Immediate Need @MentalHealthCop

Mental Health Cop

The discussion about street triage continues and I’ve deliberately stayed clear of much of it, acutely conscious as I am that my views on the whole thing usually go down like a lead balloon just after they’ve been misunderstood or even misrepresented. This BLOG is my evidence that I’ve always been a massive fan of police and mental health services having closer, more integrated relationships and I’m especially keen that they learn to talk to each other in real time. I’m also keen that we should ensure this happens in full and open acknowledgement that the police and mental health services are not here to achieve the same thing: and that what the police exist to do is often contrary to what mental health services are trying to do. We are overlapping, correlated but unidentical public services and the police quite often must do things that are not in the…

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First Minister Nicola Sturgeon reinforces Scottish opposition to repeal of the Human Rights Act

UK Human Rights Blog

Nicola-SturgeonYesterday morning, in a speech to civic organisations in Glasgow, First Minister Nicola Sturgeon warned that “no responsible government” would consider repeal of the Human Rights Act 1998 due to the numerous negative consequences, both in the domestic and international sphere, that would result from such a move – (see a transcript of the speech here).

Proposals for Repeal of the Human Rights Act

It has been a longstanding Tory policy to repeal the Human Rights Act and replace it with a British Bill of Rights. Such a policy is motivated by discontent over a handful of decisions from the European Court of Human Rights (“ECtHR”) that have allegedly “undermine[d] the role of UK courts in deciding on human rights issues”. In October 2014, the then Justice Secretary Chris Grayling announced Tory proposals to treat Strasbourg judgments as “advisory” – irrespective of the potential incoherence between treating…

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Good For Nothing: The Occupied Times

Good for Nothing by Mark Fisher in The Occupied Times, 19 March 2014

“I’ve suffered from depression intermittently since I was a teenager. Some of these episodes have been highly debilitating – resulting in self-harm, withdrawal (where I would spend months on end in my own room, only venturing out to sign-on or to buy the minimal amounts of food I was consuming), and time spent on psychiatric wards. I wouldn’t say I’ve recovered from the condition, but I’m pleased to say that both the incidences and the severity of depressive episodes have greatly lessened in recent years. Partly, that is a consequence of changes in my life situation, but it’s also to do with coming to a different understanding of my depression and what caused it. I offer up my own experiences of mental distress not because I think there’s anything special or unique about them, but in support of the claim that many forms of depression are best understood – and best combatted – through frames that are impersonal and political rather than individual and ‘psychological’. …”

” ..one of the most successful tactics of the ruling class has been responsibilisation. Each individual member of the subordinate class is encouraged into feeling that their poverty, lack of opportunities, or unemployment, is their fault and their fault alone. Individuals will blame themselves rather than social structures, which in any case they have been induced into believing do not really exist (they are just excuses, called upon by the weak). ..”

” ..Collective depression is the result of the ruling class project of resubordination. For some time now, we have increasingly accepted the idea that we are not the kind of people who can act. This isn’t a failure of will any more than an individual depressed person can ‘snap themselves out of it’ by ‘pulling their socks up’. The rebuilding of class consciousness is a formidable task indeed, one that cannot be achieved by calling upon ready-made solutions – but, in spite of what our collective depression tells us, it can be done. ..”  read complete article

[thanks to Dr Phil Thomas for highlighting on Facebook. Cheers!]

SIGN guidelines: transparency and objectivity

Hole Ousia

It has been a good while since I last wrote about SIGN Guidelines. In fact my last communication to SIGN was the following e-mail (of over a year-and-a- half ago) to the Chair of SIGN:

003 SIGN

I was concerned at that time that SIGN guidelines lacked in necessary governance regarding financial conflicts of interest.

Those that know me understand that I have an interest in ethics. That interest in itself does not make me more “ethical” than any other. I am however passionate about science. If science seeks to be objective we must insist on transparency. This is why I raised a petition for a Sunshine Act with the Scottish Parliament:

The Herald 31 Jan 2014

A year-and-a-half-on, whilst some improvements have been made by SIGN, my view is that these improvements are very far from sufficient. In terms of providing transparency of potential financial conflicts of interest my personal view is that SIGN compares poorly to…

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Six ‘biases’ against patients and carers in evidence-based medicine: BMC Medicine 1Sept15

Six ‘biases’ against patients and carers in evidence-based medicine

Trisha Greenhalgh, Rosamund Snow, Sara Ryan, Sian Rees and Helen Salisbury

logo bmc medicineBMC Medicine 2015, 13:200  doi:10.1186/s12916-015-0437-x

Published 1 September 2015

Abstract

Evidence-based medicine (EBM) is maturing from its early focus on epidemiology to embrace a wider range of disciplines and methodologies. At the heart of EBM is the patient, whose informed choices have long been recognised as paramount. However, good evidence-based care is more than choices.

Discussion

We discuss six potential ‘biases’ in EBM that may inadvertently devalue the patient and carer agenda: limited patient input to research design, low status given to experience in the hierarchy of evidence, a tendency to conflate patient-centred consulting with use of decision tools; insufficient attention to power imbalances that suppress the patient’s voice, over-emphasis on the clinical consultation, and focus on people who seek and obtain care (rather than the hidden denominator of those that do not seek or cannot access care).

Summary

To reduce these ‘biases’, EBM should embrace patient involvement in research, make more systematic use of individual (‘personally significant’) evidence, take a more interdisciplinary and humanistic view of consultations, address unequal power dynamics in healthcare encounters, support patient communities, and address the inverse care law. …

Full text article

Italian critical psychiatry @DBDouble [reblog]

Italian critical psychiatry: Dr Duncan Double; 31 August 2015

franco basaglia“I mentioned John Foot’s new book The man who closed the asylums: Franco Basaglia and the revolution in mental health care in a previous post before it was published in english. There has been very little published in english about Basaglia, which makes John’s book very welcome. He tells the story of Basaglia’s move from academia to direct the asylum at Gorizia in 1961, leading up to the passing in Italy in 1978 of law 180, which prevented new admissions to existing mental hospitals and shifted the perspective from segregation and control in the asylum to treatment and rehabilitation in society. Despite the opposition at the time, psychiatric hospitals have closed anyway over most of the Western world, as they became increasingly irrelevant to modern mental health services.

This story is interesting because, as Basaglia said in his own words, he became famous “because I ‘opened up’ a psychiatric hospital”. He was charged twice with criminal liability following serious patient homicides because he was the “man that freed the mad”.

However, what most interested me about the book was how little I know about Italian critical psychiatry, particularly the writing of Giovanni Jervis, who worked for a few years with Basaglia at Gorizia. From there he went to Reggio Emilia to develop community services.  His Manuale critico di psichiatria was reprinted continuously from 1975-97. With Gilberto Corbellini, he wrote La razionalità negata. Psichiatria e antipsichiatria in Italia (2008). It would be nice to be able to read both these books (and other related books) in english.

Jervis was not in total agreement with Basaglia. He accepted the social role of psychiatry, but still tried to expose the “margins of dissent and dysfunctionality in the system”. Within the Centre for Mental Hygiene in Reggio Emilia, there was a split between Jervis and Giorgio Antonucci, who was more anti-psychiatry, in that he “aimed to destroy psychiatry as a separate technique”. Within english language ‘anti-psychiatry’ there was a similar tension between Laing and Szsaz. I think modern critical psychiatry may well benefit from understanding the Italian historical tradition better.”