Impact News

Responding to Violence, Suicide, Psychosis and Trauma

7 Year-Old Boy Is Youngest Case Of Suicide Attempt

A new medical report calls for caution following the recent case of a boy who tried to hang himself after watching a hanging depicted in a fictional film. This seems to be the first case of attempted copycat suicide in a child under 10 years old. Exposure to suicidal behaviour in the media has been strongly linked to copycat suicide attempts but never in someone so young. This case warns of the potential danger to young people who are exposed to suicide even when it is fictional, and exposes the previously ignored role of attention deficit and impulsive behavioural traits on suicide.

The case report, published in Cases Journal, describes how a seven year-old Iranian boy was found by his mother, semi-conscious, lying down with a torn band around his neck. It was apparent that the boy had hanged himself after watching a scene in a fictional film in which four soldiers were hanged before being rescued and escaping. The boy was taken to hospital and treated effectively.

There was no history of depression or anxiety in the boy and his medical record was insignificant. The boy’s family history also displayed no suicidal tendencies. However, the boy was diagnosed with attention deficit disorder (“ADHD”) and had a tendency for impulsive behaviour. Although the roles of anxiety and depression in suicide have been well documented, there has been no research into the role of ADHD and impulsivity in such cases, and these should be considered by doctors in future.

Cases Journal publishes case reports from medical professionals from all over the world. As an online journal, it does not have the space constraints of traditional medical journals, and allows the publication of a very broad range of cases. Typically, an important case such as this might never have achieved public exposure due to the high barriers to publication in major journals.

More information about Cases Journal can be found on the website: Cases Journal is a peer-reviewed, open access journal. The editor-in-chief is Richard Smith, previously known for his role as editor of the British Medical Journal, and he is supported by an international editorial board. Unlike traditional medical journals, Cases Journal publishes any case report that is understandable, ethical and complete – the perceived interest level, or rarity of the case is not important. The journal’s ethos is that every case is important, just as every patient is important, and we can learn something from every case report.

All case reports published in the journal will be included in the forthcoming Cases Database, which will allow doctors to search all case reports to find those relevant to their practice. As an open access journal, all case reports are free for anyone to download without subscription.

Cases Journal

Filed under: Suicide, , , ,

Man has admitted killing Philip Ellison, the Lancashire Council social care worker

Posted: 24 April 2009 | Community Care
A man has admitted killing Philip Ellison, the Lancashire Council social care worker stabbed to death during a visit to a supported housing project. Robert Searle, 52, was detained indefinitely under the Mental Health Act after pleading guilty to manslaughter at Preston Crown Court today. The Recorder of Preston, Anthony Russell, ordered the detention of Searle at Ashworth Hospital, a high-security institution in Merseyside.

Ellison, a married father of three, was 47 when he was attacked at the supported living scheme in Glebe Road, Preston, in April 2008. Article continues below the advertisement

An internal review into the incident by council officers and Lancashire Care Foundation Trust is expected to be published after Searle is sentenced. Anne Brown, cabinet member for adult and community services at Lancashire Council, said today: “The death of Philip in April last year was an extremely sad and tragic incident that has deeply shocked the county council, the local community and the social care sector immeasurably.

“Although the incident happened almost a year ago we, as an organisation, are still trying to come to terms with the loss of Philip who was a professional social care worker, a valued and respected member of staff and dedicated wholeheartedly to supporting people. “On behalf of the county council, I would like to offer our sympathy to Philip’s wife and sons who have lost a loving husband and father, and to his friends and colleagues – our thoughts are with them, particularly at this very difficult time.”

This week, it emerged that Sunderland charity Mental Health Matters, will be prosecuted under health and safety laws over the death of Ashleigh Ewing. The 22-year-old care worker was stabbed to death in 2006 while visiting a client with mental health problems. Searle was originally charged with murder, but the prosecution accepted a plea of manslaughter on the grounds of diminished responsibility.

Related articles
Independent probe to investigate fatal stabbing of community support worker
Man charged over death of Lancashire community support worker

Filed under: Other Mental Health, Violence, , , , ,

Training Curbs Anger And Aggression In Adolescents With Tourette Syndrome

Article Date: 24 Apr 2009
In the first study to gauge the benefits of anger control training in adolescents with Tourette syndrome (TS), researchers at the Yale Child Study Center have found that cognitive behavioral therapy is helpful for short-term improvement in anger and aggression. The study is reported in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Children and adolescents with TS, a disorder characterized by tics-involuntary, rapid, sudden movements and vocalizations occurring repeatedly in the same way-should also be evaluated for the presence of disruptive behavior problems, according to lead author Denis Sukhodolsky, associate research scientist in the Yale Child Study Center. “In some cases, these disruptive behavior problems can cause more impairment than tics,” he said. “If disruptive behavior is present, cognitive behavioral interventions such as anger control training could be recommended to reduce the levels of aggression.” Sukhodolsky and his team studied 26 children and adolescents with TS (24 boys and two girls between the ages and 11 and 15) with moderate to severe levels of oppositional and defiant behavior. They were randomly assigned to a group that received 10 sessions of anger management or to a control group that received their usual treatment for 10 weeks. When faced with frustrating situations during anger control training, the children role-played appropriate behavior. They were asked to identify and evaluate the consequences of various actions for themselves and others who were involved in hypothetical conflicts. The children were also asked to recall frustrating situations and to problem-solve and role play behavior that would have diffused the problem. They also completed homework to practice “anger coping” skills and share their experiences at the next session. At the end of treatment, parents reported that disruptive behavior decreased by 52 percent in the anger management group, compared with a decrease of 11 percent in the control group. Clinicians who were unaware of the treatment rated 69 percent of the children who completed anger management training as improved compared with 15 percent in the control group. Sukhodolsky said this improvement was well maintained at a three-month follow-up. He and colleagues plan to conduct larger clinical trials to confirm their results. The study is part of a clinical research program directed by Professor Lawrence Scahill to develop and test interventions for children and adolescents. Other authors on the study were Lawrence Vitulano, Deidre H. Carroll, Joseph McGuire, and James Leckman, M.D. Citation: J. Am, Acad. Child Adolesc. Psychiatry, 48: 4 (April, 2009) Links: Denis Sukhodolsky Lawrence Scahill Source YALE

Filed under: Other Mental Health, Violence, , , , ,

Suicide: The Risk Factors

Date: 19 Apr 2009 – 0:00 PDT

There are many factors which can increase the risk of suicide – including being male, previous self-harm, psychiatric and/or drug/alcohol disorders, upbringing, exposure to suicide in the media, and smoking. Among employed people, doctors (particularly women), vets, nurses, dentists and farmers are all at increased risk – because they have easy access to drugs or poisons which can be used for suicide. In a Seminar in this week’s edition of The Lancet, Professor Keith Hawton, Centre for Suicide Research, University of Oxford, UK, and Professor Kees van Heeringen, Unit for Suicide Research, University Hospital, Gent, Belgium, discuss these trends. An estimated one million people die from suicide each year, equating to one every 40 seconds – but suspected under-reporting in many countries means this is probably a big under-estimate. Suicide accounts for 1.5% of deaths worldwide and is the tenth leading cause of death. Within Europe, rates are generally higher in northern countries than in southern countries. An effect of latitude on suicide rates was found in Japan, suggesting an influence of the daily amounts of sunshine on suicide. However, countries at about the same latitude, such as the UK and Hungary, can have substantially different rates of suicide. Suicide is a major concern in former Soviet states. More than 30% of suicides worldwide happen in China, where 3.6% of all deaths are by suicide. In developed countries, the male-to-female ratio for suicide is between two and four to one, and this seems to be increasing. Asian countries typically show much lower male-to-female ratios, but these might also be increasing; although in China more women than men die by suicide. Suicide rates are highest in elderly people in most countries, but in the past 50 years rates have risen in young people, particularly men. Suicide rates peak in Spring, especially among men. People born in spring or early summer, particularly women, are at increased risk of suicide. European Americans have higher suicide rates than Hispanic or African Americans, though this gap is narrowing due to increased suicides in young black people. Indigenous populations, eg, Aboriginies in Australia and Native Americans, have higher suicide rates, possibly due to cultural/societal marginalisation and higher levels of alcohol abuse. Suicide rates are, not surprisingly, higher in unemployed than employed people – in part, high rates are associated with mental illness, which is also associated with unemployment. Among people in employment, some occupational groups are at increased risk of suicide. Medical practitioners have a high risk in most countries, but female doctors are generally most at risk. Nurses also have a high risk. In both these professional groups, access to poisons seems to be an important factor in determining the high rates. Among doctors, anaesthetists are particularly at risk, with anaesthetic drugs being used in many suicide deaths. Several other high-risk occupational groups (eg, dentists, pharmacists, veterinary surgeons, and farmers) also have easy access to means for suicide. In general, men tend to choose more violent means for suicide (eg, hanging or shooting) and women less violent methods (eg, self-poisoning). Different populations use differing suicide methods, eg, women in South Asia commonly set fire to themselves to commit suicide. Access to specific methods might be the factor that leads to translation of suicidal thoughts into action. In the USA, firearms are used in most suicides, with risk of their use being highest where guns are kept in households. In rural areas of many developing countries, ingestion of pesticides is the main method of suicide, reflecting toxicity, easy availability, and poor storage. As many as 30% of global suicide deaths may involve ingestion of pesticides. Mental health problems are a major factor in suicide. Some 90% of people who take their own life are believed to have some kind of psychiatric disorder. Depression increases the risk of suicide by 15 to 20 times, and about 4% of people with depression die by suicide. Clinical predictors of suicide in depressed people include previous self-harm, hopelessness, and suicidal tendencies. Around 10-15% of patients with bi-polar disorder die by suicide, with risk at its highest during the early part of the illness. Some 5% of people with schizophrenia also die by suicide. Alcohol misuse, anorexia nervosa, attention deficit hyperactivity disorder, and body dismorphic disorder all increase suicide risk – wit the last example partly explaining why risk increases in women after breast enlargement surgery. Physical health also plays its part, but with some strange findings. Surprisingly, while people with higher-body mass index are at increased risk of depression, they have a lower risk of suicide (15% decrease in suicide risk for each 5 kg / m2 increase in body-mass index). The reasons for this are unknown. Cancer, particularly of the head and neck, HIV/AIDS, multiple sclerosis, epilepsy, and a range of other conditions also increase suicide risk. Other factors that can increase suicide risk include physical and sexual abuse throughout childhood, population-wide events such as natural disasters and deaths of celebrities. Suicide rates rose by 17%* following the death of Diana, Princess of Wales in 1997, with the increase being more pronounced in women in her age group. War decreases suicide risk, perhaps due to the social cohesion it can create in communities. People bereaved by suicide are themselves at increased risk, and clusters of suicides can happen in communities or through internet contact. The authors add: “A substantial body of evidence indicates that certain types of media reporting and portrayal of suicidal behaviour can influence suicide and self-harm in the general population.” Post-mortems of suicide deaths have shown changes to the central neurotransmission functions, for example to the serotonin (mood-improving hormone) system. Low cholesterol concentrations are associated with increased suicide risk, but the risk is higher when low cholesterol has been achieved through diet rather than statins. The authors speculate this could be because people who diet are more at risk of mental health problems, but say there is little evidence to back this. Family history of suicide at least doubles the risk of suicide for girls and women. Suicide occurs in tandem more in identical twins compared with non-identical twins. While evidence is limited, high levels of lifetime aggression are associated with a high risk of suicide, while impulsivity also increases the risk. Suicide rates rise throughout teenage years, especially in boys, and family ‘transmission’ of suicide risk occurs, especially on the maternal side. Prevention of suicide is a difficult concept due to high number of factors involved, but strategies can target high risk groups or aim to reduce the risk to the population as a whole. Each person with depression should be screened for suicide risk by specifically asking about suicidal thoughts and plans. The authors say: “In cases of high or imminent suicide risk, immediate action is needed, including vigilance and supervision of patients, perhaps through hospitalisation, removal of potential methods of suicide, and initiation of vigorous treatment of associated psychiatric disorder.” They also discuss a recent meta-analysis of randomised trials which suggested that the risk of death and suicide in people with mood disorders was reduced by 60% in those taking lithium. Removal of means used for suicide is important in management of individuals, and modification of general access to dangerous means can also be effective in suicide prevention at the population level. The authors say: “One striking example of the effect of availability of a common means of suicide was the large reduction in suicides following the change of the UK gas supply from toxic coal gas, the most common method used for suicide during the early 1960s, to non-toxic North Sea gas.” Introduction of safety barriers on bridges and increased gun control can also decrease the risk of suicide, as can safer storage of pesticides and poisons, especially in rural areas of developing nations. School programmes to improve mental wellbeing, and more stringent control of media reporting of suicide could also have a preventive effect. The authors conclude: “Future research must focus on the development and assessment of empirically based suicide-prevention and treatment protocols. The challenges of preventing suicide in developing countries need particular attention, because most research comes from developed countries, but most deaths by suicides happen in developing countries. “Suicide” Prof Keith Hawton DSc, Prof Kees van Heeringen PhD The Lancet, Volume 373, Issue 9672, Pages 1372 – 1381, 18 April 2009 Source The Lancet

Filed under: Other Mental Health, Suicide, , ,

Step-fathers who Kill

Lurking in the shadows

Posted: 09 April 2009 | Community Care Magazine

Maria Colwell. Jasmine Beckford. Heidi Koseda. Kimberley Carlile. Leanne White. Lauren Creed. Baby P. These names don’t resonate only with social workers; as some of the UK’s most notorious child deaths they conjure up grim details that are etched on the nation’s collective memory.

And they have something else in common: they all died at their stepfather’s hands. In many cases their mothers received prison sentences for offences ranging from neglect to assault or manslaughter.

Sadly, these are just a few names on the deathly roll call that stretches back to 1973 of young children killed by their stepfather or their mother’s boyfriend.

No matter how good our protective or preventive measures, there will always be parents who will harm or even kill their children. Whether the killer is their biological father or their stepfather may not seem that relevant when it comes to informing preventive policies, but research suggests otherwise.

In 1988, US data showed that children aged up to two are at about 100 times greater risk of being killed by their stepfather than their biological father. Psychologists call this the Cinderella effect. The research went on to look at British data, concluding that it indicated “considerable excess risk at the hands of stepfathers”.

With the rates of remarriage, divorce and cohabitation steadily increasing, giving rise to more stepfamilies, this is a disturbing thought. According to the Office of National Statistics, in 2006 84% of stepfamilies consisted of a stepfather and biological mother living with children from her previous relationship.

Research suggests that whereas genetic fathers often kill their children “more in sorrow than in anger”, out of perceived necessity and/or as part of a suicide, homicides committed by stepfathers tend to be more rage driven, impulsive acts motivated by hostility towards the child and characterised by violently beating or shaking them.

Despite this evidence, some researchers believe that minimal attention has been given to stepfathers – or mothers’ boyfriends – as the perpetrators of these crimes and the reasons behind them.

David Finkelhor, director of the Crimes Against Children Research Center in the US, says: “Sociobiologists point out that these are men who have no genetic stake in this child and see them as competition for attention and time, and their own offspring. Among other primates it’s not unknown for a new alpha male to kill the children of the dominant male when he comes into a group.”

But Finkelhor believes the reasons are simpler than that. “That has some reality to it, but I think it operates through more familiar psychological mechanisms; that these aren’t men who feel a natural affinity or protectiveness about the children of the women they are involved with. These are not men who are nurturing.”

Anger management

This squares with the fact that a child’s inconsolable crying is one of the main triggers for these homicides. “Frequently the dynamics of these cases are common,” says Finkelhor. “The woman leaves the child with the boyfriend or stepfather and when the child starts crying, he doesn’t have the nurturing skills to handle this in a calm way and then hits, throws, or smothers them because he wants them to shut up.

“They are not all of one sort, but a high proportion [in these cases] are violent, abuse their partners, and tend to have an anger management problem.”

Gathering any deeper psychological profile of these men is hampered by the fact that we know so little about them, and what we do know is usually learned after a child has been killed – which isn’t helped by serious case reviews that mostly focus on the pathology of the mother.

This reflects the continuing failure of agencies to engage properly with men, says David Derbyshire, Action for Children’s head of performance improvement and consultancy, and author of several serious case reviews.

“We probably don’t know a lot because too many times we come across cases where there is no involvement with men. Then there is an incident where the child is injured or dies, the serious case review takes place and we see the intervention is often only all with the woman and the man is not known about, or if he is, there’s no contact.

“If you don’t engage with the man but he is there everyday then the work we are doing is going to have a limited impact.”

Before we can even reach a position where men are properly involved, social workers need to recognise their importance to the whole familial picture and approach them with an open mind, which appears to happen too infrequently.

Research for a book he was writing on gender and child protection led says Jonathan Scourfield, senior lecturer at Cardiff University’s school of social sciences, to interview social workers about how they worked, or didn’t work, with men. He found primarily pejorative views.

“Men were seen as a threat, as no use, as irrelevant and absent – and there was a whole host of reasons given for not engaging with them.”

The dominant theme was of men as a threat, not surprisingly given the kinds of problems that caused referrals to be made to the team. But what worried Scourfield was the number of men that social workers didn’t pick up on. “Often there’s a boyfriend, the mother doesn’t mention it, but he’s hovering in the background, half noticed.”

Even if he is seen or known about, it’s all too common for no real attempt to be made to engage him. “The social work culture is an important part of that, but there’s a huge issue with the actual behaviour of these men. We are talking about men who are very difficult to work with and that needs to be acknowledged,” Scourfield adds.

This leads to questions of how a social worker can confidently decide whether to engage with the individual, or whether they are so dangerous they should be removed from the child’s life. It’s a dilemma that troubles Brid Featherstone, professor of social work and social policy at Bradford University: “We haven’t equipped social workers to work with these men. We haven’t got skills in assessing men generally, so we don’t even get as far as deciding that this man shouldn’t be in the family home.

“There is a problematic absence of an evidence base in the UK about working with men – either those who are a resource for children or a risk. Half the time we don’t know who is in a family. We don’t even record birthfathers if they are not there so how are we going to find others floating around? We tend to rely on the mother but it can be hard to establish living arrangements, as we can see in the Baby P case.”

The need for evidence

Jack Kennedy understands these difficulties. As a consultant in clinical and forensic psychology he compiles psychological reports for courts and parole boards and has worked on some of the most well-known child death cases. “Social workers have a very difficult job because they need evidence to act,” he says. “But it’s very difficult to anticipate or intervene unless there are overt indicators of risk or harm. Society almost expects [social workers] to be a ministry of pre-crime and intervene before these events happen, but to go in and remove a child on a suspicion won’t hold up in court.”

Other than obvious danger signs such as known domestic violence or injuries on a child, Kennedy suggests that where social services are involved with a family they need to be aware of mothers developing new relationships and people visiting the home. “Not least because it can be destabilising for the child having different people coming into the home. And also because they can assist a mother in actively risk managing all the time. But there is a thin line between policing and social care.”

However, any information social workers pull together often comes from the mother and therefore relies on her being honest. This is unlikely to happen if she is witness to her partner abusing her child but feels powerless to do anything about it.

While most of us would find this thought process hard to fathom, the issues behind this “collusion” can be complicated. The personality of these women can form part of the equation. Research into these deaths shows that many women lived in fear of their partners and that violence and abuse against a partner and child often coexisted.

These women can be depressed, overwhelmed or so distracted by their own difficulties that they don’t feel capable of doing anything. Women who are desperate to keep a partner will placate them, or those who are so intimidated by a partner won’t stand up to them.

“These are usually highly vulnerable women who have a confused understanding of relationships,” says Kennedy. “Their backgrounds are characterised by abuse and they are highly dependent on being in a relationship even if it’s dysfunctional because that provides them with the security they are looking for. Many women prize the man they have highly because they believe themselves to be loved in some way. Love and affection become more important to them than the needs of the child.

“They are not resilient enough to say ‘that is wrong, this is over,’ because they think they will not get anyone else. This is not about excusing their behaviour, it’s about helping us understand more about what sort of situation an individual may be in.”

Featherstone goes further, saying there are women who are terrified, and other more complex women who don’t acknowledge their ambivalence to their child. “We are hamstrung by the assumption that all mothers love their children or, if they don’t, they can be helped to. But we have to acknowledge maternal ambivalence. Hate can become the more dominant feeling. I have worked with a small number of women who were sadistic themselves. While you are not going to get lots of these women, sometimes you have to think the unthinkable.”

In 2007-8 there were 45 homicides of children aged up to four, according to the Home Office. But these figures don’t include death by neglect or cases which, although were not classified as murder, were not accidents either. Some analysts in the US believe that, there, the actual figure for child homicides may be double the official one because they can resemble deaths resulting from accidents or other causes; for example, a child who has been thrown or intentionally dropped will have similar injuries to those of one who died after an accidental fall.

The so-called Cinderella effect has no fairytale solution. Evidence of the prevalence of deaths caused by stepfathers is there, though the connection is not always made. But we owe it to the memories of all those children from Maria Colwell to Baby P to make sure we know who is present in a child’s life and whether they are a resource or a risk, so we can prevent as many children as possible from ending up on the same list.


* Crimes Against Children Research Center

* Men who Murder Children Inside and Outside the Family, K Cavanagh, R Dobash.

Filed under: Violence, , , , , ,

Hollow Mask Illusion Fails To Fool Schizophrenia Patients

ScienceDaily (Apr. 17, 2009) — Patients with schizophrenia are able to correctly see through an illusion known as the ‘hollow mask’ illusion, probably because their brain disconnects ‘what the eyes see’ from what ‘the brain thinks it is seeing’, according to a joint UK and German study published in the journal NeuroImage. The findings shed light on why cannabis users may also be less deceived by the illusion whilst on the drug.
People with schizophrenia, a mental illness affecting about one per cent of the population, are known to be immune to certain vision illusions. The latest study confirms that patients with schizophrenia are not fooled by the ‘hollow mask’ illusion, and that this may relate to a difference in the way two parts of their brains communicate with each other – the ‘bottom-up’ process of collecting incoming visual information from the eyes, and the ‘top-down’ process of interpreting this information.

Illusions occur when the brain interprets incoming sensory information on the basis of its context and a person’s previous experience, so called top-down processing. Sometimes this process can mean that people’s perception of an object is quite different to reality – a phenomenon often exploited by magicians. The new study, by scientists at the Hannover Medical School in Germany and UCL Institute of Cognitive Neuroscience in the UK, suggests that patients with schizophrenia rely considerably less on top-down processing during perception.

The study used a variation on the three-dimensional ‘hollow mask’ illusion. In this illusion, a hollow mask of a face (pointing inwards, or concave) appears as a normal face (pointing outwards, or convex). During the experiment, 3D normal faces and hollow faces were shown to patients with schizophrenia and control volunteers while they lay inside an fMRI brain scanner, which monitored their brain responses.

As expected, all 16 control volunteers perceived the hollow mask as a normal face – mis-categorising the illusion faces 99 percent of the time. By contrast, all 13 patients with schizophrenia could routinely distinguish between hollow and normal faces, with an average of only six percent mis-categorisation errors for illusion faces.

The results of the brain imaging analysis suggested that in the healthy volunteers, connectivity between two parts of the brain, the parietal cortex involved in top-down control, particularly spatial attention, and the lateral occipital cortex involved in bottom-up processing of visual information, increased when the hollow faces were presented. In the patients with schizophrenia, this connectivity change did not occur. These results suggest that patients with schizophrenia have difficulty coordinating responses between different brain areas, also known as ‘dysconnectivity’, and that this may contribute to their immunity to visual illusions. The research group is now investigating dysconnectivity in schizophrenia further, which will hopefully advance our understanding of this disorder.

Danai Dima, Hannover Medical School, says: “The term ‘schizophrenia’ was coined almost a century ago to mean the splitting of different mental domains, but the idea has now shifted more towards connectivity between brain areas. The prevailing theory is that perception principally comprises three components: firstly, sensory input (bottom-up); secondly, the internal production of concepts (top-down); and thirdly, a control (a ‘censor’ component), which covers interaction between the two first components. Our study provides further evidence of ‘dysconnectivity’ between these components in the brains of people with schizophrenia.”

Dr Jonathan Roiser, UCL Institute of Cognitive Neuroscience, says: “Our findings also shed light on studies of visual illusions which have used psychomimetics – drugs that mimic the symptoms of psychosis. Studies using natural or synthetic tetrahydrocannabinol (THC), the ingredient of cannabis resin responsible for its psychotic-like effects, have found that people under the influence of cannabis are also less deceived by the hollow mask illusion. It may be that THC causes a temporary “disconnection” between brain areas, similar to that seen in patients with schizophrenia, though this hypothesis needs to be tested in further research.”

Journal reference:

1. Dima et al. Understanding why patients with schizophrenia do not perceive the hollow-mask illusion using dynamic causal modelling. NeuroImage, 2009; DOI: 10.1016/j.neuroimage.2009.03.033

Adapted from materials provided by University College London.

Filed under: Other Mental Health, psychosis, , , , , ,

What’s it like to be a young person with mental health issues?

Three teenagers who have found it hard to forge their sense of identity as young people with mental health issues, Wednesday 15 April 2009 00.05 BST

Rachel Haddon, 21, Preston, Lancashire

Who am I? A 21-year-old female? Student? Mental illness and eating disorder sufferer? Self-harmer? Vegetarian? Or an animal lover? I am all of these things, yet none of these things. I am just me. If diagnoses were put on the end of your surname, like qualifications, I would look rather qualified! But these labels don’t aid and benefit me like qualifications would. It is time professionals stopped treating people as disordered statistics, and instead saw us as people. Ordinary humans, who just happen to have problems. After all, everyone has problems, don’t they? Perhaps our problems just affect us a little more than normal. But what is normal? The only normal I know is the setting on a dishwasher. Over the years I have met many so-called “professionals” – doctors, nurses, social workers and psychiatrists who apparently excel in their field. But most have actually made me feel worse. I don’t doubt that on the majority of occasions their intentions have been good, but instead of helping me, they have just diagnosed, medicated and hospitalised me. Of course, that is often necessary and beneficial, but the most important and helpful “treatment” is to be listened to, and believed. Sadly, many professionals seemingly fail to do this. The attitude of these professionals and the general public is obviously influenced by the media to some extent. It’s not rare to see a headline such as “Prisoner with personality disorder attacks staff”. Is it any wonder that the majority of people think having a personality disorder indicates that you are a dangerous, reckless, violent criminal? Some could argue for freedom of speech, but for those like me who happen to be diagnosed with a personality disorder (regardless of my opinions on the use of this “label”), such statements and in­accurate beliefs only add to our problems. The hope of recovery sometimes seems impossible in a world that functions on stereotypes and stigma.

Saad Butt, 21, London

It has been six years since my father died of a heart attack. Being the eldest, I looked after my mum and my younger brother and sister, as well as myself. I was 15. My GCSEs were a pressurised time and things weren’t easy. I had to grow up fast. My father and I didn’t always have the best of times. Why was it that we were so close and yet so distant? Why is it we wait so long to tell those close to us the way we feel about them? To lose someone close and still live and breathe each day was a big struggle. I had attacks of depression, identity crises and suicidal thoughts. There didn’t seem to be anyone who could help and it didn’t feel like counselling services were available either. But I kept on going, suffering in silence, living in the hope that one day things would be better. Before my dad died, I was involved in my community with the local youth parliament. That kept me going, but when I found a mentor through my community work to talk things through with, things started to change. At 18, I found in him the dad I never had. He became my guardian, had a deep-rooted concern for me, and took an interest in my studies and my extracurricular life. My emotions started to become a positive driver in my life. I love him more than anything in the world. Now I never take anything for granted; I’ve become more focused, more concentrated on what I want in life. My relationship with my mother has become closer. I’m studying for a law degree and I’m still involved with local youth issues – for example, as a member of the British Transport Police youth board. I’m getting married in the summer and looking forward to that and the new life that comes with it. I’ve also learned that it’s important to get help and talk to someone you trust. Above all, have faith, stay positive and cool about life, and go with the flow – it isn’t always as bad as it may look.
Celeste Ingrams, 24, Southampton

The most difficult thing is how people have reacted to my mental health problems. It made me think I was dangerous due to what was going on inside my head. This perception became almost a sense of identity that made me feel secure and reaffirmed my belief that I was “crazy” and uncontrollable. It took me a long time to realise that my “craziness” was my mind coping with the emotions that were reactions to me feeling unsafe and anxious. It is hard to admit vulnerable emotions and this denial came out in my behaviour, which I’m not proud of, but I couldn’t communicate my feelings in any other way. I often kicked against everything, which was self-destructive and led to people being hurt. Although I feel guilty about this, if I’d not gone through this process then I wouldn’t have been able to learn from my mistakes. How I manage is I don’t get too caught up in what’s wrong with me or how others make sense of what I do, but I stay in touch with my emotions. I use coping skills to steady myself, and prevent things getting out of control, often by spending my time expressing myself in more creative ways with art and writing. My experience of living in institutions – NHS or local authority psychiatric units, or residential therapeutic communities – was about feeling controlled and not supported. I think this affected my ability to believe or trust in myself. I try now not to feel caged by stigmas and stereotypes. I know it can be extremely difficult to do this in our society.

• Rachel, Saad and Celeste are all members of mental health charity YoungMinds

Filed under: Other Mental Health, self-harm, Suicide, , ,

Mentally Disordered More Likely To Become Victims Of Violence When Showing Increased Symptoms

Article Date: 16 Apr 2009 – 0:00 PDT

Contrary to common stereotypes, individuals with major mental disorders are more likely to become victims of violent crimes when they are experiencing an increase in symptoms than they are to commit crime, according to a new study by Brent Teasdale, an assistant professor of criminal justice at Georgia State University.

Teasdale found that patients experiencing delusions, hallucinations and worsening symptoms generally are most likely to become victims of violence. In addition, individuals with mental disorders are particularly vulnerable for victimization during times of homelessness and when suffering from alcohol abuse.

“They actually have higher rates of victimization than they have of violence commission, which I think is counter to the stereotype that highly symptomatic, obviously delusional, visibly mentally disordered people are dangerous, unpredictable and violent,” Teasdale said. “There’s no one size fits all approach to these delusions, but the odds of victimization are multiplied almost by a factor of two when a person experiences these delusions.”

Teasdale analyzed data from the MacArthur Violence Risk Assessment Study, a longitudinal study of psychiatric patients released from three psychiatric hospitals in Pittsburgh, Pa., Kansas City, Mo., and Worchester, Mass. During the MacArthur study, participants were interviewed every 10 weeks for one year about violence committed against them, stress, symptoms and social relationships.

When individuals with mental disorders experience increases in delusions, symptom severity and alcohol problems they may be more focused on their internal states and have fewer cognitive resources available to devote to interactions with other people, Teasdale said. Other research suggests that victimization happens because caretakers may be driven away, leaving the disordered unprotected.

“If the stigma is that those are people we need to protect ourselves from, one of the ways in which we might do that is self defensive violence. We might strike first and that would lead to the victimization of these folks,” Teasdale said. “If there’s a person that could intercede before that happens, that may be one strategy for reducing victimization risk.”

The findings of the study are important for clinicians who must pay attention to warning signs of worsening disorders as potential risk markers for violent behavior committed by their client, Teasdale said. They could also aid in the creation of assessment tools that focus on victimization risk and classes that better educate families about caring for the mentally ill.

Clinicians also could provide clients suggestions for reducing victimization risk when they notice patients exhibiting greater than usual symptoms, Teasdale said. For instance, during these times clinicians may recommend spending less time in public spaces, increases in guardianship or mandated community treatment programs.

“Most of us know people who have mental disorders. These are our family members and our friends and so we should care about their victimization experience,” Teasdale said. “The stereotypes persist because people are unaware of the victimization risk to people with mental illness. If they learned that victimization risk were higher than the violence commission rates, I think that would help alleviate some of that stigma and help people think about people with mental disorders in a different way.”


The study, “Mental Disorder and Violent Victimization,” was published in the 2009 edition of Criminal Justice and Behavior.

Leah Seupersad
Georgia State University

Filed under: Other Mental Health, Violence, , , , , ,

Working to understand men’s mental health

More can be done to help men in this little studied area of wellbeing

Men’s mental health is a particularly salient issue in these troubled times. Worldwide, more than one million people kill themselves each year. In the UK, men are four times more likely than women to kill themselves and there have been over 6,500 male suicides in the past six years.

Incidence data from the last century show suicide rates have peaked during past economic recessions. Gay men are two to three times more likely to have a mental health problem and 4.3 times more likely to attempt suicide than straight men, and have around double the rate of depression and anxiety. 94% of young offenders are male and 80-90% have mental health problems.

Furthermore, while the rate of deliberate self-harm is higher in females (associated with problems in interpersonal relationships), it is four times more likely to lead to suicide in males, and is associated with alcohol, employment, financial and housing difficulties. One question is, will we see an escalation of distress and suicide in males during the current economic downturn?

Men’s mental health is a dramatically understudied and poorly understood area of human wellbeing. Men are half as likely as women to be diagnosed with depression, yet twice as likely to abuse alcohol and drugs.

What’s going on here? One compelling possibility is that what society teaches men about what it means to be a man leads us to express our pain in ways that differ from women. Among the more striking differences is that men are more likely to keep their problems to themselves. We frequently suffer in silence, and sometimes with dire consequences. Our research at Clark University in the US has shown that men who are more likely to value self-reliance and stoicism are more likely to have significant symptoms of depression; they are also more likely to report feeling ashamed of being depressed, and more likely to keep the problem to themselves.

Factors that may lead to mental wellbeing or ill-health are multiple and have complex interrelationships. Comparatively little is understood about how these manifest in men differently to women. There is lack of public knowledge about mental health problems generally. During their lifetime, 25% of the population will experience a mental health difficulty. However, when asked, half of company bosses estimated levels at 0% in their workforce.

Stigma is associated with mental health problems and their perceived effect on employment. In western cultures, boys are taught that it is better to express emotions such as anger than fear or pain and there are cultural sanctions for those who deviate from this. Depression and anxiety may get expressed as anger. Men are socialised to fix problems. As one service user put it “men deal with it – I’m not dealing with it, therefore I’m not a man”. No wonder men may have a tendency to play down their problems, overestimate their ability to deal with them and have a reluctance to seek help. Nor is it surprising that it is commonly hard for those around them to spot the symptoms.

So, what can be done? Men and women need educating in what symptoms to look out for in themselves and others. Signs may include inability to concentrate; being unable to engage with people; a change in appetite; feelings of worthlessness or hopelessness; change in sleeping patterns; and increase in use of alcohol or drugs.

Some men have faulty perceptions about, and place low value on, therapy. As a society, we need to associate help-seeking with strength and courage. Media campaigns in the UK, such as Time to Change, aim to start addressing this. The effects of redundancy on men and women need consideration and employers need educating. At Clark University there are plans to establish the first centre devoted to the study of men’s mental health.

Half of people experiencing depression, after a relatively short course of therapy, go on to make a full and lasting recovery. However, sitting and talking about problems is not what many men are comfortable doing. Therapists need to develop more effective methods of engaging them.

The national strategy, Increasing Access to Psychological Therapies (IAPT), is aimed at identifying and treating anxiety and depression more effectively in the general population. Early statistics show lower take-up of this service among men. While research indicates that higher numbers of women experience mental health difficulties than men, it is unclear whether this is because it is a hidden problem and self-referral to the new IAPT services might help. Linking commissioning of educatio n, social care and health care services may lead to men’s needs being more comprehensively addressed in future.

• Michael Addis is professor of psychology at Clark University, Massachusetts

Filed under: Other Mental Health, self-harm, Suicide

Prozac, used by 40m people, does not work say scientists

I am posting this because on a recent course on responding to suicidal behaviour, I suggested that fluoxetine (Prozac), paroxetine (Seroxat), venlafaxine (Effexor) and nefazodone (Serzone) were far less effective than previously thought. One participant asked about the evidence, so here it is. happy reading! Iain Bourne

Analysis of unseen trials and other data concludes it is no better than placebo

Prozac, the bestselling antidepressant taken by 40 million people worldwide, does not work and nor do similar drugs in the same class, according to a major review released today.

The study examined all available data on the drugs, including results from clinical trials that the manufacturers chose not to publish at the time. The trials compared the effect on patients taking the drugs with those given a placebo or sugar pill.

When all the data was pulled together, it appeared that patients had improved – but those on placebo improved just as much as those on the drugs.

The only exception is in the most severely depressed patients, according to the authors – Prof Irving Kirsch from the department of psychology at Hull University and colleagues in the US and Canada. But that is probably because the placebo stopped working so well, they say, rather than the drugs having worked better.

“Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” says Kirsch. “This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported.”

The paper, published today in the journal PLoS (Public Library of Science) Medicine, is likely to have a significant impact on the prescribing of the drugs. The National Institute for Health and Clinical Excellence (Nice) already recommends that counselling should be tried before doctors prescribe antidepressants. Kirsch, who was one of the consultants for the guidelines, says the new analysis “would suggest that the prescription of antidepressant medications might be restricted even more”.

The review breaks new ground because Kirsch and his colleagues have obtained for the first time what they believe is a full set of trial data for four antidepressants.

They requested the full data under freedom of information rules from the Food and Drug Administration, which licenses medicines in the US and requires all data when it makes a decision.

The pattern they saw from the trial results of fluoxetine (Prozac), paroxetine (Seroxat), venlafaxine (Effexor) and nefazodone (Serzone) was consistent. “Using complete data sets (including unpublished data) and a substantially larger data set of this type than has been previously reported, we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance,” they write.

Two more frequently prescribed antidepressants were omitted from the study because scientists were unable to obtain all the data.

Concerns have been raised in recent years about the side-effects of this class of antidepressant. Evidence that they could prompt some young people to consider suicide led to a warning to doctors not to prescribe them for the under-18s – with the exception of Prozac, which was considered more effective than the rest.

In adults, however, the depression-beating benefits were thought to outweigh the risks. Since its launch in the US in 1988, some 40 million people have taken Prozac, earning tens of billions of dollars for the manufacturer, Eli Lilly. Although the patent lapsed in 2001, fluoxetine continues to make the company money – it is now the active ingredient in Sarafem, a pill sold by Lilly for premenstrual syndrome.

Eli Lilly was defiant last night. “Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant,” it said in a statement. “Since its discovery in 1972, fluoxetine has become one of the world’s most-studied medicines. Lilly is proud of the difference fluoxetine has made to millions of people living with depression.”

A spokesman for GlaxoSmithKline, which makes Seroxat, said the authors had failed to acknowledge the “very positive” benefits of the treatment and their conclusions were “at odds with what has been seen in actual clinical practice”.

He added: “This analysis has only examined a small subset of the total data available while regulatory bodies around the world have conducted extensive reviews and evaluations of all the data available, and this one study should not be used to cause unnecessary alarm and concern for patients.”

Filed under: Impact Training, Other Mental Health, psychosis, Suicide, , ,