tag:theconversation.com,2011:/global/topics/mental-health-treatment-5978/articlesMental health treatment – The Conversation2023-11-23T16:16:04Ztag:theconversation.com,2011:article/2180762023-11-23T16:16:04Z2023-11-23T16:16:04ZWhat the UK government’s back to work plan covers – and why it is unlikely to boost people’s job prospects<p>Ahead of the UK government’s <a href="https://theconversation.com/autumn-statement-as-it-happened-218211">latest economic statement</a>, the chancellor, Jeremy Hunt, and the secretary of state for work and pensions, Mel Stride, unveiled a new employment support package dubbed the <a href="https://www.gov.uk/government/news/employment-support-launched-for-over-a-million-people">back to work plan</a>. </p>
<p>The government’s aim is to support more than 1 million people who are either long-term unemployed or have long-term health conditions to (re)enter the workforce or remain in employment. The measures include providing additional individual support, particularly for those with health conditions, as well as revised benefit conditions and sanctions.</p>
<p>The rate of unemployment for 16- to 64-year-olds in the UK is 4.4%. While slightly higher than pre-pandemic levels, it remains, by historic standards, comparatively low. </p>
<p>But rates of what economists term “economic inactivity” have followed a different trend. Economic inactivity refers to people who are neither working nor actively looking for work. This can be due to retirement, studying, having caring responsibilities or <a href="https://journals.sagepub.com/doi/10.1068/c0851">long-term ill-health</a>. </p>
<p>In recent years, the number of people reporting to be out of work because of health issues has risen significantly. In the period May-July 2019, the Office for National Statistics reported that 2,048,000 16- to 64-year-olds were economically inactive for long-term health reasons. The pandemic has seen that figure rise by more than <a href="https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity/timeseries/lf69/lms">half a million</a> to reach 2.6 million.</p>
<p>In terms of job availability, the UK currently counts <a href="https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/jobsandvacanciesintheuk/november2023">957,000</a> vacancies across the economy. This is around 150,000 more than before COVID. </p>
<h2>What is in the back to work plan?</h2>
<p>The plan focuses on both health- and unemployment-related support by boosting four existing programmes. </p>
<p>The mental health treatment initiative NHS Talking Therapies is now set to be accessed by an additional 384,000 people, and the Individual Placement and Support programme, which is integrated in community mental health services, by an extra 100,000 people. </p>
<p>Restart, the long-term unemployment scheme for Universal Credit claimants, will be extended in England and Wales for two years and the intervention timeframe brought forward. People will now receive support from Restart after six months of being on Universal Credit, rather than nine months. In addition, extra Jobcentre support has been announced for England and Scotland.</p>
<p>The number of people to be supported under the Universal Support programme is set to increase to 100,000 (from 50,000). Participants will benefit from 12 months of personalised assistance, a dedicated keyworker, and up to £4,000 of funding for training and health-condition management. </p>
<p>The back to work plan also formally launches the new WorkWell programme, which will be piloted in 15 areas across England. Here, the aim is to help 60,000 long-term sick or disabled people find work. </p>
<p>Perhaps the most controversial changes are those relating to the medical assessment system for disability benefit claims, a system which the government has targeted for <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1142474/transforming-support-health-and-disability-white-paper-cp807.pdf">long-term reform</a>. From 2025, the Work Capability Assessment (used to determine the severity of health limitations for employment purposes) will change with the aim of reducing the number of claims for “limited capability for work and work-related activity” – if successful, these qualify for a higher benefit rate. </p>
<p>But the <a href="https://obr.uk/docs/dlm_uploads/E03004355_November-Economic-and-Fiscal-Outlook_Web-Accessible.pdf">Office for Budget Responsibility</a> (OBR) forecasts that changing the Work Capability Assessment will reduce the more severe incapacity caseload by 371,000, while increasing the less severe incapacity caseload by 342,000. In total, the OBR says changes to the assessment system will only increase employment by around 10,000 by 2028-29. </p>
<p>The plan also introduces additional levels of conditionality and sanctions, including additional contact with the Jobcentre for some Universal Credit claimants, mandatory work placement trials, and a review for those people who remain unemployed after going through Restart. This review might trigger additional work-search conditions – if the claimant does not adhere to them, they could see their claim denied altogether. </p>
<p>The plan further specifies stricter sanctions for those considered to be “disengaged” – people, for example, who do not attend multiple successive Jobcentre appointments. Potential sanctions here include closing benefit claims and withholding additional support, such as free prescriptions and legal aid.</p>
<h2>What impact will the plan have?</h2>
<p>Extending the provision of services and linking health and employment within the support that is offered to job seekers are positive steps. <a href="https://learningandwork.org.uk/wp-content/uploads/2020/04/WWU-Evidence-review-Employment-support-for-people-with-disabilities-and-health-conditions.pdf">Research shows</a> that specialist provision can play an important role in helping people with health conditions to remain in work, or return to employment. </p>
<p>However, these measures are likely to have a relatively limited impact on the labour market in the short term. The OBR estimates that, by 2028-29, the combined effect of all the welfare measures in the autumn statement, including those in the back to work plan, will raise employment by just <a href="https://obr.uk/docs/dlm_uploads/E03004355_November-Economic-and-Fiscal-Outlook_Web-Accessible.pdf">50,000</a>. </p>
<p>There are other measures the government needs to take, including tackling long waiting times for hospital treatment. Ill-health <em>within</em> the workforce has also increased over the past decade, from 2.3 million people reporting a work-limiting health condition to <a href="https://www.health.org.uk/publications/long-reads/what-we-know-about-the-uk-s-working-age-health-challenge">3.7 million</a>. This shows that the UK needs a much more comprehensive and ambitious approach to work and health over the long term.</p>
<p>What’s more, the punitive measures appear less helpful in addressing current labour market issues. Research <a href="https://www.cambridge.org/core/journals/journal-of-social-policy/article/impacts-of-benefit-sanctions-a-scoping-review-of-the-quantitative-research-evidence/9272BC857236795930DCD6AB7B8E04A1">shows</a> that although sanctions may have small positive effects on rates of people getting jobs, the quality of these jobs tends to be lower. Sanctions also increase financial hardship. </p>
<p>The government’s rhetoric around the plan, such as references to people “taking taxpayers for a ride”, as Stride <a href="https://www.gov.uk/government/news/employment-support-launched-for-over-a-million-people">has put it</a>, also appears counterproductive. It is more likely to alienate <a href="https://learningandwork.org.uk/wp-content/uploads/2023/11/Understanding_benefits_report_2023-1.pdf">the very people</a> the plan’s support mechanisms purport to engage by stigmatising back to work support. </p>
<p>Research on ill-health and work shows how important it is for people to get individualised and integrated support. In this respect, many of the announcements in the plan are positive developments. However, they are relatively modest in terms of the scale of the issue. More broadly, the likely impact of the plan is that it will limit benefit access more than it improves people’s employment prospects.</p><img src="https://counter.theconversation.com/content/218076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Sissons receives funding from The Nuffield Foundation. </span></em></p>With stricter conditionality and sanctions, the new plan looks set to limit people’s access to benefits more than it improves their hopes of getting a jobPaul Sissons, Professor of Regional Economic Development and Policy, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2033712023-05-11T12:27:42Z2023-05-11T12:27:42ZBrain-altering fungi could lead the next frontier in mental health care<figure><img src="https://images.theconversation.com/files/525125/original/file-20230509-17-pzcku9.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C5964%2C3520&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fungal metabolites, such as psilocybin, may have therapeutic potential.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cultivation-recreational-psilocybin-mushrooms-world-medical-1779792026">Kyrylo Vasyliev/ Shutterstock</a></span></figcaption></figure><p>If you were one of the millions of people who watched HBO’s TV series <a href="https://theconversation.com/the-last-of-us-a-show-that-surprised-and-challenged-audiences-even-those-who-had-played-the-game-201814">The Last of Us</a>, you probably have a heightened awareness of the threat that fungi can have to our health.</p>
<p>The series is set in a post-apocalyptic world where parasitic fungi take control of the human brain, turning people into killer zombies. The scariest part of this premise is that it’s not entirely implausible. Parasitic or “zombie” fungi that alter <a href="https://www.theatlantic.com/science/archive/2017/11/how-the-zombie-fungus-takes-over-ants-bodies-to-control-their-minds/545864/">the mind and behaviour of their hosts</a> do exist. </p>
<p>Fortunately, real-life zombie fungi (known as <em>Cordyceps</em>) only infect insects. The fungus hijacks their bodies for the sole purpose of spreading its seed-like fungal spores. When spores are ingested by insects, they germinate and grow, secreting molecules that travel to the host’s brain and interfere with its function.</p>
<p>The fungus compels the insect to forego its aversion to heights and climb upwards. Upon reaching a position optimal for fungal survival, the fungus induces the “death grip” and then devours its host from the inside-out, sprouting spore-containing mushrooms from the insect carcass.</p>
<h2>Fungi that alter our minds</h2>
<p>In the case of humans, some fungi which produce small molecules, or <a href="https://pubmed.ncbi.nlm.nih.gov/27809954/">metabolites</a>, that alter our minds – and recent research shows these have therapeutic potential. The most widely known is the hallucinogen psilocybin – the active ingredient in magic mushrooms. LSD, or lysergic acid diethylamide, is another psychedelic with fungal origins. </p>
<p>Humans have known about the hallucinogenic properties of fungi for centuries. <a href="https://www.sciencedirect.com/science/article/pii/S2173580814001527">The Aztecs</a> even gave magic mushrooms to people who were dying to promote a peaceful transition to the afterlife. </p>
<p>But recently, there’s been an <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772630">explosion of interest</a> in fungal metabolites, specifically because of their <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2032994">neurological benefits</a> and potential in treating mental health conditions. And it’s no wonder, given the mechanisms fungal metabolites use to interact with our nervous system.</p>
<p>Think of our brain like a map. When we’re young, we explore all corners of this map, sending out connections in every direction to make sense of our environment. Before long, we figure out basic truths – such as how to secure food, or where we live – and the neurological paths that make up these connections strengthen. </p>
<p>Over time, a network emerges that reflects our unique experiences. Regions we re-visit often will develop established paths, whereas under-used connections will fade away.</p>
<p>Conditions such as addiction, chronic depression and post-traumatic stress disorder (PTSD) are characterised by processes such as <a href="https://pubmed.ncbi.nlm.nih.gov/25264228/">repetitive negative thinking</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/27911470/">rumination</a>, where patients focus on negative thoughts in a counterproductive way. Unfortunately, these <a href="https://pubmed.ncbi.nlm.nih.gov/25264228/">strengthen brain connections</a> that perpetuate the unfavourable mental state.</p>
<p>But it’s believed that fungal metabolites give our brain the freedom to explore less-visited territories again. Psychedelic “trips” are thought to allow people to <a href="https://www.amazon.co.uk/Psychedelic-Experience-Tibetan-Penguin-Classics/dp/0141189630/ref=sr_1_1?crid=31L001ENA3N3M&keywords=the+psychedelic+experience+timothy+leary&qid=1683542508&sprefix=the+psychedelic+%2Caps%2C90&sr=8-1">experience a world without the boundaries of reality</a> – and more recent research suggests this is a manifestation of novel brain exploration.</p>
<p>For example, psilocybin stimulates a receptor in the brain called 5-HT2a. This receptor usually binds to serotonin, a chemical in our body which controls communication between specific nerve cells. But when psilocybin binds to the 5-HT2a receptor, it <a href="https://www.nature.com/articles/s41467-022-33578-1">makes it easier for our brain</a> to change and generate new connections (including causing hallucinations at high doses). We call this an increase in <a href="https://pubmed.ncbi.nlm.nih.gov/34566723/">neuroplasticity</a>. </p>
<p>Although the effects of a single large dose of psychedelics are transitory, evidence shows administering two smaller doses of psilocybin three weeks apart leads to a sustained <a href="https://www.nature.com/articles/s41591-022-01744-z">increase in connectivity</a> between different functional regions of the brain. Such changes in neuroplasticity have the potential to <a href="https://www.nature.com/articles/s41591-022-01744-z">disrupt the rigid thought patterns</a> that underlie certain mental health conditions.</p>
<figure class="align-center ">
<img alt="A young man speaks with his therapist." src="https://images.theconversation.com/files/525129/original/file-20230509-22-rqqpu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525129/original/file-20230509-22-rqqpu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525129/original/file-20230509-22-rqqpu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525129/original/file-20230509-22-rqqpu9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525129/original/file-20230509-22-rqqpu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525129/original/file-20230509-22-rqqpu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525129/original/file-20230509-22-rqqpu9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Combining psychedelics with traditional therapy methods could make therapy more beneficial.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-black-man-explaining-his-problems-1793034835">Prostock-studio/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Furthermore, by increasing neuroplasticity, it is believed that psychedelics allow people to <a href="https://www.amazon.co.uk/How-Change-Your-Mind-Psychedelics/dp/0141985135/ref=asc_df_0141985135/?tag=googshopuk-21&linkCode=df0&hvadid=347799774948&hvpos=&hvnetw=g&hvrand=1060708585039904868&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9045208&hvtargid=pla-547776848553&psc=1&th=1&psc=1">view life situations from a new perspective</a>. Combining psychedelics with more traditional talking therapy could make it possible to explore – and more fully understand – the initial trigger for negative thought patterns. This could potentially prevent the same negative cycle reestablishing after treatment. Indeed, research showed that combining therapy with psilocybin had a <a href="https://journals.sagepub.com/doi/10.1177/02698811211073759">prolonged anti-depressive effect</a> in adults with major depressive disorder.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/35225143/">Additional studies</a> demonstrate the positive effect of fungal metabolites in treating a <a href="https://pubmed.ncbi.nlm.nih.gov/35225143/">range of conditions</a> – including anxiety, depression and alcohol addiction. These studies also point out that psilocybin can affect the symptoms after only one or two doses – whereas anti-depressants may take many months to work.</p>
<h2>No miracle cure</h2>
<p>That said, psychedelics should not be considered a miracle cure as there is still a lot we don’t know. Furthermore, most studies on psychedelics are still preliminary as they use a limited number of participants. As such, <a href="https://www.health.harvard.edu/blog/the-popularity-of-microdosing-of-psychedelics-what-does-the-science-say-202209192819">experts are divided</a> on the efficacy of psychedelic treatment. Furthermore, psychedelics are powerful and unpredictable – and the safety and long-term effects of such treatment is unknown.</p>
<p>But given the current <a href="https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/mental-health-pressures-data-analysis">mental health crisis</a>, any intervention that offers a new approach to tackling these conditions – especially those that are treatment-resistant – needs to be carefully considered and rigorously researched. </p>
<p>Excitingly, many countries <a href="https://compasspathways.com/compass-pathways-receives-fda-breakthrough-therapy-designation-for-psilocybin-therapy-for-treatment-resistant-depression/">recognise the benefits</a> of psychedlics for mental health treatment. The Australian government even <a href="https://www.tga.gov.au/news/media-releases/change-classification-psilocybin-and-mdma-enable-prescribing-authorised-psychiatrists">legalised prescription psilocybin</a> for medicinal use in 2022. Although the UK doesn’t yet permit the prescription of psychedelics, <a href="https://www.imperial.ac.uk/psychedelic-research-centre/">multiple research centres</a> are undertaking trials to establish the <a href="https://www.kcl.ac.uk/research/psychoactive-trials-group">mental health benefits</a> of fungal metabolites. </p>
<p>While there’s still much we don’t know about fungal metabolites – including whether other molecules exist that have a similar effect on neurological function – it’s clear they have great potential in mental health treatment. Perhaps it’s time for us to relinquish certain negative connotations we have of illicit fungal drugs, and become comfortable thinking of brain-altering psychedelics as medicine.</p><img src="https://counter.theconversation.com/content/203371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edel Hyland does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Psilocybin, the active ingredient in magic mushrooms, is one example of a fungus which can alter the human mind.Edel Hyland, Senior Lecturer in Biochemistry & Fungal Biology, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2006812023-02-28T21:44:19Z2023-02-28T21:44:19ZEating disorders are deadly: What are they, who’s at risk, and what can be done about it<figure><img src="https://images.theconversation.com/files/512744/original/file-20230228-2348-obo37h.jpg?ixlib=rb-1.1.0&rect=164%2C67%2C4767%2C2919&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than 100,000 Canadians are diagnosed with an eating disorder every year.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/eating-disorders-are-deadly--what-are-they--who-s-at-risk--and-what-can-be-done-about-it" width="100%" height="400"></iframe>
<p>Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are serious health risks, and can be life-threatening. They are also <a href="https://www.doi.org/10.1037/0021-843X.116.2.422">common</a>, especially among teenage girls.</p>
<p><a href="https://www.doi.org/10.1097/YCO.0000000000000739">More than 100,000 Canadians</a> over the age of 15 are diagnosed with an eating disorder each year. Onset usually occurs <a href="https://doi.org/10.1016/j.chc.2014.08.003">between ages 14 and 19</a>. In fact, eating disorders are the third most common chronic illness among teens. </p>
<p>Adolescence is also when eating disorders have the greatest negative effects on health. <a href="https://doi.org/10.1016/S0140-6736(09)61748-7">Five per cent of the general population</a> in North America will suffer from an eating disorder in their lifetime, but few people seek treatment. The prevalence of eating disorders and struggles to access help highlight the need to increase awareness and <a href="https://doi.org/10.3390%2Fnu13082834">decrease stigma</a>. </p>
<h2>Causes and risk factors</h2>
<p>The greatest risk factor for eating disorders is sex. Eating disorders occur <a href="https://www.doi.org/10.1037/0003-066X.62.3.181">10 times more often in females</a> than in males. However, genetic, biological, psychological and cultural factors all affect the development of an eating disorder. </p>
<ul>
<li><strong>Genetics:</strong>
Specific <a href="https://doi.org/10.1038/npp.2011.108">genes have been linked to anorexia and bulimia</a>, and studies of twins suggest eating disorders are very heritable genetic diseases, with rates estimated between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010958/">50 per cent and 83 per cent</a>. People may be more likely to inherit an eating disorder if their mother was <a href="https://www.doi.org/10.1001/archpsyc.63.1.82">exposed to stressors or complications</a> shortly before or after birth. </li>
</ul>
<figure class="align-center ">
<img alt="A paper cutout of a woman icon reflected much larger in a mirror" src="https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Individuals with body dysmorphic disorder (who obsess over perceived flaws in their body) are at increased risk for developing eating disorders.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<ul>
<li><p><strong>Biology:</strong>
<a href="https://doi.org/10.1016/S0140-6736(09)61748-7">Biological factors</a> such as abnormalities in brain structure or chemistry can cause eating disorders. Developmental disorders such as autism or ADHD affect one-fifth of those with anorexia. Mood disorders such as depression or anxiety are associated with binge eating disorder and bulimia. </p></li>
<li><p><strong>Psychology:</strong>
Eating disorders are more common in people with perfectionism, obsessive compulsive traits, avoidant coping methods and anxiety. People who often have <a href="https://doi.org/10.1002/eat.22300">negative emotions, low self-esteem and who worry or stew on those problems</a> are at risk of eating disorders, as are people who are dependent and sensitive to failure. Individuals with body dysmorphic disorder (who obsess over perceived flaws in their body) are also likely to develop eating disorders.</p></li>
<li><p><strong>Society and culture:</strong>
Eating disorders are <a href="https://doi.org/10.1111/j.1460-2466.2000.tb02856.x">more common in cultures</a> that value thinness. <a href="https://doi.org/10.1002/eat.22459">Societies with unrealistic body ideals</a> (both in shape and size) encourage people to negatively compare their body to others and have poor self-esteem. Those societies also encourage a culture of criticism and bullying around weight. <a href="https://doi.org/10.1002/(SICI)1099-0968(199712)5:4%3C270::AID-ERV212%3E3.0.CO;2-3">Abuse, neglect or general adversity</a> increases the risk of developing an eating disorder.</p></li>
</ul>
<p>Unfortunately, eating disorders can be self-propelling. Eating disorders change the way you perceive food and body shape. Starvation also shrinks the brain and causes problems such as rigidity, emotional dysregulation and social difficulties that maintain the illness. The effects of starvation are particularly exaggerated during adolescence because it is a period of growth and vulnerability.</p>
<h2>Health effects</h2>
<p>Eating disorders are chronic, distressing and impede one’s ability to function. They <a href="https://doi.org/10.1002/eat.22105">increase risk</a> of depression, anxiety disorders, obsessive compulsive disorders, personality disorders, substance abuse, morbidity and future obesity. </p>
<figure class="align-center ">
<img alt="Empty candy and snack food wrappers" src="https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with binge eating disorder often suffer from weight stigma, noticeable cycles of weight changes, clinical obesity and depression.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>People with eating disorders are <a href="https://doi.org/10.1016/j.psychres.2014.05.002">six times more likely</a> to die than the general population, and <a href="https://doi.org/10.1016/j.genhosppsych.2014.01.002">five times more</a> likely to attempt suicide. In fact, anorexia has an <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107207">especially high mortality rate compared to other psychiatric illnesses</a>. </p>
<p>Eating disorders can also have consequences later in life because of their effects on the skeleton (for example, growth retardation and osteoporosis), reproductive system and brain. </p>
<ul>
<li><strong>Anorexia nervosa</strong></li>
</ul>
<p><a href="https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia">People with anorexia experience</a> hormonal changes, heart problems, electrolyte imbalances, decreased fertility, loss of bone density, anemia and suicidal ideation. Some of these effects can be deadly. </p>
<p>Without enough calories, the body is forced to slow its processes to conserve energy. As such, people with anorexia often complain of stomach cramps, constipation, acid reflux, slow heart rate, swelling in extremities, menstrual irregularities, difficulty functioning, dizziness, sleep disturbances and impaired immunity and healing. </p>
<p>Nutritional deficits can cause dental problems, dry skin, dry and brittle hair and nails, thinning hair and muscle weakness. </p>
<p>People with anorexia are often cold and develop fine hair on their body to help conserve heat. They are also <a href="https://doi.org/10.1016/j.chc.2014.08.003">often hyperactive (exercise too much), and if so</a>, can suffer higher relapse rates, younger age of onset, more severe psychopathology, lower BMI, higher dissatisfaction with their body and lowered response to treatment.</p>
<ul>
<li><strong>Bulimia nervosa</strong></li>
</ul>
<p>Since bulimia is characterized by periods of both binge eating and periods of purging or starvation, people with bulimia experience many of the same consequences of anorexia. <a href="https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia">In addition, they often have</a> noticeable changes in weight or experience fluid retention. </p>
<p>As a result of induced vomiting, they may have cuts and calluses across the top of finger joints, swelling around salivary glands, esophagus damage and cavities or tooth discoloration. </p>
<p><a href="https://doi.org/10.1016/S0140-6736(09)61748-7">Bulimia is associated with</a> self-harm, substance abuse, miscarriages, suicide and impulsive behaviours.</p>
<ul>
<li><strong>Binge eating disorder</strong></li>
</ul>
<p>People with <a href="https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed">binge eating disorder often suffer from</a> weight stigma, noticeable cycles of weight changes, clinical obesity and depression. They are <a href="https://www.doi.org/10.1001/2013.jamapediatrics.12">nearly twice as likely</a> to become overweight or obese compared to the general population, and have double the risk of developing severe depression.</p>
<h2>Treatment</h2>
<p>Despite how common, chronic and challenging eating disorders are, few people seek treatment. <a href="https://doi.org/10.1002/14651858.CD000562.pub3">Treatment is effective</a>, though. Many behavioural, psychological and physical effects of starvation clear up once weight is gained and brain mass restored. </p>
<p>For anorexia, an approach that tackles medical, nutritional, social and psychological aspects is recommended. For bulimia and binge eating disorder, <a href="https://doi.org/10.1002/14651858.CD003385">cognitive behavioural therapy</a> (which involves identifying, challenging and changing unhelpful thought patterns) has been shown to be effective, as has medication such as the stimulant <a href="https://doi.org/10.1016/j.euroneuro.2021.08.001">Vyvanse</a> (lisdexamfetamine). </p>
<p>Eating disorders are serious conditions that can endanger health, but there are effective treatments. There is hope. Increasing awareness of eating disorders helps break the stigma and encourages people to get help.</p>
<p><em>This is a corrected version of a story originally published on Feb. 28, 2023. The earlier story stated the mortality rate for anorexia was approximately 10 per cent. It now states that anorexia has an especially high mortality rate compared to other psychiatric illnesses.</em></p><img src="https://counter.theconversation.com/content/200681/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Simon Sherry receives funding from the Social Sciences and Humanities Research Council of Canada. He also owns CRUX Psychology, a private practice in psychology.</span></em></p>The mortality rate of people with eating disorders is six times higher than the general population, and they are five times more likely to attempt suicide. However, few people seek treatment.Simon Sherry, Clinical Psychologist and Professor in the Department of Psychology and Neuroscience, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1978612023-02-08T13:41:04Z2023-02-08T13:41:04ZMillions of Americans are problem gamblers – so why do so few people ever seek treatment?<figure><img src="https://images.theconversation.com/files/508445/original/file-20230206-29-977c0e.jpg?ixlib=rb-1.1.0&rect=8%2C5%2C1781%2C1258&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only about 10% of people with a gambling problem ever seek treatment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/silhouette-of-man-facing-the-light-royalty-free-image/1190407585">Sean Gladwell/Moment via Getty Images</a></span></figcaption></figure><p>The opportunity to gamble has moved from a trip to Vegas, to a drive to a local casino, to the phone in your pocket. And if you’re a sports fan, nudges to place bets <a href="https://theconversation.com/how-legalized-sports-betting-has-transformed-the-fan-experience-194994">have become nearly impossible to ignore</a>, with sports gambling ads and promos routinely appearing on TV, social media, sports radio and in arenas.</p>
<p><a href="https://www.americangaming.org/research/state-gaming-map/">The stunning expansion of sports wagering</a> following <a href="https://doi.org/10.2308/apin-52199">decades of casino expansion</a> certainly gives any rational person reason to pause. </p>
<p>For most bettors, gambling is an occasional form of entertainment – Powerball tickets <a href="https://theconversation.com/how-winning-record-2-billion-powerball-jackpot-could-still-lead-to-bankruptcy-193921">when the jackpot swells to $1 billion</a>, <a href="https://www.sportingnews.com/us/nfl/news/super-bowl-squares-grid-2023-best-numbers/ltur0ayv6wvsdkyjjk2cnmdo">Super Bowl squares</a> with co-workers, a birthday trip to the casino.</p>
<p>But for other people, the possibility of developing a gambling disorder looms.</p>
<p>To what extent should Americans be worried? </p>
<h2>To gamble is to be human</h2>
<p>A nuanced answer begins with the fact that gambling has been popular for a long, long time. </p>
<p>Evidence of gambling has been found <a href="https://dgschwartz.com/books/roll-the-bones/">in ancient cultures around the world</a>. Archaeologists have unearthed dice marked with pips, or dots, in Mesopotamia that date back to 1300 B.C. Historians have located records of dice games in Greek and Indian cities before 400 B.C. </p>
<p>In North America, one Navajo myth tells <a href="https://www.sacred-texts.com/nam/nav/gambler.htm">the story of Noqoìlpi</a>, or “the gambler.” Informal gambling games and lotteries were common in the American Colonies, including <a href="https://www.ephemerasociety.org/colonial-america-lotteries/">lotteries to fund the Continental Army</a>. </p>
<p>In the U.S., sports and gambling have long been intertwined. In the decades after the Civil War, pool halls were set up near Western Union stations so gamblers <a href="https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=3673&context=jclc">could easily place bets on horses</a>. And sports like baseball and boxing became hugely popular in the 19th century, in part <a href="https://theconversation.com/how-gambling-built-baseball-and-then-almost-destroyed-it-123254">because they attracted action from bettors</a>.</p>
<figure class="align-right ">
<img alt="Magazine cover featuring baseball coach in red uniform looking dejected." src="https://images.theconversation.com/files/508457/original/file-20230206-19-j5nxa8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/508457/original/file-20230206-19-j5nxa8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=834&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508457/original/file-20230206-19-j5nxa8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=834&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508457/original/file-20230206-19-j5nxa8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=834&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508457/original/file-20230206-19-j5nxa8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1048&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508457/original/file-20230206-19-j5nxa8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1048&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508457/original/file-20230206-19-j5nxa8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1048&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Baseball great Pete Rose was punished with a lifetime ban from Major League Baseball for betting on games while he was manager of the Cincinnati Reds.</span>
<span class="attribution"><a class="source" href="https://www.si.com/.image/t_share/MTY4MTkwMDczNzQxMjU2NjA1/1989-0403-pete-rose-si-cover-001291038jpg.jpg">Sports Illustrated</a></span>
</figcaption>
</figure>
<p>For as long as there’s been gambling, there has also been problem gambling.</p>
<p>Several writers in ancient India <a href="https://doi.org/10.4103%2F0019-5545.37674">highlighted the consequences of habitual gambling</a>. Over 150 years ago, Dostoyevsky famously wrote “Crime and Punishment” <a href="https://www.theatlantic.com/magazine/archive/2021/11/dostoyevsky-crime-punishment-birmingham-sinner-saint/620175/">to pay off gambling debts</a>. And in the 20th century, sports betting imploded the careers of baseball legends <a href="https://www.silive.com/news/2021/06/si-field-of-dreams-black-sox-outfielder-shoeless-joe-jackson-played-here-after-baseball-ban.html">“Shoeless” Joe Jackson</a> and <a href="https://www.nytimes.com/1989/08/24/sports/rose-in-deal-is-said-to-accept-lifetime-ban-for-betting-on-reds.html">Pete Rose</a>.</p>
<h2>When problems arise</h2>
<p>I describe this history because it shows that humans have always seemed to find a way to gamble, whether it’s legal or not. And, inevitably, some bettors will experience harm or a gambling disorder.</p>
<p>I direct <a href="https://www.memphis.edu/gamblingclinic">the Institute for Gambling Education and Research</a>, where we focus on the treatment of <a href="https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t39/">gambling disorder</a> and <a href="https://thegamblingclinic.com/">gambling problems</a>.</p>
<p>Psychologists have only recently begun to view problem gamblers as a form of addictive behavior, in which gambling urges, tolerance and withdrawal are akin to how substance use disorders unfold. Researchers have found that brain imaging data and symptom patterns of problem gamblers are similar to those of people who are addicted to drugs or alcohol. Gamblers can build a tolerance, meaning that they need to gamble more and bet in higher amounts in order to maintain the same levels of excitement. And attempts to cut back or stop can lead to emotional struggles. </p>
<p>There are also financial and social ramifications to gambling disorder.</p>
<p><a href="http://doi.org/10.1186/s12954-018-0251-9">Distress about money</a> is the most frequently cited reason people start questioning whether they have a problem. <a href="https://www.google.com/books/edition/Problem_and_Pathological_Gambling/TqSbEAAAQBAJ?hl=en&gbpv=1&dq=Problem+and+Pathological+Gambling+Whelan,+Andrew+W.+Meyers,+Timothy+A.+Steenbergh&pg=PR2&printsec=frontcover">But other symptoms include</a> damage done to relationships, deterioration in mood and the physical costs of this distress. Problem gamblers often lie about or hide their gambling, which can make it difficult for loved ones to recognize.</p>
<p>The <a href="https://doi.org/10.1007/s10899-014-9471-4">best prevalence research</a> shows that somewhere between 1% and 2% of the U.S. adult population, or 2 to 4 million adults, will experience a gambling disorder in their lifetime. Another 3% to 5%, or 5 to 9 million people, will, at some point in their lives, report a subclinical problem, which means that some gambling disorder symptoms are present but the psychiatric diagnosis is not warranted.</p>
<p>Despite some hand-wringing over the expansion of sports betting, I believe any increase in the rate of problems is likely to be temporary. <a href="https://opus.uleth.ca/bitstream/handle/10133/3068/2012-PREVALENCE-OPGRC%20(2).pdf">A review of 30 years of research</a> on the prevalence of problem gambling and gambling disorder reveals a pattern. More gambling availability tends to lead to a spike in the number of people reporting gambling issues in the short term. However, populations tend to adapt over time; the rate of gambling problems decreases accordingly. </p>
<p>It will be interesting to see whether the same pattern plays out for sports betting. </p>
<p><iframe id="RwMBy" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/RwMBy/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Barriers to treatment</h2>
<p>My team also operates an outpatient clinic where we treat people with gambling disorder. Our research and therapy sessions have pointed to some encouraging news, along with a few barriers. </p>
<p>The good news is that treatment, particularly when it includes <a href="https://doi.org/10.1016/j.brat.2009.04.002">cognitive behavioral techniques</a>, significantly reduces gambling disorder symptoms and psychological distress. While long-term treatment is recommended, an effective <a href="https://doi.org/10.1037/adb0000710">course of treatment</a> is about eight to 10 sessions. </p>
<p>Yet there are still roadblocks. People are often hesitant to try treatment; those who do frequently drop out. </p>
<p>People are often unaware they have gambling problems, even when they report having symptoms of problem gambling. We don’t exactly know why. The impact, though, is substantial. Only about 10% of <a href="https://doi.org/10.1556/jba.3.2014.3.7">individuals with a gambling problem ever seek treatment</a>. As a comparison, the <a href="https://doi.org/10.1176/appi.ps.201200454">rate of seeking help</a> among those with substance use disorders runs somewhere between 10% and 50%. It’s considerably lower than those experiencing depression and anxiety, 70% to 90% of whom will seek treatment. </p>
<p>We also know that gambling disorder is <a href="https://doi.org/10.1007/s10899-018-9775-x">one of the most stigmatized mental health concerns</a>. We find that people tend to blame someone who has developed gambling problems, and view them as dangerous or untrustworthy. By contrast, someone experiencing depression and anxiety is less likely to be blamed for their problems.</p>
<p>The other challenge is the rate at which people discontinue treatment before completing the standard course of therapy. For most mental health concerns, 20% who start a psychological treatment <a href="https://doi.org/10.1037/a0028226">fail to continue in that treatment</a>. By comparison, the <a href="https://doi.org/10.1037/adb0000710">dropout rate for gambling harms</a> is nearly double: 39%. </p>
<p>We believe that dropout rate is not explained by people not wanting to put in the work to change. Instead, the relationship with the therapist and ambivalence about the progress being made tend to derail the course of treatment. Finances are also a real problem. Patients might not be able to afford their appointments, or <a href="https://www.ncpgambling.org/wp-content/uploads/2014/07/ACA-brief-web-layout-publication.pdf">their insurance doesn’t cover</a> a diagnosis of a gambling disorder.</p>
<h2>Gaps in knowledge and funding</h2>
<p>About a decade ago, a friend who is an alcohol researcher observed that the thinking and research about gambling was about four decades behind where it is for alcohol. The gaps in knowledge were evident. We still don’t have good models for how a gambling problem develops, or how to conceptualize an addiction without a substance. We don’t know the long-term effects of experiencing gambling problems and gambling disorder. And we don’t fully understand the extent to which improvements from treatment are maintained.</p>
<p>While researchers around the world are chipping away at these knowledge gaps, there continue to be huge challenges – not the least of which is that gambling regulations keep changing and new forms of gambling are always emerging. </p>
<p>More importantly, there is little funding available to learn more about gambling disorder – and almost no funding from the U.S. government. In 2022, the National Institutes of Health <a href="https://www.niaaa.nih.gov/management-reporting/fy-2022-financial-management-plan">invested over $570 million</a> to study alcohol use problems. </p>
<p>The amount the NIH budgeted to study gambling? </p>
<p>Zero.</p><img src="https://counter.theconversation.com/content/197861/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James P. Whelan receives funding from Tennessee Department of Mental Health and Substance Abuse Services </span></em></p>Treatment has a high success rate. Getting problem gamblers in the door – and getting them to complete a full course of therapy – is another matter.James P. Whelan, Research Professor of Clinical Health, University of MemphisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982852023-02-07T13:35:20Z2023-02-07T13:35:20ZI treat people with gambling disorder – and I’m starting to see more and more young men who are betting on sports<figure><img src="https://images.theconversation.com/files/508172/original/file-20230204-5389-wfiqrk.png?ixlib=rb-1.1.0&rect=1%2C16%2C1014%2C793&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many young sports bettors think they're knowledgeable enough to 'beat the system.'</span> <span class="attribution"><span class="source">Nick Lehr/The Conversation via DALL-E 2</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><a href="https://scholar.google.com/citations?user=OcbcVXYAAAAJ&hl=en">As a therapist who treats people with gambling problems</a>, I’ve noticed a shift over the past few years – not only in the profile of the typical clients I treat, but also in the way their gambling problems develop.</p>
<p>In 2018, the U.S. Supreme Court made the <a href="https://www.cnn.com/2018/05/14/politics/sports-betting-ncaa-supreme-court/index.html">landmark decision</a> to allow states to legalize sports wagering. Tennessee, where I am studying clinical psychology, took advantage of this ruling, and in late 2020, the state legalized <a href="https://www.tennessean.com/in-depth/money/2020/10/31/tennessee-sports-betting-online-fanduel-draftkings-betmgm-action-247/6056604002/">online and mobile sports betting</a>.</p>
<p>With most <a href="https://www.investopedia.com/sportsbook-5217715">sportsbooks</a> offering betting apps, my clients are finding it more difficult to quit gambling than ever before. Unlike other forms of gambling, such as playing roulette or slots at a casino, these apps are on their phones and in their pockets, accompanying them wherever they go.</p>
<p>This availability makes it that much harder to resist any urges that might arise – and presents unique challenges for helping clients reduce their gambling.</p>
<h2>A new type of client emerges</h2>
<p>When I first started treating people for gambling disorder in 2019, my clients were usually older and gambled in casinos, with slot machines and card games among their favorite forms of gambling. They also tended to be poorer and often talked about how they began gambling to make some side money, viewing it as a second job. Many of them had retired and would say things like, “Going to the casino gets me out of the house” or “The casino is like my ‘Cheers’” – a nod to the popular watering hole in the eponymous sitcom. </p>
<p>That all changed when sports betting was legalized in Tennessee in November 2020.</p>
<p>Since then, I’ve noticed that my average client has started to look different. I’m now providing therapy to younger men, mostly in their 20s, who are seeking treatment for problems with sports betting. These clients tend to earn more money and be wealthier than my previous clients – a pattern that sports betting <a href="https://theconversation.com/access-to-sports-betting-in-the-us-has-exploded-since-2018-and-were-just-starting-to-learn-about-the-effects-192055">researchers have observed</a>.</p>
<p>Several of them reported being avid sports fans or having a competitive streak. And they thought they could “beat the system” due to their extensive sports knowledge.</p>
<p>Many of them started betting on sports after hearing promotions for various betting companies. Even if you’re a casual sports fan with no interest in betting, you can’t miss these ads, which regularly air during televised sporting events. For example, some ads for FanDuel, one of the more popular sports betting apps, highlight a “No Sweat First Bet,” with <a href="https://www.actionnetwork.com/education/what-does-each-sportsbook-bonus-mean">new users eligible for a risk-free bet of up to $1,000</a>.</p>
<p>There’s also a social element to sports betting. One client talked about betting on sports as a way to bond with relatives who also gambled. Similarly, a few college students I have treated told me that they started betting because they wanted to fit in with their fraternity brothers.</p>
<h2>The apps don’t make it easy to set limits</h2>
<p>But once gambling issues begin, it can be hard for these clients to stop. Most of them started by placing smaller bets on a single outcome. Over time, they start to bet more to recoup their losses. Before they knew it, their bets had increased, with many not realizing how this change even happened.</p>
<p>Betting apps are available on any smartphone and are connected to clients’ bank accounts, making it quick and easy to deposit more funds. This often leads clients to lose track of how much money they have lost. As one client told me, “It’s easier to spend money on these apps because you never really see it. The transactions are all done electronically.”</p>
<p>These apps do not make it easy for those with gambling problems to sign up for cool-off periods or self-exclusion. <a href="https://casino.draftkings.com/responsible-gaming-on-draftkings?wpsrc=Organic%20Search&wpaffn=Google&wpkw=https%3A%2F%2Fcasino.draftkings.com%2Fresponsible-gaming-on-draftkings&wpcn=responsible-gaming-on-draftkings">Cool-off periods</a> allow the user to set a time frame – from a few hours to several months – where they will be unable to log into their betting account. <a href="https://www.responsiblegambling.org/for-the-public/problem-gambling-help/self-exclusion/">Self-exclusion</a> allows the user to ban themselves from the app for longer periods of time. Specific exclusion lengths differ by state. <a href="https://www.playtenn.com/tennessee-sportsbook-self-exclusion/#:%7E:text=You%20can%20choose%20to%20exclude,consider%20your%20length%20of%20exclusion.">In Tennessee</a>, there are one-year, five-year and lifetime ban options. </p>
<p>While many apps have these features, my clients often have to search online for this information, and even when they do find it, they can’t figure out how to put these guardrails in place. If they wish to set a cool-off period or ban themselves from all sports betting apps, they must do so from each app, one at a time, which can be tedious.</p>
<p><iframe id="D0Ren" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/D0Ren/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>It’s impossible to avoid sports and smartphones</h2>
<p>Sports betting presents unique challenges <a href="https://thegamblingclinic.com/">for treating gambling problems</a>. </p>
<p>In addiction treatment, therapists, like me, often encourage clients to fill their time with activities that aren’t connected to gambling or to <a href="https://doi.org/10.1016/j.addbeh.2004.04.006">avoid situations where they may be likely to gamble</a>. But when gambling is available at the touch of a button, it becomes harder to determine what situations may lead to gambling, which makes it harder to figure out what to avoid.</p>
<p>Before the apps, clients had to make plans for how and when to gamble. Now, all they have to do is pick up their phone and open an app. It is also incredibly difficult, if not impossible, to ask a client to stop using their smartphone or stop watching sports.</p>
<p>This is why I often tailor treatment to each client’s needs and circumstances. Some may wish to quit altogether, while others may simply want to cut back on their gambling. This has forced me to consider other possible alternatives, such as showing them how to set screen time limits for sportsbook apps or talking about strategies to watch less sports.</p>
<p><a href="https://doi.org/10.1007/s10899-014-9471-4">Most people</a> who bet on sports don’t develop gambling problems. But with so few regulations in place – advertising or otherwise – those who are the most at risk are especially vulnerable to developing problems.</p><img src="https://counter.theconversation.com/content/198285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tori Horn does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In the past, typical clients tended to be retirees living on fixed incomes who played slots and card games.Tori Horn, PhD Student in Clinical Psychology, University of MemphisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1987072023-02-03T13:30:53Z2023-02-03T13:30:53ZThe ethical dilemmas behind plans for involuntary treatment to target homelessness, mental illness and addiction<figure><img src="https://images.theconversation.com/files/507705/original/file-20230201-17231-xvmqx2.jpg?ixlib=rb-1.1.0&rect=4%2C6%2C1017%2C722&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Involuntary treatment for homeless people aims to help – but also raises ethical debates.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/homeless-man-sleeps-on-a-subway-bench-september-7-2022-in-news-photo/1421695998?phrase=new%20york%20homeless&adppopup=true">Robert Nickelsberg/Getty Images</a></span></figcaption></figure><p>Over the past year, cities across the United States have unveiled new policy plans to address homelessness amid <a href="https://www.kpbs.org/news/local/2022/06/13/mayor-glorias-push-for-homeless-progressive-enforcement-leads-to-eightfold-spike-in-arrests">rising concerns</a> about health <a href="https://www.opb.org/article/2022/11/30/portland-mayor-promises-action-central-eastside-safety-concerns/">and crime</a> – for homeless people themselves, as well as for surrounding communities. Notably, several proposals include civil commitment, also referred to as involuntary treatment, for people with severe mental illness or substance use disorders.</p>
<p>In November 2022, for example, New York City Mayor Eric Adams <a href="https://www.nyc.gov/office-of-the-mayor/news/870-22/mayor-adams-plan-provide-care-individuals-suffering-untreated-severe-mental#/%5B0">announced a plan</a> to <a href="https://www.nyc.gov/assets/home/downloads/pdf/press-releases/2022/Mental-Health-Involuntary-Removals.pdf?utm_medium=email&utm_name=&utm_source=govdelivery">use mental health laws</a> to facilitate involuntary treatment when people are unable to care for themselves, or when their actions endanger others. </p>
<p>Court-mandated treatment could include therapy, social workers, housing referrals, medication or other interventions, either in hospitals or on an outpatient basis. New York’s plan builds on other recent initiatives to connect <a href="https://www.nyc.gov/office-of-the-mayor/news/087-22/mayor-adams-releases-subway-safety-plan-says-safe-subway-prerequisite-new-york-city-s#/0">more homeless</a> and mentally ill people with shelters or <a href="https://www.nytimes.com/2022/11/04/nyregion/nearly-2600-apartments-for-mentally-ill-and-homeless-people-sit-vacant.html">supportive housing</a>.</p>
<p>Political leaders in <a href="https://www.gov.ca.gov/2023/01/13/los-angeles-county-accelerates-care-court-implementation-to-support-californians-with-untreated-severe-mental-illness/">California</a> and <a href="https://www.opb.org/article/2022/12/12/portland-mayor-ted-wheeler-suggests-easing-process-involuntarily-commit-mentally-ill/">Portland, Oregon,</a> have approved similar plans to use civil commitment laws.</p>
<p>As a <a href="https://health.usf.edu/publichealth/overviewcoph/faculty/katherine-drabiak">health law and medical ethics professor</a>, I believe it’s worth explaining how these laws work and the <a href="https://www.thehastingscenter.org/new-york-citys-involuntary-commitment-plan-fulfilling-a-moral-obligation/">ethical issues</a> they raise.</p>
<h2>How civil commitment works</h2>
<p>Civil commitment laws have been <a href="https://www.jstor.org/stable/20784735?seq=3">around for decades</a>. However, they only recently appear to have regained traction as a strategy for addressing the intersection of homelessness, <a href="https://www.samhsa.gov/sites/default/files/civil-commitment-continuum-of-care.pdf">mental illness</a> and <a href="https://pdaps.org/datasets/civil-commitment-for-substance-users-1562936854">substance use disorder</a>.</p>
<p>States have enacted these laws based on two theories. First, under the doctrine of <a href="https://www.law.cornell.edu/wex/parens_patriae">parens patriae</a>, a Latin phrase that means “parent of the nation,” states have a legal and ethical obligation to step in and help vulnerable people who cannot act for themselves. Second, in public health law, the concept of <a href="https://doi.org/10.1001/jama.283.22.2979">police power</a> means that states have a duty to pass and enforce laws to preserve public health and safety, which can be impacted by homelessness.</p>
<p>Every state has <a href="https://pdaps.org/datasets/civil-commitment-for-substance-users-1562936854">different laws</a> outlining civil commitment. Importantly, these laws are a civil mechanism for courts to oversee a treatment plan for people with severe mental illness or substance use disorders that meet specific criteria. For example, a court could assess testimony and evidence from clinicians that a person has such a severe substance use disorder that he repeatedly loses consciousness, will not accept assistance and risks freezing to death outside. These laws do not “<a href="https://www.opb.org/article/2022/12/12/portland-mayor-ted-wheeler-suggests-easing-process-involuntarily-commit-mentally-ill/">criminalize</a>” or punish homelessness.</p>
<p>During the initial assessment process, the person receives care in a hospital, where clinicians determine their medical needs. Afterward, the court may order a treatment plan that would outline requirements for the person to accept shelter and maintain weekly appointments such as attending therapy or drug treatment. Treatment in inpatient hospitals are generally only used in cases of severe illness, and <a href="https://www.samhsa.gov/sites/default/files/civil-commitment-continuum-of-care.pdf">laws require</a> using the least restrictive plan possible.</p>
<p>Civil commitment laws also require due process, or a <a href="https://www.disabilityrightssc.org/involuntary-mental-health-commitments/">fair procedure</a> for people to participate in the process, object and have assistance from <a href="https://www.nycourts.gov/ad3/mhls/Ch-08_12-09-16.pdf">legal counsel</a>.</p>
<h2>Understanding chronic homelessness</h2>
<p>What is often called “the homeless” population is actually <a href="https://www.samhsa.gov/sites/default/files/programs_campaigns/homelessness_programs_resources/hrc-factsheet-current-statistics-prevalence-characteristics-homelessness.pdf">multiple groups with different needs</a>, including youth, families, veterans, people with short episodes of homelessness spurred by job loss or unexpected bills, and the chronically homeless.</p>
<p>However, the most visible population – those who are chronically homeless without shelter – suffer from <a href="https://doi.org/10.1097/JCP.0000000000001528">high rates</a> of untreated severe substance use disorders and mental illness, <a href="https://www.latimes.com/california/story/2019-10-07/homeless-population-mental-illness-disability">though estimates vary</a>. The University of California’s California Policy Lab <a href="https://www.capolicylab.org/wp-content/uploads/2019/10/Health-Conditions-Among-Unsheltered-Adults-in-the-U.S.pdf">analyzed surveys of 64,000 people</a> who were homeless across 15 different states and found that 78% of the unsheltered homeless suffered from mental illness and 75% from a substance abuse disorder. Fifty percent experienced both.</p>
<p>Clinicians note that mental illness and <a href="https://www.capolicylab.org/wp-content/uploads/2019/10/Health-Conditions-Among-Unsheltered-Adults-in-the-U.S.pdf">substance use disorders can contribute</a> to homelessness, and <a href="https://journalofethics.ama-assn.org/article/four-ways-limit-use-force-care-persons-experiencing-homelessness/2021-11">worsen it</a>, too.</p>
<h2>Ethical issues</h2>
<p>Civil commitment aims to improve the well-being of individuals and communities. But it raises difficult questions about core ethical issues such as autonomy – people’s right to make medical decisions for themselves – and beneficence, or ensuring that interventions provide more benefit than harm.</p>
<figure class="align-center ">
<img alt="People at a protest hold signs, including one that says 'Healing not Hospitalization'" src="https://images.theconversation.com/files/507719/original/file-20230201-10184-z8uwxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507719/original/file-20230201-10184-z8uwxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507719/original/file-20230201-10184-z8uwxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507719/original/file-20230201-10184-z8uwxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507719/original/file-20230201-10184-z8uwxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507719/original/file-20230201-10184-z8uwxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507719/original/file-20230201-10184-z8uwxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Opponents of New York Mayor Eric Adams’ plans for involuntary treatment participate in a rally at City Hall.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/opponents-of-new-york-mayor-eric-adams-plan-to-news-photo/1447764898?phrase=homeless%20new%20york&adppopup=true">Spencer Platt/Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1377/forefront.20180329.955541">Some experts oppose</a> using civil commitment laws and assert that states should rely on voluntary services. Voluntary treatment, some of them contend, is just as effective but preserves autonomy and the freedom to choose or decline treatment.</p>
<p>Critics also assert that involuntary commitment violates the principle of beneficence, <a href="https://www.thehastingscenter.org/new-york-citys-involuntary-commitment-plan-fulfilling-a-moral-obligation/">because it can stigmatize</a> homeless people with severe mental health and substance use disorders by implying that they do not belong in public. Others contend it is cruel and coercive.</p>
<p>Advocates for plans like New York City’s, on the other hand, assert that civil commitment laws are not only effective at <a href="https://www.sandiegouniontribune.com/news/homelessness/story/2021-04-22/fatal-shooting-raises-questions-of-police-response-to-homeless">connecting people with help</a>, but fulfill a moral obligation to prevent people from suffering on city streets. </p>
<p>In most instances, health care workers and ethicists presume that adults can make their own medical choices in line with their values and needs. But people with severe mental illness or substance use disorder may experience impairment in their ability to deliberate, assess their needs and make decisions, which <a href="https://pubmed.ncbi.nlm.nih.gov/7129619/">compromises their autonomy</a>. Though <a href="https://doi.org/10.1056/NEJMms1610124">involuntary treatment</a> violates autonomy, it can also help people regain it through stabilization and recovery.</p>
<p><a href="https://doi.org/10.1056/nejmp1811623">Many clinicians</a> and outreach workers argue that glossing over the impact of untreated mental illness and substance use disorder violates the principle of beneficence, because avoiding treatment may result in more health harms.</p>
<h2>Wider effects</h2>
<p>Ethics debates must also grapple with how treatment affects the surrounding community, <a href="https://www.opb.org/article/2022/11/30/portland-mayor-promises-action-central-eastside-safety-concerns/">such as safety</a> – including for other people experiencing homelessness. As one data point, the San Diego District Attorney’s Office has compiled data showing people who are homeless are far more likely to be the victims of crime. Its data found that this population commits <a href="https://www.sdcda.org/content/MediaRelease/Homeless%20Data%20and%20Plan%20News%20Release%20FINAL%203-21-22.pdf">dramatically higher rates</a> of vandalism, arson, assault and burglary as well, although there are few nationwide studies. And while most people who are homeless, have a mental health illness or have a substance use disorder are not violent, some studies suggest people with a severe mental health illness are <a href="https://ps.psychiatryonline.org/doi/full/10.1176/ps.2008.59.2.153?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Psychiatric_Services_TrendMD_0">three to four times more likely</a> to display violent behavior.</p>
<p><a href="https://doi.org/10.1176/appi.ps.52.3.337">Some evidence</a> suggests that civil commitment can increase follow-through with treatment plans, reduce acute hospitalization and decrease violent behavior. <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2019/09/11/gravely-disabled-homeless-forced-into-mental-health-care-in-more-states">Proponents assert</a> that despite the coercive nature of civil commitment, it provides benefit as a step toward restoring the health of each person, and of society.</p><img src="https://counter.theconversation.com/content/198707/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Drabiak does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New York City’s plan has garnered the most attention – and criticism – but several cities are expanding their own intervention programs.Katherine Drabiak, Associate Professor of Health Law, Public Health Law and Medical Ethics, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1955672022-12-06T19:03:51Z2022-12-06T19:03:51ZNetflix psychiatrist Phil Stutz says 85% of early therapy gains are down to lifestyle changes. Is he right?<figure><img src="https://images.theconversation.com/files/498648/original/file-20221202-26-qgvmzl.png?ixlib=rb-1.1.0&rect=17%2C17%2C3817%2C2138&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Netflix/Stutz</span></span></figcaption></figure><p>Jonah Hill’s Netflix documentary, <a href="https://www.imdb.com/title/tt21819228/?ref_=fn_al_tt_1">Stutz</a>, is an insightful journey into the mind of his therapist, renowned psychiatrist Phil Stutz. Hill delves into Stutz’ model of care, creatively using visual depictions of key concepts and “<a href="https://www.netflix.com/tudum/articles/stutz-the-tools">tools</a>” drawn by Stutz himself. </p>
<p>This model is founded upon one’s relationship with their physical body. When he’s discussing the importance of health behaviours like exercise, diet and sleep, Stutz estimates 85% of the initial gains to someone with mental health concerns commencing therapy can come from focusing on these “lifestyle” factors. Surprised, Hill says in the film:</p>
<blockquote>
<p>When I was a kid, exercise and diet was framed to me in like, ‘there’s something wrong with how you look’. But never once was exercise or diet propositioned to me in terms of mental health. I just wish that was presented to people differently. Because for me, that caused a lot of problems.</p>
</blockquote>
<p>So, is Stutz right?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/youve-got-a-friend-young-people-help-each-other-with-their-mental-health-for-3-5-hours-every-week-194530">You've got a friend: young people help each other with their mental health for 3.5 hours every week</a>
</strong>
</em>
</p>
<hr>
<h2>What does the latest evidence tell us?</h2>
<p>While the 85% figure is debatable, there is now good evidence therapies targeting lifestyle factors can be a critical part of treating psychiatric conditions such as depression. A recent <a href="https://bjsm.bmj.com/content/bjsports/56/23/1375.full.pdf">meta-analysis</a> (which brings together results from different research studies) shows exercise may be as powerful as anti-depressant medication for depression. </p>
<p>Our own <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y?mod=article_inline">research</a> shows a modified Mediterranean diet can substantially improve symptoms and functioning of people living with moderate to severe depression. </p>
<p>The mental health benefits of these interventions occur <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y?mod=article_inline">independent of weight loss</a>, can be used in combination with medications (such as <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/eip.12230">antidepressants or antipsychotics</a>) and are cost-effective because of societal gains such <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5504-8">increased workplace productivity</a>.</p>
<p>And the benefits of these approaches can be be experienced relatively quickly, with effects evident in as little as <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222768&utm_source=rss&utm_medium=rss">three weeks</a>. </p>
<p>Lifestyle changes can reduce the risk of common conditions such as heart disease and diabetes, which contribute to the <a href="https://www.thelancet.com/article/S2215-0366(19)30132-4/fulltext">20-year</a> life expectancy gap for those experiencing mental illness. </p>
<p>The strength of the evidence means it has now been cited in <a href="https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health-actions-findings.pdf%20Part%20I%20The%20Case%20for%20Major%20Reform">key policy documents</a>, <a href="https://www.equallywell.org.au/wp-content/uploads/2018/12/Equally-Well-National-Consensus-Booklet-47537.pdf">advocacy</a> and clinical practice guidelines in <a href="https://pubmed.ncbi.nlm.nih.gov/30257806/">Europe</a> and the <a href="https://www.nice.org.uk/guidance/ng222">United Kingdom</a>. </p>
<p>The principal organisation representing the medical specialty of psychiatry, the Royal Australian and New Zealand College of Psychiatrists, now <a href="https://journals.sagepub.com/doi/full/10.1177/0004867420979353">recommends</a> lifestyle modification should be considered the first step in treating depression. </p>
<p>Despite all of this, this approach has not been comprehensively taken up by mainstream mental health-care providers in Australia or in the setting of the Stutz documentary, the United States. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/UKCmefQdplI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘You have to give somebody the feeling they can change right now.’</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/treating-mental-illness-with-electricity-marries-old-ideas-with-modern-tech-and-understanding-of-the-brain-podcast-195071">Treating mental illness with electricity marries old ideas with modern tech and understanding of the brain – podcast</a>
</strong>
</em>
</p>
<hr>
<h2>Supporting clinicians</h2>
<p>The use of lifestyle therapies is a reasonably new area to psychiatry compared to other treatments such as antidepressant medication or talk therapy with psychologists. Our <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y?mod=article_inline">randomised control trial</a> showing diet can be a treatment strategy for depression mentioned previously was the first of its kind and was only completed in 2017. </p>
<p>There are various barriers to its translation in mental health care: training, funding, access and variability in quality given the historical absence of guidelines. </p>
<p>In October, we published the first <a href="https://www.tandfonline.com/doi/full/10.1080/15622975.2022.2112074">international guidelines</a> that can be used across any clinical setting – from general practices, to specialist mental health care and by dietitians - in any country. They cover nine established and emerging lifestyle “pillars” to support whole-of-person care. These are: </p>
<p><strong>1.</strong> physical activity and exercise – improving aerobic and resistance training, yoga, reducing sedentary behaviours</p>
<p><strong>2.</strong> relaxation techniques – such as guided breathing exercises</p>
<p><strong>3.</strong> engaging (or re-engaging) with employment or volunteering</p>
<p><strong>4.</strong> getting enough sleep</p>
<p><strong>5.</strong> mindfulness-based therapies and stress management (including coping skills)</p>
<p><strong>6.</strong> healthy diet that includes intake of a wide variety of plant-based whole foods and minimises highly processed foods</p>
<p><strong>7.</strong> quitting smoking</p>
<p><strong>8.</strong> improving social connections</p>
<p><strong>9.</strong> interaction with nature – in green spaces such as forests and parks, and blue spaces like the ocean or creeks and rivers.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman jogging in nature" src="https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498649/original/file-20221202-18-2bwhrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Exercise and engaging with natural spaces can yield mental health improvements.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-fitness-woman-running-morning-600w-608739416.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>Clinicians can shape their approach in four key ways: </p>
<ul>
<li><p>increase lifestyle and social assessments. Our <a href="https://www.tandfonline.com/doi/full/10.1080/15622975.2022.2112074">guidelines</a> contain a list of recommended tools to capture changes in a patient’s health behaviours across the course of therapy as well as social screening tools to help understand their socioeconomic backdrop (such as stable housing, access to resources)</p></li>
<li><p>get input from allied health professionals (such as dietitians or exercise physiologists), patients’ support networks including other health professionals, community, family, carers and peers. It’s important to know, for example, how someone’s household or neighbourhood may shape their ability to give up smoking</p></li>
<li><p>identify behavioural change strategies. Each individual will have a different mindset in terms of their openness to changing their behaviours. Clinicians can use the guidelines to identify the best strategies for different individuals</p></li>
<li><p>help reduce stigma and/or assumptions that <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.677">lifestyle is a choice</a>. Instead, understand and explain to patients how individual, social and commercial factors can play a role and make it harder for them to make changes. This can make it feel less like a personal responsibility or fault and help navigate realistic changes. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pharmacists-could-help-curb-the-mental-health-crisis-but-they-need-more-training-192162">Pharmacists could help curb the mental health crisis – but they need more training</a>
</strong>
</em>
</p>
<hr>
<h2>Still more to understand</h2>
<p>While these guidelines and resources are an important first step, there are key questions in this field that remain unanswered. </p>
<p>These include how to best personalise treatments using a person’s unique physiology, genetics, demographics, background and individual preferences. </p>
<p>We need to examine how this approach compares to gold-standard care such as psychotherapy, especially for more severe depression. We are currently testing this question and <a href="https://foodandmoodcentre.com.au/projects/the-harmone-trial/">recruiting</a> participants for a national trial. </p>
<p>It is important to note medication and other therapies can play an important role in mental health treatment. Medications should not be ceased or changed without consulting a medical professional. We have also created a <a href="https://foodandmoodcentre.com.au/academy/">course</a> for health professionals who want additional support. </p>
<p>For now, our guidelines provide a way for health professionals to begin addressing Jonah Hill’s point – that lifestyle factors should be presented to people as critical to their mental health.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/get-help/?gclid=CjwKCAiAyfybBhBKEiwAgtB7fga0ybZb91XDlLqKGHsCI_I1zcQ8Y6LU3VsvIJrAA1w_wrAZ1_hv3hoCeasQAvD_BwE">Lifeline</a> on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/195567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrienne O'Neil receives funding from National Health & Medical Research Council Emerging Leader 2 Fellowship (2009295). </span></em></p><p class="fine-print"><em><span>Dr Sam Manger is the pro-bono Vice-President of the Australasian Society of Lifestyle Medicine</span></em></p><p class="fine-print"><em><span>Wolfgang Marx is currently funded by an NHMRC Investigator Grant (#2008971) and a Multiple Sclerosis Research Australia early-career fellowship. Wolfgang has received funding and/or has attended events funded by Cobram Estate Pty. Ltd and Bega Dairy and Drinks Pty Ltd. Wolfgang has received consultancy funding from Nutrition Research Australia and ParachuteBH.</span></em></p>Changing your eating, exercising, socialising and engagement with nature can help treat depression. Now mental health professionals have some guidelines to shape treatment around lifestyle therapies.Adrienne O'Neil, Professor & Co-Director Food & Mood Centre, Deakin UniversitySam Manger, Senior lecturer, James Cook UniversityWolfgang Marx, Senior research fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1950712022-11-24T11:09:42Z2022-11-24T11:09:42ZTreating mental illness with electricity marries old ideas with modern tech and understanding of the brain – podcast<figure><img src="https://images.theconversation.com/files/497106/original/file-20221123-26-b9b1b1.png?ixlib=rb-1.1.0&rect=64%2C27%2C962%2C556&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In deep brain stimulation, electrodes – the pale white lines – are implanted into a patient's brain and connected to a battery in a person's chest.
</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:X-ray_of_deep_brain_stimulation_in_OCD,_L.png#/media/File:X-ray_of_deep_brain_stimulation_in_OCD,_L.png">Jmarchn/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Mental illnesses such as obsessive compulsive disorder, depression and addiction are notoriously hard to treat and often don’t respond to drugs. But a new wave of treatments that stimulate the brain with electricity are showing promise on patients and in clinical trials. In this episode of <a href="https://theconversation.com/uk/topics/the-conversation-weekly-98901">The Conversation Weekly</a> podcast, we talk to three experts and one patient about the history of treating mental illness, how new technology and deeper understanding of the brain are leading to better treatments and where the neuroscience of mental illness is headed next. </p>
<iframe src="https://embed.acast.com/60087127b9687759d637bade/637f346774e2da0012db0f5e" frameborder="0" width="100%" height="190px"></iframe>
<p><iframe id="tc-infographic-561" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/561/4fbbd099d631750693d02bac632430b71b37cd5f/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>It’s not uncommon to hear people joke about how their “OCD” makes them want to straighten a crooked picture or clean a smudge on a countertop, but for people actually living with severe obsessive compulsive disorder, the reality is anything but funny.</p>
<p><a href="https://som.ucdenver.edu/Profiles/Faculty/Profile/30555">Moksha Patel</a> is a physician and professor at the University of Colorado and has severe OCD. “OCD was really taking over my life. The most obvious of my symptoms were not being able to use any public restrooms, showering for an hour after using the restrooms each time and using chemical cleaners on my skin and my mouth,” he says. After struggling for years, Patel eventually connected with <a href="https://www.uchealth.org/provider/rachel-davis-md/">Rachel Davis</a>, a psychiatrist and researcher also at the University of Colorado. Davis suggested that he could be a good candidate for deep brain stimulation as a treatment for his OCD. </p>
<p>“Deep brain stimulation involves the implantation of electrodes in the deeper areas of the brain,” Davis explains. These electrodes then transfer into the brain itself small electrical currents that a doctor and their patient try to tune correctly. As Davis explains, “Basically we’re looking to find the settings where the patient feels that their mood is better, their anxiety is less and they have more energy.”</p>
<p>Deep brain stimulation works well for a lot of patients and has only started to get mainstream attention in the past decade or so, but ideas underlying this treatment are nearly 60 years old. As explained by <a href="https://directory.weill.cornell.edu/person/profile/jjfins">Joseph Fins</a>, a neuroethicist and professor of medicine at Weill Cornell Medical College, part of Cornell University in the US, it all started with a Spanish neuroscientist named Jose Manuel Rodriguez Delgado in 1964. “He put a thing called the stimoceiver, a deep brain stimulator, into the brain of a charging bull. And with an electrical current controlled by radio frequency, he was able to stop the bull in its tracks.”</p>
<p>While this work got Delgado on the front page of The New York Times, it came on the heels of a horrific era of mental health treatment that involved lobotomies, electroshock therapy and many other destructive and deeply unethical interventions. So when researchers began to discover drugs that could help people with mental illness, Fins says “psychosurgery and these types of somatic therapies began to fall out of favor and physicians moved away from more physical interventions.”</p>
<p>As modern neuroscience led to better understanding of how the brain works, and stigma surrounding physical treatments faded, deep brain stimulation got its second chance in the sun. And as technology has improved, researchers like <a href="https://scholar.google.com/citations?user=BD8dNTUAAAAJ&hl=en&oi=ao">Jacinta O'Shea, a neuroscientist</a> at the University of Oxford have begun to study a noninvasive technique for stimulating the brain with electricity, called transcranial magnetic stimulation. </p>
<p>“If you place a ferromagnetic coil on the scalp and pass a rapidly changing electrical current through that coil, it will induce an electric field that passes painlessly through the skull and into the brain tissue underneath,” O'Shea explains. And just as with deep brain stimulation, these electrical fields can help people overcome mental health issues like depression.</p>
<p>Researchers still don’t quite know how deep brain stimulation or transcranial magnetic stimulation work, but with every new treatment, they are learning more about the complicated world of the brain and taking steps toward the treatments of tomorrow.</p>
<p>Listen to the full episode of The Conversation Weekly to find out more. </p>
<p>This episode was produced and written by Katie Flood and Daniel Merino, with sound design by Eloise Stevens. The executive producer was Gemma Ware. Our theme music is by Neeta Sarl. </p>
<p>You can find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/">theconversationdotcom</a> or <a href="mailto:podcast@theconversation.com">via email</a>. You can also sign up to The Conversation’s <a href="https://theconversation.com/newsletter">free daily email here</a>. A transcript of this episode is <a href="https://cdn.theconversation.com/static_files/files/2792/Ep82_Neural_Psychiatry_Transcript.pdf?1694452606">available now</a>.</p>
<p>Listen to The Conversation Weekly via any of the apps listed above, download it directly via our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a>, or find out <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">how else to listen here</a>.</p><img src="https://counter.theconversation.com/content/195071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta O'Shea has consulted for Welcony Inc and is currently on the Scientific Advisory Board of Plato Science. She receives research funding from the Wellcome Trust/Royal Society and the Academy of Medical Sciences in the U.K.
Joseph Fins receives funding from the U.S. National Institutes of Health BRAIN Initiative, Dana Foundation, Greenwall Foundation, Robert Wood Johnson Foundation, Buster Foundation, NIH CTSC, NIH Eunice Kennedy Shriver National Institute of Child Health, Blythedale Children’s Hospital and from numerous editorial boards. He is also the president of the International Neuroethics Society, Chair-Elect and board member of The Hastings Center and a Trustee Emeritus at Wesleyan University</span></em></p><p class="fine-print"><em><span>Rachel Davis consults for Medtronic, Inc. She receives funding from the U.S. National Institutes of Health.
Moksha Patel has nothing to disclose. </span></em></p>Deep brain stimulation and trasncranial magnetic stimulation treat mental illness by sending electrical currents into parts of the brain. Every new patient provides researchers with a wealth of information. Listen to The Conversation Weekly podcast.Daniel Merino, Associate Science Editor & Co-Host of The Conversation Weekly Podcast, The ConversationGemma Ware, Editor and Co-Host, The Conversation Weekly Podcast, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1617432021-09-02T02:20:37Z2021-09-02T02:20:37ZWhat is EMDR therapy, and how does it help people who have experienced trauma?<figure><img src="https://images.theconversation.com/files/403943/original/file-20210602-15-1jvcc1f.jpg?ixlib=rb-1.1.0&rect=43%2C7%2C4896%2C3246&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-sit-on-beach-looking-around-745376050">Shutterstock</a></span></figcaption></figure><p>Earlier this year, <a href="https://abcnews.go.com/GMA/Wellness/prince-harry-reveals-emdr-cope-anxiety-therapy-technique/story?id=77866041">Prince Harry revealed</a> he has used a therapy called EMDR to cope with anxiety and trauma, including trauma resulting from his mother Princess Diana’s death when he was 12.</p>
<p>He demonstrates the technique in the Apple TV+ docuseries The Me You Can’t See. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/QGiqBazdPGw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>EMDR stands for eye movement desensitisation and reprocessing. But what is this therapy and how does it work?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-seeing-a-psychologist-heres-how-to-choose-the-therapy-best-for-you-114294">Thinking of seeing a psychologist? Here's how to choose the therapy best for you</a>
</strong>
</em>
</p>
<hr>
<h2>What is EMDR?</h2>
<p>EMDR is a <a href="https://www.emdr.com/what-is-emdr/">psychotherapy treatment</a> that aims to reduce distressing emotions associated with traumatic memories. </p>
<p>It involves consulting with a trained psychologist, usually over about 12 sessions.</p>
<p>Broadly speaking, the sessions involve eight steps:</p>
<ol>
<li><p><strong>History and treatment planning:</strong> the psychologist will discuss the patient’s specific reason for coming and take a detailed history</p></li>
<li><p><strong>Preparation:</strong> the psychologist will talk to the patient about what they can expect from EMDR. In this phase, the psychologist will also teach the patient relaxation techniques they can use to calm themselves during or after sessions</p></li>
<li><p><strong>Assessment:</strong> the psychologist will ask the patient to select a vivid image in their mind relating to the memory they wish to work on. The patient will also be asked to focus on any negative beliefs about themselves, or negative emotions associated with the event</p></li>
<li><p><strong>Desensitisation:</strong> the patient will be asked to hold the traumatic memory in their mind while following the movements of the psychologist’s finger back and forth with their eyes. The psychologist may also lead the patient in tapping (for example, the patient taps their knees with their hands in an alternating pattern) or auditory tones delivered through headphones. These alternatives to eye movements engage the same parts of the brain</p></li>
<li><p><strong>Installation:</strong> the patient is guided to replace the original negative belief with a positive one</p></li>
<li><p><strong>Body scan:</strong> the patient thinks of the original memory to see if there is any physical tension remaining in the body. Usually the memory processing is complete when the memory no longer causes the patient any distress. If it still does, step 4 will be repeated</p></li>
<li><p><strong>Closure:</strong> this is the end of the session. If the memory has not yet been completely reduced in intensity, the psychologist will guide the patient in relaxation exercises to do until the next session</p></li>
<li><p><strong>Reevaluation:</strong> this is the start of the next session, where the psychologist and the client assess the previous session’s work and reevaluate the treatment plan as needed.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-repetitive-transcranial-magnetic-stimulation-and-how-does-it-actually-work-160771">What is repetitive transcranial magnetic stimulation and how does it actually work?</a>
</strong>
</em>
</p>
<hr>
<p>The therapist continually checks in with the client throughout the process.</p>
<p>An important phase at the end of treatment involves looking to the future. The psychologist might ask the patient to imagine an anticipated challenge.</p>
<p>For example, if the patient had been in a car accident, they might imagine driving on a highway, perhaps at night or alone, and see if any distressing emotions arise. If they do, the patient might still need some more treatment.</p>
<p>A unique aspect of EMDR is that the person may not have to discuss any of their disturbing memories in detail. The psychologist may ask “What event do you remember that made you feel distressed?” and the patient may say, “It was something my father did to me.” The process can be done without any extra information.</p>
<h2>How does EMDR work? And who can use it?</h2>
<p>The dual activity of thinking about a distressing memory and rapidly moving the eyes from side to side appears to reduce the level of emotion in the memory.</p>
<p>One theory is that thinking about a traumatic memory and following something with the eyes requires more memory capacity than is available, therefore the distressing memory is not completely accessed and <a href="http://www.thepermanentejournal.org/issues/2014/winter/5626-emdr.html">loses its strength</a>. </p>
<figure class="align-center ">
<img alt="A young man talks with a clinician." src="https://images.theconversation.com/files/403942/original/file-20210602-17-2ucova.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403942/original/file-20210602-17-2ucova.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403942/original/file-20210602-17-2ucova.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403942/original/file-20210602-17-2ucova.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403942/original/file-20210602-17-2ucova.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403942/original/file-20210602-17-2ucova.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403942/original/file-20210602-17-2ucova.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">EMDR is undertaken with a trained therapist.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>EMDR therapy is most commonly used to treat traumatic stress symptoms and post-traumatic stress disorder (<a href="https://istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL.pdf.aspx">PTSD</a>).</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4125321/">review of 26 clinical trials</a> showed EMDR treatments significantly reduced symptoms of PTSD, depression, anxiety, and distress in people with PTSD.</p>
<p>The use of EMDR in children with PTSD has been demonstrated <a href="https://connect.springerpub.com/content/sgremdr/12/4/177.abstract">to be effective</a> too.</p>
<p>People <a href="https://connect.springerpub.com/content/sgremdr/1/1/46?">with phobias</a> or anxiety concerns can also benefit, as can people <a href="https://connect.springerpub.com/content/sgremdr/10/2/59">with depression</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-half-of-australians-will-experience-trauma-most-before-they-turn-17-we-need-to-talk-about-it-159801">More than half of Australians will experience trauma, most before they turn 17. We need to talk about it</a>
</strong>
</em>
</p>
<hr>
<p>While the research suggests EMDR is an effective approach to reducing trauma, there may be some risks <a href="https://www.medicalnewstoday.com/articles/325717">or side effects</a> involved. These include:</p>
<ul>
<li><p>an increase in distressing memories</p></li>
<li><p>heightened emotions or physical sensations during sessions</p></li>
<li><p>light-headedness</p></li>
<li><p>vivid dreams</p></li>
<li><p>the surfacing of new traumatic memories.</p></li>
</ul>
<p>Should any of these occur, the treating psychologist would typically support the patient to process these during the sessions. </p>
<h2>Is EMDR recognised?</h2>
<p>The <a href="https://www.who.int/mental_health/emergencies/stress_guidelines/en/">World Health Organization</a> and the <a href="https://istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL.pdf.aspx">International Society for Traumatic Stress Studies</a> both recommend EMDR therapy as a treatment for adults and children with PTSD. </p>
<p>It’s also endorsed by the <a href="https://www.psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/Evidence-based-psych-interventions.pdf">Australian Psychological Society</a>.</p>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/161743/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peta Stapleton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You might have heard of EMDR therapy recently after Prince Harry said he’s been using it.Peta Stapleton, Associate Professor in Psychology, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1574142021-04-06T05:13:26Z2021-04-06T05:13:26ZWakefield — new ABC series looks at mental health and treatment from the inside out<figure><img src="https://images.theconversation.com/files/393487/original/file-20210406-13-1pgcday.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C3537%2C2360&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">ABC TV</span></span></figcaption></figure><p><em>Review: Wakefield, ABC TV</em></p>
<p>From the comedy-drama of Josh Thomas’ <a href="https://www.imdb.com/title/tt2155025/?ref_=fn_al_tt_1">Please Like Me</a>, to the documentary series <a href="https://www.imdb.com/title/tt4167782/?ref_=fn_al_tt_4">Changing Minds</a> filmed inside a psychiatric hospital, the ABC has a track record of collaborating with mental health organisations and people with lived experience to create compelling, compassionate stories about mental health. </p>
<p>Created by Kristen Dunphy and inspired by her own experiences as a patient, new series <a href="https://www.imdb.com/title/tt13556320/?ref_=fn_al_tt_2">Wakefield</a> is a fictional drama mystery set in a psychiatric hospital in the Blue Mountains. </p>
<p>Wakefield presents a nuanced, multi-layered story about mental health through its ensemble cast. This eight-part series demonstrates the advantages of television’s long-form narrative over feature film. It provides greater scope to explore a range of mental health stories without resorting to caricatures and stereotypes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-tvs-troubling-storylines-for-characters-with-a-mental-illness-81456">Friday essay: TV's troubling storylines for characters with a mental illness</a>
</strong>
</em>
</p>
<hr>
<h2>Characters on a spectrum of mental health</h2>
<p>Wakefield’s first episode focuses on four characters: two patients and two staff members. Each is at a different stage in their mental health journey, from recognising their needs and seeking support, to taking the first steps towards recovery.</p>
<p>We first meet James (Dan Wyllie), dressed in a suit jacket and tie, talking on the phone with his business partners. The camera pulls back from a tight closeup on James’ face to reveal he is wearing pyjama pants - his office is actually a room in a psychiatric hospital. </p>
<p>This visual conceit suggests a man desperately keeping up appearances and living in denial of his mental health needs, which has led to him being hospitalised following an overdose. James is constantly negotiating with hospital staff for access to his phone and laptop, as he tries to keep up the pretence of a man still in control. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/f3PkRz0Qda4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘We’re all mad.’ Wakefield shows patients and clinicians on a sliding spectrum of mental health.</span></figcaption>
</figure>
<p>We next meet Ivy, a young mother of a newborn baby, returning to the hospital from a walk to the shops. As played by Megan Smart, her anxiety and fear about caring for this fragile new life are palpable. </p>
<p>By introducing James and Ivy doing everyday activities, Wakefield challenges preconceived ideas about the spectacle of madness. These characters do not look unwell, but their struggles become evident in their interactions with others. </p>
<p>Connecting these two characters is Nik (British actor <a href="https://www.imdb.com/name/nm1454287/?ref_=tt_cl_t1">Rudi Dharmalingam</a>), a psychiatric nurse who responds to James’ demands and Ivy’s anxiety with care and compassion. </p>
<p>Nik is clearly good at his job. In the first episode he deescalates a potentially violent situation using a range of strategies (throwing and catching a ball, one-word answers) to help another patient Trevor (Harry Greenwood) calm down and articulate his feelings. </p>
<p>Nik’s empathetic approach to Wakefield’s patients is in stark contrast to the officious and socially awkward head nurse Linda (Mandy McElhinney). There are echoes of Nurse Ratched, the villain in <a href="https://www.imdb.com/title/tt0073486/?ref_=nv_sr_srsg_0">One Flew Over the Cuckoo’s Nest</a>, in Linda’s characterisation and her adversarial relationship with Nik. This cliche is tempered by the revelation of her own family situation and the way McElhinney conveys Linda’s desperation and vulnerability. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman smokes on balcony." src="https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393056/original/file-20210401-23-13m5hsn.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mental health and inpatient care is presented in a more nuanced way than ‘us versus them’. Carers also have their struggles.</span>
<span class="attribution"><span class="source">ABC TV</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-may-not-like-reality-tv-but-how-mad-are-you-rightly-tests-our-assumptions-about-mental-illness-104764">You may not like reality TV but How 'Mad' Are You? rightly tests our assumptions about mental illness</a>
</strong>
</em>
</p>
<hr>
<p>Initially, Nik is presented as a stabilising influence but he is struggling with his own mental health. He can’t sleep and an 80s pop song is increasingly intruding into his thoughts. </p>
<p>Flashbacks to Nik’s childhood suggest a repressed trauma; the repeated image of him standing perilously close to a cliff edge implies suicidal thoughts. His story reminds us mental illness does not discriminate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&rect=16%2C22%2C2121%2C1461&q=45&auto=format&w=1000&fit=clip"><img alt="Two men in intense emotional embrace" src="https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&rect=16%2C22%2C2121%2C1461&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393053/original/file-20210401-21-cu9jwc.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nik (Rudi Dharmalingam) and Trevor (Harry Greenwood).</span>
<span class="attribution"><span class="source">ABC TV</span></span>
</figcaption>
</figure>
<h2>Complex stories, real and imagined</h2>
<p>In Wakefield’s second episode we meet patients Genevieve (Harriet Dyer) and Tessa (Bessie Holland) and psychiatrist Dr Kareena Wells (Geraldine Hakewill) who is struggling with anxiety and feelings of guilt about a patient’s death. </p>
<p>This episode includes the experiences of carers through Genevieve’s partner, Raff (Ryan Corr) and Tessa’s mother, Belle (Heather Mitchell). The diversity of perspectives is emphasised by repeating key scenes shot from different camera angles, which present another character’s perspective on the same event.</p>
<p>Wakefield’s multiple stories of mental health issues are told through a mix of realist and non-realist techniques, including vibrant musical performance numbers that put the viewer inside the character’s mind, showing the world as they perceive it. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teenage-mental-health-how-growing-brains-could-explain-emerging-disorders-154007">Teenage mental health: how growing brains could explain emerging disorders</a>
</strong>
</em>
</p>
<hr>
<p>Wakefield credits <a href="https://www.sane.org/information-stories/the-sane-blog/mental-illness/anxiety-book-dr-mark-cross">Dr Mark Cross</a>, who featured in Changing Minds, as consultant psychiatrist. Several mental health organisations are also acknowledged, including Mindframe, Headspace, Lifeline, Black Dog Institute, Beyond Blue, Mind Australia and SANE Australia. </p>
<p>It is encouraging to see Australian screen producers collaborating with mental health experts to create authentic stories about mental health issues. This expertise encompasses many voices. </p>
<p>With Wakefield, Kristen Dunphy has brought to the screen a fictional story inspired by her own experience as a patient and realised by her creativity as a screenwriter and showrunner. The result is an original and complex portrayal of mental health.</p>
<hr>
<p><em>Wakefield is <a href="https://iview.abc.net.au/show/wakefield">available now</a> for streaming on iView and premieres on ABC TV on April 18.</em></p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, please call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14 or <a href="https://www.beyondblue.org.au/">Beyond Blue</a> on 1300 22 4636. If life is in danger, phone 000.</em></p><img src="https://counter.theconversation.com/content/157414/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fincina Hopgood is engaged in ongoing unpaid research collaborations with SANE Australia, including PhD project supervision and membership of the Expert Reference Group for the National Stigma Report Card project. </span></em></p>Set in a mental health facility, Wakefield shows the advantages of television over feature film, giving scope to explore mental health stories without resorting to caricatures.Fincina Hopgood, Lecturer in Screen Studies, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1552322021-02-22T13:26:14Z2021-02-22T13:26:14ZThree ways virtual reality could transform mental health treatment<figure><img src="https://images.theconversation.com/files/385524/original/file-20210222-19-9ik0ha.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4881%2C3261&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Virtual reality can create immersive simulations of real environments.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-man-patient-using-virtual-1363422605">Elle Aon/ Shutterstock</a></span></figcaption></figure><p>With <a href="https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-in-england-2007-results-of-a-household-survey">one in four of us</a> expected to experience a mental health problem at any one time, increasing access to treatment has become essential. But doing so is challenging. Therapists require extensive training, and the most effective forms of therapy <a href="https://pubmed.ncbi.nlm.nih.gov/28325167/">involve coaching patients</a> in everyday situations, which is time-consuming and therefore costly. </p>
<p>Delivering psychological therapies in virtual reality (VR) may provide a solution. Here are three ways VR could transform mental health treatment.</p>
<h2>1. “In-situ” coaching</h2>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/28325167/">most successful therapeutic interventions</a> help people to modify the way they think, react, and behave in the very situations they find most challenging. This could be anything from getting on a crowded bus, to going to a social event, to simply leaving the house. </p>
<p>We tend to remember information best when we’re in the same physical or mental state as we were when the memory was initially formed. This is known as <a href="https://www.tandfonline.com/doi/abs/10.1080/02699938908408077?casa_token=dVQbjgVO43cAAAAA:VSP34Iu2YXIfJeRDylwHFjX8fxFuxmQhhIm2XZPKWQLfhOL9ZuULmXg8xufHJVuk7zy_Wt2D9Us">state dependent</a> learning. So for example, if we want someone to remember a technique that will help reduce their anxiety while food shopping, it’s generally best to actually visit a supermarket during the therapy session in order to train and practise the technique.</p>
<p>Such active “in-situ” coaching <a href="https://pubmed.ncbi.nlm.nih.gov/28325167/">can rarely happen</a> in mental health services because of factors like cost and time. This is where VR can help. </p>
<p>VR environments create immersive simulations of real world environments, allowing you to walk around and interact with the environment as if it were real. You can enter the situations you typically find challenging, and learn psychological techniques to overcome your difficulties alongside a virtual or real-life therapist. </p>
<p>Crucially, although we know the VR environment is just a simulation, we nonetheless <a href="https://pubmed.ncbi.nlm.nih.gov/17305448/">respond</a> as we would in the corresponding real-world environment, both psychologically and physiologically. As a result, any learning that’s made in VR transfers to the real world. </p>
<p>In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929408/">one study</a> of 30 patients with severe paranoid beliefs, fear of real-world social situations halved after a single VR coaching session. Similar findings have been seen for a range of other experiences, such as fears of <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30226-8/fulltext">height</a> and <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/virtual-reality-compared-with-in-vivo-exposure-in-the-treatment-of-social-anxiety-disorder-a-threearm-randomised-controlled-trial/D541B09E2FF234FA82A7001AB44E3989">social anxiety</a>.</p>
<h2>2. Flexibility</h2>
<p>Not only is VR more practical, but people are generally <a href="https://pubmed.ncbi.nlm.nih.gov/28325167/">more willing to enter virtual versions</a> of the situations they find anxiety-provoking because they know it’s only a simulation. It’s also easier to repeatedly try things out that are too scary or perhaps too embarrassing to try in the real world.</p>
<p>VR scenarios can also be graded in difficulty or even personalised for each person. In a VR study at the University of Oxford on <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30226-8/fulltext">treating fear of heights</a>, participants began in the virtual atrium of a ten-storey building and were then able to choose which floor to go to. The idea was to begin practising on the lower, less scary floors, and work their way up as they became more confident.</p>
<p>VR also allowed the researchers to make some of the scenarios more fun for participants – such as having tasks where you rescued a kitten or had to pop bubbles. This added flexibility in how participants were able to confront their fear may be one reason why their reductions in fear of heights exceeded those seen in traditional exposure therapy.</p>
<p>The flexibility of VR also means it can be adapted to help treat a range of mental health problems. VR treatments have been developed for many other phobias, such as <a href="https://pubmed.ncbi.nlm.nih.gov/31075675/">spiders</a>, as well as for other disorders such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774399/">PTSD</a>, <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/virtual-reality-compared-with-in-vivo-exposure-in-the-treatment-of-social-anxiety-disorder-a-threearm-randomised-controlled-trial/D541B09E2FF234FA82A7001AB44E3989">social anxiety</a>, <a href="https://www.nature.com/articles/s41598-018-28113-6">depression</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5948410/">eating disorders</a>, <a href="https://bmjopen.bmj.com/content/9/8/e031606">psychosis</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342674/">addiction</a>. </p>
<h2>3. Automation</h2>
<p>Perhaps the most significant advantage of VR therapies is that they can be automated. This means that in VR there can be a virtual coach with you who explains the therapy and teaches you the psychological techniques to try out. </p>
<p>For example, our team has developed a <a href="https://bmjopen.bmj.com/content/9/8/e031606">virtual coach named Nic</a>, who is used in our ongoing research into VR for mental health treatment. Nic provides encouragement to users and gives them ideas of psychological techniques to try during treatment.</p>
<p>Virtual coaches like Nic can work like a therapist without a therapist actually needing to be present at every VR session. Instead, a graduate psychologist or peer supporter (such as someone who has lived through a similar experience) can lead the sessions with the user, providing support and guidance alongside the virtual coach. </p>
<p>Because there are many more graduate psychologists and peer supporters available than highly trained therapists, VR therapy can help ensure more people are able to access the treatment they may need, without delay. VR treatment is also likely to be more affordable for the same reason.</p>
<p>Continuous improvements to VR hardware mean it’s becoming increasingly affordable and feasible to potentially use this technology in mental health services in the near future for the treatment of a range of conditions. While it would never replace therapists, it could improve the number of people able to access therapy.</p><img src="https://counter.theconversation.com/content/155232/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Poppy Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>VR treatment can overcome many of the challenges of traditional therapy.Poppy Brown, Doctoral Researcher in Psychiatry, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1525252021-01-27T22:01:04Z2021-01-27T22:01:04ZFalling through the safety net: Youth are at the heart of Canada’s mental health crisis<figure><img src="https://images.theconversation.com/files/379913/original/file-20210121-21-pufey2.jpg?ixlib=rb-1.1.0&rect=0%2C194%2C4493%2C3251&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Significant reform of youth mental health care in Canada is needed to address the high rates of mental illness in young people.</span> <span class="attribution"><span class="source">(Unsplash/Devin Avery)</span></span></figcaption></figure><p>Canada is grappling with a <a href="https://www.cihi.ca/en/child-and-youth-mental-health-in-canada-infographic">major youth mental health crisis</a> characterized by high rates of mental illness, suicide, hospitalizations and considerable delays in access to services. These issues are <a href="https://doi.org/10.1177/0706743720943820">exacerbated by the COVID-19 pandemic and opioid overdose epidemic</a>. With limited signs of progress, <a href="https://doi.org/10.1177/0706743718758968">significant reform</a> of youth mental health care in Canada is paramount.</p>
<p>As mental health researchers in the field of prevention and early intervention, we recognize the importance of youth engagement in mental health issues, and present here not only our own opinions but the lived experiences and perspectives of youth. </p>
<p>Our national youth advisory team informs multi-site research trials and supports the development and use of evidence-based youth mental health interventions. Through this collaboration, we present key challenges within the Canadian mental health-care system for youth, and offer novel solutions and recommendations for progress.</p>
<h2>Funding prevention and early intervention</h2>
<p>A key issue is the continued limited government funding for mental health, especially prevention. The <a href="https://www.budget.gc.ca/2019/docs/plan/budget-2019-en.pdf">2019 federal budget</a> prioritizes mental health literacy, harm reduction treatments for opioid use and a suicide crisis hotline. </p>
<p>Because <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">70 per cent of adults with mental health issues</a> begin experiencing symptoms in adolescence, greater investment in youth mental health and prevention is vital. Specifically, evidence-based early intervention and prevention — such as the <a href="https://www.preventure.ca">Canadian PreVenture program</a> — can reduce the prevalence of <a href="https://doi.org/10.3389/fpsyt.2018.00770">youth mental health and substance use disorders by about 50 per cent</a>. Despite the science, current funding for prevention <a href="https://www.ccsa.ca/sites/default/files/2019-05/ccsa-011332-2006.pdf">represents less than one per cent of all costs to society related to substance use disorders</a>. </p>
<p>Another ongoing issue is affordability and accessibility of services. Although free psychological help is available, <a href="https://cmha.ca/wait-times-2">waiting times are notoriously long</a>. For youth, such delays can make the difference between the need for preventive services versus treatment. </p>
<p>The alternative — privatized care — is largely unaffordable. Fees often <a href="https://mps.ca/psychologist-fees/">range from around $100</a> to <a href="http://www.psych.on.ca/About-Psychology/Getting-help/What-to-expect-when-seeing-a-psychological-profess">$225 per hour</a>, preventing access for many youth, especially those exercising their right to privacy and agency by seeking care without a guardian. </p>
<p>Giving youth access to privatized mental health care for free would reduce the strain on the public system. A step in the right direction would be for Canada’s public health plan to include <a href="https://www.assnat.qc.ca/en/exprimez-votre-opinion/petition/Petition-8629/index.html">universal access to mental health services</a>, particularly preventive and early intervention supports, at least until age 25. </p>
<h2>Accessibility of services</h2>
<p>However, our youth advisers noted the importance of addressing concerns beyond affordability. They list services’ efficiency — wait times and staff capacity, for instance — as well as functioning hours, inclusiveness, appropriateness to youth needs and location as significant obstacles to accessing care. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young woman with her head in her hands" src="https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380744/original/file-20210126-19-1m69gh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Young people are falling through the cracks in Canada’s mental health system.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Adapting evidence-based programs, including cognitive behavioural therapies and peer support services, to be <a href="https://doi.org/10.1001/jamapsychiatry.2020.1640">distance/virtually delivered</a> offers a new way to rapidly reach under-served youth. This is particularly pertinent in light of <a href="https://doi.org/10.1177/0706743720940562">recent reports of deteriorating youth mental health</a> and substantial disruptions in access to mental health care during the ongoing COVID-19 pandemic.</p>
<p>While youth may have access to mental health professionals in schools, our youth advisers found such personnel were often heavily focused on academic concerns. Indeed, school psychologists’ time and effort may be diverted towards educational assessments and evaluations of learning disabilities and behavioural problems more than other mental health conditions and research. </p>
<p>The ratio of students to psychologists also tends to be higher than the recommended <a href="https://cpa.ca/docs/File/Sections/EDsection/School_Psychology_TFpaper_Aug2014_Final.pdf">1,000 youth per professional</a>, reaching <a href="https://doi.org/10.1177%2F0829573516654585">2,000 to 8,000 students</a>. Furthermore, many school-based drug education programs delivered to students have <a href="https://doi.org/10.1016/S0140-6736(09)60744-3">limited evidence of effectiveness</a>. </p>
<p>To address this, national standards are needed for school psychologists, focused on providing clinical support to students and participating in research that will help further mental health services for youth. </p>
<h2>Towards new models of care</h2>
<p><a href="https://doi.org/10.1001/jamapsychiatry.2020.3905">In response to the need for reform</a>, new, more holistic models of care are emerging, which include a greater consideration of a persons’ developmental stage in life, and the severity of their diagnosis. </p>
<p>For example, youth-focused and integrated services like <a href="https://foundrybc.ca/who-we-are/">Foundry BC</a> and <a href="https://youthhubs.ca/en/about/">Youth Wellness Hubs Ontario (YWHO)</a> follow a similar model to <a href="https://headspace.org.au">Australia’s Headspace</a> and Canada’s <a href="https://accessopenminds.ca">ACCESS Open Minds</a> to provide fast access to evidence-based, innovative mental health services incorporating in-person, virtual and outreach care. They also seek to delay transitions to adult services by extending care to young adults. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of young people at a PreVenture workshop" src="https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=306&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=306&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=306&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=385&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=385&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380745/original/file-20210126-21-1lxz67q.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=385&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Youth at a PreVenture workshop. A number of research-informed services are paving the way for reform by engaging youth in program development and promoting a more holistic approach to youth mental health.</span>
<span class="attribution"><span class="source">(PreVenture)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>However, these services remain largely dependent on young people actively seeking help and contacting them independently, which introduces biases in the type of young person served. In this regard, partnerships with schools could be beneficial. Schools can provide clinics with the opportunity to reach more youth (potentially all youth), and clinics can assist schools in addressing mental health demands that they cannot manage on their own.</p>
<h2>Engaging young people</h2>
<p>Finally, despite growing evidence of the benefits of <a href="https://www.health.ny.gov/community/youth/development/docs/jphmp_s079-s087.pdf">engaging youth in research and services</a>, there is a <a href="https://doi.org/10.1186/s12913-018-3219-2">lack of sustained opportunities</a> for youth to inform mental health care.</p>
<p>Notably, our youth advisers expressed some reticence about openly discussing mental health because they feared stigmatization and had doubts that service providers, researchers and policy-makers would listen to their views. Overall, however, most felt that raising awareness of young people’s mental health experiences could be beneficial, and could contribute to the creation of appropriate and relevant services. </p>
<p>While we engage youth in research, YWHO and Foundry BC involve youth in service development and delivery via <a href="https://youthhubs.ca/en/engagement/">advisory committees, outreach work and peer support</a>. <a href="https://www.camh.ca/en/camh-news-and-stories/youth-have-a-voice-in-projects-aimed-at-them">By integrating these different youth engagement platforms into their institutions</a> and committing to gathering youth feedback in accessible and meaningful ways, service providers can shape their resources to better serve the needs of youth. Co-ordination between service providers and schools may also create new avenues for youth participation.</p>
<p>The pandemic and the opioid crisis highlight the urgency of developing a more adaptable mental health-care system that reaches youth across the country. Canadian youth deserve affordable and accessible mental health care that’s backed by science, informed by their own voices and co-ordinated and funded nationally and provincially. </p>
<p><em>This article was also authored by Marion Audet, research assistant in psychology at the Conrod Venture Lab, Centre de Recherche, CHU Ste-Justine. It was also co-authored by the CUSP/OPfS National Research Youth Advisory Group (including Joseph McAndrew, Neave Allen, Hans Ang, Kyla Neville, Jackie Relihan, Laila Stewart).</em></p><img src="https://counter.theconversation.com/content/152525/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ranmalie Jayasinha is affiliated with the Conrod Venture Lab, Centre de Recherche, CHU Ste-Justine, which hosts the PreVenture program. </span></em></p><p class="fine-print"><em><span>Patricia Conrod works for Universite de Montreal and CHU Ste Justine. She receives funding from Canadian Institutes for Health Research to evaluate the impact of early and targeted intervention strategies on youth mental health and substance use outcomes. She has also received consultation fees from government organizations when advising on how to develop evidence-based drug and alcohol prevention. </span></em></p>High rates of youth mental illness show the urgent need for accessible, affordable and research-backed mental health care. It’s crucial to include young people’s voices in shaping these resources.Ranmalie Jayasinha, Postdoctoral Research Fellow, Faculty of Medicine, Université de MontréalPatricia Conrod, Professor of Psychiatry, Faculty of Medicine, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1533592021-01-20T17:08:45Z2021-01-20T17:08:45ZFewer people sought help for mental illness during the UK’s first lockdown – new research<figure><img src="https://images.theconversation.com/files/379748/original/file-20210120-23-1niqedl.jpg?ixlib=rb-1.1.0&rect=26%2C13%2C8648%2C5761&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many peoples' mental health worsened during the pandemic – but many didn't seek support or treatment. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid19-pandemic-coronavirus-woman-home-isolation-1694471026">Dragana Gordic/ Shutterstock</a></span></figcaption></figure><p>During the first COVID-19 lockdown in the UK, people were encouraged to help control the virus with the message to “<a href="https://www.gov.uk/government/publications/coronavirus-covid-19-information-leaflet/coronavirus-stay-at-home-protect-the-nhs-save-lives-web-version">stay at home, protect the NHS, save lives</a>”. While there was no specific instruction to avoid seeking medical care, the number of people contacting <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30201-2/fulltext">general practices</a> and visiting <a href="https://www.health.org.uk/news-and-comment/charts-and-infographics/how-is-covid-19-changing-the-use-of-emergency-care">emergency departments</a> fell dramatically. At the same time, <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30308-4/fulltext">people’s mental health was worsening</a> due to the pandemic. </p>
<p>My colleagues and I wanted to know how the COVID-19 pandemic, and the public health messaging surrounding it, affected the mental health care people received during the pandemic. We studied the <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30288-7/fulltext">health records of more than 14 million people</a> aged ten years and over who were registered at general practices across the UK. We looked at how many people sought mental health help for the first time, from their general practice or at a hospital A&E department. We discovered that while the UK was in its first lockdown, the number of people seeking help for depression dropped by 43%, anxiety disorders by 48% and self-harm by 38%.</p>
<p>But does this drop in help seeking for mental illness and self-harm simply reflect the public’s compliance with government messaging? One possible reason for the drop could be that rates of mental illness and self-harm in the population were lower during this time. There’s evidence that some <a href="https://emergingminds.org.uk/wp-content/uploads/2020/06/CoSPACE-Report-4-June-2020.pdf">young people experienced improvements</a> in their mental health during the spring 2020 lockdown.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fitter-better-rested-more-appreciative-research-reveals-the-positive-changes-experienced-by-some-during-lockdown-152907">Fitter, better rested, more appreciative: research reveals the positive changes experienced by some during lockdown</a>
</strong>
</em>
</p>
<hr>
<p>But most research shows this lockdown had a <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30308-4/fulltext">negative impact on rates of mental distress</a>. Additionally, some mental health charities reported <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30528-9/fulltext">increases in people asking for help</a>, showing there was still a need for mental health and self-harm treatment, but said people weren’t seeking it out from clinical settings. This also suggests that the gap between the number of people needing treatment for mental illness and self-harm and the number of people receiving treatment widened considerably during this period. </p>
<p>We found significant reductions in the number of working-aged people (ages 18 to 64) and people living in the most deprived communities seeking help for anxiety and depression. Reductions in the number of people seeking help for episodes of self-harm were greatest for people under the age of 45 and women. The pandemic has been shown to have a particularly negative impact on the <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30288-7/fulltext">mental health of these groups</a>. Our findings suggest that the groups of people most in need of mental health treatment were least likely to receive help. </p>
<figure class="align-center ">
<img alt="Woman struggling to work on her laptop with her toddler beside her." src="https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379750/original/file-20210120-15-qfcf9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Other responsibilities – such as balancing childcare while working from home – might be keeping some groups from seeking help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-woman-working-home-holding-her-1694473675">Dragana Gordic/ Shutterstock</a></span>
</figcaption>
</figure>
<p>There may be a number of reasons for this. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(71)92410-X/fulltext">Research shows</a> that the availability and quality of medical care can often be lower in deprived communities. It may be possible the pandemic has further contributed to existing problems – which might partly explain the drop in help seeking in this group. In addition, the <a href="https://www.kcl.ac.uk/news/why-has-covid-19-impacted-the-mental-health-and-wellbeing-of-women-the-most">widening of existing gender inequalities</a> brought about by the pandemic could have affected women’s ability to seek support. For example, some may be balancing additional childcare duties on top of work, making it more difficult to reach out for treatment or support.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lockdown-quarantine-and-self-isolation-how-different-covid-restrictions-affect-our-mental-health-153595">Lockdown, quarantine and self-isolation: how different COVID restrictions affect our mental health</a>
</strong>
</em>
</p>
<hr>
<p>Although <a href="https://www.health.org.uk/news-and-comment/charts-and-infographics/how-has-covid-19-affected-service-delivery-in-gp-practices">GPs adapted rapidly</a> during the pandemic to by providing remote appointments, and many hospital-based mental health care units <a href="https://www.rcpsych.ac.uk/docs/default-source/members/faculties/liaison-psychiatry/alternatives-to-eds-for-mental-health-assessments-august-2020.pdf?sfvrsn=679256a_2">diverted services away from hospital emergency departments</a> to ensure they were still accessible, our findings show that people still sought help less during the lockdown period. Although some people may not have sought help for fear of contracting the virus, it’s clear that public health messaging played an important role in this drop in help seeking.</p>
<p>As the pandemic continues, public health messaging should reinforce that help from GPs and hospital mental health services is available. <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/duration-of-untreated-symptoms-in-common-mental-disorders-association-with-outcomes/BA40509E756D5B358D55FB3853891753">Delays</a> in treatment for mental illness and self-harm could lead to people suffering with more severe mental illness by the time they receive help – which <a href="https://www.england.nhs.uk/wp-content/uploads/2020/08/C0716_Implementing-phase-3-v1.1.pdf">mental health services reported</a> was the case following the spring 2020 lockdown. Providing people with prompt mental health support for <a href="https://www.mentalhealth.org.uk/statistics/mental-health-statistics-prevention-and-early-intervention">mental illness</a> or <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/routine-hospital-management-of-selfharm-and-risk-of-further-selfharm-propensity-score-analysis-using-recordbased-cohort-data/8C94009027663118923818B31BA544F7">self-harm</a> can reduce the risks of ongoing mental health problems. </p>
<p>Our study showed that, by September 2020, the numbers of people seeking help for both mental illness and self-harm were largely back to expected levels. This is likely due to the lifting of restrictions and lower rates of the virus, meaning that people were more willing to use NHS services. But the UK has faced further lockdowns in the autumn and winter of 2020, putting health services under even greater pressure. It’s currently unknown how these current restrictions will affect the number of people seeking help, but based on what we learned from the first lockdown, ensuring people can access mental health support is an urgent priority.</p>
<p><em>Those seeking mental health support can contact their GP and ask for an emergency appointment, or call 111 after hours. For immediate mental health crises, call 999 or go to A&E. For further information about getting mental health help during the pandemic, visit <a href="https://www.mind.org.uk/information-support/coronavirus/">MIND</a>.</em></p><img src="https://counter.theconversation.com/content/153359/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Steeg receives funding from UK Research and Innovation (grant reference grant COV0499). The study was also funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre.</span></em></p>During the first lockdown, the number of people seeking help for depression, anxiety and self-harm dropped by up to 48% in some cases.Sarah Steeg, Presidential Research Fellow, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1284332020-01-02T09:34:17Z2020-01-02T09:34:17ZEcotherapy aims to tap into nature to improve your wellbeing<figure><img src="https://images.theconversation.com/files/306330/original/file-20191211-95111-14vby67.jpg?ixlib=rb-1.1.0&rect=23%2C0%2C5165%2C3500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Ecotherapy' might be one promising form of mental health treatment.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/seniors-hiking-nature-on-autumn-day-151661894">Patrizia Tilly/ Shutterstock</a></span></figcaption></figure><p>As many as <a href="https://www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwide">one in six adults</a> experience mental health problems like depression or anxiety every week. And not only is mental ill-health one of the most <a href="https://www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwide">common causes of disease</a> worldwide – it’s also <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/#.Xe_REOj7TIV">on the rise</a>. Finding ways to improve mental health is therefore essential.</p>
<p>One type of therapy that is starting to become more popular is “<a href="https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health/about-ecotherapy-programmes/#.XeZgeHd2s2w">ecotherapy</a>”; which advocates claim can improve mental and physical wellbeing. Sometimes referred to as <a href="https://www.taylorfrancis.com/books/e/9781315750941">green exercise</a> or <a href="https://greencarecoalition.org.uk/about/">green care</a>, this type of formal therapeutic treatment involves being active in natural spaces. It’s also sighted to be one of <a href="https://metro.co.uk/2019/11/22/wellness-trends-set-to-be-big-for-2020-11202429/">2020’s biggest wellness trends</a>, though the practice is <a href="https://www.emerald.com/insight/content/doi/10.1108/17465729200800020/full/html">far from new</a>. </p>
<p>Although definitions of ecotherapy vary, most agree it’s a regular, structured activity that is:</p>
<ol>
<li>therapist led</li>
<li>focuses on an activity (such as gardening), rather than a health outcome</li>
<li>takes place in a natural environment</li>
<li>involves interacting with and exploring the natural world, and</li>
<li>encourages social interaction. </li>
</ol>
<p>However, the key difference between ecotherapy and recreation is the <a href="https://www.taylorfrancis.com/books/e/9781315750941/chapters/10.4324/9781315750941-16">presence of a trained practitioner or therapist</a>. The role of the therapist is often overlooked, however they are key to facilitating the clients’ interactions with both the natural and social environment and setting clinical aims for the session. Examples of ecotherapy activities might include gardening, farming, woodland walks, and nature art and crafts. <a href="https://www.taylorfrancis.com/books/e/9781315750941/chapters/10.4324/9781315750941-16">Like the client</a>, the therapist actively takes part in the ecotherapy session; in fact, it’s often difficult to distinguish between the client and therapist. </p>
<p>But why do people believe ecotherapy is so beneficial to mental health? The scientific basis for ecotherapy comes from past research which has shown that natural settings are good for both mental and physical health. One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924288/pdf/1471-2458-10-456.pdf">systematic review analysed</a> the benefits of natural environments for health and found that interacting with natural settings – such as walking or running in a public park – can provide a range of health benefits, including reduced stress and improved mood, wellbeing, and self-esteem.</p>
<p>Research has also shown that natural settings also encourage <a href="https://www.tandfonline.com/doi/pdf/10.1080/17437199.2015.1022901?needAccess=true">physical activity</a>. For example, an ecotherapy gardening session not only involves interacting with nature but also the <a href="https://www.tandfonline.com/doi/full/10.1080/01924788.2013.784942?scroll=top&needAccess=true">moderate-vigorous</a> physical activity associated with gardening. Studies show that physical activity in natural settings has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710158/pdf/2046-7648-2-3.pdf">greater health benefits</a> compared to physical activity in other environments. Some of <a href="https://www.routledge.com/Physical-Activity-A-Multi-disciplinary-Introduction-1st-Edition/Draper-Stratton/p/book/9781138696624">these benefits include</a> lower stress and improved mood.</p>
<p>Ecotherapy might also provide opportunities to socialise, giving another reason for its use as a mental health treatment. Research shows that <a href="https://www.scie-socialcareonline.org.uk/loneliness-the-state-were-in-a-report-of-evidence-compiled-for-the-campaign-to-end-loneliness/r/a11G00000017wQrIAI">loneliness and social isolation</a> are twice as harmful to health as obesity. They’re also more harmful than <a href="https://www.scie-socialcareonline.org.uk/loneliness-the-state-were-in-a-report-of-evidence-compiled-for-the-campaign-to-end-loneliness/r/a11G00000017wQrIAI">physical inactivity</a> and are as damaging to our health as smoking <a href="https://www.scie-socialcareonline.org.uk/loneliness-the-state-were-in-a-report-of-evidence-compiled-for-the-campaign-to-end-loneliness/r/a11G00000017wQrIAI">15 cigarettes daily</a>. Socialising is also associated with <a href="https://www.tandfonline.com/doi/abs/10.1080/09603123.2015.1007841">higher life expectancy</a>, with research indicating a 50% increased likelihood of survival in elderly people who have <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316">strong social relationships</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/306332/original/file-20191211-95130-1cmk4nz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306332/original/file-20191211-95130-1cmk4nz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306332/original/file-20191211-95130-1cmk4nz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306332/original/file-20191211-95130-1cmk4nz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306332/original/file-20191211-95130-1cmk4nz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306332/original/file-20191211-95130-1cmk4nz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306332/original/file-20191211-95130-1cmk4nz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Increased socialisation during ecotherapy sessions is beneficial to mental health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adventure-travel-tourism-hike-people-concept-350010896">Syda Productions/Shutterstock</a></span>
</figcaption>
</figure>
<p>Ecotherapy can also give people a sense of achievement and purpose. It can <a href="https://www.taylorfrancis.com/books/e/9781315750941/chapters/10.4324/9781315750941-16">provide structure and routine</a> to people who might not have these in their lives, perhaps because of their poor mental health. Having structure and routine is one aspect of being employed that research shows is <a href="https://www.who.int/mental_health/media/en/712.pdf">beneficial to mental health</a>. </p>
<p>The therapist is not only key to facilitating the clients’ involvement in the natural and social environments; but also ensuring that each of the ecotherapy sessions have a <a href="https://www.taylorfrancis.com/books/e/9781315750941/chapters/10.4324/9781315750941-16">defined purpose</a>. It is common for both the client and therapist to be working towards achieving this aim. For example, in the case of an ecotheraphy gardening project the aim might be to develop a community garden. In recreation activities the specific environment, types and frequency of social interaction and purpose of the chosen activity are all driven by the participant. </p>
<h2>The evidence for ecotherapy</h2>
<p>Currently, much of the evidence showing the benefits of ecotherapy comes from qualitative data. For example, <a href="https://www.emerald.com/insight/content/doi/10.5042/mhrj.2010.0366/full/html">one study interviewed people</a> referred to mental health services to understand the effects of ecotherapy. The programme reportedly improved physical and mental health, and provided daily structure and routine. It also allowed participants to learn new skills and socialise. But, there was no statistical data to support these findings. This means the study’s findings were based solely on the reported experiences of the participants, which might not provide an accurate picture of the effect ecotherapy would have on the wider population.</p>
<p>Despite this, research into ecotherapy’s benefits is growing. <a href="https://www.mind.org.uk/media/354166/Ecominds-effects-on-mental-wellbeing-evaluation-report.pdf">One in-depth analysis</a> looked at nine different ecotherapy programmes. It found that people who had participated in any type of ecotherapy programme had significant improvements in self-esteem, wellbeing and social inclusion from the start of their treatment, and also felt more connected to nature. Participants also had significant improvements in mood, with feelings of anger, tension, depression, and confusion reduced after just one ecotherapy session.</p>
<p>Other studies have suggested <a href="https://journals.ashs.org/horttech/view/journals/horttech/20/6/article-p971.xml">reduced physiological stress</a>, and <a href="https://journals.sagepub.com/doi/pdf/10.1177/1403494810396400">improvements</a> in anxiety, depression, mood, and self-esteem in people with a <a href="https://www.sciencedirect.com/science/article/pii/S1569186111700079">range of psychiatric illnesses</a>, including bipolar disorder, major depression, and better wellbeing and increasaed social engagement for <a href="https://journals.sagepub.com/doi/10.1177/1533317510385810">people with dementia</a> who took part in a gardening programme. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anxiety-and-depression-why-doctors-are-prescribing-gardening-rather-than-drugs-121841">Anxiety and depression: why doctors are prescribing gardening rather than drugs</a>
</strong>
</em>
</p>
<hr>
<p>Despite increasing reports of the health benefits of ecotherapy, there is still a need for high quality scientific evidence to <a href="https://www.taylorfrancis.com/books/e/9781315750941/chapters/10.4324/9781315750941-16">better support its effectiveness</a>. However, large-scale, randomised, and rigorously controlled research is difficult, as all ecotherapy projects are unique. Each involve different activities and environments, varying exercise intensities, and participants may have a range of health needs. However, the versatility and uniqueness of these programmes might be the very thing that contributes to positive health outcomes.</p><img src="https://counter.theconversation.com/content/128433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carly Wood does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Proponents of ecotherapy say getting back to nature can improve our mental health, wellbeing, and self-esteem.Carly Wood, Lecturer in Nutrition and Exercise Science, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1199492019-11-25T14:29:34Z2019-11-25T14:29:34ZWhat life was like in mental hospitals in the early 20th century<figure><img src="https://images.theconversation.com/files/302687/original/file-20191120-483-3agka6.jpg?ixlib=rb-1.1.0&rect=3370%2C2635%2C3549%2C2163&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nurses from Cefn Coed Hospital walk across the grounds. </span> <span class="attribution"><span class="source">Swansea Bay University Health Board Heritage Team, courtesy of Swansea Evening Post</span>, <span class="license">Author provided</span></span></figcaption></figure><p>When we think of mental hospitals, images of <a href="https://www.sciencemuseum.org.uk/objects-and-stories/victorian-mental-asylum">Gothic Victorian asylums</a>, or the fluorescent-lit linoleum of modern psychiatric wards often spring to mind. Many of our ideas about what it was like to live and work in these institutions come from films like <a href="https://www.imdb.com/title/tt0073486/">One Flew Over the Cuckoo’s Nest</a>, which portray mental hospitals as cruel and authoritarian. </p>
<p>These institutions dominated the care landscape of Britain until the <a href="https://en.wikipedia.org/wiki/National_Health_Service_and_Community_Care_Act_1990">Community Care Act 1990</a> permanently closed psychiatric hospitals and relocated patients into community settings. All but a few mental hospitals have now been demolished or <a href="https://thelincolnite.co.uk/2014/07/former-lincoln-asylum-turned-183-luxury-homes/">turned into housing</a>. </p>
<p>But although these institutions were a vital part of communities across the UK, we have limited knowledge of what it was like to live and work there. An exhibition on the <a href="http://www.wales.nhs.uk/sitesplus/902/news/50289">history of Cefn Coed Hospital</a> in Swansea from 1932-2018 provided some much-needed insight into what life was like. It found that despite cruelties, errors and suffering, the hospital was also a rich community environment that was full of life, energy and optimism.</p>
<p>During the 19th century, a <a href="http://www.bbc.co.uk/history/familyhistory/bloodlines/familysecrets.shtml?entry=county_asylum_act&theme=familysecrets">series of parliamentary acts</a> demanded that all counties in the United Kingdom provide a mental asylum. Prior to that, “pauper” lunatics were locked away in workhouses or prisons. Between 1808 and 1890, a network of county asylums emerged that provided increasingly specialised care. Swansea was therefore well behind other counties when work finally began on Cefn Coed Mental Hospital in 1914, only to stop again with the onset of the first world war. </p>
<p>When work finally resumed in 1929, psychiatry had developed into a modern and more optimistic field with the aim of <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/kathleen-jones-asylums-and-after-a-revised-history-of-the-mental-health-services-from-the-early-18th-century-to-the-1990s-1993/2580E4D636C956D09BC0E4DF9A5CE77C">both care and cure</a>. The term “hospital” now replaced “asylum”, “nurse” replaced “attendant” and “lunatics” were now “patients”. Cefn Coed Hospital emerged in the interwar years as an oddity because it was designed as a Victorian asylum, but opened as a modern psychiatric hospital. </p>
<p>Cefn Coed Hospital finally opened in 1932, on an elevated, 130-acre fenced site in the west of Swansea. It included a main hospital building and convalescent villas, a chapel, bakery, nurse’s home and eight cottages for staff who were required to live on site. </p>
<p>During the early years, patients were admitted from the local Swansea and Merthyr area and were paid for by the county. Patients were admitted with a range of diagnoses - including psychosis, depression and anxiety disorders - terms that were still evolving in clinical language. Like many hospitals of this era, it also housed people with long-term learning disabilities and elderly people with dementia.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/302692/original/file-20191120-496-mdgq6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302692/original/file-20191120-496-mdgq6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302692/original/file-20191120-496-mdgq6z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302692/original/file-20191120-496-mdgq6z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302692/original/file-20191120-496-mdgq6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=570&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302692/original/file-20191120-496-mdgq6z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=570&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302692/original/file-20191120-496-mdgq6z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=570&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fresh air therapy is just one of a range of holistic treatments used in early 20th-century mental hospitals.</span>
<span class="attribution"><span class="source">Swansea Bay University Health Board Heritage Team, courtesy of Swansea Evening Post</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The optimism of this modern era was clear in the efforts devoted to holistic treatments and occupational health. From its opening, a hospital farm was established in the grounds to provide open-air activity for patients in their recovery stages, and to supply the kitchens. In the first year of operations, 40 patients and nine gardening staff cultivated 32 acres of house garden, 28 acres of ornamental garden and 26 acres of farmland. The hospital also kept sheep, horses and chickens. The hospital farm, along with many others like it, closed in 1956 following the first of many parliamentary decisions to scale back funding. </p>
<p>The modernising of mental hospitals affected not just medical treatment but encouraged greater focus on occupation and entertainment. By the mid-1930s, mental hospitals across England and Wales had cinemas, hosted dances, and sports clubs as part of an effort to make <a href="https://brill.com/view/book/edcoll/9789042026322/B9789042026322-s016.xml">entertainment and occupation a central part</a> of recovery and rehabilitation. </p>
<p>At the centre of Cefn Coed Hospital was William Owen Hall, an ornate and formal entertainment space which could accommodate 600 patients for dining, musical performances, and dances, and which also had its own projection room.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291301/original/file-20190906-175714-1y8y3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291301/original/file-20190906-175714-1y8y3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291301/original/file-20190906-175714-1y8y3h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291301/original/file-20190906-175714-1y8y3h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291301/original/file-20190906-175714-1y8y3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291301/original/file-20190906-175714-1y8y3h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291301/original/file-20190906-175714-1y8y3h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">William Owen Hall, where cinema screenings and dances were a regular part of entertainment for patients and staff.</span>
<span class="attribution"><span class="source">Swansea Bay University Health Board Heritage Team, courtesy of Swansea Evening Post</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Saturday evening cinema screenings became a regular feature at Cefn Coed. By the 1970s, a motorised disco ball had been hung in the centre of the hall and an entertainment officer was responsible for booking regular artists and bands – including pop group Brotherhood of Man and Welsh singer Max Boyce. </p>
<p>Clive Prior, a nurse at Cefn Coed <a href="http://www.wales.nhs.uk/sitesplus/902/news/50289">interviewed for the exhibition</a>, described weekly dances, concerts, Christmas pantomimes and an annual New Year’s Eve dance. These shared social experiences gave a more human dimension to asylum life. A short entry in the hospital’s magazine in 1972 describes a Tramp’s Ball, in which the wards were transformed into a nightclub, with a mock fish and chip bar serving newspaper-wrapped fish and chips to patients. </p>
<p>By the 1990s, entertainment waned as budgets diminished and the focus shifted away from long-term care. Without proper maintenance, William Owen Hall fell into disrepair. When the floor collapsed, the hall was closed around ten years before the rest of the hospital. </p>
<p>Mental hospitals appear to us today in a state of ghostly dereliction, after years of neglect and a generation of bad press. But behind these images lies a history that is rich in everyday efforts to make institutional life more liveable. In the early years of operation, each ward at Cefn Coed had fresh flowers, their own pet canary, and a supply of books that was changed every fortnight. It was not unusual for mental hospitals during this era to have their own sports teams, education departments, and art and music classes. With mental health continuing to receive more attention than ever before, perhaps Cefn Coed’s history of care and community can help guide future treatments.</p><img src="https://counter.theconversation.com/content/119949/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This article is the result of collaborations with Swansea Bay University Health Board Arts in Health and Heritage Team who were funded by a Heritage Lottery Fund grant to develop an exhibition on the history of working life at Cefn Coed Hospital at Swansea Museum. Funding was also provided by Aberystwyth and Swansea Universities, HEFCW, Oriel Science, and CherishDe - Swansea University's Digital Economies Research Centre. </span></em></p>A portrait of Cefn Coed Hospital, which operated in Wales between 1932-2018, provides unique insight into life at a mental hospital.Elizabeth Gagen, Senior Lecturer in Human Geography, Aberystwyth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1073872019-02-04T11:23:34Z2019-02-04T11:23:34ZArt psychotherapy can help people explore themselves through museum exhibits<figure><img src="https://images.theconversation.com/files/256852/original/file-20190201-103164-dyk3zr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Museum objects can evoke powerful emotions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-united-kingdom-june-5-2014-203045116?src=BPP-xE8aYWozTqiw5uiymA-1-9">villorejo/Shutterstock</a></span></figcaption></figure><p>The idea of receiving psychotherapy in a museum might seem unusual. However, art psychotherapists are increasingly looking towards the rich resources of museums and galleries to aid them in their clinical work. <a href="http://www.baat.org">Art therapy, or art psychotherapy</a>, sees people expressing their feelings and experiences through art, as well as (or instead of) through words. It can be used to help people of all ages, living with a wide range of emotional or physical conditions.</p>
<p>NHS art psychotherapists usually work in designated therapy rooms in hospitals or outpatient centres, but for <a href="https://www.tandfonline.com/doi/abs/10.1080/17454832.2017.1380056?journalCode=rart20">our recent study</a> we wanted to explore how conducting art psychotherapy in a museum could be beneficial to a group with complex mental health difficulties. Research has found that people “<a href="https://www.taylorfrancis.com/books/e/9781135640385/chapters/10.4324%2F9781410606624-19">see themselves</a>” in museum objects, and that reflecting on our responses to objects <a href="https://www.sciencedirect.com/science/article/abs/pii/S0197455610001383">can tell us something about ourselves</a>. For example, an object can evoke powerful emotions, or symbolise an aspect of our current or past experiences. So we wanted to tap into museum objects to help our participants develop greater self-understanding. To our knowledge, this was the first time that museum objects would be used for this kind of art psychotherapy for adults accessing NHS mental health services. </p>
<p>We predicted, based on findings from <a href="http://clok.uclan.ac.uk/3362/3/3362_froggett_final_report.pdf">arts in health</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0197455610001383">art therapy</a> case studies, that a museum setting could help to inspire creativity among the group members. There is also <a href="https://www.sciencedirect.com/science/article/abs/pii/S0197455613000841">evidence</a> that a non-clinical space <a href="http://canadianoncologynursingjournal.com/index.php/conj/article/view/437">could help people</a> to feel more connected to each other and their local community, and less “set apart” by their mental health difficulties. </p>
<p>Working for <a href="https://www.2gether.nhs.uk/">²gether NHS Foundation Trust</a>, we delivered a programme for seven adults aged 18-25 at two museums in Gloucester over 18 weeks. Each session lasted for 90 minutes and started and finished in a private education room at the museums. </p>
<p>The group members explored the museum exhibitions and then made some art using a variety of different materials. At the beginning, we suggested some tasks (such as finding three objects to represent their past, present and future) but as the weeks went on they increasingly found objects they connected with. At the end of each session there was time for verbal reflections, as a group.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/256865/original/file-20190201-110834-tau8t9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256865/original/file-20190201-110834-tau8t9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256865/original/file-20190201-110834-tau8t9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256865/original/file-20190201-110834-tau8t9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256865/original/file-20190201-110834-tau8t9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256865/original/file-20190201-110834-tau8t9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256865/original/file-20190201-110834-tau8t9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Each art work or artefact can mean something different to everyone who views it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/otterlo-netherlands-august-8-2012-visitor-271886372?src=Y7Npb7wMsnzjf1k2T1lwTA-1-22">Vladimir Wrangel/Shutterstock</a></span>
</figcaption>
</figure>
<p>Speaking to the group members after the final session, and having observed the sessions as they went along, we discovered just how effective the use of museum objects can be, particularly for self-exploration. Susie (all names have been changed to protect identities) saw her desire to “wipe away the past and start again” reflected in a Victorian writing slate, and drew a modern-day device for making images and then erasing them. She also took inspiration from a model of a cross-section through the earth, drawing herself as a person with three layers and labelling it “what I show to others”, “what those close to me get to see”, and “what I feel about myself that hardly anyone knows”.</p>
<p>Another person who attended the sessions, Ellie, was inspired by a repaired Roman pot. She made a collage which expressed her sense that she was “piecing together bits in my life”. Caroline, meanwhile, made a timeline of her life (including some very traumatic experiences), saying that “I wouldn’t have done it if I hadn’t seen the timeline in the exhibition, but it felt very significant to do it – like putting things in place before moving on”. </p>
<p>Although not all the group members made artworks during the sessions, they still found therapeutic value in their encounters with the objects in the museum. Tasha, for example, was not always able to create art in the group but still reported that “using objects for self-reflection was useful”.</p>
<p>Several of the group members said that the exhibitions encouraged playfulness, as well as inspiring their creative work, and that this “meant that the group loosened up”. Some said that they felt less defined by their mental health difficulties because the group was not held on NHS premises. Our museum sessions also encouraged independence and helped participants to feel valued and connected to the world outside mental health services. </p>
<p>As one participant put it:</p>
<blockquote>
<p>You feel like you are a real person working on your own personal goals rather than just a patient going through treatment…You wouldn’t necessarily have thought that pulling objects out of museum boxes and wandering around looking at artefacts would help you feel better or make progress in recovery, but you would be surprised.</p>
</blockquote>
<p>Building on this work, art psychotherapists from the ²gether Trust have since delivered two more museum-based therapy groups, for adults of all ages, and we have written about <a href="https://www.tandfonline.com/doi/full/10.1080/17454832.2018.1564346">our experiences</a> of how we worked in these settings. We are keen to continue to “flex” our practice, stepping out of the usual therapy spaces, and to encourage fellow art psychotherapists to explore how this rich therapeutic resource can help other people too.</p><img src="https://counter.theconversation.com/content/107387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Additional funding for this pilot group was provided by NHS Gloucestershire Clinical Commissioning Group through their Cultural Commissioning programme, run in partnership with Create Gloucestershire. This article was written with input from Fiona Harrison, currently Art Psychotherapist at Somerset Partnership NHS Foundation Trust.</span></em></p>More than just home to artworks or historical artefacts, museums and galleries can help people reflect on their own health issues.Alison Coles, Lecturer In Art Psychotherapy, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/839302017-11-02T02:55:11Z2017-11-02T02:55:11ZBrain science should be making prisons better, not trying to prove innocence<figure><img src="https://images.theconversation.com/files/192826/original/file-20171101-19858-1aguezj.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Neuroscience can help incarcerated brains.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/silhouette-of-a-man-in-window-143580/">Donald Tong</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Every week, I wait for the cold steel bars to close behind me, for count to be called, and for men who have years – maybe the rest of their lives – to spend in this prison to come talk with me. I am a clinical psychologist who studies chronic antisocial behavior. My staff and I converted an office in a Connecticut state prison into research space that allows us to measure neural and behavioral responses.</p>
<p>Recently, Joe, a man serving a life sentence, came into our prison lab. Before I could even review our research consent form, he said, “You know it is all about the brain.” Joe asked if we could provide evidence that “something” in his brain was responsible for his crime. If not, could we just “zap” his brain to remove bad “stuff,” like on TV? </p>
<p>In that moment, I realized that he, like many other inmates and people in the general public, holds unfounded expectations about the wonders of neuroscience. They believe that researchers like me now can so clearly trace connections between brain and behavior that we can use our knowledge to determine guilt or innocence, decide criminal sentences or definitively assess risk and needs.</p>
<p>These expectations place a great burden on a science still in its infancy. There are many concerns about the appropriate use of neuroscience in a criminal justice setting. But there are plenty of well-supported neuroscientific findings that could make a real difference in our correctional system right now – both for those who are incarcerated and everyone else.</p>
<h2>What’s still neuroscience fiction</h2>
<p>Despite what Hollywood portrays in TV shows like “<a href="https://www.nbc.com/law-order?nbc=1">Law & Order</a>” or in movies like “<a href="http://sideeffectsmayvary.com">Side Effects</a>” and “<a href="http://www.imdb.com/title/tt0181689/">Minority Report</a>,” much of the science that makes for good entertainment doesn’t actually exist.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=342&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=342&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=342&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=430&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=430&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192836/original/file-20171101-19889-1of5lxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=430&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘Is it or is it not true that your brain made you do it?’</span>
<span class="attribution"><a class="source" href="https://allthingslawandorder.blogspot.com/2011/12/law-order-svu-spiraling-down-recap.html">NBC</a></span>
</figcaption>
</figure>
<p>For instance, despite Joe’s request, we can’t just peek into a brain and see clear evidence of innocence or guilt. A brain scan can’t show beyond a reasonable doubt that certain structures or abnormalities affected the mental state of a particular individual at the time of a crime. Electrical activity in the brain as measured by an EEG can’t distinguish between criminal conduct and common forms of antisocial behavior such as lying or cheating – qualitatively different behaviors. </p>
<p>As of yet, there’s no neuroscience measure that can predict whether an individual will engage in criminal conduct in the future. And neuroscience is no better at providing mitigating evidence during sentencing than other more reliable and less expensive tools, like a <a href="https://doi.org/10.1007/s10964-008-9343-2">history</a> of <a href="http://dx.doi.org/10.1017/S0954579498001539">exposure</a> to <a href="https://doi.org/10.1177/1541204013506920">violence</a>. </p>
<p>Unfortunately, when neuroscientific assessments are presented to the court, they <a href="http://www.jstor.org/stable/27977480">can sway juries, regardless of their relevance</a>. Using these techniques to produce expert evidence doesn’t bring the court any closer to truth or justice. And with a single brain scan costing thousands of dollars, plus expert interpretation and testimony, it’s an expensive tool out of reach for many defendants. Rather than helping untangle legal responsibility, neuroscience here causes an even deeper divide between the rich and the poor, based on pseudoscience.</p>
<p>While I remain skeptical about the use of neuroscience in the judicial process, there are a number of places where its findings could help corrections systems develop policies and practices based on evidence.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192886/original/file-20171101-19850-mc9vhu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A prisoner poses inside his solitary confinement cell at the Washington Corrections Center, where he spends 23 hours a day alone.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Solitary-Confinement-Nature/fb8738ef11674a6ea9c7855046a62f0e/1/0">AP Photo/Ted S. Warren</a></span>
</figcaption>
</figure>
<h2>Solitary confinement harms more than helps</h2>
<p>Take, for instance, the use within prisons of solitary confinement as a punishment for disciplinary infractions. In 2015, the Bureau of Justice reported that nearly 20 percent of federal and state prisoners and 18 percent of local jail inmates <a href="https://www.bjs.gov/index.cfm?ty=pbdetail&iid=5433">spent time in solitary</a>. </p>
<p>Research consistently demonstrates that <a href="https://doi.org/10.1176/ajp.140.11.1450">time spent in solitary</a> increases the chances of <a href="https://doi.org/10.1177/0011128702239239">persistent emotional trauma and distress</a>. <a href="https://www.justice.gov/archives/dag/file/815551/download">Solitary can lead to</a> hallucinations, fantasies and paranoia; it can increase anxiety, depression and apathy as well as difficulties in thinking, concentrating, remembering, paying attention and controlling impulses. People placed in solitary are more likely to engage in self-mutilation as well as exhibit chronic rage, anger and irritability. The term “isolation syndrome” has even been coined to capture the <a href="https://www.washingtonpost.com/opinions/barack-obama-why-we-must-rethink-solitary-confinement/2016/01/25/29a361f2-c384-11e5-8965-0607e0e265ce_story.html">severe and long-lasting effects</a> of solitary.</p>
<p>At first glance, replacing solitary confinement with other forms of disciplinary action may appear only to improve the lives of inmates, always a hard sell for the public and for some politicians. But keeping prisoners isolated for 23 hours a day also poses grave dangers for correctional personnel who need to manage and interact with someone who is now even more likely to act out, be less able to follow direction and who perceives the environment in a distorted way.</p>
<p>The use of solitary actually exacerbates the problems it tries to address. And when inmates are released to the community, they bring all the negative consequences of this treatment with them.</p>
<h2>Living within a prison environment</h2>
<p>A neuroscience-informed approach would also suggest a number of improvements to today’s overburdened American prisons.</p>
<p>The <a href="https://nationinside.org/campaign/prison-ecology/">Prison Ecology Project</a> maps the intersection of mass incarceration and environmental degradation. It reports that at least 25 percent of California state prisons have been cited for major water pollution problems. In Colorado, 13 prisons are located in contaminated areas that violate standards set by the Environmental Protection Agency. And in several other states there are known ecological violations in overpopulated prisons.</p>
<p><a href="https://doi.org/10.1038/nature10190">Overcrowding contributes to deficits</a> in the neural mechanisms needed for managing stress. <a href="http://www.noiseandhealth.org/text.asp?2002/5/17/35/31836">Noise pollution increases stress hormones and cardiovascular risks</a>. Ecological toxins, such as inadequate sewage and waste disposal, poor water quality, and the presence of asbestos and lead produce deficits and dysfunctions in <a href="https://doi.org/10.1146/annurev-publhealth-031912-114413">brain</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1280407/">behavior</a>. These factors negatively affect brain regions responsible for emotion, cognition and behavioral control and worsen already problematic behavioral tendencies.</p>
<p>Importantly, the effects are felt not only by the inmates. Prison personnel work long hours in the same environment. <a href="https://www.ncjrs.gov/pdffiles1/Digitization/208756NCJRS.pdf">Correctional officers</a> have higher rates of mortality, stress disorders, divorce, substance abuse <a href="http://dx.doi.org/10.1080/13811119708258270">and suicide</a> than workers in many other occupations. They, along with inmates, are being poisoned by an environment that is toxic on a number of levels. Their families and communities feel the effects, too, when these workers return home suffering the physical and mental health consequences of such dangerous conditions.</p>
<h2>Neuroscience approaches to mental health</h2>
<p>On any given day, <a href="http://www.treatmentadvocacycenter.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf">up to a fifth</a> of incarcerated American adults <a href="https://www.ncbi.nlm.nih.gov/pubmed/18086741">suffer from serious mental illness</a>. Personality, mood, trauma and psychotic disorders are prevalent; substance use disorders are widespread. <a href="https://www.appi.org/American_Psychiatric_Association_Publishing_Textbook_of_Forensic_Psychiatry_Third_Edition">These disorders</a> often are linked to <a href="https://doi.org/10.1192/bjp.180.6.490">impulsivity and violence</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=571&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=571&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192887/original/file-20171101-19894-6rvd72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=571&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some prison counseling programs try to help mentally ill inmates learn more about their conditions.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Prisons-Mental-Health/2335976428be4dbc9b0bd649a2dd4265/7/0">AP Photo/Mike Groll</a></span>
</figcaption>
</figure>
<p>Neuroscience can help replace the current “one size fits all” approach to treating the sorts of personality and substance use disorders that affect so many incarcerated individuals. These disorders have various subtypes, each with different underlying mechanisms that have different appropriate treatments. Whether through the use of psychotherapy or psychopharmacology, treating them all the same can actually worsen symptoms and contribute to recidivism.</p>
<p>My own research provides one successful example of how neuroscience can help practitioners target treatment to specific skills deficits particular to various offenders. We found that six weeks of computerized cognitive training aimed at helping inmates with specific cognitive-affective dysfunctions – such as paying attention to different pieces of information in their environment or acting without overreacting to emotion – resulted in <a href="https://doi.org/10.1177/2167702614560744">significant neural and behavioral changes</a>. By matching the treatment to the underlying cognitive-affective dysfunctions, we were able to change the neural and behavioral problems of some of the most hard-to-treat offenders.</p>
<p>Similarly, there is evidence that <a href="https://doi.org/10.1016/j.psychres.2012.04.033">strategies targeting empathy</a> in specific types of offenders lead to lasting behavior change, even in populations considered to be the most recalcitrant.</p>
<p>A more personalized treatment approach is very cost-effective, both in terms of resource utilization and its effect on recidivism. Unfortunately, it’s not currently the norm in most prison mental health programs or, for that matter, in treatment outside the prison system. </p>
<h2>Using the solid neuroscience we do have</h2>
<p>So, for now, Joe, I’m sorry we cannot help “prove” your lack of criminal intent and I don’t think that we are going to be “zapping” your brain any time soon. </p>
<p>But neuroscience can improve the current criminal justice landscape, which is plagued by racial, ethnic and economic disparities. Strategies based on robust, empirical neuroscientific evidence can provide win-win outcomes for correctional personnel, inmates and society at large. Improving conditions for all those who work and live on the inside will also improve public safety when inmates are released.</p><img src="https://counter.theconversation.com/content/83930/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arielle Baskin-Sommers receives funding from National Institutes of Health and the Harry Frank Guggenheim Foundation. </span></em></p>Hollywood pushes a fantasy version of what neuroscience can do in the courtroom. But the field does have real benefits to offer, right now: solid evidence on what would improve prisons.Arielle Baskin-Sommers, Assistant Professor of Psychology, Yale UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/657632016-09-22T11:30:25Z2016-09-22T11:30:25ZThe trauma caused by violent protests can be acute, but is largely ignored<figure><img src="https://images.theconversation.com/files/138498/original/image-20160920-12481-1du68k5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Reuters/Siphiwe Sibeko</span></span></figcaption></figure><p><em>Public protests are a <a href="https://theconversation.com/what-rising-protests-in-south-africa-say-about-attitudes-towards-local-government-61109">regular feature</a> in many countries. People routinely take to their cities’ streets to make demands. Some protests turn violent. Physical injuries are common. But what about the less obvious, unintended emotional consequences? Professor of psychiatry Christopher P Szabo explains the trauma that protesters – and even onlookers – can experience.</em> </p>
<p><strong>What does research tell us about the links between protests and trauma?</strong></p>
<p>There is not a significant amount of empirical research data that shows the link between violent protest and emotional trauma. But <a href="http://onlinelibrary.wiley.com/doi/10.1002/jts.22105/full">recent research</a> looking at the protests in <a href="http://www.bbc.com/news/world-us-canada-30193354">Ferguson, Missouri in the US</a>, where demonstrators took to the streets after the state failed to charge a white police officer who shot and killed 18-year-old Michael Brown, showed that exposure to violence during the protests resulted in high levels of distress. </p>
<p>The study involved both the community and police officers and wanted to examine how the proximity to community violence would have an impact on mental health, specifically post traumatic stress disorder and depressive symptoms as well as anger. While it seems that community members reported more symptoms than police officers, the overall finding was that exposure to such violence led to high levels of distress among those directly exposed.</p>
<p>The research suggested that mental health interventions might be necessary for some members of the community who were directly exposed to the violence that ensued.</p>
<p><strong>What are the risks – beyond the physical – for people who are directly involved in protest actions that turn violent? What sort of trauma might they experience?</strong></p>
<p>It is possible that people who are involved or directly exposed to violent situations will experience emotional upset. In more vulnerable people, such as those who have a more anxious disposition, this might lead to them developing features of an acute stress disorder.</p>
<p><a href="http://psychcentral.com/disorders/acute-stress-disorder-symptoms/">Acute Stress Disorder</a> could arise in response to exposure to a traumatic event such as threatened or actual violence. Typically, the person feels anxious and relives the event through involuntary memories, dreams or flashbacks which are experienced as intrusive and distressing. They may occur in response to reminders of the event. Symptoms would appear after exposure and, if a diagnosis is made, would need to have existed for at least three days but not lasted for more than a month.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"778125761366593537"}"></div></p>
<p><strong>Can people who are not directly involved in these protests suffer trauma - through, say, watching protests unfold or hearing their friends’ stories?</strong></p>
<p>People who are not directly exposed to a trauma can still experience “vicarious” traumatisation. This has been described in a range of situations, such as among college students in the wake of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/14975780">September 11 attacks in New York</a>. </p>
<p>Similarly, children who watched the <a href="http://ajp.psychiatryonline.org.psychiatryonline.org/doi/full/10.1176/ajp.156.10.1536">Challenger space shuttle explode</a> in 1986 also experienced this vicarious traumatisation. </p>
<p>It appears that geographical proximity without being directly exposed can influence someone’s emotional state. In addition, connectedness to the site of an event as well as the extent of media exposure might also have an influence. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"778126816590561281"}"></div></p>
<p><strong>How does trauma manifest itself? What signs should people be looking out for in themselves and others?</strong></p>
<p>It could manifest as anxiety along with sleep and concentration problems. It could also affect the person’s daily functions. And they may, for example, avoid the place where the incident happened.</p>
<p><strong>What should they do to deal with trauma?</strong></p>
<p>When someone starts to experience these feelings, it is important to share these changes with someone they trust. They should also be open to the possibility of counselling if the changes persist. They should also realise that being unsettled may be a perfectly normal response. The extent to which there is persistence and impact on the way that they function would influence the need to potentially seek professional assistance.</p><img src="https://counter.theconversation.com/content/65763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher P. Szabo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People risk being physically harmed during violent protests. But there is also an emotional element at play.Christopher P. Szabo, Professor and Head, Department of Psychiatry, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/490212015-10-15T10:44:34Z2015-10-15T10:44:34ZThe problem with most NHS-recommended mental health apps? There’s no evidence they actually work<figure><img src="https://images.theconversation.com/files/98431/original/image-20151014-15162-114zxpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Easy to access, hard to prove</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The unmet need for mental health services is reaching an <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/thousands-attempt-suicide-while-on-nhs-waiting-list-for-psychological-help-9734284.html">unprecedented level</a> thanks to rising demand and continually falling NHS resources. <a href="http://www.mentalhealth.org.uk/content/assets/PDF/publications/manifesto-better-mental-health-manifesto.pdf">Monthly referrals</a> to community mental health teams increased by 13% in 2013, and 16% in the case of crisis services. Yet more than 200 full-time NHS mental health doctors and 3,600 nursing positions <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/cuts-leave-nhs-mental-health-services-dangerously-close-to-collapse-9667370.html">have been lost</a> over the same period.</p>
<p>As so many of us now have access to and rely on smartphones, one increasingly popular solution to this problem is the use of apps to provide automated forms of mental health treatment. Apps are relatively inexpensive, widely available and, unlike traditional NHS mental health services, can be used by more than one person at any specific time. Some apps, such as <a href="https://www.bigwhitewall.com/home/how-it-works.aspx#.Vh49G_lViko">Big White Wall</a>, offer a community support service with access to trained healthcare professionals at any time of the day. Others provide automated <a href="http://thriveport.com/products/moodkit/">cognitive behavioural therapy</a>(CBT) and methods for <a href="https://www.moodscope.com/">mood tracking</a> or <a href="http://www.happyhealthyapp.com/">self-reflection</a>.</p>
<p>Only a half of people <a href="http://www.mind.org.uk/media/280583/We-Need-to-Talk-getting-the-right-therapy-at-the-right-time.pdf">have a choice</a> about when they receive conventional mental health therapy and just 13% can choose where. Using mental health apps would allow people to access a form of treatment on their terms and could even extend therapy to people who are currently unable to engage with it. This could include the teenager who is too anxious or stigmatised to discuss his condition face-to-face, the armed forces serviceman who needs anonymity, or the single mother who struggles to schedule an appointment around her childcare and work commitments. </p>
<h2>No hard evidence</h2>
<p>The reality is that there is a large gap between the theoretical benefits of mental health apps and what they are likely to deliver in practice. Of the 27 mental health apps endorsed and recommended through the NHS health apps library, 14 are designed to treat or manage the symptoms of depression and anxiety. They are frequently described as helping users to do things like <a href="https://itunes.apple.com/gb/app/the-mindfulness-app/id417071430?mt=8">control stress</a>, <a href="http://mentalhealthpartnerships.com/resource/five-ways-to-wellbeing-app/">improve well-being</a> and <a href="http://www.blackrainbow.org.uk/">beat depression</a>.</p>
<p>Yet <a href="http://ebmh.bmj.com/content/early/2015/09/16/eb-2015-102203">only four</a> of these apps currently provide any hard evidence of results reported by <a href="https://www.bigwhitewall.com/home/how-it-works.aspx#.Vh49G_lViko">real-world users</a>. And <a href="https://www.moodscope.com/">just two</a> make use of NHS-accredited ways of measuring the effectiveness of mental health treatments, such as the <a href="http://archinte.jamanetwork.com/article.aspx?articleid=410326">Generalised Anxiety Disorder 7</a> questionnaire. This leaves a question over the effectiveness of the remaining 12 out of 14 (85%) of NHS-accredited mental health apps.</p>
<p>In 2013, there were 1,536 depression-related apps available for download but just 32 published research articles studying <a href="http://www.jmir.org/2013/6/e120/">their effectiveness</a>. This pattern of high availability and a low evidence base can also be seen in apps for treating <a href="http://www.jmir.org/2015/8/e198/">bipolar disorder</a>, <a href="http://www.sciencedirect.com/science/article/pii/S0005796714001624">bulimia nervosa</a> and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439418/">post-traumatic stress disorder</a> (PTSD).</p>
<p>But the real problem is with the apps that come with a seal of approval from a world-leading healthcare system. Accreditation by the NHS gives apps an appearance of quality, and the reputation and legitimacy of an app <a href="http://www.jmir.org/2013/4/e86/">correlates with</a> how many people are likely to download it. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98432/original/image-20151014-15137-684rs6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98432/original/image-20151014-15137-684rs6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98432/original/image-20151014-15137-684rs6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98432/original/image-20151014-15137-684rs6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98432/original/image-20151014-15137-684rs6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98432/original/image-20151014-15137-684rs6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98432/original/image-20151014-15137-684rs6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Therapy on the go.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="http://www.%0Amind.org.uk/media/280583/We-Need-to-Talk-getting-the-right-therapy-at-the-righttime.pdf">Three in ten</a> people with an untreated mental health issue choose to pay for private treatments, and apps that have yet to demonstrate any measurable benefits are a potential waste of their money. But they could also compound levels of anxiety in those with the greatest need and the least access to effective NHS-led mental health services. Unsuccessful attempts to resolve any mental health issues are only likely to make sufferers feel that no solution is possible.</p>
<p>The NHS usually provides a regulatory framework that is second to none, and winning over its guidance body, NICE, is usually seen as a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391507/">major hurdle</a> for developers of new medical products. Unfortunately, it seems as though the same level of evidence-based decision making has not been applied to the apps that the NHS has been recommending to mental health patients. </p>
<p>Luckily, it would appear that this subject is now being taken more seriously. As of October 16, the NHS health apps library will officially cease to exist and the organisation is looking for new ways to assess and regulate such products. A framework to help app developers understand what level of clinical quality and evidence they need to reach would be highly beneficial.</p>
<h2>Spotting the good ones</h2>
<p>In the meantime, there are some clear signs of quality that users can look out for to ensure mental health apps do not do more harm than good. Firstly, apps that are supported by a mental-health practitioner are on average more than <a href="http://www.sciencedirect.com/science/article/pii/S027273581200027X">twice as effective</a> as those developed without professional expertise.</p>
<p>While the NHS itself may not have enforced such rigour, well-established regulatory bodies such as NICE and the US Food and Drug Administration can help highlight apps that offer real solutions. It is also worth checking how much information the app developers provide about their products. Is there any proof that their claims of “beating depression” are anything more than marketing?</p>
<p>Finally, it is worth remembering that some mental health apps are designed with clinical quality and effectiveness in mind and provide real support to their users. For example, <a href="https://www.bigwhitewall.com/landing-pages/landingv3.aspx?ReturnUrl=%2f#.Vh5I2flViko">Big White Wall</a> boasts a recovery rate of 58%, better than the 44% recorded by the NHS’s flagship initiative to increase access to traditional mental health therapies <a href="http://www.hscic.gov.uk/catalogue/PUB14899/psyc-ther-ann-rep-2013-14.pdf">over the same period.</a>. So apps can improve people’s mental health, at a low cost and from the comfort of their own home, but only if done properly.</p><img src="https://counter.theconversation.com/content/49021/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Leigh consults to MINeD ACCESS Ltd, a a technology company delivering solution-focused brief therapy (SFBT). </span></em></p>If apps aren’t proven to make users’ mental health better they could end up making it worse.Simon Leigh, Health economist, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/371702015-10-12T03:51:41Z2015-10-12T03:51:41ZHealth Check: seven nutrients important for mental health – and where to find them<figure><img src="https://images.theconversation.com/files/98007/original/image-20151012-23288-t3ve32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While nutrient supplementation can have a role in treating certain psychiatric disorders, all kinds of nutrients should, in the first instance, be consumed as part of a balanced wholefood diet.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nakrnsm/3815441846/">PROPatrick Feller/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Dietary nutrients are critical for brain structure and function, so they have a potentially profound impact on mental health. An increasingly <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract">robust body of research</a> points to the detrimental effect of unhealthy diets and nutrient deficiencies, and to the protective value of healthy diets – along with select nutritional supplements as required – for maintaining and promoting mental health. </p>
<p>Research literature suggests dietary improvement and nutritional interventions may help reduce the risk, or even arrest the progression, of certain psychiatric disorders. <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract">Clinical studies</a> support the use of certain nutrients, which influence a range of neurochemical activities beneficial for treating mental disorders, as medicinal supplements.</p>
<p>Evidence from clinical research supports the use of several nutritional medicines for certain psychiatric disorders: omega-3 fatty acids; N-acetyl cysteine (NAC); S-adenosyl methionine (SAMe); zinc; magnesium; vitamin D; and B vitamins (including folic acid). Other natural compounds such as amino acids, plant-based antioxidants and microbiotics (derived from fermented food or laboratory synthesis) are also known to influence brain health. </p>
<p>But while some evidence supports these natural compounds as having brain chemical-modulating effects, or having a role in treating certain mental disorders, we cannot currently name particular foods as being effective for the treatment of mental illness. The best nutritional advice at this point is to cultivate an unprocessed wholefood diet, with judicious prescriptive use of nutrients (if required) based on advice from a qualified health professional. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=353&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=353&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=353&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=444&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=444&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=444&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oily fish such as sardines are the best source of omega-3 fats.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jmenj/9434507959/">Jeanne Menj/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In the meanwhile, here are seven key nutrients that may positively influence brain health, and the foods they appear in.</p>
<p><strong>1. Omega-3</strong> </p>
<p>Polyunsaturated fats (in particular omega-3 fatty acids) <a href="http://www.ncbi.nlm.nih.gov/pubmed/23538073">have a vital role</a> in maintaining proper neuronal structure and function, as well as in modulating critical aspects of the inflammatory pathway in the body. Taking omega-3 supplements appears beneficial for addressing symptoms of depression, bipolar depression and post-traumatic stress disorder. And it may potentially help <a href="http://www.ncbi.nlm.nih.gov/pubmed/20124114">prevent psychosis</a>.</p>
<p>Omega-3 fats can be found in nuts, seeds and oysters, although the highest amounts exist in oily fish such as sardines, salmon (especially King salmon), anchovies and mackerel. Due to higher levels of mercury, larger fish, such as mackerel, should be consumed in moderation.</p>
<p><strong>2. B vitamins and folate</strong></p>
<p>We need B vitamins for a range of cellular and metabolic processes, and they have a critical role in the production of a range of brain chemicals. Folate (B9) deficiency <a href="http://www.psychiatrist.com/JCP/article/Pages/2009/v70s05/v70s0503.aspx">has been reported</a> in depressed populations and among people who respond poorly to antidepressants.</p>
<p>Several studies have assessed the antidepressant effect of folic acid (the synthetic form of folate) with antidepressant medication. <a href="http://www.psychiatrist.com/JCP/article/Pages/2009/v70s05/v70s0503.aspx">Some show positive results</a> in enhancing either antidepressant response rates or the onset of response to these medications. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nuts are a good source of folate, amino acids and minerals.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/addiction/62824084/">Ahmed Al Masaood/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Folate is found in abundance in leafy green vegetables, legumes, whole grains, brewer’s yeast and nuts. Unprocessed meats, eggs, cheese, dairy, whole grains and nuts are, in general, richest in B vitamins. If you’re going to take supplements, it’s advisable to take B vitamins together as <a href="http://www.ncbi.nlm.nih.gov/pubmed/23253391">they have a synergistic effect</a>.</p>
<p><strong>3. Amino acids</strong></p>
<p>Amino acids are the building blocks for creating proteins, from which brain circuitry and brain chemicals are formed. Some amino acids are precursors of mood-modulating chemicals; tryptophan, for instance, is needed to create serotonin. Another example is cysteine, a sulphur-based amino acid that can convert into glutathione – the body’s most powerful antioxidant. </p>
<p>When given as a supplement, an amino acid form known as N-acetyl cysteine (NAC) converts into <a href="https://en.wikipedia.org/wiki/Glutathione">glutathione</a> in the body. We have <a href="http://www.ncbi.nlm.nih.gov/pubmed/23369637">evidence that it’s helpful</a> in bipolar depression, schizophrenia, trichotillomania and other compulsive and addictive behaviours. Another amino acid-based nutrient known as S-adenosyl methionine (SAMe) <a href="http://www.ncbi.nlm.nih.gov/pubmed/24856557">has antidepressant qualities</a>. </p>
<p>Amino acids are found in any source of protein, most notably meats, seafood, eggs, nuts and legumes.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Amino acids are found in sources of protein such as meat.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/wurzeltod/357151207/">Suzanne Gerber/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p><strong>4. Minerals</strong> </p>
<p>Minerals, especially zinc, magnesium and iron, have important roles in neurological function. </p>
<p>Zinc is an abundant trace element, being involved in many brain chemistry reactions. It’s also a key element supporting proper immune function. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25012438">Deficiency has been linked</a> to increased depressive symptoms and there’s emerging evidence for zinc supplementation in <a href="http://www.ncbi.nlm.nih.gov/pubmed/21798601">improving depressed mood</a>, primarily alongside antidepressants. </p>
<p>Magnesium is also involved in many brain chemistry reactions and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19085527">deficiency has been linked</a> to depressive and anxiety symptoms. Iron is involved in many neurological activities and <a href="http://www.biomedcentral.com/1471-244X/13/161">deficiency is associated with</a> anxiety and depressive symptoms as well as developmental problems. This is, in part, due to its role in transporting oxygen to the brain.</p>
<p>Zinc is abundant in lean meats, oysters, whole grains, pumpkin seeds and nuts, while magnesium is richest in nuts, legumes, whole grains, leafy greens and soy. Iron occurs in higher amounts in unprocessed meats and organ meats, such as liver, and in modest amounts in grains, nuts and leafy greens, such as spinach. </p>
<p><strong>5. Vitamin D</strong></p>
<p>Vitamin D is a fat-soluble compound that’s important as much for brain development as it is for bone development. Data suggests low maternal levels of vitamin D are <a href="http://www.ncbi.nlm.nih.gov/pubmed/22796576">implicated in schizophrenia risk</a>, and deficiency is linked to <a href="http://www.ncbi.nlm.nih.gov/pubmed/23377209">increased depressive symptoms</a>. But there’s little evidence to support the use of <a href="http://www.ncbi.nlm.nih.gov/pubmed/24423304">vitamin D supplements for preventing depression</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=362&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=362&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=362&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vitamin D can be synthesised via sunlight.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/naturesdawn/4299041739/">Dawn Ellner/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Vitamin D can be synthesised via sunlight: 15 minutes a day on the skin between 10am and 3pm during summer, although be sure to seek professional health advice regarding skin cancer concerns. Aside from sunlight, vitamin D can also be found in oily fish, UVB-exposed mushrooms and fortified milk.</p>
<p><strong>6. Plant-based antioxidants</strong></p>
<p>An increase in oxidative stress and damage to brain cells has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/22271002">implicated in a range of mental disorders</a>, including depression and dementia. Antioxidant compounds (such as “polyphenols”, which are found in fruits and certain herbs) may “mop up” free radicals that damage cells to <a href="http://www.ncbi.nlm.nih.gov/pubmed/22334236">provide a natural way</a> to combat excessive oxidation.</p>
<p>Consuming natural antioxidant compounds through your diet is better than taking supplements of high doses of synthetic vitamin A, C or E, as the oxidative system is finely tuned and excess may actually be harmful. </p>
<p>Fruits and vegetables contain these antioxidant compounds in relative abundance, especially blackberries, blueberries, raspberries and goji berries; grapes; mangoes and mangosteen; onions; garlic; kale; as well as green and black tea; various herbal teas; and coffee.</p>
<p><strong>7. Microbiotics</strong></p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/23384445">Research</a> shows a connection between the bacteria in our guts and brain health, which may affect mental health. When the composition of the gut microbiota is less than optimal, it can result in inflammatory responses that <a href="http://www.ncbi.nlm.nih.gov/pubmed/21135322">may negatively affect</a> the nervous system and brain function. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Diets high in sugary, fatty and processed foods are associated with depression and poor brain health.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/brizzlebornandbred/9375507295/">Paul Townsend/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>A balanced microfloral environment is supported by a diet rich in the foods that nourish beneficial bacteria and reduce harmful microbial species, such as <em>Helicobacter pylori</em>. Beneficial microflora can be supported by eating fermented foods such as tempeh, sauerkraut, kefir and yoghurt, and also by pectin-rich foods such as fruit skin. </p>
<h2>What now?</h2>
<p>Diets high in sugary, fatty and processed foods <a href="https://theconversation.com/you-are-what-you-eat-how-diet-affects-mental-well-being-27115">are associated</a> with depression and poor brain health. While nutrient supplementation can have a role in maintaining proper brain function and treating certain psychiatric disorders, nutrients should, in the first instance, be consumed as part of a balanced wholefood diet.</p>
<p>There is now enough research evidence to show the importance of nutrients for mental as well as physical well-being. A <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract">discussion about diet and nutrition</a> should be the starting point in conversations about mental health, just as it is for physical health.</p>
<p><em>If you’re interested in participating in a clinical trial prescribing nutrients for treating depression (SE Queensland and Victoria only), visit <a href="http://nutrientsdepressionstudy.com/">nutrientsdepressionstudy</a>.</em> </p>
<p><strong>Acknowledgement</strong>: Dr Drew Ramsey contributed to this article.</p><img src="https://counter.theconversation.com/content/37170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jerome Sarris has received funding from Integria Health, Blackmores, Bioceuticals, Pepsico, HealthEd, Soho-Flordis, Pfizer, Elsevier, the Society for Medicinal Plant and Natural Product Research, CR Roper Fellowship, and The National Health and Medical Research Council. He is affiliated with The International Society for Nutritional Psychiatry Research. </span></em></p>A growing body of research points to the detrimental effect of unhealthy diets and the protective value of healthy diets – along with select nutritional supplements as required – for maintaining and promoting mental health.Jerome Sarris, Senior Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/439922015-07-01T02:55:28Z2015-07-01T02:55:28ZFactCheck: Is a job a prescription for a young person with mental health issues?<blockquote>
<p>“A job is a prescription for a young person with mental health issues.” – <strong>Minister for Social Services, Scott Morrison, <a href="http://scottmorrison.dss.gov.au/speeches/a-good-deal-on-welfare-address-to-acoss-national-conference">speech</a> to ACOSS National Conference, Friday June 26, 2015.</strong></p>
</blockquote>
<p>Social Services minister, Scott Morrison, <a href="http://junkee.com/scott-morrison-reckons-getting-a-job-is-a-prescription-for-young-people-with-mental-health-problems/60157">ruffled</a> a few feathers when he said last week that a job is a prescription for a young person with mental health issues, with some <a href="https://twitter.com/search?q=scott%20morrison%20prescription%20job%20&src=typd">opining</a> this reflected a simplistic view of mental health treatment.</p>
<p>But as it happens, there is quite a bit of research supporting what the Minister said.</p>
<h2>The evidence</h2>
<p>The full quote, in context, was: </p>
<blockquote>
<p>$19.4m will be provided for young people with mental health conditions. I particularly want to thank Headspace and Orygen’s Patrick McGorry for their very strong investment in the development of these initiatives when they brought them to me earlier this year. In this trial we are helping young people enter the work force and treat their conditions at the same time, through an individualised placement and support programme. A job is a prescription for a young person with mental health issues – that’s what was put to me by Pat and we are very pleased to be able to respond in this way and we are very invested in seeing this programme work and understanding its broader implications and applications.</p>
</blockquote>
<p>It is clear that the “a job is a prescription” line was not intended literally. Employment was not claimed to be a substitute for good mental health care. Rather, Mr Morrison’s comment is a reference to, and recommendation of, the <a href="http://waamh.org.au/development-and-training/individual-placement--support-ips.aspx">Individual Placement and Support</a> (IPS) approach.</p>
<p>The IPS program helps overcome barriers that many people with mental health conditions face in obtaining paid employment. The program matches employers with suitable jobs to employees who have mental illness, and helps support both employers and employees over time. </p>
<p>The IPS program is a relatively new response to the problem of <a href="http://www.ncbi.nlm.nih.gov/pubmed/22718112">high unemployment</a> among <a href="http://www.ncbi.nlm.nih.gov/pubmed/21541697">young people with mental health conditions</a> in Australia. The government’s support of such a program is good news for Australia because this is what independent scientists have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/16683974">recommending</a> for over ten years.</p>
<p>The IPS <a href="http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201300262">approach</a> has consistently <a href="http://www.ncbi.nlm.nih.gov/pubmed/23161326">proven</a> to be two to three times more <a href="http://www.ncbi.nlm.nih.gov/pubmed/24030739">effective</a> than any other methods for adults with severe and persistent mental illnesses (such as schizophrenia and bipolar affective disorder) who have employment goals.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/18669993">Studies</a> have <a href="http://www.ncbi.nlm.nih.gov/pubmed/25016950">shown</a> it also works well for young people with mental health conditions, such as generalised anxiety disorder, major depression, and first episode psychosis, provided they have employment goals.</p>
<p>Those who don’t have employment goals are not usually invited to participate. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18669993">Two</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/25284162">studies</a> conducted in Australia confirm that IPS can be implemented successfully within the existing systems <a href="http://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12162/abstract">even though</a> there are important <a href="http://www.ncbi.nlm.nih.gov/pubmed/24684182">challenges</a>. </p>
<p>When implemented successfully, the results for IPS are significantly <a href="http://www.ncbi.nlm.nih.gov/pubmed/24684182">better</a> than the national average results for Disability Employment Services.</p>
<p>Under the IPS approach, better forms of mental health treatment and care also need to be provided in support of high quality employment assistance. Employment services also need to be better tailored to individuals than in existing services. </p>
<p>The employment assistance is also <a href="http://www.ncbi.nlm.nih.gov/pubmed/22660842">more intensive</a> when needed, to ensure that each person’s own employment preferences are respected and attained.</p>
<p>Mental health care for people employed under the IPS program is also intended to continue longer than is usual in Australia, to the point where both the person’s mental health and their employment become manageable. </p>
<p>Even after the program is successful, rapid re-entry pathways <a href="http://www.ncbi.nlm.nih.gov/pubmed/22660842">need</a> to be established to ensure that “graduates” of IPS programs can maintain employment and good mental health. </p>
<h2>IPS in Australia</h2>
<p>Australia, like most developed countries, has been slow to respond to this evidence. IPS services are <a href="http://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12162/abstract">not yet widely available</a>, even though the IPS approach is now over 20 years old. </p>
<p>The current DES funding framework does <a href="http://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12162/abstract">not</a> yet fully <a href="http://www.researchgate.net/publication/239947942_To_love_and_to_work_The_next_major_mental_health_reform_goals">support</a> the IPS services needed by young people with early psychosis and other emerging mental health conditions.</p>
<p>It remains unclear to what extent Australia’s existing mental health services <a href="http://www.researchgate.net/publication/239947942_To_love_and_to_work_The_next_major_mental_health_reform_goals">accept</a> that restoring employment and education is part of recovery oriented treatment. While many mental health services are moving in this direction, most remain very health outcome focused. </p>
<p>In other countries, such as the United States, vocational rehabilitation is considered the core business of mental health services because it contributes to the overall recovery of the people it aims to help. So the way that the term “recovery” is defined by mental health services determines the range of services that can be provided. </p>
<h2>Implementation matters</h2>
<p>In principle, Mr Morrison is on the right track and the government’s support of such programs could be an exciting step forward, but it all depends on how well the new contracts are specified, and how well any new IPS programs for young people are actually implemented. </p>
<p>For adults with severe mental illnesses, for instance, an employment specialist’s caseload should be limited to 20 active cases at any time. For youth with less severe mental health conditions, a slightly higher active caseload may be warranted, but probably not more than 30 (depending on how many service users actually need one-to-one assistance).</p>
<p>Another risk concerns the quality of existing mental health services, which need to be of sufficient quality, frequency, and duration for the health service to work in partnership with an employment service.</p>
<p>Success is likely if the principles of IPS are built into the contracts that govern how the new programs are delivered.</p>
<h2>Verdict</h2>
<p>Mr Morrison’s comment is supported by research that shows a well-managed employment program, such as IPS, can contribute significantly to improved employment outcomes, and this often improves mental health outcomes (in combination with good mental health care) for people with employment goals.</p>
<p>Effective assistance to get a job can be an important option for young people with employment goals, as long as basic conditions for delivering that assistance are met. Namely, that the employment assistance is integrated with good quality ongoing mental health care, is sufficiently intensive and individualised, and is implemented in accord with the other IPS principles and practices that have proven so effective over the past 20 years. </p>
<hr>
<h2>Review</h2>
<p>This review is spot on. The contention that employment is positive for those with mental illness is strongly supported by the evidence and is consistent with best practice internationally. This is more than just a motherhood statement. </p>
<p>There have been scientifically strong Australian randomised controlled trials <a href="http://www.ncbi.nlm.nih.gov/pubmed/25284162">indicating the benefit</a> of the Individualised Placement and Support approach to employment for the mentally ill. These findings are consistent with many international studies reporting that being employed leads to greater autonomy, status and acceptance within society, opportunities for personal development and a sense of well-being. </p>
<p>Further, these reports <a href="http://www.ncbi.nlm.nih.gov/pubmed/23399859">indicate</a> that employment is able to facilitate recovery from mental illness. An effective modern mental health program needs to incorporate such approaches to employment and vocational training in addition to medications and psychosocial assistance. <strong>–– Philip Mitchell</strong></p>
<hr>
<p><div class="callout"> Have you ever seen a “fact” that doesn’t look quite right? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at checkit@theconversation.edu.au. Please include the statement you would like us to check, the date it was made, and a link if possible.</div></p><img src="https://counter.theconversation.com/content/43992/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoffrey Waghorn has received funding in the past from the federal government and from COAG through the Queensland government.</span></em></p><p class="fine-print"><em><span>Philip Mitchell receives funding from the NHMRC.</span></em></p>Social Services Minister Scott Morrison has said that a job is a “prescription” for a young person with mental health issues. What does the research on employment and mental health show?Geoffrey Waghorn, Head, Social Inclusion and Recovery Research, Queensland Centre for Mental Health Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/418042015-05-28T05:28:36Z2015-05-28T05:28:36ZYour smartphone could be good for your mental health<figure><img src="https://images.theconversation.com/files/82949/original/image-20150526-24757-13c7cn9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Self-help</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>When it comes to mental health, technologies such as smartphones and social media networks are almost always discussed in terms of the dangers they pose. Alongside concerns expressed in <a href="http://www.telegraph.co.uk/news/health/children/11486167/Are-smartphones-making-our-children-mentally-ill.html">the media</a>, some experts believe that technology <a href="http://www.everydayhealth.com/adhd-awareness/does-technology-cause-adhd.aspx">has a role</a> in the rising rates of mental health problems. However, there is also evidence to suggest your smartphone could actually <a href="http://www.nhsconfed.org/%7E/media/Confederation/Files/Publications/Documents/the-futures-digital.pdf">be good</a> for your mental health.</p>
<p>The brain is a sensitive organ that reacts and adapts to stimulation. Researchers have looked into smartphone usage and the effects on the day-to-day plasticity of the human brain. They found that the finger movements used to control smartphones are <a href="http://psychcentral.com/news/2014/12/25/smartphone-use-alters-our-brains/79111.html">enough to alter</a> brain activity.</p>
<p>This ability of technology to change our brains has <a href="http://www.everydayhealth.com/adhd-awareness/does-technology-cause-adhd.aspx">led to questions</a> over whether screen-based activity is related to rising incidence of such conditions as attention deficit hyperactivity disorder (ADHD) or an increased risk of depression and insomnia. Technology has also <a href="http://cyberbullying.us/cyberbullying_and_suicide_research_fact_sheet.pdf">been blamed</a> for <a href="http://www.tandfonline.com/doi/abs/10.1080/13632752.2012.704684">cyber-bullying</a>, isolation, communication issues and <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1746-1561.2010.00548.x/abstract">reduced self-esteem</a>, all of which can potentially lead to mental ill health.</p>
<h2>Positive potential</h2>
<p>However, focusing only on the negative experiences of some people ignores technology’s potential as <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841358/">both a tool</a> for <a href="http://www.researchgate.net/profile/Gregory_Gahm/publication/23458726_Soldier_attitudes_about_technology-based_approaches_to_mental_health_care/links/0a85e53360459de11d000000.pdf">treating mental health issues</a> and for improving the quality of people’s lives and promoting emotional well-being. For example, there are programmes for depression and phobias, designed to help lift people’s moods, get them active and help them to overcome their difficulties. <a href="http://www.nice.org.uk/guidance/ta97/resources/guidance-computerised-cognitive-behaviour-therapy-for-depression-and-anxiety-pdf">The programmes</a> use guided self help-based cognitive behavioural principles and have proven to be very effective.</p>
<p>Computer games have been used to <a href="http://www.technologyreview.com/view/517561/the-computer-game-that-helps-therapists-chat-to-adolescents-with-mental-health-problems">provide therapy</a> for adolescents. Because computer games are fun and can be used anonymously, they offer an alternative to traditional therapy. For example, a fantasy-themed role-playing game <a href="https://research.sparx.org.nz">called SPARX</a> has been <a href="http://www.bmj.com/content/344/bmj.e2598">found to be</a> as effective as face-to-face therapy in clinical trials.</p>
<p>Researcher David Haniff has created apps aimed at <a href="http://www.bcs.org/upload/pdf/ewic_hc07_popaper4.pdf">lifting the mood</a> of people suffering from depression by showing them pleasing pictures, video and audio, for example of their families. He has also developed a computer game that helps a person examine the triggers of their <a href="http://issuu.com/onlinetherapyinstitute/docs/tiltiss9/9">depression</a>. Meanwhile, smartphone apps that play subliminal relaxing music in order to distract from the noise and worries of everyday living have been proven to be beneficial in <a href="http://www.sciencedaily.com/releases/2014/03/140318111900.htm">reducing stress</a> and anxiety.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/82951/original/image-20150526-24760-1trpggn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82951/original/image-20150526-24760-1trpggn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82951/original/image-20150526-24760-1trpggn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82951/original/image-20150526-24760-1trpggn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82951/original/image-20150526-24760-1trpggn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82951/original/image-20150526-24760-1trpggn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82951/original/image-20150526-24760-1trpggn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Doctor on call.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Technology can also provide greater access to mental health professionals through email, online chats or video calls. This enables individuals to work remotely and at their own pace, which can be particularly useful for those who are unable to regularly meet with a healthcare professional. Such an experience can be both empowering and enabling, encouraging the individual to take responsibility for their own mental well-being.</p>
<p>This kind of “telemedicine” has already found a role in child and adolescent <a href="http://www.ncbi.nlm.nih.gov/pubmed/19302764">mental health services</a> in the form of online chats in family therapy, that can help to ensure each person has a chance to have their turn in the session. From our own practice experience, we have found young people who struggle to communicate during face-to-face sessions can be encouraged to text their therapist as an alternative way of expressing themselves, without the pressure of sitting opposite someone and making eye contact.</p>
<p>Conditions such as social anxiety can stop people seeking treatment in the first place. The use of telemedicine in this instance means people can begin combating their illness from the safety of their own home. It is also a good way to remind people about their appointments, thus improving attendance and reducing drop-out rates.</p>
<h2>New routes to treatment</h2>
<p>The internet in general can provide a gateway to asking for help, particularly for those who feel that <a href="http://www.mentalhealthcare.org.uk/discrimination_and_stigma">stigma is attached</a> to mental illness. Accessing information and watching videos about people with mental health issues, including high-profile personalities, helps to normalise conditions that are not otherwise talked about.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/TcPRF9slENI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>People can use technology to self-educate and improve access to low-intensity mental health services by providing <a href="http://www.sane.org.uk/what_we_do/support/supportforum">chat rooms</a>, <a href="https://www.time-to-change.org.uk/join-the-conversation">blogs</a> and <a href="http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/low-mood-stress-anxiety.aspx">information</a> about mental health conditions. This can help to combat long waiting times by providing support earlier and <a href="http://www.opsba.org/files/2014CYMHS_PS5_Handout1.pdf">improving the effectiveness</a> of treatment.</p>
<p>More generally, access to the internet and use of media devices can also be a lifeline to the outside world. They allow <a href="http://www.mentalhealth.org.uk/help-information/mental-health-a-z/I/internet/">people to connect</a> in ways that were not previously possible, encouraging communication. With improved social networks, people may be less likely to need professional help, thus reducing the burden on over stretched services.</p>
<p>Research into the potential dangers of technology and its affect on the brain is important for understanding the causes of modern mental health issues. But technology also creates an opportunity for innovative ways to promote engagement and well-being for those with mental health problems. Let’s embrace that.</p><img src="https://counter.theconversation.com/content/41804/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s not all isolation and cyber-bullying: technology offers access to communication and therapies that could help sufferers of mental illness.Joanna Rodriguez, Senior tutor, University of SurreyNadine Page, Teaching Fellow (Integrated Care), University of SurreyLicensed as Creative Commons – attribution, no derivatives.