Schizophrenia: the most misunderstood mental illness?

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Schizophrenia: the most misunderstood mental illness?

Let’s face it, when most people think about schizophrenia, those thoughts don’t tend to be overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness, Googled the phrase ‘schizophrenics should…’ when researching a potential campaign, we were so distressed by the results, we decided to drop the idea completely. I won’t go into details, but what we found confirmed our worst suspicions.

Over 60 per cent of people with mental health problems say the stigma and discrimination they face is so bad, that it’s worse than the symptoms of the illness itself. Stigma ruins lives. It means people end up suffering alone, afraid to tell friends, family and colleagues about what they’re going through. This silence encourages feelings of shame and can ultimately deter people from getting help.

Someone who knows first hand how damaging this stigma can be is 33 year-old Erica Camus*, who was sacked from her job as a university lecturer, after her bosses found out about her schizophrenia diagnosis, which she’d kept hidden from them.

Erica was completely stunned. “It was an awful feeling. The dean said that if I’d been open about my illness at the start, I’d have still got the job. But I don’t believe him. To me, it was blatant discrimination.”

She says that since then, she’s become even more cautious about being open. “I’ve discussed it with lots of people who’re in a similar position, but I still don’t know what the best way is. My strategy now is to avoid telling people unless it’s comes up, although it can be very hard to keep under wraps.”

Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative perceptions of schizophrenia can have a direct impact on patients. “Some people definitely do internalise the shame associated with it. For someone already suffering from paranoia, to feel that people around you perceive you as strange or dangerous can compound things.

“I think part of the problem is that most people who have never experienced psychosis, find it hard to imagine what it’s like. Most of us can relate to depression and anxiety, but a lot of us struggle to empathise with people affected by schizophrenia.”

Another problem is that when schizophrenia is mentioned in the media or portrayed on screen, it’s almost always linked to violence. We see press headlines about ‘schizo’ murderers and fictional characters in film or on TV are often no better. Too often, characters with mental illness are the sinister baddies waiting in the shadows, they’re the ones you’re supposed to be frightened of, not empathise with. This is particularly worrying in light of research by Time to Change, which found that people develop their understanding of mental illness from films, more than any other type of media.

These skewed representations of mental illness have created a false association between schizophrenia and violence in the public imagination. In reality, violence is not a symptom of the illness and those affected are much more likely to be the victim of a crime than the perpetrator.

We never hear from the silent majority, who are quietly getting on with their lives and pose no threat to anyone. We also never hear about people who are able to manage their symptoms and live normal and happy lives.

That’s why working on the Finding Mike campaign, in which mental health campaigner Jonny Benjamin set up a nationwide search to find the stranger who talked him out of taking his own life on Waterloo bridge, was such an incredible experience. Jonny, who has schizophrenia, wanted to thank the man who had saved him and tell him how much his life had changed for the better since that day.

The search captured the public imagination in a way we never could have predicted. Soon #Findmike was trending all over the world and Jonny was making headlines. For me, the best thing about it was seeing a media story about someone with schizophrenia that wasn’t linked to violence and contained a message of hope and recovery. Jonny is living proof that things can get better, no matter how bleak they may seem. This is all too rare.

As the campaign grew bigger by the day, I accompanied Jonny on an endless trail of media interviews. What I found most fascinating about this process was how so many of the journalists and presenters we met, were visibly shocked that this young, handsome, articulate and all-round lovely man in front of them, could possibly have schizophrenia.

Several told Jonny that he ‘didn’t look like a schizophrenic’. One admitted that his mental image of someone with schizophrenia was ‘a man running about with an axe’. It was especially worrying to hear this from journalists, the very people who help shape public understanding of mental illness.

Many of the journalists also suggested that through the campaign, Jonny has become a kind of ‘poster boy’ for schizophrenia and in a way, I think he has.

Jonny has mixed feelings about the label. “I hope that by going public with my story, I’ve got the message out there that it is possible to live with schizophrenia and manage it. It’s not easy, it’s an ongoing battle, but it is possible. But I’m aware that I’m one of the lucky ones. I’ve been given access to the tools I need like CBT, but that’s not most people’s experience. Because of our underfunded mental health system, most people don’t get that kind of support. I can’t possibly represent everyone affected, but I hope I’ve challenged some stereotypes.”

As Jonny rightly says, one person cannot possibly represent such a diverse group of people. Schizophrenia is a very broad diagnosis and each individual experience of the illness is unique. Some people will have one or two episodes and go on make a full recovery, while others will live with the illness for the rest of their lives. Some people are able to work and be independent and others will need a lot of support. Some people reject the diagnosis altogether.

What we really need is a much more varied and nuanced depiction of mental illness in the media that reflects the true diversity of people’s experiences.

What I hope Jonny has managed to do is start a new conversation about schizophrenia. I hope he has made people think twice about their preconceptions of ‘schizophrenics’. And most importantly, I hope he has helped pave the way for many more ‘poster boys’ and girls to have their voices heard too.

For more information, visit Rethink Mental Illness

*Name has been changed

 

More than half of bullied children become depressed as adults, survey shows

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More than half of bullied children become depressed as adults, survey shows

55 per cent of children who have been bullied develop depression – with more than one in three becoming suicidal or self-harming as a result, according to a Europe-wide poll released today.

The shocking statistics have provoked calls for urgent action, with more than 100,000 people joining a campaign by the BeatBullying charity calling on the European Commission to introduce new laws to protect children from bullying and cyberbullying.

This comes after an inquest in May heard how a British teenager walked into the sea to drown after suffering cyberbullying over Facebook.

Callum Moody-Chapman, 17, from Cumbria, had been sent online threats by a former friend who was going out with his ex-girlfriend. The 17-year-old boy threatened to beat him, set fire to his home and encourage friends “to stamp on your head”. A verdict of suicide into the youngster’s death last December was recorded by the coroner, who cited the abusive messages as “by far the most significant aspect of this case”.

Attitudes need to change if such tragedies are to be prevented, according to campaigners.

Emma-Jane Cross, chief executive of BeatBullying, said: “Far too many European citizens still see bullying as ‘part of growing up’ and don’t take it seriously. This is pushing young people to the brink with some even resorting to harming themselves in order to cope.”

She added: “How many more children have to tragically lose their lives before these outdated perceptions change? Today more than 100,000 children, families, schools and charitable organisations are sending the European Commission a clear message that enough is enough. We urge them to listen.”

And Sarah Crown, editor of Mumsnet, one of the organisations backing the protest, commented: “These figures demonstrate once again why bullying ought not to be treated as ‘part and parcel’ of growing up. It’s a serious matter that can result in severe consequences for the victim.”

Little Mix, Amanda Holden, JLS singer Aston Merrygold, and reality TV star Jamie Laing from Made in Chelsea are among the names supporting the campaign. Leigh Anne of Little Mix said: “Myself and the girls have all experienced being bullied at some point in our life, when we see on Twitter that some of our fans are going through it now we find it so upsetting, and that’s the reason we feel so passionate about this campaign.”

And the effects on victims can be long-lasting. For childhood bullying can continue to damage mental and physical health for decades afterwards, causing higher rates of depression, ill health and unemployment in adult life, according to a study by researchers from Kings College London published earlier this year.

One Sri Lankan Tamil’s testimony: beaten, branded, suffocated and raped

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One Sri Lankan Tamil’s testimony: beaten, branded, suffocated and raped

Siva, a Tamil from Sri Lanka, is facing deportation from the UK for the second time in two years. The last time he fought the journey every inch of the way.

“They loaded me on the plane first, right at the back, because I was making a lot of noise, screaming. I was very scared and begged them not to send me back but they said if I didn’t go quietly, they would handcuff me and force me to go,” he told the Guardian.

Given his account of what he had lived through in his home country, his panic is unsurprising. Since the brutal end to the Sri Lankan civil war five years ago, human rights groups have accused the government in Colombo of routinely abducting and torturing Tamils it suspects of sympathies with the defeated Liberation Tigers of Tamil Eelam (LTTE) insurgency.

Rape and sexual abuse of men and women is a factor in two-thirds of the cases studied by Freedom from Torture, the British advocacy group.

Siva was detained in a police station, tortured and forced to perform oral sex on his guards over a period of five weeks. He only escaped after his family paid a bribe. But, when he finally arrived in the UK, the Home Office did not believe his account. He was deported in 2012 after exhausting his appeals.

“I was confused and frightened. I couldn’t sleep and was on sleeping pills. At first I thought I’d get a last-minute reprieve because twice before I’d been taken to the airport to be deported but not been sent.

“This time I realised it was going to happen when three people surrounded me and escorted me on to the plane and stayed there till it started to move. After takeoff I just sat there and didn’t speak to anyone because I was too scared.”

When he arrived at Colombo airport, he was interrogated by police for five hours, but they did not appear to be aware he had been in detention before and had claimed asylum. He was allowed to go, but soon the police came looking for him, forcing to him to flee and hide with friends in the tea plantations, never venturing outdoors. It was attending his sister’s wedding in Colombo that was his undoing.

Police officers came for him on the second evening, arrest warrant in hand, claiming he had helped channel money to the LTTE when he’d worked in a shop in Colombo five years earlier and was now trying to reorganise a terrorist organisation.

“I don’t know how to describe what went through my head at that moment; I was very scared. I cried and shouted but they handcuffed and blindfolded me and put a gag in my mouth to silence me. They started hitting me even inside the vehicle and put a gun to my head because they were angry that I’d hid from them. I knew I was going to be tortured again.”

It started that first night at the police station in Colombo, with kicking, punching, slapping and beating with blunt instruments. Siva was hung upside down by his feet, his hands tied behind his back, and his head submerged in a barrel of water.

He was suffocated by having a plastic bag soaked in petrol tied over his head. He was, branded on several occasions with a hot metal rod, leaving 11 visible scars on his back, and burned with cigarettes leaving at least 17 visible scars.

An expert independent medical report subsequently obtained in the UK confirms Siva’s scars are consistent with his account of torture. He also has the arrest warrant and court documents renewing his detention to prove he was indeed held in custody.

He was also repeatedly raped. “Even at night they didn’t allow us to sleep; they sexually tortured us. I was raped by different men and sometimes other men watched. They were not wearing uniform and they were drunk. They called me ‘Tamil slave’ and ‘son of a bitch’.”

Ten months later, Siva’s family again paid a bribe for his release, though the official police records say he escaped. Siva took a boat to India and then made his way back to the UK, arriving this year. When he went to the Home Office to apply for asylum again, he says he wasn’t eligible because he had already been deported. Now he has to sign in at a police station monthly but every time he fears he could be detained again and deported.

In Sri Lanka, his parents also have to report to the police; as soon as Siva fled the island, his father and brother were detained. He doesn’t know if they have been mistreated because they have never talked about it.

“If I am deported for a second time, I won’t go; I’d rather die here. Because of the immigration people here I suffered more; they didn’t take the right decision and because of them I was detained for months and suffered physical and mental torture.”

Asked what he felt about the global summit on preventing sexual violence being held in London Docklands, a few miles from where he is staying, he said: “I feel like the British government has double standards hosting this summit; they are showing two different faces to the world.”

International protocol launched to deal with sexual violence in conflict

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International protocol launched to deal with sexual violence in conflict

An international protocol for dealing with rape and sexual violence in conflict was launched on Wednesday at a historic London summit on the issue, providing guidelines on the investigation of sex crimes and the collection of evidence for future prosecutions.

“For decades – if not centuries – there has been a near-total absence of justice for survivors of rape and sexual violence in conflict. We hope this protocol will be part of a new global effort to shatter this culture of impunity, helping survivors and deterring people from committing these crimes in the first place,” the UK foreign secretary, William Hague – who is co-hosting the summit with film star Angelina Jolie – wrote in a foreword to the 140-page protocol.

The Global Summit to End Sexual Violence in Conflict opened on Wednesday with 117 countries formally represented, plus scores of UN and aid agencies, civil society organisations, survivors and nearly 2,000 delegates from around the world.

Zainab Bangura, the UN’s special representative on sexual violence in conflict, said conflict-related rape was no longer considered “a marginal issue, an inevitable by-product of war or mere collateral damage. It can no longer be amnestied or pardoned as the price of peace. It cannot be dismissed … as a private matter. And the countless women, girls, men and boys affected can no longer be deemed second-class victims of a second-class crime.”

Bangura had witnessed the enduring effects of sexual violence in the civil war of Sierra Leone. “The scars that remain beneath the surface of society make peace less possible. We’re here today to write the last chapter in the history of wartime rape and to close the book once and for all on humanity’s tolerance for such inhumanity.”

To survivors, she said: “Your voices are being heard. Wartime rape is now among the greatest global security priorities of our time.” To perpetrators: “We will pursue with every means at our disposal. There will no hiding place and no safe haven. Sooner or later, we will get you … This is not mission impossible.”

In a video message, Hillary Clinton paid tribute to Hague and Jolie as “formidable champions of this cause”. The summit was a historic opportunity to effect change, she added.

The protocol, funded by the UK government and the result of two years’ work, aims to provide best practice on the documentation of sexual violence. It includes practical advice, checklists and sample questions for fieldworkers.

For example, it provides a template for personal data to be collected from survivors and witnesses, tips on carrying out interviews and gathering testimonies, and guidance on photographing, filming and sketching crime scenes, and on the collection of physical evidence.

About 25 experts were involved in compiling the protocol, whose contents were “field tested” in countries such as Uganda and the Democratic Republic of the Congo before publication.

Humanitarian agencies at the London summit have documented the long-term physical and psychological effects of sexual violence in conflict, including the rejection of victims by their communities and the birth of children conceived during rape.

Government troops and peacekeeping forces have not only failed to protect women from sexual violence, but have also been among the perpetrators, they say.

Jolie and Hague arrived together at the summit at the ExCel conference centre in Docklands, London, on Wednesday morning. The pair were later due to co-host a screening of Jolie’s 2012 film about rape in Bosnia, In the Land of Blood and Honey, which led to the foreign secretary’s espousal of the issue.

However, criticism has been levelled at the UK government for failing to give protection to victims of sexual violence when they arrive as war refugees. Women were not being believed when recounting their experiences, and were being further traumatised by the asylum process, according to the Refugee Council.

“It’s critical that the government tackles this issue with the same gusto at home as it’s doing abroad and protects the survivors of sexual violence,” said Anna Musgrave, of the Refugee Council, who said the UK government was guilty of hypocrisy.

At the opening session, UK foreign minister Lady Warsi described “harrowing moments” as a lawyer hearing the testimonies of women from Bosnia-Herzegovina, who were seeking asylum in the UK. “Having spent sometimes many, many hours with these women in preparing for their cases, we would find out only at the 11th hour the most horrific aspect of their experience – the rape and the sexual violence.

“And what was even more heartbreaking for me was when those women wouldn’t just tell you that at the last moment, but it would also be with a caveat – ‘But I don’t want you to tell anybody else this. I don’t want it to be part of my case’,” she said.

Angela Atim, who is speaking at the conference, was kidnapped at the age of 14 by the Lord’s Resistance Army in Uganda.

“These people who are accountable for the sexual violence in armed conflict, they have to be brought to justice,” she told the BBC.

“It’s part of our healing because it’s really painful to see that they are still walking around, they are still doing the same thing.”

Malnutrition in conflict: the psychological cause

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Malnutrition in conflict: the psychological cause

Treating malnutrition in humanitarian crises, such as conflict and natural disaster, is far more complex than simply curing disease and providing children with therapeutic foods. Often, post-traumatic stress disorder – common in extreme situations – hinders treatment and its success. In Bangui, in the Central African Republic (CAR), the number of children suffering from life-threatening malnutrition has tripled since the outbreak of violence in December 2013.

Each month, 180 patients are being seen in a ward that initially had just 49 beds available for malnourished children. For many weeks, two to three patients – and their caregivers – were sharing single beds, increasing the risk of cross-infection of illness and delaying recovery.

The cause of severe acute malnutrition runs far beyond economic hardship and lack of food. Many of the hundreds of thousands of people displaced by fighting have been directly exposed to death threats, witnessed the deaths of neighbours or family members, and lost nearly all of their belongings. They are often exhausted by the harsh living conditions in camps.

75% of over 1,000 case studies of the parents of malnourished children collected by Action Against Hunger between July 2013 and March 2014 presented symptoms of post-traumatic stress linked to their exposure to extreme violence. The stress prompted behavioural changes, flashbacks, fatigue, isolation, excessive irritability, and feelings of hopelessness and despair.

These experiences also provoked reactions that – while understandable, normal, and usually temporary – can be disabling enough to impact a mother’s ability to nurse and feed her child. Nurses leading pre- and post-natal sessions with women in the 12 health centres around Bangui have reported that some mothers become convinced they cannot produce milk, or fail to respond to their child’s needs, resulting in early weaning that can be fatal for babies in an already challenging environment. In extreme cases, some mothers have attempted suicide and infanticide.

Children, while too young to fully understand what they have witnessed, may develop physical symptoms such as continuous crying, refusing to eat and bed wetting. Even small babies can present signs of trauma, such as feeding and sleep disturbances, continuous crying, and poor interaction. Not recognising the signs, some parents don’t make the connection and severely scold their children. To combat this, malnourished children and their carers are receiving psychological and social support.

At the nutritional therapeutic ward of Bangui’s main pediatric hospital, Action Against Hunger’s nutritional, psychological and social teams offer free treatment for severely malnourished children from a specialised counselling team. Feeding times, medical monitoring and psychological and motor activities pace the daily routine.

When Dieumerci Tsongbele, a single parent to his six-year-old daughter Jessica, arrived at the hospital, she had been refusing food and was not interacting with others. When he joined a welcoming session led by psychological and social experts, Tsongbele and other parents learned about factors that exacerbate malnutrition, including trauma. The information evoked an emotional response from the father, who had witnessed people killed. While he managed to escape the violence, the experience had left him unable to sleep, irritable and hypervigilant. Overwhelmed by the situation, he admitted he had been less attentive to his daughter’s needs.

During the programme, Tsongbele and the other parents participated in various activities with their children ranging from toy making to baby massage, which aim to provide both parents and children with a safe space to recreate natural and vital bonds that are essential for human development. Play sessions help to limit the negative effects of malnutrition strengthen parent-child relationships. Malnutrition treatment is not simply about filling stomachs, but also restoring the desire to eat.

Names have been changed to protect identities.

Stephanie Duvergé is a Action Against Hunger psychologist in the Central African Republic. Follow @ACF_UK on Twitter.

On the front lines: Documenting evidence of rape is a fraught task

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On the front lines: Documenting evidence of rape is a fraught task

In my line of work it’s impossible not to notice the chilling impact rape has on its victims. The shame and humiliation they are made to feel means disclosure can be very difficult, even in a ‘safe’ setting such as a doctor’s examination room.

Taking statements and documenting evidence of rape for use in legal proceedings is not easy – it requires skill and experience to gather all of the required information from a survivor of such a terrible crime while respecting their rights, supporting their health care needs, ensuring their safety, their confidentiality and minimizing further traumatization. Giving this kind of harrowing testimony often comes at a personal cost to the survivor, and their courage never fails to astound me.

In the UK it is estimated that almost 90 per cent of victims of serious sexual assault never disclose it to the police, and around 38 per cent tell no one (at the time of the crime.) Yet, in the UK we have support available for survivors of sexual violence and a comparatively open society that generally supports the victim and does not stigmatise them.

Imagine then, how hard it is to disclose rape in a place like the Democratic Republic of Congo where the perpetrators of such crimes are often the police and army personnel – the very officials charged with the protection of civilians.

A new report by Freedom from Torture reveals the routine use rape, gang rape and multiple rape to torture politically active women in official state detention centres in the country. The levels of impunity enjoyed by those who commit these crimes is breathtaking and it is this lack of accountability that the Global Summit aims to address.

The Protocol on Investigation and Prevention of Sexual violence in Conflict which will be launched by Angelina Jolie and William Hague at the Global Summit on Wednesday and will set out best practice for obtaining witness testimony of crimes of sexual violence in conflict.

It will ensure that the evidence collected is of a standard that can be used in international criminal courts to charge not just those who committed the crimes directly but also their commanding officers. Though work still needs to be done to get this document right, and to resource evidence collection, it is a very welcome step towards holding perpetrators to account both nationally and internationally.

My big concern is that while so much noise is being made about the protection of survivors of sexual violence in conflict at the Global Summit, the Home Office remains out of step.

Every week I see survivors of persecutory rape who have fled their countries and are seeking protection in the UK from the horrors that have been inflicted on them and their families. Sadly their experiences as asylum seekers rarely afford them the dignity, security and peace they need in order to be able to disclose sexual violence.

Repeated interrogation by Home Office officials about what they have been through – all too often conducted from a clear standpoint of officials’ disbelief inadequate welfare support and difficulties in accessing the medical care and psychological services they so desperately need all serve to compound their trauma.

Protection through asylum is a key element in the fight to end sexual violence and support survivors of these crimes. Accordingly, it should be at the forefront of this week’s discussions.

A third of first-time mothers suffer depressive symptoms, research finds

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A third of first-time mothers suffer depressive symptoms, research finds

One in three first-time mothers suffers symptoms of depression linked to their baby’s birth while pregnant and/or during the first four years of the child’s life, according to research.

And more women are depressed when their child turns four than at any time before that, according to the study, which challenges the notion that mothers’ birth-related mental struggles usually happen at or after the baby’s arrival.

The findings have led to calls for all women giving birth in the UK to have their mental health monitored until their child turns five to ensure that more of those experiencing difficulties are identified.

The results are based on research in Australia, but experts believe that about the same number of women in the UK experience bouts of mental ill-health associated with becoming a mother.

In all 1,507 women from six hospitals in Melbourne, Australia, told researchers from the Murdoch children’s research institute and royal children’s hospital in Parkville, Victoria, about their experience of episodes of poor mental health at regular intervals until their child turned four.

The authors found that almost one in three first-time mothers reported “depressive symptoms on at least one occasion from early pregnancy to four years postpartum [and that] the prevalence of depressive symptoms was highest at four years postpartum”. The women’s depressive symptoms are often short-lived episodes and do not mean that the women were diagnosed with postnatal depression. Studies in both the UK and internationally have estimated that between 10% and 15% of new mothers suffer from that clinical condition.

The researchers also found that four years after the child’s birth 14.5% display depressive symptoms, of whom 40% had not previously reported feeling very low. At that time, women with only one child were much more likely (22.9%) than those with two or more offspring (11.3%) to be depressed.

Dr Jim Bolton, a member of the Royal College of Psychiatrists and a consultant psychiatrist at a London hospital, said that one in three women giving birth in the UK were likely to become depressed at some point during those first four years. “If a similar study was done here, I wouldn’t be surprised if the results were similar. Usually the sorts of mothers who are at greater risk of depression are younger mothers who feel they can’t cope and mothers living in situations of adversity or deprivation or partner violence,” he said.

“These findings are about depressive symptoms, which can be very short-lived, not a formal diagnosis of illness or postnatal depression. This study isn’t saying that one in three women gets that,” stressed Bolton, who treats mental health problems in pregnancy and after birth among new mothers in his hospital’s women’s health unit.

The authors recommend that the UK overhauls its monitoring of maternal mental health, which focuses on pregnancy and the early years after birth, because more than half the women who experience depression after becoming a parent are not identified by GPs, midwives or health visitors.

More women could have postnatal depression than the usual estimate of 10%-15% partly because women may mistake the signs of it – which include being more irritable than usual or unusually tearful, inability to enjoy being a parent or worrying unduly about the baby’s health – as being things undergone by all new mothers.

Health professionals do not always spot it or ask the right questions to identify it, though are far more aware of it than ever, Bolton added.

One leading psychiatrist said that the one in three women who had depressive symptoms was between two and five times higher than the estimated number of people in the general population who would experience serious low mood in their lifetime, but was higher than the number of women who experienced the most severe forms of depression. Between 5%-10% of people generally suffer major/serious depression during their lifetime.The study, published in BJOG: An international journal of obstetrics and gynaecology, is the first to follow a sizeable number of new mothers for as long as four years after birth. Elizabeth Duff, senior policy adviser at the parenting charity the NCT, said: “This study has included mothers for four years after birth, so suggests that perinatal mental health needs to be monitored for a longer period. Given the devastating effects of postnatal depression, health professionals should give equal consideration to the mental and physical health of parents with young children.”

A Department of Health spokeswoman said it welcomed any new research that would lead to women receiving better help with maternal depression.

“We want to do everything we can to make sure women and families get as much support as possible throughout pregnancy and beyond. That’s why, earlier this month, we announced that expert training in mental health will be rolled out for doctors and midwives to identify and help women who are at risk of depression or other mental health issues,” she said.

Numbers of midwives and health visitors have been growing under the coalition, while specialist mental health doctors and midwives will help improve earlier diagnosis of such problems, she added. However, the Royal College of Midwives said that even more midwives were needed to ensure mothers received the best possible care of their psychological welfare.

Sleepy brains neglect half the world

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Sleepy brains neglect half the world

Damage to certain parts of the brain can lead to a bizarre syndrome called hemispatial neglect, in which one loses awareness of one side of their body and the space around it. In extreme cases, a patient with hemispatial neglect might eat food from only one side of their plate, dress on only one side of their body, or shave or apply make-up to half of their face, apparently because they cannot pay attention to anything on that the other side.

Research published last week now suggests that something like this happens to all of us when we drift off to sleep each night. The work could help researchers to understand the causes of hemispatial neglect, and why it affects one side far more often than the other. It also begins to reveal the profound changes in conscious experience that take place while we fall asleep, and the brain changes that accompany them.

Hemispatial neglect is a debilitating condition that occurs often in people who suffer a stroke, where damage to the left hemisphere of the brain results in neglect of the right half of space, and vice versa. It can occur as a result of damage to certain parts of the frontal lobes, which are involved in alertness and attention, and the parietal lobes, which process information about the body and its surrounding space.

In clinical tests, patients with hemispatial neglect are typically unaware of all kinds of stimuli in one half of space – they fail to acknowledge objects placed in the affected half of their visual field, for example and cannot state the location of touch sensations on the affected side of their body. Some may stop using the limbs on the affected side, or even deny that the limbs belong to them. Patients with neglect can usually see perfectly well, but information from the affected side just does not reach their conscious awareness.

In 2005, researchers at the MRC Cognition and Brain Sciences Unit in Cambridge reported that reduced alertness dramatically alters spatial awareness in healthy people by shifting attention to the right so that they neglect visual stimuli to the left. To investigate further, they recruited 26 more healthy participants and tested their spatial awareness while they fell asleep.

To do so, they took the participants one by one into a dark room and told them to sit back in a comfortable reclining chair and relax. They recorded the participants’ brain wave patterns using electrodes attached to the scalp, and measured their reaction times, to determine exactly when they started getting drowsy, then played sounds to either their left or right, and asked them to indicate which side each one came from by pressing one of two buttons.

Again, the researchers saw that reduced alertness caused a rightward shift in spatial attention. During the few moments of drowsiness just before falling asleep, the participants consistently mislocated sounds played to their left, and said that they had been played to the right.

“This is an exciting development,” says Masud Husain, a clinical neurologist at the University of Oxford who studies neglect in stroke patients. “It suggests that while falling asleep the healthy brain behaves in a similar way to stroke patients who have difficulty keeping alert.”

The findings further suggest that the attentional deficits associated with hemispatial neglect apply to sounds as well as to sights and bodily sensations, and also provide clues about why, in the vast majority of cases, neglect only persists after damage to the right hemisphere of the brain. “Both groups appear to have particular difficulty attending to information to their left, consistent with the view that frontal and parietal regions of the right hemisphere play a key role in maintaining alertness.”

The study also provides clues about the brain mechanisms underlying neglect. “People don’t necessarily miss items on the left as they become more drowsy, but instead respond as if they had come from the right,” says Husain, “as if their perception of space becomes skewed to the right as their alertness declines.”

“The implication is that right hemisphere brain mechanisms that are crucial to representing space around our bodies also interact with processes that keep us vigilant and alert,” he adds. “The results are intriguing but need to be confirmed, perhaps with a more precise method than pressing buttons.”

Reference: Bareham, C. A., et al. (2014). Losing the left side of the world: Rightward shift in human spatial attention with sleep onset.Scientific Reports 4, doi: 10.1038/srep05092

Rape action plan: investigations must ‘focus on accused, not complainant’

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Rape action plan: investigations must ‘focus on accused, not complainant’

Prosecutors and police investigating rape cases must place greater emphasis on examining whether suspects sought consent for sex from alleged victims, according to an official action plan published on Friday.

In a coordinated attempt to reverse declining conviction rates, the director of public prosecutions, Alison Saunders, and a senior Metropolitan police officer, Assistant Commissioner Martin Hewitt, have agreed to examine how a suspect’s “reasonable belief” that consent had been given is assessed by the courts.

The focus on establishing what steps a defendant took to ensure that sexual activity was consensual and whether the alleged victim was capable of giving consent is aimed at improving procedures.

While the number of prosecutions and convictions has increased following changes to the way rape cases are handled, the conviction rate dropped from a record high of 63.2% in 2012-13 to 60.3% in 2013-14.

CPS figures express the percentage of cases charged as rape and resulting in conviction for rape or another offence. Most rape complaints do not lead to charges being brought while as few as 10% of rapes are estimated to have even been reported to police in the first place.

The Rape action plan, agreed by Saunders and Hewitt, who is the national policing lead on rape offences, is partially a response to a sharp drop in the number of cases being referred by police to the CPS in 2012-13.

The document urges police officers and prosecutors to “focus their cases on the behaviour of the accused, not the complainant”, noting that pervasive myths remain, not only among investigators but society as a whole, which may be a barrier to justice for vulnerable victims.

“Despite efforts to raise awareness, many people still believe a rapist is a man in a balaclava in a dark alley, and a victim is a woman who shows her fear through fight,” the plan adds. “That is very rarely the case – most rapists know their victim, many victims do not physically fight, and the trauma of being raped will effect each victim differently.

“There is an urgent need to change the discourse on rape. Our police officers, our prosecutors, our courts and our communities must reject the out of date myths and acknowledge the realities of rape. We also need to debate and understand the fundamental issue of consent.”

Another proposed change is in the handling of cases that do not result in charges. Officers and prosecutors are to be encouraged to “develop an exit strategy following a police decision to take no further action in order to assess the risk of reoffending by the alleged perpetrator, and to safeguard the victim against future abuse”.

The action plan is the outcome of more than six months of discussions by a rape scrutiny panel convened to investigate the fall in the number of rape-flagged cases referred by police to the CPS. The latest figures show an 8% rise in the volume of police referrals for 2013-14 compared with 2012-13. Seven hundred more defendants have been charged over the same period – an increase of 25% from the previous year.

Saunders, said: “Even though there have been slightly more defendants convicted, the steady increase in conviction rates we have seen in recent years has halted, and this must be addressed immediately.

“The new action plan makes very clear that, as with cases of child sexual abuse, the focus of any investigation and case preparation should not be on the credibility of the victim but on the credibility of the overall allegation, including the actions of the suspect.

“Where cases turn on the issue of consent prosecutors must focus on what steps a suspect has taken to seek consent from the complainant and the extent to which an alleged victim is capable of giving consent.”

Hewitt, said: “All the changes we have made in the way police deal with sexual offences – specialist training of officers, the introduction of early evidence kits, greater access to sexual assault referral centres and working closely with support groups – are changes that have emerged from looking at ourselves and realising that we can do things better.”

Labour’s shadow attorney general, Emily Thornberry MP, welcomed the plan. She said: “We have been pressing for months for action on falls in the numbers of rape cases charged, prosecuted and convicted so it’s good to see some concrete measures.

“However, given that the proportion of rape cases referred by the police for charges fell to a third in 2012-13 and that conviction rates are falling sharply as well, it remains to be seen whether these measures will be strong enough to turn around these worrying trends. If we don’t see the necessary change, ministers will need to consider imposing more stringent obligations on how prosecutors and police handle these cases.”

Professor Liz Kelly, co-chair of End Violence Against Women Coalition, said: “Everyone reporting sexual violence deserves the highest standards from the criminal justice system and the national scrutiny panel has identified actions, which, if implemented consistently across England and Wales, provide an opportunity to achieve this.”

Facing up to rape: Victim speaks out about the ‘faceless’ crime

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Facing up to rape: Victim speaks out about the ‘faceless’ crime

Up until two weeks ago, Francesca Ebel had never told anyone in her family – or indeed most of her friends – that she had been raped. Yet she has now gone public, and the response has been overwhelming.

There were no dark alleys or threats of knives. There were no dodgy areas of town or even strangers involved. And that’s the whole point, explains the 20-year-old student, who is in her first year of studying Russian and French at Cambridge University.

“It happened three years ago. I was 17 and at a party. I got drunk and so friends helped me up the stairs and into bed. It was there that I was awoken by a crashing noise and burst of white light. I realised that someone was wrenching back the duvet and clambering on top of me, frantically pressing his lips to mine. Then my legs were pulled apart and I felt a sudden, tearing pain.”

Even in her drunken stupor, Francesca knew instinctively that something was very wrong and tried to shove him off. She even said “No”. More than once. “But he ignored me, breathing heavily in my ear.”

When it was over, Francesca stumbled outside, to find him smoking and laughing with his friends, and in the days afterwards, he boasted and joked about their sexual encounter.

Suspecting that she would be branded, at least by some, as an attention-seeker and a liar, she did not accuse him of rape. In fact, even when she confided in a close friend, it didn’t occur to her to use the word rape. “How could I claim to have been raped when ‘rape’ conjures up such violent images? How could my experience possibly parallel brutalities such as gang-rapes in India? It was unthinkable. Mine was not a violent rape; my rapist’s motives were not hateful or destructive. Furthermore, I felt embarrassed, ashamed and humiliated. So I put it behind me and got on with my life.”

And to a large extent, she succeeded. “Thankfully, my enjoyment of sex has not been affected and I’ve flourished in functional relationships. So how could I even begin to claim to identify with other victims’ experiences?” she says.

But about a year ago, when Francesca was in a relationship with a lawyer, she told him what had happened. “He stared at me and said: ‘You do realise that that is legally rape. You said no and that you didn’t want it to happen’. It was the first time I saw things clearly.”

Shortly afterwards, Francesca started university and was struck by how many other women, including a close friend, talked about similar experiences – something that certainly doesn’t surprise Rape Crisis, the charity, which claims that an estimated 90 per cent of those who experience sexual violence know the perpetrator in some way.

“There was a major survey that came out last month, which found that more than one in 13 women at Cambridge University had been sexually assaulted and that the vast majority – 88 per cent – did not report it,” Francesca says. “The study got people talking about their own experiences.”

According to the survey, women at the university are routinely groped, molested and raped. Like Francesca, one of the rape victims explained that she did not report her attacker because she thought that nothing would come of it. “I have no reason to believe that my report will be taken seriously, be investigated or result in a conviction. On the contrary, I have every reason to believe that he would be acquitted,” the woman stated. A couple of weeks later, an article appeared in the Cambridge Tab – of which Francesca is news editor – on what to do if you are raped. “We had run a few anonymous stories of sexual assault in our publication, but this one, which was written by the brother of a rape victim, really got to me, because it listed all of the things that I wish I’d done at the beginning. Suddenly, I just felt sick of this feeling of frustration, powerlessness and stigma about what had happened to me and so many others, and I felt a need to speak out. So I did.

“By storing the incident up inside me, I had let it gnaw away at me – the questions, anxieties and fury had built up to a level which was almost intolerable,” she explains. “And perhaps most critically of all, I wanted to turn a negative experience into something constructive.”

Francesca’s article appeared in the next issue, on 17 May, titled “There are people behind recent rape statistics and you must take their stories seriously”. What followed the headline was a candid, honest and brave account of her own experience, together with a plea for readers to recognise that behind stories of rape and sexual harassment, there are people who have to carry on with their lives and come to terms with what has happened, no matter how violent or “ordinary” their experience.

“Rape can happen to anyone at any time and I hoped that my story would demonstrate that,” she explains. “I also wanted to shed some light on why it is so hard to report an incident, and finally, I want to educate and initiate. Rape is not just confined to shady, impoverished corners of the globe; and it has to stop.”

It would have been far easier to write it anonymously, she admits. “Speaking out about rape has its consequences, not just for the person themselves, but for their family and friends. But there are too many faceless victims. I wanted to put a face to a story that has happened to so many people. I’m not disparaging anonymity in any way, but it does depersonalise the issue and I think that, as a result, people often don’t realise that rape is so common.”

Almost instantly, the article went viral, having had more than 28,000 views so far. Francesca has also been inundated with private letters and comments online, mostly from women who tell similar stories.

“It has been chilling to see the same story told again and again, and they all say the same thing – that they were full of self-doubt and fear of being labelled as an attention-seeker or that they wouldn’t be believed. Many, like me, don’t see themselves as a victim or the incident as defining them, but it has nonetheless affected them hugely.”

The responses also revealed just how frightened people are of reporting it. “Many of the women explained how they couldn’t face the trauma of the very system that is meant to protect us.”

Others wondered if it would even get to court – and with just 6 per cent of cases reported to police ultimately ending in a conviction, according to Rape Crisis, who can blame them?

“For reasons I can’t express even to myself, I have no current plans to report my case,” Francesca says. “But actually for me, what has been most empowering is to have gone public, to have helped raise awareness of both how ‘normal’ this is and how harmful it is.”

On reflection, Francesca’s original fear of attention-seeking has a certain irony: “I am certainly seeking attention now. That night, I was forced to share a level of intimacy which I usually reserve for the people I trust and care for. I was violated against my will, by a friend who unfortunately remains on the periphery of my life.

“Rape is incredibly complex and can have devastating consequences, whatever the situation. Right now, there is a critical and pressing need for us to broaden our understanding of the issues and educate future generations on the nature of consent.”

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