Mental Health Connect

Date: 23 February 2012

Chair: Maree Teesson

Speaker: Kate Sanders

Kate Saunders take the stage.

UK background:

- 200,000 presentations to UK hospitals

-top five cause of admission to hospitals

-one of the highest rates in Europe

-2/3 patients under 35 years

-women – highest rates seen in young women

-gradual decline of suicide rates over past years 1990-2008 (graphic shown)

-there is a range of policy coming from range of organisations weighing up evidence and economic implications

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-Lancet published study – cross sectional – national suicide data from England and Wales

-where they had implemented recommended they did see reduction in suicide, follow up important

-Data suggests if you implement recommendations it can make a difference

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Recession

- the recession known to be associated with poor psych outcomes

-there has been expectation that self-harm would rise – lots of media coverage, that we would see increase

-in Oxford and Manchester have not seen change in self- harm /suicide but in Ireland we have seen an increase

-clearly cant assign causal relationship with this we need to keep this in mind

-We are facing biggest change currently in health care and it is causing uproar – changing the NHS – battling on despite opposition from range of health bodies – lots of demonstrations

-They are proposing – change in Commissioning – GPS can now form into a commission, GPS dont generally want this – introduction with much greater competition , could mean that if you take overdose – referred back to GP, then services can be provided by a range of organisations meaning cohesive care will be difficult.

Attitudes to Self-Harm

-Discusses attitudes to people that self harm compared to others such as drug and alcohol dependency – findings how there is a lot of stigma against those that self-harm

-Doctors were more negative – re attitudes where as psychiatrists were most positive than doctors in other specialties

-What are the characteristics of patients and their self harm with regard to attitudes: – children with SH were viewed more positively whereas those that regularly self harm more negative, females were viewed more positively than male

-Does training make a difference to health professionals and their attitudes? – there was a common view that SH (self-harm) did not represent a presence of mental illness, suicide risk acknowledged but underestimated.

-Impact of Training Studies: all but one had positive results ie health professionals undergoing SH training, interactive and regular training had better outcomes, even though they may forget the facts their attitudes remained more positive to SH patients.

_We often forget the emotional needs for those working in general hospitals – many have very little training in this area, so appropriate supervision and support is important within this situation.

-We have not yet gone as far to see if the training has made a positive impact to the Patient Experience. It needs to translate into patient care.

Initial Findings from Cochrane Review looking at treatments for Self-Harm

-There has been a lot trials since the original review.

-Discusses Short Term Psychological Therapy – predominantly CBT or problem solving therapy vs treatment as usual- shows positive effects

-Some core things that many of the therapies share such as safety plans, engagement, relapse prevention tasks, monitoring of depression hopelessness and others

-Summary – we can be confident that these interventions can be useful.

Discussion – from the floor

1. Carer – discusses looking after her son that would regularly overdose go to hospital, then told him to wait for pscyhiatrist who had left for the night, the hospital staff attitudes was that they were wasting their time at the hospital, discusses lack of services in the past 16 years

Response from Kate (speaker)  - agrees re the issue of lack of services

2. Is there any evidence that the double triple handling by doctors is negative to the patient ie people telling the same story how does this impact?

Response – yes the issue of seeing multiple people is negative, which is why rely more on nursing staff as they are consistently with the patient.

3. Lifeline employee asks about guidelines how lifelines should be supporting the clinical services

Response- yes it is very helpful, confidentiality can be an issue – notes that one phone call for every 50 seconds in the UK re suicide

4. You mention CBT but most studies are Cognitive therapies rather than Behavioural therapies is there a reason for that?

Response – people may have shied away from behavioural therapies, Maree (Chair) discusses lack of evidence in that area – its important  issue and need more trials in that area.

5. Carer – asks about Narrative Therapy – and having good self regard for the person, discusses Michael White and narrative therapy

6. Are any interventions better for adolescents?

Response  - I dont think there are enough numbers to look at it, but there is nothing to suggest something magical happens at 18 to change interventions.

7. Discusses short intervention trials and how positive this has been with high- risk groups – pilot sites across Australia (20) will be rolled out more generally via Medicare locals – has been operating for few years – positive evaluation.

Response  - discusses the issue of not including high-risk groups in trials and how this is difficult re studies

8. Can you comment on other groups such as schools and families?

Response – not many available,  she has done work with school nurses in UK, this has been done in Scotland good data – re attitudes to self-harm – huge burden on schools to cope with it.

9. I dont think it is a good idea to accept the stigma that occurs in emergency rooms – The mental health commission of Canada have – anti-stigma campaigns – they are more longitudinal  and studies are targetted to youth and health care providers. One is via Emergency depts reducing anti-stigma. (comment from the floor – about what is happening in Canada)

10. Dominant studies UK  and Aust – but why not in the US

Response – part due to stigma and partly due to how health is provided. More difficult in the US – inevitable bias re english speaking re publication, Europe may still be difficult.

11. Discussion about admission and self-harm – saying those environments can be confronting

12. Community mental health worker comments – says she does the coalface work, what studies in the UK  harness that information – as oppposed to hospital data – says she doesnt have access to the studies and it would be valuable.

Response – yes it would be valuable for you to have that data, on those that are not in hospitals – agrees.

13. Comment from the floor about sexual abuse and self harm

Response – agrees sexual abuse is a risk factor for mental health and for self-harm.

14. Discussion about  NHS now prioritising acute mental health patients over those that drop-in and how this is a concern.