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Institute of Health and Wellbeing Early Career Researchers' Blog

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  • May 06 / 2015
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Current Affairs

IHAWKES election special part III: Professor Rory O’Connor

Have the major Scottish political parties prioritised mental health in their manifestos?

Although nearly half of all ill-health among people under 65 years of age is attributable to mental ill-health, it is estimated that only about a quarter of those with mental health problems are in treatment (Centre for Economic Performance, 2012).   In addition, a recent analysis has revealed the historic and chronic under-funding of mental health research in the UK (MQ Research, 2015). Add to this the rising rates of suicide in the UK; there are approximately 6,000 deaths each year, with more than three quarters of all suicide deaths accounted for by men (ONS, 2015). The personal costs of suicide are devastatingly clear but many people do not know that the economic burden of suicide is also vast. Take Scotland, for example: it is estimated that the economic and social cost of each death by suicide is £1,290,000 (Platt et al., 2006).   Taken together, it is self-evident, therefore, that the challenge of improving mental health research and treatment is urgent and long overdue. In recent months, mental health has become more visible on the political agenda. However, I was keen to look beyond the media representation to investigate to what extent mental health features in the manifestos of the four major Scottish parties (based on having MPs and/or MSPs). To do so, I simply searched for any mention of mental health in their manifestos. Here’s what I found:

Scottish Conservatives (http://www.scottishconservatives.com/wordpress/wp-content/uploads/2015/04/Scottish-Manifesto_GE15.pdf)

There are two mentions of mental health in their manifesto. They will “provide significant new support for mental health benefiting thousands of people claiming out-of-work benefits or being supported by Fit for Work.” The only other reference to mental health is in terms of using social impact bonds and payment by results with a focus on mental health (as well as youth unemployment and homelessness).

Scottish Greens (http://www.scottishgreens.org.uk/wp-content/uploads/downloads/2015/03/SGP-Westminster-2015.pdf)

There is only a single mention of mental health in their manifesto. The Scottish Greens aim to improve both physical and mental health by tackling poverty and health inequalities including via the Living Wage as well as affordable housing and a fairer social security system.

Scottish Labour (http://www.scottishlabour.org.uk/blog/entry/the-scottish-labour-manifesto-2015)

There are 12 clear references to mental health in the Scottish Labour manifesto. They highlight the scale of the challenge of mental health as well as the 10-fold increase in young people waiting more than a year to be treated by mental health services. They also mention the issues of parity of esteem with those with physical health problems as well as the need to address the, often debilitating, consequences of mental health stigma. They pledge to invest £200 million in a new Mental Health Fund to help those who are vulnerable and to “improve child mental health by focusing on prevention and early intervention.”

Scottish Liberal Democrats (http://www.scotlibdems.org.uk/manifesto2015)

A document search yields at least 17 hits for mental health within the Scottish Liberal Democrat manifesto. A guarantee of equal care for mental health is on the front page of their manifesto. The Lib Dems pledge that the Scottish Parliament will have the resources it needs “to make sure mental health has equal status with physical health”. There is also specific mention of helping “people struggling not to harm themselves” by providing emergency help at A&E. In the context of helping people find work, they pledge to help provide work placements tailored for those with mental health problems. They also pledge to fund the NHS properly, “ending the discrimination against mental health which has existed too long, and delivering equal care.” They also highlight the scale of mental ill-health, the stigma faced by many and the difficulty accessing services. They propose to expand the provision of psychological treatments as well as developing “new provision to support young people who need urgent mental health support”. If pilots as successful, they may also role out the provision of trained mental health professionals in A&E departments. They also plan to simplify and streamline back to work support for those with mental health problems. Furthermore, they will also establish “a world-leading mental health research fund, investing £50 million to further our understanding of mental illness and develop more effective treatments.” Support for veterans with mental health problems is also mentioned.

 Scottish National Party (http://votesnp.com/docs/manifesto.pdf)

Mental health is mentioned four times in the SNP manifesto. Within the context of ensuring fairness in the welfare system, they “will demand an urgent review of the conditionality and sanctions regime” taking account of the “needs of people with mental health issues.” They also pledge to increase the £15 million already committed to a mental health innovation fund, stating that they will “increase this investment to £100 million over the next 5 years”. They will also focus on treatments in the primary care sector and aim to focus on investment in child and adolescent mental health services.

Comment

Mental health appears to be a priority for Scottish Labour, the Scottish Liberal Democrats and the Scottish National Party. It is encouraging to see the specific pledges made by each of these parties in terms of the provision of mental health services. However, as a researcher who knows first hand how poorly funded mental health research is, I was particularly pleased to see the Scottish Liberal Democrats pledge to establish a world class mental health research fund – with funding ear-marked. Whoever (and in whatever configuration) is in power after May 7th, it is incumbent on each of us to hold the Government to their election promises!

Disclaimer: I acknowledge that my search strategy was crude but each manifesto was subject to the same ‘analysis’, and therefore, I believe it provides a valid (albeit high level) overview of the each party’s pledges on mental health. Due to idiosyncrasies of search functions in pdfs, I may have missed one or two mentions of mental health in the manifestos that contained multiple references to mental health.

References

Centre for Economic Performance (2012). How mental illness loses out in the NHS. A Report by the Centre for Economic Performance’s Mental Health Policy Group. http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf

MQ Research (2015). UK mental health research funding: MQ landscape analysis. http://www.joinmq.org/news-opinion/entry/new-analysis-reveals-historic-under-funding-of-uk-mental-health-research

ONS (2015). Statistical Bulletin. Suicides in the United Kingdom, 2013 Registrations. http://ons.gov.uk/ons/rel/subnational-health4/suicides-in-the-united-kingdom/2013-registrations/suicides-in-the-united-kingdom–2013-registrations.html

Platt, S et al (2006). Evaluation of the first phase of Choosing Life: The national strategy and action plan to prevent suicide in Scotland: Annex 2 – The Economic Costs of Suicide in Scotland in 2004. Edinburgh: The Scottish Government http://www.gov.scot/Resource/Doc/146980/0038521.pdf

  • May 06 / 2015
  • 1
Current Affairs

IHAWKES election special part II: Professor Andy Gumley

£1 doesn’t mean the same thing to all:

One remarkable moment in the electoral campaign was David Cameron’s reassurance to the UK public that the proposed Conservative budget cuts amounted to a £1 reduction for every £100 – something that every family or business could cope with. I guess in a society where the principle of equality is cherished and where policies are geared towards improving equality and minimizing inequality then such reassurances are well grounded.

Equality is related to better physical health, greater feelings of trust and lower levels of violence. Inequality measured by how much richer the top 20 percent than the bottom 20 percent is in each country, is related to increased rates of mental illness (r=0.73) and drug problems (r=0.63).

Psychosocial factors are key in understanding the associations between income inequality and health where social hierarchical organisation favours those ranked highly and disfavours those ranked at the bottom. Internal threats arising from the experience and perception of inequality increase stress through feelings of shame, threat and distrust, which acts on psycho-neuro-endocrine mechanisms. External threats acting on the person include exposure to antisocial behaviour, reduced civic participation, less social capital and reduced social cohesion increase feelings of disconnectedness, loneliness and paranoia.

Not just perception of rank but the availability of resources within systems are key to understanding the health effects of social hierarchies. Lynch and colleagues (2000) argued “the effect of income inequality on health reflects a combination of negative exposures and lack of resources held by individuals, along with systematic underinvestment across a wide range of human, physical, health, and social infrastructure” reflecting the manifestation of the sum of historical, cultural and political-economic processes.

In the past 30 years alcohol and drug-related deaths, violent deaths and suicide have increased to a greater extent in Scotland compared to the rest of the UK and Europe. Physical health inequalities have increased in Scotland relative to the rest of the UK evidenced by premature death due to cardiovascular disease, cancer and stroke. McCartney and colleagues have shown that these increasing inequalities are associated with the Index of Economic Freedom (or in other words the extent to which neoliberal or monetarist economic policies predominate).

So £1 isn’t the same to every individual and neither is £1 the same to every community or every nation within the UK. Problems of inequality and its terrible consequences cannot solved by austerity. Austerity can only further hit the more vulnerable groups in our society who already experience greater risks of disconnection, alienation and hopelessness. What’s happened in Scotland during the last 30-years in terms of inequality and what is happening in Scotland during this election provides an important opportunity for UK based parties to start to seriously rethink the impact of policies that increase inequality, and the associated costs to us all. Maybe adopting a principle of Equality in the UK would be a good start.

References:

Lynch, JW., Davey Smith, G., Kaplan, GA. & House, JS. Income inequality and mortality: importance of health of individual income, psychosocial environment or living conditions. BMJ. 2000 April 29; 320(7243): 1200–1204.

McCartney, G, Walsh, D., Whyte, B., & Collins, C. (2011) has Scotland always been the ‘sick man of Europe’? An observational study from 1855 to 2006. European Journal of Public Health, Vol. 22, No. 6, 756–760

  • May 06 / 2015
  • 0
Current Affairs

IHAWKES election special part I: Professor Kate O’Donnell

Health and wellbeing – for some, but not others:

Watch the news – any news – and you may have noticed that there is an election this week! Key battlegrounds have been the NHS, migration, austerity and welfare. Of course, these all get intertwined. We are told by some parties that migrants are coming to the UK – indeed “flooding” the UK – to reap the benefits of our NHS. This, despite the fact that a report commissioned by the Department of Health found evidence of health tourism at best limited. On the other hand, the NHS depends on migrant workers across all professional groups, and may become increasingly reliant on overseas workers to meet the many pledges of increased staff made by parties of all colours.

However, what we have not discussed nearly enough is the awful situation we see unfolding in the Mediterranean and the role that our foreign and domestic policies play in exacerbating that situation. Only the horror of hundreds of migrants drowning in the Med in the last month or so led to the re-instatement of the Mare Nostrum search and rescue missions, something that the Tory/Lib Dem Coalition Government pulled the UK out of, citing the operation as an “unintended ‘pull factor’”. As someone involved in migrant health research and – I hope – as a decent human being, I have to ask is this really true? Is the UK such a Utopia that men, women and their children (small, newborn and unborn) feel it is worth spending a small fortune to board a rickety boat or dingy and set out across hundreds of miles of open sea?

Rather – what is driving this movement of people? Amnesty International ‘s report today sheds some light on the conditions that drive people to move. Shockingly graphic, it describes Syria’s “Circle of Hell”, describing the situation daily facing civilians in Aleppo. Little wonder then that the boat alternative seems worth a try ….. And yet, too often our media glosses over the bigger picture that contributes to this movement of people, preferring instead to talk about “illegal” migrants and benefits seekers.

The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Clearly, for those now living in war-torn settings, this has long since ceased to be a reality. The UK has a wider responsibility, as part of the EU, to set policies and play a role that may help resolve some of the currently intractable situations that make the WHO definition unattainable for millions of people. In doing so, there needs to be more discussion about the way in which foreign policy, immigration policy and commitments to international aid intersect. We also need to be ready to welcome those in greatest need to the UK and to our NHS.

  • Nov 20 / 2014
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Current Affairs

On comet landings and academic inspiration…

By Adele Warrilow:

It would be difficult to write a science blog this week without mention of the Rosetta mission landing the Philae craft on a comet, the result of a ten year project. This inspirational news story has captured the imagination of people around the world – scientists from all disciplines, the general public and children (aka potential scientists of the future). I enjoyed seeing the excitement from the control centre on the news – a particularly great reaction from Professor Monica Grady of the Open University is shown on the BBC website.  In an interview Guardian newspaper, Dr Brian Cox said that showing scientists as people like anyone else can help to inspire the next generation of scientists “If you can make that link – they were people like you! They did their work, they went to university and now they are landing on a comet!… You can do it if you want”.

Even in a high profile space mission things can go wrong, and not just with the technical aspects. There has been considerable media debate about the shirt worn by one of the Rosetta scientists, culminating in a tearful apology. Presenting scientists as real people and not just middle aged men in lab coats is important. My own opinion, however, was that this particular shirt was indeed inappropriate attire for a professional and I wonder why his wider team (e.g., press officers) did not intervene to prevent this – after all they have had ten years to prepare!

As PhD researcher there will be times when our work is going well (even if we are the only ones jumping up and down about finally getting rid of an error code in our analysis) but also times that projects do not go as planned. It is the enthusiasm and curiosity for our subject that keeps us focussed and determined. And you never know, the next big scientific advance may just be around the corner! The “shirt incident” is a good reminder of the importance of the wider training we can access at PhD level such as the Voice of Young Science Media Workshop, practical media training and public engagement.

Last weekend I attended the British Medical Association conference for junior clinical academic. This was a great opportunity to meet others at a similar career stage using a variety of research approaches – from the role of stem cells in skin grafting to global health policy research. Professor Trisha Greenhalgh gave an inspirational keynote speech describing her career and route into academia (as well as competing as a member of the British Triathlon Team!). Prof. Greenhalgh spoke about seeing first-hand the difference that policy could make to health, working on a neurosurgical ward at the time of the introduction of seatbelt legislation. It is this potential to improve outcomes at a population level that has inspired me to have a public health focus to my research.

We hope the Profcast section of our blog inspires you – check it out!

  • Nov 05 / 2014
  • 1
Current Affairs

Ebola is a global affair

By Uduak Ntuk:

The 2014 Ebola epidemic has compelled the world to see the fragility of the overall global health system. It is the worst Ebola epidemic to date with nearly 5,000 deaths reported in west Africa’s Liberia Sierra Leone and Guinea, and the death toll keeps rising1,2. Sporadic cases in Mali and the USA have also been recorded. The recent case fatalities in the United States and Spain sadly bring home the truth that viruses do not respect national territories and that ‘when danger lurks somewhere then there is danger everywhere’. It is thus imperative that in dealing with issues like this, prompt proactive global measures are taken.

Ebola Virus Disease (EVD) is characterised by a constellation of signs and symptoms beginning with fever and progressing to diarrhea, vomiting and in a subgroup of patients, hemorrhage3. Human transmission of Ebola is through direct contact with blood, secretions, organs or other bodily fluids of infected people and with surfaces and materials such as beddings, clothing contaminated with these fluids2.  In addition to its health impact on society, it has an overwhelming impact on the economies of the affected countries4.

Several research studies are underway to understand the clinical illness and epidemiological impact of Ebola. A study in the New England Journal of Medicine (NEJM)5 showed that in addition to clinical characteristics and demographic factors, age is an important determinant of disease mortality. Patients under 21 years have a lower case fatality rate than those over the age of 45 years. According to the WHO, trials of Ebola vaccines are to start in December this year following discussions at a high-level meeting on accelerating testing and production, with plans to dispense vaccines in 20156. This decision comes amid a growing realisation that vaccines could play an important part in halting the current epidemic in West Africa.

There is hope that the fight against Ebola can be won. First Senegal and then Nigeria have been declared Ebola-free by the World Health Organisation1. As a Nigerian I feel proud to hear such compliments. Apart from the global respect Nigeria has won for herself in fighting Ebola, it also shows the brave leadership, commitment to ingenuity, courage and sacrifice in the line of duty of the Nigerian people. Such success helps to overcome criticisms of corruption and incompetence that West African governments are often labelled with. But the fight against Ebola in Nigeria wasn’t won with conferences or public relations talks; it took massive efforts to quarantine those infected, and monitor all of their contacts, until the spread of the virus was contained. What then are the other West African countries not doing right to combat Ebola? Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources and call for support has been given high priority.

The bulk of the human and financial resources being deployed across the epicentre of this outbreak come from Western nations and very few resources have been deployed from sister African countries, which is very disheartening.

The recent issue of whether to quarantine health care workers, returning to their home countries has also been a topic of huge debate. From a public health perspective, the idea of placing primary contacts under relaxed medical surveillance that depends on self-reporting and individual cooperation may comply with respect for individual rights but it appears to be difficult to manage. Perhaps it may be necessary to still adhere strictly to full quarantine even in instances where the primary contacts of index cases are minimal and manageable, and Individuals may be encouraged with different forms of incentives and remuneration for them for the period of their confinement. This may turn out to be be far cheaper and easier than frantically searching for contacts, such as passengers on flights, when a primary contact breaks self surveillance.

How do you think we can handle quarantine in a different way?  Do you think treatment given to health care workers with primary contact with cases is an infringement of their human rights?  I would love to hear your opinion!

References:

  1. World Health Organisation. Ebola response roadmap situation report. Available from http://apps.who.int/iris/bitstream/10665/137424/1/roadmapsitrep_31Oct2014_eng.pdf?ua=1 .Accessed 4 November 2014
  2. Breman JG, Johnson KM. Ebola Then and Now. N Engl J Med 2014; 371:1663-1666.DOI: 10.1056/NEJMp1410540
  3. World Health Organisation. Ebola virus disearse. Available from http://www.who.int/mediacentre/factsheets/fs103/en/. Accessed 29 October, 2014
  4. BBC . Ebola crisis: The economic impact. Available from: http://www.bbc.co.uk/news/business-28865434. Accessed 27 October, 2014
  5. Schieffelin JS, Jeffery GS, Goba A, Gbakie M, Gire SK, Colubri A , et al . Clinical illness and outcome in patients with Ebola in Sierra Leone. N Engl J Med; October 29, 2014. DOI: 10.1056/NEJMoa1411680
  6. World Health Organisation. WHO convenes industry leaders and key partners to discuss trials and production of Ebola vaccine. Available at: http://www.who.int/mediacentre/news/releases/2014/ebola-vaccines-production/en/. Accessed 29 October, 2014.
  • Sep 10 / 2014
  • 2
Current Affairs

Suicide Prevention: We Need Everyone

By Olivia Kirtley

 

Today is World Suicide Prevention Day.  Last week the World Health Organization (WHO) released the first ever World Suicide Report, showing that around 800,000 people die by suicide each year.  In fact, around the world, one person will die by suicide every 40 seconds, which means in the time it’s taken me to write these few sentences, around 14 people have taken their own lives.  Every mortality statistic in suicide research represents many personal tragedies.  Sometimes I find the sheer scale of the task in front of us, as suicide researchers, overwhelming.  But all around the world, people are doing something to try and reduce suicide.

The sad death of Robin Williams last month prompted an outpouring of tributes and stories of people’s favourite memories of him.  One of the things I remember Robin Williams for the most, is his role as inspirational teacher Mr Keating in the Dead Poets Society.  In one scene, he stands on his desk and asks his students why he is doing this.  He says: “I stand on my desk to remind myself that we must constantly look at things in a different way.”  I’ve been thinking a lot about this quote recently and how if we’re going to reduce suicides, we need to look at suicide in a different way.

A different way of looking at suicide is something highlighted in several recent journal articles (Glenn & Nock, 2014; Klonsky & May, 2014; O’Connor & Nock, 2014): we need to become better at working out what’s different between people who think about suicide, without acting, and those who actually translate those thoughts into actions.  This is one of the main aims of the Suicidal Behaviour Research Laboratory (SBRL) here at the University of Glasgow.  We do research using experimental and self-report methods to try and work out what some of these differences may be, because once we know, we can develop interventions to try and stop suicidal thoughts from becoming suicide attempts.  But we know that one size does not fit all, so we also need to think about which risk factors are specific to the individual.

Researchers are not the only ones trying to look at suicide in a different way.  New York photographer Dese’Rae L. Stage is working on a remarkable project called Live Through This, which pairs the stories of suicide survivors along with a photographic portrait of the person and for a topic such as suicide, this is completely groundbreaking.  Suicide is too often the stigmatising preserve of hushed voices and side-ways glances and those who have attempted suicide face that stigma also.  Live Through This is a quantum leap in the fight against stigma and shows that people who attempt to end their lives are regular people like you and me.

Why is this important?  Because sometimes for a really big task, like trying to reduce suicides, research is not enough on its own.  We need people to give faces and voices to those who have thought about and attempted suicide, to research potential causes and interventions for suicidal behaviour, to translate that research into policy change, to implement these changes into our healthcare and education services and to share their own stories and experiences of survivorship and bereavement.  The theme for this year’s World Suicide Prevention Day is “Suicide Prevention: One World Connected”, so carpe diem!  Do something today to help prevent suicide.  We need all the help that we can get.  We need everyone.

How do you think we can look at suicide in a different way?  Do you feel like your research area requires a global “group effort”?  IHAWKES would love to hear from you.  Please leave comments below.

  • Jul 30 / 2014
  • 0
Current Affairs

Promoting equality: what can we do?

By Adele Warrilow:

As I write, the 2014 Commonwealth Games are well underway in Glasgow – there is a fabulous atmosphere across the city and there has been a good haul of medals for Scotland and the other UK teams! Although the opening ceremony received varying reviews across social media, the collaboration with UNICEF was something that everyone could show their support for. During the ceremony they showed videos of the work that UNICEF is doing to promote the rights of children: the right to an education, to be healthy, to a childhood, to be treated fairly and to be heard.

The UNICEF Children First campaign is a magnificent idea and to date, Glasgow and the Commonwealth have raised a staggering £3.5 million! (You can still donate online or by text: click here to find out more )

There are numerous ways that researchers at all career stages can work to reduce inequality. These include: supporting others with similar goals, being aware of and contributing to university/institute policies, conducting research that seeks to understand or reduce inequality, considering whether your research is inclusive, presenting science careers and your research in accessible ways and being a good role model – taking action when you see practices that promote inequality.

Equal access to educational opportunities is something that I have felt strongly about ever since visiting the David Livingstone centre as a child and being struck at how motivated and committed this young boy was to his studies and ambition to become a doctor – propping his books on the loom to read as he worked at the mill. Without the opportunities, role models and support that I have had there is no way I would be training as a medical academic today. Sadly, there are children around the world with the talent to become leading scientists who will never fulfil their potential without access to education.

We are incredibly privileged to have the opportunities for education in the UK that we do. There are still inequalities however, particularly in the number of women reaching senior positions in science, technology, engineering, mathematics and medicine (STEMM) academia. Raising awareness of the importance of equal opportunities is important throughout our research careers and this is highlighted in the Researcher Development Framework (Section D1:8 for anyone completing their Postgraduate Review Paperwork!). The Institute of Health and Wellbeing, together with the University of Glasgow recognises the importance of equality in academia and their commitment to tackling inequality through the Athena Swan Charter and awards which promote the importance of gender equality in academic careers.

Gender inequalities in the encouragement to pursue certain interests begin early. In the toy department of a local shop, I was shocked to find educational fridge magnets labelled – “girl’s words” and “boy’s words” [sic]. The “girls’ words” included “make-up, sparkle, hairband, cooking, butterfly, love, friends” whereas the “boys’ words” included “money, climbing, aeroplane, skeleton, dinosaur”. Such products promote inequality and in particular may discourage girls from STEMM subjects from a young age. I contacted the shop regarding this and I am pleased to report that the shop in question had similar feedback from other customers and no longer stocks these products.

In choosing a PhD topic I was keen to choose a field of study that could raise awareness of the inequalities faced by children with neurodevelopmental problems throughout their lives. As a child and adolescent psychiatrist, my research interests include the epidemiology of children with neurodevelopmental difficulties who despite having multiple problems, do not meet the criteria for a specific psychiatric diagnosis and, I suspect, subsequently face multiple health and social inequalities. This is challenging as until now, much of the scientific research has focussed on single disorders but it is an important field of study and clinical practice that requires a scientific evidence base. Anna Isaacs’ IHAWKES blog, PhD research with marginalised communities: a few questions about ethics, discussed some of the dilemmas and challenges faced by students working to reduce health inequalities.

IHAWKES would love to hear from you! Tell us about how your research could help to reduce inequalities. Has considering potential inequalities had an impact on your research?  Have you been involved in any projects to promote equal access to STEMM subjects? Any good ideas? What encouraged you to work in academic science?  Please leave your comments below.

 

 

 

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