Yesterday we published a visual summary of the findings of the latest CQC MHA Annual Report.
You can download the full report, an easy read version, a summary and an audio version from here: http://www.cqc.org.uk/public/reports-surveys-and-reviews/reports/mental-health-act-annual-report-2011/12
#RT via Bridget
Some people need to be detained, but they shouldn’t be held for months longer than necessary.
It’s a sad but [un]avoidable fact that sometimes, people with mental health problems become so unwell that they need to be detained against their will.
It should be happening a lot less than it currently does, but the fact remains that there will always be a need for some form of secure care for people who pose a risk to others, or much more likely, to themselves.
As long as this kind of care exists, we all have an interest in ensuring that powers to deprive someone of their liberty are used in a way that is just, compassionate and effective.
Mental illness can affect anyone. If it was your sibling, your mother or your child who became ill, you would rightly expect these powers to be exercised with extreme caution, and if detention really was the only option, that they would receive the best possible treatment and care.
Unfortunately, according to a report out today from the Care Quality Commission on how the Mental Health Act is being used in practice, this is not what’s happening.
The Annual Mental Health Act Report has raised concerns that too many people are being detained unnecessarily and that the care and treatment they receive once they get there, is often found seriously lacking.
There are around 7-8,000 people detained under the Mental Health Act in secure hospitals at any one time. These include high secure hospitals such as Broadmoor, Rampton and Ashworth, although the majority of patients are in medium and low secure facilities. This costs us £1.2 billion a year, making up almost 20% of the total NHS adult mental health budget.
My role as a commissioner on a year-long enquiry into the state of care for schizophrenia in 2012, for me, really brought into sharp focus how disproportionate this spending is.
The truth is, we have a risk-averse system which is clearly not getting the balance right. Resources which could be keeping people well in the community, and preventing them from ever being sectioned in the first place, are being consumed by expensive secure care.
The Commission identified huge amounts of money being wasted because people are getting stuck in a system which is easy to get sucked into, but can be incredibly hard to get out of. We heard far too many examples of people who were judged by psychiatrists to be clinically well enough to leave secure care but who continued to be locked up, because of red tape.
A just society cannot stand by while people who have both paid the penalty for any offence they have committed and are judged well enough to rejoin the community, are held against their will.
This is not only unfair and potentially damaging to the individual – it is also wasting money which could be used to prevent others reaching this acute stage of illness.
There are three aspects of the system that need to change. Firstly, more investment in early intervention is key. Many people who end up in secure care have a long history of mental illness, which has not been effectively treated at an earlier stage. If the system did have the proper resources to support people when they first became ill, huge amounts of money could be saved and it would divert people away from patterns of offending which lead them to prison or secure care.
Studies show that for every £1 invested in early intervention for conduct disorder for example, society saves £8 in the long term.
The second change is to overhaul the system for planning secure care. Services need to be designed carefully, so that they promote hope and recovery and allow people to move through the system and, when they’re well enough, back to the community.
This won’t be easy. Responsibility is fragmented between different parts of the NHS and the Ministry of Justice – but this does not mean it can’t be done. There is too much at stake to leave things as they are.
The final issue is one of culture. As Sir Robin Murray, the chair of The Schizophrenia Commission put it, psychiatrists are not sacked for keeping people in hospital unnecessarily, but they are sacked for letting people out too soon.
This is not to play down risk assessment, which is an important part of the role of all practitioners working in the mental health system. It does however, call into question whether it’s possible to get the balance between risk and recovery right under these conditions.
When you add into the mix, sections of the media who only seem to report on mental health when it’s linked to a horrific crime, you do not have a recipe for logical, rational debate.
This is simply not good enough and we can do much better. There’s no doubt some people do need to be detained, but they should be able to expect effective treatment rather than to be held for months longer than necessary.
We have allowed a mental health system to evolve which is far too timid in its aspirations for people with severe mental illness and has focussed on managing risk, at the expense of quality care and treatment.
#RT via Bridget via http://www.independent.co.uk
Looking for new members of SLaM Service User/Carer Advisory Group for Mood, Anxiety & Personality Disorder ServicesPosted: January 30, 2013
The South London & Maudsley Mental Health Foundation Trust (SLaM) Mood, Anxiety & Personality (MAP) Cinical Academic Group (CAG) Service User and Carer Advisory Group is looking for new members.
The group has been meeting monthly for around 2 years and its core aim is to
- Make sure that the views and experiences of people who use the services and their families and carers are at the heart of the development of the CAG and its services
The group would like to increase its membership and is looking for people who have experience of using the following SLaM services and family members/carers
- Psychological Therapies (secondary care)
- Improving Access to Psychological Therapies (primary care)
- Personality Disorder Services
- Assessment & Brief Treatment services in community mental health teams (MAP community teams)
To be part of the group you will need:
- Some previous experience of service user/carer involvement
- To understand and be able to work with the aims, aspirations and ethos of the group
- The confidence to speak in meetings
- The ability to read and absorb written information to commit to attending the meetings
- Some time / interest to give time in between meetings as appropriate/necessary.
To find out more, please read the attached documents
and if still interested contact:
Patient & Public Involvement Lead – Mood Anxiety & Personality CAG and Psychological Medicine CAG
email: email@example.com tel: 020 3228 0959
113 Denmark Hill |The Maudsley Hospital | Denmark Hill | London | SE5 8AZ
CoolTan Arts ‘Dickens News’ exhibition final instalment
18th Feb 2013 – 23rd June
Cooltan Arts’ wonderful project The Dickens News has worked hard during Dickens bicentenary and is now moving towards its finale in 2013. We are delighted to invite you to the final exhibition in our Dickens News series –‘The Underground Edition’, which celebrates the life and work of Charles Dickens, with a contemporary creative twist and social comment to boot! As a finale to the Dickens News Series, this exhibition will be an investigation into the underbelly of Victorian London. Original artwork, textile, sound art, and the written word will tell the secret histories of those outside of society in the age of Dickens.
The exhibition runs from the 18th February 2013 to the 23rd June 2013 at the Charles Dickens Museum, 48 Doughty Street, London WC1N 2LX.
This exhibition will support Dickens’ interest in social reform by giving a voice to the diverse communities found in the multi-cultural city of London. The richness of London’s diversity is illustrated with historical accounts of local black and Jewish communities, reviews of Dickens’ essays on Africa, slavery & the black population in London, child labour, the mentally ill, the poor and destitute, Victorian recyclers, and lesbian, gay and trans stories are drawn together to weave the underground edition of Dickens work.
The extraordinary announcement that GPs may no longer be able to sign their patients off work for periods longer than 4 weeks, offers an insight as to corporate involvement which underpins the policy decisions of neoliberal governments. There are doubtless many shades of understanding and levels of cynicism amongst both the supporters and the protagonists of these policies, but there are certainly those who know exactly how to deliberately spin the narrative to achieve the desired financial outcome for the ‘markets’. This post attempts to draw out some of the strands.
Lord Freud, Minister for Welfare Reform, has announced a new way in which this government can potentially deter the disabled and long-term sick from claiming benefits. No longer would the GP be able to sign patients off work for longer than 4 weeks. After that period, the professional expertise of the medic would be subject to an independent assessment, presumably by the highly questionable tick list/points system used by a private contractor such as ATOS. Furthermore, according to a Guardian report People who are signed off sick would also be put on to jobseeker’s allowance, rather than employment support allowance, for a period of three months. They would receive less money and have to prove they were looking for work.
So yet another tranche of ill and disabled people would have to comply with an inappropriately structured assessment with all the attendant worrying, potential exacerbation of symptoms and travel expenses; not to mention additional costs to the tax-payer, that such a superfluous assessment entails.
Labour MP Dennis Skinner said: “Last year, the government said GPs should be accountants in charge of the money that is spent in the NHS. This year they want assessors to be GPs. It’s crazy. No wonder the country is going to the dogs.”
So why are we being told that, on the one hand, the GPs are the right people to determine the spending of billions of tax payer’s money on health commissioning, notwithstanding their lack of expertise, but that they cannot be trusted to use their professional judgement in assessing a patient’s health and/ or the need for a referral to occupational health?
One answer is to ‘follow the money’. The medical profession diagnose some patients with intractable long-term illnesses like Fibromyalgia, Chronic Pain, Lyme Disease, Myalgic Encephalomyelitis (ME), and so on… all of which could prove ruinously expensive for private health providers like the US employment protection insurer Unum.
‘Unum’s 1995 ‘Chronic Fatigue Syndrome Management Plan’ sounded the alarm: ‘Unum stands to lose millions if we do not move quickly to address this increasing problem’
Unum (www.unum.com) is one of the leading providers of employee benefits products and services and the largest provider of group and individual disability income protection insurance in the United States and the United Kingdom.
Unum’s close involvement with Welfare Reform, politicians, psychiatrists, academics and think tanks is well documented, and arguably can be likened to the tentacles of the Goldman Sachs squid extending across European governments. http://think-left.org/2011/11/07/the-market-has-a-name-it-is-goldman-sachs/
Unum’s UK activity since the 1990s is referred to in:
But in addition, Private Eye has also raised questions about Unum’s involvement with the DWP (Department of Work and Pensions).
The Eye first questioned Unum about the possibility of a serious conflict of interest back in 1995… Tricky questions are again being asked about the profits American insurance giant Unum stands to make from its massive media push on income protection cover, promoted as the answer to the latest tough welfare reforms …..
Meanwhile disability activists who have fallen foul, and been forced to appeal cuts in DWP benefits based on flawed Atos assessments, and campaigning groups like Black Triangle, think the whole thing stinks and are urging MPs to investigate.
It is clear that there is a ‘happy match’, a common objective, between the neoliberal political view of benefits, and the interests of private health insurers. The neoliberal politician wants to shrink the State and reduce public expenditure via privatisation, and the private health insurer wants to maximize profitability by not having to pay out for any claims. Both, therefore, want to remove people from benefit entitlement and, to that end, working collaboratively within the DWP would clearly make ‘sense’. Unfortunately, neither the agenda of the politician, nor the health insurer, address or include the actual reality of diverse problems of ill health and the myriad of difficulties faced by sufferers … and as has been described there are several million sufferers of intractable long-term illnesses and permanent disabilities. In effect, the DWP agenda is motivated towards denying ‘illness’ and associated legitimate need, wherever possible.
In order to bridge this gap between the policy makers and reality, a narrative must be constructed which is both compelling and achieves the common objective without it being obvious that the real agenda is privatization and withdrawal of public expenditure. The narrative chosen usually attributes some innate characteristic to a particular group. For example:
‘GPs are our most trusted members of society and know what is best for their patients… therefore they should do healthcare commissioning for the NHS’
‘GPs are too emotionally involved and do not know what is best for their patients … therefore, we need an ‘objective’ assessment.’
However, the underlying assumptions about illness upon which the DWP predicate their actions seem to have slipped out in the following quote:
Justifying the new proposals, UK’s national director for health and work, and the former head of the British chambers of commerce David Frost, said when people were off sick for longer than four weeks they started “to lose the will to work”
Anything more than cursory consideration, indicates that this is a ludicrous and totally unsubstantiated statement. All people become work averse after 4 weeks of being so ill that the GP considers them unfit to go to work? Where is the evidence for such an assertion? It is not even clear how it would be possible to validate such a claim scientifically.
However, this statement is consistent with the biopsychosocial model of illness which needs to be explored more fully in another article. Suffice it to say that this Orwellian model redefines ‘illness’ and was created by ‘psychiatrists and academics … happy to draw on their moral authoritarianism and neo-liberal policy prescriptions (and unmentioned links with Unum) to produce a monograph, The Scientific & Conceptual Basis of Incapacity Benefits (TSO, 2005, Waddell and Aylward) which was published by the DWP, and provides the intellectual framework for the 2006 Welfare Reform Bill (1).
The proposition, “to lose the will to work” amply indicates one of the moral panics of authoritarianism that human beings only behave ‘properly’ if offered ‘the stick or the carrot’… ie. people will pretend to be ill to get out of work if given the opportunity.
This view of humanity or ‘model of man’ underpins both neoliberal policy decisions and the justification for the so-called ‘free-market’. The nature of ‘Man’ is perceived as innately self-interested, greedy, and wanting to ‘pull a fast one’, unless they are restrained by laws or offered incentives. That it is considered to be innate, and therefore immutable, justifies both taking advantage of others to get the best deal, and the imperative to punitively control the other to prevent having that advantage taken away. Hence, we have a one-sided neoliberalism.
‘..neoliberalism has not so much been about increasing wealth, but about redistributing it.
Unsurprisingly, given the lack of fit with reality:
‘The work capability assessment programme, which assesses benefit claimants to see whether they are fit for work is “teetering on the brink of collapse” as the system becomes clogged up with appeals.’
Appeals have quadrupled, and Citizen’s Advice Bureau’s are inundated with people seeking advice on how to appeal.
It is clear that the changes and cuts made to the benefits system are based on the interface of ideological, psychological, political and financial factors, and are simply not tenable. The appalling impact of these ‘welfare reforms’, ungrounded in reality, are only now beginning to come to light with tragic reports of suicideshttp://diaryofabenefitscrounger.blogspot.com/2011/11/latest-disability-news-roundup.htmlbut little reported in the mainstream media are the increased levels of hardship, worry and deprivation for the disabled and long-term sick whom the overwhelming majority of the population would wish to support.
Somewhat horrifyingly, these facts are used to the advantage of Unum UK in their advertising ploys:
McGarry, chief executive at Unum UK, earlier this year warned: “The government’s welfare reform bill will seek to tighten the gateway to benefits for those people unable to work due to sickness or injury. Each year up to 1m people in the UK become disabled and the reforms mean that working people will be able to rely less on state benefits to maintain the standard of living they were used to prior to their illness.”
So, Unum warns people to get insured against the cuts in benefits … of which they, Unum, were major architects …. either directly as advisory consultants, or through their funding of psychiatrists who created the intellectual framework, the funding of think tanks and academics who in turn recommend policies to the DWP, and by offering ‘jobs for the boys’. For example, by funding the 1.6m UnumProvident Centre for Psychosocial and Disability Research at Cardiff University, and appointing Mansel Aylward (the former DWP Chief Medical Officer and co-author of the DWP biopsychosocial monograph) Director of the unit..
It is hard to believe that there are not some very hard-headed individuals in Unum who are not fully aware of the heist that they have perpetrated.
It should be noted that there are many other private health providers who have doubtless played a similar role in creating Lansley’s new model for the NHS…
However, it cannot be avoided that many of these policies stem from New Labour’s period in office. It is particularly noteworthy that a common link is provided by Lord Freud who switched from New Labour to the Conservatives in 2009, having been appointed by Tony Blair to provide an independent review of the British welfare to work programme in 2006, and then rehired as an adviser to the government when James Purnell was appointed Secretary of State for Work and Pensions in 2008. A former journalist for the FT, Freud became the vice-chairman of investing banking at UBS AG until his retirement in 2003. His expertise in disability or long-term illness is rather notably absent but his background in asset management and financial structures is clearly impressive.
UBS AG (SIX: UBSN, NYSE: UBS) is a Swiss global financial services company headquartered in Basel and Zürich, Switzerland, which provides investment banking, asset management, andwealth management services for private, corporate, and institutional clients worldwide, as well as retail clients in Switzerland. (Wikipedia)
In order to become Real Labour, Ed Miliband and his team must draw a clear line away from New Labour’s policies, and devise a programme of Welfare Reform which is fit for purpose, and which really meets the needs of some of the most vulnerable people in society. The present arrangements should be rejected because they are dangerous, punitive and would be completely unacceptable to most of the population if their true impact was exposed. Philip Gould, one of the architects of New Labour, advised Tony Blair in 1997 to ‘Reassure, reassure, reassure’. Ed Miliband explicitly needs to ‘Reassure, reassure, reassure’ the population of the UK, that they will be appropriately protected and helped if they or their family are, or should find themselves, vulnerable and in need due to long-term illness or disability.
#RT via Olly via http://think-left.org
This article may be triggering: please don’t click on the links if you think you may be adversely affected by reading about suicide.
A moving video recorded by youngsters in Kent for SAFE Suicide Awareness for Everyone.
By Michelle RobertsHealth editor, BBC News online
Alcohol changes our sleep patterns
A tipple before bedtime may get you off to sleep faster but it can disrupt your night’s slumber, say researchers who have reviewed the evidence.
The London Sleep Centre team says studies show alcohol upsets our normal sleep cycles.
While it cuts the time it takes to first nod off and sends us into a deep sleep, it also robs us of one of our most satisfying types of sleep, where dreams occur.
Used too often, it can cause insomnia.
Many advocate a nightcap – nursing homes and hospital wards have even been known to serve alcohol – but Dr Irshaad Ebrahim and his team advise against it.
Dr Ebrahim, medical director at the London Sleep Centre and co-author of the latest review, published in the journal Alcoholism: Clinical & Experimental Research, said: “We should be very cautious about drinking on a regular basis.
“If you do have a drink, it’s best to leave an hour and a half to two hours before going to bed so the alcohol is already wearing off.”
He said people could become dependent on alcohol for sleep.
And it could make sleep less restful and turn people into snorers.
“With increasing doses, alcohol suppresses our breathing. It can turn non-snorers into snorers and snorers into people with sleep apnoea – where the breathing’s interrupted.”
From the hundred or more studies that Dr Ebrahim’s team looked at, they analysed 20 in detail and found alcohol appeared to change sleep in three ways.
Firstly, it accelerates sleep onset, meaning we drop off faster.
These two changes – which are identical to those seen in people who take antidepressant medication – may be appealing and may explain why some people with insomnia use alcohol.
But the third change – fragmented sleep patterns the second half of the night – is less pleasant.
Alcohol reduces how much time we spend in rapid eye movement (REM) sleep – the stage of sleep where dreams generally occur.
As a consequence, the sleep may feel less restful, said Dr Ebrahim.
Chris Idzikowski, director of the Edinburgh Sleep Centre, said: “Alcohol on the whole is not useful for improving a whole night’s sleep. Sleep may be deeper to start with, but then becomes disrupted. Additionally, that deeper sleep will probably promote snoring and poorer breathing. So, one shouldn’t expect better sleep with alcohol.”
The Sleep Council said: “Don’t over-indulge. Too much food or alcohol, especially late at night, just before bedtime, can play havoc with sleep patterns.
“Alcohol may help you fall asleep initially, but will interrupt your sleep later on in the night. Plus you may wake dehydrated and needing the loo.”
#RT via Bridget via http://www.bbc.co.uk
FAMILY CARERS’ SKILLS PRACTICE WORKSHOP
SATURDAY 9th FEBRUARY 2013 9.30am – 4.30pm
COST PER PERSON £60.00.
THE INSTITUTE OF PSYCHIATRY, 16 DE CRESPIGNY PARK LONDON SE5 8AF
NEAREST STATION DENMARK HILL
Booking form here: BOOKING FORM FOR THE FAMILY CARERS’ WORKSHOP SATURDAY 9th February 2013
BBC documentary lifts the lid on ‘offensive’ code used to describe disabled and jobless.
A BBC documentary investigation into one of the firms responsible for delivering the government’s £5bn Work Programme claims to have found evidence of staff using an ‘offensive’ code to describe disabled and jobless people.
Clients of Triage, a key player in the government’s plan to pay private companies to move people from benefit into work, were referred to as ‘LTB’ – code for “lying, thieving bastards”, a former employee alleges.
Linda Smith, who worked for Triage, which operates in Scotland and the north of England, told the BBC that the term was used to describe jobless and disabled clients, and that the company used a practice known as ‘parking’ to keep disabled people on their books.
Mrs Smith said that under the scheme firms can earn more money from taking on the disabled people as clients, but that once they are on the company’s books staff are told to spend as little time as possible helping them find work.
“They would be put on telephone interviews… just to make sure that there was this contact made so they could tick a box to say, ‘Yeah, they’re still on the Work Programme’,” Mrs Smith said.
The BBC claims that four other former Triage employees confirmed the use of the LTB code and told the BBC similar stories about clients on their books being ‘parked’.
Tony Wilson, 34, from Middlesbrough was referred to the Work Programme through Triage in February 2012, told the BBC he believes he has been ‘parked’: “They haven’t done a single thing to help me in any way.”
He also condemned the use of the LTB label allegedly given to those on long-term benefits: “That’s offensive. It’s unprofessional. It’s – so many words I could say about that. It’s just wrong.”
In response to the allegations Triage said: “It is standard practice, particularly for those clients that are sick or who have otherwise been unable to attend, to telephone them to check on their progress and maintain contact. Triage’s delivery structure of the Work Programme does not allow for ‘parking’.
“The compliance requirements of the programme demand a frequency of contact and this together with our own commitment to excellence and meeting client needs means that ‘parking’ is not an option.”
Triage also claimed that use of the term LTB was an isolated incident, adding: “This is not a phraseology used or accepted by Triage.”
Panorama: The Great Disability Scam? is on BBC One, Monday, 28 January at 20:30 GMT and then available in the UK via the BBC iPlayer.
#RT via http://www.independent.co.uk
From Monday 28th January our new Greenwich home is at: 141 Greenwich High Road SE10 8JA
Greenwich BR/ DLR
Services moving include:
- Mental Health Drop-ins
- 50+ Group
- African Health & Wellbeing Group
- METRO Harbour
- HIVE Peer Support Group
- METRO Youth Services Team
- Pitstop Clinics
Flyer here: METRO Relocation
Thursday 31st January 2013 – 1 to 4pm
Civic Suite, Lewisham Town Hall, Catford Road, SE6 4RU
Flyer here: Patient event flyer KS edits_DEB_V2_230113
Local GPs would like your views on plans to improve health services in Lewisham.
Last summer we asked many people in Lewisham what they thought of their local NHS and their experiences of using the services.
We have used what we heard in our plans for improving health care in Lewisham.
We are holding an event to give the public and patients a chance to:
- Hear what you told us last summer.
- Let you know how we have used this information.
- Hear about our plans for improving health services and the health of
- our residents.
- Tell us what you think of these plans and what we may need to change
- or include.
- Find out how you can get more involved in your local health services.
A light lunch will be available.
The detailed programme will be sent to you prior to the event. If you are able to attend or would like further information, please contact Grainne Bellenie, Engagement Manager on 020 3049 3204 or firstname.lastname@example.org.
Lewisham Clinical Commissioning Group.