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


, , , , , , , , , , ,

‘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’


, , , ,

‘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


, , , , , , , , , , , , , , , , , ,

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


, , , , , , , , , , ,

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


, , , , , , , ,

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


, , , , , , , , , , , , ,

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.”

More members of Amazonian tribe seek help from Brazil


, ,

More members of Amazonian tribe seek help from Brazil

More than 20 members of an isolated Amazonian tribe have made contact with the Brazilian authorities amid growing fears that they are being driven from their forest home by drug smugglers or illegal loggers.

The outreach – effectively a plea for sanctuary, support and weapons – follows earlier encounters in June and July that were captured on video.

This time it was a larger group – 23 men, women and children, probably from the same tribe – that crossed the border from their territory in Peru to seek help from Brazilian government officials, despite a long reluctance to make contact with the outside world.

Brazil’s health ministry is monitoring the physical condition of the group, who are at the Xinane monitoring post neat the Envira river in Acre state. They appear healthy but, lacking antibodies against common diseases, they are taking a considerable health risk through their action. After previous similar contacts, many tribes have been decimated by deadly flu epidemics.

The group are aware of such dangers, but appear to be more frightened of attacks on their territory by intruders. They are said to have confirmed earlier reports that elder tribesmen were massacred and their homes burned by outsiders.

Their migration has disturbed settled communities of the Asháninka indigenous group, as the tribe have stolen food, clothes and weapons from many homes.

The Brazilian government now faces a tough decision on the best way to help them and avoid the tragedies that have followed so many previous contacts.

The National Indian Foundation (Funai) recently reopened the base at Xinane, which it had abandoned in 2011 after attacks by drug traffickers, who run a lucrative cocaine trail across the border from Peru – the world’s biggest coca producer. But long-term observers of the situation say protection on the Peru side of the border is negligible and resources for support on the Brazilian side are inadequate.

José Carlos Meirelles, a frontiersman who has spent more than 20 years as an official in the region, said Brazil had a responsibility to help the young tribesmen who had made contact, otherwise there was a danger that another tribe would be wiped out. “They are asking Funai to do what the Brazilian state has the duty to do. They should not need to ask, it is our obligation,” he told Blog da Amazônia.

Survival International, the movement for tribal people’s rights, urged the Peruvian government to do more to protect its isolated indigenous communities. “The accounts given by these Indians – of the killing of their relatives, and the burning of their houses – were incredibly disturbing,” said Stephen Corry, the group’s director. “This appears to have taken place on the Peru side of the border, probably at the hands of the illegal loggers and drug traffickers whose presence has been known of for years. What will it take for the Peruvian government to actually protect these tribes’ territory properly?”

Survival has launched a letter-writing campaign to urge the governments of the two countries to provide more support for the tribes.

Bondi fitness scheme turns the tide on treating mental illness


, , ,

Bondi fitness scheme turns the tide on treating mental illness

A groundbreaking “lifestyle medicine programme” developed on the surfers’ paradise of Bondi Beach in Australia will be used by the NHS to improve the scandalously neglected physical health of people with serious mental illness.

There are more than 300,000 people in England diagnosed with conditions such as schizophrenia, bipolar disorder and psychosis. But their antipsychotic medication, while reducing disturbing symptoms such as hearing voices and experiencing hallucinations, also causes rapid weight gain within two months of starting a course, precipitating diabetes and heart and circulatory diseases. Weight gain is often why some patients who stop taking their medication relapse and have to be sectioned and return to hospital.

In addition, many people with mental illness are heavy smokers, have chaotic lifestyles, take little exercise and have poor diets and it is hardly surprising that they die, on average, 15 to 20 years earlier than the general population. Gaps between those responsible for mental healthcare and physical wellbeing were revealed in the 2012 National Audit of Schizophrenia, a survey of 5,000 NHS patients with a diagnosis of schizophrenia. It found that only 29% received an adequate assessment of risk factors for cardio-metabolic disease (body mass index, smoking, blood pressure, blood glucose and cholesterol).

About five years ago, health workers in the Bondi Beach suburb of Sydney who were treating young people experiencing their first episode of serious mental illness, started to raise concerns about their patients’ rapid weight gain.

Professor Katherine Samaras, a diabetes and obesity specialist at the University of New South Wales, and one of the architects of the Bondi programme, told the Guardian that despite international expectations of a sunny climate and beach culture Bondi, Sydney (and Australia in general), shares first-world problems of inactivity and overeating calorie-rich foods. Antipsychotic medications also increase feelings of hunger and encourage inactivity, she says, thereby creating a potentially lethal mix.

As a result Keeping the Body in Mind, a multidisciplinary programme was devised, providing patients with vital life skills: what to eat, where to buy it, how to cook it, and how to exercise.

Each patient gets 12 weekly individual sessions with a dietitian and exercise physiologist, weekly group education sessions and access to a gym.

The “show how to cook/exercise/eat/shop” part of the programme was so popular, it was integrated with seeing the psychiatrist and mental health workers, which boosted attendance and engagement, says Samaras. “We have compiled a cookbook of recipes, to which the young people contributed to as well, with their favourite recipes.”

Pilot research presented at the international congress of endocrinology in Chicago earlier this month compared 16 young people who took part in the lifestyle intervention programme with a control group who received the usual care. Over the course of 12 weeks, the lifestyle intervention group gained an average of 1.2 kg, compared with 7.3 kg in the control group. Now the programme is undergoing a formal cost effectiveness analysis.

“Our programme was relatively cheap and of course this early investment in health offsets the cost of treating heart disease and diabetes,” says Samaras.

Some 60 young people aged 15-25 come through the Bondi model. It now forms part of the National Institute for Health and Care Excellence (Nice) guidelines on the care of young people with serious mental illness. And it is being piloted by the NHS in Worcester under the guise of Shape – the Supporting Health and Promoting Exercise – programme for young people with psychosis with a view to it being rolled out across the NHS.

The Bondi model dovetails with the introduction from April this year of physical health “MOTs” for seriously ill inpatients in every NHS mental health trust in England.

Dr Geraldine Strathdee, NHS England’s national director for mental health, describes the MOTs as the world’s largest ever initiative to improve the physical health of people with mental illness and a “clinical quality game changer”.

As part of the MOTs, trusts will be paid to ask patients about smoking status and diet, and monitor weight, blood pressure, glucose and cholesterol levels.

Mental health nurses, psychiatrists, health care assistants and psychologists will carry out the MOTs. This marks a sea change in the way psychiatric patients are treated. It is hoped this will prevent them from falling through the gaps in services historically divided under physical or mental health banners.

Back in Bondi Julio De Le Torre was 21 when he was diagnosed with bipolar disorder in 2012. He says the Keeping the Body In Mind programme helped him shed some 20kg he gained as a result of medications, enabling him to finish his degree and pursue a career in engineering. He is back on the surf and says: “I feel like a normal person now”.

One in 10 do not have a close friend and even more feel unloved, survey finds


, , , , , , , , ,

One in 10 do not have a close friend and even more feel unloved, survey finds

Millions of people in the UK do not have a single friend and one in five feel unloved, according to a survey published on Tuesday by the relationship charity Relate.

One in 10 people questioned said they did not have a close friend, amounting to an estimated 4.7 million people in the UK may be leading a very lonely existence.

Ruth Sutherland, the chief executive of Relate, said the survey revealed a divided nation with many people left without the vital support of friends or partners.

While the survey found 85% of individuals questioned felt they had a good relationship with their partners, 19% had never or rarely felt loved in the two weeks before the survey.

relate 1208 WEB

“Whilst there is much to celebrate, the results around how close we feel to others are very concerning. There is a significant minority of people who claim to have no close friends, or who never or rarely feel loved – something which is unimaginable to many of us,” said Sutherland.

“Relationships are the asset which can get us through good times and bad, and it is worrying to think that there are people who feel they have no one they can turn to during life’s challenges. We know that strong relationships are vital for both individuals and society as a whole, so investing in them is crucial.”

The study looked at 5,778 people aged 16 and over across England, Wales, Northern Ireland and Scotland and asked about people’s contentment with all aspects of their relationships, including their partners, friends, workmates and bosses. It found that people who said that they had good relationships had higher levels of wellbeing, while poor relationships were detrimental to health, wellbeing and self-confidence.

The study found that 81% of people who were married or cohabiting felt good about themselves, compared with 69% who were single.

The quality of relationship counts for a lot, according to the survey: 83% of those who described their relationship as good or very good reported feeling good about themselves while only 62% of those who described their relationship as average, bad or very bad reported the same level of personal wellbeing.

The survey, The Way We Are Now 2014, showed that while four out of five people said they had a good relationship with their partner, far fewer were happy with their sex lives. One in four people admitted to being dissatisfied with their sex life, and one in four also admitted to having an affair.

There was also evidence of the changing nature of family life – and increasing divorce rates – in the survey, which found that almost one in four of the people questioned had experienced the breakdown of their parents’ relationship.

When it comes to the biggest strains put on relationships, a significant majority (62%) cited money troubles as the most stressful factor.

The survey also found that older people are more worried about money, with 69% of those aged 65 and over saying money worries were a major strain, compared with only 37% of 16 to 24-year-olds.

When it comes to employment, many of those questioned had a positive relationship with their bosses, but felt putting work before family was highly valued in the workplace.

Just under 60% of people said they had a good relationship with their boss, but more than one in three thought their bosses believed the most productive employees put work before family. It also appears that work can be quite a lonely place too: 42% of people said they had no friends at work.

Nine out of 10 people, however, said they had a least one close friend, with 81% of women describing their friendships as good or very good compared with 73% of men.


Get every new post delivered to your Inbox.

Join 98 other followers