Prone restraint in mental health hospital

My partner and I recently finished Season 4 of Orange is the New Black (highly recommend), and one episode particularly resonated with me. In fact, it made me cry, and I’m not a crier.

The episode centred around an inmate named Poussey, who, in the midst of an ‘incident’ within the prison, was forcibly held to the ground by a prison guard for an extended period of time, whilst the prison guard was being tackled by another inmate.

My partner had no idea what the result of this act would be. I knew, through my work within Public Law and mental health, and I knew that the use of such restraint can bring about death.

Prone restraint is where a person is held to the ground in a face-down position and is physically prevented from moving from that position. Too much force and the result can be fatal. The concern is that prone restraint can result in dangerous compression of the chest and airways, thus placing the person being restrained at a huge risk.

The majority of NHS Trust policies on the use of such restraint suggest that it ought to be used only as a last result, following unsuccessful attempts at de-escalation. Unfortunately, I am aware of incidents where prone restraint appears to be used as a first port of call, often on those with severe learning disability, and often in mental health hospital.

I appreciate that professionals within such a setting must keep themselves, the service user and other patients’ safe, but it is frightening that use of prone restraint remains commonplace, and remains the norm, despite policy suggesting that it should be used only in the most extreme circumstances.

There is a reason that prone restraint ought to be used as a final option – in 1998, a 38 year old gentleman named David Bennett was held in the prone restraint position by 5 staff members for a 25 minute period, resulting in his death. An independent inquiry (bbc article 18/06/13) found that Mr Bennett died as a direct result of prolonged face-down restraint and the amount of forced used by staff.

Did this end the use of prone restraint? No. According to Mind (2013), there have been 13 reported incidents of restraint related deaths in the UK since this. This figure is only for those detained under the MHA 1983 and included only those deaths which were actually reported. The figure is therefore likely to be higher, particularly taking into account the years following the study.

Shockingly, as someone living and working in the North East of England, Northumberland Tyne and Wear NHS Foundation Trust responded to a freedom of information request from Mind and stated that, in 2011-2012, prone restraint was used 923 times.

This is not uncommon, however, with Stewart et al (2009) finding that manual restraint is used 5 times per month on an average mental health ward. According to Mind, one Trust which responded to an FOI request stated there had been 38 incidents of prone restraint, whilst another said there had been over 3000 incidents.

Mind’s recommendation from the 2013 research was, of course, that the government ought to end the use of face down physical restraint.

Has this happened? Of course it hasn’t. The figures speak for themselves. Prone restraint continues to be used, on a large scale, and for as long as this is the case, there will be more and more restraint related deaths.

Not only ought the risk of death be enough for professionals to use every possible de-escalation technique available, but the use of such restraint can cause physical injury and psychological harm. Mind (2013) provided a quote from someone who had experienced such restraint; “it made me feel like a criminal, like I had done something wrong, not that I was ill and needed to get better”.

The free reign to use prone restraint is frightening. The fact that it is used to varying amounts across the country is worse, because it suggests either that instances of prone restraint often aren’t reported, or that staff aren’t provided with the same training across the board. I fear that both are correct.

Those detained under the MHA 1983 are in hospital, usually, for assessment and/or treatment. The mental health hospital ought to be viewed as a place of safety, where care is provided to those in crisis. The possibility of attending hospital and dying there due to an excessive use of force by those who were supposed to be caring for you, is a frightening concept, but it is one that is all too real.

Patients need to feel safe in the hospital environment. The use of prone restraint must be ended.

Mental health service closures

Whilst working within mental health and mental capacity law, I’ve found that there are many situations which really strike me personally. In particular, I have developed an interest in wrongdoings within mental health services, because I can see the situation from the perspective of the outpatient service user, having been involved with services since 2012.

Access to services is a huge issue at the moment. I was rather lucky in that I was able to gain access to services quite quickly through IAPT, though, once my course of CBT had ended, I was basically left in the dark.

I read something on twitter the other day from a service user, stating that he’d missed an appointment because the letter from the hospital had taken so long to arrive. I mean, in 2016, how is that still happening? It may seem like a small thing to some, most likely to the hospital, but these appointments, in times of both crisis and calm, provide routine and stability for service users.  When I was making regular trips to appointments with mental health services, it gave me a sense of comfort just to know that I was doing something. Had I missed an appointment because of the appointment letter being sent by carrier pigeon, particularly with my anxiety when it was at its worst, that would have been one of the worst things that could happen; from the outside looking in, it seems that mental health services can’t empathise with this or many others’ experiences.

Access to inpatient services is where this real division of interest is shown. We’re all aware of the distinct lack of beds within mental health units, which are needed by those who are usually in crisis and cannot be treated effectively in the community. Yet despite this known issue, more and more mental health units and hospitals are closing every year.

According to The Kings Fund, ‘Mental health under pressure’ (November 2015) 40% of mental health trusts experienced a reduction in income in 2013/14 and 2014/15. The analysis by The Kings Fund confirms what many of us interested in this area already know – there are more and more people being detained under the Mental Health Act (a 9.8% increase in 2014/15 compared to the previous year); a lot of these actually receive poor care, particularly when in crisis (only 14% of patients say that they received appropriate care in a crisis); the number of beds is decreasing, meaning that services cannot meet the demand; and, despite this, mental health units continue to be closed down. So, what is the outcome from that? People are either left without the help that they need, or are detained in a hospital somewhere far from home, far from normality, and far from comfort. According to a Freedom of Information request by the Community Care and BBC News, 4,447 patients were sent out of area by 37 NHS mental health providers in 2014/15. 88% of the 4,447 were sent out of area due to beds being full.

I have been looking in to closures of mental health units and, even if you just give it a quick google, you can see the scale of the problem. By way of example, in October 2015 Bootham Park Hospital, York’s only public adult mental health hospital, was closed following a report by the CQC, with 5 days’ notice being given. How many people did this affect? 30 inpatients and 400 outpatients. When something like this happens, particularly with such short notice, it must be like being abducted, and ripped away from everything you knew. In February 2016, Outpatient services resumed, after a huge amount of local pressure. However, for those patients in crisis, requiring inpatient care, they, and their families, are expected to travel 50 miles.

50 miles isn’t the worst it could be. There are instances of people being placed 300 miles from home. But, when these patients are very unwell, to be placed in hospital in a completely new area, in my opinion, surely can’t help them in the short term. Whilst detained under the Mental Health Act, a patient can be granted section 17 leave from their Responsible Clinician. I can’t imagine how difficult it must be to enjoy leave in an area you have never been before. Leave is a way of readying patients for discharge, but, certainly for those with anxiety, going out in the community in an unknown area would be incredibly daunting, and could even be a bit of a step-back. It’s hard to see how having leave in a town 100, 200, 300 miles from home is going to prepare you for living in your community.

Another example of mental health unit closures, resulting in patients having to travel, and one that is actually happening right now, is The Welland Centre, in Market Harborough. I came across this closure in an article a couple of weeks ago – The Welland Centre, which provides adult community health services, hosts clinics for up to 450 patients. That’s 80 patients each week and approximately 4000 appointments each year, and patients will be expected to travel elsewhere to access the help that they need.

One patient of the service has developed a petition to save the service – https://petition.parliament.uk/petitions/131744 – which currently has 764 signatures, one of those, of course, being my own. Should the Welland Centre close, patients would be expected to travel for one hour and a quarter to reach the service. For those who do not drive, like myself, this is two bus journeys. When I was having regular appointments with mental health services at Warwick Uni, I had to travel by bus from where I lived in Leamington Spa onto campus. Sometimes, when I was feeling particularly low, I simply couldn’t do it. I had so much anxiety around the University campus, the bus, the students, that I physically couldn’t get on the bus to get to the appointment sometimes. I probably never would have attended any appointments if I had to take two buses.

Now, putting my legal hat on, one big issue for me in situations involving closures of services, is that patients, families, and those who simply have an interest, do not know that the law can assist. When people are informed that their service, usually a service they have used for many years, is closing, they can feel alone. People generally don’t know (and, to be honest, why would they) that there are possible ways to legally challenge the decision to close the service – to go back to Bootham Park hospital in York (https://www.theguardian.com/society/2016/mar/14/the-nhs-mental-health-hospital-closed-with-just-five-days-warning), lawyers are representing the families of some former patients of the hospital and are seeking a judicial review of the “forced closure” of the service.

Judicial review is where a case is taken to the High Court, and it is argued that a decision of a public body is unlawful. This could be that the body has acted beyond its powers, or has not taken something into account etc. Obviously, there is no guarantee that any challenge would be successful, but I think that it is vital that there is something that can be done legally, at least to try to stop any decision to close a service.

That is why I really enjoy working within this area of law. Despite all of the issues with mental health services, and despite the general thought that lawyers are cold and can’t help real people, I like to think that in this area we actually could make a difference and, if a difference can’t be made, it is always nice to say we tried.

 

Welcome back

So, it has been a loooong time since I have posted a blog, and there are many reasons why.

I think one of my last posts surrounded my attempt at positivity after discovering that the law firm I worked for in mid 2015 was making redundancies. To cut a long story short, I loved the job and had been getting to grips with mental health law – the firm shut down, and I was left with no clue what would happen next.

I felt so strongly about my wish to work within mental health law, but, at the time, there was a distinct lack of such roles in the North East. I had loved working within mental health law; representing the vulnerable and ensuring that their rights are upheld, I feel, is one of the most important things that we, as a society, ought to do.

In November 2015, everything took a turn for the better, and I took a role at a national law firm in Newcastle. I have been there since that date and, whilst I didn’t think it was possible to better my previous job, it is amazing. The role is Public Law Paralegal, meaning that I assist directly on cases, and get to have a lot of client contact, which I love. I hadn’t had experience of public law, though my role within it centres largley around Community Care and Mental Capacity. I feel just as passionate in this role, as, again, I view it as being incredibly worthwhile. I do also still get to do some mental health work, which, obviously, I love!

Mental Capacity is an incredibly interesting area of law, and involves those who lack capacity to make a certain decision for themselves, and a decision being taken in their best interests. I’ll post a lot more about this in later blogs.

So, another reason I haven’t posted is because life has simply gotten in the way. I have just finished first year of the Legal Practice Course, having taken (and aced may I say) a module in Mental Health Law, and, now I have gotten fully to grips with my new job, I feel that I’ve got a good balance. I’ve even taken on afew voluntary roles, which I’m really happy about – currently, I work with Parkinson’s UK, Tiny Lives and Rethink Mental Illness.

I hope that you can forgive my disappearance, and I’m looking forward to writing more blogs and getting to grips with all things mental health, mental capacity, and law.

Thanks for having me back!

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Deprivation of Liberty Safeguards

The number of people living with Alzheimer’s who are subject to deprivation of liberty safeguards (DoLS) is on the increase. DoLS are intended to ensure that residents in care homes and hospitals are protected in a way that does not deprive them of their liberty (if a person lives in supported living or their own home then it is possible to deprive them of their liberty in their best interests, but this must be done by applying directly to the Court of Protection). Effectively, DoLS authorise a deprivation of liberty when it is necessary to do so for a patient or resident who lacks capacity to consent to care or treatment in order to keep them safe from harm.

It has recently been reported that DoLS are linked to delays in families being able to bury their loved ones when they have died in a care home. This is because regulations require state inquests into such deaths, even when the cause of death is fairly clear – the deceased who was subject to the safeguards is considered to have died ‘in state detention’ thus an inquest is needed and the release of the body is delayed.

The Independent on 28th May 2015 interviewed a relative of someone who had been subject to the safeguards and who was forced to wait for 2 months before being able to bury the deceased. That relative stated “who actually benefits from these safeguards? It’s a box ticking exercise and I’m just so glad it’s finally over”.

There has been a dramatic rise in DoLS applications over the past year – The Independent quotes that 113,000 applications were made and that 36% of these were granted. That same article also includes a quote from George McNamara, Alzheimer’s Society, who states “DoLS are important for people with dementia to make sure they are not wrongly deprived of liberty but the current system is complicated and there is lack of awareness about the process”. I agree entirely with this statement and hope that this post will bolster people’s understanding of DoLS and their beneficial uses.

Deprivation of Liberty Safeguards are part of the Mental Capacity Act 2005. A deprivation of liberty is described as occurring when ‘the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements’.

For a person to have capacity, they must be able to : 1) understand information relevant to the decision they want to make 2) retain that information long enough to allow them to make a decision 3) weigh up that information to come to a decision 4) communicate that decision.

The ECtHR has clarified what may amount to a deprivation of liberty. Examples of such deprivation include: restraint so that someone may be admitted to hospital; medication given against the person’s will; staff making all decisions about a person; and staff restricting a person’s access to family and friends. The point is that, whilst doing these things does deprive someone of their liberty, it is done for the person’s own benefit – therefore a DoLS is something that legally authorises the deprivation of liberty. If the examples above took place without a DoLS in place, then the person’s human rights would have been breached. Thus, under the MCA restraints and restrictions are allowed to be used when in a person’s best interests, but DoLS are needed if this restriction and restraint amounts to a deprivation of liberty.

If a relative were in a care home/hospital, and you felt that they were being deprived of their liberty but there is no authorisation for such deprivation in place, then the first port of call would be the care home manager – always attempt to resolve things from the bottom and an agreement could be reached re more freedom for your relative. If the care home manager does not think that an authorisation is needed, then you would approach the local authority and ask them to investigate whether a deprivation of liberty has taken place.

It is against the law to deprive someone of their liberty without there being an authorisation in place.

The recent case of Re AJ [2015] clarified that a local authority, when it knows that a person will be entering a care facility on a permanent basis, should make an application to the court or carry out a DoLS assessment. Effectively, authorisation should be obtained before any deprivation of liberty occurs. If an authorisation has not been made prior to a person’s move into a care setting, then an urgent authorisation could be made by the care home/hospital manager when the person arrives, although Re AJ [2015] confirmed that such an authorisation should last for no more than seven days, save in exceptional circumstances, and that an application for standard authorisation ought to be made at the same time.

The assessment process for a standard authorisation involves at least two independent trained assessors – one mental health assessor and one best interest’s assessor. If the pair do not think that all of the conditions have been met then the deprivation of liberty will not be authorised. This procedure is intended to protect the patient or resident in question. Part of the assessment process is that family, friends and paid carers who know the person well be consulted so that they may give suggestions as to how the person may be supported without depriving them of their liberty.

Should the care home resident or hospital patient concerned have no family or friends, they can utilise the support of an IMCA (Independent Mental Capacity Advocate) during the assessment process.

Following authorisation, a Relevant Person’s Representative (RPR) should be appointed as soon as possible. It will tend to be a family member or friend who will fulfil this role but if no one will take on the role on an unpaid basis then the supervisory body will have to pay someone to be the person’s RPR. In such a case, it is likely that this will be an advocate. If the RPR is unpaid (which would be the case if it were a friend or family member) then both the person and the RPR are entitled to the support of an IMCA.

An authorisation for a deprivation of liberty is intended to last for the shortest time possible, with the maximum authorisation time being 12 months, during which time regular checks must be carried out to determine whether the authorisation is still needed. If the authorisation is no longer necessary, then it must be removed. The patient/resident and their RPR are able to challenge the deprivation of liberty in the Court of Protection at any time, and can also require the authorisation for the deprivation to be reviewed at any time. The review would determine whether the criteria to deprive the person of their liberty is still met and, if so, whether the conditions need to change.  The home or hospital should do all that it reasonably can to explain to a detained person and their family what their rights of appeal are.

Useful info on DoLS can be found at:

http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/deprivationlibertysafeguards.aspx

http://www.scie.org.uk/publications/ataglance/ataglance43.asp

Me, myself and Anxiety

“The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture. Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level. It is produced by nature and it is produced by nurture. It’s a psychological phenomenon and a sociological phenomenon. In computer terms, it’s both a hardware problem (I’m wired badly) and a software problem (I run faulty logic programs that make me think anxious thoughts)”               Scott Stossell, ‘My Age of Anxiety’

The major problem when it comes to Mental Health issues is not the person, not the illness, but the fact that such issues are surrounded by a cloud of silence and stigma.

Mixed anxiety and depression is the most common mental health disorder in Britain, with 9.7% of the population experiencing it.

During my second year of University, the pressure of exams was looming and I found myself in a place I had never previously been – one filled with anxiety, feelings of failure and a constant fear that I would never be good enough to embark upon the career that I had worked so hard for.

At the time that my journey with anxiety began, I was putting in 14 hour stints at the library – that seemed like normality for the majority of students at my University. I thought that I was fine, I had always prided myself on my emotional strength. That was, until it came to the date of my Contract Law exam and I had a panic attack in the library whilst I was attempting to read through my revision notes. It had taken me around two hours to read one page and it was clear that something was wrong. I didn’t want to have a panic attack, but I couldn’t stop it and, honestly, I had no idea what was going on. I didn’t know what a panic attack was, but I was left shaking and crying uncontrollably on the quiet floor of the library, 2 hours before what was, in my mind, the most important exam of my life. Of course, it wasn’t- that was the anxiety talking.

I had been revising for around two months – I should have been ready for exams. I was ready, but my brain would not let me pass this wall of panic in front of me.

Funnily enough, I actually had no idea that there was a problem with my mental health until the day that I had that first panic attack. Following that, things started to click in to place and I realised that, for the two months prior to that panic attack, revision had taken over my life and I was rarely eating and barely sleeping. My room was a mess (which was very unlike me) and, in all honesty, I was too.

I sought help from my GP, and utilised the help of IAPT. I was given medication to help to control my anxiety (Citalopram worked really well for me and I, thankfully, haven’t had to chop and change pills to find what suits me). I attended Cognitive Behavioural Therapy which taught me to change the way that I thought. Apparently, doing this means that I am in a minority – a YouGov survey of 2300 adults in Britain carried out for Mental Health Awareness Week 2014 found that one fifth of people who have experienced anxiety do nothing to cope with it. Indeed, fewer than one in ten people have sought help from their GP to deal with anxiety.

At first, admitting that I had a problem made me feel that I was weak. Once I had come to terms with my anxiety disorder and felt that I could tell those closest to me about it, I found that most people’s instant reaction would be to ask ‘Well, what are you anxious about?’ There was absolutely no malicious intent behind that question, it was just a question that simply could not be answered. As Critchley (2009) has stated, “If fear is fearful of something particular and determinate, then anxiety is anxious about nothing in particular and is indeterminate”. It can be difficult to come to terms with the fact that you have anxiety whilst at the same time having absolutely no idea why.

Now that my anxiety disorder is behind me and I have learnt to cope with any feelings of anxiety that I may experience, I feel slightly angry when I look back at that time of my life – that I didn’t know that I had a problem until it was too late. If only more people spoke out about mental health issues, and the help available were promoted further, people may not have to wait for their mental health issues to manifest themselves externally before they are able to receive help.

People simply do not talk enough about mental health issues and, even whilst writing this, I feel a sense of worry that people may look down upon me because of my experience with anxiety. That is wrong.

In the UK, one in four people will experience some kind of mental health illness in the course of a year. That’s a lot of people, and it’s likely that the majority of those people are too frightened to speak about their experiences, for fear of discrimination and being ridiculed.

We need to raise awareness of mental health issues and let people know that it is ok to speak out about their experiences. Speaking of your experiences with a mental health issue, whilst a bit daunting at first, is actually incredibly refreshing and, you never know, you could be the difference between someone suffering in silence or attending their GP and getting the help that they need.

During Cognitive Behavioural Therapy, I learnt more about what a panic attack was, and what the early signs of an attack were for me personally. Some techniques which helped me included focusing on something other than the attack. It used to be that I would be so worried and anxious that I would have a panic attack that I brought one on myself. My therapist told me to focus on colours, perhaps the colours of different leaves on a tree. I personally preferred to rub tea tree oil or some other scent on my wrists and simply focus on smelling that. It sounds so simple but it really did work.

Another simple thing that can make a huge difference is to talk about any issues you may be having with those around you. I was able to talk to my friends and my partner who were incredibly helpful and, as some of my friends also had mental health issues of their own, I was able to use some of their advice (the smelling scent distraction actually came from my best friend whose mum is an aromatherapist).

I also really like ‘The Quiet Place’ at http://thequietplaceproject.com/thequietplace which had the effect of basically bringing me back to normality. For me, my anxiety was mainly linked to exam stress and the general hardship of life. The Quiet Place is great as it allowed me to take a step back and really put my fears into perspective, the majority of which were totally irrational.

Mental Health is no longer something that should only be spoken about behind closed doors and I hope that we, as a society, are now moving in the right direction towards a better understanding of mental health issues and a more accepting approach towards those who suffer. In talking about mental health issues, we raise awareness and it is that awareness of such issues that will help those suffering to get the help that they need.

I have struggled with anxiety and have overcome it, hopefully by speaking out we can help others to do the same.

Mental Health under the Tory Government

In their election manifesto, the Conservative Government reaffirmed the commitment made under the Coalition that Mental Health Services would be put on a par with physical health. On top of this, the Conservatives stated that they would ensure that there are therapists in every part of the country providing treatment.

The manifesto stated that funding for Mental Health care would increase, though no details were given to actually support this bold statement. Indeed, according to the BBC in March 2015, the budgets for Mental Health trusts in England fell by more than 8% over the course of the Conservative Lib Dem Coalition – 8% may not seem like a great deal, but it equates to around £600m. According to Paul Farmer, Chief Exec of charity ‘Mind’, “the treatment gap for Mental Health is huge- 75% of people with Mental Health problems get no help at all… the next government will need to hit the ground running on Mental Health. We need to see a permanent increase in the NHS Mental Health budget of at least £1bn if we are to reverse the damage caused by years of neglect and recent cuts”.

5 days ago, David Cameron proposed 7 day hospital services and 7 day extended hours GP access, with 5000 more GP’s. Whilst this would be fantastic for me – it is a nightmare trying to get a doctor’s appointment when working full time and a good one hour away from the doctor’s surgery – where is the money for this going to come from? NHS England’s Five Year Forward View called for £8bn more annually (along with efficiency savings of £22bn) but, according to The King’s Fund, whilst “a seven day NHS is the right ambition… delivering it by 2020 will be a tall order”, £8bn “will not pay for new initiatives such as seven day working”.

Personally, I attended my GP for my anxiety disorder as I was not aware of any other services available for Mental Health issues. It appears that I am not alone in this, with around 90% of people with Mental Health problems receiving all of their treatment from primary care services rather than a specialist Mental Health service.

With regard to Mental Health specifically, the Conservatives touched upon “enforcing access standards” and increasing funding, but they went no further.

For now, then, we are left a little in the dark and it remains to be seen what will happen with our Mental Health Services. What I do know is that services for Mental Health need to be more readily available and that people with Mental Health issues need to feel confident that they are able to access such services without judgement. Clearly, there is disparity between the number of people who have a mental health issue and the number of people who get treatment or seek help for a mental health issue – In Britain, it is estimated that only around one quarter of people with a Mental Health problem receive ongoing treatment. With longer GP opening hours, more people with mental health issues will have the opportunity to attend their GP and get the help that they need. But is it extra hours that we need, or more confidence so that we are comfortable telling people about our mental health issues with no worry of stigma being attached?

Depression and Parkinson’s Disease

Today’s headline reads ‘Depression may be factor in Parkinson’s risk’. This comes from a Swedish study where more than 500,000 people were tracked for over two decades.

The finding was that people with depression may be almost three times more likely to develop Parkinson’s disease.

Parkinson’s Disease is something very close to my heart – my grandfather was diagnosed with Parkinson’s Disease rather late, as doctors thought that his troubles may be caused by a past heart operation, leading them down the wrong path. Diagnosis took a while and the disease took hold of my Grandad pretty quickly. I was 16 years old when he passed away, and in the end he was bedbound, unable to swallow, blink or talk. It was awful to see, particularly given that only 5 years prior to that he was dragging me round in a sledge at the age of 76 when I was quite clearly too heavy.

Often, people associate Parkinson’s Disease with shaking, but my Grandad never really had that and, though people say that you cannot die from Parkinson’s Disease, that is what went down on my Grandad’s death certificate.

Because of my experience with Parkinson’s, I really want to make whatever difference that I can. Parkinson’s UK is not government funded and therefore relies entirely on donations from the public. Two weeks ago, myself and my partner walked 6 miles for Parkinson’s UK and raised just under £350 in the process. It really isn’t a huge amount but the charity was very grateful.

parkinsons

The problem with Parkinson’s is that there isn’t enough money available to fund research into the disease. In truth, people don’t seem to view Parkinson’s as one of the ‘big’ diseases (for want of a better phrase) and therefore know very little about it.

Parkinson’s is a neurodegenerative disease, affecting around 127,000 people in the UK (or one in every 500). It is the second most common neurodegenerative disease after Alzheimer’s and it is a condition which causes loss of nerve cells in the brain. The disease is categorised by shaking, slowness of movement and stiffness.

This study has now linked Parkinson’s and depression, though it is not certain as to whether depression is a “very early symptom” of Parkinson’s, or whether depression is a risk factor which increases the chances of developing the disease.

140,000 Swedish citizens over the age of 50, who had been diagnosed with depression between 1987 and 2012, were studied. Each person was matched with three control participants i.e. someone who had not been diagnosed with depression and who had the same year of birth and sex as the person with depression. It was discovered that 1.1% of those with depressive symptoms developed Parkinson’s. In comparison, the figure for those who did not suffer depression was 0.4%.

Interestingly, no link was found between Parkinson’s, depression and genetic or environmental factors – there was no link between one sibling having depression and the other having Parkinson’s. Crucially, when the researched adjusted for other conditions related to depression such as alcohol and drug abuse, the link between depression and Parkinson’s did not change.

The more serious the depression, the greater the risk of Parkinson’s disease. People who had been hospitalised for depression were 3.5 times more likely to develop Parkinson’s disease than people who had been treated for depression as outpatients.

This new study could really have an impact on our understanding of Parkinson’s Disease and our understanding of depression. My hope is that the articles on this study in newspapers today will raise awareness of both issues, and will encourage earlier, more accurate diagnosis in sufferers. Every single hour, someone in the UK is told that they have Parkinson’s Disease, and we need to work together to find a cause and ensure that people are able to live a long, happy life with Parkinson’s Disease.