Mental Health
The mental health working group aims to promote and develop knowledge exchange and knowledge transfer in relation to mental health, based on the existing and potential research and teaching activities of the University. The group is drawn from both academic and research staff and research users, including policy makers, professionals and practitioners and service users.
The initial project, intended to evolve iteratively towards an 'unconference', is a set of 'conversations': open, innovative events inviting all who participate to contribute to thinking together about salient features of mental health and illness in Scotland. Indicative further projects may include:
- Mapping mental health research interests across the University, notably in the Humanities and Social Sciences;
- Contributing to internal discussion of mental health and related issues among both administrative and academic staff and students.
For further information, and to explore possibilities for knowledge exchange and transfer, contact Steve Tilley.
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Repository
Can we talk about mental health and mental illness in the University of Edinburgh? (6th February 2012)
Steve Tilley's Summary
Ann Diment briefed on the University’s and the University’s signing of the ‘See Me’ Pledge, and on the initiative in which staff in the Hugh Robson Building have been trained to offer voluntary peer support for colleagues wanting to talk about mental health / mental illness matters. The latter indicates that, increasingly, we can talk about mental health and illness in the University; less clear is how much collective conversation there is across staff / student boundaries – mental health and illness can seem ‘always someone else’s problem’. Conversation: The lead on the NHS Lothian 12S programme (for higher and further education institutions in Lothian) said the programme’s focus was on whole institutions and the ‘healthy university’, in the context of national policy on mental health and well-being. There was discussion on how policy reflects categories of ‘mental health’ and ‘mental illness’ (and diagnoses in the latter), and conventional practices. Proliferation of categories of mental illness in the US diagnostic system was noted, and a related need to have a diagnosis to get recognised and get support you need a label to access resources. “Society is part of the problem”: categories are part of diversity e.g. mad / mad student may reflect the person’s point of view and experience of relationships with professionals; lithium may be considered a dietary supplement. There is interest, including among undergraduates, in expanding areas in the university for inclusive conversations. How can the University cater for international students who need support with adjustments to a different city, climate, etc.?
Sheila Williams described services and support provided by the Student Disability Service (SDS), including the Mental Health Mentor service (part of SDS) and the Student Counselling Service. There needs to be evidence of disability for students to access SD S via students disclosing their impairment. There may be under-disclosure on applications to the University. There has been a 44% increase in disclosures of mental health problems in the current academic year compared to last year, with a rise in disclosure from international students.
The Student Counselling Service has seen a 68% increase in referrals [note: at February 2012]. Student use of the Student Disability Service has increased by 40% since the move to the Main Library. Schools have concerns about demands on staff dealing with student mental health issues. The Disability Committee’s Mental Health Sub-Group considers policies and strategies regarding student mental health, and the University has a mental health policy for students (currently under review). Different policies for staff and students may lead to missing opportunities to address issues common to everybody.
Conversation: Language is an issue – 1) classes provided through SDS could provide a way to get help without have to self-identify as disabled; is it a mental health policy or a mental illness policy?; 2) do you need a diagnosis to be able to access not just services, but policy? Definition of mental illness is a difficult issue: a person may move through stages from coping with stresses to depressed; labels may produce dividing lines in the community, militating against seeing each member as a human being and looking out for each other, allowing for differences. There are conversations about mental health/illness at different levels in the University: organisational talk is important, it is important to know where conversations are taking place and to get involvement of the top person e.g. in committee structures; someone needs to be taking an overview. The Equality and Diversity Committee is seen as to key committee regarding staff mental health/illness policy; the SDS’s core function relates to student disability; what is the role for HR in addressing staff mental health? The ‘see me’ initiative can be a vehicle for getting areas of the University on board, but writing policy and practising policy are two different things. NHS Lothian 12S can provide an ‘outside perspective’ on mental health / illness issues e.g. by making contact with the Principal and work with EUSA. The value of different levels and systems to enable students to work with and look out for each other was noted e.g. EUSA is to approach the Rector as a possible mental health champion. Can we talk about mental health / illness? We can officially, but we can’t; we have policies, but no vision.
Sue Cowan addressed the lack of discourse around prevention of mental health problems / illness, and the universities as a cause of mental health problems for staff and students. Figures on Europe and UK indicate 10.8 million (staff) working days are lost per annum are due to anxiety/stress caused by the workplace; mental health difficulties are the largest category of work-related illness, with high costs of personal suffering, impact on families, and economic costs to society, and impact on organisational health as a whole (e.g. ‘presenteeism’ – people frightened to go off sick, trying to avoid loss of jobs in challenging times). Work-related mental health problems linked e.g. to excessive workload and problems of managing change) constitute a growing epidemic in post-16 education. What can be done to address these issues? Work organisation, design and management are major sources of stress for staff. Risk assessment every 12 to 18 m, maximum every 2 years is a standard of good practice. This, along with effective risk management means that sources of stress can be identified and addressed before they cause harm to staff. Stress on students may be seen e.g. in missing lectures, staying at home. Conversation: There is a lot going on to address these issues e.g. health and safety processes may enable accommodations, but it is not pulled together. Examples were given of classes at Cambridge University aimed at enhancing staff and students’ positive mental health and well-being. The evening’s Conversation was noted as a place where different sort of conversation and connections were made regarding matters of mental health and illness, and projects based on university-mental health work - Talbot Rice Gallery-Royal Edinburgh Bicentenary Project, and the Oor Mad History - noted.
Robert Whitaker Lecture (Channel Fife)
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PPN's Duelling narratives: An international dialogue on mental health (21st November 2011)
Steve Tilley's Summary
In the second PPN Mental Health Conversation of 2011-12, Robert Whitaker, investigative journalist, former Director of Publications at Harvard Medical School, and author of Anatomy of an Epidemic, gave an overview of the argument in that book. He described his shift from accepting a narrative of a great leap forward in psychopharmalogical treatment of major mental illnesses, to finding facts that did not fit that narrative of progress. Instead he found another, duelling, narrative, based on studies showing increasing, not decreasing, rates and burden of illness and disability. He identified as elements responsible for the first narrative’s dominance the power of psychiatry as a guild with prescribing powers, and a merging of interests of the pharmaceutical industry and psychiatry to promote a story of improved diagnosis. He argued that science supports the counter-narrative.
Desmond Ryan, responding, accepted Bob’s analysis, and used the context of professionalisation theory explore how and why psychiatry has been successful in sustaining the dominant narrative in the US. Factors include: exclusion of psychiatries not centred on drugs e.g. psychodynamic psychiatry; creation of a single authoritative hymn sheet (the various Diagnostic and Statistical Manuals [DSMs]); America’s religious society is susceptible to authoritative statements; the therapeutic efficacy of medicine is not contested; increasing direct-to-public/patients advertising spurring patients’ self-referral to psychiatrists to get specific drugs; a risk discourse focused on threats to individual safety and ‘dangerous mentally ill’; legal privileges to control the market. He recalled former US President Eisenhower’s warning about the dangers of a ‘military-industrial complex’: Bob’s analysis points to the dangers of a ‘medical-industrial (pharmacological)’ complex, through the transformation of a functional specialism (psychiatry) to a successful business model industry. Bob agreed, saying the US wants to export the industrial-medical model to other countries, by rewarding those who get on with this model of care.
Topics raised in the discussion included:
- ethical dilemmas, e.g. what is best for patients e.g. combination (drugs / CBT), but CBT is expensive; psychiatrists in US are paid by hour and don’t want to lose patients through high charges;
- this session has been about the effects of drugs prescribed for mental illness – is there research on the food industry and the impact of foods and food additives on mental illness?
- with long waiting lists for NHS CBT, less experienced people are providing it;
- there is a tradition of alternative responses (alternative to drugs and hospitalization) for people experiencing e.g. psychoses (examples the work of RD Laing and Loren Mosher’s Soteria House), but those alternatives are not currently supported by funders;
- how does psychiatric training lead to the US situation? (That situation is characterised by the power of top psychiatrists in top universities to influence medical education and act as opinion leaders on use of medications; and by attacks on non-dominant views as ‘heresy’ voiced by ‘know-nothings’);
- each new DSM has expanded the number of disorders and thereby the range of conditions for which payment for treatment mediated by professionals can be reimbursed and the pending DSM 5 in particular would expand anxiety disorders; UK psychiatrists outraged;
- treatments used before the antipsychotics e.g. chlorpromazine may have been worse for patients?;
- the medical industrial complex contributes to stigmatisation of mental illness;
- the shift in the way we think of people’s experience e.g. from “nervous breakdown” to brain disease contributes to seeing those suffering as not normal (othering);
- the role of GPs as gatekeepers to psychiatry;
- France has different traditions of treatment of mental illness but these are being eroded;
- the role of alternative therapies - psychiatry should be separated from the rest of medicine;
- train nurses to destigmatise mental illness e.g by referral for social interventions (telephone CBT);
- a mental health professional: if I accepted Bob’s analysis, I would resign from my post; DSM5 could worsen the current situation by recommending medication for prodromal (early) symptoms;
- brain imaging equipment can contribute to understanding mental illness, but will the medical-industrial complex buy up and control that equipment;
- who contests how evidence (on mental illness, treatment effects, harmful effects) is accumulated?;
- how are our ways of understanding mental health and illness, and responses to these, evolving (treatment of people scientifically or as persons; pathologising children signifying a new philosophy of being; the DSM as a philosophy of diminishing self-responsibility philosophy being marketed too - everyone will be in DSM 5);
- a challenge - how can society help people who are in terrible places to recover full life; does the evidence base guide care and social policy?
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Dementia Diaries
You can now check the short video about the Edinburgh performance of the DEMENTIA DIARIES.
Contacted by Mark Hewitt, director of Dementia Diaries, PPN linked with University of
Edinburgh (i.e. Centre for Cognitive Ageing and Cognitive Epidemiology) and other partners (including the local Polish community) to promote knowledge exchange in the two Dementia Diaries events in Edinburgh.
This page was published on 16 April 2012