Impact News

Responding to Violence, Suicide, Psychosis and Trauma

From anger management to addiction: online therapies

* Lucy Atkins
* The Guardian, Tuesday 12 May 2009

Eating Disorders

www.b-eat.co.uk offers multimedia support using videos, podcasts, mobile phone browsing, live web chats, message boards, blogs and email or text help, plus one-to-one online support for under 25s from trained advisers. “Authoritative websites are essential as the antidote to pro-anorexia websites,” says Janet Treasure of the Institute of Psychiatry who is also BEAT’s chief medical adviser. The programme allows sufferers to work through their issues and behaviour at their own pace, anonymously, at home. The online CBT approach to bulimia has been tested by a team from the Institute of Psychiatry, and government guidelines suggest that CBT is the best psychological treatment for bulimia. “I didn’t think anyone would answer my message but they did,” says one bulimic woman who used the site. “They were very supportive and I didn’t feel ashamed for the first time ever.”

Sex therapy

therelationshipspecialists.com offers expert help from accredited sex therapists. You fill in a detailed questionnaire about your problem and get a confidential online response within three working days, for £25. Follow-ups with the same therapist cost £35 a pop. The site is run by Paula Hall, a respected sexual psychotherapist accredited with the British Association of Sexual & Relationship Therapy and registered with the UK Council of Psychotherapy. She also works as a family counsellor for Relate. “Lots of people find it difficult to talk about their sexual problems and it’s a lot easier to take that step online,” she says. The virtual approach works best for detailed advice, tips or information on specific sexual problems but, “if it’s very obviously a long-term relationship problem, face-to face sex therapy is usually more appropriate,” says Hall.

Addiction

Former City trader Dan Butcher established the Recovery Network (www.trntv.co.uk) – a social networking site with a difference – after his cocaine addiction landed him in the Priory. The site allows addicts and their families to support each other anonymously. Subscribers also get access to two full-time, trained addiction therapists who run Ask Our Expert sessions, group therapy and live web chats. They can also chat, blog and share information under the watchful eye of the site’s monitors. Real-world friendships spring up and families and friends of addicts feel they are not alone. Monthly subscriptions cost £8.50.

Young people

achance2talk.com is run by the NSPCC and offers counselling, support and information for 12- to 16-year-olds on any troubling issue (abuse, bullying, exams, drugs and self-harm are common ones). Young people can share problems on message boards, or set up a private inbox and email an adviser, who will reply within 24 hours. A confidential “121” service also means that you can talk online with an adviser (you get the same person if you need to talk again). youthhealthtalk.co.uk is another innovative source of online support where young people can access virtual peer support in the form of interviews with other young people talking about their experiences of anything from teenage cancer to the pressure to perform like a porn star during sex. The site is the brainchild of the DIPEx Research Group at the University of Oxford, so there are plenty of health bigwigs on board, as well as an introduction about the power of storytelling from writer Philip Pullman, and a video clip of Radiohead’s Thom Yorke explaining how to use the site. Both are free of charge.

Anger management

angermanagementonline.com is based in the US and run by psychotherapist and anger management specialist Kathy Garber who treats individuals, corporate clients and those referred by US courts. You buy your self-help programme in time chunks (starting at 10 hours for £33) and sessions will address your anger issues and develop problem-solving and communication skills. There is no direct contact with a therapist though, so this may not work for all. As Phillip Hodson of the British Association of Counselling and Psychotherapy cautions, “Online anger management therapy will not work for everyone – anger can be very difficult and complicated to tackle, so group or one-to one therapy tends to be most effective.”

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Filed under: Other Mental Health, ,

Trust ‘sorry’ for murders by patients in its care

• Reports criticise Humber mental health trust for failure of care
• Mother of five and elderly woman died in separate incidents

* Sam Jones
* guardian.co.uk, Wednesday 6 May 2009 00.30 BST

A mental health trust has apologised to the family of a pregnant woman who was killed by a paranoid schizophrenic man, and to the relatives of an 82-year-old woman who died at the hands of her mentally ill son.

New reports into both cases have criticised Humber mental health teaching NHS trust for failing to provide better care for the two men.

Tina Stevenson, a 31-year-old mother of five, was on her way home from an ante-natal class in Hull on 5 January 2005 when she passed Benjamin Holiday. The 25-year-old man, who had missed his medication the day before, stabbed Stevenson in the back. Neither she nor her unborn twin boys could be saved.

Holiday admitted manslaughter during his trial in May 2006 and was ordered to be detained indefinitely at a secure mental hospital.

An independent report into his care and treatment published by NHS Yorkshire and Humber concluded he had been “under-treated” by the trust.

Holiday, who had been suffering mental health problems since 2001, spent a fortnight in a secure unit in 2004 but was later discharged and treated in the community. The report admitted that Holiday, whom it referred to as “B”, was a difficult patient to engage with and was skilled at masking his symptoms.

It concluded: “The root cause contributing to B’s continuing severe mental disorder was that of ‘under treatment’. B’s situation and condition could and should have been more assertively managed.”

The chief executive of the Humber trust, David Snowden, apologised to those affected by the case and promised lessons would be learnt. He said his trust “fully accepted the recommendations, which we are taking very seriously”.

The trust also apologised to the family of Ivy Torrie, 82, who was killed by her mentally ill son, Michael, in Pocklington, East Yorkshire, in 2003.

A separate report attributed Michael Torrie’s actions to the “rapid reduction of medication and the way this was managed in the absence of a risk assessment”.

Marjorie Wallace, chief executive of the mental health charity Sane, said that although such events were rare, they did not “come out of the blue”.

“It is not an expensive revolution in care we need but common sense,” she said. “You do not leave an 82-year-old mother alone to care for her mentally ill son whose medication has been radically changed, with no support.

“Nor do you allow someone who may be becoming severely disturbed to dictate their own care and treatment without rigorous assessment of the risk they may pose to themselves or others.

“We have had 15 years of independent inquiries all exposing the same fault lines in the care and treatment of people with serious mental illness.”

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

Untold stories set to tackle stigma

* Fay Wertheimer
* The Guardian, Wednesday 6 May 2009

Profesor Protasia Torkington, director, Granby Community Mental Health Group, Liverpool.
Protasia Torkington has edited a book by black users of a mental health centre in Liverpool.

A rundown four-storey Georgian terrace in the Toxteth area of central Liverpool, probably built on the back of slave trade money, couldn’t have been the most propitious location for a day centre for black mentally ill adults. But 18 years after it opened its doors, Granby Community Mental Health Group’s drop-in and advocacy project, at the now immaculate Mary Seacole House, offers rights advice, recreational activities, care and a calming environment to 90 people, six days a week.

And to ensure that its legacy endures, seven members’ life stories have been documented in a book called Their Untold Stories, to be launched later this week at a black mental health conference at Liverpool Convention Centre.

Edited by the centre’s co-founder and Hope University emeritus professor Ntombenhle Protasia Khoti Torkington – known as “Pro” for short – the book features clients’ histories in the form of artwork, poetry and prose, which are cathartic and morale-boosting exercises.

Torkington, born in South Africa, qualified as a nurse and midwife and then came to the UK to get specialist paediatric training at Alder Hey Children’s Hospital, where she worked as a ward sister before going back into education.

She says of the book: “I asked people when they first realised they were ill, and then to what they attributed their illness. What unfolded was often rooted in serious sexual violence, long-term physical abuse and racial discrimination. I also encouraged contributors to consider the voluntary and statutory sector services available to them, and to suggest solutions for their own individual needs. Our book concludes by pinpointing key issues that providers should consider when delivering services to mainly black and racial minority communities with mental health needs.”

It logs Mary Seacole House’s success in keeping members out of hospital and endorses the links between a childhood in care and poor mental health. It also supports the request by staff – the nine full-time staff and part-timers are supported by Liverpool primary care trust, the city council and Mersey Care NHS mental health trust – for extra premises to cater for the centre’s 20 daily visitors.

Two weekly art sessions in a small basement, which is also used for IT and snooker, aren’t enough to nurture members’ burgeoning artistry. But this hasn’t deterred 56-year-old Kojo Udarku from attending the centre four days a week since 2005. Following years of discrimination, illness and prison, he found understanding at Mary Seacole House.

“Dictating my story and having my pictures in the book gave me confidence and greater self-trust,” Udarku says. “But those negative feelings from the past never go. My mother, being a white woman in Liverpool with five black kids, had it very hard. And being black in Liverpool in them days was always bad. I was illiterate too, years before they called it dyslexia and gave you help. I experienced prisons, hospitals and sectioning, and I still avoid authority.”

The book presents guidelines for running a non-medical drop-in for mainly black mentally ill adults, as well as displaying their talents – which Torkington hopes will help to tackle the stigma these people face every day.

• Their Untold Stories, edited by Protasia Torkington, can be ordered from Waterstones, price £19.99. maryseacolehouse.com

Filed under: Other Mental Health, , ,

Mental health and offending: One man’s prison experience

A new report today by Lord Keith Bradley says offenders with mental health problems are being failed by the criminal justice system. David Smith, who suffers from schizoaffective disorder, explains why prison wasn’t the right place for him

* Mary O’Hara
* guardian.co.uk, Thursday 30 April 2009 16.47 BST

Like many people who run up against the criminal justice system while dealing with a serious mental health condition, David Smith [not his real name] felt that neither the police nor the prison service were equipped to deal with him. Smith has schizoaffective disorder. He manages his condition with fortnightly injections but in early 2008 he missed a series of appointments for medication, and became unwell.

By April his symptoms returned. These included hearing voices. David went to speak to his mother, with whom he had a fraught relationship, about his problems but the encounter turned into a confrontation that frightened her. At 2am the police arrested him on suspicion of common assault. He was locked in police cells for four days.

When he finally went to court they asked for a psychiatric report. The judge recommended that Smith receive hospital treatment but in the absence of a bed in a secure mental health unit Smith was instead sent to Wormwood Scrubs prison and spent a total of four months there.

“I have difficulty remembering my appointments; I never intend to miss any, I just find it difficult to remember when they are,” David says, explaining his state of mind at the time of his arrest. “My regular CPN [community psychiatric nurse] understands this and she gives me a ring the day before to remind me. When she went on leave I got a new CPN. He knew I couldn’t remember my appointments but he wouldn’t ring me with a reminder.

“I must have missed more than one injection,” he concludes. “My friends tell me there’s a pattern when I’m getting unwell. My symptoms came back and when I was at home one day I heard my mum screaming, ‘I’m going to kill myself’. I went to speak to her. I tried to talk to her. Mum just got frightened. I didn’t get anywhere with her so I went home.”

When he was arrested, Smith says, he did his best to explain himself to police officers but what happened was unsettling and frustrating. He recalls: “At the station another police officer asked me exactly the same questions; they didn’t look at any of the notes that had been taken. The policeman was trying to wind me up. I was so pissed off, I just said ‘yeah, whatever’ and sat down. They knew I had a mental illness as my mum phoned the hospital before she phoned the police. I was interviewed and put in a cell for four days. When I went to court the solicitor explained about my condition. One of the first things they said was that they needed a psychiatric report. Then the judge said I should be in hospital but there weren’t any secure beds so I went straight to Scrubs.

“When I got there I was very unwell but I didn’t know I was so I told them I didn’t have a mental illness and they put me on a general prison wing. They did put me in a single cell so I guess they had my [medical] notes. On my first day someone took the TV out of my cell. I thought to myself they’ll take anything, so I sat in my cell for two weeks. For those two weeks I was probably getting worse, more unwell. No one noticed, they [the prison] haven’t got the staff to notice.”

After throwing a chair and wardens intervening because his behaviour became so erratic, Smith was put in the hospital wing of the prison but was soon transferred back into the general prison population.

He reacted by throwing a chair.

“I spent the last two months in the general wing. I was well then. I talked to staff a lot. They were good to me. When I’m well I’m very polite so I was no trouble.”

Smith says that most of all he felt unlistened to, as if what he was going through was misinterpreted and that the prison wasn’t equipped to deal with his problems. He decided to write to a judge to see if he could get his point of view across.

“I wanted the judge to know what happened from my point of view. I felt I hadn’t been heard in court,” he explains. “Everyone talked about me and not to me. I wanted to say I was sorry. My case came up again and the judge said that I had clearly stabilised, I understood what had happened and that I had already served the time I would have done on a guilty plea while waiting for a bed in a secure hospital so I could go.”

Prison life is simply not the right environment for people like himself, Smith believes.

“If you can handle yourself when in prison you’re OK, if not it’s all over,” he says. “I managed but I met guys who came in after me and they tried to commit suicide or burn down their cells. It’s a 23-hour lock down. I spent most of my time pacing in my cell. I can still remember the pattern my pacing took, the same one over and over again. I never want to go back. I’m doing everything in my power not to go back. I’m keeping myself busy.”

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

Adolescents At Risk Of Developing Psychosis Benefit From Early And Network-Oriented Care

Date: 15 May 2009 – 3:00

Family and network oriented, stress-reducing care improves level of overall functioning and mental health in adolescents at risk of developing psychosis, suggests a recent Finnish study. Jorvi Early psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital (HUCH), Jorvi Hospital, Finland, is a project with an early intervention team for adolescents at risk of developing first-episode psychosis. As developing psychosis has been suggested to be a result of a combination of acute life stressors and trait-like vulnerability to psychosis, the intervention is based on the idea of multiprofessional, need-adapted, community-, family- and network-oriented, stress-reducing, overall functioning supporting and low-threshold care. The JERI team meets with adolescents at ages 12-20 in their natural surroundings, e.g. at school or at home, together with their parents and community co-worker, who has originally contacted the JERI team because of unclear mental health problems. The aim of the team is to recognize potential risk cases and reduce the stress level by family and network intervention. A follow-up study was performed to test how presented intervention will help adolescents at risk. Data was collected between January 2007 and May 2008. During the intervention, mean scores rose statistically significantly on overall functioning and scores on quality of life, depression, anxiety and pre-psychotic symptoms decreased statistically significantly, showing an improvement in overall functioning and mental health in adolescents at risk of developing first-episode psychosis. Adolescents did not receive other therapy or any antipsychotic medication. “JERI- intervention seems to improve level of overall functioning and support mental health in adolescents at risk of developing first-episode psychosis, even though further study with larger number of subjects, with a proper control group and with a longer follow-up time is needed”, says Dr. Niklas Granö, the leader of the research.

Results are published in the journal Early Intervention in Psychiatry. Reference: Niklas Granö, Marjaana Karjalainen, Jukka Anto, Arja Itkonen,Virve Edlund and Mikko Roine: An intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first-episode psychosis in Finland. Early Intervention in Psychiatry (2009; 3: 94-98) Source: Niklas Grano, Ph.D. University of Helsinki

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