A Newer Narrative-- Mental Health and Wellness

[amuse.ed]

MENTAL HEALTH

America Has Reached Peak Therapy. Why Is Our Mental Health Getting Worse?

 

Illustration by Katie Kalupson for TIME
BY JAMIE DUCHARME

AUGUST 28, 2023 8:00 AM EDT

The U.S. has reached peak therapy. Counseling has become fodder for hit books, podcasts, and movies. Professional athletes, celebrities, and politicians routinely go public with their mental health struggles. And everyone is talking—correctly or not—in the language of therapy, peppering conversations with references to gaslighting, toxic people, and boundaries.

 

All this mainstream awareness is reflected in the data too: by the latest federal estimates, about one in eight U.S. adults now takes an antidepressant and one in five has recently received some kind of mental-health care, an increase of almost 15 million people in treatment since 2002. Even in the recent past—from 2019 to 2022—use of mental-health services jumped by almost 40% among millions of U.S. adults with commercial insurance, according to a recent study in JAMA 

 

But something isn’t adding up. Even as more people flock to therapy, U.S. mental health is getting worse by multiple metrics. Suicide rates have risen by about 30% since 2000. Almost a third of U.S. adults now report symptoms of either depression or anxiety, roughly three times as many as in 2019, and about one in 25 adults has a serious mental illness like bipolar disorder or schizophrenia. As of late 2022, just 31% of U.S. adults considered their mental health “excellent,” down from 43% two decades earlier.

Trends are going in the wrong direction, even as more people seek care. “That’s not true for cancer [survival], it’s not true for heart disease [survival], it’s not true for diabetes [diagnosis], or almost any other area of medicine,” says Dr. Thomas Insel, the psychiatrist who ran the National Institute of Mental Health (NIMH) from 2002 to 2015 and author of Healing: Our Path from Mental Illness to Mental Health. “How do you explain that disconnect?”

 

Dr. Robert Trestman, chair of the American Psychiatric Association’s (APA) Council on Healthcare Systems and Financing, says there are multiple factors at play, some positive and some negative. On the positive side, more people are comfortable seeking care as mental health goes mainstream and becomes less-stigmatized, increasing the total number of people getting diagnosed with and treated for mental-health issues.

 

Less positively, Trestman says, more people seem to be struggling in the wake of societal disruptions like the pandemic and the Great Recession, driving up demand on an already-taxed system such that some people can't get the support they want or need.

Some experts, however, believe the issue goes deeper than inadequate access, down to the very foundations of modern psychiatry. As they see it, the issue isn’t only that demand is outpacing supply; it’s that the supply was never very good to begin with, leaning on therapies and medications that only skim the surface of a vast ocean of need.

 

What's really in a diagnosis
In most medical specialties, doctors use objective data to make their diagnoses and treatment plans. If your blood pressure is high, you’ll get a hypertension drug; if cancerous cells turn up in your biopsy, you might start chemotherapy.

 

Psychiatry doesn’t have such cut-and-dry metrics, though not for lack of trying. Under Insel, numerous NIMH research projects aimed to find genetic or biological underpinnings of mental illness, without much payoff. Some conditions, like schizophrenia, have clearer links to genes than others. But by and large, Insel says, “we don’t have biomarkers. We don’t have a lot of things that you would have in other parts of medicine.”

 

What psychiatry has is its Bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM sets diagnostic criteria for mental-health conditions largely based on symptoms: what they look like, how long they last, how disruptive they are. Relative to other medical fields, this is a fairly subjective approach. It’s essentially up to each clinician to decide, based on what they observe and their patient tells them, whether symptoms have crossed the line from normal to disorder—and this process is increasingly occurring during brief appointments on teletherapy apps, where things can easily slip through the cracks.

 

Dr. Paul Minot, whose nearly four decades as a psychiatrist do not stop him from vocally critiquing the field, feels his industry is too quick to gloss over the "ambiguity" of mental health, presenting diagnoses as certain when in fact there's gray area. Indeed, research suggests both misdiagnosis and overdiagnosis are common in psychiatry. One 2019 study even concluded that the criteria underlying psychiatric diagnoses are “scientifically meaningless” due to their inconsistent metrics, overlapping symptoms, and limited scope. That's a sobering conclusion, because diagnosis largely determines treatment.

 

“If I’m giving you an antibiotic but you have a viral infection, it’s not going to do anything,” Trestman says. Similarly, an antidepressant may not work well for someone who actually has bipolar disorder, which can be mistaken for depression. This imperfect diagnostic system may help explain why, even though antidepressants are one of the most-prescribed drug classes in the U.S., they don’t always yield great results for the people who take them.

Joseph Mancuso, a 35-year-old DJ, music producer, and content creator in Texas who uses the stage name Joman, has been in and out of the mental-health care system since he was a teenager. Over the years, he’s received a range of diagnoses, including depression and bipolar disorder, that he says never felt quite accurate to him. (More recently, he received a diagnosis that felt right: complex post-traumatic stress disorder.) These diagnoses led to numerous prescriptions, some of which helped and many of which didn’t. “I felt at times that I was just a dartboard and they were just throwing darts and seeing what would stick,” he says.

Some treatments don’t seem to stick regardless of whether a patient was properly diagnosed.

 

In a 2019 review article, researchers re-analyzed data used to assess the efficacy of supposedly research-backed mental-health treatments. Some methods—like exposure therapy, through which people with phobias are systematically exposed to their triggers until they’re desensitized to them—came out looking good. But a full half of the therapies did not have credible evidence to back them, the authors found.

 

“It’s not the case that, holy shit, therapy just doesn’t work at all,” says co-author Alex Williams, who directs the psychology program at the University of Kansas. But Williams says the results inspired him to make some changes in his practice, leaning more heavily on therapeutic styles with the best data behind them.

 

Over-medicated...and over-therapized?
Even styles of therapy with solid evidence behind them can vary in efficacy depending on the clinician at the reins. One of the best predictors of success in therapy, research has shown, is the relationship between patient and provider—which may explain why it can feel like a crapshoot, with some people leaving their sessions feeling enlightened and empowered and others feeling the same as when they walked in.

 

The latter scenario was the case for “Shorty,” a 31-year-old from North Carolina who asked to be identified by his nickname to preserve his privacy. Shorty became disillusioned with therapy after trying it while struggling with substance abuse in college. “We just talked,” he says, “but we [weren’t] really solving anything. I was just paying this dude money.”

 

Some people may indeed benefit from therapy, Shorty says. But it annoys him that the practice is sometimes seen as an automatic fix for life’s problems when both anecdotal evidence and scientific data suggest it doesn’t work for everyone. The APA says about 75% of people who try psychotherapy see some benefit from it—but not everyone does, and a small portion may even experience negative effects, studies suggest. Those who improve may need 20 sessions before they have a breakthrough.

 

Given the significant investment of time, money, and energy that may be required for therapy to succeed, it’s perhaps unsurprising that medication, which is by contrast a quicker fix, is so popular. As of 2020, about 16% of U.S. adults had taken some kind of psychiatric drug in the past year. Within that class, antidepressants are the most commonly used.

 

There certainly are people who report that their symptoms improve or disappear after taking an antidepressant, and research suggests they are particularly effective for people with severe depression. People with anxiety and other conditions may also benefit from their use, according to the National Library of Medicine. But the data on antidepressants aren’t as solid as one might expect for one of the most widely used drug classes on the market.

 

In the early 2000s, the NIMH ran a large, multi-stage trial meant to compare different antidepressants head-to-head, in hopes of determining whether some worked better than others across the board or in specific groups of patients. Instead, Insel says, “what we came out with was the evidence that, actually, none of them are very good. It was really striking how poorly all of the antidepressants performed across the entire population.” Most people had to try multiple drugs, or take multiple at once, to go into remission, and about 30% of people in the trial never saw complete relief. Lots of people also dropped out before the study ended.

 

In the years since, studies have reached lukewarm findings about antidepressants. A 2018 meta-analysis of data from 522 trials found that all of the 21 analyzed drugs worked better than placebos—but their benefits were “mostly modest.” A 2019 review went further, concluding that antidepressants' effects are “minimal and possibly without any importance to the average patient with major depressive disorder.”

 

Dr. Joanna Moncrieff—a founding member of the Critical Psychiatry Network, a group for psychiatrists who are skeptical of the mental-health establishment—believes that’s because some antidepressants don't work the way they're advertised. For decades, researchers theorized that depression stems from a shortage of mood-regulating neurotransmitters, particularly serotonin, in the brain. Blockbuster antidepressants like Prozac, which hit the U.S. market in the 1980s, are meant to boost those serotonin levels.

 

But Moncrieff’s research, as well as other scientists’ work, suggests that depression isn’t caused by low serotonin levels, at least not entirely. And if serotonin isn’t the main problem, Moncrieff says, taking these drugs is “not correcting a chemical imbalance. It is creating a chemical imbalance.”

 

So why do some people feel better after taking antidepressants? They clearly have some effect on the brain, potentially improving mood, but Moncrieff isn’t convinced they’re really treating the root cause of depression. To do that, she believes, clinicians need to help people solve problems in their lives, rather than simply prescribing a pill.

 

“Lots of people would disagree with that,” Moncrieff admits. But studies, including the 2019 research review on psychiatric treatments, do show that “problem-solving therapy,” a modality that teaches people how to manage stressors, can work.

That’s the approach taken by Minot, who believes psychiatry is too quick to label feelings like sadness and worry as symptoms rather than helping people understand where they come from, what they mean, and how to overcome and even grow from them. In some cases, he says, feeling bad can motivate people to change problematic habits, choices, or relationships.

 

Not everyone is convinced by this argument. Sadness may be part of life, but Insel says that’s an entirely different beast than depression, which can manifest more like feeling “dead” and may have no clear link to what’s going on in someone’s life. “People who think that’s just on the continuum of the human experience…have never met anybody who’s truly depressed,” he says.

 

Minot agrees that severe depression, as well as serious mental illnesses like schizophrenia and bipolar disorder, may require pharmaceutical treatment. Overall, though, he feels psychiatry leans on medications so it doesn’t have to do the more difficult work of helping people understand and fix life circumstances, habits, and behaviors that contribute to their problems.“If you can sell people Band-Aids,” Minot asks, “why bother curing them?”

 

Dr. Edmund Higgins, an affiliate associate professor of psychiatry at the Medical University of South Carolina, has grappled with this tension in his own work with incarcerated people—many of whom, he says, would benefit from therapy. But without the time and resources to do that long-term work, he’s mostly limited to writing prescriptions. “You can put them on medicines and they’ll have some improvement,” in some cases more than others, Higgins says. “But guess what? They’re still anxious and depressed.”

There are a couple reasons for that, Higgins says. One is that changing the brain can be difficult, and currently available treatments aren't always up to the task. Another is that “so much of our mood and [mental health] is situational.”

 

A medication might help with symptoms, but it can’t overcome the basic facts of someone’s life, whether they’re incarcerated, going through a divorce, being bullied at school, dealing with discrimination, or struggling with loneliness. Nor can a pill change the fact that we live in a bitterly divided country where gun violence is common, the effects of climate change are obvious, more than 10% of the population lives in poverty, bigotry persists, COVID-19 is still spreading, and the legal system is rolling back rights.

 

“A lot of people are suffering from material conditions and [are] having a reasonable, rational human response to suffering,” says Mancuso, the musician from Texas. But in his experience, the psychiatric system doesn’t always acknowledge the range of factors that can influence mental health—from personal trauma all the way up to the geopolitical climate—and instead seems more focused on getting people diagnosed, medicated, and out the door.

 

Mancuso points to a sentiment expressed by the philosopher Jiddu Krishnamurti: “It is no measure of health to be well-adjusted to a profoundly sick society.”

 

Beyond the couch
Improving mental health at scale, Insel agrees, requires the system to look beyond the therapist’s couch. (Insel co-founded a startup focused on community-based behavioral care.) Seemingly non-medical solutions—like improving access to affordable housing, education, and job training; building out community spaces and peer support programs; and increasing the availability of fresh food and green space—can have profound effects on well-being, as can simple tools like mindfulness and movement.

“That’s not the way we roll in health care,” Insel says, but that's incrementally changing. California, for example, has made efforts to broaden what qualifies as health care, and the federal government is funding an expansion of the country’s network of Certified Community Behavioral Health Clinics, which provide a range of behavioral and physical health services.

Nonetheless, policy solutions are complex, slow-moving, and not guaranteed to take effect—particularly in a bitterly divided political system. So in the meantime, expanding access to mental-health care is important, the APA’s Trestman maintains. A system that is short an estimated 8,000 providers is never going to do its job perfectly, particularly when the existing network is concentrated in certain geographic areas, does not reflect the diversity of the U.S. population, and is financially out of reach for many people.

To make the biggest dent in rates of mental illness, Insel says the system needs to focus on adding resources in the right places. Teletherapy has grown enormously since the pandemic, which is important but has limitations. Many teletherapy apps meet demand by expecting clinicians to take on a huge quantity of short appointments, TIME’s previous reporting has found, which makes it difficult for providers to diagnose accurately, establish a rapport with patients, and provide holistic care.

 

Plus, it’s not clear that online services adequately serve people “in the deep end of the pool,” Insel says. Patients with severe psychiatric diagnoses often need specialized care that can’t be effectively offered through a mass-market app, and may not have the resources to access these services anyway. Brick-and-mortar, community-based care still plays an important role for people with serious mental illness, Insel says.

 

Focusing on quality, not just quantity, of care is also important, Trestman says. To the extent that people receiving mental health care are measured, these metrics usually focus on process—how long they’ve been seen, whether they schedule follow-up appointments—rather than whether their condition is improving, Trestman says. Research suggests fewer than 20% of mental-health clinicians measure changes in symptoms over time.

 

“What really matters is, is someone getting better? Are they able to return to work? Are they able to care for their family? Are they able to start planning for their future?” Trestman says. “Those are the key issues that we’re talking about, and those are just not measured in any consistent way.”

 

In his own practice, Trestman asks patients to define their priorities and what successful treatment means to them. These data may not be as objective as a blood test, but they build in some of the accountability Trestman feels is often lacking.

 

Patients like Mancuso are hungry for an approach that goes even further—one that recognizes the influence of the world beyond their therapist’s door and focuses not on medication, but on real-world improvement and understanding. That kind of care isn’t always the default of a for-profit system struggling to meet demand. But Mancuso believes it’s what’s necessary to see improvements in mental health at both a national and personal level.

 

“I had a rough upbringing. I had a lot of people take advantage of me. I was bullied really badly in school,” Mancuso says. “I needed more than pills. I needed guidance.”

 

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United Kingdom 

‘The medical model has presided over four decades of flat-lining outcomes’

Author, anthropologist and psychotherapist, Dr James Davies, on his journey into the field of mental health and his work as co-founder of the Council for Evidence-based Psychiatry.

 

16 August 2022

Author, anthropologist and psychotherapist Dr James Davies tells Fauzia Khan about his journey into the field of mental health and his work as co-founder of the Council for Evidence-based Psychiatry.

 

What brought you into the field of mental health?

My journey into the field, psychologically speaking, I could probably trace to my ninth year, when there was a lot of upheaval in my family. I would often spend long stretches of time away from them. Outside the safety of their care for the first time, I felt very exposed, afraid and unprotected. Who were these new people now taking care of me? Who could I trust, who could I not? As a result, I awoke rapidly from that warm haze of childhood to become hypervigilant about my new surroundings, mostly due to instinctual self-preservation.

 

Later on, I learnt that such experiences are very common in children whose primary environment has been disrupted or precipitously removed. Childhood ends early for them. On the upside they may become resourceful, ‘streetwise’ and very perceptive for their age; on the down, they are more exposed to various dangers and harms, psychological, situational, relational etc. There are many literary representations of this childhood predicament – they are the Gavroches, the Dodgers and the Saroo Brierleys.

 

And that early vigilance developed into a fascination with Psychology?

Only much later. In my early 20s I was experiencing a lot of emotional turmoil, some of it related to those earlier years. I began reading vociferously to work things out. One influential book I encountered was Peter Kramer’s Listening to Prozac. As everything felt so painfully complicated at the time, I was seduced by its simple message that a pill could remedy my suffering.

Putting my hopes in Prozac, I went to my GP and asked for a prescription. He sent me away, stating that I ‘didn’t look depressed’ to him! So, my reading and searching continued, which ultimately led me into therapy. And so my entrée in our field was through my own lived experience, just as for so many others.

 

You’re the co-founder of the Council for Evidence-based Psychiatry (CEP). Can you tell me about that?

Yes, I co-founded the Council nearly a decade ago with the campaigner, Luke Montagu, who had suffered a truly harrowing experience when trying to withdraw from benzodiazepines and antidepressants (which he’d been originally prescribed for a failed sinus operation). The psychiatric profession, at that time, mostly denied the protracted harms that could be caused by psychiatric drug withdrawal and dependency. There were hundreds of thousands of people supporting each other online, often in the absence of their doctors recognising their problems as real. We started CEP to lobby with those disenfranchised people, sometimes referred to as the ‘prescribed-harm community’.

I went to my GP and asked for a prescription. He sent me away, stating that I ‘didn’t look depressed’ to him!

Our joint work with that community led to some significant changes over the years, especially after CEP became secretariat to the All-Party Parliamentary Group for Prescribed Drug Dependence, which we helped to co-found in 2017. Our joint work with campaigners like James Moore, Marion Brown, Beverley Thomson, Fiona French, Stevie Lewis, and so many important others, led to the first major government review of prescribed drug dependence (PHE), which helped vindicate the claims of harmed patients and raise the profile of the withdrawal issue. It also led NICE to change its withdrawal guidelines to recognise, for the first time, protracted antidepressant withdrawal… a change also later ratified by the Royal College of Psychiatrists, under the crucial guidance of Dr Mark Horowitz. Right now, CEP’s central work is getting dedicated provision established for those adversely affected. 

 

Much of your work is focused around challenging psychiatry and the medical model, then?

Yes. And this work has emerged out of a diversity of factors: personal, clinical, the experiences of others close to me, and what I think an honest appraisal of the research obliges us to accept. The medical model has presided over four decades of flat-lining outcomes, at best, while in contrast outcomes in general medicine have significantly improved. For instance, the effectiveness of psychiatric drugs has not increased since the 1980s, despite billions spent on research, marketing and promotion. Mental health disability rates have also trebled, while the prevalence of mental health problems has risen considerably (despite stable levels of general well-being in the community). Furthermore, for people diagnosed & treated for the most serious mental health issues, the gap between their life expectancy and everyone else’s has widened (from 10 years to 20).

 

Some might put those statistics down to a lack of mental health funding and/or ailing social environments.

Yes, and there is some truth to this of course. But if this becomes the only truth, we by default exonerate the medical paradigm from any responsibility. This would be wrong given outcomes have remained uniformly poor over differing historical and social contexts, and that we’ve also invested over a quarter of a trillion pounds in UK mental health services and research since the 1980s.

I believe our significant failure in outcomes cannot therefore be primarily attributed to events and deficits in spending, but to our spending on the wrong kind of ideas and practices; on ones that have privileged the depoliticisation and commodification of our emotional pain, that have increased social and self-stigma, that have worsened long-term outcomes, that have neglected non-medical (yet effective) psycho-social alternatives, that have misdirected countless billions into bio-psychiatric research that has yielded very little of clinical value, and ones that have facilitated the over-medicalisation and unnecessary medicating of large swathes of the population, with approaching 25 per cent of UK adults now receiving a psych-drug prescription each year.

It is important to remember that mental health is a volatile field where every position is contested.

And then, of course, there are the harms caused by the epistemic confusions this model has sown in the general population about the nature of emotional pain and distress; its causes, meaning and implications.

 

The medical model broadly sees suffering as an index of internal ‘dysfunction’ (as defined by the DSM), rather than, as say, the organism’s legitimate protest against psycho, social or relational predicaments that hold us back – predicaments that our medicalised interventions were never designed to treat. In other words, the medical model is structurally and linguistically configured to dismiss the often deeply purposeful nature of emotional pain; pain whose functional meaning is revealed when you care to look deeply enough. At the very least such pain is a legitimate call to change harmful circumstances, seek accommodations, or to address unmet human needs and/or traumas yet worked through. It therefore demands care, understanding, relational and social support – not simplistic pathologisation. And yet, our services, as they are currently configured, make the medicalisation of our suffering or divergence the core precondition for receiving any care or support at all. That is wrong and must change.

 

Would you say you are ‘anti-psychiatry’?

No, contrary to the impression my criticisms may convey! I accept that psychiatric drugs have a place when judiciously prescribed. I accept that there’s a role for psychiatry in mental health care. It may be a very different role from the one we witness today, a more modest and tightly regulated role, but it’s a role nonetheless… as I discuss in my latest book, Sedated.

 

And so this leads me onto one of the concerns I have with the label ‘anti-psychiatry’ more generally.

 

It not only often misrepresents many different critical perspectives, but it threatens to denigrate those perspectives given the multiple negative associations the phrase has come to accrue. What concerns me most is when I see the phrase being weaponised to try and silence, misrepresent or delegitimise critical debate and dissent. This happens a lot on social media, where the rules governing scholarly engagement do not hold. On the other hand, if someone wishes to self-identify as anti-psychiatry that’s fine with me if that’s their choice. What I object to, in essence, is the strategic imposition of the phrase against a person’s will with the aim of dismissing that person as ideologically rather than evidence driven.

 

Other pejorative phrases are also used to dismiss the critical voice. In all of this rancour, however, it’s important to remember that mental health is a volatile field where every position is contested, and if you are a ‘loud voice’ often the louder the cry against you.

 

You may feel or actually be poorly treated. But the important thing is not to wallow in that. Instead, speak your insights, keep an open mind, and learn to learn rather than be offended.

 

So, say you encounter a Psychiatrist, or Psychologist come to that, who says ‘James, I agree with you. Every day, I come across that pain, I recognise it as a legitimate call to change harmful circumstances or to address unmet human needs. But I am just one person – one person who thinks, like you, that psychiatric drugs can have a place in judicious care. I’ll do my bit, and hope other professionals, policy makers and politicians do theirs.’ What do you say?
Well, before I say anything, I’d like to learn more about this particular professional to test whether what they say is a veiled justification for complicity in a broken system. That sounds harsh, I know, and I am sorry, but I’ve seen this dynamic so often before. I’ve met well-meaning professionals who, for example, equate believing in a bio-psycho-social perspective with ‘doing their bit’ while they continue to practice in only bio-medically informed ways. I’ve heard professionals equate ‘doing their bit’ with working in multi-disciplinary teams, despite such teams being structurally determined to operate within (as so by default privilege) the dominant biomedical frame.

We need to repoliticise our understanding of emotional pain, and cease relying on drugs to fill the vast gaps in relational, social and community-based interventions.

On the other hand, ‘if doing your bit’ means, let’s say, publicly challenging the problems as you see and experience them – taking a stand, being brave and political (rather than complicit), then I would say carry on doing your bit, and look for some collective support in doing so.

 

What else still needs to change?

We need to significantly de-medicalise our services, interventions and narratives (starting by removing making being medicalised a precondition for receiving any care). We need to repoliticise our understanding of emotional pain, and cease relying on drugs to fill the vast gaps in relational, social and community-based interventions. We need to learn far more from service users and survivors in terms of service design. We need to remove coercion, decentre the biomedical approach, and with increased funding implement more widely effective community and relationally-based interventions. Finally, we need to reconceptualise our understanding of emotional pain so we can see more clearly what suffering or divergence may be trying to teach the individual or collective. For these things to happen we require wider structural change in our political economy. This is a vast area, which I partly explore in 

 

Tell me about your books.

The four books I have written analyse different aspects of our mental health arena through a sociological or anthropological lens. My first book, The Making of Psychotherapists, constituted an anthropological analysis of the institutional dynamics that have fuelled hostility between the different psychotherapeutic traditions. I tried to expose ethnographically the tacit institutional devices used in training to transform persons into professional defenders of the tradition, often at the expense of patients, integration and progress. Much that I found occurring within analytic institutes I have subsequently learnt also exists within psychiatric training.

 

My second book, The Importance of Suffering, is a philosophical enquiry into the nature of emotional pain, exploring the idea that suffering can be highly psychologically facilitative, if understood and managed properly. It’s very humanistic in orientation and provides the intellectual basis for the next two books that directly challenge the over-medicalisation of everyday life – its causes and consequences.

The first, Cracked, was mostly for the general reader, in part based on interviews with leading figures from the world of mental health. The book emerged from the frustration I’d experienced while I worked as a psychotherapist in the NHS, which enabled me to dive deep into the many conflicts and excesses of psychiatry. I wanted to write a book that could benefit service users as they struggled through systems they often experienced as harmful. It explored the ways in which psychiatry may do more harm than good, even in the face of good intentions, so it was a controversial book as you can imagine.

 

My most recent book, Sedated, explores the mechanisms that have enabled our medicalised system to remain dominant despite its poor outcomes.

 

I argue it has secured its position by becoming, since the 1980s, a handmaiden to ‘neoliberalism’ (i.e. late capitalism). The mechanisms by which it has served neoliberalism include: conceptualising human suffering in ways that protect the current economic order from criticism; redefining ‘wellbeing’ in terms that are consistent with the aims of our economy; turning behaviours and emotions that perturb or disrupt the established economic order (e.g. low worker satisfaction) into a call for more psych-interventions; and turning suffering into a market opportunity, for the purpose of increasing taxation, profits and share-value.

 

I don’t argue that these and other mechanisms were engineered in a calculated way, but that they arose spontaneously as our mental health sector struggled to endure and adapt under a new set of socio-economic arrangements from the 1980s onwards.

 

I locate on-going poor outcomes, systemic failure, growing harms and public disillusionment, in our mental health sector’s servitude to neoliberalism.

 

What projects are you working on?

My academic life is structured around two primary occupations: writing books for the academic and general reader, and undertaking academic research that is relevant to social policy. In the latter area, most of my recent work has been around psychiatric drug dependency and withdrawal (its human and economic costs), while in the book department, I am currently exploring a number of themes. One I return to again and again is the issue of post-traumatic-depressive-etc growth. How does that actually happen? What do we really know about it? And why is it such a threatening idea to the status quo? I’m looking forward to digging deeper and reporting on what I find.

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Understanding and addressing mental health stigma in Asia

October 2020  

 

THOUGHT LEADERSHIP

Understanding and addressing mental health stigma in Asia
 

According to a 2018 mental health survey conducted by the Institute of Mental Health (IMH)1, approximately 14% of Singaporeans have experienced some form of mental health condition in their lifetime, up from 12% in 2010. Despite this, the majority of these people do not seek any form of help for their mental health conditions and those who do tend to do so after a significant delay after the occurrence of the condition. This phenomenon can largely be attributed to mental health stigma, which remains prevalent in Asian countries like Singapore. Mental health stigma causes mental health disorders to be seen as negative, socially discrediting behaviour, so much so that it becomes an undesirable and rejected stereotype rather than an accepted and normal one. It is also the driving force behind poor support and care for both the mental root cause and the physical symptoms, with wider, more significant impacts on the society. But what exactly is the reason for its prevalence?

 

Reasons for mental health stigma in Asian cultures

In Singapore’s context, mental health stigma can largely be traced back to traditional beliefs and mindsets that are rooted in Asian cultures. Asian cultures, for instance, tend to place honour, pride and collectivism in high regard, especially within families. Anomalies such as mental illness can therefore be seen as a sign of weakness and a source of shame for the family. A study led by IMH’s research division2 echoes this, with findings indicating that Asian respondents tended to feel more threatened by mental illness as a mark of shame. Similarly, Asians are found to have a lower sense of responsibility towards the mentally ill, as compared to respondents from the other ethnic groups. The concept of ‘face’ comes into play in this regard, as it deals with our moral standing in society3. The need to ‘save face’ and retain honour results in the blatant disregard or trivialisation of mental illness, especially since acknowledging it may lead to a perceived loss of social standing. Likewise, prominent gender roles in Asian cultures also exacerbate mental health stigma, as men are discouraged from exhibiting physical or mental weakness due to traditional notions of masculinity. The influence of these traditional values contributes to the deep-rooted mental health stigma that Asian societies like Singapore face, with generations after generations passing down and reinforcing these mindsets. A research study on Asian immigrant adults, for instance, found that older generations are “more subject to cultural misconceptions and stigma related to mental disorders”4. Unless there is greater awareness on the importance of mental health, as well as a proactive push against its trivialisation, its impacts on our health and society can be more serious than anticipated.

 

Negative effects of mental health stigma

For those who suffer from mental health conditions, the implications of mental health stigma are undeniably severe. This is especially true as mental health is not a high priority in most Asian countries5. In a 2018 study conducted by the IMH, a staggering 78.4% of individuals with mental health conditions never actually seek any form of professional treatment for their condition. For those that do, the treatment delay remains rather significant. This delay averages 11 years for people with obsessive-compulsive disorder (OCD), 4 years for those with bipolar disorder, 2 years for anxiety and 1 year for depression6.

 

Poor mental health can also manifest as physical health issues. These problems include chest pain, gastrointestinal problems, musculoskeletal problems or women’s health issues. However, patients without awareness of this link between poor mental and physical health may seek treatment without realising their root cause, leading to unnecessarily prolonged issues and treatment journeys.

 

Further exacerbating this problem is the lack of mental health support available in Singapore. Singapore has one of the lowest rates of psychiatrists among similar high-income nations, with approximately 2.8 psychiatrists for every 100,000 residents. By comparison, another comparable high-income nation, such as Australia, has 13.5 psychiatrists per 100,000 residents7. On a societal level, this general lack of awareness, urgency and public resources results in lasting negative impacts on the general public perception of mental health, which only serves to make the battle against mental health stigma more difficult. Allowing this stigma to remain so prevalent could lead to the creation of a vicious cycle that trivialises mental illnesses, as we have previously discussed. In Singapore, this phenomenon has been noted by psychologists, who remarked that the public’s general perception of a mentally ill person is one that is violent, unreliable and unstable. Furthermore, it is clear that the stigma is already embedding itself in sections of the younger generations. A 2017 study on mental health stigma in Singapore’s youths8 found that approximately 44.5% of respondents associated mental illnesses with negative, derogatory terms like “stupid”, “dangerous”, “crazy” and “weird”, while 46.2% of them said they would be “very embarrassed” if they were diagnosed with a mental illness. In contrast, only 25.5% of them associated mental illnesses with sympathetic terms like “pitiful”, “sad” and “needs love/care”. With mental health stigma so prevalent in society, it normalises a lack of knowledge and awareness about mental health and further discourages patients to seek help for their condition.

 

Impacts of mental health stigma in the workplace

In the workplace, mental health stigma can lead to indirect ramifications on our relationships and work performance. A study conducted by the National Council of Social Service9 found that more than 50% of respondents are not willing to live, live nearby or work with persons that have mental health conditions. Additionally, 60% of respondents also believe that mental health conditions are caused by a lack of self-discipline and willpower, so persons with them should not be given any responsibility. This lack of understanding could mean that our employees are suffering in silence without any possible avenues of support - the very same that may make all the difference in getting them started on better mental care and management. Instead, this lack of support could show up in more tangible ways, like higher rates of absenteeism, presenteeism, attrition and even poorer overall return on investment (ROI).

 

Absenteeism

 

Mental health problems are currently the leading cause of absenteeism10. As the frequency of employees’ attendance drops, so does their capability in contributing productively to the company. This means that employers are likely to face greater, tangible losses in terms of their company’s overall performance. For employees, however, this may also mean that the constant absenteeism could reflect negatively on their work performance in the eyes of their colleagues and superiors. Because of this, they might force themselves to show up at work even when their mental health is poor, contributing to an equally worrying trend of presenteeism.

 

Presenteeism

 

As you may have already inferred, presenteeism refers to the misconception that work attendance equals productivity. Companies with this point of view tend to believe that their best employees are those who work the longest hours, take the least amount of leave, and even show up when they are unwell. Combined with the fear of ‘losing face’ when it comes to acknowledging existing mental health conditions, employees are led to believe that their jobs and reputations will be on the line should they attempt to seek help or practice self-care. It is the perpetuation of beliefs like these that push employees to avoid taking medical leave for mental care. As such, they show up for work despite needing time off to rest and recuperate and are likely to function at less than full capacity despite being physically present.

 

Our 360° Wellbeing Survey in 2018, for instance, found that almost 70% of global employees go to work when ill or burned out, even though this causes their productivity to drop by approximately 21% while further delaying their chances of recover11.

All this ultimately amounts to massive costs for our companies and our economies. While both absenteeism and presenteeism have been found to cost organisations anywhere from 23 to 44 billion dollars annually12, presenteeism undoubtedly forms the bulk of these costs. More specifically, research tells us that presenteeism has been costing us anywhere from 3 to 10 times more than absenteeism13.

 

Attrition

 

The prolonged perpetuation of mental health stigma in the workplace can also lead to high staff attrition rates. For employees who live with existing mental health conditions, having to deal with the stresses of working life while facing mental health stigma at work could be the catalyst that forces them to resign. These staff resignations come at a cost to the employer too. Research has shown that replacing staff who leave their jobs can result in significant costs of up to 33% of an employee’s annual salary14. Moreover, unusually high employee turnover rates could also prove to be detrimental to the company’s overall reputation. Hiring replacements would then be even more difficult and costly. Constant staff turnovers also generate instability in the company, contributing to an overall lack of direction and cohesiveness, which would then affect the company’s growth and competitiveness in the market.

 

In recent times, the scale of this issue has been growing with a greater number of young employees entering the workforce. Younger workers tend to place a much greater emphasis on their own mental health and are thus more likely to resign when their job contributes to a decline in their mental health. A 2019 study found that half of millennial employees and 75% of Generation Z employees have left jobs for mental health reasons15, signifying how important this issue has become for younger employees. On the bright side, however, this also indicates a crucial generational shift towards becoming more cognizant about mental health and destigmatising therapy.

 

ROI

 

Thus far, we have focused on the negative effects that mental health stigma has in the workplace. On the flipside, cost-benefit research has shown that there are net benefits to be gained by companies who invest in mental health support and prioritise destigmatising mental health. A recent WHO-led study estimates that depression and anxiety disorders cost the global economy US$ 1 trillion each year in lost productivity16. Beyond showing a clear need for greater expenditure for proper mental health support in the workplace, the results of this study also imply that an improvement in the mental health of employees could lead to a huge improvement in work productivity. If employees have proper mental health support systems available to them, allowing them to better manage their conditions will help to reduce absenteeism, presenteeism and staff attrition rates - all of which would have contributed to the loss in productivity. The same WHO-led study backs this up, with findings estimating that for every $1 put into scaled-up treatment for common mental disorders, there is a return of $4 in improved health and productivity17.

 

Addressing mental health stigma in the workplace

While some of us have already been pushing against the de-stigmatisation of mental health care, there is still much to be done. In a Working in Asia Pacific report that was conducted just last year in 2019, Singapore fared the worst in workplace mental health issues as compared to other Asian countries like Hong Kong and China18. However, the respondents of the same report also identified some key concerns that may help us to better understand and fight against mental health stigma in Singapore. As such, we have gathered 3 main points from these findings, as well as suggested some possible solutions that can help address each of them:

 

Concern 1: Many people do not feel equipped enough to support a colleague facing mental health issues at work.

 

As an employee, supporting a fellow co-worker who is facing mental health issues can be as simple as lending an ear while keeping an open mind. One way to do this is to let your words guide your thoughts. By revolutionising the language that we use to talk about mental health and redirecting it in a more sensitive, empathetic and compassionate direction, we can open ourselves up to opportunities for more meaningful discussions. This is one way that we can gain a greater understanding of mental health and better support others as we move forward.

 

As an employer, you can also support your employees in learning more about mental health by making professional support and resources more easily accessible. The more we normalise mental care, the easier it will be to overturn the negative stereotypes of mental illnesses.

 

Concern 2: Many respondents did not feel comfortable discussing mental health conditions with their colleagues.

Having open and honest discussions about mental health despite its existing stigma can prove to be difficult for some, especially with their job on the line. It will take time for us to develop trusting and friendly relationships for these conversations to take place, but this is a necessary step that can help improve the workplace culture nonetheless. To accelerate this process, committing ourselves to mental health-related programmes and resources can put us more at ease when it comes to talking about topics that are new to us. It can also introduce us to fresh perspectives that we may not have been aware of previously, all of which are essential when it comes to fighting against mental health stigma.

 

Concern 3: Many respondents felt that they simply lacked time and resources to invest in mental health care.

 

Employers have a key role when it comes to empowering employees to invest in mental health care. Implementing policies that send a message that the company treats physical and mental health equally is one way of doing so. When employers provide more opportunities for self-management and self-care through solutions like flexible working hours or telecommuting, employees are made aware of the freedom that they are afforded in order to best care for themselves. The recent pandemic has proven that productivity remains high with remote working arrangements - and can even increase productivity in some cases. A study found that working from home for as little as one day per week can already boost output by up to 13%19. With employees having more time and resources to practice mental care at home, one might even say that this boon to work performance is almost expected.

 

Over to you

As companies in Asia begin to turn their attention towards mental health in the workplace, many are grappling with similar issues and figuring out where responsibility for mental health should lie. With the enormous stigma and taboo surrounding the topic, many are also realising the importance of incorporating sustainable mental health solutions into their employee wellbeing strategies. After all, it has been estimated that “50% of the general population in middle- and high-income countries will suffer from at least one mental disorder at some point in their lives”20, making this a serious issue that is only growing more urgent by the day. Reforms within our work cultures can therefore go a long way in fighting against mental health stigma and reinforcing Whole Person Health . Our belief is that our physical and mental health are inherently connected, which means that we will need to invest in both our body and mind in order to care for ourselves holistically. In this sense, building support networks within family, friend and colleague groups can be a great help in reducing the general taboo around mental health. And if we can start off by getting these basic units of society to push against deep-rooted mental health stigmas, then it follows that society as a whole will be able to do it as well.

 

Committed towards making real progress in this area, Cigna Healthcare invites senior executives and people managers from all organisations to take the 5% Pledge – to commit 5% of your work hours to listen, craft and implement tangible change to improve mental health and well-being in your company. Visit The 5% Pledge for more information.

Resources:

1. Institute of Mental Health. (2018). Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime.
2. Pang, S., Liu, J., Mahesh, M., Chua, B., Shahwan, S., & Lee, S. et al. (2017). Stigma among Singaporean youth: a cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population.
3. Nair, D. (2019). Saving face in diplomacy: A political sociology of face-to-face interactions in the Association of Southeast Asian Nations.
4. Jang, Y., Chiriboga, D., & Okazaki, S. (2009). Attitudes toward mental health services: Age-group differences in Korean American adults.
5. Meshvara D. (2002). Mental health and mental health care in Asia.
6. Institute of Mental Health. (2018). Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime.
7. Our Better World. (2019). Mental health in Asia: The numbers.
8. Ng, K. (2018). ‘Crazy, weird, scary’: Survey unveils negative labels youths associate with mental illness. TODAYonline.
9. National Council of Social Service. (2018). Understanding the Quality of Life of Adults with Mental Health Issues.
10. Starling Minds. (2020). The Economic Impact of Mental Illness: Absenteeism & Presenteeism.
11. Mills, P. (2019). Building a Whole Person Health Approach to Chronic Stress at Work. Cigna.
12. Starling Minds. (2020). The Economic Impact of Mental Illness: Absenteeism & Presenteeism.
13. Starling Minds. (2020). The Economic Impact of Mental Illness: Absenteeism & Presenteeism.
14. Springhealth. (2020). The Hidden Costs of Mental Illness.
15. Hoffower, H. (2019). 50% of millennials have left a job for mental-health reasons, a new study found — and it speaks to some of the biggest problems plaguing the entire generation. Business Insider.
16. World Health Organisation (2019). Mental Health in the Workplace.
17. World Health Organisation (2019). Mental Health in the Workplace.
18. Park, R. (2019). Stigma and mental health in the workplace.
19. Lufkin, B. (2020). The remote work experiment that upped productivity 13%. BBC.
20. Trautmann, S., Rehm, J., & Wittchen, H. (2016). The economic costs of mental disorders.

 

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*** Content is suicide related. Reader's discretion is required. ***

 

Four Types of Suicides

 

In today’s society, the number of suicide cases is becoming increasingly common due to the increased stress individuals face. We, are taking the term “Suicide” too liberally without understanding that suicide itself has different reasoning and intent behind the action. 

 

According to Emile Durkheim, the term suicide is applied to all cases of death resulting directly or indirectly from a positive or negative act of the victim, which he/she knows will produce this result (Pickering & Walford, 2011).

 

Durkheim identifies four different types of suicide which are egoistic suicide, altruistic suicide, anomic suicide and fatalistic suicide.

 

Egoistic suicide is seen as stemming from the absence of social integration. It is committed by individuals who are social outcast and see themselves as being alone or an outsider. These individuals are unable to find their own place in society and have problems adjusting to groups. They received little and no social care. Suicide is seen as a solution for them to free themselves from loneliness or excessive individuation.

 

Altruistic suicide occurs when social group involvement is too high. Individuals are so well integrated into the group that they are willing to sacrifice their own life in order to fulfil some obligation for the group. Individuals kill themselves for the collective benefit of the group or for the cause that the group believes in. An example is someone who commits suicide for the sake of a religious or political cause, such as the infamous Japanese Kamikaze pilots of World War II, or the hijackers that crashed the airplanes into the World Trade Centre, the Pentagon, and a field in Pennsylvania in 2001. During World War II, Japanese Kamikaze pilots were willing to lay down their own lives for their countries in the hope that they will win the war. These pilots believed in their nation’s cause and were willing to sacrifice their lives. Similarly, suicide bombers around the world were willing to give up their lives in order to make a political or religious statement because they firmly believed in their group’s cause.

 

Anomic suicide is caused by the lack of social regulation and it occurs during high levels of stress and frustration. Anomic suicide stems from sudden and unexpected changes in situations. For example, when individuals suffer extreme financial loss, the disappointment and stress that individuals face may drive them towards committing suicide as a means of escape.

 

Studies conducted by the Centres for Disease Control and Prevention (CDC) have found that historically, suicides for people aged 25 to 64 rose during economic downturns (Sternheimer, 2011). There was a significant increase in suicide rates in USA from 1928 to 1932 when unemployment rates were nearly 24%. On the other hand, suicide rates were at a low in 2000 when unemployment was about 4%. In addition to economic downturns, disasters can also be associated with increases in suicide. The Japanese public health department reported that there was a rise in suicide rates after the 1995 Kobe earthquake. Earthquake survivors faced great stress and difficulty in trying to rebuild their livelihood and soon realised that their lives will not return back to normal due to the lost they suffered. Suicide became a means for them to escape reality.

 

Fatalistic suicide occurs when individuals are kept under tight regulation. These individuals are placed under extreme rules or high expectations are set upon them, which removes a person’s sense of self or individuality. Slavery and persecution are examples of fatalistic suicide where individuals may feel that they are destined by fate to be in such conditions and choose suicide as the only means of escaping such conditions.

 

In South Korea, celebrities are being put under strict regulations. There was a case where, a singer committed suicide due to exhaustion to keep up with society’s rules and regulations. In 2017, celebrity Kim Jonghyun ended his life due to severe depression and the pressure of being in the spotlight as he felt that he  could not fulfil the society’s expectations  of his performance (Lee, 2018).

 

This article is contributed by Dr Amir Singh from the School of Psychology. 

 

References

Lee, J. (2018, September 8). Family of late SHINee star Jonghyun sets up foundation support young artists. Retrieved from The Straits Times: https://www.straitstimes.com/lifestyle/entertainment/family-of-late-shinee-star-jonghyun-sets-up-foundation-to-support-young

W. S. F. Pickering; Geoffrey Walford; British Centre for Durkheimian Studies (2000). Durkheim’s Suicide: a century of research and debate. Psychology Press. p. 25. ISBN 978-0-415-20582-5. Retrieved 13 April 2011.

 

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SOS (Samaritans of Singapore)

1-767 (24hrs)

 

Care Email

pat@sos.org.sg

 

Care Text: https://www.sos.org.sg

accessible via Chatbox function

Daily (24hrs)

 

For International helplines, kindly refer to Befrienders Worldwide. If you or someone you know is in immediate danger, contact 24-hour emergency medical services

 

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* Turn on cc for English subtitles

** Timestamps available 

 

 

Published: 04 Jan 2024

Edited January 6 by amuse.ed

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Mad in the UK

Mainstream narratives: a person-centered paradigm of care is gaining favor in the Global North
By Samantha Lilley -05/01/2024
    
As the history of psychiatry reveals, the “management” of mental illness has gone through numerous phases, with one paradigm of care after another failing the test of time. A narrative review of published debates on this subject from 1990 to 2020 concludes that the biomedical model, which became the dominant paradigm of care following the publication of DSM-III in 1980, is giving way to a “person-centered, biopsychosocial spiritual model.”

 

The authors, Paulann Grech and Reuben Grech, faculty at the Department of Mental Health at the University of Malta, in an article published in the European Journal of Mental Health, write that this shift is occurring even though “a paucity seems to exist in the empirical evidence-base related to a number of these [alternative] approaches, especially when compared to mainstream treatment options such as pharmacotherapy and psychotherapy.”

Through a literature search, the authors found 36 articles that highlight the ongoing debate between what they characterized as the biomedical model and the “individual-community.” They wrote:

 

“This journey through the history of ‘modern’ psychiatric treatment highlights the multifaceted characteristics of mental health and its illnesses, with explanations and treatments lying on a spectrum that features social explanations, biological ones, psychological understandings, and spiritual beliefs. In view of all these considerations, selecting appropriate treatment options depends on feasibility and meaningfulness and not simply on effectiveness and availability.

 

Conclusively, whilst many service providers and health carers claim that their practice stands based on a holistic and person-centered approach, this may not always be the case. This is where the debates and theories that have been explored in the paper may serve as a reflective exercise on the historical debates on mental health care, in a bid to facilitate a critical evaluation of contemporary practice.”

In their paper, the authors tell how the arrival of chlorpromazine into asylum medicine in the 1950s, and introduction of other psychiatric drugs, kicked off what is remembered today as a “psychopharmacological revolution.” The introduction of these drugs is understood to have played a role in the downsizing of psychiatric asylums, and “completely changed the practice of psychiatry as well as its status in society.”

 

However, a counter-narrative to this story of progress is present in the literature, according to Grech and Grech. Historian Andrew Scull has told of factors other than the introduction of chlorpromazine that led to deinstitutionalization and “the demise of the traditionally oppressive psychiatric system.” Such factors included fiscal considerations and adjustments in state policy.

Since the arrival of Prozac, a fierce debate has emerged over the effectiveness of psychiatric drugs. A “multitude of clinical trials” have concluded that they provide a “significant beneficial effect,” the authors write. This “evidence-base” is the foundation for a “medical model” that attaches a “medical label to the presenting symptoms of mental illness and the provision of medications to eliminate them. In this view, success is measured by the level of symptom reduction.”

 

The criticism of that model begins with a challenge to claims of the drugs’ “effectiveness.” Kirsch, Healy, Moncrieff, Breggin, and others have noted that in the clinical trials of antidepressants, there is little benefit in the drug group over placebo. The quality of psychiatric trials is poor, positive results from industry-funded trials are exaggerated, and the drugs, rather serve as a cure, could be understood to induce their own “abnormal brain states.” Critics argue that the drugs should be used more as tools in periods of crisis, rather than as maintenance drugs, and that forms of care that focus on “personal satisfaction and quality of life” should be embraced.

 

The authors point to the work of Dutch psychiatrist Marius Romme as one of the “pioneers” in the development of alternatives to the medical model. He reconceptualized “psychosis as meaningful, a phenomena that must be explored and understood rather than suppressed or disguised.” His work led to the formation of the Hearing Voices Network.

 

Romme wrote:

 

“So, accepting voices is not accepting everything as they are perceived, but is the beginning of looking differently at them; normalizing them; being with many others who hear voices; creating hope and opening personal possibilities.”

The Hearing Voices Network can be understood to belong to a “recovery model” that is fundamentally different from the medical model. In the latter, “the patient assumes the ‘sick role’ and is expected to follow the doctor’s guidance to recover.” The recovery model focuses on “self-determination, empowerment, and interpersonal support—a focus on collaboration rather than adherence and compliance.”

The authors quote Pat Deegan on this point:

 

“The recovery model is rooted in the simple yet profound realization that people who have been diagnosed with a mental illness are human beings. Those of us who have been diagnosed are not objects to be acted upon. We are fully human subjects who can act and in acting, change our situation. We are human beings, and we can speak for ourselves. We have a voice and can learn to use it. We have the right to be heard and listened to. We can become self-determining. We can take a stand toward what is distressing to us and need not be passive victims of an illness. We can become experts in our own journey of recovery.”

During the past 30 years, the authors conclude, “the person-centered movement [has] continued to spread over the globe and has now become one of the leading approaches to mental health treatment, particularly in Europe. This approach, and the rise of the recovery movement, provided alternatives to the Medical Model, leading the way to a more humane management of mental illness.”

 

 

****

Grech, P. & Grech, R. (2022). Main Debates on the Management of Mental Illness: 1990-2020. A narrative review. European Journal of Mental Health, 17(1), 101-109. (Link)

 

Editor’s Note: Part of MITUK’s core mission is to present a scientific critique of the existing paradigm of care. Each week we will be republishing Mad in America’s latest blog on the evidence supporting the need for radical change.

 

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Mental Illness or Mental Health Concern?

by Jeffrey Rubin, PhD

Welcome to From Insults to Respect. 

The two dominant manuals for “diagnosing mental disorders” are the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases. (ICD). Their overarching concept is mental disorders. Synonyms are psychopathology, and mental illness. To access mental health services, most people are required to accept being labelled as having a mental illness. Not everyone respects this requirement.

 

These manuals continue this pathologizing despite the long history of such terminology being cogently criticized. In contrast to this pathologizing concept, there exists a peer reviewed published article that advocates an alternative method for accessing services, one that replaces the “mental illness” overarching concept with “mental health concerns” that includes the idea that these concerning experiences often serve adaptive functions. It is argued that this approach is a significant improvement over the pathologizing concept.

 

Criticism of the Mental Illness Concept

Professor William James

 

William James (1902/1961) was an early critic of the concept of psychopathology, referring to it as “simple minded” (p. 29) and “superficial medical talk” (p. 324). In his 1896 Lowell Lectures on Exceptional Mental States (which were reconstructed by Eugene Taylor in 1984 from James’s notes), he stated that experiences that are commonly viewed as unhealthy or morbid are really “an essential part of every character” and give life “a truer sense of values” (p. 15). James went on from there to note that medical writers tend to, represent the line of mental health as a very narrow crack, which one must tread with bated breath, between foul friends on the one side and gulfs of despair on the other….

 

There is no purely objective standard of sound health. Any peculiarity that is of use to a man is a point of soundness in him, and what makes a man sound for one function may make him unsound for another…. The trouble is that such writers use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with…. The only sort of being, in fact, who can remain as the typical normal man, after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity. Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all? (pp. 163-165)

 

In more recent time, Schroder, et al. (2023), carried out a relevant study. It presents data from a study in which participants with self-reported depression histories viewed a series of videos that explained depression as a “disease like any other” with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition). The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression.

 

Additional recent criticism of the mental illness concept has been presented by the World Health Organization (WHO) and the United Nations (UN). In its jointly published report titled “Mental health, human rights, and legislation: guidance and practice” (2023), it states:

 

The biomedical model of mental health is based on the concept of mental health conditions being caused by neurobiological factors (1, 2). As a result, care often focuses on diagnosis, medication, and symptom reduction, rather than considering the full range of social and environmental factors that can impact mental health. This can lead to a narrow approach to care and support that may not address the root causes of distress and trauma (p. xiii).

 

The same report also states:

 

Every person should have the opportunity to define what recovery means for them, and which areas of their life they wish to focus on as part of their own recovery journey. Recovery considers the person and their context as a whole, and no longer adheres to the idea or goal of the person “being cured” or “no longer having symptoms” (p. xiv).

 

Is it possible to respectfully address these issues?

 

I  have proposed an alternative classification system (Rubin 2018; Rubin in press) titled “Classification and Statistical Manual of Mental Health Concerns” (CSM). This approach does not simply exchange the mental illness concept with mental health concerns; rather, the mental health concerns concept is different in several important ways.

 

The CSM assumes each person seeking to access services as a unique individual. Rather than labeling anyone, it labels expressed concerns. Whereas the mental illness concept declares there is something wrong with the person, the CSM emphasizes, mental health concerns often turn out to be indispensable stages in acquiring valued fruits.

 

A mental health concern, as defined in the CSM, occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of these topics: behavior, emotion, mood, addictions, meaning of life, death, dying, managing chronic pain, work, relationships, education, eating, cognition, sleep, and challenging life situations. This is an observable event that occurs at a specific time and place, and therefore avoids the well documented reliability and validity problems of the mental illness concept.

Once it has been established what the concerns are, a collaborative effort between the mental health service provider and service seeker, begin creating answers to a semi-structured psychological formulation that looks at:

 

How distressing is each of the concerns that were mentioned on a scale of 1 to 7?

When and in what situations is the concern most problematic?

When and in what situations is the concern least problematic?

What are personal strengths?

Levels of functioning in the areas of sleep, eating, employment, education, relationships, on a 1 to 7 scale?

What is a tentative theory of cause or causes, jointly created, that considers the full range of social and environmental factors.

Arguments for the Practicality of the CSM In Some Settings Using Expressed Concerns Has Worked Fine

When I was doing my PhD practicum at the University of Minnesota’s Counseling Center, I worked there for a whole year and we had no need to use the “mental disorder” jargon of the DSM and ICD to communicate. When my advisor asked me to quickly tell him about my morning cases, I would reply with words like, “My 9:00 a.m. case is concerned about feeling depressed, my 10:00 case is concerned about his failing grades, my 11:00 case is concerned about how anxious she is in social situations.”

If my advisor wanted to know more about a case, we went into the psychological formulation type of information. This informal way to communicate among the professionals and graduate students at the counseling center flowed smoothly while we provided a wide range of mental health services.

The CSM Is Practical Because It Maintains the Concept of “Mental Health”

Currently, we have such enormous organizations as Mental Health America and its state and regional affiliates, the National Institute of Mental Health, university and college programs offering degrees in mental health counseling, and states offering certifications in this field. Psychologists, social workers, counselors, and psychiatrists regularly refer to themselves as providing services under the umbrella of “mental health service providers.” For these reasons, the CSM would maintain the concept of “mental health” so it can be comfortably and realistically accommodated into the many large organizations currently using it.

However, the CSM would use the term “mental health” in a way that is different from what is implied in the DSM and the ICD. The CSM would explicitly reject the idea that the opposite of mental health is mental illness. Rather, the word “health” in the CSM’s “mental health” would be phrased in a manner that indicates that professionals dealing with mental health concerns are part of the allied health professions. The reason for thinking of these professionals as health providers follows.

Many of the concerns that would fall under the CSM’s list of related topics have been identified in scientific studies as “physical health risk” factors. For example, people who express a concern about being addicted to alcohol are at increased risk of developing sclerosis of the liver (O’Shea, Dasarathy, & McCullough, 2010). Those who express concerns about eating more than average may be at greater risk of diabetes and heart disease (Mokdad et al., 2003). Quality of interpersonal relations, lack of sleep, depression with thoughts of suicide, and various other concerns or clusters of concerns can be studied for the degree of physical health risk that they pose.

A major goal of mental health providers under the proposed CSM system is to turn “physical health risk” factors into “physical health protective” factors. The degree to which this is successful can be studied using currently available methodologies. It is in this very specific sense that the mental health concern topics are viewed not merely as mental concerns but also mental health concerns. By being explicit about this change in conceptualizing mental health, we have good reason to believe that the CSM proposal holds promise for avoiding most of the negative baggage that comes with this type of terminology.

So, in brief, the CSM approach promises to reduce stigma, improve care, increase self-efficacy, and open new avenues of research. In going forward, I encourage people to begin the process of reconceptualizing what has been promoted as mental illnesses to a mental health concerns. Moreover, for those who have any influence with those in the world of psychology and psychiatry, please encourage them to adopt the CSM approach.

 

My Best,
Jeff

———————————
ABOUT THE AUTHOR

Dr. Jeffrey Rubin
Jeffrey Rubin grew up in Brooklyn and received his PhD from the University of Minnesota. In his earlier life, he worked in clinical settings, schools, and a juvenile correctional facility. More recently, he authored three novels, A Hero Grows in Brooklyn, Fights in the Streets, Tears in the Sand, and Love, Sex, and Respect (information about these novels can be found at http://www.frominsultstorespect.com/novels/). Currently, he writes a blog titled “From Insults to Respect” that features suggestions for working through conflict, dealing with anger, and supporting respectful relationships.

 

[amuse.ed]

** Guidance content like this works differently from person to person. Kindly listen to the content with more discretion and applied wisdom on what works and not work for the individual. Thus discuss with professionals where needed.

 

 

Edited January 15 by amuse.ed

[amuse.ed]

Mad in the UK

Plotting a research path to a new model of mental health care

By Kelli Grant -15/01/20240105
    
Both the World Health Organization and the United Nations, through the Office of the Special Rapporteur on Health, have urged that psychiatry’s biomedical model be replaced by one that centers on human rights, with an understanding that social determinants—poverty, race, violence, and environment—are factors that greatly influence mental well-being. This is a model that combines safeguarding rights for the individual with collective solutions for improving the social determinants of health, and in a recent article in Psychiatry, Psychology and Law, Yvette Maker and Bernadette McSherry, both faculty at law schools in Australia, argue that an “interdisciplinary research collaboration”  is needed to further develop this model of care. They write:

“Limited attention has been paid to the connection between social determinants of mental health as matters of human rights. This paper explores the potential for incorporating elements of both social determinants and human rights approaches to provide a new framework for mental health research, policy and practice.”

The authors provide a succinct recap of the history that led to this human-rights model for mental health. In 2000, the United Nationals Committee on Economic, Social and Cultural Rights stated that the enjoyment of the “right to health requires governments to take action on a range of ‘underlying determinants’ of health,” but at that time, didn’t address the “mental health” element in that right to health.

 

However, in 2008, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) stated that those with physical and mental disabilities “enjoy the right to the highest standard of physical and mental health without discrimination on the basis of disability,” and this can be seen as the founding document for a “human rights” model of mental health care.

During his tenure as U.N. Special Rapporteur on Health (2014-2020), Dainius Pūras told of how a convergence of the two discourses—on the right to health and the social determinants of health—was crucial to developing this new paradigm of care.

 

The authors write:

 

“He was particularly concerned that rights-based approaches to mental health tend to adopt ‘a narrow, individual focus on the prevention of mental health conditions’ through influencing individuals, meaning inadequate attention is given to wider social, economic, legal, political and other structural factors that affect mental health and well-being.”

The World Health Organization, in its 2021 “Guidance on Community Mental Health Services,” echoed this theme. That document, Maker and McSherry write, “observed that social determinants such as poverty, discrimination, violence and unemployment are often overlooked or ignored in relation to mental health, which they characterized as a hindrance to the realization of a human rights approach to mental health for people living with mental health conditions and psychosocial disabilities.”

 

A synthesis of human rights and social determinants perspectives, the authors write, can provide compelling evidence for implementing social policy that furthers both a human rights agenda and mental health goals. They cite two examples: research from eight European cities that showed a connection between poor housing quality (dampness and mold) and depression, and research in the United States that found a reduction in psychological distress when adults experiencing homelessness were placed in permanent housing.

 

Access to decent shelter is the human right here, and it helps provide a remedy to one of the social determinants of mental health: poor housing or no housing at all.

The prevailing biomedical model, the authors note, presents a conceptual barrier to remaking mental health care in this way. That model focuses on “locating problems and solutions within individuals [which] obscures the need to address the structural factors that make lives unliveable.”

 

The authors note that “interdisciplinary research has been defined as a ‘collaboration of [researchers] with largely non-overlapping training and core expertise to solve a problem that lies outsides the grasp of the individual [researcher].” What is needed is a collaboration that brings together service users, mental health practitioners, human rights lawyers and sociologists, which admittedly will “involve wrestling with competing cultures, values and priorities.”

The way forward, they conclude, will “include developing a common research agenda, working to articulate concrete measures that can be taken at local, national and global levels to advance health equity and the right to health in relation to mental health, and research to develop models for the implementation of such measures in mental health systems and beyond.”

 

****

Maker, Y. & McSherry, B. (2023). Human rights and the social determinants of mental health: Fostering interdisciplinary research collaboration. Psychiatry, Psychology, and Law, p. 1-15. (Link)

 

Editor’s Note: Part of MITUK’s core mission is to present a scientific critique of the existing paradigm of care. Each week we will be republishing Mad in America’s latest blog on the evidence supporting the need for radical change.

 

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[amuse.ed]

FROM INSULTS TO RESPECT

Mental Illness or Below Average Functioning?

A William James Perspective by Dr Jeffrey Rubin

“Good morning, Barbara,” I say, as my first counseling case walks into my office. I notice she looks a little angry. Upon sitting down, she declares, “I’m terribly frustrated. I’ve been depressed now for over two weeks, and I just can’t shake it!”

 

It’s easy for me to empathize because I regularly have bouts of what I refer to as melancholy. A deep anguish comes over me, and during this period I often begin to think about how I went through my father’s death when I was twelve, how I’m getting older and can no longer do the many athletic things that thrilled me when I was younger, and on and on. Sometimes these dark melancholy experiences come about because something clearly happened that upset me, and sometimes they seem to come out of the blue.

 

Beyond Listening in a Caring Manner

After listening in a caring way to Barbara for a few minutes, I ask her if something specifically happened that led her into her current emotional experience. Then I explore with her a question about how often she has these experiences and if she feels she has them more frequently than most people, about as often as most, or less than most. Then, I ask her about how she has been functioning in other areas of her life–sleep, eating, exercise, interpersonal relationships, work/school, household responsibilities.

functioning.

 

You see, as people experience depression, or other concerns that often lead to a classification of having a mental disorder, some people go about their lives functioning as they typically were doing before the concern arose, while some find that in some areas they begin to function below the levels that are typical for them, while some find that their functioning increases in one or more areas. For example, some sleep about the same amount, some less, and some more. I have met people who, when they are depressed, start cleaning every inch of their home, while others find it difficult to get out of bed.

sleep.

 

Also of interest when exploring a person’s expressed concern is to look at how the person had been functioning before the onset of the presenting concern. If some important relationships had begun to function below average, or if the person had been sleeping less than average to keep up with work demands, these facts can be insightful when seeking ways to address the presenting concern.

 

Now, once I found out what Barbara was concerned about, what might have precipitated the concern, and how she had been functioning in various areas of her life, I had a pretty good idea as to how to proceed in addressing her concern. I had no need to decide whether or not she had a mental disorder. However, many mental health practitioners are required to declare that the person seeking mental health services has a mental disorder if they want to get paid. Is this mental illness labeling really necessary?

 

Mental Illness Labeling Versus an Addressing Concern Approach
 

There are those who embrace this mental illness/disorder labeling. One reason is the pharmaceutical industry’s promotion of this idea to sell people on the idea that they need certain drugs to live a more normal, healthier life.

 

Beyond that, another major reason for this is that these individuals have a group of people in their lives that blame them for the way that they have been feeling or acting. When a doctor has declared, for example, that John Smith has a mental disorder, he may feel vindicated. “You see, there really is something wrong with me!” he may cry out in his defense.

 

In actuality, those who are doing the blaming may continue their blaming despite the doctor’s opinion. Moreover, many of us don’t blame people whenever they find some concern has arisen in their lives even if they are going through a non-illness experience.

 

I know I’m not blaming myself when I experience melancholy, and I was not at all blaming Barbara for what she was going through. Those who are uncomfortable about the use of “mental illness” terminology point out they are stigmatizing because they are used as put downs in our society. Moreover, the media associates the most heinous crimes with those referred to as the mentally ill even though the vast majority of those classified in this manner are not violent.

 

Among the most articulate individuals to voice objections to the mental disorder labeling was Harvard psychologist and philosopher William James. Over one hundred years ago he wrote a book titled, The Varieties of Religious Experience (1902). At that time many medical doctors argued that people who were religious were all mentally ill. In response, Professor James wrote:

 

Medical materialism seems indeed a good appellation for the too simple-minded system of thought which we are considering. Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic.

 

Teresa as an hysteric, Saint Francis of Assisi as an hereditary degenerate. George Fox’s discontent with the shams of his age, and his pining for spiritual veracity, it treats as a symptom of a disordered colon. Carlyle’s organ-tones of misery it accounts for by a gastro-duodenal catarrh. All such mental overtensions, it says, are, when you come to the bottom of the matter, mere affairs of diathesis (auto-intoxications most probably), due to the perverted action of various glands which physiology will yet discover. (p. 29)

 

James goes on from here to point out that it is true, of course, that psychology has found that there are definite psycho-physical connections that “hold good” (p. 30). Psychology, therefore:

mental statesassumes as a convenient hypothesis that the dependence of mental states on bodily conditions must be thoroughgoing and complete. If we adopt the assumption, then of course what medical materialism insists on must be true in a general way, if not every detail…. But now, I ask you, how can such an existential account of facts of mental history decide in one way or another on their spiritual significance? According to the general postulate of psychology just referred to, there is not a single one of our states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditioned just as much as religious emotions are; and if we only knew the facts intimately enough, we should doubtless see “the liver” determining the dicta of the sturdy atheist as decisively as it does those of the Methodist under conviction anxious about his soul. When it alters one way the blood that percolates it, we get the Methodist, when in another way, we get the atheist form of mind. So of all our raptures and our drynesses, our longings and pantings, our questions and beliefs. They are equally organically founded, be they religious or of non-religious content. (p. 30)

 

James points out that in the natural sciences and the arts it never occurs to anyone to refute opinions, beliefs and experiences by putting down their author’s neurological constitution. Value is determined by “judgments based on our own immediate feelings primarily; and secondarily on what we can ascertain of their experiential relations to our moral needs and to the rest of what we hold as true” (p. 33).

 

James was additionally concerned that medical materialism greatly overgeneralizes its knowledge of the connections between physiological variables and mind states. In James’s day, the pathology writers would take the few psychophysical correlations that they obtained under highly specialized conditions and then vaguely generalize their findings to discredit, to their satisfaction, all of the states of mind that they disliked.

 

The Modern Day View

Now, modern day psychiatrists sometimes respond, “Well, certainly in James’s day we indeed knew almost nothing about such matters, but today our knowledge has vastly increased! Thus, James’s position is no longer valid because we can now make sound statements about the connections between physiological states and mind states.”

 

To this, I respond that in point of fact there is currently a renewed respect for the extraordinary complexity that exists during the integration process between mind, physiology, behavior, and environmental variables. Whereas it is true that there have been large gains in our knowledge, these gains are best likened to moving from a few drops of knowledge to a glass almost full; yet, to really understand the integration process, we would need oceans and oceans of knowledge. Trillions and trillions of interactions are involved.

It is for these reasons that the mental illness/disorder terminology is misleading. As Dr. Thomas Insel, the former director of the National Institute of Mental Health, recently said about the psychiatric labeling process known as the DSM.

 

The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century as we have understood that symptoms alone rarely indicate the best choice of treatment.

 

Conclusion

When individuals express a concern, exploring how they are functioning in the main areas of their life can be enormously helpful. Someone who reports a concern about experiencing depression, whom, by some gentle questioning, we find out has been functioning below average in the areas of sleep, interpersonal relationships, and exercise may benefit enormously if we work together on getting these areas of functioning in a more optimal range. This is true for those who report other types of concerns such as experiencing anxiety, hearing voices, below average range of attention, obsessive thoughts, and on and on. With a model that includes addressing concerns and exploring ways to improve functioning, labeling someone as having a mental disorder becomes unnecessary and may actually interfere with the aims of a counseling/psychotheraputic relationship.

 

For those who desire, for whatever reason, to be labeled as having a mental disorder, I am not proposing that we interfere with this. But for those who desire to have their concerns addressed by well trained mental health professionals without being referred to as having a mental illness or disorder, I do propose that we do provide a reasonable option for them to access mental health services. In my view, mental health professionals, once we hear our clients’ concerns and how they are functioning in the various areas of their lives, we have the basics to formulate, in full cooperation with our clients, a plan for addressing these concerns. I hope you give this some thought.

———————————

ABOUT THE AUTHOR

 

Dr. Jeffrey Rubin
Jeffrey Rubin grew up in Brooklyn and received his PhD from the University of Minnesota. In his earlier life, he worked in clinical settings, schools, and a juvenile correctional facility. More recently, he authored three novels, A Hero Grows in Brooklyn, Fights in the Streets, Tears in the Sand, and Love, Sex, and Respect (information about these novels can be found at http://www.frominsultstorespect.com/novels/). Currently, he writes a blog titled “From Insults to Respect” that features suggestions for working through conflict, dealing with anger, and supporting respectful relationships.

 

Content was edited, kindly click HERE for online full article.

 

Edited February 3 by amuse.ed

[amuse.ed]

Singapore 

 

Delivery of mental health services to be moved into community to widen reach Singapore is planning an effective mental health ecosystem to tackle the growing prevalence of mental health disorders.

SINGAPORE – The delivery of mental health services in Singapore will be moved into the community to widen the number and variety of touch points for those in need of the services, and to include more non-healthcare workers in the provision of such services.

 

And, by 2030, all 1,350 projected Healthier SG general practitioner (GP) clinics and all polyclinics will offer mental health services, Dr Janil Puthucheary, Senior Minister of State for Health, told reporters on Jan 31, ahead of a parliamentary motion on mental health in the week of Feb 5.

 

The plan to rope in the community and more GPs and polyclinics to provide mental health services was first announced in October 2023. Currently, around 450 GPs have undergone training to deliver mental health services, while 19 out of 24 polyclinics offer mental health services.

Singapore is planning an effective mental health ecosystem to tackle the growing prevalence of mental health disorders.

 

The Inter-agency Taskforce on Mental Health and Well-being, chaired by Dr Janil, launched the National Mental Health and Well-being Strategy on Oct 5, 2023, after working on it for about 2½ years.

 

Five MPs have filed a motion to debate this strategy. Dr Janil said five political leaders, including Deputy Prime Minister and Finance Minister Lawrence Wong, will speak about it in Parliament early in the week of Feb 5.

 

Broadly speaking, the Government wants to shift “the centre of gravity” of how it delivers mental health care services from hospitals to the community, said Dr Janil, who is also Senior Minister of State for Communications and Information. In the process, it will reduce the amount of medicalisation or institutionalisation around issues of mental health and mental wellness.

 

Second, the Government wants to broaden the delivery of care services to non-healthcare workers, including volunteers, colleagues or even friends, through workplace health and peer support programmes, for instance.

 

The third shift the Government wants is for the public to understand that mental health is a “spectrum”, Dr Janil said.

 

The 2022 National Population Health Survey found that the prevalence of poor mental health rose from 13.4 per cent in 2020 to 17 per cent in 2022.

 

Young people, aged 19 to 29, are the largest population sub-group in the survey with poor mental health, at 25.3 per cent.

 

“The absolute incidence of mental health illness is rising, but rising even faster are the anxieties and concerns of people who don’t have a mental health illness, but have symptoms or concerns which are about their mental health,” said Dr Janil.

 

“Broadly speaking, we have three groups. We have the issues to do with the normal stressors of life: family dynamics, work pressures, relationship pressures. These may cause some degree of mental health symptoms, but really the response needs to be about social networks and resilience; how we cope.”

 

Another group comprises those who may have mood or behavioural issues, but not a mental illness. The people who fall into this group would require an approach “probably best done by a community care provider”, said Dr Janil.

He added that it is not necessary to escalate and medicalise every case, or take a person out of the community, “where they have the social support (and) normal routines”.

 

In the third group are those who have mental illnesses and need specialised access to mental health services.

More funding for mental health services as demand for such help rises
More GPs join national programme to treat patients with mental health conditions

A key part of the strategy is a tiered-care model that provides the support to meet the severity of each person’s needs, across health, social and education settings. 

 

He said the outcome of the tiered-care model the authorities hope for is to have “a much larger number of touch points”, and that people can go to where they are comfortable for their needs.

 

“We hope this will improve access for members of the public. We hope it will improve acceptability and reduce stigma for the access to mental health services,” he added.

 

Dr Timothy Singham, a clinical psychologist at Viriya Community Services, who is a member of the task force’s implementation committee for the model, said the tiered-care model is a way to help various providers, like family service centres and social service agencies, know where to refer an individual who needs a higher or lower intensity of support in a timely manner.

 

“We know, anecdotally, mental health services in the hospitals are overwhelmed. And also, the waiting time for psychological assessment may take even longer. We need a way to get people the help they need at the community level,” he said. 

Madam Lim Chin Yin, a senior school counsellor at Ang Mo Kio Primary School, said she is aware of the high caseloads handled by school-based mental health service Reach and the Institute of Mental Health, and welcomed the new initiatives by the inter-agency mental health task force.

She has worked with her school to initiate a new preventive health programme called Buddy Grove@AMKP for at-risk pupils.

 

It is guided by the principles of positive psychology to develop the pupils’ emotional management skills, build resilience, as well as cultivate a positive mindset by teaching them effective coping strategies, she said.

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[amuse.ed]

Singapore

 

Mental health 'key priority' in national agenda; 900 more GP clinics to be added to community care network
 

Mental health 'key priority' in national agenda; 900 more GP clinics to be added to community care network

Mental health services will also be introduced at all polyclinics, says Deputy Prime Minister Lawrence Wong. 

 

Mental health 'key priority' in national agenda; 900 more GP clinics to be added to community care network
Deputy Prime Minister Lawrence Wong speaking on the parliamentary motion on mental health on Feb 7, 2024.

Grace Yeoh
07 Feb 2024 02:25PM (Updated: 08 Feb 2024 12:40AM)

SINGAPORE: The government will make "significant moves" to improve Singaporeans' mental health and well-being, as Deputy Prime Minister Lawrence Wong on Wednesday (Feb 7) called for a more inclusive "Singapore Dream" and a mindset change on what constitutes success.

 

Weighing in on a parliamentary motion on advancing mental health, Mr Wong announced a raft of measures. These include:

 

Increasing capacity at the Institute of Mental Health (IMH) and the redeveloped Alexandra Hospital.

Ramping up the number of public sector psychiatrists and psychologists by 30 per cent and 40 per cent respectively.

Training an additional 28,000 frontline personnel and volunteers.

Introducing mental health services at all polyclinics and 900 more GP clinics.

The government aims to implement these measures by 2030 or earlier. 

 

Mr Wong stressed that the government is making mental health and well-being a “key priority” in the national agenda and called on Singaporeans who are passionate about the issue to join in this national movement. 

 

“We have lots to do and a full agenda ahead of us. The government has set out clear plans and deliverables. But the issues are complex and we do not have all the answers,” he said. 

 

“We want everyone on board, so that we can learn together, and continue to fine-tune our strategies based on your feedback and ideas, and our shared experiences and insights.”

CHANGING DEFINITION OF SUCCESS

While attitudes towards mental health issues are shifting, Mr Wong acknowledged that the stigma remains. And this “reduces a complex and difficult problem into unhelpful labels and stereotypes”, he said.

 

“It opens people struggling with mental health to discrimination, such as in the job market. It may cause them to be socially ostracised. It makes them feel ashamed, isolated, and stops them from seeking treatment.” 

 

Improving overall mental health also means mindsets have to be changed over what is considered success, said Mr Wong on the second day of the debate.

 

He pointed out that this was, in fact, one of the key points from the Forward SG engagements, where the majority of Singaporeans had said they wish to see a "more inclusive Singapore Dream". 

 

The dream was defined as “one where we are not pressured to conform to narrow definitions of success; where we embrace excellence and talents across many areas, and find meaning and purpose in what we do”, he added. 

 

Mr Wong, who chaired the Forward SG exercise, noted that the government is making policy moves by reviewing the education system, narrowing wage gaps and strengthening safety nets. But he reminded the House that “we cannot make this happen through policy alone”. 

Instead, attitudes and mindsets must also change and align with aspirations for a “refreshed” dream.

WIDE SUITE OF SOLUTIONS 

The national mental health and well-being strategy, which was launched in October last year, aims to provide more tailored care for different needs across the spectrum.

 

On Wednesday, Mr Wong reiterated the need to appreciate and understand the “full range of mental health issues”. 

 

On one end, mental health conditions like bipolar disorder and schizophrenia can be “debilitating”, while issues like anxiety and stress on the other end of the spectrum may not typically require medicalisation. But it does not mean the latter should be taken lightly, he noted. 

 

As mental health issues exist on a spectrum, there is a need for “a broad suite of solutions”. 

While the government will hire more psychiatrists and build more capacity at IMH, this solution is not the be-all and end-all. 

 

“We also need to strengthen capabilities across our entire spectrum of care, including at our polyclinics and GPs, and also across other settings like schools, workplaces, and in the community, so that more timely support can be rendered to those in need,” said Mr Wong. 

 

To that end, the government has specific targets that it aims to achieve by 2030 or earlier. 

 

First, it will increase capacity at IMH and the redeveloped Alexandra Hospital for those who need specialist care. Capacity at long-term care facilities will also be increased to provide “step-down care” for those who need it.

 

Second, it will increase the number of public sector psychiatrists and psychologists by about 30 per cent and 40 per cent respectively.

 

Third, it will introduce mental health services to all polyclinics and 900 more GP clinics, bringing such services closer to the community. 

 

Fourth, it will equip and train 28,000 more frontline personnel and volunteers who serve at various community and social service touchpoints. This will help them “identify people struggling with mental health and offer early assistance”. 

 

The government will also “redouble” existing efforts, added Mr Wong. 

 

The Education Ministry is on track to achieving its target of deploying more than 1,000 teacher-counsellors across schools. This is in addition to the basic counselling skills that all teachers will be trained in, as well as the one to two counsellors that every school will have to support students with “more challenging social and emotional needs”. 

 

Parents will also be provided with resources to help them support their children’s mental health and well-being needs. 

 

There will also be more peer support networks established in the community, such as in schools, institutes of higher learning (IHLs), workplaces and among national servicemen. Such networks will have “trained peer leaders” who can provide a “first line of response” to friends and colleagues who need help. 

 

INSURANCE COVERAGE, WORKPLACE STIGMA 

Addressing concerns raised by MPs on Tuesday about better insurance coverage for mental health conditions, Mr Wong pointed out that life insurers in Singapore have offered coverage to people with mental health conditions.

“But the underwriting of such persons can be a complex matter, as our own data is limited, and insurers here typically reference the underwriting guidelines of global life reinsurers,” he said. 

 

The government will nonetheless review how the coverage can be improved and ensure that financial institutions deal fairly with all their customers, including those with mental health conditions, he added.

 

In the workplace, the government is also taking steps to help companies better understand employees’ mental well-being. 

 

It will launch iWorkHealth Lite, which is a “dipstick survey” that can be completed in five minutes and is for companies to gauge their employees’ work stress and burnout, announced Minister of State for Manpower Gan Siow Huang in parliament on Wednesday. 

 

The iWorkHealth Lite comes under the Ministry of Manpower’s iWorkHealth assessment tool – a free online, company-administered tool that employers can currently use to gain insight into their employees’ mental well-being, including workplace stressors they may be facing. 

 

The shortened survey was the result of feedback from companies to use iWorkHealth as a “pulse survey” to monitor the mental well-being of staff more frequently. 

 

Echoing sentiment among MPs about eradicating stigma, Ms Gan pointed to the upcoming Workplace Fairness Legislation, which “sends a strong signal that there is no place for discrimination against employees and jobseekers with mental health conditions”. 

 

Employees should be treated fairly and based on merit even if they have chosen to disclose their mental health conditions, she said. 

 

In his closing speech, Dr Wan Rizal (PAP-Jalan Besar), who had filed the motion along with four other MPs, also highlighted the common concern among those who spoke over the two-day debate: Stigma. 

 

Stigma is “not just a societal issue”, he reminded the House. 

 

“It's profoundly personal, affecting individuals and families in every corner of our community. The stigma mutes voices that need to be heard. It isolates those who feel alone in their struggle and deepens the wounds of those silently suffering.” 

 

As such, cultivating an environment where people are not afraid to seek help or talk openly is a mission that spans “every facet” of society, he said. 

The motion on advancing mental health care was unanimously passed in parliament on Wednesday afternoon.

 

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[amuse.ed]

Singapore

 

Commentary: How do we know Singapore’s mental health and well-being strategy is working? 

26 Feb 2024 06:00AM

(Updated: 26 Feb 2024 03:36PM)

SINGAPORE: “So let there be no doubt: The government is making mental health and well-being a key priority in our national agenda”. 

 

As an advocate and community organiser of mental health since my own brush with depression in 2006, it was impossible not to feel emotional hearing this declaration from Deputy Prime Minister Lawrence Wong earlier this month, along with a robust debate across two days in parliament on the Advancing Mental Health motion. 

 

Making mental health a national priority with a national mental health office was the impassioned plea I made in my 2019 Budget speech; in the following year’s Budget, I implored the government to improve accessibility, affordability and quality of mental healthcare.

 

These words by the incoming prime minister not only commit the government to making significant policy shifts to address one of the most existential challenges of our time but will most certainly shape social attitudes and behaviours positively towards mental health and well-being across all segments of the population. 

ARE WE INVESTING ENOUGH IN MENTAL HEALTH AS A NATIONAL PRIORITY?

Across the world, governments spent an average of just over 2 per cent of their health budgets on mental health in 2020, according to the World Health Organization Mental Health Atlas. Additionally, 66 per cent of total government spending on mental health was directed towards an outdated approach: Psychiatric hospitals. 

The World Bank deemed “all countries can be considered ‘developing’ countries in the context of mental health, as all are lagging in addressing the growing burden”. 

 

We are certainly guilty of that too. In 2017, Singapore’s mental health spend at S$300 million was only 3 per cent of the Ministry of Health’s total expenditure, versus 11 per cent for diabetes and 6 per cent for aged care.

In 2022, the projected mental health spend increased to S$434.6 million but stayed at 3 per cent of total healthcare expenditure (not including COVID-19 expenditures). More interestingly, only 3 per cent of Singapore’s mental health spend in 2022 was for promotion and prevention, while 97 per cent was on treatment.

 

The National Mental Health and Well-being Strategy launched in October last year, however, is clearly premised on a new policy narrative that mental health is a continuum, not merely the absence of illnesses - a much-welcomed shift. 

Under the new national strategy, a tiered care model will organise mental health services and support measures according to the severity of an individual's needs, along with multiple touchpoints including a new national mental health hotline and text service.

Certain goals have also been set for implementation by 2030, including making mental health services available in all polyclinics and 1,350 HealthierSG GP clinics. The number of public sector psychiatrists is also set to grow by about 30 per cent to 260, and the number of psychologists by about 40 per cent to 300. In addition, the number of Community Outreach Teams (CREST) catering to youths will be nearly doubled to 15, from eight currently.

Indeed, there is no doubt that our mental health spend will and must certainly increase beyond 3 per cent of total health expenditure in the next six years.

 

If one in seven Singaporeans (14 per cent) has a mental health condition according to the 2016 Singapore Mental Health Study (and likely more by now), should we not invest more than 3 per cent of the total health budget on mental health? 

 

I hope that we would also see a more even distribution between mental health promotion/prevention and care treatment as we take a population health approach. 

 

Because where, and how much, we invest is where the change will be. 

HOW DO WE KNOW IF THESE MEASURES ARE ENOUGH?

I am most heartened by the promise of a whole-of-government coordination in the national strategy through the setting up of the National Mental Health Office by 2025 “with officers from the health, social, and education sectors to oversee the implementation of the strategy, to ensure cohesive alignment of policies and programmes at the national level, and to track the progress and impact of our strategy”. 

 

Indeed, how do we know if these measures are enough? 

 

As of 2022, there were 203 registered psychiatrists and 212 psychologists in the public sector. It is difficult to fathom if having just 57 more psychiatrists and 88 more psychologists in the next six years will help reduce waiting times and improve quality in the public sector. 

 

At 260 psychiatrists and 300 psychologists by 2030, this works out to roughly 6.3 psychiatrists and 7.2 psychologists per 100,000 population based on 2023 resident population figures.

 

Compare this to 44 psychiatrists per 100,000 population for Switzerland and 28 for New Zealand versus 1.0 for Malaysia and 0.3 for Indonesia. 

 

According to the Ministry of Health, there is no international consensus on the optimal ratio of psychiatrists and psychologists to population. What then is the basis for our targets of 260 psychiatrists and 300 psychologists by 2030? 

 

Similarly, will 15 CREST teams catering to youths in 2030 be sufficient to address upstream the “worrying trend” of a surge of youth mental health issues as Mr Wong alluded to?

 

What is also not known is an aggregated map of all mental health efforts across the ecosystem that would augment these government measures for a fuller picture of national capacity and capability.

 

For example, the Community Foundation of Singapore has a project to train 1,000 community mental health champions that could supplement the effort to train 130,000 frontline personnel and volunteers.

 

Aside from the state-directed online initiatives such as MindSG and Mindline.sg, there are also homegrown mental health platforms like Intellect that use their business technologies for individuals to access support. 

 

This partnership between the government and all stakeholders would need to be even more intentional and coordinated, as DPM Wong also affirmed.

 

I hope that we will know more about the explicit targets of and dedicated resources allocated to the national mental health office in the upcoming Committee of Supply debates.

WHAT DOES SUCCESS LOOK LIKE FOR A MENTALLY HEALTHY AND THRIVING SINGAPORE?

The National Mental Health and Well-Being Strategy aims to work towards “improving a mental health ecosystem in Singapore where individuals with mental health needs can seek help early without stigma and will receive help readily for their recovery”. 

 

We have committed decisively on the actions, but have we committed explicitly to clear outcomes? How do we know we are moving in the right direction with the strategy if we don’t know where we are going? 

 

For instance, are we working towards reducing waiting times by X per cent by 2030 with these strategies? Or do we want to see suicides reduced to Y and stress-related illnesses to Z in six years? What do we hope to see as the mental health prevalence in 2030 with these measures to create a more effective mental health ecosystem? 

 

The national strategy aims to close the treatment gap which is a baseline goal we must have, but can we also go further to boldly declare mental well-being as fundamental a priority as our economic well-being for sustainable and meaningful growth as a nation? 

We know without a doubt that economic success alone does not guarantee the mental well-being of our children, elderly and communities or we would be one of the last places to have a mental health challenge, given the economic growth that we have had since independence. 

 

In fact, anxiety and depression collectively cost Singapore’s economy S$15.7 billion in productivity every year, according to a study by Duke-NUS and the Institute of Mental Health. This works out to 2.9 per cent of our gross domestic product (GDP) for 2022. 

So mental health and well-being are inextricably tied to economic performance. Imagine celebrating success equally in our “gross well-being progress (GWP)” alongside gross domestic product (GDP). 

 

We must be the change we want to see around us. Our present circumstances don’t determine where we go; they merely determine where we start. 

I look forward to the day when we embrace our mental well-being and personal thriving as a life goal individually and a sustainable growth imperative as a nation. 

 

Anthea Ong is a former Nominated Member of Parliament, a leadership and life coach, a social entrepreneur and author. She founded SG Mental Health Matters, a community-led initiative that aims to educate the public on mental health policies through parliamentary tracking, public consultations, and policy recommendations.

 

Kindly click HERE for full article and various hyperlinks to other content in relation to the topic.

[amuse.ed]

Singapore

 

Gen Zen: What does taking a healthy dump have to do with your mental health? A lot more than you think

 

Increasingly, people are becoming aware of the importance of mental health and well-being in our lives. In our weekly Gen Zen series, TODAY looks at ways that we can feel better while coping with the mental stresses of modern life.

 

Psychological factors such as stress, anxiety and depression can influence gut health through the release of stress hormones

 

Yet, poor gut health can also affect mental health

 

This is when microorganisms in the gut are out of balance and produce chemicals that affect the person's mood

 

The first step to a healthier gut and mind is a diet that promotes gut health 

 

There should also be more collaboration between mental health professionals and gastroenterologists to provide better care for patients

 

Justin Ong

 

BY JUSTIN ONG

Published March 4, 2024

Updated March 4, 2024

 

SINGAPORE — Late last year, I chanced upon a website that made an outlandish promise: Get paid US$500 (S$670) each time you donate your stool. 

 

The website was promoting faecal microbiota transplantation, which is a procedure where faecal matter from a healthy donor is transferred to a gut of a recipient to restore the “balance” of micro-organisms that live in the digestive tract, and this improves their immunity and digestion. 

 

However, there was a catch — it is estimated that only 0.1 per cent of the human population is considered healthy enough to qualify as high-quality stool donors. 

 

As expected, there were some physical factors: The donor had to be young (preferably under 30), athletic, had a certain stool type and had minimal antibiotic use, since these would affect the micro-organisms in the gut. 

 

Then, to my surprise, there were psychological requirements as well: A successful donor had to be typically happy and relatively stress-free, or in other words, was in the pink of mental health. 

 

It got me wondering: What does mental health have to do with gut health, and can eating food beneficial to our gut also help our mood as well? 

 

HOW STRESS, ANXIETY AFFECT GUT HEALTH

 

I put some questions to Dr Ganesh Ramalingam, who is medical director and specialist in general surgery at G&L Surgical Clinic.

 

He said that psychological factors such as stress, anxiety and depression can indeed influence gut health, through the release of stress hormones such as cortisol and adrenaline. 

 

“These stress hormones can affect how our gut works by changing how quickly food is digested, weakening the intestinal walls and disturbing the balance of helpful bacteria inside the gut,” Dr Ganesh said. He specialises in upper gastrointestinal surgeries, among other procedures. 

 

This gut-brain link made sense to me — whenever I felt anxious before making a speech in public, or felt nervous about the outcome of a job interview or test result, I would feel my stomach turn and lose all appetite for hours on end. 

 

And likewise, our gut health can also affect our mental health. 

 

“Inside our gut there are organisms called microbiota that help produce chemicals that affect our mood like serotonin and dopamine,” Dr Ganesh said. 

 

“When these microbes are out of balance due to factors like diet or medication, it can contribute to mood disorders like anxiety and depression.” 

 

Indeed, a study in 2019 with a sample size of more than 1,000 participants found that two “beneficial bacteria” for the gut — coprococcus and dialister — were less common in people with depression. Such bacteria can be cultivated by consuming fruit, vegetables, whole grains and fermented foods. 

 

Another study conducted in Spain in 2009 showed that people who ate the traditional Mediterranean diet — which consists of whole grains, fruit, vegetables, fish, beans and nuts — were about half as likely to receive a diagnosis of depression within a span of four years. 

 

FIRST STEP TO MANAGING GUT HEALTH: OUR DIET

For those looking to improve their diet and live a healthier life, it may be heartening to know that it can improve their mental health, too. 

 

“What we eat can have an impact on both our gut and mental health,” Dr Ganesh said.  

 

“A diet packed with fibre, fruit, vegetables and probiotics supports gut health, which in turn can positively influence mental well-being.”

 

The reverse is also true. 

 

“But if we're loading up on processed foods and unhealthy fats, it can throw gut bacteria out of balance, making us more prone to mental health issues,” Dr Ganesh added. 

 

This can also turn into a vicious circle if left unchecked: The stress and anxiety triggered by a bad diet can lead to more gastrointestinal issues, which can lead to poorer mental health. 

 

HOW TO MANAGE BOTH MENTAL AND GUT HEALTH 

 

When it comes to improving mental health, there is recognition that sports and exercise play a big role. Perhaps it is time other factors such as gut health are taken more seriously as well, Dr Ganesh said. 

 

He believes that the link between gut health and mental health means that a “multidisciplinary approach” is needed. 

 

“In my view, mental health professionals can include gut health assessments in their treatments, considering factors like diet, stress and gastrointestinal symptoms,” he said. 

 

They might then suggest dietary changes alongside other stress management treatment and even refer their patients to gastroenterologists if their gut problems are suspected to be affecting their mental health.

 

Similarly, gastroenterologists could ask about patients' mental health during consultations and work with mental health professionals as needed. 

 

“They can also educate patients on the gut-brain connection and suggest lifestyle and diet changes,” Dr Ganesh said. 

 

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Edited March 10 by amuse.ed

[amuse.ed]

Singapore 

 

Forum: Holistic strategy needed for mental health care

UPDATED FEB 28, 2024, 05:02 AM

The Health Care Services Act restricts psychologists from using the term “treatment” and those with doctoral degrees from using the title “doctor” in case they are misconstrued as offering medical services (Psychologists call for better regulation of profession amid mental health push, Feb 13).

 

The implicit message is that mental disorder is a (medical) condition “treatable” only with medical procedures, reflecting a reductionist approach to mental health care. Mental disorder, as characterised by a complex network of biological and psychosocial factors interacting with each other in feedback loops, requires a multidimensional paradigm. The meaning of “treatment” must be expanded.

 

The American Psychological Association differentiates between medical and psychological treatments. The former includes psychotropic drugs, whereas the latter includes psychotherapy.

 

In the case of depression, using both psychotherapy and antidepressants is more helpful than medication alone. In some circumstances, psychotherapy may be more effective than medication as psychotherapy teaches life skills to prevent relapse.

 

Psychotherapy enhances mental well-being by improving functioning in some brain regions, suggesting that therapeutic experiences gained from psychotherapy can modulate the neurobiological architecture.

 

When the Act recommends psychologists use the word “support” instead of “treatment”, members of the public may misinterpret psychotherapy as an adjunct to medication.

 

A reductionist approach also over-medicalises everyday life suffering. Medicalisation and increased use of psychotropic medication may not reduce the stigma of psychiatric diagnoses, but induce fear and a sense of losing personal control in some cases.

 

I do not see how the “doctor” title will cause serious ethical problems.

 

Although a doctoral-level psychologist may be mistaken for a physician, malpractice is unlikely to happen because medical treatments are regulated in Singapore.

 

Psychologists adhere to professional codes of conduct by not performing therapies they are not trained in. They will recommend pharmacotherapy when necessary. The issue is not whether the “doctor” title would confuse members of the public, but whether they know the different complementary roles played by psychologists and psychiatrists.

 

The multidimensional character of mental disorder requires a multidisciplinary approach without prioritising a particular treatment over another. This holistic strategy is necessary for progress in mental health care when mental well-being is now a national priority.

 

Lee Boon Ooi

Edited March 10 by amuse.ed

[amuse.ed]

Singapore (2019 article)

Feeling isolated, stressed and depressed, more LGBTQ individuals seek mental health support

 

BY EVELINE GAN
Published July 20, 2019
Updated July 20, 2019

Four years after reading about a teenager who allegedly hung himself in 2015, the tragedy continues to weigh heavily on the mind of a 48-year-old gay man.

 

Online users have said that the teenager in Singapore experienced homophobic bullying on social media before his death, though that has not been verified.   

 

Talvin (not his real name), who works in the music industry, told TODAY: “I don’t even know this boy personally, but I was (and am still) very affected by his death.”

 

Talvin does not want to be identified because he is afraid there may be repercussions for his work. He is well-acquainted with discrimination against lesbian, gay, bisexual, transgender and queer (LGBTQ) people and the emotional toll it can take on individuals and their families.

 

Over the last 30 years, he has experienced intense periods of rage and bouts of depression due to work and relationship issues. He also had suicidal thoughts.

Hate speech affects LGBT people, too
“I’ve always felt like I’m a one-man army," he said.

 

Last year, for the first time in his life, he sought help from a professional counsellor. An acquaintance in his workplace suggested counselling after pointing out his increasingly destructive behaviour — he was drinking too much and got overly emotional while interacting with others.

 

INCREASED AWARENESS

 

Talvin is among the increasing number of LGBTQ individuals in Singapore seeking mental health support in recent years.

 

Experts attributed it to an increased awareness of mental health and LGBTQ-related issues, along with greater access to support services.

 

At Oogachaga, a non-profit community-based organisation that works with LGBTQ individuals, demand for counselling services has doubled in the past five years. 

 

Last year, Oogachaga’s counsellors handled a total of 2,012 counselling sessions, up from 974 sessions in 2013.

Pink Dot plans social media campaign to cast spotlight on discrimination
They included professional face-to-face counselling as well as counselling sessions conducted via phone, WhatsApp and email. Sexuality, gender identity, relationship and mental health issues make up the bulk of the cases seen by its counsellors.

 

Think Psychological Services, which offers counselling services for LGBTQ-related issues among its other psychological services, has seen an estimated 50 per cent increase in the number of LGBTQ clients in the last three years. It now sees around 10 to 12 cases every month.

 

Think’s clinical psychologist Vyda S Chai said that many seek help to work through the coming-out process, and relationship and infidelity issues.

 

“There have also been numerous cases grappling with oppression, discrimination and social issues related to their LGBTQ identity,” she said.

 

MENTAL HEALTH PROBLEMS

 

Research has shown that LGBTQ people face a higher risk of having mental health issues such as depression, anxiety, substance abuse, suicide and self-harm than heterosexuals.

 

For instance, gay and bisexual youth are four times more likely to have attempted suicide in the past year than their straight classmates, based on a 2015 report by the United States’ Centers for Disease Control and Prevention.

 

While not all LGBTQ individuals have the same struggles, experts told TODAY that stress from discriminatory experiences are a recurring theme among those seeking mental health support.

 

A 2012 study here done by Oogachaga found that three in five LGBTQ respondents surveyed reported some form of discrimination as a result of their sexual orientation and/or gender identity.

 

Dr Adrian Wang, consultant psychiatrist at Gleneagles Medical Centre, said the patients he sees from the LGBTQ group generally have similar mental health issues, such as anxiety attacks, depression and work stress, as the straight population. However, discrimination, the lack of acceptance and support network can compound mental health issues. Dr Wang sees three to four LGBTQ patients every month.

 

“Being gay does not make one biologically predisposed to mental health disorders. Rather, it is because some of them face discrimination and acceptance issues at their workplace or at home,” Dr Wang said.

 

“One of the most depressing things LGBTQ people face is when they are not accepted by their own family members,” he added.

 

Oogachaga’s executive director Leow Yangfa, a registered social worker, said that discriminatory experiences can occur at various life stages, and can affect LGBTQ people from all walks of life.

 

They may include homophobic slurs in school or religious community, family members disapproving same-sex relationships, social isolation of an elderly or disabled LGBTQ person or racism faced by LGBTQ people from ethnic minority backgrounds, Mr Leow said.

 

They could also be in a workplace environment where people are transphobic, meaning there are negative attitudes, dislike or prejudice against transgender or transsexual people.

 

Transgender individuals, in particular, tend to experience even higher levels of stress and poorer mental health. 

Ms June Chua, who founded transgender shelter The T Project in 2014 with her late sister, said: “If you are gay or lesbian, you can choose to ‘come out’ to selected groups of people, and not others. But for transgender people, the physical aspect and changes of transitioning makes it impossible for them to choose, which can be very stressful.”

 

BATTLING STIGMA AND ISOLATION

 

Ironically, some of the most hurtful and discriminatory slurs targeted at Talvin came from the gay community.

 

“One time, someone invited me to ‘gay night’ at a club. When his friend saw me, he whispered loudly, ‘Eh, why you bring Indian here?’

 

“I’ve also been accused of ‘straight-acting’ by gay men. It’s really depressing,” he said.

 

Straight-acting is a term used to describe a person who does not look like or behave in a way that is considered typical of gay individuals.

“My straight friends and bosses from my previous companies don’t seem bothered by (my sexual orientation). My experience is the reverse — the LGBT people I’ve met have been quite nasty to me,” Talvin disclosed.

 

At home, Talvin continues to experience stigma and isolation. His 70-year-old mother is unable to accept his sexual orientation.

 

Once, she insisted that he read a news article of a man who was allegedly beaten to death at Orchard Towers for offering oral sex to his attackers.

“I don’t understand why my mum did that. Did she really think I was the type to do that?” he said.

 

“My mum has also grumbled to people about never being able to have a daughter-in-law or grandchildren. She doesn’t realise that her words have hurt me a lot and definitely played a part in me being a darker, colder person. 

 

MORE AVENUES OF SUPPORT

 

Even as LGBTQ individuals battle stigma and discrimination, more support services are opening up to cater to the LGBTQ group.

 

Ms Chua said that mental health and social support services for LGBTQ individuals are now more readily available than before, although there is room for improvement.

 

The T Project started offering counselling services by professional counsellors, at a fee, at its Alicia Community Centre in Kovan earlier this year. It is supporting 12 people at the moment.

 

“Back then, if you were a transgender person, there was no support service, but now, there are services like The T Project and an increasing number of other online support platforms,” Ms Chua said, adding that the online platforms are usually informal support groups.

 

Ms Chai from Think Psychological Services encourages LGBTQ individuals grappling with mental health issues to reach out and get support. Her advice: When seeking support from professionals, it is important to ensure that they are qualified and hold a current professional registration. If they feel that the professional is not well-equipped to support them, they should seek a second opinion.

 

On the other end, more social workers, counsellors, psychologists and other social service professionals have signed up for Oogachaga’s professional training workshops, which impart appropriate skills and information to help professionals better connect with LGBTQ clients.

 

From an average of 50 to 80 participants a year when it first started in 2008, Oogachaga’s professional workshops has seen around 100 to 120 participants yearly in the last five years.

However, there may be still some way to go in equipping mental health and social service professionals with skills to support people from sexual minorities here.

 

Mr Leow said: “In our experience working with LGBTQ individuals, couples and families for over 20 years, some of them reported that they feel uncomfortable or are not adequately supported by these professionals.”

 

In a study here published in the International Social Work journal in 2015, three-quarters of the 89 registered social workers surveyed said that they did not have adequate skills to attend to LGBT issues. Nine in 10 felt they did not have enough training.

 

Dr Wang said that, technically speaking, no special training is required for mental healthcare professionals to support LGBTQ individuals.

 

“We are all humans. You just need to be a non-bigoted, non-discriminatory person to treat anyone with mental health issues,” he said.

 

Although Talvin does not think his issues can be easily resolved, he intends to continue with his counselling sessions. “Talking to a counsellor has been very helpful. I think I got lucky — my counsellor is not judgmental at all despite me sharing with her my darkest thoughts,” he said. 

 

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Edited March 10 by amuse.ed

[yogateacher]

On 1/15/2024 at 7:14 PM, amuse.ed said:

** Guidance content like this works differently from person to person. Kindly listen to the content with more discretion and applied wisdom on what works and not work for the individual. Thus discuss with professionals where needed.

 

 

Thanks for sharing, it is very useful  

[amuse.ed]

America (Counselling Today Magazine)
                        
An Unstoppable Force
By Jennifer L.W. Fink

March 2024

Determined or lazy? Unafraid to prioritize their mental health or just entitled? Tech-savvy or dependent on screens and uncomfortable with in-person communication?

 

Each of these descriptors has been applied to Generation Z, the demographic cohort born between approximately 1997 and 2012. The oldest members of Gen Z just passed their mid-20s and are entering the counseling workforce, while the youngest members are still in middle school. Each year, the proportion of Gen Z counselors increases.

 

“Everyone else in counseling — the millennials, the Silent Generation, the Boomers, Gen X — we’re all getting smaller in numbers as Gen Z gets bigger,” says Taylor Sweet-Cosce, PhD, LMHC, a late millennial who wrote a dissertation about Gen Z counselors-in-training. She is assistant director for student personal and professional development at the University of South Florida.

 

Understanding Gen Z’s motivations, preferences and challenges can help educators and employers nurture and support the generation that will move counseling forward and shape mental health treatment for years to come.

 

Gen Z Characteristics

Most of Gen Z doesn’t remember the Sept. 11 terrorist attacks; the oldest Gen Zers were just four years old when the Twin Towers fell, and most weren’t yet born. The U.S. was at war in Iraq and Afghanistan most of their lives. Their childhood and adolescence have been marked by mass shootings, marriage equality victories, climate change, a widening wealth gap, and the Black Lives Matter and #MeToo movements — all of which they’ve experienced in real time via digital connections.

 

“Gen Z is the first generation that are true digital natives,” says Daniel Hall, PhD, LPC, a millennial who is an associate professor and program director of the counselor education program at the University of Lynchburg in Virginia. “Technology has been ubiquitous throughout their lives.”

 

The COVID-19 pandemic disrupted and reshaped their education; no other generation has entered the workforce without in-person counseling experience. And because the pandemic and its resulting shutdowns occurred during Gen Z’s youth and adolescence, many lacked in-person interactions with peers and non-family members at critical points during their development.

 

These events and circumstances have heavily influenced Gen Z. And while Gen Z is comprised of a vast array of individuals, the cohort shares a few common characteristics. Let’s take a look.

 

Comfort with Technology

“Gen Z has such a knack and competency around technology,” Sweet-Cosce says. They may not be as familiar as their older co-workers and supervisors with desktop computers, email, Microsoft Office and printer/scanners, but “the learning curve is a lot shorter for Gen Z in terms of picking up new technologies,” Hall says.

 

As a result, Hall says, Gen Z is more likely to adapt and experiment with new technologies in their counseling work. Gen Z counselors and counselors-in-training may be more likely to recommend that clients use digital applications to track their moods or artificial intelligence chatbots to provide empathetic, in-the-moment support. They may use video games in therapy and likely use digital platforms to support their own professional interests.

 

“Look at TikTok and Instagram — they’re filled with mental health counselors, psychiatrists, doctors and other health care professionals,” Sweet-Cosce says. “These platforms create more visibility for counselors and also help them create their own identity as a counselor.”

 

Broadly speaking, Gen Z counselors gravitate toward virtual counseling, likely because many routinely used videoconferencing tools during the pandemic and because the pandemic loosened regulations that previously limited virtual care.

 

“I’ve seen more people within my generation remain online and have a preference for virtual counseling,” says Jasmine Trotter, LPC, a Gen Z counselor who uses the pronouns she/they and works with Wild Cactus Therapy at its Fort Worth, Texas, location. She’s noticed a strong demand for virtual therapy as well, particularly among fellow Gen Zers.

 

Gen Z is not opposed to in-person interactions, however. “Gen Z still values in-person communication and interaction,” Hall says. “They just don’t want to be forced into it.”

 

Educators and supervisors should carefully consider which activities require in-person connection and which can be effectively delivered via email, text messaging or videoconferencing. “If it’s simple communication of information, send it out and let people engage with it on their own time,” Hall suggests. “Bring folks together for activities and purposes that necessitate interpersonal interaction.”

 

Emphasis on Mental Health

Anxiety, depression and suicide are not taboo subjects for Generation Z. “Mental health is a normal part of conversations for this generation,” Hall says. In fact, he says, “they have a better understanding of their own mental health and of the impact of mental health on all areas of their lives.”

 

Regular discussion or acknowledgment of mental health, though, does not mean that Gen Z is mentally healthier than previous generations.

 

According to a recent survey by Gallup and the Walton Family Foundation, just 15% of Gen Z members ages 18 to 26 described their mental health as “excellent.” Compare that to millennials a decade ago when they were the same age: 52% of them said their mental health was “excellent” at the time.

 

Technology plays a role in this generation’s experience — and management — of mental health. “I want to curate my work environment so it’s something that’s going to be healthy and helpful for me right now,” say Trotter, the Gen Z counselor, “instead of just buckling down, grinding my teeth and sitting it out, which is often what I’ve heard older therapists tell me.

That’s not great for my mental health.”

 

Trotter chose to work virtually for a practice where she has “complete control” over her schedule, can set her own rate and decide how many clients to see. “If I want to have a three-day weekend, I can,” she says, “and no one can tell me otherwise.”

 

Social Justice Orientation

Traditionally, the counseling field has treated multiculturalism and social justice approaches as “secondary,” Sweet-Cosce says, instead focusing on therapeutic modalities that center issues of the individual. In contrast, social justice counseling — a concept embraced by many Gen Z counselors — recognizes “issues of power, privilege and oppression as being central to client conceptualization,” according to Sweet-Cosce.

 

Gen Z is acutely interested in social justice, diversity and inclusion, and Gen Z counselors and counselors-in-training tend to bring this interest to their work. “They really want to be big advocates for themselves, for their clients, for the world and for society as whole,” says Kayleigh Underwood, LPC-A, a millennial and crisis coordinator at the Southeastern Louisiana University Counseling Center. “That can be really wonderful on one hand but also cause some issues.”

 

Some members of Gen Z distrust “the system,” she says, because they think that government and social systems have failed to protect individuals, families and marginalized groups. So, they may need support as they grapple with the cognitive dissonance of becoming part of a system they previously resisted or criticized.

 

Underwood works with counselors-in-training and asks them to think about how they can reconcile their disappointment with larger systems with their role as mental health professionals.

 

“For some, it’s ‘let me join the system so I can take it down from within,’” she says. “For others, doing what they can to help clients so they get what they need is enough.”

 

Gen Z also embraces diversity. They aren’t simply “tolerant,” “accepting” or “LGBTQ-friendly.” Instead, they celebrate diverse identities and create inclusive, welcoming spaces.

 

“I use inclusive language and gender-neutral terms,” Trotter says. “I don’t necessarily need to have a rainbow flag in the background to make my client feel welcomed in this space because I do that with language.”

 

Prioritization of Boundaries and Balance

Gen Z cares deeply about their work, but their careers are not the centerpiece of their lives. “It’s definitely more of a ‘work to live’ mentality instead of a ‘live to work’ mentality,” Sweet-Cosce says.

 

But having this mindset doesn’t mean that Gen Z doesn’t want to work. In fact, Sweet-Cosce says she finds Gen Z counselors to be “incredibly determined, tenacious and very invested in getting what they need.”

 

Compared to older generations, however, they’re less likely to tolerate working conditions they deem unfair or exploitative. They set and enforce firm work-life boundaries and actively pursue jobs that allow flexibility in terms of work hours and geographic location.

 

“Gen Z is not afraid to want what we want right now,” Trotter says. “It’s not ‘I’ll wait five to 10 years and maybe ask later when I have more seniority.’ It’s ‘I want the schedule that works for me right now. I want the benefits that work for me now.’ Same thing with pay.”

 

Counseling centers and health care systems that insist on rigid schedules and don’t offer counselors freedom and flexibility are already having trouble retaining young counselors. “They get the folks who need to get hours toward licensure, but as soon as those folks get their hours, they’re gone,” Hall says.

 

“Gen Z is almost universally choosing jobs that have tremendous amounts of flexibility where they can set their own working hours and work at a location of their choosing.”

 

Commitment to Authenticity

Gen Z doesn’t want to tuck parts of their identity away during the workday. “They want work that aligns with and makes sense for who they are as people,” Sweet-Cosce says.

 

That’s a bit of a shift for the counseling field. “In school, I was told to make sure you don’t share too much with the client,” Trotter says. “There’s a lot of wisdom in that advice, but I was often told to sort of remove myself from the room and that’s not what clients want — at least not what my clients want.”

 

Trotter says she shows her “human” side with her clients. “I’ll say things like, ‘yeah, that sounds pretty messed up’ or ‘that’s really hard and we’re going to work through it,’ instead of just saying, ‘well, how does that make you feel?’ I want to connect and talk and be real.” She takes a genuine interest in her clients’ interests and isn’t afraid to share relevant experiences.

 

“We are no longer in a space where we can be blank slates as counselors,” Sweet-Cosce says. Although maintaining professional boundaries can be a challenge, particularly when working with similarly aged clients, Gen Z counselors are committed to linking arms with clients in ways that feel “safe, practical and appropriate,” she says.

 

Gen Z expects and appreciates authenticity, transparency and honesty from co-workers and colleagues as well. However, supervisors and colleagues should consider delivering feedback in language they can easily understand. When Underwood used the phrase “it’s giving some boundary issues” to critique her intern’s counseling session, the intern understood the message as intended — as feedback to maintain professional boundaries during therapy sessions and asked how to improve.

 

Embracing Gen Z’s energy, enthusiasm and knowledge can strengthen the counseling field.

 

“We have to be willing to change,” Underwood says. “This field can’t stay stuck in the ’80s or 2000s. It has to move into 2024 because that’s where our clients are.”

 

Kindly click HERE for full article and various hyperlinks to other content in relation to the topic.

 

 

[amuse.ed]

12 hours ago, yogateacher said:

Thanks for sharing, it is very useful  

 

@yogateacher You are welcome. Thank you for taking time and effort to go through the content as well. 

[amuse.ed]

Hongkong - South China Morning Post 

 

How gay ‘conversion therapy’ survivors in Hong Kong were given mentally traumatic ‘treatment’, but learned to embrace their sexual orientation

The Post speaks to two gay men who underwent ‘conversion therapy’ – resulting in PTSD for one – that aimed to turn them straight

The United Nations called for a global ban on conversion therapy in 2020, but the practice is not yet banned in Hong Kong

Ashlyn Chak

Published: 6:15pm, 7 Mar, 2024

In the 1990s, Hong Kong-based lawyer Tan Loke-khoon was, in his words, a “staunch Christian”. He served his religious community, giving sermons and leading bible study sessions.

But he was also repressing his homosexuality.

 

He felt there was something wrong with him, and that he could not be accepted by the church. When he sought help from his pastors, they told him he would go to hell if he did not “get cured”.

Desperate for change, Tan flew to Asheville, in the US state of North Carolina, to have “conversion therapy” from the now-defunct Christian organisation Exodus International, whose mission was to “help” gay Christians become straight.

Conversion therapy uses sustained efforts to discourage or change behaviours related to one’s sexual orientation or gender identity.

The programme required him to repent by confessing his desires and experiences in great detail. For 10 days, Tan prayed, fasted – and cried from morning till night.

 

“It was mentally very traumatic and physically very exhausting. There was a lot of aggressive shouting and it felt like I was being scolded. It was already decided that ‘you did something wrong, so you better tell me the details’.

 

“It was like that throughout the entire period – it’s not physical, but psychologically you feel smaller and smaller and smaller.”

Most people he met there went willingly, but some were pressured by their families, who would otherwise disown them. Many participants were on the brink of committing suicide, Tan recalls, as they thought they did not deserve to live unless they were “cured”.

Alvin Cheung Hui-fung has a similar story.

 

He first realised he experienced same-sex attraction when he was in primary school in Hong Kong. He fell in love with a boy in secondary school, but his conservative Christian upbringing and internalised homophobia led him to deny it.

At age 21, he came out to a Christian “close friend” who encouraged him to seek out conversion therapy, which he did in 2005. “God can help you,” the friend assured him.

Cheung discovered the New Creation Association, a conservative Christian group in Hong Kong founded by Kelvin Chung Kam-fai, who received training from Exodus Global Alliance, which was formed out of Exodus International in 2004.

Exodus International dissolved in 2013 after its then president renounced conversion therapy and apologised to those who had taken part in its programmes.

 

Exodus Global Alliance, however, is still active and promotes “a transformed life through the power of Jesus Christ” for those “affected by homosexuality”, according to its website.

 

He said, ‘Homosexual individuals only use each other for sexual purposes, and their needs are like a black hole that’s never satisfied’

Alvin Cheung on what psychiatrist Dr Hong Kwai-wah told him

Hong Kong’s New Creation Association provides LGBTQ “counselling” services, and Cheung had weekly individual sessions with a so-called “ex-gay” counsellor.

“We discussed how to suppress my sexual arousal, how to control my emotions regarding the men I was attracted to, and explored the causes of homosexuality … [I was told] it should not be part of God’s creation but rather [was] a result of human sin,” Cheung says.

 

Cheung felt “very lonely” at the time.

“Christians at church would not accept my homosexuality, while friends who accepted gays could not understand why I had to change my sexual orientation.”

The counsellor referred Cheung to a support group, which was set on “restoring masculinity as God created it and developing ‘healthy’ same-sex relationships”.

“It felt like brainwashing,” he says. “The more I suppressed my needs, the more I yearned to attach to men and the more guilty and forbidden I felt about being close to them.

 

“This led to more compulsive psychological abuse on myself under the intervention of friends, counsellors, pastors and ‘professionals’ in the group meetings.”

 

Eight months later, he found himself “mentally collapsed” and was referred to Dr Hong Kwai-wah, a licensed and practising psychiatrist in Hong Kong who is also a founding member and chairman of the New Creation Association.

Cheung was diagnosed with depression and anxiety disorders, prescribed medication, and charged thousands in medical fees.

Hong told him that true love does not exist for gays. “He said, ‘Homosexual individuals only use each other for sexual purposes, and their needs are like a black hole that’s never satisfied,’” Cheung says.

 

Cheung was led to believe that “being a good Christian meant following Jesus, bearing the cross and sacrificing my own feelings” and if he worked hard to suppress his intimate desires, he “could become normal and heterosexual again”.

 

Over the course of a year under Hong’s supervision, Cheung became more stressed and torn. He left conversion therapy, which he says had “planted seeds of self-rejection” and “self-blame” in his mind.

 

Cheung has since been diagnosed with complex post-traumatic stress disorder (PTSD) but has learned to embrace his sexual orientation.

It is a terrible form of abuse disguised as a treatment. It attempts to treat a ‘problem’ that simply does not exist
Hong Kong-based psychologist Dr Michael Eason on ‘conversion therapy’

The Post reached out to New Creation Association for comment but did not receive a response. Hong’s clinic acknowledged that the doctor practises “LGBT counselling” but declined to connect the Post with the doctor for further comments.

 

When Tan returned to Hong Kong from the US after 10 days in the conversion therapy camp, he did not feel any differently towards his sexuality. He did, however, feel more shame, guilt and self-hatred.

 

“In conversion therapy, they don’t teach you to love yourself; they teach you to hate yourself,” he says.

 

“I felt as if something bad would happen to me if I didn’t change, because God was so unhappy with me. That’s the nature of conversion therapy, which is brainwashing.”

He chose to remain in his heterosexual marriage and went on to have three children with his then wife.

 

In his early 40s, Tan fell in love with a man, Peter Leong, who would become his husband.

 

“It made me realise I had a chance to be honest. Life is so short. I didn’t want to continue living a lie to my family.”

He also found another source of religious inspiration: the late reverend Yap Kim-hao, the first Asian archbishop of the Methodist Church in Singapore and Malaysia. He was known for setting up LGBTQ-friendly Christian churches and advocating for LGBTQ rights in Singapore.

 

“Reverend Yap, who was also my pastor, told me, ‘God made you special. God gives us gifts and has given you the capacity to love differently. You should embrace it.’ And suddenly, it’s like magic. What he said made me realise that I was going to stop fighting myself and start loving myself.

 

“When I started loving myself, everything changed. I was no longer angry and suddenly had the capacity to help others.”

 

A few years later, he divorced his wife, and came out to his law firm, where he is a senior partner. He has since been leading LGBTQ initiatives across the region for the firm.

 

“The feeling of coming out was so amazing. It’s like you carry this heavy bag and suddenly it disappears and you’re free. I felt that physical release, like all that guilt that I had went away.”

He waited until his children were a little older before coming out to them, and married Leong in December 2022 in Vancouver, Canada.

 

He told his family, but his parents could not understand and his religious older sister chose not to attend the wedding.

His children did, though, and spoke at the dinner, while his ex-wife sent a wedding present.

 

Cheung has been a social worker for 15 years, and has also worked as a lecturer and fieldwork supervisor for social-work students. He integrates LGBTQ-affirmative counselling into sessions with clients in an aim to empower them by promoting self-acceptance, resilience and self-confidence.

 

“I discovered that I function better when I help and love others,” he says.

He uses what he has learned to support other vulnerable people who may be affected by counsellors who attempt “conversion therapy” using different terminology but the same methods.

 

Historically, these methods even extended to brain surgery, electric shock and nausea-inducing drugs.

In 2020, the United Nations called for a global ban on conversion therapy, which the World Psychiatric Association has also discredited. However, the practice is not yet banned in Hong Kong.

Psychologist Dr Michael Eason specialises in LGBTQ affirmative therapy in Hong Kong. He has seen the harmful effects of conversion therapy, which he says is “an unethical and discredited form of ‘therapy’ that leaves devastating psychological impacts”.

 

“It attempts to change a person’s core identity and sexual orientation. Far from being therapeutic, such attempts have been proven to cause increased anxiety, depression, self-harm and suicidality,” he adds.

 

Dr Michael Eason is a psychologist who specialises in LGBTQ affirmative therapy, and is the co-founder and clinical director of Lifespan Counselling in Hong Kong. 

He has never met a person who benefited from the practice. Instead, he finds the survivors often carry “intense feelings of internalised shame and self-hatred” and “require many years of trauma-informed counselling to restore their well-being”.

 

“It is a terrible form of abuse disguised as a treatment,” he says. “It attempts to treat a ‘problem’ that simply does not exist.”

 

Kindly click HERE for full article and various hyperlinks to other content in relation to the topic.

[amuse.ed]

The Guardian

Mental health

‘It feels like we’ve been lobotomised’: the possible sexual consequences of SSRIs

Long-term sexual dysfunction is a recognised side-effect for some patients who take these widely prescribed antidepressants, and can leave sufferers devastated. So why is there so little help available?

 

David Cox

Sat 2 Mar 2024 06.00 EST

During Melbourne’s strict lockdown of 2020, Rosie Tilli, a then 20-year-old nurse living and working in the city, began to experience growing anxiety and depression.

 

Visiting her GP, she was quickly prescribed escitalopram, a commonly used drug from a class known as selective serotonin reuptake inhibitors (SSRIs). These medicines attempt to treat depressive symptoms by boosting the levels of the hormone serotonin in the brain and rank among the most widely prescribed drugs. In the first 11 months of 2023 alone, more than 80m prescriptions for antidepressants were issued by the NHS.

 

Tilli was nervous about escitalopram but, reassured by a psychiatrist, she began taking the tablets. However, rather than experiencing relief, she soon noticed a worrying drop in her libido combined with an inability to feel any sexual sensations at all.

 

Nearly four years on … I can’t experience any physiological sexual response. No arousal even when physically touched

A quick Google search alerted her to a condition known as post-SSRI sexual dysfunction (PSSD), where both men and women who have taken various SSRIs have been left with sexual problems, persisting for years or even decades. Alarmed, she began tapering off the medication after four months, but there was no change.

“I reassured myself that I would be fine as soon as I fully ceased the medication, but I wasn’t,” she says. “Now nearly four years on, I’ve learned to put on a sunny disposition, but internally I am riddled with psychological grief and anguish. I can’t experience any physiological sexual response. No arousal even when physically touched. It’s as if the entire electrical hardwiring of the sexual system has been short circuited. My clitoris feels like my elbow now, and there’s nothing I can do to reverse it.”

 

While the first reports of persistent sexual side-effects in response to SSRIs began emerging in the early 1990s, PSSD as a condition was not recognised by the European Medicines Agency until 2019. A patient organisation called the PSSD Network has been launched, and its affiliated Reddit community has amassed more than 10,000 members around the world.

Psychiatrist David Healy, founder and CEO of the company Data Based Medicine, which is dedicated to making medicines safer, is particularly concerned because the majority of patients who are treated with SSRIs are not the most severe cases of depression. Instead, he says, they tend to be individuals with milder symptoms, often teenagers and young adults. “They’re being handed out without much thought these days,” he says.

 

“Now absolutely, people who are at high risk of suicide do need treatment. But the average family doctor is handing SSRIs out to people who are anxious or mildly depressed. They need to realise that if you cause PSSD, you’re going to lead to suicide cases because people feel they can’t live this way.”

 

Rosie Tilli: ‘Pharmaceutical companies and psychiatrists have a moral, ethical and professional responsibility to fund research.’ 

Tilli describes herself as “completely broken” due to the effects of PSSD, and like many with the condition she fears being perpetually alone because it has made sexual intimacy and romantic relationships impossible. Another sufferer told the Observer that it feels akin to having been “lobotomised”.

 

“I know of other women with PSSD who are now speaking of getting artificial insemination [to have a child] because all of their relationships have failed due to the condition,” says Tilli.

 

Now Healy and other researchers around the world are working to try to understand why PSSD occurs, and whether it may be possible to reverse the symptoms.

 

Possible brain alterations

There is no precise consensus regarding the prevalence of PSSD, but when SSRIs were launched clinically, their initial labels stated that less than 5% of patients in clinical trials had reported sexual dysfunction. However, in some unpublished phase 1 trials of the drugs, more than 50% of healthy volunteers developed severe sexual problems, which in some cases persisted after treatment stopped. One post-market research study found that between 5% and 15% of patients developed sexual impairments after taking SSRIs, and Healy and other doctors are now concerned that the prevalence could be greater than previously thought.

 

SSRIs have been marketed to patients for more than three decades, yet the PSSD Network says patients’ suffering is being ignored by mainstream psychiatry. Few doctors, it says, have attempted to delve into why this side-effect occurs, and why some people are especially vulnerable.

 

Through testing in male rats, some studies have indicated that these drugs may cause toxicity to the testicles. Last year researchers from São Paulo found that the SSRI paroxetine can cause testicular changes in lab animals, including impaired sperm production, which persisted after the drug was stopped. However, the few scientists who have dedicated themselves to this topic believe that the root cause of the genital numbness, lack of libido and plethora of other sexual side-effects that PSSD sufferers experience happens in the brain.

 

“I believe that PSSD is primarily a neurological disorder relating to altered brain functionality,” says Prof Roberto Melcangi of the University of Milan, who has been researching the condition for the last three years and has also spent more than a decade studying sexual dysfunction caused by the drug finasteride, which is taken for male pattern baldness.

 

Melcangi and his team have conducted their own research on paroxetine in rodents, which he is now hoping to replicate in a small study of male PSSD patients. Initial results indicated that the drug could alter certain so-called steroid hormones, which act as important regulators of brain function, including sexual behaviour. Further experiments have suggested that paroxetine might also impair the gut microbiome, which interacts with the brain.

 

Antonei Csoka, a researcher on ageing at Howard University, who has been studying PSSD intermittently since the early 2000s, suspects that as a side-effect of targeting serotonin receptors in the brain, SSRIs drive epigenetic changes, particular DNA modifications, which then affect the activity of genes relating to sexual function. Why this seems to happen in some unlucky patients and not others remains a mystery.

 

“Various scientists, including myself, have published studies showing that an SSRI can change epigenetics and human cells,” says Csoka. “If that’s happening, then those cells or tissues may not immediately revert back to how they were once treatment stops. It’s as though an imprint has been left there. However, it’s still not known precisely what these epigenetic changes are. So what we need to do is narrow it down – what is happening?”

 

Medical gaslighting

 

When Tilli first began experiencing symptoms, she was called neurotic by her GP, who insisted that SSRIs could not cause sexual dysfunction and sent her home to do deep breathing exercises. But far worse would follow.

“When I reached out for help with my local mental health service, I was sectioned and placed involuntarily into psychiatric care as the psychiatrist said I had ‘delusional disorder’, and tried to put me on antipsychotics,” she says. “It shattered my trust in ever seeking help for my mental health again.”

 

The psychiatry profession and pharmaceutical companies have a moral, ethical and professional responsibility to fund research
Tilli and other PSSD patients feel they should have been given greater warning of the potential side-effects of SSRIs before commencing the drugs. However, most of all they describe feeling completely abandoned to their fate by the medical community, through cases of what they call “medical gaslighting”, with psychiatrists refusing to acknowledge this source of drug-induced harm.

 

At the same time, the PSSD Network and researchers say that funding to better understand the cause of these symptoms and further the search for potential treatments remains virtually nonexistent. Much of Csoka’s research into PSSD so far has needed to be covered by grants relating to ageing, while Melcangi’s work is partly crowdfunded by PSSD patients themselves.

 

“The psychiatry profession and pharmaceutical companies have a moral, ethical and professional responsibility to fund research into the biological pathophysiology and treatments for PSSD,” says Tilli, who is part of the PSSD Network. “They are mocking harmed patients by forcing us to self-fund our own PSSD research. On top of that, many sufferers are teenagers and university students, who either work part-time for minimum wage or not at all.”

 

When the Observer approached leading SSRI manufacturers GSK and Eli Lilly for comment, neither indicated that they would consider funding PSSD research in future. GSK representatives said: “As with all medicines, SSRIs have potential side-effects. These are clearly stated in the prescribing information and patients should only take these medicines under the direction of a medical professional.”

 

The Lilly public affairs team issued a similar statement regarding the SSRI fluoxetine, commonly known as Prozac: “Fluoxetine continues to be considered to have a positive benefit-risk profile by regulatory authorities, physicians and patients around the world. Lilly continues to submit fluoxetine safety data to regulatory authorities around the world.”

 

Both Melcangi and Csoka believe that potential therapeutic solutions for PSSD are out there, either through repurposing existing drugs or using emerging technologies to target the epigenome. Csoka is aware of case reports where patients have managed to regain at least partial sexual function either through taking various nutraceuticals, using low-power laser therapy, or drugs that attempt to readjust the chemical imbalances in the brain, such as bupropion and vortioxetine. In the coming years, Melcangi hopes to raise funds to conduct a trial using a drug called allopregnanolone, which he believes could modulate the abnormal brain behaviour behind cases of PSSD.

 

But there are many challenges. PSSD is likely to have many underlying causes, which vary both between individuals and between the sexes. Different therapies may be required for different patients, a level of biological variability that is both challenging and costly to try to understand. But Melcangi is optimistic that even with limited resources, something might ultimately be done to help people with the condition.

 

“It will be difficult to find a therapeutic approach … for all the effects of PSSD, but an important step would be to at least counteract some of the side-effects,” he says.

 

For Tilli and others, having even a glimmer of hope is vital. “Our community has had many suicides,” she says. “Our main goal is to raise awareness so that we can get funding for research to pave a path towards hopeful treatments and prevent the despair that leads many to end their lives.”

 

Kindly click HERE for full article and various hyperlinks to other content in relation to the topic.

 

Edited March 13 by amuse.ed

[amuse.ed]

Workplace mental health service firm faces investigation

[amuse.ed]

Decoding the Mind: Basic Science Revolutionizes Treatment of Mental IllnessesBy Linda Brady, Margaret Grabb, Susan Koester, Yael Mandelblat-Cerf, David Panchision, Jonathan Pevsner, Ashlee Van’t-Veer, and Aleksandra Vicentic on behalf of the NIMH Division of Neuroscience and Basic Behavioral ScienceMarch 21, 2024

[amuse.ed]

Singapore 

 

Arrest or Help? Police Power and Mental Health Intervention in Singapore 

 

Mr Barry Tse 

 

27 March 2024

 

In response to the proposed legislation in Singapore that would empower law enforcement to detain individuals suspected of having mental health issues, there is a palpable concern within the mental health community regarding potential abuses of power and the adequacy of police training in mental health crisis intervention. (For news announcing this proposal please click here)

 

The proposal raises significant questions: Should individuals suffering from mental illness be arrested for behaviors that may pose a risk to themselves or others, or should they receive more compassionate, appropriate assistance? Are law enforcement officers adequately equipped to assess the mental state of individuals they encounter? Do they possess the requisite training to manage crises involving mental health issues safely and effectively? 

 

I advocate for a balanced approach that ensures the safety of both the police force and individuals with mental health issues, while also respecting their rights, dignity, and well-being. Law enforcement officers frequently encounter challenging situations requiring swift intervention to prevent harm. In these instances, having the authority to restrain is essential for immediate safety. Yet, this authority must be wielded with the understanding that individuals in a mental health crisis are not criminals but people requiring care and support.

 

The practice of granting law enforcement the right to restrain individuals deemed dangerous to themselves or others, due to mental illness, is common in many countries. However, these nations also implement safeguard measures and provide adequate training to ensure fair treatment for all involved. A prominent example of such measures is the Crisis Intervention Team (CIT) program, which equips officers with the skills needed to handle mental health crises with compassion and efficacy.

 

The efficacy of CIT programs in other jurisdictions offers a compelling argument for adopting a similar approach in Singapore. Evidence suggests that CIT programs enhance police officers’ ability to handle incidents involving individuals with mental health issues more compassionately and effectively, thereby reducing the likelihood of arrest and directing individuals towards appropriate mental health services instead (Parker et al., 2018). Research highlights the dangers of law enforcement handling mental health crises without specialized training or inter-agency cooperation. Studies suggest that the absence of CIT programs could increase the likelihood of arrest among individuals with mental health issues. This could contribute to their further criminalization and place additional burdens on police resources. (Charette et al., 2014; Watson et al., 2009).

 

Moreover, the implementation of CIT programs has been linked to positive outcomes, such as reduced injuries among individuals with mental illness, fewer jail suicides, and more favorable attitudes among officers towards those experiencing mental health crises (Wells & Schafer, 2006). These programs promote safer interactions between the police and individuals with mental health issues, emphasizing specialized training and collaboration between law enforcement and mental health services.

 

Comparative studies have shown that CIT-trained officers are significantly more likely to direct individuals with mental health issues towards treatment rather than arrest, with arrest rates in some cases as low as 2% (Compton et al., 2006). This starkly contrasts with outcomes in jurisdictions lacking CIT programs, where the absence of specialized training can lead to higher arrest rates and potentially wrongful detentions of individuals with mental health issues (Watson et al., 2014).

 

The Singapore parliament will debate the proposed bill. I hope there will be considerations given to the adoption of proven, compassionate models like CIT. Embracing such models could dramatically reduce wrongful arrests and ensure that individuals with mental health issues receive the respect, care, and treatment they deserve.

 

References

 

Charette, Y., Crocker, A., & Billette, I. (2014). Police encounters involving citizens with mental illness: use of resources and outcomes. Psychiatric Services, 65(4), 511-516. https://doi.org/10.1176/appi.ps.201300053

Compton, M., Esterberg, M., McGee, R., Kotwicki, R., & Oliva, J. (2006). Brief reports: crisis intervention team training: changes in knowledge, attitudes, and stigma related to schizophrenia. Psychiatric Services, 57(8), 1199-1202.

https://doi.org/10.1176/appi.ps.57.8.1199

 

Klimley, K., Broj, B., Plombon, B., Haskamp, C., Christopher, R., Masias, E., … & Black, R. (2021). Involuntary psychiatric admissions initiated by two US police departments: a descriptive analysis. Journal of Forensic Practice, 23(4), 350-359. https://doi.org/10.1108/jfp-03-2021-0011

Parker, A., Scantlebury, A., Booth, A., MacBryde, J., Scott, W., Wright, K., … & McDaid, C. (2018). Interagency collaboration models for people with mental ill health in contact with the police: a systematic scoping review. BMJ Open, 8(3), e019312. https://doi.org/10.1136/bmjopen-2017-019312

 

Wells, W., & Schafer, J. (2006). Officer perceptions of police responses to persons with a mental illness. Policing an International Journal, 29(4), 578-601. https://doi.org/10.1108/13639510610711556

 

Watson, A., Ottati, V., Morabito, M., Draine, J., Kerr, A., & Angell, B. (2009). Outcomes of police contacts with persons with mental illness: the impact of cit. Administration and Policy in Mental Health and Mental Health Services Research, 37(4), 302-317. https://doi.org/10.1007/s10488-009-0236

 

 

[amuse.ed]

Disclaimer: Kindly read this article at one’s discretion. There are no one-size-fits-all methods in interventions or theories. Results may vary with individuals.

 

Beyond Symptom Reduction: The Future of Mental Health Outcomes

JESSICA WATROUS, PHD
MARCH 21, 2024

Dr. Jessica Watrous, Director, Clinical Research & Scientific Affairs from the Modern Health team explores the broken health care system and why continuing the status quo of solely focusing on symptom reduction is failing.

Symptom reduction has been the primary, and oftentimes sole focus of mental health care for years. But is that enough? In this conversation, we spoke with Modern Health's Dr. Jessica Watrous, Director of Clinical Research & Scientific Affairs to explore how focusing solely on symptom reduction may overlook certain areas of mental health concerns. We will also look into the role of workplace culture and environment in influencing mental health outcomes and the innovative strategies and solutions that Modern Health provides to support employee mental health beyond traditional methods.

 

How does focusing solely on symptom reduction in mental health support potentially overlook broader workplace factors contributing to employee well-being?

Symptom reduction is one of our strongest indicators of whether or not mental health treatment works - if we want to know if a specific intervention for depression works, then we have to measure depression and see how those symptoms change as a function of our intervention. 

 

That being said, symptom reduction alone does leave a gap in our understanding of the impact of mental health concerns. First, most of what we’re doing in healthcare focuses on specific mental health disorders like depression, anxiety, or posttraumatic stress disorder. This is important, and it may leave individuals out who are either experiencing symptoms of these specific concerns or whose distress is showing up in other ways, like relationship problems or difficulty motivating themselves. 

 

Second, reducing our outcomes only to symptom reduction prevents us from truly providing patient-centered care. For example, maybe I want to go to therapy for treatment of PTSD, but ultimately, it’s not that I want to see my symptoms change; it’s that I want to be able to go to the grocery store without feeling distressed or attend my children’s sporting events without getting overwhelmed. Symptom reduction can help us as practitioners understand if we’re moving toward those goals, but ultimately, we have to incorporate measures that are meaningful to the patient themself. 

 

And last, mental health concerns aren’t occurring in a vacuum. Even if someone is presenting for depression treatment, only focusing on the reductions in their depression symptoms may not tell us if their functioning is improving in other domains like at work or at home. If we want to deliver holistic care, we have to understand the impact that care is having on all facets of a person’s life. 

 

To tie this back to the workplace and factors that are important to employers as they’re investing in mental health benefits, symptom reduction is a piece of the puzzle they should be evaluating.

Does the solution you’re providing drive meaningful improvements in clinical outcomes should be the first question. And you can take it a step further:

 

are employees demonstrating meaningful engagement?

 

Can they build skills that help them in their personal and professional lives?

 

Are they engaging in strategies that will set them up for long-term health?

 

In order to answer these questions, we need other data points from multiple modalities of mental health and well-being care and support.

 

What role do workplace culture and environment play in influencing mental health outcomes for employees, and how can employers address these factors effectively?

Ultimately, we have to acknowledge that, similar to many health domains, individual change, like going to therapy, is a small aspect of improving mental health. Work plays a big role in many of our lives, which means that if things are not good, they can take a toll on us both mentally and physically. 

 

The US Surgeon General’s report on workplace well-being from a couple of years ago really did a wonderful job of highlighting how the workplace directly impacts our well-being and mental health. The framework from that report really creates an actionable guide for employers to make changes across the pillars (Protection from Harm, Connection and Community, Work-Life Harmony, Mattering at Work, and Opportunity for Growth) that can result in improving employees’ experience at work. 

 

What are some examples of innovative strategies or programs that Modern Health provides to support employee mental health beyond traditional symptom reduction techniques?

The first thing that I would call out is that our core benefit, which includes access to evidence-based digital content, Circles (our group offering), coaching, and therapy, are already impacting outcomes beyond just symptom reduction. We have peer-reviewed papers that demonstrate that our platform helps members reduce symptoms of depression and anxiety and we have papers on other outcomes. One of our papers demonstrated that after using Modern Health for 3 months, members improve their loneliness.

 

To me, this finding is amazing because loneliness could be as detrimental to people’s health as smoking 15 cigarettes daily! We’ve also presented data that Modern Health members improve their physical activity after engaging in the platform, which is another key health behavior that improves long-term mental and physical health outcomes. 

 

My team, the Clinical Research team, is focused on examining what other types of outcomes we’re impacting because that helps us know if we are having a holistic impact, and it helps us innovate in the product about areas where we can really optimize our care. This leads to a more direct answer to the question: at Modern Health, we are taking our programs beyond just those that are only focused on symptom reduction.

 

That could look like working with a coach on issues like financial stress or maybe improving health behaviors. It could also look like engaging in one of our Pathways, which are a combination of 1:1 meetings with a Pathways specialist paired with digital content specific to the topic you may be working on. Modern Health Pathways is the first of its kind in the digital mental health industry and the only modality of care that guides members through specialized topics with an evidence-based structure, ongoing 1:1 support from a dedicated Pathway Specialist, self-guided experiences, and topic-specific assessments to measure impact.

 

We have a full set of Pathways that are specific to the workplace, like those for managers, and we have some for parents, too. I’m most excited this year that we’ll be going deeper in how we’re focusing on the intersection between physical and mental health. We already know Modern Health helps members improve their physical activity; now, what would happen for members who sign up for a Pathway specifically focused on improving that key health behavior? 

 

How can employers measure the success of their mental health initiatives when considering factors beyond symptom reduction, such as employee engagement, productivity, and overall satisfaction?

In my mind, employers should be looking for initiatives that maximize value. What I mean is that you don’t want something that drives a lot of engagement but doesn’t actually move the needle on mental health. You also don’t want something that’s VERY effective at improving mental health, but no one at the organization uses. You’re looking for that sweet spot of something effective that drives high engagement. 

 

This may mean, when it comes to mental health, making sure that it delivers clinical outcomes like symptom reduction. And then taking a broader look from there at other indicators that are relevant to more of your population. So,

 

can members learn skills that help them manage better?

 

Can they gain a sense of community in the offerings?

 

What about modalities of care that support them in mental health adjacent domains like parenting stress?

 

I think other areas where we can get quantifiable metrics are things like retention (i.e., is retention improving for members that engage in the initiative?) and satisfaction (i.e., do members like the initiative).

Edited April 7 by amuse.ed

[amuse.ed]

Childhood trauma can lead to mental health issues among young adults: Study

 

The findings of the study were shared at NUS’ Social Service Research Centre Conference 2024 on March 20.

Syarafana Shafeeq
UPDATED MAR 22, 2024, 04:58 PM

SINGAPORE – Traumatic childhood experiences like emotional neglect may lead to a higher prevalence of mental health issues such as anxiety when the child becomes a young adult, says a new study.

 

Dr Lee Jungup from the National University of Singapore’s (NUS) department of social work found that childhood trauma is a risk factor for mental health issues.

 

The study, which has not been published yet and is under review, found that issues like neglect, cyber bullying and abuse during childhood can lead to depressive and anxiety symptoms in a young adult.

 

Dr Lee shared the findings of the study at NUS’ Social Service Research Centre Conference 2024 on March 20. The conference, focused on youth mental health, also touched on topics like effectiveness of digital well-being initiatives.

 

Of a sample size of 1,000 students from local universities aged 18 to 30, almost 75 per cent reported experiencing emotional neglect during childhood. This included feeling lonely and not having any casual conversations with their families.

 

Around 56 per cent said they experienced physical neglect, while around 37 per cent recalled physical abuse in their childhood.

 

Students with multiple childhood trauma experiences were strongly associated with conditions like depression, anxiety and post-traumatic stress disorder.

Panellists at the event said that digital tools could be useful in supporting the well-being of young people.

 

Ms Janice Weng, deputy director at the Ministry of Health Office for Healthcare Transformation (MOHT), said digital solutions alone are inadequate because young people have said they desire human contact. However, anonymity, which digital means can provide, is still highly valued due to stigma.

 

Manpower challenges will continue to grow with increasing demands, and the use of digital technologies is a sustainable cost-effective way, she added.

 

MOHT senior manager Caleb Tan said digital solutions can complement in-person support.

 

He said: “If you face emotional struggles in the middle of the night, who do you call? I can’t call my social worker as they would be fast asleep. This is where people can turn to digital platforms.”

 

Speaking at the conference, Senior Minister of State for Health Janil Puthucheary said there are two major factors in Singapore relating to mental health – an individualistic society and the prevalence of social media.

Society is now more fragmented and social networks are smaller despite the availability of online platforms.

Dr Janil noted that people need “human connections that allow us to offload, share, and have a shoulder to cry on”. “We have fewer and fewer people like that in our lives. We have to make an effort to find such connections – human, personal, real-world connections.”

 

At the same time, with the “Instagram effect”, people are faced with a lot more information about everyone else’s socialisation and lives, which may not be correctly represented, he noted.

Dr Janil said young people are a receptive audience who want to do something for themselves, and a collective approach is needed to tackle the issue.

 

The Interagency Taskforce on Mental Health and Well-being was set up in 2021 to oversee national mental health efforts, and it launched the National Mental Health and Well-being Strategy in October 2023.

Youth mental health has been under the spotlight recently, with Deputy Prime Minister Lawrence Wong announcing several plans to make mental health a top national priority. These include boosting the number of mental health professionals by up to 40 per cent by 2030, and introducing mental health services to all polyclinics and 900 more general practitioner clinics.

 

Dr Janil said efforts should be holistic – ensuring young people have the resilience to deal with mental health issues before these become a problem, while also identifying signs of distress in youth and supporting those who are struggling.

 

Dr S. Vasoo, emeritus professor at the NUS department of social work, said more resources should be deployed during early intervention, and called for a focus to identify those who are potentially vulnerable and how they can be helped earlier.

 

“The earlier we intervene, the better prospects for them to become more resilient in dealing with their problems,” he added.

Associate Professor Eddie Tong, director of NUS’ Social Service Research Centre, said: “I personally do not feel that youth are suffering mental health issues because they are so-called ‘soft’, lacking resilience in their character or lacking creativity and drive in problem-solving.

 

“Yes, some youth need more help than others, but one also needs to understand the broader context that our youth are in, that could feed into their sense of pessimism and insecurity, such as over cost of living issues, academic worries, career prospect concerns and even climate change.”

Kids exposed to adversity in womb have faster brain development, higher risk of mental health disorders
Mental health matters: Where different groups in S’pore can get help and support

 

Kindly click here for online article.

Edited April 9 by amuse.ed

[amuse.ed]

 Untitled

 

Taboo topics in societies

Issues that aren't suppose to be 

Spoken 

Discussed 

Debated 

A lack of freedom of speech

A lack of expression of liberty 

 

Sex, religion, politics and even AIDS 

Topics that make one's eye twitch

Mostly swept under the carpet

Talked behind closed doors

 

Ironically, as educated as one may seems

Yet the door remain shut even locked

Out of bounds to many

 

How about mental health? 

Should it be kept Private & Confidential?

Supposed to be kept in anonymity?

 

NO! Let's advocate

NO! Let's change a new narrative 

NO! Let's talk about it openly

NO! Let's shared how it's so traumatic

The "wish to talk behind closed doors" majorities seems to be forgotten

 

Advocates, kindly slower down the pace

This is the East least the West 

Challenges are dealt differently 

And often collectively 

Ideologies and concepts from West should be least imposing 

More person centered adaptations are needed 

 

To counter the no one-size-fits-all solution 

Perhaps mental health challenges has no immediate resolution(s)

It's a life journey one needs to experience 

The need to build one's resilience, the pace and time to rebound

 

Greater self autonomy must be given 

in any medical treatments or... 

perhaps it's much easier to handover one's health over to the system

And blame it when issues don't go flourishing as it may seem to be

 

Oh yes that is much easier

And yes if that the case, let's stick to the old same narrative

Change no longer is the only constant 

And yes the mental health system will keep flourishing 

Just to explain its pure existence(s)

 

Hopefully I will be dead by then... not to witness the detrimental...

 

ET

07.04.2024 (Sun)

[amuse.ed]

Singapore 

HUMAN RIGHTS

 

WP MP He Ting Ru voices concern over MHCTA amendment, citing wrongful arrest case

WP MP He Ting Ru expressed concern about MHCTA amendments perpetuating stigma against those with mental health conditions. She also sought clarification on recourse for those wrongly detained or subjected to excessive force.

 

Published 3 days ago on 3 April 2024 By Yee Loon

 

Ms He Ting Ru, Workers’ Party Member of Parliament for Sengkang GRC, expressed concern regarding the proposed amendment to the Mental Health (Care and Treatment) Act (MHCTA), which grants the police authority to apprehend individuals perceived as posing a danger to themselves or others.

 

During her participation in the debate for the Law Enforcement and Other Matters Bill on Tuesday (2 April), Ms He raised apprehensions about the potential consequences of reducing the threshold from a condition of reasonably imminent risk to one of reasonable likelihood under the MHCTA.

 

“I am worried that the amendments to the MHCTA unnecessarily perpetuate stigma against persons living with mental health conditions.”

Furthermore, she sought clarification on the recourse available to those who believe they have been wrongly detained or subjected to excessive force or trauma.

 

In response to Ms He’s concerns, Ms Josephine Teo, the Second Minister for Home Affairs (MHA), reassured that the Police do not intend to exacerbate the challenges faced by individuals with mental health conditions or their families.

 

She emphasized that both MHA and the Police strongly oppose any misuse of authority by officers and affirmed that appropriate action will be taken in cases of misconduct.

 

The amendment allows Police to apprehend individuals with mental health conditions for medical treatment
One key amendment to MHCTA empowers the police to apprehend individuals with mental health conditions deemed hazardous to themselves or others and facilitate their transfer for medical treatment.

Under this Act, rather than arresting such individuals, the police can now apprehend them to seek medical assistance, avoiding incarceration.

During her parliamentary address introducing the bill, Josephine Teo highlighted that the High Court had differentiated between apprehensions and arrests under the Criminal Procedure Code.

 

As a result, police officers lacked certain essential powers typically associated with arrests, notably the authority for search and seizure to ensure the absence of dangerous items.

 

“In particular, the High Court determined that the police do not have powers of search and seizure to ensure that the person is not hiding dangerous weapons or items.”

 

This posed a challenge, as police were expected to transfer individuals to medical facilities while ensuring they were not concealing any weapons, said Mrs Teo.

 

To address this issue, the bill also amends the Police Force Act to explicitly grant relevant powers, including search and seizure capabilities, to the police during apprehensions under the MHCTA or other related Acts.

 

“This does not mean that the person will be needlessly roughed up. On the contrary, having assessed that the person may be suffering from mental health conditions, police officers are minded to carry out search and seizure with due care and respect,” noted Mrs Teo.

 

High Court judgment on Mah Kiat Seng’s case in January 2023
Ms He in her speech highlighted the precedent set by the High Court judgment in January 2023, citing the case of Mah Kiat Seng who was wrongly detained for less than a day in 2017.

 

In that case, the court held that the use of the word “danger” implies a degree of imminence, meaning that without police intervention, such behaviour is likely to occur within a short time frame, typically a matter of hours rather than days.

The court clarified that there must be a reasonably imminent risk of physical harm to the person apprehended or others.

 

She then discussed the new amendment proposed in the Bill, which empowers police and special police officers to apprehend a person if they believe that person may endanger their own or another person’s life or personal safety.

 

Additionally, a new sub-clause 2(aa) is introduced, stating that it is sufficient for the danger to life or personal safety to be reasonably likely to occur, without the need for it to be imminent, and actual harm is not required.

 

While acknowledging the Minister for Home Affairs’ previous statement in the House that laws should not inadvertently result in defensive policing, Ms He stressed the importance of ensuring that amendments reducing the threshold to apprehend a person are subject to safeguards.

 

“With the proposed amendments, I would like to seek clarification from the minister, of my understanding that these changes are in response to the high Court’s ruling in Mah’s case.”

She expressed concern about the lowering of the threshold from a “reasonably imminent risk” to a “reasonable likelihood” of danger to life or personal safety, particularly in its application to individuals with mental health conditions.

 

She asked if the government has considered its obligations under the UN Convention on the Rights of Persons with Disabilities (CRPD) in proposing these amendments and how they align with Singapore’s CRPD commitments.

Ms He also inquired whether individuals suspected to be suffering from mental health crises and falling under the new threshold would be subject to background checks for a history of mental disorder.

In addition, She asked about safeguards, guidelines, training, and support provided to police officers in applying the new threshold, particularly concerning situations involving individuals with mental illness and conditions.

 

“After all we are drawing a delicate balance between Public Safety on the one hand, and the proper treatment and approach to those living with mental illness and conditions.”

 

She referenced an article by Chan Li Shan, who shared personal experiences of being arrested during a psychotic episode in an article published on Jom, expressing concerns about the potential trauma inflicted on individuals with mental illness during arrest procedures.

 

Ms He sought clarification on redress for alleged erroneous detention and excessive force

Ms He then transitioned to the issue of recourse for individuals who believe they were erroneously detained or subjected to excessive force or trauma.

Again she referring to the High Court ruling in Mah’s case in January 2023, where discrepancies were found between police statements, evidence, and medical reports.

 

“The Mah case was one where the officer was found to have made certain statements which were later withdrawn after being contradicted by BWC footage, and the judge also expressed concerns about the discrepancies between the medical report produced by the examining doctor and the evidence later submitted. ”

 

“The safeguards and guidelines I asked about are thus extremely important if an occasion arises where the conduct of the arrest and subsequent procedures are problematic, ” Ms He stressed, reiterating concern that the amendment might perpetuate stigma against persons living with mental health conditions.

 

MHA 2nd Minister assured govt’s effort to destigmatize mental health conditions

In response, MHA Second Minister Josephine Teo reiterated the government’s commitment to advancing mental health and recognized individuals with mental health conditions as part of society, emphasizing efforts to destigmatize mental health conditions and ensure individuals do not hesitate to seek help.

She clarified that the police do not seek to burden individuals with mental health conditions or their families, emphasizing that the police’s involvement is only when called to prevent harm from happening.

She addressed misconceptions about the use of Section 7 of the MHCTA for mental health management, stating that apprehension under the MHCTA is not a criminal offence and individuals are brought to medical practitioners for assessment, not placed in lock-ups.

Ms Teo also explained the role of the police in assessing whether the threat of physical harm is attributable to a mental disorder and highlighted the consultation with mental health professionals and updates in police training to identify and respond to mental health conditions.

 

On Ms He’s question on redress for alleged erroneous detention and excessive force, Ms Teo said, “Let me state categorically that MHA and the Police do not condone officers abusing their powers or acting inappropriately. ”

“Police ground response force officers don body-worn cameras which ensure accountability and transparency. Their actions can be audited very easily because it’s recorded.”

 

If the officers have breached the law and committed criminal offences, the Police will refer the matter to the AGC for criminal prosecution.  If the officers are guilty of misconduct but it is not a criminal offence, the Police will conduct internal investigations and take disciplinary action as necessary.

In serious cases, the officers are dismissed, she added.

Copyright © 2023 Gutzy Asia

 

Kindly click here for online article.

 

[amuse.ed]

Trigger warning: Content article related to issues on suicide and euthanasia. Kindly read at one’s discretion and discuss with the professionals if necessary. 

 

Depressed but physically healthy Dutch woman, 28, with a borderline personality disorder says she will end her life by euthanasia next month

By Natasha Anderson
19:11 04 Apr 2024, updated 10:56 05 Apr 2024

A physically healthy 28-year-old woman who suffers from depression and has autism and a borderline personality disorder will end her life with euthanasia, she has said.

 

Zoraya ter Beek, who lives in a small village in the Netherlands, will be 'freed' early next month, she has claimed. She will be euthanized on the sofa in her home with her boyfriend by her side.

Ter Beek decided she wanted to die after a psychiatrist told her 'there's nothing more we can do for you' and that 'it's never gonna get any better', The Free Press reported.

 

It is understood that a doctor will give her a sedative before administering a drug that will stop her heart.

 

Euthanasia has been legal in The Netherlands since 2002 for those experiencing 'unbearable suffering with no prospect of improvement'.

 

After ter Beek's death, a euthanasia review committee will evaluate her case to ensure the doctor adhered to all 'due care criteria' and if so, the Dutch government will declare her life was lawfully ended.

 

Zoraya ter Beek, who lives in a small village in the Netherlands, suffers from depression and has autism and a borderline personality disorder. She has decided to end her life by euthanasia after a psychiatrist told her 'there's nothing more we can do for you' and that 'it's never gonna get any better'

It is understood that a doctor will give her a sedative before administering a drug that will stop her heart. Ter Beek is pictured in 2017 with her do not resuscitate badge

When she was just 22, ter Beek opted to get a do not resuscitate badge, something that is typically worn by elderly people.

 

Now, after doctors have reportedly said they cannot do anything else to help improve her mental health, she has decided she is tired of living.

 

The 28-year-old told the newspaper she has always been 'very clear that if it doesn't get better, I can't do this anymore'.

 

She has decided against having a funeral and will be cremated. Her 40-year-old boyfriend, with whom she is in love, will scatter her ashes in 'a nice spot in the woods' that they have chosen together.

'I don't see it as my soul leaving, but more as myself being freed from life,' she said of her expected death, admitting: 'I'm a little afraid of dying, because it's the ultimate unknown. 

 

'We don't really know what's next - or is there nothing? That's the scary part.' 

Ter Beek has carefully planned her 'liberation', telling the newspaper that she 'will be going on the couch in the living room' and there there will be 'no music' playing.

 

She explained that during a euthanasia the 'doctor really takes her time' and will first try to 'settle the nerves and create a soft atmosphere'.

 

The doctor will then ask if she is ready, according to ter Beek, and she 'I will take my place on the couch'.

 

The doctor will ask 'once again' if ter Beek wants to go through with her euthanasia, before starting the procedure and wishing her a 'good journey'.

 

Ter Beek added: 'Or, in my case, a nice nap, because I hate it if people say, "Safe journey". I'm not going anywhere.'

Ter Beek she has always been 'very clear that if it doesn't get better, I can't do this anymore'. She has decided against having a funeral and will be cremated.

 

When she was just 22, ter Beek opted to get a do not resuscitate badge, something that is typically worn by elderly people.

The Netherlands is one of only three countries in the EU where the practice of assisted dying is legal, with rights groups arguing it gives people battling terminal illness or crippling disease the right to end their suffering humanely. 

 

Data revealed that 8,720 people in the Netherlands ended their lives via euthanasia in 2022 - an increase of 14 per cent on the year before.

 

The figure represents 5.1 per cent of all deaths in the country - but the actual number could be much higher given that research suggests around 20 per cent of euthanasia deaths are not reported, according to Dutch media. 

 

No scientific research has been carried out to establish a reason for the dramatic increase in people opting to euthanize themselves, according to the Netherlands Regional Monitoring Committees (RTE) that track the deaths. 

 

Per Dutch law, to be granted the right to euthanasia, a patient must secure the consent of two independent doctors, both of whom must agree their case meets detailed criteria. 

 

The patient in question must also be deemed to be 'mentally competent' to make the decision to euthanize - something which poses a problem for patients suffering from dementia who request euthanasia but are not said to be of sound mind. 

 

However, the Dutch government is working to make the practice of euthanasia accessible to a wider range of people following campaigns by various rights groups.

The latest figures from the Netherlands Regional Monitoring Committees (RTE) show 8,720 people ended their lives via euthanasia in 2022 - an increase of 14 per cent on the year before.

In April last year, it was announced that parents in the Netherlands can euthanize their terminally ill children aged 12 and over, with plans to introduce laws to expand euthanasia regulations for terminally ill children between one and 12 years old.

 

Such an expansion would apply to an estimated five to 10 children per year, who suffer unbearably from their disease, have no hope of improvement and for whom palliative care cannot bring relief, the government said.

 

However, some experts believe the gradual relaxation of country's euthanasia law could lead to a 'slippery slope' which could see physically and mentally healthy people who 'find that their life no longer has content' choosing to die early. 

 

Stef Groenewoud, a healthcare ethicist at Theological University Kampen, told The Free Press that he is now seeing physicians and psychiatrists treat euthanasia as an 'acceptable option' instead of the 'ultimate last resort', as it was previously.

 

'I see the phenomenon especially in people with psychiatric diseases, and especially young people with psychiatric disorders, where the healthcare professional seems to give up on them more easily than before,' Groenewoud said.

 

Theo Boer, a healthcare ethics professor at Protestant Theological University in Groningen, echoed Groenewoud's claim, alleging that while he served on the review committee for nine years he saw the Dutch euthanasia practice 'evolve from death being a last resort to death being a default option'.

 

Lawmakers in Scotland are expected to debate an assisted dying bill this upcoming autumn that would allow adults with an incurable illness can seek a lethal dose of drugs from their GP. Medics who have a 'conscientious objection' will be able to opt out under the safeguards proposed in the bill.

Meanwhile, lawmakers in Scotland are expected to debate an assisted dying bill this upcoming autumn. 

 

Under the proposed Assisted Dying for Terminally Ill Patients (Scotland) Bill, terminally ill Scots as young as 16 years old will be able to ask doctors for help to end their lives. 

 

The legislation proposes that adults with an incurable illness can seek a lethal dose of drugs from their GP. Medics who have a 'conscientious objection' will be able to opt out under the safeguards proposed in the bill.

Supporters say the law will ensure people have the choice of 'safe and compassionate assisted dying'. But critics have condemned the legislation as 'dangerous' and warned it will 'normalise' suicide. 

 

MSPs are expected to be given a free vote on the issue, with the Bill likely to face its first Holyrood test later this year before a final vote is held at some point in 2025. 

 

© Associated Newspapers Ltd

 

Helplines

 

Mental well-being

• Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)

• Samaritans of Singapore: 1800-221-4444 (24 hours) /1-767 (24 hours)

• Singapore Association for Mental Health: 1800-283-7019

• Silver Ribbon Singapore: 6386-1928

• Tinkle Friend: 1800-274-4788 

• Chat, Centre of Excellence for Youth Mental Health: 6493-6500/1

• Women’s Helpline (Aware): 1800-777-5555 (weekdays, 10am to 6pm)

• Aware’s Sexual Assault Care Centre: 6779-0282 (weekdays, 10am to 6pm)

• National Anti-Violence and Sexual Harassment Helpline: 1800-777-0000

 

Counselling

• TOUCHline (Counselling): 1800-377-2252

• TOUCH Care Line (for seniors, caregivers): 6804-6555

• Care Corner Counselling Centre: 6353-1180

• Counselling and Care Centre: 6536-6366

 

Online resources

• eC2.sg

• www.tinklefriend.sg

• www.chat.mentalhealth.sg

• carey.carecorner.org.sg (for those aged 13 to 25)

• limitless.sg/talk (for those aged 12 to 25)

 

For International helplines, kindly refer to Befrienders Worldwide. If you or someone you know is in immediate danger, contact 24-hour emergency medical services

Edited April 9 by amuse.ed

[amuse.ed]

Trigger warning: Content article related to issues on violence in relation to mental health challenges, stigmasation and discrimination. Kindly read at one’s discretion and discuss with the professionals, where necessary. 

 

Australia

Sydney attacker had ‘mental health issues’ but most people with mental illness aren’t violent

Published: April 15, 2024 5.12am BST
James Ogloff, Swinburne University of Technology

The man who killed six people and injured countless others at a Bondi shopping centre on Saturday, 40-year-old Joel Cauchi, reportedly had “mental health issues”, police explained soon after the tragic event, while ruling out terrorism.

Cauchi had reportedly been diagnosed with a mental illness at age 17 years and had received treatment in the public and private sector. But Queensland Police said Cauchi’s mental health had declined in recent years.

No matter the circumstances, such acts of violence must be condemned. If mental health issues contribute to such acts, they need to be understood and prevented.

 

However it’s important to note the vast majority of people with mental illness do not pose a risk of violence to others.

 

Tragically, there is still an unacceptable level of stigma and misunderstanding of mental illness, including the mistaken belief that people with mental illness are violent. People may draw conclusions from cases such as the Bondi attack, where people with histories of mental illness engage in violence.

 

So is there a link between mental illness and violent crime? Here’s what the evidence says.

 

For most people with mental illness, there’s no increase in violence
Research from Australia and overseas shows a small percentage of people with serious forms of mental illness may be at increased risk for violence.

 

Our research in Victoria, for example, shows 10% of people with schizophrenia (a serious form of mental illness where the person can be so unwell as to be out of touch with reality) have perpetrated a violent crime. This compares with about 2.4% of the general population. So, while the people who have schizophrenia were more likely to have a violent offence, the vast majority of them did not.

 

The findings are mixed regarding a direct relationship between more common mental illnesses, such as anxiety and depression, and violence.

Although the reasons that anyone – including people with psychiatric illnesses – offends vary, we identify three categories of people with mental illness who engage in violence.

 

1. Irrational thinking and beliefs

The first is the very small group of people with a serious mental illness, typically schizophrenia, who act violently as a direct result of symptoms of mental illness.

 

For these people, their illness leads to irrational thinking and beliefs that can increase the likelihood of them behaving violently. A person may develop delusional beliefs they are being targeted or their lives are in danger if they do not act violently against perceived enemies.

 

For these people, if they did not have the particular symptoms of mental illness, they would not offend.

 

People in this category may be found not guilty by reason of mental impairment. They are then typically held in secure hospitals or prisons where they are treated and eventually released, when they are no longer found to be a risk to others.

 

2. Overlap with social factors

The second category is much larger, and more varied. For this group, people do not offend because of their mental illnesses, per se, but due to the related individual and social issues that may accompany mental illness.

 

People with some forms of mental illness may be more likely to engage in substance misuse, for example, which may, in turn, contribute to offending.

Many of the negative social factors associated with serious forms of mental illness overlap with the negative social factors that increase the probability of being violent.

 

People with serious forms of mental illness who have backgrounds characterised by social and family disruption and disadvantage together with abuse, behavioural disturbances, substance use and educational failure and disengagement are significantly more likely to offend than people with mental illnesses who do not have such disturbances in their backgrounds.

 

Of course, most people with a psychotic illness do not come from such disadvantaged backgrounds.

Research and clinical experience also show factors related to offending within this group are similar to those who do not have mental illness. In addition to substance abuse, this can include violent attitudes, exposure to trauma and violence, association with people who are antisocial, and poor family and professional support.

 

3. Mental illness isn’t related

The final group of people with mental illness who offend do so irrespective of their mental illness. People in this group are typically characterised by early onset antisocial and illegal behaviour.

 

They differ from other offenders with mental illness by having a pervasive and stable pattern of offending regardless of their mental state. This behaviour almost always precedes the onset of mental illness.

 

While people with a psychopathic or antisocial personality disorder will be included in this group, not all of the people in the group will have such a personality disorder.

 

Mental health care can reduce the chance of violence

It’s not the mental illness per se that causes people to be violent. Rather, it’s symptoms of the illnesses and related factors.

 

There is good evidence therefore that providing psychiatric and psychological care can help manage symptoms of mental illness and reduce the likelihood of violence.

 

It’s also important to address the broader factors that are related to offending and violence among people who are mentally ill.

 

Unfortunately, partly as a result of the pressures on mental health services, staff have few resources to help address the array of factors that can lead to one behaving violently.

 

Continued investment and education is required to boost the services and address the factors that lead to violence among people with mental illness.

 

While we have made some progress in the recognition that mental illness affects a large percentage of the population, individual acts of violence committed by someone with mental illness must not lead us to jump to conclusions that all people with mental illness are violent.

Copyright © 2010–2024, The Conversation

[amuse.ed]

Trigger warning: Content article related to issues on stigmasation, discrimination and substance abuse. Kindly read at one’s discretion and discuss with the professionals, where necessary. 

 

What Would Jess Say?

Psychiatrists are depressed, but none of them attribute their own feelings to brain chemical imbalances

Dr Jess explores shocking new findings that psychiatrists are depressed, don’t attribute their feelings to mental disorders, and are frightened of being pathologised…

 

DR JESSICA TAYLOR
APR 04, 2024

An insightful new report from Medscape was published yesterday - and the findings have fascinated me.

 

As I’ve said in the title of this article, psychiatrists report feeling totally burned out, overwhelmed and depressed, but none of them attributed their valid trauma responses to the biomedical model theory of ‘brain chemical imbalances’.

 

Further than that, none of them reported wanting to take antidepressants, and many of them feared that they would be pathologised if they admitted how they were feeling to their employer or their colleagues. As if that wasn’t enough, psychiatrists reported that they were using exercise, spending time with loved ones, meditation, and self-care to cope with their thoughts and feelings of overwhelm and depression - whilst the public are told that these approaches won’t work (or worse, the approaches are actively mocked by psychiatrists and mental health professionals who see them as useless or dangerous).

 

What does this all mean? Why are members of the public told by their psychiatrist that their ‘depression’ is biochemical, but psychiatrists are looking to their environment and their traumas to understand their own experiences?

 

Over 9000 practicing psychiatrists took part, and the findings reveal deep cognitive dissonance in the profession.

I will outline some key findings here, and then discuss them from an anti-pathology, trauma-informed lens (APTI).

 

Before I begin though, I would just like to say that whilst this article will focus on the dissonance, hypocrisy, and conflict of the anonymous answers of psychiatrists versus the narratives of psychiatry, I do accept and believe that psychiatrists are burned out, suffering, struggling, and feeling pretty terrible in their lives and their roles. Their trauma, distress and burnout is real, and it is valid. They are fellow humans, exposed to human suffering every day, and they also play a role in causing it. It is likely they will be harmed by their work, in addition to their own personal traumas (whether they admit to them or not).

 

The key findings I would like to discuss here are as follows:

Psychiatrists named nine top issues that were causing their depression, and none of them were biological, and they stated that 99% of their depression and burnout was caused by their jobs - but none of them reported or spoke of serotonin, brain chemicals, or biological causes

 

Only 1% of psychiatrists said that their depression and burnout did not interfere with their daily lives

 

79% of psychiatrists reported that their feelings of depression and burnout negatively affected their personal relationships

 

Whilst 40% of psychiatrists said that it would help them if they were able to talk about how they felt with their colleagues, they were sceptical and/or cynical as to whether they would actually get any support from them

 

The most common coping mechanisms used by psychiatrists for their depression and burnout were non-medical and non-therapeutic

 

Psychiatrists are frightened of being pathologised and judged by their own profession

 

55% of psychiatrists stated that they would not seek any help for their feelings of depression and burnout. Of those, 34% of psychiatrists reported that they had never sought help for their depression and burnout, and they would not seek any help in the future either

 

Finding 1: Psychiatrists named nine top issues that were causing their depression, and none of them were biological.

By far, one of the most important findings in this report pertains to the way psychiatrists seem to be able to identify the distress and trauma in their own lives to explain their own depression, and do not see themselves as having biochemical imbalances or disorders of the mind that require medication.

 

Psychiatrists were asked what issues were significantly contributing to their depression, and they reported the following:

 

Job burnout - 66%

Physician responsibilities - 48%

Health issues - 26%

Finance issues - 26%

World events - 23%

Romantic relationship issues - 17%

Personality - 16%

Their own insecurities - 15%

Family issues - 15%

 

What is utterly fascinating about these answers, is the way psychiatrists are able to attribute their own suffering to external (absolutely valid) factors such as their jobs, finances, world events, relationship issues, health problems and family conflict - but millions of their own patients are being told that their depression is caused by low serotonin levels in the brain, genetic risk, and biological issues that require medication and sedation.

 

As an anti-pathology, trauma-informed, psychologist myself, I believe these psychiatrists have correctly identified the real sources of their ‘depression’.

 

But why have they found it so simple to do for themselves, and so hard to validate for their patients and clients?

 

Why are they able to come up with a list of external distress, stressors and traumas that are causing their feelings, but attribute the suffering of their clients and patients to a set of abstract mental illnesses?

 

Why are patients and clients being told that their depression is a mental illness caused by biological factors?

 

Finding 2: Only 1% of psychiatrists said that their depression and burnout did not interfere with their lives

This finding interested me due to the way that psychiatrists will often define a ‘mental disorder’ as a feeling or experience that is so severe that it ‘interferes with our day-to-day lives’.

 

Only 1% of psychiatrists said their feelings did not interfere with their day-to-day lives.

 

It seems such a simple, obvious point - and that’s because it is. So much of human suffering is simple - and if someone is suffering, it is going to impact their day-to-day life. This does not mean they have a mental illness, and yet this is one of the ways we define them.

 

When I teach critical perspectives of psychiatry and psychology, I often tell my students that this is one of the biggest flaws of this discipline. There are no norms, averages, tests, upper or lower limits of anything - so everything is based on subjective observation and self-report measures. ‘Does this feeling interfere with your day-to-day life?’ is going to result in extremely high positives, because most suffering impacts us on a daily basis. This doesn’t make it evidence of an illness. It doesn’t mean anything, really.

 

What is most curious though, is that whilst psychiatrists recognised that their own depression and burnout was affecting them every day, the report doesn’t suggest that any of them have a mental disorder.

 

Finding 3: 79% of psychiatrists reported that their feelings of depression and burnout negatively affected their personal relationships

I noted with interest that the majority of psychiatrists reported that their feelings of depression and burnout were impacting their personal relationships - and it made me think about the way issues with relationships are used in psychiatry to diagnose (predominantly women) with personality disorders, attachment disorders and bipolar disorder.

 

I have personally met many women who have been diagnosed with EUPD and BPD based on their ‘dysfunctional’ relationships, lack of intimacy, trust, connection, safety in their relationship and relationship breakdown. They have been told by their psychiatrist that they are fundamentally disordered, and that their relationships are suffering because of their mental health issues.

 

I’ve seen this happen repeatedly, even when women report serious trauma and distresses in their lives that are clearly impacting their relationships.

 

Again, why are psychiatrists able to recognise that their vicarious trauma and burnout from their jobs and their lives are impacting their relationships but don’t seem to be able to do this with their own clients? Do they believe they have developed personality disorders and attachment disorders too?

 

Seems not.

 

Finding 4: Whilst 40% of psychiatrists said that it would help them if they were able to talk about how they felt with their colleagues, they were sceptical and/or cynical as to whether they would actually get any support from them

I wanted to raise this finding because I have plenty of friends and colleagues who work in psychiatry, and none of them trust the people around them. I have friends who are HCAs and nurses in mental health wards, and I have friends who are medical doctors, clinical psychologists and even a few psychiatrists who have told me many times that they wouldn’t trust their colleagues, their their work environment is toxic, that bullying is rife, and that they don’t speak to their colleagues about anything personal.

 

In an industry that is supposedly about opening up about your struggles, it is rather telling that the professionals themselves don’t trust each other, and witness bullying and abuse of each other regularly. 60% of psychiatrists stated that it wouldn’t help them to talk openly about their feelings of depression and burnout at work, and the authors noted high skepticism and cynicism in psychiatrists towards their colleagues and teams.

 

What use is a mental health team who are hiding who they really are, and how they really feel, from each other? How can these wards and services be safe for people to disclose their feelings, when the professionals can’t even do this safely?

 

Finding 5: The most common coping mechanisms used by psychiatrists for their depression and burnout were non-medical and non-therapeutic

One of the most interesting findings in this report was the way psychiatrists are trying to cope with their feelings of depression and burnout. Are they taking SSRIs? Are they having endless CBT?

 

No. They are not. Instead of traditional pharmacological approaches, or therapeutic interventions, psychiatrists reported the following:

 

Talking with my family or friends - 52%

Sleeping more - 49%

Spending time alone - 48%

Exercise - 40%

Play or listen to music - 38%

Eat junk food - 35%

Meditation - 30%

Binge eat - 18%

Drink alcohol - 16%

Use prescription drugs - 9%

Smoking cigarettes - 6%

Smoking weed - 2%

 

There is so much to say about these findings, I could write a whole article on them. Firstly, I was surprised to see such holistic approaches from a group of people who reject holistic approaches so loudly and so publicly.

 

Only last month, a nasty argument broke out on mental health Twitter because a professional posted that exercise was extremely effective for depression. She was mocked, trolled, and rebutted by psychiatrists for over a week. She was called dangerous. She was positioned as an idiot.

 

But according to this survey of over 9000 practicing psychiatrists, exercise is one of their most common approaches to their own depression and burnout. In fact, their most common approaches to dealing with their depression and burnout were anti-pathology, trauma-informed - and were not remotely psychiatric. Even if we looked at the 9% of psychiatrists who said they were using prescription drugs, this answer was nowhere near as common as the others (and we can’t be sure which drugs these were, as they could be sleeping pills, painkillers, or antidepressants/antipsychotics).

 

So why don’t psychiatrists practice what they preach? Why don’t they assume that their depression is caused by their ‘low levels of serotonin’ and take ever-increasing dosages of SSRIs for decades? Why do they exercise, if they ridicule it in public? Why do they increase their sleep? Why do they meditate, if that is just hippy woo-woo bullshit as they so often claim?

 

Could it be because deep down, they know that their depression and burnout is caused by real external stressors, and they know that they need support, help, sleep, peace, support, and exercise to feel better?

 

Or could it be that their see their patients as below them? Broken? No-hopers who need to shut up, take their pills and stop wasting their time?

How is this dissonance happening? How is it being maintained?

 

Finding 6: Psychiatrists are frightened of being pathologised and judged by their own profession

As the psychologist who has been banging on about the power of pathologisation for years - I was absolutely blown away to read the results to this question. Over 9000 psychiatrists were asked why they don’t tell anyone about their depression.

The findings confirm everything I have ever said about pathologisation, but also raise some questions. Let’s have a look at their answers:

 

50% of psychiatrists said they didn’t tell anyone about their depression because they were worried that their ‘medical board or their employer would find out’

 

48% said they didn’t tell anyone because ‘people might doubt their abilities as a physician’

 

27% said they didn’t tell anyone because ‘people will think less of me’

 

27% said they didn’t tell anyone because ‘it makes a negative statement about me personally’

 

6% said ‘I consider depression to be a weakness’

 

So, a LOT to discuss here.

 

My first thoughts were that psychiatrists know how stigmatising mental disorder diagnoses are, and they are clearly frightened of them.

 

They are working in an industry that they are ultimately scared of. They don’t want their employer knowing they are struggling, they don’t want to be pathologised, they don’t want to be seen as inferior or incapable, they don’t want to be judged, and they perceive their own completely valid feelings as weaknesses and negative.

 

It saddens me to read this, actually.

Thousands of intelligent, capable professionals, struggling with their own feelings and thoughts, too scared to admit it because they know their own discipline will frame them as mentally ill.

The dissonance. They hypocrisy. The conflict. The utter internal chaos.

 

How can we possibly believe that psychiatry is good humankind, when the people who work in it every day are so frightened of it? They know what will happen if they admit they are not coping. They know what happens if they admit their own suffering and trauma. Is that a safe working environment?

 

Pathologisation is rife in psychiatry - not only towards clients and patients, but towards each other. I’ve said this many times before, and I will say it again here: there is no such thing as ‘ending mental health stigma’, unless we completely depathologise human suffering, and reject psychiatry as a concept. Distressed humans are not mentally disordered.

 

We’ve built a house of cards, and the psychiatrists are inside it.

 

Finding 7: 55% of psychiatrists stated that they would not seek any help for their feelings of depression and burnout. Of those, 34% of psychiatrists reported that they had never sought help for their depression and burnout, and they would not seek any help in the future either

The final finding I would like to discuss is the amount of psychiatrists who reported that they would not seek any help for their feelings. I wanted to raise this one because I think it is important to normalise how many people (even psychiatrists) do not feel able to talk about their feelings, or seek help. Our professions (psychiatry, psychology and mental health) have chanted mantras about seeking help, talking to someone, going to a doctor or seeking therapy for years - and yet many professionals do not follow their own advice.

 

Further, lots of professionals have had terrible experiences with therapies, medications, and seeking support - but daren’t say it out loud, for fear of tarnishing their own industry. I follow a woman who talks about bad therapy, harmful psychotherapy, and harmful approaches to trauma - and she is consistently criticised by therapists and psychologists who claim she is harming the industry, and attacking the profession. It seems even admitting that our fields can cause great harm is forbidden, let alone admitting that we as professionals are likely to also have had such bad experiences of seeking help, that we avoid it in future.

 

What Would Jess Say?
My final thoughts on this keep coming back to the validity of psychiatry as a concept, as a discipline, as a service for humans in distress. The biomedical model is not fit for purpose. Convincing distressed humans that their experiences are irrelevant, and instead, that they are mentally ill, in need of long term intervention, and could even be ‘treatment resistant’ - is gaslighting them. Psychiatrists seem to look outside themselves for the cause of their suffering, but inside others for the cause of their suffering.

 

This reminds me of a theory of cognitive psychology that I teach regularly, called ‘fundamental attribution error’. FAE is a cognitive phenomenon in which a person attributes external reasons to their own suffering, but internal reasons to the suffering of others. For example, they might believe that their relationships keep failing because their exes are all pricks - but might conclude that their patients’ relationships keep failing because they have a personality disorder.

 

What is left of psychiatry and the biomedical model, if psychiatrists do not apply it to themselves?

 

Why are safe, trauma-informed approaches to depression and distress being ridiculed by psychiatrists on social media, but being used in private?

 

Why are harmful and addictive medications being doled out to millions of people who are depressed and burned out, but not used by psychiatrists themselves?

 

Why are psychiatrists pushing to diagnose millions of people with more and more mental disorders, but don’t want anyone to diagnose them with a mental disorder, because they are frightened of being pathologised?

 

My work is criticised and ridiculed every day. Mainly by psychiatrists, clinical psychologists and people who work within mental health services. I suggest that human distress is valid and real, but mental disorders are not. I argue that pathologisation is a form of stigma, oppression and labelling that has a profound impact on people. I suggest that there are better approaches to human suffering than medication and psychiatric diagnosis.

 

I even talk openly and consistently about vicarious trauma and burnout in the workplace, and how professionals are being pathologised, and are too frightened to seek support for fear of being seen as inferior.

 

It appears that this report has confirmed every single thing I say, and this time, the results came from 9000 psychiatrists.

 

So, now what?

 

Do we tell the psychiatrists to shut up, take their pills, and fix their serotonin imbalances? Should we label them and pathologise them, too? Gaslight them that they need to be more resilient at work? Send them for useless CBT? Suggest that they have ADHD and they need stimulants so they can keep up at work?

 

Or do we help them to address their valid feelings, their toxic work environments, and their utter burnout, in an ethical, anti-oppressive, anti-pathology, trauma-informed approach?

 

I know which one I would prefer.

 

Report by Medscape: Psychiatrist Burnout and Depression Report 2024

Sample size: 9266

 

Recruitment period: 5th July 2023 - 9th October 2023

© 2024 Dr Jessica Taylor
 

[amuse.ed]

Trigger warning: Content article related to issues on stigmasation, discrimination and violence. Kindly read at one’s discretion and discuss with the professionals, where necessary. 

 

Australia

SCHIZOPHRENIA IS A COMPLEX CONDITION NOT A CAUSE OR A CRIME

Rachel Green
18 April 2024

As humans, we’re driven to seek answers.

 

When the unthinkable happens, our natural instinct is to try to make sense of it.

 

But in our rush to process the horror that unfolded in Bondi, we must resist the urge to draw simplistic conclusions.

While we grieve with the loved ones of those who lost their lives, the truth is, we may never know what drove this man to commit these terrible acts.

 

Despite this, many in the media and on social media, have drawn a straight line between his diagnosis of schizophrenia and his actions on that day. For some, this provides a neat explanation for what happened.

 

But a diagnosis of schizophrenia does not tell us everything we need to know.

 

Millions of Australians with mental illness live, work and play in the community, and with appropriate care and support, can live healthy, contributing lives. They are people like us.

 

Some people living with more severe or complex mental ill health require a higher intensity of care for them to thrive. Early intervention is critical. Long term, consistent and reliable support is needed not just for the individual but also for their family and carers.

 

Living with a mental illness does not make you inherently violent. The research is clear – people with mental health conditions are far more likely to be victims of crime than perpetrators.

When an incident of harm does happen, the tragedy is it will often be precipitated by days, weeks, months and even years of system failures within our mental health system, often compounded by related social factors like abuse, homelessness, poverty and substance use.

 

Rather than simply linking criminal behaviour with mental illness, the conversation we need to be having is how desperately under-resourced our mental health system is and has been for decades.

 

We don’t even know how many people in Australia are living with schizophrenia because the most recent data set is from 2007. This woefully out of date data directly impacts our ability to plan and resource services.

 

As more details emerge of this man’s story, what is apparent is he fell through the gaps of a fragmented and inaccessible mental health system.

This will come as no surprise to struggling families and those working on the frontlines of a system at breaking point.

 

SANE’s recent Bridging the Gaps survey found that more than half of all people living with complex or long-term mental illnesses had not ever received assistance accessing mental health or social services.

 

Only seven per cent were able to access mental health care without paying a gap fee. Waiting lists for non-crisis psychiatric care was 6 months or more.

 

There is an urgent need to fund early intervention and prevention and psychosocial supports for people with complex presentations, to prevent deterioration that can lead to acute crisis.

 

It strikes me as a sad irony that the stigma faced by the many Australians living with complex mental health conditions – which is currently being exacerbated by sensationalist media reporting – can often be the reason they can’t access the support they need to stay well.

 

While public awareness of mild to moderate conditions like anxiety or depression has grown, and people sharing their personal experiences are often celebrated, this is not the case for conditions like schizophrenia.

 

The lack of public understanding can create barriers to housing and employment, and sometimes mental health care, because they’re deemed “too complex.”

 

At SANE, we hear this story every day. Thousands of Australians access our online services for support and advice because they can’t get support anywhere else.

 

When tragedies like the one at Bondi happen, there is always an immediate cry for justice. , but there is a risk that justice might simply involve an expensive coronial inquest and a remembrance statue.

 

If we really want to make sure this doesn’t happen again, we need to stop tinkering around the edges and fund the mental health system properly. Fill the service gaps and provide access to the early intervention and support people need to get on a road to recovery.

 

We owe that to the victims and their families.

 

Rachel Green is the CEO of SANE.

SANE provides free, nationally accessible support services for people with complex mental health needs.

 

Visit sane.org/get-support.
 

[amuse.ed]

Scotland

Locum psychiatrists providing poor care in Scotland, campaigners say

Scottish NHS boards have spent more than £125m since 2019 to provide temporary cover amid drop in consultant numbers

 

Severin Carrell

Sun 21 Apr 2024 15.59 BST

Mental health campaigners have protested about the significant use of temporary locum psychiatrists in Scotland, alleging that it leads to substandard and harmful medical care.

Peter Todd, a campaigner based in Caithness in the north of Scotland, said the heavy reliance on locum psychiatrists by the NHS was a sign of a growing crisis in mental health services across the country.

 

Scotland’s NHS boards told him they had spent more than £125m since 2019 paying for locums to fill in for the scores of consultants who have either retired, quit the NHS or not been recruited.

Todd said that in his experience, which echoes those of other patients in his area, the heavy reliance on locums led to poor continuity of care and badly maintained notes. A survivor of child sexual abuse, he said each new psychiatrist meant restating his lifetime experiences and medical issues, a process that had amplified his trauma.

 

“When you see a permanent psychiatrist, you only have to explain once, but if you’re seeing locum after locum after locum, you feel like you’re a tape recorder having to repeat yourself and repeat yourself,” he said.

 

NHS Tayside, which has run up a series of significant deficits, has spent more than £29.8m on locum psychiatrists since April 2019, NHS Grampian £22.3m, and NHS Fife £17m.

The true cost of the crisis emerged earlier this month when NHS Western Isles confirmed that it had spent more than £1.2m in 2022/23 on locums to fill two psychiatry posts at its general hospital in Stornoway, paying them by the hour.

 

For a population of 26,600 people, it has had to spend more than £4.3m on freelancers to cover those posts since the 2019/20 financial year.

 

In common with other rural health boards, NHS Western Isles struggles to recruit doctors on current pay scales and has been forced to pay well above normal. Last month it offered new GPs salaries of up to £150,000 to work a 40-hour week, 40% higher than normal.

 

The Scottish Liberal Democrats said NHS data showed that in October last year 117 locum psychiatrists were working in the region, compared with 462 staff psychiatrists, and that up to 46% of posts were unfilled in some boards.

 

NHS Grampian said the Covid pandemic was not a cause of the crisis.

 

“Recruitment and retention was an issue pre-pandemic, and this persists,” it said in a statement. “Some clinicians have opted for early retirement, in part due to a change in their pension rules, and there are fewer suitably trained psychiatrists coming into the job market. This is not an issue unique to Grampian.”

Dr Jim Crabb, of the Royal College of Psychiatrists, said far more needed to be done by the NHS and Scottish government to incentivise and value psychiatry. Mental health had not had the 10% of health spending it had been promised, and was being cut by 5% a year.

 

“Funding has always been bad,” he said. “Despite serious illnesses such as schizophrenia, depression and anxiety costing economically developed societies more than conditions such as asthma and arthritis, far less is spent on mental health compared to physical healthcare.”

 

NHS Tayside said it faced significant recruitment challenges; it takes 13 to 15 years to train as a consultant psychiatrist. Data showed that 42% of consultant psychiatrists were over 50 years old, and that many intended to retire early.

 

“This peak in retirements will far exceed the number of new consultants,” it said, adding that it was working hard to recruit doctors from the local area.

 

“Despite these efforts, trainee numbers are relatively low, and this, coupled with the length of training, means recovery from the current position of high locum usage in psychiatry will take a number of years to achieve,” it said.

Willie Rennie, a Scottish Liberal Democrat MSP who campaigns on mental health funding, said: “It is all very well for ministers to pay lip service to mental health, but the proof is in the pudding when it comes to budget time.

 

“Alongside training more staff, there also needs to be a serious look at how we attract and secure staff to work in every type of community so that everyone can access mental health support no matter where they live.”

 

A Scottish government spokesperson said recruitment had been improving recently, but agreed that more needed to be done “to secure best value” for health spending.

 

“We are considering how we can better support the recruitment and retention of psychiatrists, including actively exploring possible solutions to address issues such as the use of locums and how we attract new or existing psychiatrists to take up posts in Scotland,” they said.

© 2024 Guardian News & Media Limited or its affiliated companies. All rights reserved. (dcr)
 

[amuse.ed]

Trigger warning: Content article related to issues on pathologised psychiatric and substance abuses. Kindly read at one’s discretion and discuss with the professionals, where necessary. 

 

Psychology Today

PSYCHIATRY
When Substance Abuse and Psychiatric Issues Collide

Co-occurring disorders have taken a toll on celebrities and regular folk alike.
Updated April 5, 2024

Reviewed by Hara Estroff Marano

KEY POINTS
Many people have a substance use disorder (SUD) and serious psychiatric issue at the same time.

Experts and the public have struggled with whether drugs caused psychiatric illness or vice versa.

Carrie Fisher and Matthew Perry may have self-medicated over distress, or SUDs triggered psychiatric ills.

Sexual, physical, or emotional traumatic events in childhood increase risks for co-occurring disorders.

Often starting in adolescence or young adulthood, many individuals have both a substance abuse disorder and at least one psychiatric disorder, although which diagnosis came first is frequently unclear. This “double trouble” problem is also called “co-occurring disorders (CODS),” as well as “concurrent disorders” and “dual diagnosis.”

The combination of disorders has been discussed in speculative articles about celebrities like Charlie Sheen, Demi Lovato, Justin Bieber, Jhene Aiko, Britney Spears, and Russell Brand. More in-depth scientific and biographic articles about Ernest Hemingway, Carrie Fisher, and Kurt Cobain have helped explain the complexity of CODs. Some of us were mesmerized and sad watching their struggles. Kurt Cobain’s lyrics, performance, and even some of his songs (like “Lithium” and “All Apologies” ) come to my mind as both a fan and a psychiatrist.

 

But it’s not just celebrities who are suffering from both substance abuse and mental health issues. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2022, 21.5 million people in the United States had both a substance abuse disorder and a mental illness.

 

In the past, experts believed it was best to treat one disorder (usually the substance issue) and assumed any psychiatric issues would sort themselves out. However, if the psychiatric issue persisted, it was eventually treated.

 

In contrast, current thinking is both disorders should be treated in about the same time frame, because ignoring either could be problematic for the patient. If someone is severely depressed, anxious, or has another psychiatric disorder, it may be possible for them to detoxify from a substance, but it’s very hard to develop longer-term control over substance dependence and any accompanying mental illnesses when both issues are not addressed.

 

For adolescents and young adults with underlying psychiatric disorders, abusing substances provides an unfortunate early opportunity for incorporating bad learning. For example, if they struggle with anxiety, teens may discover that alcohol calms their nerves, making them less anxious about meeting new people or engaging in social interactions. Early self-medication of psychiatric symptoms is double trouble, as alcohol causes brain changes and effects that can trigger alcohol use disorder (AUD.) Some people describe the first drink as magical, that first taste feeling like the key to previously locked-out relief.

 

More Intense Treatment Is Needed with SUDs Combined with Psychiatric Diagnoses

 

Individuals diagnosed with co-occurring disorders often need more intense treatment than others due to the complexity of their cases. They also may face greater consequences from their substance abuse compared to patients diagnosed with a mental illness only. Examples of such possible consequences may include a greater exacerbation of their psychiatric symptoms, hallucinations and/or suicidal thinking, an increase in aggressive and violent behaviors, concurrent medical, nutritional, and infectious issues, more emergency room visits than other patients, and a greater number of falls and injuries.

Those with CODs are also more likely to experience head injuries and physical fights with others as well as sexually transmitted infections (STIs). Some have a greater frequency of involuntary inpatient psychiatric placements. These patients need a psychiatric assessment and treatment from experts in both addictions and psychiatry.

Possible Causes of CODs

 

One theory to explain CODS, the self-medication theory, was developed by the late Harvard psychiatrist and psychoanalyst Ed Khantzian, M.D. He assumed anhedonia (the inability to experience pleasure) or suffering in general was the driving force behind addiction. This theory hypothesizes that underlying psychological disorders compel individuals to self-medicate their feelings with alcohol and/or drugs. In addition, patients are sometimes distinguished by their drugs of choice. For instance, patients with an alcohol use disorder might have been battling social anxiety and self-medicating with alcohol for performance anxiety, shyness, or nervousness in social settings; stimulants such as cocaine or methamphetamine often are used by those with depression or untreated attentional disorders like attention deficit hyperactivity disorder (ADHD).

The self-medication hypothesis was first put forth in a 1985 cover article in the American Journal of Psychiatry. It focused on how and why individuals are drawn to and become dependent on drugs. The self-medication hypothesis was derived from clinical evaluation and treatment of thousands of patients spanning five decades and remains a credible theory.

As I have stated in the American Journal of Psychiatry, it is one of the most “intuitively appealing theories” about addiction. But drugs of abuse and addiction can also cause psychiatric illnesses by targeting the brain’s mood and pleasure systems and inadvertently undermining them.

 

Neuroscientist Kenneth Blum developed the theory of reward-deficiency syndrome (RDS) as the cause for co-occurring addictive disorders and psychiatric diagnoses. In many ways, RDS is a natural extension of Khantzian’s theory, but it’s an update, attributing the cause to an underlying dopamine deficiency or neurochemical dysfunction that supports drug-seeking/self-medication.

People with RDS, which may be inherited, are miserably unhappy and their lives may be intolerable due to their inability to gain satisfaction from work, relationships, or their accomplishments.

 

An emerging, newer approach of “preaddiction” as an early or moderate stage of substance abuse is championed by leaders of the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Institute of Mental Health (NIMH).

 

Preaddiction is conceptually analogous to prediabetes, a risk factor for type-2 diabetes. Prediabetes has contributed to a quantum leap in early detection of people at risk for type-2 diabetes, shortened delays between symptom onset and treatment entry before the onset of diabetes, and overall been a remarkable success in halting progression to diabetes. Similarly, the earliest possible detection of substance abuse will save more lives as experts develop and focus on the evolving concept of preaddiction.

 

A Possible Environmental Cause: Adverse Childhood Events (ACEs)

 

In the late twentieth century, a large insurance provider in California worked with researchers to identify adverse childhood experiences (ACEs) that later reverberated in the lives of adults. The researchers found that individuals who reported the greatest numbers of ACEs—such as physical abuse, sexual abuse, loss of a biological parent, witnessing physical violence, and other severely traumatic childhood events—were significantly more likely than those with no ACEs to have psychiatric problems and substance abuse issues in adulthood. They were also at greater risk for suicidal behaviors.

 

Nirvana's Kurt Cobain was a person with bipolar disorder, substance use and a heroin habit, according to a cousin who described their family history in detail and noted that two uncles had killed themselves with guns. Cobain, who suicided in 1994, purportedly had at least four ACEs, including witnessing domestic violence, experiencing psychological abuse, being neglected, and suffering from his parents’ divorce. Such a score markedly increased Cobain’s risk for suicide as an adult.

 

Treatment of CODs Should Not Be Delayed

 

Although an extensive description of how CODs should best be treated is beyond the scope of this article, the key point is to not delay treatment of one disorder in favor of the other. Instead, as much of a simultaneous approach as possible is best. This often means a team of experts is needed, including a psychiatrist, psychologist, therapists, and others to assess the problem, determine whether inpatient, residential, or outpatient treatment is best, and develop a cohesive treatment plan for the patient.

 

In opioid use disorder treatment, the current standard of care is to focus on prevention of overdose and replacement of opioids with medication-assisted treatments (MATs.) However, detoxification from opioids or maintenance on a MAT would provide little symptomatic relief for a person with opioid use disorder, suicidal ideas, and bipolar illness.

 

It is also recommended to evaluate individuals for past or recent trauma and co-occurring psychiatric and medical illnesses and treat patients accordingly. Often this means psychotherapy is needed as well as psychiatric treatments. Psychotherapy may include cognitive behavioral therapy (CBT), motivation enhancement therapy (MET), dialectical behavior therapy (DBT), and other forms of therapy. Trained and experienced therapists are crucial. Depending on the substance on which patients depend, medication treatment for their detoxification, relapse prevention, and craving may or may not be available. Currently, medication treatments exist for tobacco use disorder, alcohol use disorder, and opioid use disorder.

 

Summing It Up

 

Not only celebrities but many people with a substance use disorder have at least one other psychiatric problem, and when this situation occurs, all disorders need to be identified and treated. I recommend professional help in checking for substance use disorders in psychiatric patients and also looking for psychiatric illness and a history of trauma in people with substance use disorders.

 

Future breakthroughs in genetic and other scientific research should make clearer why some individuals are more prone to such disorders, as well as lead experts toward the best medications, therapies, and other treatments to alleviate much more of this terrible suffering.

 

References

Cross, Charles R. Heavier than Heaven : a Biography of Kurt Cobain. New York :Hyperion, 2001.

 

Gold MS. Dual disorders: nosology, diagnosis, & treatment confusion--chicken or egg? Introduction. J Addict Dis. 2007;26 Suppl 1:1-3. doi: 10.1300/J069v26S01_01. PMID: 19283969.

 

Buckley PF, Brown ES. Prevalence and consequences of dual diagnosis. J Clin Psychiatry. 2006 Jul;67(7):e01. doi: 10.4088/jcp.0706e01. PMID: 17107226.

About the Author
Mark Gold M.D.
Mark S. Gold, M.D., is a pioneering researcher, professor, and chairman of psychiatry at Yale, the University of Florida, and Washington University in St Louis. His theories have changed the field, stimulated additional research, and led to new understanding and treatments for opioid use disorders, cocaine use disorders, overeating, smoking, and depression.

Psychology Today © 2024 Sussex Publishers, LLC

[amuse.ed]

Trigger warning: Content article related to issues sucides. Kindly read at one’s discretion and discuss with the professionals, where necessary. 

 

Singapore

 

8 in 10 falsely believe talking about suicide can make a person take his life: SMU study

 

Eight in 10 think that when someone talks about suicide, that person could take his life, according to the study’s findings.

Shermaine Ang
UPDATED APR 24, 2024, 12:04 AM

SINGAPORE - More than half of respondents falsely believe that most suicides happen suddenly without warning, a recent survey by the Singapore Management University (SMU) has found.

 

Some 56 per cent of them think this way, slightly higher than the 53 per cent in 2022 when a poll on the same issue was done.

 

The latest results showed that 31 per cent believe a person dying by suicide was unwilling to seek help, up from 27 per cent in 2022. 

Eight in 10 think that when someone talks about suicide, he could take his life, according to the study’s findings released on April 18.

 

This is “the most outstanding prevailing myth about suicide”, said SMU principal lecturer of statistics Rosie Ching, who led 140 undergraduates to conduct the survey on attitudes around suicide.

 

Done in partnership with Samaritans of Singapore (SOS), the survey found that misconceptions about suicide persist from 2022, when an earlier survey was conducted. From January to March 2023, 5,274 people were polled through face-to-face interviews, telephone calls and Zoom.

 

The poll comes on the back of a record-high number of suicides reported in 2023 by SOS, and 476 suicides reported in Singapore in 2022, the highest since 2000.

Ms Ching said SOS asks callers whether they are thinking of taking their lives. “They don’t beat about the bush. A person will feel release and relief when they are offered opportunities to talk about it, rather than dancing around the topic.”

 

Eight in 10 respondents believe there is stigma around suicide in Singapore. Ms Ching said there was great pushback among those who were asked to participate in the survey, such as parents and seniors. “Some may have had brushes with suicide in their family and the topic is too painful for them.”

 

She said the lack of conversations on the topic is due to the fear of making the situation worse and she herself was afraid of conducting the study for this reason.

 

Only about one in three of those polled said he or she would do something to help someone who is suicidal. Of the two-thirds who would not try to help, more than 70 per cent cited their fear of making the suicidal person feel worse, their lack of ability to do anything and lack of knowledge.

 

Other key findings include the continued stigma around suicide, education levels making no difference in knowledge about suicide, and differing views towards suicide in different age groups.

 

The older an individual, the more he does not believe suicide can be predicted. More than 70 per cent of survey respondents below the age of 21 believe suicide can be predicted, while only 43 per cent of those in their 80s believe the same.

 

SOS chief executive Gasper Tan said it is important to be equipped with skills to identify signs of distress through suicide prevention training conducted by agencies like SOS.

 

For those more removed from suicide, the top reason for their low knowledge levels was the absence of a personal connection to suicide.

 

But those with immediate family members or relatives who had attempted or died by suicide cited a lack of outreach or education. This group also forms the highest proportion of those who believe that talking about suicide may give someone the idea of taking their lives.

Ms Ching said this shows a lack of understanding about suicidal feelings, even among those with loved ones who are troubled. “Suicide leaves a lot of unanswered questions, questions that may never be answered, and leads to a lifetime of confusion, grief, anger and guilt.”

 

Despite this, 90.2 per cent of respondents believe suicide can be prevented and that Singapore needs a suicide prevention strategy.

 

Mr Chirag Agarwal, co-founder of therapy platform Talk Your Heart Out, said: “People who want to talk about their own suicide ideation fear judgment or discrimination, while people who want to reach out to others fear making it worse or do not have the right vocabulary to engage in a conversation about it.

 

“It takes some practice to learn how to ‘hold space’ for someone and empathise with their situation and state of mind.”

 

Mr Tan said some progress in raising awareness about mental health has been made, especially after the Covid-19 pandemic. Yet, changing deeply ingrained beliefs requires ongoing education, open dialogue and challenging societal norms to foster greater understanding and empathy, he said.

 

“At SOS, we have seen a significant increase in service users tapping our continuum of services, indicating that the stigma of suicide and barriers to help-seeking are decreasing. But this takes an all-of-society approach as we continue to take strides forward to further reduce the stigma of suicide,” he added.

Helplines

Mental well-being
Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)
Samaritans of Singapore: 1800-221-4444 (24 hours) /1-767 (24 hours)
Singapore Association for Mental Health: 1800-283-7019
Silver Ribbon Singapore: 6386-1928
Tinkle Friend: 1800-274-4788 
Chat, Centre of Excellence for Youth Mental Health: 6493-6500/1
Women’s Helpline: 1800-777-5555 (weekdays, 10am to 6pm)
Counselling
TOUCHline (Counselling): 1800-377-2252
TOUCH Care Line (for caregivers): 6804-6555
Care Corner Counselling Centre: 6353-1180
Counselling and Care Centre: 6536-6366
Online resources
moht.com.sg/mindline-sg
eC2.sg
www.tinklefriend.sg
www.chat.mentalhealth.sg
carey.carecorner.org.sg (for those aged 13 to 25)
limitless.sg/talk (for those aged 12 to 25)

Copyright © 2024 SPH Media Limited. All rights reserved.

[amuse.ed]

Trigger warning: Content article related to issues on mental health condition stigma. Kindly read at one’s discretion and discuss with the professionals, where necessary. 

 

America

 

If We Want to End Mental Health Stigma, It’ll Take More Than Talking

 

Johnson, PsyD. — By Sam Dylan Finch on March 16, 2021

Brave conversations need to happen — but we need to think bigger if we want to end stigma for good.

We strive to share insights based on diverse experiences without stigma or shame. This is a powerful voice.

I remember the first time I expressed a desire to go to therapy. I was 17 years old, unknowingly struggling with obsessive-compulsive disorder (OCD).

The anxiety I was living with tormented me, but I was still terrified to ask for help.

 

When I finally found the courage to tell my parents I needed support, their response was less than stellar. “That’s family business,” they said, aghast.

 

The shame was written all over their faces. They rejected the idea that their son might need professional help — and I quickly internalized that shame, too.

 

It would take another year, tormented by my condition, before I would finally get the help I so badly needed.

Why are mental health issues so stigmatized?

Stories like mine are far from unique.

More than half of Americans with a mental health condition still remain untreated, impacted by a deep societal stigma that leaves us reluctant to reach out.

 

The impact on those already struggling is undeniable.

 

According to the American Psychiatric Association (APA), stigma results in reduced hope, lower self-esteem, increased symptoms, difficulties at work, and a lower likelihood of maintaining your treatment plan.

 

So where does this stigma come from?

 

Attitudes around mental illness are still reinforced in our culture and media.

People with mental illnesses — especially those with less understood conditions, like bipolar disorder and schizophrenia — are still widely believed to be dangerous, untrustworthy, and incompetent, despite experience and evidence showing this is rarely the case.

 

In fact, people with schizophrenia are more likely to be the victim of violence, rather than the perpetrator.

 

Still, being labeled “crazy” by what feels like much of society can feel like a shameful burden that few are willing to take on.

 

Even the jokes we make — like calling ourselves “so OCD” when we wash our hands or “bipolar” when our moods shift — lead to others taking these disorders less seriously.

 

This stigma is intensified further for historically marginalized groups — like people of color, women, and LGBTQIA+ people — who have traditionally been depicted as “crazy” or “unstable” due to prejudice, increasing their mistrust of the mental health system.

 

This is a system that frequently misdiagnoses vulnerable communities because of these same prejudices. The consequences of stigma are far-reaching, too. Research has shownTrusted Source that discrimination in the workplace, housing, healthcare, and more can be connected to mental health stigma.

How do we reduce stigma?

There’s a far-reaching assumption that simply talking about mental health is enough to reduce stigma. However, recent research Trusted Source suggests that the effectiveness of these campaigns is actually very limited — more must be done.

 

To truly break down stigma, it has to be addressed at multiple levels:

 

Systemic change.

Discrimination is still an everyday reality for those with disabilities, including psychiatric disabilities. There’s a high correlation between stigma and structural inequality. To truly address stigma, the rights and dignity of people with disabilities have to be meaningfully addressed in education, housing, the workplace, and healthcare, including increased access to treatment.

Research and funding.

To better understand mental health and illness, more research is needed to increase our knowledge about these conditions and to improve the effectiveness of our interventions, as well as funding to make treatment more accessible.

Media interventions.

Media, including television and film, can be a huge accelerant of stigma. Media must be challenged to handle topics of mental health and illness more responsibly to reduce stigma.

Mental health literacy.

Simply being “aware” of mental health isn’t enough to address stigma. People must be empowered to take command over their own mental health, like knowing where to access help and how to advocate for themselves.

Increased awareness.

For many people, there’s still mystery about what mental healthcare really is or looks like. By becoming more active and visible in their communities, healthcare practitioners can reduce a possible fear of the unknown. For communities with a history of mistrust in the healthcare system, seeing a healthcare professional who looks like them and is from the same community can be beneficial. While talking about mental health is a great starting place, more will be needed to truly better the lives of those with mental health conditions.

Common myths about mental health conditions

While stigma won’t change overnight, it’s still true that change begins with us. This starts by addressing our own attitudes about mental health.

 

Below are some common myths that still exist today:

 

Mental illness is just an excuse for poor behavior

Mental illnesses aren’t chosen — and they certainly aren’t an excuse for someone’s behavior. They’re complex conditions that result from biological, genetic, and environmental factors.

 

Only a certain kind of person ends up with a mental illness Mental health conditions touch every single community. Chances are, you already know someone who lives with a mental health condition. Mental illness doesn’t affect a certain kind of person — it can affect anyone.

 

You could snap out of it if you tried hard enough. If we could snap out of it, most of us would, gladly. These conditions are much more complicated than that, though. Most people with a mental health condition will benefit immensely from some combination of therapy, medication, and community support.

This is why it’s crucial that we support people seeking the help they need.

 

Mental illness is a private issue that shouldn’t be talked about. Everyone will have a different relationship to their health journey. Some will choose to keep their mental health issues private; others will find it empowering to share their story. There’s no right or wrong way to talk about your mental health.

 

Mental illness can be completely cured
While many people will see improvements in their mental health, and some may make a full recovery, most mental health conditions can’t actually be cured. They’re chronic conditions to be managed with the right support.

What’s next?

Since my teen years, I’ve had the privilege of accessing therapy and medication for my OCD. It’s made an enormous difference — as it has for many people living with mental health conditions.

 

While stigma won’t change overnight, that change begins with brave conversations.

 

More than just talking about mental health, we need to examine what changes have to happen to make mental health accessible to all.

 

As I approach my 30th birthday, I’m immensely grateful that so many people are opening their hearts and minds to these conversations.

 

Far from being “family business” or a personal issue, mental health is our collective business and responsibility. Each and every person deserves mental health. And we deserve to live in a world where people with mental health conditions feel safe, supported, and affirmed.

 

Access to care ranking 2020. (2020).
https://mhanational.org/issues/2020/mental-health-america-access-care-data
Diversity & health equity. (n.d.).

https://www.psychiatry.org/psychiatrists/cultural-competency
Stigma, prejudice, and discrimination against people with mental illness. (2020).

https://www.psychiatry.org/patients-families/stigma-and-discrimination
Stuart H. (2016). Reducing the stigma of mental illness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314742/

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