The government has sacked an independent national health adviser for questioning ... whether the money for its mental health strategy was new or came from the existing NHS budget.

When Nick Clegg announced £400m to improve access to modern psychological "talking therapies" last Wednesday, David Richards, professor of mental health services research at the University of Exeter, told the Guardian that the money was not additional ...

Instead of being spent on training therapists, it could end up used to plug other gaps in the NHS, he said ...

He said it had been explained at a meeting of the IAPT group just over two weeks earlier that the money would have to come from the existing NHS budget ...

My comments and dismissal arose because I had not received answers to three vital questions.

First, to what extent is the promised money "real" and not to be met from cost pressures – the DH euphemism for cuts – elsewhere in the NHS budget?

Second, what mechanisms have been put in place to ensure every penny of the money will be spent on training, employment and treatment costs for people with anxiety and depression?

Finally, what systems have been put in place to ensure existing funds currently being used to provide therapy services in England are not cut as part of the cost pressure actions required of NHS commissioners and providers, as has happened in the past?   [Gdn]

Guardian  07 Feb 2011                    Dystopia of Individualism

"Britain has become the true Prozac Nation. I believe this trend has gone too far. We must cut the number of anti-depressants prescribed by doctors. Pills must not be a crutch for the wider issues in our society which cause mental health problems."   [Nick Clegg]

... the spread of the US model of capitalism is responsible for the epidemic of emotional distress that has swept across the developed world ... We end up treating ourselves and others as commodities, as mere means to vacuous ends ... Anomie, alienation and addiction await us ...   [Oliver James]

There are more mentally ill people on incapacity benefits than the total number of unemployed people on benefit ...   [LSE Depression Report]

It seems likely that the announcement that doctors are to be awarded bonuses for 'spotting' the mentally ill probably comes from Nick Clegg.

The rational probably goes like this: mental illness = more benefits = threat to cutting the deficit.

Therefore, let's throw a few crumbs at the problem - £150m to be exact - and save more on benefits later.

The realisation that the, er, 'wider issues in our society which cause mental health problems' might have some connection with Clegg's 'Orange Book' neoliberalism would be a step too far, of course.

As David Smail put it:

... we are free to do only that which we have the power to do ... much of our sense of agency follows necessarily from our nature as embodied creatures ... we invent a language of autonomy and responsibility that does not in fact stand up to critical examination and analysis.

If we want to understand what we are up to and why we suffer, we are going to have to pay far more attention than we have in the past century to the structure and dynamics of social space-time.

Reorganising mental health services into clusters doesn't make sense

... somebody tweeted me a link to a piece on the Guardian's social care network, in which a social worker had written of their concerns about "shoehorning" mental health service users into predetermined "clusters". And suddenly the penny dropped, the lights came on and the full scale of the nightmare became apparent.

This isn't some local reorganisation but a national diktat direct from the Department of Health.

All mental health service users must be assigned to one of 21 clusters. Failure to comply will result in withdrawal of funding.

The cluster you are assigned to depends on how your psychiatrist scores you in response to 18 questions.

These scores are entered into a computer, which performs a series of algorithms and finally spits out a cluster.

This is then branded on your forehead and you are herded to the appropriate pen.

I'm not joking (all right, maybe the last bit). I only wish I were.

Apparently, it's all about payment by results. In Mental Health plc we can't afford to be sentimental.

Patients are commodities to be sorted, labelled and processed.

Doctors are data inputters.

Relationships, which may have taken years to build, don't count. The share price is everything.

Gdn  31 Jan 2012            

Mental health cannot be shoehorned into predetermined 'clusters'

Mental health services must keep up with changes in treatment

PbR update – October 2011

Mental health care clusters and payment by results

Mental Health Clustering Tool Case Study

Supporting system reform agenda in mental health

Western Cluster

Antidepressant use in England soars

The use of antidepressants has risen by more than a quarter in England in just three years, amid fears that more people are suffering from depression due to the economic crisis.

The number of prescriptions for antidepressants increased by 28% from 34m in 2007-08 to 43.4m in 2010-11, according to the NHS information centre.

Depression is also costing the economy nearly £11bn a year in lost earnings, NHS care and drug prescriptions.

Research by the House of Commons found the cost to the NHS of treating the illness is more than £520m a year.

People who are unable to work due to depression lose £8.97bn of potential earnings a year, while the loss of earnings from suicide is put at £1.47bn.

Gdn  30 Dec 2011

Cartesian Dualism and the Mentally Ill    Oliver James

Escalating depression crisis is costing Britain £11bn a year

Cognitive behavioral therapy

Antidepressants: The Emperor's New Drugs?

Precarity

The Moral Tyrannies of Therapy

Depression

Patients 'struggle to get emergency mental health care'

I have been reading reports like this since I started this site in 2003. People with mental illness are at the bottom of the pecking order in the NHS, in society - where they are dismissed as 'nutters' - and above all by the neoliberals, to whom they another group of people who fail the autonomy test. As benefit claimants they are most likely to be found fit to work, and - should they be lucky enough to get a job - are least likely to be accepted by their new, er, 'colleagues'.

Mind chief executive Paul Farmer said: "People experiencing mental health emergencies can be faced with long waits, poor quality care and in some cases are unable to access help at all.

"People told us what they most wanted in crisis wasn't complicated, but simply being able to get treatment when they needed it, therapeutic hospital environments, personal safety, someone to talk to and something to do.

"The sheer simplicity of what is missing shows that there is some way to go before all mental health services are delivering on the fundamentals of good care for people in mental distress." ...

BBC NEWS  21 Nov 2011    Third Meltdown Log

Cartesian Dualism and the Mentally Ill

Killings in Swindon by mental health patients 'avoidable'

Postnatal depression: NHS is failing new mothers

Researchers from the charity 4Children surveyed all health trusts in England and Wales to find out what sort of treatment was being received by the one in 10 new mothers who suffers from the condition.

They found that, of those whose symptoms were recognised at all by their GPs, the vast majority were being prescribed antidepressants, against guidance from the National Institute for Clinical Excellence, which recommends "talking therapies" ...

The survey, by parenting club Bounty on behalf of 4Children, also found that few health authorities were collecting information on the prevalence or severity of postnatal depression, while others seemed to have only a patchy understanding of the issue.

There were vast disparities between those who did hold information – two primary care trusts claimed they had had only one case in the past year, while another reported 1,350 cases.

Only 9% of health trusts were keeping track of the condition in their area ...

Gdn  01 Oct 2011    Third Meltdown Log    

Marginalised

The mental health ward at Lancaster Farms Young Offenders Unit is to be closed

Staff on the mental health ward, which serves young prisoners who are suffering a mental health crisis or at risk of or who have attempted suicide, are NHS staff although the centre is within the prison itself.

Lancaster Farms houses some of the most troubled and damaged young men in the North of England.

Many of them are care leavers and most have come from abusive backgrounds.

They have committed or are on remand for serious crimes. About 20 jobs will go.

Gdn  27 June 2011    Coalition Log    Cutting the Deficit    Prison & Probation    'We're all in it together'

Mental health services in crisis over staff shortages

Mental health services have been in crisis since before I started this site in 2003

Overcrowded and understaffed psychiatric wards are leaving patients fearful for their safety and unable to make proper recoveries, according to a damning assessment of Britain's mental health service by its lead professional body.

Professor Dinesh Bhugra, the outgoing president of the Royal College of Psychiatrists, told the Guardian that widespread failures in inpatient care for mentally ill people meant many hospital wards did not meet acceptable standards and discharged back into society sick people who remained a risk to themselves and others ...

His warnings are supported by a study to be published next week in which the royal college describes how about half of patients – mostly women – report feeling unsafe in many of worst-performing hospital trusts. The report also says:

• Average bed occupancy rates in English inpatient units are much higher than the 85% standard, with some wards running at 120% occupancy.

• Access to psychological therapies falls far short of acceptable standards recommended by the National Institute for Health and Clinical Excellence and other health bodies.

• Daily one-to-one contact with nursing staff is less than that accepted as being conducive to recovery.

• Outreach links into the community are insufficient in two-thirds of the wards inspected by the royal college's centre for quality improvement ...

Gdn  20 June 2011    Coalition Log

Money woes 'linked to rise in depression'

The figures, obtained from NHS Prescription Services under the Freedom of Information Act, cover anti-depressant prescribing from 2006 to 2010, during which time the country had to cope with the banking crisis, recession and the start of the spending cuts.

They showed the number of prescriptions for selective serotonin re-uptake inhibitors, the most commonly prescribed group of anti-depressants, rose by 43% to nearly 23 million a year.

The data also showed increases in other types of anti-depressants, including drugs such as Duloxetine which tends to be used for more serious cases ...

BBC NEWS  07 April 2011

Northern doctors prescribe more antidepressants

Male depression 'set to increase'

Budget changes will 'cut income by £200'

... around half a million Incapacity Benefit claimants could find themselves declared fit for work after a re-assessment of their health.

Trials of compulsory health checks for claimants in two parts of the country have found about a third of those tested were deemed to be able to work.

The mental health charity, MIND, has criticised the new Work Capability Assessment (WCA), calling it not fit for purpose.

It surveyed more than 300 people currently claiming the benefit and found 75% said concern about the WCA had made their mental health worse.

BBC NEWS  03 Apr 2011

Fitness for work test not fit for purpose

£5m scheme to divert mentally ill offenders from prison

The first stage in setting up a national service to divert mentally ill people from prison is due to be announced by the health secretary, Andrew Lansley, and the justice secretary, Ken Clarke.

The two cabinet ministers are to announce they have found £5m to put into 100 "diversion sites" across England and Wales as part of their plan to create a national liaison and diversion service by 2014.

The decision is part of Clarke's plans for a radical restructuring of sentencing and the prison system, with the money coming mainly from the health budget as the justice ministry grapples with a 23% cut in its spending.

Clarke's green paper, Breaking the Cycle, recognises that the justice system is not always the best place to manage the problems of less serious offenders where their criminal behaviour is related to their mental health problems.

A prison service survey published in November revealed that 12% of inmates had a mental illness or depression as a longstanding illness ...

Lansley will announce that £3m is to be spent creating up to a further 40 diversion sites for adults and £2m for up to a further 60 sites for young people this year. They hope it will be a national service by 2014 ...

Guardian  28 Mar 2011

GPs to share £150m bonus pot for spotting mental health problems

Ministers call for new approach in drive to tackle underlying causes of mental illness ...

With mental health already costing the NHS £10bn a year – a figure forecast to double in real terms over the next two decades – ministers are calling for a new approach that tackles the underlying causes of the illness which represents a third of GP cases.

By 2013 the government says 15% of the £1bn financial incentives that hold family doctors to "account for high-quality care" will be focused on prevention, especially in mental health.

Given the state of the economy there is rising concern that unemployment and job insecurity could cause a rise in such problems ...

marystanleyjuliajane
2 February 2011 10:01PM

As a mental health nurse and the mother of 2 children with mental health problems, I am bemused to say the least by all of this.

Currently I work with young people (12 - 18) who have committed serous crimes which lead them to need secure provision and see every day how much input is provided.

All this is marvellous but then my own children who have committed no crimes receive the bare bones in terms of support and only then because they have a mother who knows the system and knows how to fight for help.

Given the cuts that we all know are upon us, I really struggle to see how better provision is going to come about; before my current job I worked with adults on acute wards where the only way in my opinion, to save money from there, would be to turn off the heating and the lights.

It seems to me that the way to avoid the young souls I work with needing the input they receive would be to intervene much much earlier to deal with the social problems that have led them to behave in such a way that prevents them from being in society but that will need much much more than this government, keen on cuts everywhere else, is prepared to give.

Guardian  02 Feb 2011

Mental health

Young unemployed 'face mental problems'

Say a big 'thank you' to the Washington Consensus, and corporate capital's need for a 'reserve army'! Stand by for the Dacre, Express and Sun to label people with mental illness as scroungers.

The study, called the Prince's Trust Macquarie Youth Index, found young people were twice as likely to self-harm or suffer panic attacks if they had been jobless for a year.

About one in six respondents to the survey said being out of work was as stressful as a family breakdown, and one in eight said unemployment gave them nightmares.

Half of young people seeking work said visits to a job centre made them feel ashamed, and more than half said that job-searching had left them feeling disillusioned or desperate.

The study showed young people who were not in education, employment or training were less happy across all areas of their lives.

Martina Milburn, the charity's chief executive, said the longer young people were out of work, "the greater the risk" ...

BBC NEWS  29 Dec 2010

'State-funded idleness'

Jobless total 'will reach 2.7 million'

Call to increase child therapists

Child depression drug use soars

Mental health patients 'locked up in hospitals without legal authority'

Health regulator says blanket measures introduced in the name of patient security may infringe human rights law ...

Matt Kinton, the report's author, said there was a "real worry that the more mental health wards look like prisons, the less they function as hospitals where people will get better and be able to live independently".

Kinton said one of the driving forces of this trend towards security was that the private sector had built many new low-security wards.

"It is the old adage that if you build a hospital, patients will fit it."

The regulator also noted that there was a sharp rise in the doctors prescribing compulsory treatments for mental health problems.

On average, 367 community treatment orders (CTOs) have been made each month.

This is at least ten times the number anticipated when the legislation was introduced in 2008 ...

Guardian  27 Oct 2010

Mind says mental health patients need faster access to therapy

One in five people with mental illnesses do not get the right therapy from doctors – despite good evidence of its effectiveness, the mental health charity Mind says today.

The charity said that its research showed that early access to "talking therapies" such as counselling was essential in treating people with mental illnesses and depression.

Those waiting fewer than three months from assessment to treatment were almost five times more likely to report that it helped them get back to work than those waiting between one and two years.

Yet more than two-thirds of patients were given no choice, Mind said, left with little more than the offer of drugs.

Mental distress costs the economy in England an estimated £105bn each year – equal to the entire NHS budget.

"The Government has made a commitment to choice in its health white paper, and a promise to improve access to talking therapies," said Mind's chief executive Paul Farmer.

"The forthcoming comprehensive spending review is their opportunity to demonstrate that they are serious about both."

Guardian  14 Oct 2010

Britain's £100bn mental health crisis

Mental illness in England cost the nation more than £100bn last year, highlighting some of the most serious emotional and psychological problems in Europe.

More than £21bn was spent on such health treatments as antidepressants and social care such as befriending services, an increase of 75 per cent since 2003.

Experts warned that the figure is likely to rise as government cuts to public services start to have an impact.

The statistics, released today by the Centre for Mental Health, show mental health-related sick leave and unemployment cost the economy more than £30bn.

The true impact is likely to be much higher, as the costs of underperformance and poor productivity are not included.

The cost of the less tangible, human toll of mental illness is calculated to be £50bn: this figure takes into account the negative impact that conditions such as depression, anxiety, psychoses and bipolar disorder have on quality of life and life expectancy, as well as the costs of providing informal care ...

Independent  03 October 2010 'Wasted Lives'

'A narrow definition of self'

On the failure of Methodological Individualism

Antidepressant use rises as recession feeds wave of worry

Prescriptions have doubled in decade, NHS figures show, with doctors warning drugs are covering for counselling shortage ...

The health service issued 39.1m prescriptions for drugs to tackle depression in England in 2009, compared with 20.1m in 1999 – a 95% jump.

Doctors handed out 3.18m more prescriptions last year than in 2008, almost twice the annual rise seen in preceding years, according to previously unpublished statistics released by the NHS's Business Services Authority.

The increase is thought to be due in part to improved diagnosis, reduced stigma around mental ill-health and rising worries about jobs and finances triggered by the economic downturn.

But tonight doctors warned that some people are being put on the drugs unnecessarily, especially those with milder symptoms of depression, partly because there is too little access to "talking therapies", which use discussion rather than drugs to tackle problems ...

Guardian  11 June 2010    Reserve Army

Stress link to financial squeeze

Work pressures during the recession have caused a big rise in mental health problems, the charity says.

A survey for Mind suggests that one in 11 British workers has been to the GP for stress and anxiety from the financial squeeze.

And 7% said they were prescribed medicines to help them cope ...

BBC NEWS  17 May 2010    

GPs call for better treatment for depression sufferers

Some 65% of doctors say they can "rarely" offer psychological therapy to depression sufferers within two months of referral, a study suggests.

The Royal College of GPs survey of 590 UK doctors also found 15% said access to psychological services was only "usually" possible in that timeframe.

The survey is part of a campaign by mental health charity Mind calling for better access to therapies ...

Depression affects one in 10 people a year, with more than half of those experiencing more than one episode ...

The programme director for Wellbeing at the London School of Economics, Professor Lord Layard, who is spearheading the campaign, has stressed the economic as well as the humanitarian case for investing in treatment, suggesting that successful therapy can help many people return to the workplace.

"Mental illness is perhaps the greatest single cause of misery in our country," he said.

"The least we should offer is the same standard of care we would automatically provide if they had a physical illness."

BBC NEWS  21 Mar 2010    Oliver James

Affluenza

Guardian: Mental Health

More money makes society miserable

The Moral Tyrannies of Therapy

The blight of depression affecting hundreds of thousands of people across Britain is costing the nation's ailing economy £8.6bn a year, £3bn more than a decade ago, The Independent can reveal.

Mental health workers are demanding more funds to attempt to turn around the rising cost to the country of the condition, which leads to lost working hours, inefficiency and long-term unemployment. But many fear spending will be squeezed further by a reduced NHS budget, which looks increasingly likely ...

Jo Swinson, the Liberal Democrat MP who commissioned the figures, described the findings as "shocking evidence of the dramatic scale of the cost of depression".

She said: "Unemployment is already growing. In this financial crisis we can no longer afford to ignore the preventable causes of depression that are all around us. High levels of unsecured personal debt, job insecurity and workplace stress all damage our wellbeing. More Government focus on mental health and wellbeing makes economic sense. Measures to tackle workplace stress, extend flexible working rights, encourage responsible lending and keep people in work, would benefit us all. Ministers can no longer allow mental health care to be a Cinderella service." ...

The Independent 16 June 2009

A depressingly widespread problem

Cheap Labour

A report on diverting mentally ill offenders from the prison system is set to call for better assessment and treatment and more community sentences.

It is expected to highlight how anti-social behaviour orders and penalty notices can accelerate the treatment of mentally ill people as criminals.

Lord Bradley's report is expected to make 80 recommendations it says could save thousands of prison places.

Some estimates suggest 70% of inmates have two or more mental disorders.

One in 10 has serious mental health problems, it is also estimated.

The report published on Thursday aims to "deal with what everyone in the criminal justice system accepts is a major problem", says BBC home affairs correspondent Rory Maclean.

Lord Bradley is expected to call for proper assessment of mental health and learning difficulties in custody suites ...

BBC NEWS 30 April 2009

Prison Reform Trust

Doubly punished

Jail healthcare 'not good enough'

Rise in use of secure hospitals

Depression among the young at an alarming level

A significant number of young people are depressed or struggling to cope and the situation is likely to worsen as recession takes hold, according to a report by the Prince's Trust.

One in 10 16- to 25-year-olds polled by the charity for its Youth Index study said they felt that life was meaningless, and more than a quarter (27%) said they were always or often down or depressed.

Almost half of all those surveyed (47%) said they were regularly stressed ...

Peter Kellner, of YouGov, which conducted the research, said the majority of young people had a generally positive outlook on life. He warned, however, that the serious concerns of the "core" of unhappy people under the age of 25 "need to be addressed". He added that failing to take the issue seriously "would be storing up big problems for the future" ...

Guardian 05 January 2009    Warning over youth mental health

The terrible cost of cuts in Manchester’s mental health services is clearly illustrated by the death of William Scott, a 49 year old man from Manchester. William suffered multiple stab wounds that his family say were self inflicted. This tragedy was neither unforeseen nor inevitable.

William had recently lost the support worker who had cared for him for the past eight and half years.

His family had pleaded with bosses at Manchester mental health and social care trust, who had recently “reorganised” their services, to allow William’s support worker to resume their visits, but to no avail. ...

William’s daughter Emma told the Manchester Evening News, “We tried desperately to get my dad admitted to hospital. I asked them, ‘Does he have to hurt himself or someone else before he gets help?’

“He had an excellent support worker who visited him two or three times a week, but after they left, dad went for three weeks without any home visits.”

In the week following William’s death, another vulnerable patient took her own life. According to the Manchester Evening News she was upset after her support worker was moved on. ...

Socialist Worker 23 October 2007

Karen Reissmann, a nurse for 25 years and an elected member of Unison’s national health service group executive, was suspended from work on June 15th. On a Friday afternoon, an important outpatient appointment with a very vulnerable patient and her consultant was interrupted, and on the direct orders of the chief executive, she was instructed to leave the out-patient consultation and the hospital. [RKR]

... Apart from enabling a basic level of economic success, sufficient to pay for food, health and education, the purpose of government is to minimise the amount of mental illness by creating a benign society, like the Scandinavians have been doing for 70 years. Blatcherism has done the opposite. If you can face it, here's a glimpse of what really happened to our social psychology in the past 10 years, starting at the beginning of life.

Foetuses depend on having calm, happy mothers. There is abundant evidence that feeling stressed in the last trimester is an independent cause of hyperactivity and behaviour problems. The mother's high levels of cortisol - the fight-flight hormone - are passed through the placenta and continue to affect the child nine years later. Yet, since 1997, women have been more, not less, likely to work right up to the birth.

It just goes on from there, as if the New Labour control freaks are oblivious to the evidence of what makes for mental health. Caesareans have multiplied several-fold, even though they interfere with bonding. British babies are even less likely to be breastfed than anywhere in Europe, again reducing emotional intimacy. Then, mental illness-inducing strict routines for babies, like insistence on four-hourly feeding or imposed sleep schedules, have become widespread. Where is the government action, following the damning study of this method published last year? It shows that, compared with babies raised in infant-centred regimes (for example, demand-feeding or sharing the parental bed when distressed), at three months the routine-nurtured babies spend 50 per cent more time crying or fussing: the Discontented Little Baby. ...

Oliver James The Independent, 13 May 2007

Infected by affluenza

The report reveals the following striking facts:

• There are more mentally ill people on incapacity benefits than the total number of unemployed people on benefit. ..

• One in six of all people suffer from depression or chronic anxiety, which affects one in three of all families.

• Only a quarter of those who are ill are receiving any treatment – in most cases medication.

• Modern evidence-based psychological therapy is as effective as medication and is preferred by the majority of patients.

• In most areas, waiting lists are over nine months, if therapy is available at all. • A course of therapy costs £750 and pays for itself in money saved on incapacity benefits and lost tax receipts.

• We can therefore provide a service in every area at no net cost. This would require 10,000 therapists and 250 local services, with 40 new services opened each year till 2013. With proper leadership from the centre and protected funding, this is totally feasible.

LSE 19 June 2006

Peadar Kirby looks at the treatment of the “mentally ill” in Western countries, and argues that notions of ‘individuation’ - springing from Cartesian ‘dualism’ - are seen as the key to treating mental health problems:

The mind is separate from the body, the disease from the person who has it ... people become the 'objects' rather than the 'subjects' of their own activity ...

This dominant Western psychology of the self ... has led to the emergence of a psychotherapeutic model that is largely based on individualistic assumptions.

In such a schema, 'individuation' and a strong separate ego are seen as the key to mental health. This constricted sense of self highlights our division from one another, and allows for the objectification of others and ourselves.

... The ideological framework informing much of the psychological treatment given to those who are labelled 'mentally ill', identifies their behaviour as 'abnormal' ... the moral and political dimensions of the deviant behaviour are not addressed.

Illness in such a world view is an individual matter.

There is no language of social suffering that can speak to the moral and political experience of both sufferer and the suffering community ... Denial of the desire to live in harmony with the natural world leads to alienation, numbness, anxiety and depression.

[VaV page 156, pbk edition 2006]

The Moral Tyrannies of Therapy

Rank Theory