MHT Blog

 Dan Parton (14/02/12) hopes to see continued research progress ...

Two recently-published studies have brought us another step closer to understanding dementia and its effects on the brain, giving renewed hope that a cure can be found. The studies also reinforce the value of research into the condition.

Firstly, scientists in the US have shown that dementia moves along synapses in a similar way to infections, meaning that the process might be able to be stopped, early on.

This finding is significant as it shows that dementia does not just ‘pop up’ in different parts of the brain, over time, as formerly thought.

Meanwhile, scientists at the University of Cambridge have developed a new way to study Alzheimer’s disease using stem cells, which allows researchers to track the disease over a matter of weeks.

Skin cells donated from healthy volunteers and those with Down’s syndrome were turned into stem cells. These were then used to generate networks of functioning nerve cells in the lab, which resemble the complex wiring of cells in the human cerebral cortex, which makes up over three quarters of the brain and suffers particular damage during Alzheimer’s.

People with Down’s syndrome have an extra copy of chromosome 21, a segment of DNA that carries a gene responsible for producing the Alzheimer’s protein amyloid. Due to this extra version of the gene, people with Down’s syndrome have a much higher incidence of Alzheimer’s than the rest of the population. By generating nerve cells from the skin cells of people with Down’s syndrome, the scientists could observe the disease process over a period of weeks and compare this to those cells derived from healthy volunteers.

These studies again offer hope that a cure – or more effective treatment – for dementia might be on the horizon. One of the medical ‘holy grails’, it has taxed scientists for generations, but these studies show that they may be getting closer to the breakthrough.

While this is good news, it should always be remembered that this is research, so if any new treatments result from it, they will not be available to the public for many years.

These studies also emphasise the importance of continuing research into dementia. In financially constrained times, research is often one of the first things to suffer in a round of budget cuts. But, with the promised breakthroughs dependent on further research, that could be a false economy.

People are living longer, so the number of people with the condition is growing rapidly – and set to break through the 1 million mark in the UK alone, within the next 10-15 years. Finding a cure, or more effective treatments, is therefore an imperative. The cost of dementia to the UK runs into billions per year, and finding a cure could save a large proportion of that. When put in those terms, can the Government afford not to invest in research? 

Dan Parton (14/02/12) wonders why an amendment was needed before mental health was put on an equal footing with physical health ... 

Last week, the House of Lords made an amendment to the Health and Social Care Bill which will place a duty on the Health Secretary to give mental health the same priority as physical health. But you have to ask; why wasn’t the commitment there in the first place?

The amendment, tabled by cross-bench peer Lord Patel, was passed by a margin of 4 votes. Three Liberal Democrat peers rebelled against the Government.

This is good news, although the margin of the vote still seems awfully close for something that is vitally important for all mental health service users.

But that the amendment was even needed was a surprise. When the Government’s mental health strategy ‘no health without mental health’ was launched last year amid much fanfare, one of its key tenets was putting mental health on a par with physical health. Doesn’t the title say it all?

At the time, the consensus was that this was long overdue, and it was hoped that it would be the end of mental health being treated as a ‘Cinderella’ service that often lagged behind those concerned with physical health. But all that seems to have been forgotten somewhere along the way – until the Lords intervened.

The need for mental health to have a higher priority in health services is undeniable, and, handily, the Centre for Mental Health and think-tank, The King’s Fund, published statistics last week, that back up this assertion.

They report that the failure to treat mental illnesses appropriately adds some £8 billion to the costs of treating long-term conditions like diabetes and heart disease, as well as dramatically increasing a patient’s risk of dying prematurely from those conditions.

This report also adds weight to calls for greater integration of physical and mental health services. Again, this is something that those across the sectors have been calling for, for years, but never quite seems to have happened.

Hopefully the Government will accept the amendment, although this is not guaranteed, as the recent Welfare Reform Bill debates showed, with MPs overturning some of the Lords’ amendments to employment and support allowance clauses.

Of course, all of this is assuming that Government doesn’t abandon the Bill entirely, as some of its many critics – including mental health bodies, such as the Royal College of Psychiatrists – have called for. But from what Prime Minister David Cameron and Health Secretary Andrew Lansley have said, the Government is determined to see the Bill through Parliament, despite the increasing opposition to it.

If that is to be the case, then the amendment could at least help to give mental health the prominence it deserves and break down some of the boundaries that still exist between services and perhaps even start to make a difference to the mental health of the nation.

Dan Parton (07/02/12) hopes a new campaign will herald a Time for Change ...   

Last month Hollywood star Brad Pitt admitted publicly that he has battled depression in the past. It was a timely reminder that mental illness can happen to anyone at any time, and came just after the launch of a new initiative from anti-stigma campaign group Time to Change that encourages people to talk about their problems.

Time to Change’s new campaign is called ‘Its time to change. Its time to talk’, with the aim to get more people talking about mental health issues, thereby challenging the stigma that can grow when it is not spoken about.

It seems that talking about our mental health is something people in the UK are still not good at. While mental health stigma is not what it once was, it is still a problem and many people do not feel comfortable or able to talk about their feelings.

Statistics released to coincide with the campaign revealed:

o Only 15% of the British public admit to being truthful all of the time about how they’re really feeling
o Younger people between 18 and 24 years are twice as likely (27%) to hide how they’re feeling compared to those aged 65 and over (12%)
o A third of people confess the reason they’re not always honest is because they don’t want to depress other people (37%) or don’t like talking about how they’re feeling (35%).

These statistics don’t surprise me. Talking about feelings is difficult – and other people don’t always want to listen. At least some of that will be down to the stigma of having a mental health problem.

This is why Time to Change’s campaign is needed. The adverts on television that form part of the campaign have made an impact and got people thinking and, hopefully, talking, which is a step in the right direction.

Let’s hope people take the lead from this campaign and follow several well-known figures who have spoken openly about their mental health problems in recent years, including actor/presenter Stephen Fry to Somerset and England cricketer Marcus Trescothick.

Such public admissions are very welcome; it all helps to ‘normalise’ mental health problems in the public eye and make it part of everyday life – which, of course, it is. With celebrity magazine favourites such as Brad Pitt also talking about mental health, it can only encourage others to do the same.

Time to Change has done some great work in addressing mental health stigma in the past four years, and this latest campaign should carry on that work. As the organisation admits, challenging mental health stigma is a long-term aim, but with funding secured until 2015, plans can be laid for more sustained campaigning and advertising that will keep mental health in the public eye and help people to open up and talk and break down the stigma that still exists.

Dan Parton (17/01/12) looks forward to the year ahead - sort of ...  

For the first blog of 2012, I’m going to look forward to what the year may hold for those interested in mental health. Unfortunately, I’m finding it difficult to be optimistic.

Mental health seems to have fallen down the government’s agenda in the past 12 months. Yet, when the national mental health strategy, ‘No health without mental health’ was launched in February of last year, there was a lot of optimism that it would be a priority.

The strategy’s focus on outcomes, early intervention and wellbeing were all welcomed as being long overdue, as was the intention to put mental health on the same footing as physical health.

However, optimism was quickly tempered by disappointment when, at the end of March, the government axed the National Mental Health Development Unit (NMHDU). At the time, many wondered who would pick up the mental health baton within government, and the fears this prompted appear to have been confirmed. Since then, the government has gone very quiet on the strategy.

Yet the ministerial advisory group, which is tasked with leading the delivery of the strategy, has met a few times and has asked for service users and carers to join the group. Hopefully more will be heard from it this year.

But there is cynicism about whether the strategy can be delivered in the face of swingeing public sector cuts. In 2011 there were regular stories from around the country of mental health services being cut back, and anecdotal evidence from service users that social care was also being reduced. This is not going to get any better in 2012 – if anything, things will get worse, as cuts continue to bite and the NHS and councils struggle to balance their books. Sadly, this will be the situation for years to come.

For service users, worries about benefits remain. The work capability assessment for employment and support allowance (ESA) is still being criticised for not adequately taking into account mental health issues – despite further revisions in 2011 – and many people on incapacity benefit are set to be reassessed for ESA this year, and could lose their benefit, under the revised eligibility criteria.

Upcoming disability living allowance reforms are also causing concern, with many worrying that the assessment process will not adequately recognise the impact of fluctuating conditions.

Mental health charity, Rethink Mental Illness, has called for the government to pause on its welfare reforms – in the light of widespread protests from people with disabilities and mental health problems – but, at the time of writing, the government has given no indication that it plans to do any such thing. On the contrary, it has said that it plans to push ahead with its reform programme.

Though times are undeniably tough, nobody should become entirely disheartened. There are many individuals and organisations doing great work with people with mental health problems – and making a real difference to their lives – regardless of funding cuts or government policy. And, constrained finances could drive innovation, as organisations and professionals seek to provide personalised services at lower cost.

While 2012 is set to be a difficult year for many people in the sector, it is important that good and innovative practice is given the prominence it deserves. Hopefully, that will ensure that such practice develops more widely and that the negative effects of cuts will, at least in part, be mitigated. 

Dan Parton (19/12/11) hopes the release of a new report into dementia care in hospitals finally leads to some much-needed changes

The news that the National Audit for Dementia has called for a shake-up of hospital care for people with dementia will come as no surprise to those working in the sector - we’ve been here before with this one.

The Audit found that many staff lacked basic training in dementia and only 6% of hospitals have a dementia care pathway. Meanwhile, at a lower level – but often what can make a big difference to a person with dementia – 59% of wards reported that personal items, such as family photographs or cards, were not placed where the patient could see them for reassurance.

If all this seems familiar, it’s because it is. This report has striking similarities to the Alzheimer’s Society’s 2009 report ‘Counting the Cost’. It seems little has changed in the intervening two and a half years.

But, given that up to a quarter of acute hospital beds taken up by people with dementia, and 97% of nursing staff and nursing managers admit that they are usually caring for someone with dementia, according to the Alzheimer’s Society, it seems odd that provision for dementia care is seemingly so poor – and has remained so.

The recommendations the Audit makes are also quite similar to those made by the Alzheimer’s Society. They include all staff given basic training in dementia awareness, putting in place a senior clinical lead for dementia and personalising bed areas. Not that hard to do, you would think.

So, will those with power in government and the NHS listen to this report? You have to hope they will.

The fundamental point is that it is about improving care for people; everyone should have access to the best possible treatment that takes account of and is sensitive to their condition. After all, they are still people, not just someone with dementia. Surely this is at the heart of the NHS?

But I’m not naïve enough to believe that this will be the key driving force for change. If it was, it would have happened by now. No, for change to happen will require evidence of cost savings that would be made if the Audit’s recommendations were implemented; in these austere times, bottom-line savings are often the way to make people take notice.

But implementing these changes could save money. For instance, if hospital care is improved through better training and more person-centred care, then people with dementia could be released earlier – currently they stay in hospital up to twice as long as other people who go in for the same procedures – it could save millions each year.

Again, this point was made in ‘Counting the Cost’, and it is perhaps more pertinent now as budgets are being squeezed, and will be for some years to come. The evidence of the need for change is mounting; it is now up to those in power to act. 

Dan Parton (8/12/11) considers the potential impact of the world's first stalking centre  

Today sees the launch of what is reported to be the world’s first stalking treatment centre in London – and it’s long overdue. 

Stalking is one of those crimes that seem to be viewed with a degree of levity. People make jokes about it; not malicious per se, just off-the-cuff comments, such as bumping into the same person in the office kitchen several times and saying “are you my stalker?”, that sort of thing. 

But to victims, it is all too serious. Stalking is recognised as a component in more than three quarters of cases involving people murdered by ex-partners, according to a 1999 study by McFarlane et al. Overall, 1 in 5 women and 1 in 10 men will be the victims of stalking at some point in their lifetime, according to the British Crime Survey. 

Stalking doesn’t always seem to have been treated with the seriousness it deserves in mental health services either. While there is provision for the victims, who can suffer terribly, it can be patchy.  

But treatment for stalkers themselves is scarcer; like other kinds of offenders, can repeat their offences and without treatment many return to stalking either the same, or a different, victim.  

Treatment and rehabilitation can be effective, according to various expert reports, so the launch of the National Stalking Clinic (NSC), to be run by Barnet Enfield and Haringey Mental Health NHS Trust, which has extensive experience of working with stalkers, is a great step forward on several counts. 

Firstly, it means that recognised stalkers can get access to specialist assessment and treatment. 

This could help cut down on future incidents of stalking, which is good news for everyone. 

And, if crimes are averted, it cuts down on the psychological harm done to victims, who can suffer depression, anxiety or post-traumatic stress disorder. This would also cut down on costs for mental health teams – something that always has to be considered in these austere times. 

If this clinic is a success, then hopefully the model will be replicated in other trusts around the country, and some of the thousands of stalking incidents that occur each year can be prevented. 

Dan Parton (28/11/11) looks into two major reports on the state of mental health services by Mind and by the Royal College of Psychiatrists. 

While both reports released last week looked at a different aspect of mental health, crisis care and psychological therapies respectively, each found that significant numbers of service users have to wait to access treatments.

The two reports concurred that while there are examples of great practice out there, some people struggle to access services quickly enough to stop their mental health deteriorating further.

Mind’s independent inquiry, ‘Listening to experience’, into accessing emergency treatment, found that while excellent crisis care does exist, there are problems with in-patient hospitals and community crisis teams. These include: people struggling to get help, staffing problems, poor quality care environments and not enough treatment provided to help people recover.

The findings prompted Paul Farmer, chief executive of Mind, to say: “Mental health crises need urgent treatment, yet our investigation found that far from receiving the instant, 24-7 response we expect for physical health emergencies, 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.”

Meanwhile, the National Audit of Psychological Therapies (NAPT) – commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement – reported that 1 in 7 people wait more than 3 months for their first appointment.

Both reports are surprising. Timely interventions for people with mental health problems – whether acute or secondary – are crucial in preventing further deterioration and getting people on the road to recovery, more quickly.

It is widely accepted that early intervention can reduce the need for longer and more expensive services – whether in- or out-patients – which is surely crucial in this era of austerity and counting every penny?

If you’re reading this and thinking that the above sentences are statements of the obvious, then you’re not alone. I do too. But judging by the findings in these reports, the message isn’t getting through to every service. And it needs to. People are suffering unnecessarily and everyone loses out as a result.

While these reports are useful pointers to show where improvements can be made, it is now up to the providers – and those involved in commissioning services – to make the necessary changes.

Pressure needs to applied, from government downwards, and service users upwards, to ensure that they do. Austere times are not an excuse for allowing poor practice to continue.