CBT in the Guardian

The Guardian have this rather funky little video explaining about CBT.
I watched it – I think it’s important that information like that is put out there – and then I felt a pang of anxiety.
The lady who has kindly allowed the BMJ (who made the film) into her OCD world describes some of the tasks that she was given to show her that nothing bad would happen if she didn’t was her hands ten million times. The example they show in the film is of her putting her hand down the toilet, then eating without washing her hands.
Now, I’ve been told I have “OCD tendencies” but I don’t know ANYONE that wouldn’t be knocked a bit sick by that. It’s the equivalent of throwing a tarantula at someone with a spider phobia and saying pleasantly, “now, how did that make you feel?”
I’m aware that they don’t have a huge amount of time to show everything, and there is a risk that people could have “information overload” but how hard would it be to say “this process is done gradually, exploring your feelings and actions as you go, with goals and tasks being managable” See? How long did that take?
If I had OCD and saw that film, I’d probably think “holy fucking shit, there’s no way I can do that” and resign myself to a lifetime of chapped skin and a clean loo.
CBT is done GRADUALLY, people, and if you really really struggle with a task, they look at doing it a bit differently, or more slowly.
Now, how did that make you feel?

…aaand breathe

I try hard not to read the Daily Mail because I end up getting far too shouty, and I know there is little point in commenting on something written therein, but I get angry with articles published that are misleading, one sided and downright irresponsible – especially when concerning mental health issues. And, when TV psychologist Oliver James writes an article entitled “Therapy on the NHS? What a crazy waste of £600 million!” I can’t help myself, even when I bear in mind that 1) Oliver James has recently had a book published and is therefore likely to want a load of publicity, and 2) this is the Daily Mail.
Dr James is an outspoken person at the best of times. He has made unethical and potentially damaging comments in the past – most notably about Peter Mandelson. Now, he turns his attention to the general public, poo-poohing CBT – one of the most successful treatments for mental health issues such as anxiety disorders, depression, PTSD, and others. He doesn’t merely question the efficacy of this treatment, and provide links to evidence – instead he dismisses CBT as a “crazy waste” of money. He supplies anecdotal ‘evidence’ to support this. He spouts ‘facts’ about relapsing after CBT without backing them up. He comes out with impressive sounding phrases like “research has shown” without going further to say who researched what and where the reader can learn more.
The validity of his claims are questionable, however more worrying is that these claims have been published in a widely read national newspaper, and basically say “having CBT? Don’t bother – you’ll be just as bad as ever in a couple of years…” According to biographies all over the internet, Dr James has had clinical experience, so he should know that the mind is a fragile thing when it is being assaulted by a mental health problem – in other words, the very minds that CBT can probably help. He should know that many people with depression and anxiety disorders frequently have a negative image of the future. CBT is hard work mentally, and I can’t help wondering how many people would give up if they read an article like this, written by a psychologist who has featured on “This Morning” and written successful self help books.
If Dr James is so against CBT, why not research it properly? Why not suggest possible solutions to the perceived problem? Dr James advocates Cognitive Analytic Therapy instead of CBT, yet studies have shown that in Generalised Anxiety Disorder, CBT was more effective. Dr James suggests that “where patients have been examined two years later, at least half of panicky ones have relapsed or sought further help.” yet makes no reference to the fact that CBT is an ongoing process – and techniques should be practiced long after the patient has stopped seeing their therapist. I personally would like to see research into how many people expect to be ‘cured’ (indeed James uses that word in the article) and go back to their normal lives. How many people didn’t really realise that they would need to practice CBT techniques to keep their symptoms at bay or help stem a relapse. But rather than suggesting that patient follow-up should improve, James dismisses the entire therapy.
He talks about CBT as though it’s as structured as a course of antibiotics. In fact, CBT is tailored to the individual. The principles are essentially the same, but because the problems that CBT can help are so diverse, obviously individual patients receive individual care. The three cases he refers to in the article do sound as though they are very disillusioned with their experience of CBT, but this could be for a myriad of reasons, not because CBT “doesn’t work”.
I really can’t understand why he has written the article in this way. It’s certainly not been written with the best interests of sufferers in mind. Why be so negative? What does he stand to gain from approaching it in this way? At the start of the article, he talks about how CBT is inexpensive, therefore would appeal to the government. Maybe it’s an incredibly round about way of saying the government isn’t spending enough money on Mental Health Services. If this is the case, I’m sure there are a million other ways of doing it without saying ‘CBT is a load of crap’.
I’d like to think that Daily Mail readers would have more sense than to take this somewhat vitriolic rant at face value, but I don’t know. When you factor in things like third party recanting, and the strange way in which these illnesses mess about with your emotions, you have a rather worrying mix. The media’s enormous reach has the power to cause much harm – just look at the MMR vaccine controversy.
I’m not writing this because of my own feelings on CBT. Having been ‘in the game’ for a while, I know better than to advocate one particular treatment over another. CBT seems to be working for me, others may find that it’s not for them. I personally think it is up to the individual and their therapist to come together with a plan for therapy that is most suitable for them, their problem, their personality and their lifestyle. If your therapist suggests CBT, have a go and be open minded. If they say something or suggest something you don’t feel happy with, tell them. Good communication with your therapist is paramount. Remember, even though it doesn’t work for some people, it does work for a hell of a lot of others. Have a look here for some success stories where CBT was used to help people with Social Anxiety Disorder. Hopefully, it will redress the balance.
Finally, please for the love of all that is sacred, can the media get their facts right about how much disability benefit is? £750 a month? I bloody wish…

Crikey

Um, hello to all the lovely people coming here from The Guardian.
I feel like I should say something meaningful, but I can’t think what. I shall post something proper soon – all my time at the moment seems to be spent knitting food…

Food for Thought

On October 10th, it’s World Mental Health Day.
I only found out about this last week, although the World Federation for Mental Health says they’ve been doing it since 1992. I can’t help feeling bemused that “Breast Cancer Awareness” gets a whole month of promotion, and a hell of a lot of it too – while mental health issues which (at a guess) affect a hell of a lot more people only gets one day, and not very much promotion unless you’re looking for it.
When I heard about it, I did a bit of a search to see what I could write up here to promote it. The Mental Health Foundation have a campaign called “Make a Meal of it” – the idea being that we get together with friends and family for a meal. I was incredibly cynical about this – people with social phobias are going to love that idea, and the Foundation’s own research in 2001 found that one in three people felt that friendships had become strained or they had lost contact altogether. Rebuilding those bridges takes time and a hell of a lot of effort – something many people with mental health issues would feel to be overwhelming.
Eventually I came to the conclusion that it wasn’t these people that the MHF are targetting. Maybe they’re going after the people who sometimes go to their GP for a sicknote for “stress”, or claim they have depression because they’re feeling a bit down after a breakup or redundancy. I guess for many people, these simple ideas could work, but I’m not sure how this campaign is going to highlight awareness of mental health issues in a scopic way.
I want to take part – but don’t like this social eating idea. Then I remembered – I’m taking part in a knitted “teddy bear’s picnic” for National Knitting Week. I’m doing the food…

oh nurse…

I didn’t always want to be a nurse. When I left school in the mid 1980’s with no qualifications, I had no idea what I wanted to do for a living, but my interests were firmly in the arts – drawing and writing. “No-one in Real Life does that, though” I thought. I remember going to the careers office aged 16, and telling them I wanted to be a window dresser in a department store.
It took me til I was 20, working in various shops and going nowhere near the window displays, before a chance opportunity saw me change direction completely. I started working in the Occupational Therapy department of the hospital, in Stroke Rehab. This was on a government scheme, and at a time when retail jobs were few and far between, I thought I had nothing to lose.
I loved it, and was fascinated by the myriad of ways in which a stroke can affect someone. I discovered a thirst for learning, far removed from my school days when I quickly got bored, and was told I’d never amount to anything. At the end of the year, there was no budget for an OT Helper, so I decided to go to college and try doing some O levels while I figured out what to do next. I didn’t think I had the brains to go to university to do OT, and the Head OT in the department had mentioned that there weren’t many jobs about anyway. I loved working in the hospital, I loved helping people, so I made a decision. I was going to train to be a nurse.
A year later, I had five O level passes, a student handbook and application form for nurse training. The process was not a quick one, so bearing this in mind, I started another government training scheme. (I tried going down the route of being an auxilliary nurse on the nurse bank, but there were no vacancies at the time). This time, I ended up on the Day Surgery Unit. The Sister and Charge Nurse were both fantastic – knew I wanted to do my training, and tried their level best to make sure I had both a good grounding in basic nursing skills, and a wide variety of experiences. It is something I shall always be grateful for.
I eventually started nurse training in early 1994, under the new Project 2000 scheme. I learned because I wasn’t afraid to ask, and because I already had that groundwork, I really think the ward staff appreciated my previous experience, and not having to teach me the basics.
In June 1995, disaster struck. Two weeks before an important exam (CFP, if you’re interested), my beloved Grandma died. I was devastated. She had more or less raised me as a child, and we were incredibly close. I sunk into a deep depression and contemplated suicide. I started having panic attacks (although I didn’t know what they were) and I stopped caring about myself or what happened to me. It happened during a placement on children’s ward, and I guess in that respect I was lucky – at least I wasn’t looking after old ladies…
Back in college a week or so later, my heart sank when I looked at the timetable – Wednesday morning, “last offices and bereavement”. This certainly was a case of bad timing, and I asked the tutor if I could sit out. She said no. The college was well aware of the situation. I’d sat in with my personal tutor a few times, in floods of tears, trying to explain how important Grandma had been. Now the college ignored that. I sobbed silently through the lecture, and eventually walked out, unable to listen to any more.
The following week, I was to sit the exam. I blundered through it, was referred, resat it the week after with similar results. I appealed to the university, and after hearing my heart wrenching plea, they said I could take it again. Three days later.
I was in no fit state to sit exams, and inevitably, I failed again. My nursing career was over. I found out several months later that I could have taken six months out and joined the intake behind ours, but this was never suggested to me. In all, the support from the so-called “caring profession” was frankly shit.
In the coming months and years, I found myself frequently regretting what had happened. As time went on, I became interested in new things and considered new careers. I still wondered one day whether I would go back. Later, when people asked, I said no – I wouldn’t go back partly because of my health problems, and partly because my interests have moved.
I still maintain an interest in the medical profession, being a fan of Tom Reynolds, Dr Crippen and Mental Nurse, but when I read this post by Dr Crippen about an email from a student nurse, I felt glad that (even though traumatsing) I’d got out early.
Now, if I’m asked if I’d go back into nursing, I’ll refer them to that post, and say “not on your nelly”.

Mental Health Services failing…

The Healthcare Commission have released a review today of mental health services in England. It comes as no surprise that they’ve found something like half the clients/patients are getting a “sub-standard” service. It seems to me that this is nothing new. Mental Health charities often release reports that highlight the poor deal that people with mental health problems get. Waiting lists to see a clinical psychologist are horrendously long, and from what I can see, the service is often overworked and under resourced.
This is just the tip of the iceberg if you read the BBC’s “Have Your Say” board on the subject. Some of the comments about poor service are downright scary. Read the corresponding news article here.
Of course more funds are desperately needed, but I shall refrain from commenting on the abysmal way in which I think NHS funding is being used…
Mental Nurse has also written about this from a staff perspective.

They’re off again…

Yesterday morning, I caught a snippet of BBC Breakfast News where a guy was talking to a nice lady who’d been on disability benefits then retrained as an AA repair person. I didn’t see it all, so I apologise if I’ve missed something crucial in this. Later, I searched the BBC website for the story. It took a while, but there it was, nestled on the side of the page. Unfortunately, it seems to be a rehash of something that was published a few months ago, and contained little further information, aside from “it’s happening”. At the time, I wrote about it, and got a couple of emails from people who were scared that they would end up losing benefits because their health meant that they couldn’t attend training etc.
Yet again, the government is trying to pidgeonhole people with disabilities who are on benefits. Making everything black and white, accountable, measurable. As I’ve shown previously, even just looking at people with mental health problems throws out a myriad of symptoms that cannot simply be assessed with yes or no answers. This whole idea of work based training means that there is every chance that someone who can’t manage that training because of their health problems will be seen as not even trying. They can’t even get doctors who correctly assess benefit eligibility, so who exactly is going to assess the appropriate-ness of a particular training course? How will that assessment be made? Will it count that I’ve managed to teach myself html, css and the like? Or would I be sent to do some basic mundane thing, because the general impression of mental health clients is that they’re stupid? Will it make people’s health problems worse, because the Benefits Agency can’t possibly be expected to understand all the little nuances of their claimants mental health condiditons, and could technically send someone with OCD to work in a dirty garage?
Plus, would job based training end up being like the vocational training courses of the late 1980’s and 1990’s? I did one of them – I got paid my unemployment benefit plus £10, and worked full time for a year. I did it to get work experience in the field that I was interested in at the time, but when my colleagues were getting paid three and four times as much for doing exactly the same things, it seemed that many of my VT peers were doing this because “the dole office said so” or as a last ditched attempt to regain some of their employment dignity at a time when jobs were scarce.
We shall see. I have often said that if the government put more money into mental health services, and accepted that healing from past traumas etc takes time, it would be much better. People can wait up to two years to see a clinical psychologist, and getting to see someone you ‘gel’ with, and learning to trust that person can take a hell of a lot of time In the meantime, my experiences so far of dealing with the Benefits Agency have left me feeling incredibly anxious about all this. I have already proved that it isn’t the case that “genuine claimants needn’t worry”…
More info on epolitix. (which I can’t look at, because I just want to smack Hutton’s smirking face, and might break my monitor…)