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stigma

Skype, freemasonry, and the International Healing Foundation: more strange tales of reparative therapy

7 Feb, 10 | by Steven Reid, Evidence-Based Mental Health

Following last year’s Sex and the City conference in London, Patrick Strudwick writes in the Independent of his undercover exploits in the world of reparative therapy: therapists claiming great results in switching a person’s sexual orientation and “helping people exit the gay world.”

Struck by a study published in BMC Psychiatry reporting that 1 in 6 of UK mental health professionals surveyed had tried to help lesbian, gay or bisexual patients change their sexual orientation, he went in search of such treatment and came across a psychotherapist (accredited with the British Association of Counsellors and Psychotherapists) and psychiatrist willing to oblige. And what a bizarre experience it proves to be:

I ask how she views homosexuality – as a mental illness, an addiction or an anti-religious phenomenon? “It’s all of that,” she replies. “At the heart of homosexuality is a deep isolation, which is where God needs to be”. A search for cause follows with questions about birth: “It’s just something I have noticed. Often [with homosexuality] it is quite traumatic, the baby was put into intensive care and because of the separation from the mother there can be that lack of attachment.” Excuse me? And what about family: “Any Freemasonry in the family? Because that often encourages it as well. It has a spiritual effect on males and it often comes out as same sex attraction.”

Sessions with the psychiatrist are by webcam, and include a recommendation to join Christian men’s groups. I’m not sure what the Royal College of Psychiatrists would make of that. If you want to know more, you should head for the International Healing Foundation where you can find therapists and ‘ministry leaders’ to guide you, and a compelling introductory video. Alternatively, if you’re interested in the evidence you might want to look at an overview on the RCPsych website. However, do bear in mind that, in the words of one correspondent, this may have been written by ‘active homosexuals’.

Madness at the Movies

27 May, 09 | by Steven Reid, Evidence-Based Mental Health

“Explaining madness is the most limiting and generally least convincing thing a movie can do.” That was the view of the critic Pauline Kael, and despite mental illness and its treatment remaining an ever-popular source for film-makers it is an opinion that I think still holds true. Psycho-killers, maniacs, hysterics, and the ubiquitous manipulative, deviant psychiatrist: stereotypes and clichés abound.

I recently watched Clint Eastwood’s film Changeling, a drama set in Depression-era Los Angeles ostensibly based on real events involving a missing child. A major theme is the role of psychiatry as a means for the social control of women. A subject worthy of exploration certainly, but we could do without the almost inevitable addition of the ‘Cuckoo’s Nest’ scenes: the barbaric use of involuntary electroconvulsive therapy. ECT certainly makes for melodramatic viewing, but it was introduced as a treatment in 1936 and wasn’t being used in 1928 when the film is set.

Last month saw the US release of The Soloist, a film ‘based’ on a book telling the story of Nathaniel Ayers, a musician with schizophrenia. I can’t comment as it hasn’t reached the UK, but typically it has received contrasting reviews for its depiction of psychosis: a sentimental cheapening, or a triumph. Your views would be welcome on this or other films that you believe provide a persuasive and truthful account of living with mental illness.

Coincidentally one of The Soloist’s lead characters is played by Robert Downey Jr. – an actor who provoked outrage in the scabrous Tropic Thunder for satirizing Hollywood’s ham-fisted approach to mental illness and learning disabilities. If you want to win an Oscar: “Never go full retard. You don’t buy that? Ask Sean Penn, 2001, “I Am Sam.” Remember? Went full retard, went home empty handed…”

Offensive? Certainly, but as honest an appraisal of the portrayal of mental disorder in film as you’ll find anywhere.

Do we need yet another homicide inquiry?

17 May, 09 | by Steven Reid, Evidence-Based Mental Health

Last week NHS Yorkshire and Humber released the findings of an external investigation into the care and treatment of Benjamin Holiday. You can find the report here. In January 2005 Holiday, a young man with schizophrenia, killed a pregnant woman, Tina Stevenson, stabbing her in the street close to her home. He was under the care of a community mental health team and living at home with his mother. Having no recollection of the attack he pleaded guilty to manslaughter with diminished responsibility and has been detained indefinitely in a special hospital.

Department of Health guidelines (shouldn’t that be directives?) call for a series of reviews when a homicide has been committed by a person who has been in contact with mental health services:
1) A fast-track (72 hours) investigation to identify any necessary immediate action
2) An internal mental health trust investigation (within 3 months)
3) And finally, an independent investigation commissioned by the Strategic Health Authority.

The reasons for an external investigation are obvious: lessons must be learned to prevent such events happening again. But do they work? They certainly provide a revealing insight into the day to day care of someone living with a severe mental illness, affording a degree of transparency for relatives and carers that is rarely available elsewhere. And outcomes? There have been at least 400 homicide inquiries in the last 15 years yet the rates of homicide by people with mental disorder remains unchanged: 30-50 from 800 homicides annually, with fewer than 10 committed by people with a psychotic illness (the remainder largely related to personality disorder and drug misuse). The recommendations have become familiar too: improved risk assessment, better communication and better record-keeping. Another report isn’t needed to tell us that. The Holiday Inquiry illustrates their inefficiency. Tina Stevenson was killed in 2005; the inquiry reports four years later in which time things have changed. We have a new Mental Health Act, community treatment orders, crisis resolution teams and I’m sure that like elsewhere, services in Hull have been completely reorganised. The authors acknowledge that much of what they say was reported in 2006 by the mental health trust’s internal review.

Much has been made of bringing an end to the ‘blame culture’ in the NHS which encourages staff to cover up errors for fear of retribution. The new focus is on systematic factors that allow such errors to be made. It is human nature, however, to search for a scapegoat and in this inquiry: “…if we are allowed to indulge in one piece of viewing this investigation through a ‘retrospective-scope’ we would conclude this was a missed opportunity to possibly break into the cycle”. What they are referring to here is the decision by a social worker not to complete an application to detain Holiday under Section 3 of the Mental Health Act two months before the homicide. At the time however, he was agreeing to an informal admission, and following his discharge one month later he was seen by a nurse on two occasions and given his depot antipsychotic injection. It is just as plausible that by detaining him at that time he may have become less cooperative with treatment and disengaged completely – a classic example of hindsight bias.

Of course these points have been made before. In 1999 the DoH’s Safer Services report recommended that homicide inquiries be scrapped but they keep on coming. Clearly they fulfil a social need. The Department of Health guidelines state that mental health services must ‘be seen to investigate’ any serious incident and though not explicit, the allaying of the publics’ anxiety about the mentally ill is key. We used to have asylums to contain the mad, but now we have community care – an idea that now attracts as much vilification as political correctness. The fear of mental illness is as potent as ever and homicide inquiries serve to remind us that whilst they may live among us, they remain alien and dangerous – as illustrated by headlines such as this: Crazed Killers – trust’s failings exposed.

Welcome to the asylum!

30 Apr, 09 | by Steven Reid, Evidence-Based Mental Health

If they are not mad when they go into these cursed Houses, they are soon made so by the barbarous Usage they there suffer.
Daniel Defoe, Augusta Triumphans (1728)

“Civil lunatics are people that the society doesn’t want to be roaming around causing problems, unfortunately they are dumped in our prisons”, comments the controller of Enugu Prison in Nigeria. In this article from the BBC Andrew Walker visits a prison where people with mental illness may be detained indeterminately by court order, often on spurious grounds. Given the level of overcrowding in Nigerian jails, the prison service itself is keen for ‘civil lunatics’ to be diverted elsewhere – sounds familiar?

Prison Rehabilitation and Welfare Action
(PRAWA) is a human rights organisation lobbying for the discharge of the mentally ill from prisons. Since 2007 they have managed to get 54 people released from Enugu Prison, clearly an arduous task. And what happens in the community? You can read more about mental health care in Nigeria here.

Interesting fact: there are more Nigerians working as psychiatrists in the UK alone than in the whole of Nigeria.

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