Self Care and Mental Health

Self care is a bit of a buzz word at the moment, with tonnes of articles about the benefits of taking time out to look after yourself. Sometimes, self care is used as another way to describe pampering, with things like bubble baths or face masks cited as a type of self care. Self care can also be more basic, for example simply eating regular, balanced meals, or getting enough sleep. This post will examine the science behind the magazine articles, to see what self care is, and whether it is really beneficial for your mental health.

Self care is really just another way of saying ‘look after yourself’ or taking time to do things you enjoy. The mental health charity Mind list different ways self care can help improve your mental health. Their suggestions include being aware of your mental health, being kind to yourself, making sure you interact and feel connected with others. They also suggest taking time to relax, either through mindfulness or getting outside, as well as keeping physically healthy. If you’d like to find out more about self care strategies, click here for further information.

 

Self-care

 

But what is it about self care which improves our mental health? One hypothesis is that  taking part in these activities helps people have a sense of purpose and gives life more meaning, which in turn increases self-esteem (Deegan, 2005). Some participants in this study reported that taking part in self care activities which gave life more purpose (e.g. belonging to a singing group, or volunteering) had helped them stay well, decreasing symptoms and avoiding negative outcomes such as hospitalisation. Other more routine aspects of self care, such as shopping or talking on the phone were used as strategies to reduce anxiety or other unwanted symptoms.

Meditation, or mindfulness has also been explored as a way of using self-care to reduce burnout and stress in healthcare professionals. One study by Shapiro et al taught trainee therapists a mindfulness-based stress reduction programme, and found that participants who received the training had lower stress & anxiety levels, less rumination and higher levels of self-compassion than participants who didn’t receive the training. These results suggest that mindfulness is a way of improving the mental health of professionals at a high risk of burnout.

The evidence suggests that taking the time to engage in self care activities could be something we can all do to improve our mental health. Self care is more than just bubble baths; it includes look after our physical health, changing our diet or doing something like volunteering which gives us a sense of purpose. Have you tried self care before? Let me know in the comments if you think it worked for you!

References:

Deegan, P.E., 2005. The importance of personal medicine: A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health33(66_suppl), pp.29-35.

https://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-problems-introduction/self-care/#.WzPZQEgvy00

Shapiro, S.L., Brown, K.W. and Biegel, G.M., 2007. Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and education in professional psychology1(2), p.105.

image reference: Sacha Chua via http://ryersonian.ca/a-post-election-guide-to-self-care/

Advertisements

Not Ill Enough

Imagine living with depression. It affects every aspect of your life, from your work to the time you spend with your family. You experience intrusive negative thoughts. You begin to suffer from insomnia, which in turn increases feelings of anxiety. Imagine living with depression, but being told you are not ill enough to qualify for mental health treatment.

This scenario is unfortunately far too common in those seeking help for mental illness. Adult mental health services are often only able to treat the most severely ill, with their treatment focus on those with severe and enduring mental illnesses, such as psychosis or bipolar disorder (McGorry, 2007). This has led to strict eligibility criteria to be put in place when assessing whether someone is suitable to be cared for at their service, something thought to be in part due to a lack of funding and resources (Belling, 2014). If someone visits A&E with a broken arm we don’t wait for it to get worse before we treat it, so why does this happen if someone goes to their doctor with signs of an eating disorder? A recent investigation by the British Medical Associate found waiting lists of up to 2 years in some parts of the UK, (BMA, 2018). Once again this shows the disparity between our attitudes to physical vs mental healthcare.

According to the eating disorder charity BEAT, some people had to wait an average of 182 days to access care in some areas of the UK. This is despite all evidence pointing to the advantages of early intervention: an individual with an eating disorder is 50% less likely to relapse if they can access treatment early. Treatments have also been shown to be more effective if accessed at an early stage (BEAT, 2018).

beat

This problem isn’t just specific to the UK – one study of carers with mental illness in Australia found that they had to push for their relatives to access appropriate care, with one of the main barriers being that they were not ill enough to be admitted to hospital for their mental health, in some cases despite being suicidal (Olasoji, 2017). Another study looked at the treatment gap in different countries (the percentage difference between the numbers needed treatment and those receiving treatment for it) and found the treatment gap for major depression to be between 36% in the Netherlands to 73% in Finland (Kohn et al, 2004). The international nature of this disparity in mental health care shows how global attitudes to mental illness need to change to allow people to access appropriate treatment as soon as they need it.

Young people can also experience disruption to care due to not meeting the eligibility thresholds in adult services, despite being eligible in the children’s service. In contrast to adult mental health services having high thresholds for care, those at children and adolescent mental health services can be much lower. Children’s services are generally perceived as being more supportive and nurturing than adult services, with a focus on treating emotional and developmental disorders, including autism and ADHD (McGorry, 2007). However this means that when young people reach the upper age limit of children’s services (at around 16-18 years old), they cannot be transitioned to adult care, as they do not meet the eligibility threshold. Therefore at this transition boundary, young people can ‘fall through the gap’ between services despite still being unwell. One study in Ireland estimated that two-thirds of young people do not receive a referral to adult services, despite still being unwell when they reached the upper age limit of children’s services (McNicholas et al, 2015). Those who do receive a referral can still experience a gap in care: adult services can have waiting lists of up to 6 months (Hovish et al, 2012).

It is clear that something needs to change to ensure that people with mental illness are able to access timely and appropriate support, without having to wait for their condition to get worse in order to qualify for treatment.

Please share and let me know your thoughts using the hashtag #MHAW18 and help raise awareness.

 

References:

image reference: https://www.beateatingdisorders.org.uk/early-intervention-strategy [accessed 13/05/18]

Belling, R., Mclaren, S., Paul, M., Ford, T., Kramer, T., Weaver, T., Hovish, K., Islam, Z., White, S. & Singh, S. P. 2014. The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services. Journal of health services research & policy, 19, 169-176.

https://www.bma.org.uk/news/2018/february/the-devastating-cost-of-treatment-delays %5Baccessed 13/05/18]

Hovish, K., Weaver, T., Islam, Z., Paul, M. & Singh, S. P. 2012. Transition experiences of mental health service users, parents, and professionals in the United Kingdom: a qualitative study. Psychiatric rehabilitation journal, 35, 251.

Kohn R, Saxena S, Levav I, Saraceno B (2004). The treatment gap in mentalhealth care. Bulletin of the World Health Organization 82, 858-866

McGorry, P. D. 2007. The specialist youth mental health model: strengthening the weakest link in the public mental health system. Medical Journal of Australia, 187, S53.

McNicholas, F., Adamson, M., Mcnamara, N., Gavin, B., Paul, M., Ford, T., Barry, S., Dooley, B., Coyne, I. & Cullen, W. 2015. Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland. Irish Journal of Psychological Medicine, 32, 61-69.

Olasoji, M., Maude, P. and McCauley, K., 2017. Not sick enough: Experiences of carers of people with mental illness negotiating care for their relatives with mental health services. Journal of psychiatric and mental health nursing24(6), pp.403-411.

 

Gut Microbiomes and Mental Health

One exciting and emerging field of mental health research which is gaining in popularity is the relationship between microbiomes in our gut, and our mental health. Our gut microbiome contains up to 1 trillion bacteria, as well as viruses and fungi, which form a kind of ‘eco-system’. Our microbiome begins forming after birth, and can be influenced by factors such a environment, diet, travel, hormones and illness (D’Argenio & Salvatore, 2015). It is crucial in digestion and our immune system, and recent research suggests that having a healthy microbiome is important for a healthy brain and nervous system (Foster & Neufeld, 2013).

Research into the link between the gut and brain (known as the microbiota-gut-brain axis – see image below) has found links between dysfunction in the microbiome and mental illness such as depression and anxiety (Foster & Neufeld, 2013).

Gut-Brain-axis

For example, one study carried out at Stellenbosch University compared the gut microbiomes of people with and without Posttraumatic Stress Disorder (PTSD) after experiencing a traumatic event. They found that three bacteria were different in people who did and did not have PTSD, with those with PTSD showing lower levels (Hemmings et al, 2017).

Lots of research in this area has also been carried out using mice, which has shown that the microbiome can directly affect behaviour. For example, one study transplanted bacteria from mice who had high anxiety to mice who had low anxiety. The mice who had received the transplant then started to show symptoms of anxiety (Bercik et al., 2011a).

The interaction between the gut and brain can also work the other way, as stress and emotions can influence the microbiome via the hypothalamus–pituitary–adrenal (HPA) axis (Montiel-Castro et al., 2013). The HPA axis is involved in cortisol production and controls our immune system. Stress results in increased inflammation, which impacts the equilibrium of the microbiome which can lead to diseases, allergic reactions or risk of infection (Glaser & Kiecolt-Glaser, 2005).

This field of research could influence therapies for mental illness, with anxiety and depression treated by interventions targeted to alter the microbiome, as well as traditional drug or talking therapies. What are your thoughts about this new branch of medicine? Let me know in the comments below!

 

References:

Bercik, P., Park, A. J., Sinclair D. Khoshdel, A., Lu J. Huang, X., Deng, Y., Belnnerhassett, P. A., et al. (2011a). The anxiolytic effect of Bifidobacterium longum NCC3001 involves vagal pathways for gut–brain communication. Neurogastroenterol. Motil. 23, 1132–1139.

D’Argenio, V. and Salvatore, F., 2015. The role of the gut microbiome in the healthy adult status. Clinica Chimica Acta451, pp.97-102.

Foster, J.A. and Neufeld, K.A.M., 2013. Gut–brain axis: how the microbiome influences anxiety and depression. Trends in neurosciences36(5), pp.305-312.

Glaser, R., and Kiecolt-Glaser, J. K. (2005). Stress-induced immune dysfunction: implications for health. Nat. Rev. Immunol. 5, 243–251. doi: 10.1038/nri1571

Hemmings, S.M., Malan-Müller, S., van den Heuvel, L.L., Demmitt, B.A., Stanislawski, M.A., Smith, D.G., Bohr, A.D., Stamper, C.E., Hyde, E.R., Morton, J.T. and Marotz, C.A., 2017. The microbiome in posttraumatic stress disorder and trauma-exposed controls: an exploratory study. Psychosomatic medicine79(8), pp.936-946.

Montiel-Castro, A.J., González-Cervantes, R.M., Bravo-Ruiseco, G. and Pacheco-López, G., 2013. The microbiota-gut-brain axis: neurobehavioral correlates, health and sociality. Frontiers in integrative neuroscience7, p.70.

image reference: https://www.nature.com/news/the-tantalizing-links-between-gut-microbes-and-the-brain-1.18557

Time to Talk Day 2018

Today, February 1st, is Time to Talk day in the UK. This campaign aims to reduce the stigma and discrimination around mental illness, and encourage people to talk about their mental health.

Days like today which aim to raise awareness of mental health problems are important to change the conversation around mental health. By raising awareness they also highlight the problems of funding and resources: mental illness is still not treated with the same importance as most physical health problems, with some people left on long waiting lists to access care (e.g. Hovish et al 2012).

These statistics reproduced from Mental Health UK show the scale of the global burden of mental illness:

  • Mental health problems are one of the main causes of the overall disease burden worldwide.
  • Mental health and behavioural problems (e.g. depression, anxiety and drug use) are reported to be the primary drivers of disability worldwide, causing over 40 million years of disability in 20 to 29-year-olds.
  • Major depression is thought to be the second leading cause of disability worldwide and a major contributor to the burden of suicide and ischemic heart disease.
  • It is estimated that 1 in 6 people in the past week experienced a common mental health problem.

Did anything surprise you? If an estimated 1 in 6 people are currently experiencing a problem with their mental health then why is it still not something we feel we can talk about openly? By joining in the conversation, you can make a difference in how mental illness is perceived and help reduce the stigma. Talking about mental health can also make a big difference to people struggling with mental illness at all stages of their recovery.

thunderclap-image

If you’re interested and would like to find out more then click here to access their website.

One of the great features about the website is that it contains clear advice on what to do if you think a friend, colleague or family member is struggling with their mental health. If you’re worried about someone and would like some help then follow this link to find out more: https://www.time-to-change.org.uk/about-mental-health/support-someone

Thanks for reading – if you liked this post then please share, with the hashtag #timetotalk

 

References:

https://www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwide

Hovish, K., Weaver, T., Islam, Z., Paul, M. and Singh, S.P., 2012. Transition experiences of mental health service users, parents, and professionals in the United Kingdom: a qualitative study. Psychiatric rehabilitation journal35(3), p.251.

Effects of Sleep Deprivation

How are you feeling today? If you’re anything like me and my friends the answer might well be ‘tired’. In modern society it can seem as though everyone is trying to cram as much as possible into their day, with work, family commitments, studying, exercising and fitting in a social life. This coupled with increased smart phone use (hands up if you scroll through Instagram before you go to sleep..), especially in the evenings can lead to people just not getting as much sleep as they should be.

Sleep deprivation is defined as having less that 7-8 hours of sleep a night for adults (Colten, & Altevogt, 2006). However, a recent survey in the UK found that 70% of adults say they sleep for less than 7 hours each night and over 25% said they regularly slept badly (Sleepcouncil.org.uk).

In today’s society it appears to be normal to be sleep deprived. What effect is this having on our mental health?

2017-05-15-Sleep-deprivation-and-your-body-1

Perhaps unsurprisingly, sleep deprivation has been shown to impair our ability to focus. Studies which have examined the effects of sleep deprivation on driving and found participant’s ability to stay in lane was as impaired as a group who were over the legal alcohol limit (Fairclough & Graham, 1999).

Another study looked at the effects of sleep deprivation in students and found that those who had gone without a night of sleep performed significantly worse at a cognitive task than those who had 8 hours sleep the night before (Pilcher & Walters, 1997). Interestingly, the sleep deprived participants in this study rated their performance on the task as higher than those who weren’t sleep deprived! This suggests that when we’ve not slept enough we might not always realise the effect it can have on our performance the next day.

As well as affecting your ability to focus, sleep deprivation has the largest effect on mood (Pilcher & Huffcott, 1996). One study asked participants to go without two nights of sleep, and compared scores on a personality trait questionnaire at baseline and again after they had been awake for 56 hours. When they were sleep deprived, participants showed higher scores of anxiety, depression and paranoia (Khan-Greene et al 2007). Another study has shown than just losing one night’s sleep can increase anxiety scores (Sagaspe et al, 2006). These research suggests that going without sleep can affect the parts of your brain involved in mood regulation such as parts of the prefrontal cortex.

For tips on how to improve your sleep – the full report by the Sleep Council has some useful tips (and more surprising stats) here: https://www.sleepcouncil.org.uk/wp-content/uploads/2013/02/The-Great-British-Bedtime-Report.pdf

 

References:

Colten, HR.; Altevogt, BM. Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: The National Academies Press: Institute of Medicine; 2006.

Fairclough, S.H. and Graham, R., 1999. Impairment of driving performance caused by sleep deprivation or alcohol: a comparative study. Human Factors41(1), pp.118-128.

Kahn-Greene, E.T., Killgore, D.B., Kamimori, G.H., Balkin, T.J. and Killgore, W.D., 2007. The effects of sleep deprivation on symptoms of psychopathology in healthy adults. Sleep medicine8(3), pp.215-221.

Pilcher, J.J. and Huffcutt, A.I., 1996. Effects of sleep deprivation on performance: a meta-analysis. Sleep19(4), pp.318-326.

Pilcher, J.J. and Walters, A.S., 1997. How sleep deprivation affects psychological variables related to college students’ cognitive performance. Journal of American College Health46(3), pp.121-126.

Sagaspe, P., Sanchez-Ortuno, M., Charles, A., Taillard, J., Valtat, C., Bioulac, B. and Philip, P., 2006. Effects of sleep deprivation on Color-Word, Emotional, and Specific Stroop interference and on self-reported anxiety. Brain and cognition60(1), pp.76-87.

https://www.sleepcouncil.org.uk/wp-content/uploads/2013/02/The-Great-British-Bedtime-Report.pdf

Resilience – innate or acquired?

Hi everyone, and Happy New Year! I’m back after having a few weeks off blogging, and plan to stick to my schedule of 1 post a week in 2018 (usually posted on Thursdays, 4pm GMT).

To start off this year, I thought I’d talk about a concept in psychology which is being applied more to mental health – resilience. Whilst the idea of something being resilient probably isn’t new to you, you may not be aware of how people can be resilient, and what the benefits are of this personality trait.

In psychology, resilience means that someone is able to cope and adapt to difficult life events or stressful situations such as serious health problems or losing their job. It is therefore able to protect against negative outcomes of the stressful event and enable individuals to ‘bounce back’ quicker.

The protective factor model of resilience states that a protective factor such as social support, or self-esteem, interacts with the stressor to reduce negative outcomes such as anxiety or depression (O’Leary et al, 1998). People who have higher levels of social support are more likely to cope with stressful situations, with one study showing that social support moderated the effect of stress on depression scores (Pengilly & Dowd, 2000). Another well-studied protective factor is hardiness, which was identified by Kobasa in 1979. He compared personality traits in executives, and compared who did or did not get ill after stressful life events. He found that those who did not get ill showed more hardiness, which he defined as having a ‘commitment to self’ – an active participation in activities and the outside world; an ‘internal locus of control’ – the idea that you are in control of events that happen to you; and a sense of meaningfulness.

resilience-3
image from https://help4hd.org/on-being-resilient/

As resilience has been shown to have several protective factors on stressful life events, there has been some debate about whether resilience can be taught to improve how people cope, and therefore improve their mental health. One study carried out in college students compared scores on stress levels between a control group and a group who received a resilience intervention (Steinhardt & Dolbier, 2008). The intervention focused on teaching problem solving, coping strategies and awareness of the different responses to stress. Participants in this group were also encouraged to take responsibility and self-leadership (actions coming from the self). Results showed that the group that took part in resilience training had higher resilience scores and scores of protective factors such as self-esteem. They also showed more effective coping strategies and lower scores on tests assessing depression and stress than the control group who did not receive the intervention. This effect was found with only 4 2-hour teaching sessions, showing that resilience can be taught in a relatively short space of time.

Several other studies have shown that resilience can be taught, something which is now gaining in popularity and can be applied to several populations from students to soldiers. Healthcare professionals are also taught resilience techniques as a way of coping with long term stress in emergency situations (McAllister & McKinnon, 2009).

There are some things you can try if you want to improve your resilience. Taking a break, using your support network, and looking after your physical health are all things which could improve how you cope with pressure or stressful situations. For more information on these tips and more, check out Mind.org’s advice here.

 

References:

O’Leary, V.E., 1998. Strength in the face of adversity: Individual and social thriving. Journal of Social issues54(2), pp.425-446.

Pengilly, J.W. and Dowd, E.T., 2000. Hardiness and social support as moderators of stress. Journal of clinical psychology56(6), pp.813-820.

Kobasa, S.C., 1979. Stressful life events, personality, and health: an inquiry into hardiness. Journal of personality and social psychology37(1), p.1.

Steinhardt, M. and Dolbier, C., 2008. Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. Journal of American college health56(4), pp.445-453.

McAllister, M. and McKinnon, J., 2009. The importance of teaching and learning resilience in the health disciplines: a critical review of the literature. Nurse education today29(4), pp.371-379.

Why do we dream?

Have you ever stopped to wonder why we dream at night? From sweet dreams to recurring nightmares, our mind is rarely silent – regardless of whether we can really remember their content in the morning.

Sometimes, we find our dreams are linked to things going on in our lives right now, worries about future events or strong memories from the past. This therefore seems to suggest that dreams are in some way linked to our memory, but exactly how, no one seemed sure.

Recent research has investigated the role of dreams and REM sleep (the phase of deep sleep) in the consolidation of long term memory. Consolidation just means the process whereby our memories move from short term to long term storage. In our long term memory, memories are stored for recall. Rehearsal (thinking about) these long term memories briefly involves short term processing, and this rehearsal strengthens the storage of these memories. Dreams may play a part in this consolidation and rehearsal process.

To find out more about REM sleep and our sleep cycle then why not read my previous post here.

151112_DRIFT_Dream-Research.jpg.CROP.promo-xlarge2

Photo by clownbusiness/Shutterstock, with additional illustration by Lisa Larson-Walker

As I mentioned early, our dreams can have similarities to events which have taken place in our lives. Some research has focused on investigating the content of our dreams and found that the events which tend to be included in our dreams are ones which are rated as more emotional, although not more stressful, than those not incorporated (Malinoski & Horton, 2014). This suggests that REM sleep might help to process emotional memories. Further evidence to support this hypothesis is that levels of REM sleep are lower in people with depression (Cartwright, 1983) and PTSD (Ross et al, 1989).

However, although these dreams can contain elements of real life, they are often distorted: it is rare for the complete memory to be ‘played out’ in our dream. It is been suggested that this is because during sleep we cannot access full episodic memories (memories of events) but instead just traces of them.  This has been hypothesised to be due to reduced hippocampus (the part of our brain involved in memory processing) activity during REM sleep (Buzsàki, 1996). The fact that our dreams can contain strange events or impossibilities is thought to be due to a lack of activity in the prefrontal cortex – the area involved in attention and logic (Stickgold et al, 2001).

In addition to consolidating episodic memories another proposed function of our dreams is to enhance learning of procedural tasks (Smith et al, 1996). Studies in rats have found increased levels of REM sleep after procedural learning, and that less REM sleep resulted in poorer memory (Smith et al, 1985).

Whilst REM sleep and our dreams may be useful for certain types of memory consolidation, it doesn’t mean that this is the only way consolidation takes place, or that it is needed to consolidate every type of memory (Stickgold et al, 2001). The authors of this review hypothesize that dreaming enables the brain “to identify and evaluate novel cortical associations in the light of emotions… during REM”. To put it simply, when we dream our brain is working on processing new memories, learning procedures, and our emotions to events.

 

Seasonal Affective Disorder

It’s that time of year – the clocks have gone back, it’s cold, and already getting dark on our commute home. Whilst many people moan about this time of year, for some it can trigger symptoms of low mood and depression.

Seasonal Affective Disorder is defined as “a type of depression that comes and goes in a seasonal pattern.” (NHS Choices). It’s typically worse from December to February, getting better in spring and summer. For SAD to be diagnosed, there has to be clear evidence of worsening symptoms during winter, which can’t be explained by other circumstances (DSM-IV). In addition, there needs to be evidence for part or full remission during the summer months. Symptoms of SAD are similar to those of depression: low motivation and self-esteem, sleep problems, changes in appetite, withdrawing from social interactions and persistent negative thoughts.

Medicap-Pharmacy-sad

Estimates of the prevalence of SAD range from 0 – 9.4% of the population, depending on who is being studied (Magnusson, 2000). One study compared rates of SAD at 4 different latitudes in the USA and found that is was most common in the northern latitudes (Rosen et al, 1990), which would be expected as SAD can be triggered by lower levels of natural light. This study also found higher rates of SAD in females than males (this finding is in line with overall levels of depression between men and women). It is thought to be caused by the lack of sunlight in winter months disrupting our circadian rhythm, which can be described as our internal body clock. This can affect the serotonin system in the brain, which is responsible in part for mood regulation.

There are various different treatment options for SAD, including light therapy, cognitive behavioural therapy, or antidepressants (Lurie et al, 2006). I’ve spoken about CBT before on this blog (see here for more information), so today I’ll just focus on light therapy and antidepressants as treatments for SAD.

sadimage

Light therapy involves sitting by a specialised lamp, which emits a specified wavelength and brightness of light (at least 2500 lux). It is thought to work by encouraging the brain to produce serotonin – a neurotransmitter which is linked to feeling happy. Sitting by a lamp for 30 minutes to an hour each morning is the recommended ‘dose’ of light (NHS.uk). One meta-analysis has shown that light therapy is as effective as drug therapy in treating SAD (Golden et al, 2005).

Some antidepressants also work by increasing our serotonin levels. Known as SSRIs (selective serotonin reuptake inhibitors), they work by stopping as much serotonin from being reabsorbed at synapses in the brain and therefore leading to an increase in our mood. For antidepressants to be optimally effective in SAD, the NHS recommend starting to take them before winter and continue until spring.

 

Prevention is better than cure – Youth Mental Health in the UK

In Theresa May’s recent speech to parliament she stated that she wanted to end the stigma of mental illness and improve the state of mental healthcare in the UK. As a researcher into mental health services for children and adolescents, I hear often about the struggle parents have to get an appointment for their child to be seen by a psychologist, or the problems they face when care ends at 16-18, without the smooth transition to adult services enabling continuity of care.
Whilst it is vital that more money is spent on the NHS as a whole (recent talks of ‘crisis’ in A&E departments shows the obvious need for more resources), money which is promised to mental health services cannot be diverted to other areas which are struggling. These areas are definitely important, but they should not be funded to the detriment of youth mental health services.
Research by Young Minds (2014) found that 77% of NHS Trusts who responded had cut or frozen their Child and Adolescent Mental Health Service (CAMHS) funding between 2013 and 2015. Significantly, demand for these services increased over this time. This increase reflects a general trend over the last 20 or so years, for example the number of 15-16 year olds with depression nearly doubled between the 1980s and 2000s, and the number of young people being admitted to hospital for self harm has gone up by a massive 68% in the last 10 years (http://www.youngminds.org.uk/training_services/policy/mental_health_statistics).
Current services do not meet the need for care, with up to one in every four or five teenagers thought to have a mental illness. In a typical school, this would be around 3 in each classroom in the UK. With 75% of mental illness having an onset before the age of 24 (Kessler et al, 2005), it is vital that young people can access the services they need during this critical time in their development.
getimage-aspx
 
As mentioned above, care at CAMHS often ends when a young person is between the ages of 16 and 18. There are separate services for children and adults (CAMHS, versus AMHS) and this can represent a significant disruption of care. Young people have to move to a new adult service, in a new location and form a relationship with new healthcare professionals.  Previous research has found that only 4% of patients experienced an optimal transition (Singh et al 2010). Problems identified included a shortfall in time spent planning for transition, inadequate information transfer, and poor continuity of care. There may not even be an appropriate adult service in the local area which the young person can move to, for example in the case of autism or attention deficit disorder.
I am a researcher on the Milestone Project, an EU funded study currently investigating transition in nine different countries in Europe. My role involves interviewing young people and parents about their experiences of mental health services in the UK, and following them up over a period of time to see what happens to them when they leave CAMHS. The results of this study won’t be ready for some time, however it is clear to me that more needs to be invested into improving access for young people to mental health services.

Behavioural Activation

This week’s post is about a technique used as part of cognitive behavioural therapy for people with depression. As you probably know already, symptoms of depression include low mood, low self-esteem, feelings of anxiety and helplessness, and having low motivation and interest in activities which they previously enjoyed.

Behavioural activation focuses on the ‘B’ of the CBT model, in this case on the last symptom in particular – the withdrawal from usual activities and friends. For example, they may start to avoid social engagement and ignore invites from friends or make excuses as to why they can’t meet up, whereas before they would have been happy to go. Although in the short term this avoidance causes a temporary relief, such as a lowering of anxiety, it simply reinforces feelings of low mood or low self-esteem. This maintenance of the condition is illustrated by this diagram below:

Screen Shot 2016-07-28 at 19.49.10

Therefore, in order to break this cycle, behavioural activation aims to change the unhelpful behaviours which continue the cycle of low mood. It does this by gradually building up activities that the person can do, which is turn will improve their mood, and lead eventually to them getting back to activities they used to enjoy. This progression is important, as the change in mood is needed before larger behavioural changes can occur.

Key features of Behavioural Activation are as follows (taken from Jacobson et al, 2001):

  • Firstly, the model is presented to patients by their clinician, who explain a bit about it and why it works. This is called a treatment ‘rationale’ and it is important for the patient to feel confident that this will work. A good relationship and trust with the therapist is also important.
  • Developing treatment goals through collaboration between the patient and the therapist – these goals are new behaviours rather than moods or emotions.
  • Analysis of causes and maintenance factors of the depression
  • Graded task assignment – e.g. starting with something small such as walking to the corner shop. This is scheduled in between sessions, and a hierarchy is discussed with the therapist.
  • Establishing a routine, in the hope this results in improved mood.

Ultimately, the aim of Behavioural Activation is to help the patient re-engage and find joy in activities which they have been avoiding. This will raise mood, and therefore help someone recover from depression.