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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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.

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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.

Police cells as ‘places of safety’

According to an article in today’s @guardian Home Secretary Theresa May has pledged up to £15m to provide health-based alternatives for the 4000 people per year who spend time in detention in police cells under the Mental Health Act.

Currently, people detained under the MHA can be held in a hospital or a police station for up to 72 hours, with the premise being that a police station is a place of safety.

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Section 135 empowers police officers to enter private premises (with a warrant) to remove a person suspected of needing an urgent mental health assessment. Section 136 gives power to the police to remove someone from a public place to a ‘place of safety’ where, under the Mental Health Act, they can be detained for up to 72 hours. In around one third of cases, the ‘place of safety’ is a police cell.

Under the new policing and sentencing bill which is due to be released next week, the use of police cells to detain children with mental health problems will be banned.

This comes soon after research published by the Centre for Mental Health in late 2014. The research was commissioned by the Department of Health and the Home Office and found that for many people, being detained by the police was a frightening experience. That does not really come as a surprise – I know that I certainly wouldn’t choose to spend time in a police cell and Theresa May appears to be on the right track that people with mental health issues should not be ‘locked up’. This is particularly so given the report’s statement that “we found broad agreement among all those who worked with or had been subject to sections 135 and 135 that police custody should seldom if ever be used as a ‘place of safety’… there was widespread agreement that the use of these sections with children and young people was especially problematic”.

Whilst this Tory plan to put more funding into creating more suitable places of safety for young people with mental health issues came as a nice surprise to me, it does only apply to children. The new legislation will, however, ensure that police cells are only used as a place of safety for adults if the person’s behaviour is so extreme that they cannot otherwise be safely managed. Immediately, my mind asks what on earth ‘so extreme’ refers to and whose call it is as to when behaviour meets that threshold. I guess only time will tell with that one.

I think that it would be a good starting point to have age-appropriate places of safety. Of course, the legislation discussed above is more concerned with people under the age of 18, who are therefore classed as more vulnerable. But what about older people? I can say with conviction that a police cell absolutely would not be a suitable place for my 81 year old grandma.

We won’t know the exact ins and outs until the bill is set out in next week’s Queen’s speech but for now it is suggested that the bill will reduce the current 72 hour maximum period of detention and will enable places other than police cells and health-based alternatives to be ‘places of safety’.

In utilising police cells for the purpose of detention under the Mental Health Act, it automatically feels as though the person detained has done something wrong when, of course, in the vast majority of cases they have not. When you think of a police cell you don’t think of it as a place of safety, you think of it as a place for punishment, regardless of what its purpose actually is. I understand that sometimes there simply aren’t enough beds to go around but surely a prison cell can’t be the only alternative? Imagine how daunting it would be to be taken from a public place and put into a prison cell, ostensibly for your own safety. I know that I would be beside myself and would probably be quite scared that I was being accused of some sort of a crime. Do people with mental health issues really need these extra levels of hardship when what we should be doing is re-assuring them that they are safe and protected, but also that they have done absolutely nothing wrong. This could be particularly important given the fact that after the detention period there will be a mental health assessment. We ought to be reducing stress-levels, not increasing them.

If those with a physical illness were turned away from hospital due to overcrowding and were taken to a police cell, there would be a massive outcry. Shockingly, it is estimated that between 20% – 40% of police time is spent dealing with people with mental health issues. Needless to say, the correct place for someone with a mental health problem is not a police cell and the best people to look after them are not police officers.

Let us hope that Theresa May puts her words in to actions and we see more health-based and perhaps community-based places of safety for the mentally ill.

Should workplaces screen for depression?

The world is still reeling from the news that 150 people had died on Germanwings flight 9525. Speculations began shortly after the crash that the plane had deliberately been brought down, by the co-pilot Andreas Lubitz.

With this suspicion in mind, focus turned to Andreas’ private life and what dark goings-on could lead him to kill 150 innocent people. One of the first things that reporters were very quick to jump on was the suggestion that he had depression because, of course, having depression automatically means that you’re going to do terrible things.

Nevertheless, it was Andreas’ history of depression that was the focus of investigations.

IMAG0123The Daily Mail went for this delightful headline – “Suicide pilot had a long history of depression – why on earth was he allowed to fly?” whilst The Sun simply stated “Madman in Cockpit”.

I am not going to comment on Andreas or Flight 9525, I simply wish to use it to highlight how quickly people, influenced by the media, can give negative connotations to depression, a mental health illness which the sufferer has no control over. No one chooses to be depressed, and it certainly does not make you a bad person if you have depression.

It seemed that the discovery that the co-pilot had depression was the piece of information that everyone needed to enable them to blame him. Now, in light of this, BBC News has recently asked whether there should be screening for mental illness at work. My answer, and that of BBC News, would be an emphatic ‘no’.

Screening is something that the majority of us are familiar with, it being mostly used in testing for cervical cancer. Screening is fantastic because it allows you to assess for a disorder in an individual who does not know that they are ill and who has no symptoms.

One well-established principle in medical screening is that there is a ‘latent’ stage where the disorder is present but it is not apparent to the individual. Not only is there no recognised latent stage of depression, but the idea of ‘symptom free’ depression is difficult to entertain.

Even if mental illness screening were possible, I would feel great unease if it were done in the workplace. In ‘testing’ for mental illness there is the automatic sub-conscious connotation that mental illness is wrong. It is wrong and therefore your workplace must know about it.

For me, screening for mental illness would add further stigma to those suffering, particularly if screening is introduced off the back of the story of Andreas. It would most likely serve to discourage people from speaking of their mental health issues and this can only be counter-productive.

Say that an employee has such a screening and a mental illness is discovered, what then? Are they fired? Are they closely monitored because they have depression and therefore there is a chance that they may endanger someone?

It simply does not make sense, at a time where awareness for mental health issues ought to be raised and stigma reduced, to screen for mental illness.

We do not need to screen for mental illness. What we do need is to encourage sufferers to get the help that they need and to feel comfortable in doing so.