University of Glamorgan

Jacqui Smith, the Home Secretary, announced yesterday in Parliament her intention for Cannabis to be reclassified as a Class B drug.

The decision appears to be made both on grounds of enabling the policing of Cannabis and of making a stance that the Home Office is tough on drugs use. But is it based on grounds of evidence? And indeed should it be?

The Home Secretary was up front in stating that she was not acting on the grounds of evidence so much as ‘sending a message.’

The Advisory Council on the Misuse of Drugs acknowledges the risks of Cannabis use particularly in a small number of cases where people have been found to develop Schizophrenia after prolonged use. However the level of risk is identified as low. About 1 in 100 people develop Schizophrenia in the general population while, as the Advisory Council states,

‘to prevent one case of schizophrenia in men aged 20 to 24, about 5,000 men would have to be prevented from ever smoking cannabis.’

So where does the reclassification leave us?

It leaves us with questions:

1. What is the balance between risk and intervention that is acceptable?

2. What is the balance between scientific evidence and political capital that is acceptable?

3. What would happen if the British Medical Association or the Nursing and Midwifery Council decided that clinical practice should be designed to send a message rather than be evidence based?

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Research from King’s College London and Oxford and Newcastle Universities has shown that administering neuroleptic medication to people suffering from Alzheimer’s Disease can exacerbate people’s communication difficulties.The research was reported on the BBC today.

The surprise is that it has taken so long for this to be recognised. The earliest neuroleptic drugs such as Chlorpromazine (Largactil) have been around since the 1950s and the side effects in people not suffering from Alzheimer’s Disease have been recognised as including drowsiness and lack of motivation. So add dementia to that mix and what might you expect?

In these days of Evidence Based Medicine it is important to have evidence from research to back up decisions about what prescriptions people might be given. Without such research we wouldn’t know we were doing any harm would we?!!!!!!!!

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Research in the United States suggests that Selective Serotonin Reuptake Inhibitors (SSRIs) are no more effective than placebos in the treatment of depression. Newspapers leaped on to this with lurid headlines that:

"Anti-depressants taken by thousands of Brits 'do NOT work', major new study reveals" (Daily Mail)

“Taking Prozac for depression is mostly a waste of time, say scientists” (The Scotsman)

Such headlines will no doubt have caused alarm in many people who have been prescribed such drugs.

But what does the research say?

The findings of the research actually tell us that Prozac and the like are effective drugs in the treatment of severe depression but are of less efficacy when the depression is mild to moderate.

This is somewhat reminiscent of the the benzodiazepine problem that emerged from the 1960s. Psychiatry seems to be searching for a wonder drug and in the 1960s benzodiazepines such as valium were marketed as “Mother’s little helper” and prescribed to many people. It seems that SSRIs have gone down the same route of being prescribed to lots of people who might have been better served with another approach.

Like many psychiatric treatments Prozac works for some people but not for everybody. When it works it works well. But nothing works for everybody yet something works for most people.

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I’ve just spent the biggest part of this week interviewing applicants who wish to enter University to study Mental Health Nursing. Just a few thoughts spring to mind:

1. Do your homework – have some idea about the course for which you have applied and be able to give a brief description of what you expect.

2. If you want to be a Mental Health Nurse, before you attend interview have a stab at asking yourself why nursing and why mental health and not, say, Occupational Therapy, Social Work etc.

3. When you are asked to talk about yourself discuss more than what educational qualifications you are pursuing. Discuss your interests and hobbies.

4. Have an idea about what mental health nurses do.

5. Don’t feel foolish about writing a few notes to remind you of any questions you might have.

6. Don’t chew gum throughout the interview.

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For many years newspapers have been guilty of using particularly lurid headlines when reporting mental health issues. Language has also been hijacked in ways that is not strictly accurate. So it is not unusual to see reference made to Psychos or schizos. Nor is it unusual to see the media report that someone is schizophrenic about something when what is meant is that the person is in two minds about an issue.

It is understandable that newspaper editors wish to sell newspapers and facts such as the murder rate by people with mental illness has not increased in forty years or that most people with mental health problems live in society without causing their neighbours any problems do not sell as many papers as one person with a samurai sword attacking someone in the street.

A handbook guide has now been issued by Shift to help journalists produce stories that avoid stigmatising people with mental health problems.

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A Conservative Assembly Member, Jonathan Morgan, has put forward a bid to change mental health legislation in Wales. The bid, if successful, would enable mental health patients in Wales to have access to earlier assessment and treatment under the Mental Health Act 2007 than their counterparts in England.

Given that one of the powers in the new Mental Health Act will be compulsory treatment in the community, and given that most mental health professionals and user groups consider such powers to be unworkable anything that will avoid the element of compulsion being introduced can only be a good thing.

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A newly-published Royal College of Psychiatrists’ Report says that around 50% of mental health nurses have been attacked in their work places. Interestingly one of the recommendations of the report is that staff require training and skills to ensure that these events are reduced.

The Nursing and Midwifery Council (NMC) has recently closed the consultation on the pre-registration nursing curriculum. In this consultation there were strong moves towards doing away with pre-registration mental health nurse training and having a generalist curriculum. A generalist curriculum would by its very nature reduce the the amount of training and skills that nurses would receive.

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The three councils - Westminster, Islington and Camden have joined on an initiative intended to reduce the vulnerability of children in families where substance misuse contributes to abuse.  Read the rest of this entry

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What is in the bill for people with mental health problems?

The introduction of supervised treatment in the community. What does this mean? Not a lot really, if someone is living in the community and is refusing to take medication there is no practical way that it can be enforced short of taking people back in to hospital.

An important philosophical point is raised with ensuring people take their medication in the community. If the medication, when taken, removes symptoms then surely a person who, at that point, refuses it is making a rational decision. If the person is not making a rational decision then the medication cannot be effective and so why is it being enforced?

A change in the definition of mental disorder - The Government wants to remove the concept of treatability from mental health legislation. This is deemed to be necessary for the containment of risk and dangerousness. However the Five Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness published yesterday shows that the murder rate by people with a diagnosis of metnal disorder has remained both small and constant for years. Furthermore, given the reduction in psychiatric beds over time, this means that although the number of people cared for in the community has increased the murder rate has stayed the same indicating that the risk has reduced.

Sexual deviancy is no longer excluded from being classified as a mental disorder. This raises the problem of how do you treat a peson's sexuality? You incapacitate a perosn from acting on a sexual deviancy but you do not treat the deviancy.

Nearest Relative - The only substantive change to the nearest relative is to recognise civil partnerships so that same-sex partners move up the hierarchy of nearest relatives. This is to be welcomed but why can't a person choose who might be the person to speak on his/her behalf?

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The study which interviewed lottery winners found that 97% of million pound or more winners were happier or just as happy as before. Only 3% were less happy.

So what does this tell us? Not a lot really. The chances of any of us winning the lottery in the million pound bracket are so small as to be negligible.

The study also suggests that most people do not make massive changes to their lives. So people keep the same friends, are able to pay their bills, live in a slightly bigger house and probably have a more reliable car. So just like motherhood and apple pie, winning the lottery is generally a good thing.

So everyone buy a ticket and dream on.

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The school forms part of the MSc in Disaster Relief Healthcare that is run as a joint venture between University of Glamorgan and HAMK University of Applied Science.

An interesting experience to find that Finland is a. flat and b. boiling hot (temperature in the arctic circle was 21°C).

The mental health issues that we discussed during the course were interesting. Should we impose a Western psychiatric imperialism on other cultures? Should we assume that just because someone has been exposed to trauma s/he will develop mental health problems?

I also tasted reindeer for the first time.

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A comment by the Zito Trust said that this is a very high figure and is obviously cause for concern.

However, as the researchers themselves say, a figure of 1 crime in 20 being carried out by people with a diagnosis is probably lower than many people in society would imagine. It means that 19 out of every 20 violent crimes are carried out by people without any serious mental illness.

The Sainsbury Centre for Mental Health argues that the figures should undermine the prejudices that many people hold about illnesses like schizophrenia.

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The most interesting point of contact was to find that, in the Institute of Mental Health in Singapore (IMH), nurses were trying to find new ways of improving their ability to spend time with patients in meaningful and therapeutic ways.

This mirrors the dissatisfaction felt in the UK and the desire of UK nurses to solve similar problems.

In the UK the Reviews of Mental Health Nursing in both England and Scotland have recommended that nurses follow a recovery based approach. The National Service Framework in Wales follows a similar train of thought.

In the IMH in Singapore nurses have introduced milieu therapy which essentially looks at creating an environment that is more conducive to interaction between professionals and service users.

It will be interesting to follow up on these parallel developments. Is it different strokes for different folks or can ideas cross borders?

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Drugs such as Prozac and Seroxat are known as Selective Serotonin Reuptake Inhibitors (SSRIs).

A new study in California has compared sales of Prozac with suicide rates since the 1960s and discovered that as the prescription of prozac has increased so the suicide rate has declined.

It should be noted; however, that SSRIs have been associated with increased suicidal ideation in young people.

Furthermore we need to see more research on this. One of the commonest means of suicide is overdose and SSRIs are acknowledged as being less dangerous in overdose than the older anti-depressants which they replaced. So it might be expected that, if more people are prescribed a less toxic drug, fewer will succeed in killing themselves.

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We have a Mental Health Tsar and a drugs Tsar and various other Tsars. Perhaps it's time to regulate all of these Tsars by having a Tsar Tsar.

People with the surname Gabor may not apply!

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