He's just not that into you...

New research, conducted by the Time to Change campaign, has found that a partner is four time more likely to leave you because of a mental health condition like depression than because of a physical disability.

Attitudes to severe mental illnesses like schizophrenia are even worse. The survey, which asked people about issues that would make them break off a romantic relationship found that 20 per cent of British women wouldn’t stay with someone if they were diagnosed with schizophrenia, yet only per cent of them would break up with someone who became disabled and needed to use a wheelchair.

Dave Stocks, who had a breakdown and gets depression, says: “I think people do feel awkward when they know you have a mental, rather than physical illness. They’re embarrassed, don’t know what to say to you. Some of my mates reacted like that. But Jools, my girlfriend, she’s been great. We’ve been through some tough times together, but even in my darkest days she stood by me. It can be hard though – I told her it might be easier for her if she didn’t tell her friends about my problems, just to make life easier. We both know that mental health conditions are stigmatised, but it hasn’t stopped us. Being able to be open about it has actually helped my recovery. We’re strong and happier now than ever, having been through this together”

Stuart Baker Brown, who has been diagnosed with schizophrenia says: “I have been well for a few years now and made a good recovery, but the stigma attached to having a schizophrenia diagnosis still follows me around. Dating can be hard at the best of times, but it can be even harder when you’re facing outdated attitutdes about mental health conditions. I met one woman, and everything was going well, we planned to meet up for a date. Then she found out about my diagnosis before I had a chance to tell her and that was it – she just didn’t turn up. I later discovered she was worried about her children. She’d assumed I might be dangerous. She was wrong, the idea that someone is going to be a danger just because they have had schizophrenia is a myth. It was really hurtful. I’ve met somebody new now, and she sees the real me, not just the label. Thankfully some people can see through the stigma and see the person”.

Time to Change is England’s most ambitious programme to end the discrimination faced by people with mental health problems, and improve the nation’s wellbeing. Led by Rethink, Mind and Mental Health Media and backed up with £16m from the Big Lottery Fund and £2m from Comic Relief. The campaign has a string of celebrity supporters, such as Alastair Campbell, Stephen Fry, Ruby Wax and Patsy Palmer – all of whom have experienced mental health problems. It also has the backing of Gordon Brown, David Cameron and Nick Clegg.

Cash for recession depression

The Government has allocated an extra £13m to therapy services for people who are suffering from depression because of the impact of the recession on their lives.

The mental health charity Mind welcomed the extra funding and said there had never been a more important time to invest.

Mind's Chief executive Paul Farmer told BBC News: "Redundancy and money worries put strain on family relationships, cause sleepless nights, trigger stress and increase the risk of developing depression.

"When it comes to the scale of the current recession we are in uncharted territory about how many people could be affected.

"We must learn from the mistakes of past recessions where people lost their job, their confidence and their self esteem leaving them unable to return to the workforce."

Paul Corry, from the mental health charity Rethink, said: "One in four of us is going to experience a mental health problem at some point in our lives.

"We know from history that recessions, depressions and economic troubles bring on mental health problems in people."

Shadow Health Secretary Andrew Lansley said: "We welcome this announcement, not least because we called for these measures to be introduced last year.

"Yet again we see that where the Conservatives lead, the government follows."

I wouldn't go as far as agreeing with the Tories, but I do agree that this is a positive move - I recently wrote a feature about the increase in mental health problems that have been a consequence of the credit crunch, and I am glad that this is being acknowledged by the Government.

Work and mental health

As the recession deepens in Britain, a huge rise in the number of people with mental health conditions has been predicted. Stigma and lack of support in the workplace means people are losing jobs or being refused work at the time when they need them most, and recent Government welfare reforms could complicate things further for those in mental distress. Gemma Pritchard reports.

“The mentally ill are an easy target. Despite the fact 1 in 4 people have a mental health condition, only sufferers and their families understand what it’s like, because you can’t see their symptoms or their distress.”

“The Great British public get whipped up into a frenzy about the idea of people unfairly claiming money from the state, which means people with mental health problems become a target – we are classed as workshy and useless. Our illnesses may not be visible at all or take socially unpleasant forms, so we end up being doubly ostracised. There is a huge amount of hostility.

“The paradox is that people with mental health conditions do want to work, but often people won’t employ them, which says a great deal about the insecurity of employers,” says Chris Danes, 47, from Essex.

Chris has Bipolar Disorder (Manic Depression). His condition has meant that 11 years ago he was forced to leave a successful career in teaching as a Deputy Head of a public school, after a serious episode of the illness. Chris is one of millions of people in the UK who have found that a mental health condition has become a massive barrier to their employability and career. Chris has been able to continue to earn a living by writing books from home and doing some media work about his experiences. But Government research shows others are less fortunate, and many people in the UK with psychological problems fall into a benefit trap which is then very difficult for them to get out of.

At the end of last year, the Government announced a package of welfare reforms intended to get people on benefits back in to work. This includes the introduction of the Work Capability Assessment which will push people on benefits onto Jobseeker’s Allowance, placing emphasis on the responsibility of the individual to find work. But a growing body of evidence suggests that employers are not willing to take on people who have experience of a mental health condition, and they are failing to provide staff with adequate mental health support.

As the recession deepens, this problem can only get worse, with unemployment currently around the 2 million mark, and increased anxiety amongst employees about their future. The Conservative party predicted in November that we will see a massive 26 per cent increase in the number of people experiencing mental health problems by 2010 as a direct result of the economic crisis in Britain. And for people already struggling with mental distress, debt will only make their problems worse.

A poll by mental health charity Mind found that 58% of people had to leave a job because of lack mental health support, 31% had been sacked or forced out of a job after disclosing a mental health problem and 26% had been demoted after disclosing a mental health problem. Even more worryingly, 1 in 4 had job offers withdrawn after disclosing a mental health problem, which is illegal under the Disability Discrimination Act. Yet they found themselves powerless to do anything about it.

Over 200,000 people with mental illnesses move from work onto benefits each year. Although one review has found 9 out of 10 people with mental distress still want to work, Government research has shown that less than 4 in 10 employers would be willing to take them on.

Chris has experienced first-hand the gung-ho attitude of employers who are unwilling to accept a mental health condition as a legitimate reason for sick leave.

“When I was ill and off work for six months,” he says, “no-one from the school visited or came for a meeting with me. My ex-wife, herself a doctor, was bombarded with phone calls from my fellow deputy saying ‘he’s just got to get back’. As in many boys’ schools of its time, it was ‘sink or swim’ for the boys and the staff. Thus medical evidence and doctors’ opinions were overridden. I was made to feel that it was a moral failure.”

The major mental health charities in the UK, which include MIND, Rethink and the Sainsbury Centre, have battled workplace discrimination for many years. Julia Lamb, spokesperson for MIND says: “There remains a long-term stigma and discrimination around people with mental health issues.

“In the workplace, this can translate as anything from problems applying for jobs in the first place, being turned away from jobs, and even cases where people who have been made a job offer disclose a diagnosis and then have the offer withdrawn. There are off course long-term problems too, such as if they get the right support when they are in a job. It can be a massive barrier.

“Of course, there are people who are lucky enough to have employers who are willing to make adjustments to help them and take their needs in to account, for example if someone is taking medication which makes them slow in the morning, an employer could say they can start work a bit later.

“Generally though, there is a lack of awareness in the workplace about mental distress and people don’t get the support they need. This can put a lot of stress on people, and they may have to take time off sick from work. The problem is the longer they are away from work, the harder it is for them to return and get back into it, because they lose their confidence. There are also incidents where people have been off sick for so long that they get sacked.”

MIND are supportive of the Government’s ‘fit note’ scheme, but remain cautious of how it should be implemented. The idea is that instead of ‘sick notes’ people will be assessed for ‘fit notes’, where their doctor will liase with their employer to tell them what they are capable of doing at work. This should raise retentions rates, with people working at a reduced capacity until they are well enough. The idea has caused a lot of noise and even outrage, but MIND say they are for anything that supports people who want to remain in employment.

“It is more complex than that though,” says Julia. “In some cases, it might have been their job which caused the problem in the first place. There are also concerns over whether GPs will have the ability to say what people are capable of- mental health problems aren’t as tangible as physical health conditions – someone may be physically capable of working a 40 hour week, but psychologically can’t cope with the stress. GPs aren’t psychologists or occupational health experts, and for this to work they will need a lot of training and a great deal of sensitivity when making their assessments.”

Dr Jed Boardman, from the Royal College of Psychiatrists adds: “The Welfare Reform Bill is seemingly designed to combat the workshy, currently in the unreformed benefits system.

But it encompasses a large number of people with a range of mental health problems, many of whom want to work and with the right kind of support could be helped in to work.

“It is crucial that the systems to support people in to work are fair, adequately resourced, and based on evidence of what works for people with mental health problems. As psychiatrists, a key role of ours is to help in the recovery of people with mental health problems and help break down the barriers to social discrimination.”

The Government at present remain optimistic about the benefits of the new welfare reforms and argue that we are in a good position to provide people with the support they need, both in and out of the workplace. Public Health Minister, Phil Hope MP, says: “We are building stronger links between the NHS and employment services, to give people integrated support if their depression is linked to unemployment.

“Our programme for expanding psychological therapies has set up 35 new services in 35 PCTs this year and training more than 1,100 people to deliver cognitive behavioural therapy. More services will come on stream over the next two years.

“We are also piloting Employment Advisors in 12 of the 35 new talking therapy services. This will test whether integrated services like this can help prevent people losing their jobs and help people return to work as soon as possible.”

Despite this, there is no question amongst mental health professionals that these new reforms will provide significant challenges for them and their medical colleagues.

Professor Sally Hardy, Head of Mental Health & Learning Disabilities at City University says: “Mental health care professionals, working from a recovery approach, aim to support and enable survivors to regain their sense of self worth and their place in the world, but at a level that feels right for each individual. Using such a person-centred approach can work well alongside the ‘Fit Note’ scheme, as long as it is focusing on what people can achieve rather than on what they cannot offer.

“However, training GP’s to work with people to identify their strengths is a new technique for the consulting rooms that will take more time than many GP’s are able to offer. Many people experience their GP as hardly someone they can collaborate with and share knowledge, but rather as a one-sided diagnostic procedure. The new fitness scheme will certainly take some getting used to, but if implemented with adequate resources could prove beneficial to mental health care sufferers and survivors seeking employment opportunities, as they offer some valuable insights into what it means to be vulnerable and human in a tough world.”

Today's big health stories...

1. Cheap alcohol fuelling health crisis in Scotland

It has been revealed the World Health Organisation (WHO) figures that half of men and 30% of women in Scotland drink to excess. The country has the fastest growing rate of cirrhosis.
Alcohol misuse is estimated to cost Scotland £2.25bn per year in extra services across the NHS, police, courts, social services and lost economic productivity. The availability of cheap alcohol in supermarkets has been flagged up as a possible cause.

2. Mental health taboo

Research shows that coming out as being gay is easier than admitting to a mental health condition.

A survey commissioned by the Time to Change campaign, found that of 2,000 people across Britain, almost 30% said they would find it difficult to admit publicly to having a mental illness, compared with 20% who said they would have difficulty coming out as gay. Admitting to a mental health condition was also deemed harder than admitting to a drink problem or going bankrupt.

About a third of respondents believed someone with a mental health problem couldn't do a responsible job.


3. Start the obesity battle as early as possible

Department of Health officials have asked experts to develop ways to test children as young as two to determine if they are becoming overweight.

Tam Fry, Chairman of the Child Growth Foundation, said it was crucial to be monitoring the weight of children.

He told the Daily Mail: "One reason we have an obesity problem is that for 25 years we have consistently failed to monitor children and their increasing wirght from pre-school, such that we now hat 20 per cent overweight or obese at school."

4. Peanut allergy cure

Good news for sufferers of peanut allergies. In a world first, doctors have managed to cure children with severe forms of the allergy, by using a form of desensitisation treatment.

Doctors at Addenbrooke's hospital, Cambridge gave four children tiny doses of peanut flour every day, gradually increasing the dose. They can now eat ten or more nuts a day.

Previously the children would have been at risk of anaphylactic shock or even death if they accidentally ate even a trace amount of peanut.

5. Work pressure behind binge drinking boom?

Britons work hard and play harder, say psychologists. Bottling up our emotions at work leads us to let off steam by drinking a lot at weekends.

Prof van Wersch said (reported in the Daily Mail): 'Young people go out in large groups for the purpose of getting drunk because they have spent all week working hard and bottling up their emotions. It is an adventure. They do not know where the night will take them.'

She added: 'If people didn't have the 'big night out with friends' to look forward to, what would they do and feel like at the end of the week? We don't want a nation on Prozac, do we?'

War, what is it good for...

Yesterday I visited the Wellcome Collection's War & Medicine exhibition. Divided into three parts (organisation, the body and the mind), the exhibition looks at the paradox of war which means that as through history mankind has developed increasingly horrible and effective ways to maim and kill through warfare, so to we have had to rapidly adapt our medicine and health care to try to stem the damage we can do to each other.


Starting at the Crimean War and working through to modern day Afghanistan, the exhibition is an impressive collection of salvaged objects and memorabilia, photography, installation, videos and significantly, a lot of art - the link between art and science is present throughout all of the exhibits at the Wellcome Collection.

Initially, although fascinating, it does not seem like the most uplifting of viewing experiences. But there is, I think, an interesting angle for the optimist who cares to seek it. I was struck by how many of the most important medical developments of the last hundred years or so only came about as a response to the injuries and casualties of war. For example, the Russian's invention of triage as a method of treatment prioritisation during the Crimean War. The first facial reconstructive surgery and skin grafts were carried out during World War I because of the damage done by shell blasts. The extent of ongoing medical problems and injuries as a result of World War Two even led to the creation of the NHS. The horror of war through the ages has forced the medical profession to raise its game and now in the 21st century we are reaping the huge benefits of their discoveries, which save lives.

War has also transformed the way we deal with people's response to stress and trauma. The third and final section of the exhibition is focussed on just this - the injuries sustained by service personnel that although not outwardly visible were no less serious. This section of the gallery is quieter and calmer than the rest, with fewer interesting oddities to examine and an abundance of art and photography, almost all of which is fittingly black and white. There is an emphasis on art as being a release for people who have suffered the psychological horrors of war, and a way to communicate what they perhaps cannot vocalise.

By the end of WWI, the British Army had dealt with over 80,000 cases of shellshock. During the war, there were some medical officers and physicians who argued that shellshock was merely a physical reaction to the shell bursts, characterised by exhaustion, hallucination and insomnia amongst other undesirable symptoms.

Shockingly at that time, those who were incapacitated by this 'shellshock' to such an extent that they didn't feel able to continue fighting, could be accused of 'desertion' or 'cowardice', both of which were punishable by death. Over the years, medical officers began to understand that everyone is susceptible to battle-related stress. As the narrator on one US Army film about the psychological effects of battle says: "Every man has his breaking point." Now we call it Post Traumatic Stress Disorder (PTSD) - a term which can apply to the psychological outcome of any shocking or traumatic event, not just war. War has helped to develop our knowledge of this condition and out therapeutic response to it.

A list in one of the glass cases shows the names of 306 soldiers who were executed by the British Army during WWI for these reasons. I think this is something we now find very hard to swallow. There was an instance in 2005 were there was a prolonged campaign to secure a pardon for Harry Farr, a serviceman executed for cowardice, who had undergone five months of treatment for shellshock only a year before his death.

In 2006 the then Defence Secretary, Des Browne announced a formal pardon. He said: “Although this is a historical matter, I am conscious of how the families…have had to endure a stigma for decades.” The Government went one step further in Nov 2006 and agreed that all soldiers executed in WWI should be given posthumous pardons.

The last part of the exhibition is the most hopeful, and colourful. In 2006 Catherine Panter-Brick, an anthropologist at Durham University, conducted a large scale survey of schoolchildren aged 11-16 in Afghanistan, which aimed to assess their mental health in the context of their direct experience of war. As one part of this the children were asked to draw themselves as they saw themselves now and in the future. These drawings are displayed on the wall here. Though vastly different, they share a common theme – the children may be unhappy now, but the drawings of their future selves reveal optimism, hope and ambition. One Girl, 14, draws herself now collecting scrap plastic in the street for her father to sell to support their family. But she writes of her future, ‘I want to be a painter, newscaster and actress.’ I think the most striking thing about these drawings is they provide a visual manifestation of our ability to heal psychologically after even the most traumatic and horrible events. And it’s that thought that I take with me as I leave the Wellcome Collection.

(NB: The War & Medicine exhibition is a temporary collection which ends tomorrow, so if you want to check it out you need to be super quick. However, the two permanent collections at Wellcome are well worth a look, and I am also looking forward to their next exhibition ‘Madness and Modernity’ , with installations by performance artist Bobbi Baker about her experience of having a mental health condition).

Does our mental health policy work?

The Mental Health Foundation has issued warnings that employers should do more to support the mental wellbeing of their staff after they return to work after sick leave.

A new report has found that many people suffering on returning to work after a period of prolonged absence for both physical and mental illnesses.

The study, which was carried out at Loughbourough University, looked at the role of depression in returning to work after a period of sickness absence across 4 types of chronic illnesses: depression and anxiety, back pain, heart disease and cancer.

Using focus groups with employers and interviews with employees, the Foundation found that poor adjustment to work and continuing exposure to work-related stress may lead to a ‘relapse’ in sickness absence, early retirement or unemployment.

The report shows that almost half (45%) of those with a physical condition experienced mild to moderate depression, but were more worried about telling their employer about their mental health issues than their cancer or heart disease.

This is one of several big stories surrounding work and mental health issues in the media recently. Another example which has caused much debate is Cheltenham Borough Council sueing its former managing director for just under £1m for failing to disclose a history of depression, after she took a period of paid sick leave from her current position. There is a good comment piece by the Guardian’s Clare Allan here.

This case raises important questions of what a person should be obliged to declare on a job description. Was the woman Christine Laird really ‘lying’ by not mentioning that she had suffered three bouts of depression in the last 12 years? I’m sure that many people with sympathise with her for not wanting to reveal this – after all Government statistics have shown that less than 40% of employers would even consider hiring someone with a history of mental health problems. It will be very interesting to see how this one plays out in the High Court over the next few weeks.

Feature writing can be a chore...

...especially when you are constantly battling press officers for a small smidgen of relevant information.

But I'm pleased to report I've had a particularly positive experience this last week whilst writing a feature for my health journalism class about mental health and workplace discrimination. I have found SHIFT, the Department of Health, Rethink, MIND, the Royal College of Psychologists and the Sainsbury Centre all helpful, thoughtful and prompt in their response, even though I was upfront about being a student journalist. I also had interviews with two members of staff at City University, Yasmin Fulder from the Clinical Psychology course and Professor Sally Hardy the newly appointed Head of Mental Health and Learning Disabilities. I will post the feature up here after it has been marked.

I was really glad to have had such a response from these new contacts, as I believe, as you may have noticed from the contents of this blog, that it's really important for health journalists to cover mental health issues. The current economic downturn means we are potentially facing a huge increase in the number of people suffering from a psychological condition. Seeing it written about could be the budge people need to seek the help they need.

Some recommended reading...

Very interesting piece here in the Times today by writer Francesca Okeke about growing up with a mentally ill parent.

While we're on the subject, also worth a look is Horizon's 'How Mad Are You?' on Channel 4 at the moment. Taking a 'reality TV' approach to mental illness, the first episode last Tuesday pulled in nearly 2 million viewers.

The documentary makers put five people with mental illnesses alongside five "normal" people in a house, and challenged experts to identify which was which.

The second part of the investigation is to be aired tomorrow (Tuesday 18th Nov). The first part is available on 4OD online.

The 'last taboo'

Writing about mental health can cause lots of problems for journalists. There are so many stereotypes to bypass; myths, misconceptions, misinformation. The language you use to report them is crucial, and the points you make need to be clear enough to communicate with the vast majority of people who believe that those with mental health problems are dangerous or unpredictable.

Yet, it’s such an important area to report on. So much of the stigma surrounding psychological problems could arguable be traced back to lack of information, or perpetuated negative stereotypes, both of which the media can have a huge influence over.

As a journalism student and freelance journalist, mental health has always been a primary area of interest for me. A key principle for journalists is to look for the human interest in a story – and stories relating to mental health have that in abundance. The prevalence of these problems in modern society means we all know someone who has struggled with depression, anxiety, or even more serious conditions such as schizophrenia and obsessive compulsive disorder. The more unlucky amongst us have experienced them first hand. But an experience I’ve had all too frequently is pitching stories related to these issues to tutors or editors, and having them rejected, because ‘mental health just isn’t sexy’, ‘it’s too morose’, ‘too depressing’ or whatever reason they care to throw at me.

Whatever you think, the stats speak for themselves. 1 in 4 people will suffer from a mental health problem during their lifetime. That means one out of every four people who pick up your publication could be dealing with these problems – and journalists have a responsibility to address them.

National papers are full of examples of stories related to mental health, both good and bad. The overwhelming majority of those we see in the popular press leave something to be desired in terms of good reporting. ‘Amy Madhouse!’ and ‘Bonkers Britney!’ are the sort of headlines we are used to seeing in the tabloids. The terms ‘schizo’, ‘nutter’ and ‘basket case’ are bandied about, without any real consideration for the people they describe, or what it is like to be on the receiving end of these terms. If anyone desperately needs to be treated with sensitivity and empathy, it’s a person who is struggling with a mental health condition. The treatment they receive from other people could make a huge difference to their recovery and to how they cope with their condition.

The papers seem to fixate particularly on suicide. It’s easy enough to understand why this is newsworthy: it’s usually a violent act, horrific and shocking. As they say: bad news sells. But journalists need to be very careful with this. However contrived it seems, copycat suicides can and do happen. One study found that following reports of a suicide in which anti-freeze was mixed with lemonade and drunk in a field, the following month there were nine cases of deliberate anti-freeze self-poisoning (compared to an average of two per month). And back in March of this year, we saw a spate of young people commit suicides in the town of Bridgend- 17 in total between January and March. The local MP Madeleine Moon has been outspoken about the fact that she believes media coverage is, at least, partially to blame. The situation is so grave that the Press Complaints Commission (PCC) has added a new clause which stipulates that journalists must take care to avoid providing excessive detail about the method used in a suicide.

So the point to be made is this: journalists need to pay more attention to mental health stories, and they should never avoid reporting them, however unpalatable or uncomfortable they may be to hear. But how they report them is key. They need to use sensitive and appropriate language, to choose where to provide detail and when not to, and to source real life case studies instead of relying on ‘experts’ for all quotes. Mental health problems cost the UK economy over £77bn a year. Surely there must be something we as journalists can do to break down the stigma and offer support and advice to the people that really need it, and still write great stories at the same time?