Explaining tokophobia, the phobia of pregnancy and childbirth

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Explaining tokophobia, the phobia of pregnancy and childbirth

Some studies have also identified patterns with age, suggesting younger mums are more vulnerable, as are those with less education, and mums without a strong social network.

However, a recent study found that one of the biggest influences women reported on their fear of childbirth was the media. Hospital-based reality television programs and medical dramas often feature storylines with dramatic emergency situations during childbirth and this may be all women know of giving birth prior to the event.

We also know that around 95 per cent of pregnant European women report searching for pregnancy and birth information online, and social media and blogs hold the potential for the circulation of misinformation that may heighten fears rather than allay them.

There is another group of women who may find pregnancy and childbirth frightening due to related fears. One of the most common phobias in adults is blood/injury phobia, often including a fear of injections. Pregnancy and childbirth is hence very confronting for these women, who may faint or experience extreme distress at even routine blood tests throughout their pregnancy.

Researchers have found that for first time mothers, a positive birth experience can often relieve the fear of childbirth so that it is no longer an issue for future pregnancies. However, whether or not women start with a fear of childbirth, a negative birth experience can make them up to five times more likely to develop tokophobia for future pregnancies.

A negative experience of birth may be due to complications, feeling out of control, dissatisfaction with care providers, or just not having the birth that was expected. Between 2-6 per cent of women report post-traumatic stress syndrome (PTSD) following a difficult birth experience. PTSD is the disorder once known as ‘shell shock’ for its affliction of soldiers following war, and is characterised by nightmares and re-experiencing of the birth trauma, avoidance of all reminders of the birth, and hyper-arousal. Without treatment, PTSD can limit family size and cause problems in women’s relationships with their partner and their child.

While we may not hear much about tokophobia and post-birth PTSD, their prevalence suggests we do need to look out for women who may be suffering both before and after birth. In addition to the distress at the time, stress and anxiety during pregnancy are linked to a higher rate of preterm birth and later behavioural problems in children.

The good news is that like all anxiety disorders, the fear of childbirth and PTSD can be addressed and treatments are available. One of the most vital elements of treatment is education on birth, whether through the obstetric care provider, midwives, or antenatal classes. Knowing what to expect and having an agreed plan with your care provider can assist to overcome some of the irrational fears.

Linked to this, a supportive and trusting relationship with the care providers who will manage the birth is essential. This is not always possible as some obstetric settings do not allow for repeated contact with the same provider, but a relationship of trust will be more likely to create a positive birth experience.

When problems do occur in pregnancy and birth, a post-birth debriefing can be useful and may help prevent the development of PTSD symptoms. Understanding what went wrong and why things happened the way they did can help with processing the events and accompanying trauma.

As with other anxiety disorders, relaxation, light exercise and slow breathing can help to calm the body and relieve the hyper-arousal that comes with the fear of childbirth. A psychologist can assist with other anxiety management techniques that can help to minimise fears.

For those who find the idea of pregnancy and birth overwhelming, it is important to know that help is available and such symptoms can be successfully treated. The first step is confiding your fears so that those around you can start to support you through what could be a wonderful journey.

Awareness during surgery can cause long-term harm, says report

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Awareness during surgery can cause long-term harm, says report

At least 150 and possible several thousand patients a year are conscious while they are undergoing surgery in the operating theatre, according to a report which warns that some people suffer long-term psychological damage as a result.

In the vast majority of cases, patients have been given muscle-relaxing drugs that temporarily paralyse them, preventing them from warning theatre staff that they are awake. It happens most often during caesarean sections under general anaesthetic and during heart surgery.

A three-year investigation carried out by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland found that usually the experience of awareness was short-lived, at the beginning or end of the operation.

Half of those who were aware of what was happening to them were distressed by the experience, and 41% said they suffered long-term psychological harm. The sensations they experienced included tugging, stitching, pain, paralysis and choking.

Patients described feelings of dissociation, panic, extreme fear and suffocation. Some said they feared they had been entombed, buried alive or were dead.

Prof Jaideep Pandit, consultant anaesthetist at the John Radcliffe hospital in Oxford and one of the authors of the report, said the Royal College and Association had “recognised the problem officially for the first time”.

He said: “For a long time it has been a discussion on the periphery. This is real. We need to understand it and tackle it.”

Not all experiences were traumatising, he said. Some patients spoke of feeling removed from what was happening. The drugs did not cause unconsciousness but made them feel detached. Sometimes they felt this was acceptable, and Pandit said there was an unanswered question as to whether all patients would want oblivion during surgery or whether some might prefer pain-free awareness.

It was vital, however, he said, that patients are told before they have surgery that there is a possibility, however remote, of having some consciousness of what is going on.

Estimates of how often this happens vary, says the report. When patients are asked after surgery whether they had any awareness, one in 600 say yes. But only one in 19,000 will come forward to talk about it voluntarily after the surgery. That would put the numbers at between 150 and 4,500 a year.

The team looked at three million episodes where a general anaesthetic was given in a hospital and reviewed in detail 300 cases of awareness reported by patients.

In 97% of cases, patients received muscle-relaxing drugs as well as the general anaesthetic. This makes it harder for an anaesthetist to be sure the patient is unconscious.

Around 10% of cases were caused by drug errors. In some, the muscle relaxant had been given without the general anaesthetic, which meant the patient was fully conscious but paralysed throughout their operation.

Where that happened, says the report, there were organisational as well as individual errors. “These included ill-considered policies for drug management, similar-looking ampoules, poorly organised operating lists, high workload, distraction and hurriedness,” says the report.

“These patients were severely distressed and severely harmed in the long term,” said Pandit. The report recommends a checklist before surgery, which would require the anaesthetist to line up the drugs they intend to administer and point to each one in turn. Pandit said mistakes “seem to occur in a highly pressured environment”.

 

China struggles with mental health problems of ‘left-behind’ children

China struggles with mental health problems of ‘left-behind’ children

Yes, it is just a simple stuffed toy. But put it into a child’s arms and watch as he pretends to feed it, talks to it, even crowns it as a monarch. First, it gives him security; then it allows him to role-play and develop social skills.

Chinese authorities hope tips like these, included in a book for parents and nursery teachers, will help to stem mental health problems among the country’s young. While budgets for child and adolescent mental health services are being frozen or cut in the UK, China is seeking to expand provision, promote psychotherapeutic approaches and adopt preventative measures.

Since 2012 Beijing nurseries and schools have promoted mental health as well as physical fitness. Last year China passed its first mental health law and told paediatricians to screen patients for warning signs: Do the three-month-old baby’s eyes follow moving objects? At 18 months, can she make eye contact? Officials have also enlisted foreign psychotherapists to help train specialists and increase awareness.

“The government is paying a lot of attention to psychological health,” said Dr Zheng Yi, president of the Chinese Society for Child and Adolescent Psychiatry and deputy director of Beijing Anding Hospital at Capital Medical University.

The preliminary results of research he has overseen, to be released later this year, suggest around 15% of Chinese children have mental health problems. He said that compared favourably with a rate of around 20% elsewhere, but noted that some problems, such as anxiety disorders, appear to be on the increase.

Rising living standards have allowed more parents to focus on their children’s emotional wellbeing, but development has also brought new problems, including dramatic changes in family structures and increased educational and social pressure. “For a lot of children, economics are not a problem. The problem is that opportunities to play are fewer,” said Zheng.

Others cite the impact of the generation gap created by China’s transformation and the impact of the “one child” policy. Only children may enjoy better care but can become over-indulged “little emperors”, or suffer loneliness because they lack company their own age.

Viviane Green of the department of psychosocial studies at Birkbeck College, one of the international experts developing the training programme, said cases were often similar to those in the UK, with “acting out teenagers; early attachment issues”.

But she added: “What probably is slightly different is how emotions are expressed, because the culture is different and filial piety is very strong. People do have conflicts – but the sense of self is not an individualised model as we have here – [the idea] that good mental health is about separating and moving away. It’s much more about duty to the family of origin and the links you keep with them.”

Psychotherapy is growing fast in China, but the country’s specialists must “help these new ideas to relate to other kinds of experience they have got from local culture, as well as people like psychiatrists,” said Dr Wang Qian, who has organised the international training as director of the executive office of the national psychoanalytical unit.

Dr Sverre Varvin, who chairs the China committee of the International Psychoanalytical Association and has trained Chinese professionals for years, added: “China is a really metaphorical culture and you have to spend some time to discover what the metaphors are.”

Serious problems remain in the provision of services. There is a dearth of child psychiatrists in China, which Zheng said would be addressed by training paediatricians and general doctors in early diagnosis and basic treatment.

Services are scarcest of all in the countryside, where they may be most needed. Many migrant workers leave their offspring at home when they move, because China’s “household registration” system means they struggle to get services such as education in the cities. Most are reunited once a year at best.

Almost 50% of these “left-behind” children suffer depression and anxiety, compared with 30% of their urban peers, according to a new study funded by the Heilongjiang provincial government. They are also more likely to suffer from mood swings and stress. The lead researcher, Yang Yanjie of Harbin Medical University, said their psychological problems tended to be more complex: “Left-behind children usually have inferiority complexes, lower self-esteem and lower confidence. Many appear to lack security and are too afraid or feel too much anxiety to interact with other people,” she said.

Some are effectively raised by single parents; in other cases, both parents work, and they are reared by grandparents who may lack the time and energy to nurture them. Guardians were often focused on material support and ignored children’s emotional needs, said Yang.While there is little funding for programmes targeting vulnerable groups at present, the appetite for them is striking. Save The Children initially provided “psychological first aid” in emergencies such as natural disasters, offering basic support and identifying those who need further assistance. But Pia MacRae, its China director, said staff and partners then requested it extend training to workers at centres for street children.

Zheng believes attention must be focused on prevention as well as cure. Social changes need not be damaging if people adapt appropriately: making sure only children spend time with other boys and girls their own age; perhaps alternating stints as migrant workers so that there is always one parent at home.

But the first big challenge, he said, was to tackle perceptions so that mental health problems no longer carried a stigma for children. “If we can get rid of that, seeing a psychiatrist will be like seeing a doctor if you have a fever,” he said.

‘Culture of denial’ leaving UK children at risk of serious abuse

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‘Culture of denial’ leaving UK children at risk of serious abuse

Children are at risk of serious abuse across England because of a culture of “wilful blindness” about the scale and prevalence of sexual exploitation across swaths of local government and in police forces, the deputy children’s commissioner warns.

In a highly critical interview given in the aftermath of the Rotherham abuse inquiry, which concluded that hundreds of children may have been abused there over a 16-year period, Sue Berelowitz said she had been “aghast” at the examples of obvious errors and poor practice she found.

Berelowitz told the Guardian she had discovered that police and council officers were in some cases still either looking the other way, not asking questions or claiming abuse was confined to a certain ethnic group – such as Asian men – or a particular social class.

Berelowitz is the author of a detailed report into child sexual exploitation in gangs and groups last year following a series of high-profile cases in towns such as Rochdale and Oxford as well as Rotherham.

On a recent field visit to a police force, Berelowitz was surprised to learn that the officers’ top search on their internal computer profiling system was “Asian male”. When she asked what would happen if the perpetrators were not Asian, the officer in charge replied that the force was “not looking for those”. “I was astonished. I said: ‘I think you better start looking.'”

She said that in other cases a culture of blaming the victims remained prevalent: “I had another case when I met the chair of the safeguarding board of a large city [meant to co-ordinate the protection of children from abuse or neglect]. When I mentioned cases of child sex exploitation, he said: ‘Oh yeah, those two girls are prostitutes always walking up and down this street.’ I won’t mention the city as you’d be aghast to learn who it was.”

Berelowitz said she was shocked to discover that although “there had been progress” by authorities in the aftermath of the grisly series of gang-rape and trafficking scandals, “there are still instances of not looking, of wilful blindness. We have to be careful none of us is in denial about the terrible reality of what happened in places like Rochdale and Rotherham.”

Because the subject matter is uncomfortable and scrutiny damaging, Berelowitz added that there was a “culture of denial” that had been exposed by Prof Alexis Jay’s inquiry into the handling of child abuse in Rotherham. It found at least 1,400 children were sexually exploited by predominantly Asian criminal gangs between 1997 and 2013.

A day after the Jay report was published, South Yorkshire’s police and crime commissioner Shaun Wright, a former Labour councillor who was cabinet member for children and youth services on Rotherham council between 2005 and 2010, came under intense pressure to resign his post.

On Wednesday night, after the Labour threatened to suspend him, he resigned from the party but insisted he remained committed to his police role. He said: “I was elected to deliver the people’s policing and crime priorities in South Yorkshire, and I intend to see that duty through.”

Theresa May, the home secretary, and Wright’s party, Labour, both said he should go. Wright’s former colleague and council leader, Roger Stone, resigned following publication of the Jay report.

Berelowitz’s comments, however, are intended to broaden the issue beyond Rotherham and similar cases of abuse. She cautioned that despite the emphasis placed on the fact that most of the victims in the northern towns were poor and white, while the perpetrators were Asian, she said that the issue affected “all communities, all races”.

“Usually people say to me that it was an issue of Asian males and white girls. When we dug deeper we found Afro-Caribbean girls and sometimes boys as victims, or Roma perpetrators. There’s a culture of wilful denial to the reality out there. It’s white people, it’s Asians. Parts of every community are involved.”

Most troubling was the rise of peer-to-peer sexual abuse and exploitation, where both victims and perpetrators are minors. She said that in another extremely disturbing case, police officers had caught a gang of 14- and 15-year-olds who had gang-raped an 11-year-old over a number of days. “The police caught the offenders and charged them not with rape, but with drugs offences. I told them that the message was ‘don’t do drugs but rape is fine’. The force is now working to bring the case back.”

She also warned that the rise of technology had enabled children to be seduced and controlled more easily than before, with young girls texted threats to “murder their mother, whom a gang leader has just seen pull up in a new car, if they talk about an attack” or blackmailed with an incriminating video taken on a mobile of their own rape, filmed to ensure their silence.

There was also a gap in the research explaining what led apparently otherwise normal men to commit rape and torture on often vulnerable girls, Berelowitz said.

“Most of the research into adult males who sexually abuse children in paedophilic mode has been on white males serving long sentences in prison. There’s no research into the particular model of Rotherham or Oxford or Sheffield.

“My own personal hypothesis is that they live in a patriarchal environment and are likely to have grown up with a fair amount of domestic violence.”

The scale of abuse, too, was alarming. The office of the Children’s Commissioner estimated that 16,500 children are at risk from abuse from criminal gangs. In London there are about 3,500 street-gang members, Berelowitz’s most recent work says, adding that estimates that one in 20 of the population had suffered intra-familial abuse “are far too low”. “In London alone there are about 3,500 young people aged between 13 and 25 involved in street gangs. There is a level of extraordinary violence involved. Now any girl living in a neighbourhood is at risk. I’d say there was more than one girl for every gang member at risk,” she said.

Reinforcing the point that the problem is not easily categorised, a report from University College London and Barnardo’s reveals that the number of boys affected by child sexual exploitation may be much higher than previously thought. The report – which looked at 9,042 children affected by childhood sexual exploitation and supported by Barnardo’s since 2008 – reveals that 2,986, or one in three, were male.

Society, said Berelowitz, was only just coming to terms with the disturbing nature of the problem and the scale of the abuse. “I think we are facing a public health problem here. We need to mount a public information campaign like that done about seatbelts and get money for therapy. We cannot arrest our way out of this problem.”

‘Running helps me with cope with post-traumatic stress disorder’

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‘Running helps me with cope with post-traumatic stress disorder’

I am a runner – and I suffer from post-traumatic stress disorder. One of the many things I think about while I’m running, and also when I’m not, is the relationship between the two.

I have always loved to run, and I have fuzzy memories of running pretty much anywhere, anytime, as a child. We would spend family holidays in north Wales, and I remember galloping into the hills, pretending to be a horse, then sitting in the grass and watching a snowstorm move up the valley. Now in my 40s, running has become far more structured, and an essential contribution to my life and ability to manage my illness. Yet I find that some people are concerned about my need for it, which always surprises me, as it seems like a positive thing to do. One doctor recently asked me if it felt like I was running away and I answered: “What does it matter? It makes me feel better.”

Experiences of loss and repeated trauma from childhood resulted in an early onset of depression and severe anxiety, culminating in a complete breakdown at 27 from which I’ve never fully recovered. It took over 30 years of seeing multiple mental health professionals before I even had an explanation for my inability to get well (a correct diagnosis was only reached in my late30s). A good day for me is managing the walk to my son’s school, greeting teachers and other parents, then perhaps doing some food shopping, without having a panic attack. On a really good day, I might have a friend round for coffee and a chat, but by and large my life is isolated – and that’s OK. My wonderful husband enjoys taking the boys out, while I (for the most part) am the stay-at-home support. I have more than I ever dreamed possible.

Four years ago, my husband’s work took us to the US, where our second son was born, and shortly after that a friend introduced me to trail running. I have always felt at home in the mountains, and the Appalachians are breathtakingly beautiful. At first, I couldn’t manage more than a mile or two without stopping, but I nonetheless made the most incredible discovery. How to articulate this? As well as the powerful medicinal effect of being surrounded by nature, running makes life feel simple. Battling an illness such as mine is utterly debilitating all day, every day, year after year. There is no respite. Many people will know what I mean when I refer to having a dream where you are suddenly, sharply falling, causing you to wake with a jolt and a racing heart. I have this sensation many times a day while wide awake, for absolutely no visible reason – I am perpetually fearful. In addition to this, the depression (and grief) can be crippling: it slowly numbs your brain and sends your body into a state I imagine being rather like hibernation – an attempt to withdraw from the pain. Going for a run not only gets me physically moving, it also takes my thoughts out of the equation: all I have to do is keep putting one foot in front of the other and breathe.

Initially, my incentive was an 18-mile trail race up a mountain, with a total of around 5,300ft of ascent. Having been a 100-metre sprinter at school, this seemed like an impossible, if not ludicrous, goal, but it somehow represented my life. I knew a run of that magnitude was going to be physically and mentally exhausting, as well as painful, but I needed, at the very least, to survive it. It was a daunting challenge, and I was almost convinced that failure was inevitable, but I approached it by being scientific: reading, researching, asking advice and putting my trust in training. Even just getting out for a run could be next to impossible, due to my agoraphobia. Some runs would be particularly fast, with the extra injection of fear-induced adrenaline. And I had a very patient, kind partner for the weekend long runs, which I could never have done on my own.

On the day of the race, I kept my head down to avoid total panic among the crowd of runners at the start and set no time target: it was about getting to my family at the finish line and looking at the view from the top of the mountain; being, for once in my life, one of the achievers.

That was over a year ago, and we have now moved to yet another country, but I have brought the running with me, along with my race finisher’s shirt. Our new home backs onto 2,000ft of rugged hill, with rocky, brutally steep trails to the summit, from where miles and miles of mountain tops stretch away to the edge of the Earth. I embrace running in all weathers: sun, heavy rain, high winds, snow and hail, always with a considerable amount of ascent. As I fight my way up the climbs, I often imagine that the hill is my illness and I am going to slowly and steadily conquer it. Yet it never feels like suffering and, once at the top of the hill, I can reach out and touch the sky. At home, I am always struggling to stay afloat, fearing I will lose the battle with my illness and fail my husband and children, but all of that slips away when I am running. It is just me and the hills and some long-distant memories, and I always come home smiling and with my head full of stillness.

Mindfulness therapy comes at a high price for some, say experts

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Mindfulness therapy comes at a high price for some, say experts

In a first floor room above a gridlocked London street, 20 strangers shuffle on to mats and cushions. There’s an advertising executive, a personnel manager, a student and a pensioner. A gong sounds softly and a session of sitting meditation begins. This is one of more than 1,000 mindfulness courses proliferating across the UK as more and more people struggling with anxiety, depression and stress turn towards a practice adapted from a 2,400-year-old Buddhist tradition.

Enthusiasm is booming for such mindfulness-based cognitive therapy (MBCT) courses, which an Oxford University study has found can reduce relapses into depression by 44%. It is, say the researchers, as effective as taking antidepressants. It involves sitting still, focusing on your breath, noticing when your attention drifts and bringing it back to your breath – and it is surprisingly challenging.

Lifestyle magazines brim with mindfulness features and the global advertising giant JWT listed mindful living as one of its 10 trends to shape the world in 2014 as consumers develop “a quasi-Zen desire to experience everything in a more present, conscious way”.

But psychiatrists have now sounded a warning that as well as bringing benefits, mindfulness meditation can have troubling side-effects. Evidence is also emerging of underqualified teachers presenting themselves as mindfulness experts, including through the NHS.

The concern comes not from critics of mindfulness but from supporters, such as Dr Florian Ruths, consultant psychiatrist at the Maudsley hospital in south London. He has launched an investigation into adverse reactions to MBCT, which have included rare cases of “depersonalisation”, where people feel like they are watching themselves in a film.

“There is a lot of enthusiasm for mindfulness-based therapies and they are very powerful interventions,” Ruths said. “But they can also have side-effects. Mindfulness is delivered to potentially vulnerable people with mental illness, including depression and anxiety, so it needs to be taught by people who know the basics about those illnesses, and when to refer people for specialist help.”

His inquiry follows the “dark night” project at Brown University in the US, which has catalogued how some Buddhist meditators have been assailed by traumatic memories. Problems recorded by Professor Willoughby Britton, the lead psychiatrist, include “cognitive, perceptual and sensory aberrations”, changes in their sense of self and impairment in social relationships. One Buddhist monk, Shinzen Young, has described the “dark night” phenomenon as an “irreversible insight into emptiness” and “enlightenment’s evil twin”.

Mindfulness experts say such extreme adverse reactions are rare and are most likely to follow prolonged periods of meditation, such as weeks on a silent retreat. But the studies represent a new strain of critical thinking about mindfulness meditation amid an avalanche of hype.

MBCT is commonly taught in groups in an eight-week programme and courses sell out fast. Ed Halliwell, who teaches in London and West Sussex, said some of his courses fill up within 48 hours of their being announced.

“You can sometimes get the impression from the enthusiasm that is being shown about it helping with depression and anxiety that mindfulness is a magic pill you can apply without effort,” he said. “You start watching your breath and all your problems are solved. It is not like that at all. You are working with the heart of your experiences, learning to turn towards them, and that is difficult and can be uncomfortable.”

Mindfulness is spreading fast into village halls, schools and hospitals and even the offices of banks and internet giants such as Google. The online meditation app Headspace now has 523,000 users in the UK, a threefold increase in 12 months. But mounting public interest means more teachers are urgently needed and concern is growing about the adequacy of training. Several sources have told the Guardian that some NHS trusts are asking health professionals to teach mindfulness after only having completed a basic eight-week beginners’ course.

“It is worrying,” said Rebecca Crane, director of the Centre for Mindfulness Research and Practice in Bangor, which has trained 2,500 teachers in the past five years. “People come along to our week-long teacher training retreat and then are put under pressure to get teaching very quickly.”

Exeter University has launched an inquiry into how 43 NHS trusts across the UK are meeting the ballooning demand for MBCT.

Marie Johansson, clinical lead at Oxford University’s mindfulness centre, stressed the need for proper training of at least a year until health professionals can teach meditation, partly because on rare occasions it can throw up “extremely distressing experiences”.

“Taking the course is quite challenging,” she said. “You need to be reasonably stable and well. Noticing what is going on in your mind and body may be completely new and you may discover that there are patterns of thinking and acting and behaving that no longer serve you well. There might be patterns that interfere with living a healthy life and seeing those patterns can bring up lots of reactions and it can be too much to deal with. Unless it is handled well, the person could close down, go away with an increase in self-criticism and feeling they have failed.”

Finding the right teacher is often difficult for people approaching mindfulness for the first time. Leading mindfulness teaching organisations, including the universities of Oxford, Bangor and Exeter, are now considering establishing a register of course leaders who meet good practice guidelines. They expect mindfulness teachers to train for at least a year and to remain under supervision. Some Buddhists have opposed the idea, arguing it is unreasonable to regulate a practice rooted in a religion.

Lokhadi, a mindfulness meditation teacher in London for the past nine years, has regular experience of some of the difficulties mindfulness meditation can throw up.

“While mindfulness meditation doesn’t change people’s experience, things can feel worse before they feel better,” she said. “As awareness increases, your sensitivity to experiences increases. If someone is feeling vulnerable or is not well supported, it can be quite daunting. It can bring up grief and all kinds of emotions, which need to be capably held by an experienced and suitably trained teacher.

“When choosing a course you need to have a sense of the training of the teacher, whether they are supervised and whether they themselves practise meditation. Most reputable teacher training courses require a minimum of two years’ meditation practice and ensure that teachers meet other important criteria.”

The bizarre sleeping habits of Brits revealed: From sleep-walking to sleep-drawing

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The bizarre sleeping habits of Brits revealed: From sleep-walking to sleep-drawing

A new study of sleeping habits in the UK has shown Brits are a restless bunch, with over 40 per cent talking in their sleep, and more surprisingly almost 10 per cent getting creative by drawing, painting or writing while in the land of nod.

The study also showed that one in 10 people are somnambulists, or sleep-walkers. Sleepwalking usually occurs in a period of deep sleep during the first few hours after falling asleep.

While the exact cause is unknown, it seems to run in families, according to the NHS. Sleep deprivation, stress and anxiety, and drinking too much alcohol, taking recreational are among the factors that can trigger sleep walking.

The research commissioned by Ibis Hotels also gave in an insight into the mysterious world of dreams, with some 16 per cent of adults convinced that they had dreamt something that they claim later came true. Meanwhile, a quarter of those surveyed reported having a recurring dream for six months.

The peculiarities of sleepers across the UK were also revealed, as people in the North East were more likely to have recurring dreams, while a quarter of people in the same region admitted to dream cheating on their partners. But the Scottish appear to be the most self-conscious about their behaviour, as a fifth have had a sexual dream about someone and felt embarrassed to see them the next day.

Meanwhile, Londoners were more prone to having the same dreams as their friends and families on the same night. Residents of the capital were also more likely to be able to get back into a dream after waking up.

More than 300 rapes reported in schools in past three years

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More than 300 rapes reported in schools in past three years

Sexual abuse in British classrooms is increasing fast, according to official figures that reveal a 40 per cent increase in reports of rape in schools in the past three years.

At least 2,865 sex-crime reports have been recorded by police between 2011 and 2013  – and more than half of them were committed by other children, according to data released to The Independent by police under the Freedom of Information Act.

The figures showed that more than 320 alleged rapes were reported in schools in the last three years, with the NSPCC saying that pupils’ easy access to online pornography has likely driven the surge in online child abuse.

Last year alone, there were at least 1,052 alleged sex offences reported in schools, of which 134 were reported as rape.

Statistics on rape and sex crime reports that took place in schools were released by 37 out of 46 UK police forces. Children accounted for more than 90 per cent of alleged abuse victims, but more than half of the claimed offences were also said to have been committed by children.

The Department of Education (DfE) has resisted calls to introduce mandatory reporting of abuse allegations but the Government is now facing renewed pressure to reform child safeguarding. Currently, headteachers are urged to report allegations to child-protection experts, but there is no legal penalty if they choose not to.

Among cases that have come to light in recent years, a 12-year-old girl was allegedly stripped naked and raped by pupils at a school in Hampshire. The school, however, believed she had consented and excluded her for breaking rules by having sex on its grounds, a tribunal heard. In May, the Crown Prosecution Service said no charges would be brought against the suspects because of insufficient evidence.

In another case, a religious-education teacher in Manchester groped and kissed a teenage pupil in one-on-one meetings he arranged in his classroom. Richard Jones, 57, started a secret relationship with the girl, but was arrested when and when her family discovered explicit messages on her computer.

He was sentenced to eight years in prison last month after admitting a string of sexual offences.

Claire Lilley, of the NSPCC, said: “Schools must make sure they have adequate safeguarding procedures in place and that parents and teachers are able to recognise warning signs early so they can take swift action when required.

“However, the damaging behaviour of these children can be turned around if caught early. Prevention has to be the key.”

The National Association of Headteachers claimed the increase in child-abuse reports may reflect “alleged victims being more confident about making a disclosure”. A spokesperson said the work being done in schools to create a safe environment was “excellent”.

But Labour called on the Government to take “urgent action”. Yvette Cooper, the shadow Home Secretary, said: “These figures are very disturbing. Schools should be a place of safety for children and young people. The Government needs to take action given the evidence of growing sexual violence amongst young people.” She added they must “introduce compulsory sex and relationship education in all schools”.

A Department for Education spokesperson said: “There is nothing more important than protecting children from harm – any allegation of abuse must be taken very seriously. Schools’ safeguarding arrangements are regularly inspected.”

Australia’s detention regime sets out to make asylum seekers suffer, says chief immigration psychiatrist

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Australia’s detention regime sets out to make asylum seekers suffer, says chief immigration psychiatrist

The chief psychiatrist responsible for the care of asylum seekers in detention for the past three years has accused the immigration department of deliberately inflicting harm on vulnerable people, harm that cannot be remedied by medical care.

“We have here an environment that is inherently toxic,” Dr Peter Young told Guardian Australia. “It has characteristics which over time reliably cause harm to people’s mental health. We have very clear evidence that that’s the case.”

Young is the most senior figure ever to condemn the detention system from within. Until a month ago he was director of mental health for International Health and Medical Services (IHMS), the private contractor that provides medical care to detention centres on the Australian mainland, Christmas Island, Nauru and Manus Island.

Young has extensively briefed Guardian Australia about a system he says is deliberately harsh, breaks people’s health, costs a fortune, compromises the ethics of doctors and is intended to place asylum seekers under “strong coercive pressure” to abandon plans to live in Australia. “Suffering is the way that is achieved.”

He believes this process is akin to torture: “If we take the definition of torture to be the deliberate harming of people in order to coerce them into a desired outcome, I think it does fulfil that definition.”

Young strongly criticised the immigration department for:

• Delays that endanger health in bringing patients to Australia from Manus and Nauru: “It is seen as undesirable because it undermines the idea that people are never going to Australia and also because of the concern that if people arrive onshore then they may have access to legal counsel and other assistance.”

• Leaving people in detention who are acutely suicidal: “Trying to manage them in a non-therapeutic setting like that is just inherently futile. It’s not going to work.”

• Returning patients with less severe problems to detention despite medical advice that they cannot be expected “to fully respond to treatment in an environment that was making them sick”.

• Misusing patient information. “People disclose a lot of personal information which is then recorded in notes which are then available to non-medical people for other purposes.” Young says the dual role of IHMS staff treating detainees but reporting to the department raises fundamental ethical problems for doctors in the system.

• Displaying an obsession with secrecy: “Speaking out of turn is clamped down on whenever it occurs … they continue to maintain the fantasy that they can keep everything a secret.”

• Reluctance to gather and use mental health statistics that might “result in controversy or threaten the application of the policies of deterrence”.

• Directing doctors not to put in writing that detention has led to deterioration in their patients’ mental health. IHMS doctors ignored the direction. Young said they saw evidence all around them of detainees “sick because they are there and getting sicker while they remain there”.

The Manus camp particularly appalled Young. “When you go to Manus Island and you walk down what is called the ‘walk of shame’ between the compounds and you see the men there at the fences it’s an awful experience,” he says.

“You have to feel shame. You have to understand what that feeling is about in order to be able to be compassionate. By feeling the shame you stay on the right side of the line.”

Young told Guardian Australia IHMS figures had shown for some time that a third of adults and children in the detention system had what he called “a significant-level disorder”. If they were living in Australia, that would require the care of specialist medical health services. The figures only got worse as detainees stayed longer in detention: “After a year it approaches 50%.”

Last week, in alarming evidence to an Australian Human Rights Commission inquiry, Young said the immigration department had refused to accept IHMS statistics proving damage to children and adolescents held in prolonged detention. He told the inquiry: “The department reacted with alarm and asked us to withdraw the figures.”

In a belligerent appearance before the inquiry, the secretary of the immigration department, Martin Bowles, accused the president of the Human Rights Commission, Gillian Triggs, of making “highly emotive claims” about health problems in the detention system. He had not heard evidence of the problems provided by Young and other IHMS doctors earlier in the day.

His hand shook as he confronted Triggs. When his evidence produced laughter he demanded the room be silenced. He refused to answer some questions and retreated at times behind a wall of bureaucratic prose.

But Bowles did not deny a link between prolonged detention and mental illness. He called this a “well-established” issue and insisted his department was doing “everything it humanly can” to provide “appropriate medical care” to address the mental health problems of detainees.

Young told Guardian Australia that was impossible: “The problem is the system.”

Young is confident that in his time at IMHS the men and women working for him made better assessments of detainees’ health and delivered much better treatment than in the past.

“But you can’t mitigate the harm, because the system is designed to create a negative mental state. It’s designed to produce suffering. If you suffer, then it’s punishment. If you suffer, you’re more likely to agree to go back to where you came from. By reducing the suffering you’re reducing the functioning of the system and the system doesn’t want you to do that.

“Everybody knows that the harm is being caused and the system carries on. Everybody accepts that this is the policy and the policy cannot change. And everybody accepts that the only thing you can do is work within the parameters of the policy.”

The window of reasonableness closes
Young arrived in the system in 2011 at a crucial moment: the high court was about to knock back the Gillard government’s proposed “Malaysia solution” and, as the boats arrived in ever-increasing numbers, the detention system was bursting at the seams. So the government began processing detainees quickly and releasing large numbers into the community on bridging visas. “The problems that we were seeing from a mental health perspective decreased massively.”

Young has been a psychiatrist for nearly 20 years, most of that time working in public health. He joined IHMS believing the detention system was problematic but confident that good could be done from the inside. “I felt that given the experience I had I could work between the immigration department and IHMS and the detention health advisory group to bring about positive change.”

The year before Young’s arrival, the immigration department had been put on notice once again that prolonged detention harms mental health. Professor Kathy Eager of Wollongong University reached that conclusion in a study commissioned by the department itself.

“There is,” she wrote, “almost universal criticism of the policy of detaining asylum seekers, particularly in terms of the mental health implications.”

Her findings were backed by the department’s independent Detention Health Advisory Group (Dehag), the Australian College of Mental Health Nurses and the Australian Psychological Society. In 2011 the Royal Australian and New Zealand College of Psychiatrists declared: “Prolonged detention, particularly in isolated locations, with poor access to health and social services and uncertainty of asylum seeker claims, can have severe and detrimental effects.”

While detainees were being rapidly released, Young observed attitudes towards them improved throughout the system. They were not treated as prisoners.

Their mental health was generally good: “These people are actually quite robust and psychologically healthy individuals despite all the suffering that they have been through.”

But what Young calls “the window of reasonableness” stayed open for only six months. With boats arriving in unprecedented numbers and the opposition in full cry, the government reversed direction. Once again boat people were to be held for long periods. The camps on Manus and Nauru were reopened. Kevin Rudd announced that no new boat arrivals would end up living in Australia.

“You just can’t overstate how things changed so rapidly when the policy changed,” Young says. Once again the system treated them as prisoners. The impact on their mental health was as predicted: fine for a few months, then increased depression, anxiety and stress.

“Most people have a level of resilience which allows them to function fairly well for a few months, but after that time there is a steady deterioration … after six months the cumulative harms accelerate very rapidly.”

Asylum seekers self-harming is ‘seen as bad behaviour’.
Uncertainty does the worst damage, Young says. Then comes hopelessness. “They are constantly given a message that they are on a negative pathway, meaning their claim is not going to be accepted. This is despite what we know about the outcomes of processing in the long term, which is that greater than 80% of people are found to be genuine refugees.”

And they have so little autonomy. “Just the day-to-day daily lives that they experience living in the detention system means that they have very little control over what they do. It makes things particularly difficult for people who are there with their children as well. Their capacity to act as parents and to make decisions on behalf of their families is so restricted.”

Young sees immigration detention as inherently more harmful than prison. “In prison those with mental health problems generally improve. People are more well on their release than when they entered. What we see in detention is the opposite of that. Over the course of time in detention, they get sicker.

“We don’t have families in prisons. Secondly, when people go to prison they go through a recognised independent judicial process. It’s not arbitrary. This is an arbitrary process and people see it as being unfair and that is another factor.

“Also, when people are in prison they have a definitive sentence so they know there is an end point. This is not like that at all. This is indefinite.”

Each quarter IHMS presents the department with figures on the health of detainees. The data for July to September 2013 showed a third of those held in detention for more than a year were experiencing extremely severe depression; 42% were suffering extremely severe anxiety; and 42% were extremely stressed. The report notes these figures are consistent with internationally published research: “The pattern shows the negative mental health effects of immigration detention with a clear deterioration of mental health indices over time in detention.”

Abbott takes power
“People didn’t really take Rudd seriously,” Young recalls. “But everybody was saying when the Libs get in it’s really going to get tough. So there was a building up of expectation that things were going to get worse, which made it worse in itself.”

When the change came in late 2013, there was no radical shift in policy. “Everything just got harsher.”

Relations between the department and its independent health advisers were already rocky. Dehag had been set up in 2006 at a time of acute embarrassment after it was discovered that a schizophrenic Australian resident, Cornelia Rau, was being held in the detention.

She was thought to be German, was desperately ill and the immigration department refused to release her for treatment. She was finally identified naked in the yards of the Baxter detention centre.

Dehag had an independence the department came to regret. Its dozen members were nominated by peak medical authorities, including the Australian Medical Association, the Mental Health Council of Australia and the professional colleges for nursing, general practitioners and psychiatry. The experts were at the table but the department found itself dealing with people who could neither be corralled nor muzzled.

“It’s always been a very tense relationship,” says Louise Newman, director of the centre for developmental psychiatry and psychology at Monash University. Newman chaired the group for a time. “At every meeting until they disbanded us we would make a statement that we did not support mandatory detention or prolonged detention of any form, that it was damaging and that it created problems that we could not fix.”

Young, who sat in on the group’s meetings, confirmed the experts’ fundamental objection to detention: “That’s been the baseline position that they have always held and they have always presented.”

The group watched with concern as the Gillard government reversed its policy of swift release for asylum seekers. Newman sees the second round of detention as worse than the first because it came as the evidence of harm was even more firmly established. “They replicated the very conditions that they have admitted contribute to mental harm and deterioration,” she said.

“It’s seen as collateral damage. The department does what it can to reduce it but in the name of the greater good of border protection and deterrents it doesn’t really matter. We’re saving lives by sending people mad.”

The group drove change. “The department was very pleased to use things that we brought in, so any positive reforms that have gone on in the system in terms of screening people and healthcare and health standards were all done by Dehag.”

But Newman alleges the department later sabotaged medical screening of asylum seekers for signs of torture and trauma. “We argued that no one who had been tortured should be detained or particularly not in remote places. The departmental doctors decided the best way to get around that was not to do the screening, so they didn’t find out who was tortured. They stopped it on Christmas Island so people could be shipped away before it was even known if they were trauma survivors.”

Tension between Dehag and the department intensified after Bowles was appointed secretary of the department in 2012, Newman says. Bowles is not a doctor but for much of his career was a health administrator before joining the defence department. He is one of a group of former army and defence figures who now hold the most senior positions in the immigration department.

Bowles announced a review of Dehag, which he renamed the Immigration Health Advisory Group (Ihag). He failed in manoeuvres to change its membership but imposed a former military doctor, Paul Alexander, as its chairman. “It was meant to be a much more controlled group,” Newman says.

Bowles wanted the experts to withdraw from public debate. Young says: “They wanted the thing to be more watertight.” The experts were not accused of leaking. “But they expressed views in public which were relevant to the business before the committee.” They continued to do so. The most vocal was Newman.

The experts and the department continued to be at loggerheads over the standard of care for detainees. Newman says Dehag and Ihag always argued that detainees had to be looked after “regardless of visa status” while they were in Australian hands, and it was an ethical obligation on all medical practitioners working in the system to provide care to Australian standards.

But once Nauru and Manus reopened, the department began to demand treatment be pegged to the much lower standards of care on those islands. There would have to be exceptions – no inpatient mental healthcare is available on Manus or Nauru – but the department’s wish was to lower the general standard of care for detainees in those camps.

At what was to be the last meeting of Ihag in August 2013, the issue was debated at length. An impasse was reached, says Newman. “The department at a very high level from secretary down argues the Australian government is not obliged to provide our standard of care to these people.”

But experts insisted that standards must be maintained and that the department’s plan was an ethical minefield for doctors. “Clinicians who go along with it are absolutely compromised,” says Newman.

Ihag experts continued to work in the system, but they never met as a group after Abbott’s victory in the federal election of September 2013. A long pattern of suddenly cancelled meetings ended with no meetings called at all. In mid-December the experts received letters thanking them for their service. They were dismissed. Alexander was now to be the sole adviser on medical matters to the renamed Department of Immigration and Border Protection.

Scott Morrison, the new minister, issued a statement: “The large membership of the group made it increasingly challenging to provide balanced, consistent and timely advice in a fast-moving policy and operational environment.”

Young says: “That doesn’t wash at all. Ihag had consistently told the department things it didn’t want to hear and the department had pretty transparently sabotaged the operation of it for more than 12 months.”

The chiefs of peak medical bodies, including the AMA’s Dr Steve Hambleton, expressed shock at Ihag’s demise. Abbott condemned the generally negative reporting of the move as “a complete beatup by the ABC and some of the Fairfax papers”. The prime minister declared: “This was a committee which was not very effectual.”

The rising tide of data
Morrison had been in the job only a few months when he assured Australia that mental health problems among detainees were on the wane. In mid-December, Nine News reported: “Immigration minister Scott Morrison yesterday said diagnosed mental health problems among detainees in Australia had fallen from a peak of 12% in 2011 to the current rate of 3.4% as a result of greater resourcing.”

Young is scathing about Morrison’s figures. “That’s not a prevalence rate. It never has been. It’s a pale shadow of what the real prevalence rate is because of the way that data is derived.”

Young says Morrison was ignoring the figures revealed by regular screening and instead using a count of visits to GPs or psychiatrists where mental health problems were raised. “It doesn’t take into account people who may have a disorder who are not seeing either of those two categories of clinicians.”

Gathering better statistics was one of Young’s key ambitions in his time at IHMS. The department dragged its feet on his proposals to use new measures to screen mental health problems. “There seemed to be a fear that it would result in controversy or threaten the application of the policies of deterrence,” Young says.

But the chief psychiatrist finally got his way and the new measures were used for the first time in the first quarter of this year. Young presented these figures to the Royal College of Australian and New Zealand Psychiatrists in May. They confirmed the long-established pattern: about a third of all those in detention had clinically significant problems – and the longer the detention, the worse the problems.

Half those who had been detained for 19 months or more were extremely or severely depressed; 40% were extremely or severely stressed; and 40% were extremely or severely anxious. The worst scores were gathered on Manus and Nauru. But the figures show a common pattern across the whole detention system.

In a PowerPoint presentation provided to Guardian Australia by the college, Young concludes: “All show linear deterioration in mental health status over time in detention.”

Young’s staff were also collecting figures on the impact of detention on children. “Changing to instruments more appropriate for children has been something the department has dragged their feet on for quite a long time.”

Young shocked the Human Rights Commission inquiry last week by alleging the department refused to accept these Honosca (Health of the Nation Outcome Scales for Children and Adolescents) figures.

He told Guardian Australia: “This is not the only instance where data which has been seen as controversial or just difficult to understand has been buried.”

But Triggs requested the figures be given to her inquiry. They show across the mainland detention system a large number of children showing emotional distress or related symptoms. Young considered the figures a sign of serious problems that needed urgent consideration and action. Some of these children are those that IHMS doctors reported as showing issues of self-harm, regression, aggression, bed-wetting and despair.

The Health of the Nation Outcome Scales for Children and Adolescents figures
When Bowles was questioned at the inquiry, he did not deny his department issued instructions to IHMS to withdraw the figures but was at pains to suggest to the commission that they remained under consideration by the department. He said: “I have no doubt that most of this sort of reporting is mainstream.”

Giving evidence to Triggs’s inquiry was Young’s last assignment for IHMS. As his three years with the commercial providers drew to a close, he decided to make a professional and public assessment of the detention system once he was free to do so.

“As a medical practitioner your duty is always to your patients and the people you look after,” he says. “To them you have a broader moral and ethical responsibility. In this case you see harm being done and as the primary duty of a doctor is to do no harm, your duty is to speak out against that harm – to say that harm should not be done.”

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