draft of the tome suggests, it will, I think, force psychiatrists to take certain cases more seriously than they presently do.  Maybe I’m being ridiculously idealistic in supposing this, but I do think that whatever happens, this is a positive development.  Of course, some of the ‘traits’ discussed are pretty negative in tone, and I suppose the danger exists for a clinician to be biased against a particular patient.  It is my hope that most are more professional than this…

Anyway, onto other stuff I came across this week.

In light of a recent news story in which a man in a long-term coma was shown to be able to communicate with scientists using a brain scanner, the Independent has run an article asking just how much we know about the human brain.  My immeadiate reaction was that we know sod all really, but there is a surprising amount of information detailed in this fascinating article.  Of course, what is known is infintessimal relative to what is unknown, but nevertheless the material presented here sheds light on this intriguing subject.

The Big Question: What Do We Know About the Human Brain and the Way it Functions?

The following is quite an old article from Psychiatric Times, apparently dating back to 1996.  To that end, the material therein is probably quite outdated, but it does address a question that has bothered me for some time (yes, my life is that sad) – in what way is psychopathy distinct from anti-social personality disorder?  My understanding had been that as things stand, ASPD was the new name for psychopathy – yet in popular terms at least, the two aren’t equated much; a psycho- or sociopath is seen as someone so much more than someone with ASPD.  This article discusses the distinction and confusion surrounding the diagnoses.

Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion

Here we have yet another article on the therapeutic relationship.  Not one of my favourite topics, or anything *whistles innocently*

This is also from Psychiatric Times, which is fast becoming one of my most-visited websites.  There isn’t anything especially revelatory in it, but nevertheless it intelligently discusses therapuetic boundaries, issues of transference and countertransference, and why the unilateralness of the relationship is an inherently good thing (even though it doesn’t damn well feel it most of the time, from this side of the couch anyway), but doesn’t stop the therapist caring for the client, nor sharing an intimate relationship with him/her.

I can think of a certain someone that would do well to read this and similar articles.

Boundaries and Benefits of Psychotherapy

Finally, something vaguely amusing (or so it was to me).  Last night, in a rage at C, A Googled “fucking incompetent therapist”.  This turned up the highly reliable and unbiased (!) site of Stop Bad Therapy, in which you can take a test to see whether or not your therapist really is as shite as you think he or she is.

I answered ‘yes’ to 13 out of 40 questions.  Apparently:

If you answered ‘yes’ to ten or more questions, you need to carefully question your therapist about the relevance of your therapy. If the outcome of this discussion fails to reassure you, decisive action is warranted. Rather than walk away from this therapist, or even trot, consider sprinting from therapy as rapidly as you can. Any therapist who elicits this many ‘yes’ responses is likely incompetent. He is probably doing you much more harm than good.

To be clear, I am not taking this remotely seriously.  But I thought it was entertaining

Evaluate Your Therapy

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Your comments on all or any of these articles are most welcome.

I was going to recommend a long academic paper on child trauma and dissociation, but I would have to admit that I haven’t read it all yet due to being really mental these last few days.  Nevertheless, it presents several interesting hypotheses, so if you’re interested:

Betrayal Trauma: Traumatic Amnesia as an Adaptive Response to Childhood Abuse [PDF]

The following I have read in full.  This is an article from the Suite 101 which discusses the possible meaning of dreams, as conceived by the likes of Freud and Jung.  I’m always loathe to take this kind of thing seriously, as I think it’s very unlikely that we’ll ever really know the point or meaning of dreams, but nevertheless, the article succinctly describes interpretations of some of the most common symbols in dreams.

The most pertinent for me was falling.  Like many others, it’s a dream that I experience frequently.  I always wake because I’ve acted out what I am doing in the dream – ie., I am flailing about as I ‘fall’.  According to the article, this dream could represent repressed despair or anxiety, with the subconscious using the dream to express “the threat”.

In all honesty, that probably proves that there’s nothing particularly revelatory in this piece but nevertheless, it’s worth having a quick look at.

Meaning of Dreams and Nightmares: Analysis of Symbols and Images in Dreams Can Uncover a Hidden Theme

There were a number of interesting psychiatric / psychological articles upon which I happened this week, but only one really stood out, probably simply because I have a strong interest in the subject matter.  The article comes from Psychiatric Times (PT) and discusses the phenomenon of stalking.

The comprehensive article discusses a range of factors pertaining to stalking, one of the most interesting for me being the statistical profiles of offenders.  I was interested to note that PT cite a high rate of cluster B personality disorders in perpetrators.  Of course, on the surface, one might have expected a high incidence of anti-social personality disorder, but this illness is not singled out, so one has to wonder if diagnoses such as BPD are prevalent also.  Great!  (Not, obviously).

In line with generally accepted statistics, the article suggests a high rate of offenders being known to their victims.  Another interesting discussion is on classifications of stalkers; I should have assumed that such categorising was logical, but nevertheless this information was news to me.

Finally, there is a short discussion on the best way a therapist or psychiatrist can engage with the offender, including a case study.

This is a fairly long piece, and parts of it are quite heavy on statistics, but if you’re interested the area of forensic psychiatry and psychology, it’s a satisfying read.

Stalking: The Veiled Epidemic

Only one article for this week’s entry, and it is from Kathy Broady at Discussing Dissociation, who has written a post on externalising versus internalising responsibility.

Basically, the post discusses whether individuals who have suffered trauma blame those who were the actual perpetrators or whether, in fact, the victim blames him or herself.  Kathy writes that most individuals who have DID internalise responsibility, and indeed this is probably true of others who have been through trauma; it is certainly, to some extent, true of me.

Kathy offers a typically compassionate and informed take on this phenomenon, and on what those who find difficulty in externalising blame can do about it in and outside of therapy.

Externalizing Responsibility and Externalizing Responsibility

Feel free to contact me with any articles you think are worthy of inclusion in this series.

The Main Course

My favourite psychiatric article this week was on schizophrenia.  Specifically, the piece from X-Ray Technican Schools (I agree that this seems a curious place to have an article on schizophrenia) provided a concise, accessible but intelligent refutation of the many myths that surround this illness.

One of my pet hates is the mistaken belief that so many seem to hold that schizophrenia is, or at least shares key symptoms with, dissociative identity disorder.  I suspect I’m preaching to the converted on a blog about mental illness, but lest there be any doubt schizophrenia does not involve multiple personalities!!!

Another mistaken and highly stigmatic belief that I despise is that mentally ill individuals (especially schizophrenics) are more dangerous and/or violent than normals.  This simply is not true, as statistics frequently demonstrate.

This article analyses these two myths, plus eight others, discussing how they’ve arisen and why they are false.  Many thanks to Wounded Genius for posting this for us to find.

10 Myths About Schizophrenia

For Afters

There were so many excellent articles upon which I stumbled this week that it’s hard to narrow them down.  Here’s the runners-up that I’ve come up with.

A close second to the above schizophrenia article is a piece in the New York Times that discusses the “Americanisation” of mental illness.  By “Americanisation”, as far as I can tell they really mean “Westernisnation” (not that that’s a word).  This is quite a long article, but its well worth sticking with.  It goes into considerable and fascinating detail as to how some mental illnesses are (or were) culturally dependant, and how they now seem to be becoming increasingly homogenised – in line with Western interpretations.

The Americaisation of Mental Illness

Jonah Lehrer at Science Blogs have a post on daydreaming, and why it isn’t necessarily such a waste of time:

Intelligence and the Idle Mind

Science Daily reports that migraines may have links to child abuse.  This could explain a lot…

Abuse in Childhood Linked to Migraine and Other Pain Disorders

Finally, I want to have a look at two articles from Psych Central that discuss transference and the therapeutic relationship, both written by Sonia Neale.  The first discusses how the therapist can never really return your transference – not in a manner in which you would know it anyway.  It discussing how what it terms ‘transference love’ is very real, given as all any of us ultimately want (allegedly) is to be loved, but will always (sadly) be one-sided.

Transference is Not Transferable

The second article explores a similar, but distinct, aspect of therapeutic relationships – that fantasy that we can or will, eventually, be friends with our psychotherapists.  Ms Neale discusses why this is a bad idea, but argues that it’s not necessarily transference but a genuine connection that drives this.

Why You Can’t Be Friends With Your Therapist – Ever!

*SI walks away, whistling innocently*

Anything Else?

Any suggestions for Article of the Week are very welcome, as are comments on those posted here.  Get in touch or leave a comment.

I’ve decided to undertake a new venture for a new year.  Whilst I feel very lucky that so many people enjoy this blog (why?!), I also thought it would be good if I could make it of some use too by sharing some of the most interesting psychiatry and psychology articles I come across through my travels on teh interwebs.  To that end, every Wednesday where possible, I shall put up my Article of the Week.

Article of the Week

The first is from Current Psychiatry, who have an excellent article on the differences between borderline personality disorder and bipolar disorder.

There’s an analysis of the overlapping symptoms, a look at what is different between the two illnesses, and possible reasons as to why one illness is often misdiagnosed as the other.  The article also points out that there is, genuinely, a high correlation of co-morbid BPD and bipolar disorder (especially type II), nodding at the possible biology underpinning both conditions.

A slight warning: some of this stuff is technical (well, it is for psychiatrists!), but if that doesn’t faze you, this is a very insightful article.

Borderline, Bipolar or Both?  Frame Your Diagnosis on the Patient History.

Honourable Mentions

A mention too to Kathy Broady at Discussing Dissociation, who writes a moving post on the hopelessness and despair felt by those who have been affected by psychological trauma.  She also advises on how to combat these feelings.

Hopelessness and Despair

The Canadian Globe and Mail asks whether or not psychiatrists and therapists have their own significant mental health difficulties.  The author says at one point that she has wondered if her therapist has, and I can certainly confirm that I too have made the same mental queries.

The Secret Life of Psychiatrists

Finally, Psychiatric Times posted a decent entry on how therapists and psychiatrists can end the therapeutic relationship with minimum disruption to the patient’s well-being (maybe C should read this).

Psychiatric Abandonment: Pitfalls and Prevention

Any Suggestions?

I find most of these articles via interesting links from Twitter, as well as my own explorations.  If you want to suggest an article for inclusion here, I’d be delighted.  I can be contacted in a variety of ways, or you can simply leave a comment here.