We must identify girls at risk from gangs

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gangs, isolation, risk, self-harm, sexual abuse, sexual exploitation, vulnerability

We must identify girls at risk from gangs

When I met Rita she was 17 and in custody for the 13th time. Her offending had escalated from moped theft and “antisocial” behaviour with boys when she was 11, through to firearms possession. She had been self-harming for the past three years, had contracted chlamydia, was malnourished, had developed an addiction to crack cocaine, and was being sexually exploited by the street gang to whom she was associated.

This had not happened to Rita overnight. It was the consequence of years of exploitation by her male peers, isolation from her friends, exclusion from school, and being sexually abused by a family member when she was eight years old. From a young age, a myriad of professionals had opportunities to intervene and protect Rita, but, instead, her risk snowballed.

A report published this week by the Centre for Mental Health demonstrates that Rita’s case is not a one-off. The report is based on data from 8,000 10- to 18-year-olds, who, following their arrest between August 2011 and November 2012, were screened for 29 different risk factors and health issues, such as family conflict, homelessness and victimisation, as part of a study to identify the most appropriate interventions. The screening process was a pilot run in 37 areas of England. Gang-involved girls were found to be over nine times more likely to exhibit 19 or more of these risk factors than the other young people screened.

Gang-involved girls navigate harmful environments and relationships. According to the study, young women who had “histories of parental imprisonment, poor parental mental health, parental substance misuse, or neglect” were three to five times more likely to be gang-involved than other girls who were screened. In addition, they were three times more likely to be identified as victims of sexual abuse and four times more likely to have been excluded from school.

The same girls were also more likely to have difficulties with their physical and mental health and wellbeing than other young people screened. Like Rita, 30% were reported to be self-harming or at risk of suicide, and were over three times more likely to have sexual health needs.

When public attention is focused on the horrendous accounts of groups of adult men sexually exploiting girls around the country, it is easy to forget about girls and young women who are at risk from their peers. The information provided clearly demonstrates that risk can be present in homes, peer groups, schools, neighbourhoods and in wider society, which increases the vulnerability of girls to street gangs. This report provides a statistical backdrop to the accounts given to me by hundreds of women and girls during the Female Voice in Violence project; now it is time to turn the stories and figures into action.

From preventing vulnerability, to the identification of girls linked to gangs, through to the programmes delivered to support them, and routes of safety that are offered, our processes need to be gender-specific. This groundbreaking report throws into sharp relief the impact of gang-association and the opportunities that exist to intervene across a young woman’s lifetime. Of the girls that were screened, 73% engaged with an intervention that was offered to them. It is critical that all agencies who work with girls and young women use the evidence to mobilise and evaluate interventions that will better identify and protect those involved with gangs.

Britons show Victorian attitudes to epilepsy as children who suffer from the condition are accused of being ‘possessed’

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Bullying, Children, discrimination, epilepsy, friends, possession, prejudice, seizure, teachers

Britons show Victorian attitudes to epilepsy as children who suffer from the condition are accused of being ‘possessed’

One in five children who suffer with epilepsy has been accused of being “possessed” after having a seizure, according to shocking new research.

Britons’ Victorian attitudes to the condition are exposed in a report published by the charity Young Epilepsy.

It finds that over three quarters of people of all ages have experienced discrimination as a result of their epilepsy. More than 40 per cent of children have experienced discrimination or exclusion from their peers, and almost a third have faced discrimination from teachers.

In addition, two fifths have faced discrimination from strangers, and 8 per cent by doctors and medical professionals, according to polling for Young Epilepsy by Opinion Matters.

Negative reactions from others after a child suffers a seizure include being told being told that epilepsy is contagious, which happened to a third of affected children, and being asked if they could speak to spirits, which occurred to 18 per cent.

David Ford, chief executive of Young Epilepsy, said: “It’s a level of prejudice more akin to 1913 than 2013. We knew there was some discrimination but we had no idea it was on this scale.”

Conservative MP Laura Sandys said: “I’m epileptic and I know from personal experience that this is what people think.

“There’s been a sea-change in people’s perceptions of most disabilities, but epilepsy still seems to be seen as something you keep quiet about; it still hasn’t shaken off that perception that you’re somehow possessed by the devil or demonised.”

Ms Sandys, who is chair of the All-Party-Parliamentary Group on Epilepsy, said: “There have only been two MPs who have declared their epilepsy, but statistically there should be another four.”

Experts are concerned that this prejudice means that children with epilepsy are less inclined to be open and discuss their condition, something which could have serious health implications.

This guardedness continues into later life, with 55 per cent of those adults who were questioned in the survey saying that they never disclose their epilepsy to new people because they fear a negative reaction from them.

Professor Helen Cross, Prince of Wales chair of childhood epilepsy at University College London and Great Ormond Street Hospital, said: “These high levels of prejudice have a huge impact on how children can manage their condition. If you’re worried about being bullied then you don’t want to talk to people about it, which means you don’t have buddies who know what to do if you have a seizure.”

She added: “Epilepsy is as common as diabetes, and in childhood it’s more common, but while I bet every schoolchild can name someone they know with diabetes, I’m sure that’s not the case with epilepsy.”

Case study: Elliot Harden, 11

Julie Harden from Oxted, Surrey, is mother of Elliot, 11, who suffers from a life threatening form of complex epilepsy

“Some people are really quite nasty about epilepsy. In conversations Elliot has been called ‘a retard’, ‘mad’, ‘not right’ and ‘that scary boy’. Even coming into my house people jump back from him as if they’re worried they’re going to be attacked.

I’ve got friends who won’t come round to our house with their children because they’re scared of what they might see. One time my other son Cameron, who is 8, was playing with other children upstairs. Elliot came up to see them and the other children ran away downstairs.

One of my neighbours even bangs on the wall saying ‘f-ing this and that’ when Elliot is having a seizure and fighting for his life. Another neighbour ran out of the house when he had a seizure.

Are mental illnesses such as PMS and depression culturally determined?

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culture-bound syndromes, Depression, diagnosis, DSM, mental health issues, symptoms

Are mental illnesses such as PMS and depression culturally determined?

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders – DSM 5 – was published over the weekend. Produced by the American Psychiatric Association, it describes the symptoms of a vast range of mental illnesses and is intended as a guide to diagnosis.

Why should we in the UK care? Simple: the political dominance of the US means that as soon as a mental disorder is named in the DSM, that disorder becomes valid in the eyes of many.

But not everyone is a fan. The DSM committee has been accused of continually expanding the categories of mental illness, resulting in“diagnostic inflation” – with the result that increasing numbers of us are diagnosed with one condition or another.

The committee has also fallen foul of the US National Institute for Mental Health (NIMH), which dislikes the DSM’s symptom-based approach. The NIMH argues that laboratory tests for biomarkers are the only rational way to diagnose mental illness.

And two weeks ago the British Psychological Society released a statement claiming that there is no scientific validity to diagnostic labels such as schizophrenia and bipolar disorder.

Indeed, the DSM’s fondness for the categorisation of mental illness is a major reason for its unpopularity in many quarters. According to Gary Greenberg in the New Yorker, frustrated scientists believe its beloved categories “don’t correspond to biological reality”.

Is that a fair criticism? I would argue that the categorisation of mental illness based on symptoms can be useful. But – and it’s a big, fat, hairy but – we must accept that those diagnostic categories are cultural constructions, not global certainties.

Culture-bound syndromes are most often the preoccupation of anthropologists. Typically, the patient displays symptoms that are recognised as indicating a particular illness only by other members of that patient’s cultural group. The dhat syndrome observed in parts of India, characterised by fatigue, anxiety and guilt and usually experienced by men, is a well-documented example of a psychological culture-bound syndrome, as is the susto, or fright sickness, of Latin America.

In a recent editorial in the British Journal of General Practice, Professor Christopher Dowrick argues that depression could be a western culture-bound syndrome, rather than a universal disorder. In support of his case, Prof Dowrick notes the lack of consensus in psychiatry over what even constitutes depression: the endless shifting of diagnostic goalposts.

He points out that there is no discrete genetic variation known to cause depression. Rather, there is genetic overlap across a range of mental illness, including depressive disorder, autism and schizophrenia.

Prof Dowrick’s point is that as China and India become politically dominant, spreading different concepts of what constitutes mental illness, we will have to be more sceptical of our cherished diagnostic categories. “In western anglophone societies we have developed an ethic of happiness, in which aberrations … are assumed to indicate illness,” he writes.

Others have argued that pre-menstrual syndrome, too, is a Western culture-bound syndrome. In 1987, Thomas S Johnson claimed that the symptoms were an expression of “conflicting societal expectations” on women. In 2012, a meta-analysis of published research failed to find evidence that negative mood correlates to the pre-menstrual phase of the menstrual cycle. And earlier this year, a qualitative study found that a “cognitive reframing” of the symptoms could reduce self-reported pre-menstrual distress.

Could depression and PMS really be culture-bound syndromes rather than biological entities? For sure, no one is arguing than they are not genuine illnesses – to the patient, the symptoms are real and painful. I used to be convinced by the biomedical model of depression, but now I’m not so sure. Could depression, and other familiar mental conditions, be interpreted as a kind of local language – our culturally established way of expressing distress and asking for help?

A DSM-style categorisation of illness based on symptoms could still be useful, provided we bear in mind that our local diagnostic categories are no more universal than our local language. We may also need to accept that treatments for mental disorder are not universally applicable. Culture-bound syndromes need culture-bound treatments: interventions recognised as “medicine” by both patient and practitioner.

It’s a very complex subject – not least because there may be crossover between the cultural and the biological; between the BPS’s dismissal of diagnostic labels and the NIMH’s desire to find a biomarker for every illness.

“I think the distinction between ‘biological’ and ‘social’ causes can get tricky. Lots of human practices that are clearly culturally patterned – child-rearing practices, diet, and sleep patterns, for example – affect our biology,” Dr Rachel Cooper, author of Classifying Madness, tells me in response to an email. “You could have cases where a ‘core’ biological disturbance is expressed differently in different cultures. Some have suggested that this might be the case with western-style depression and Chinese neurasthenia.”

And in the end, as Dr Cooper concludes, “A biomarker can only tell you that a person is different – not whether that difference should be considered pathological.” Much of mental pathology could be a consequence of culture.

Is it ever right for a therapist to cry?

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crying, therapists, Therapy

Is it ever right for a therapist to cry?

Ask most people about their idea of a therapy session and it will probably be a dispassionate professional sitting quietly taking notes as a patient pours out their darkest secrets – possibly on the analyst’s couch. The patient may even break down in tears.

Suggest that it was the therapist who cried during a session and many might dismiss the notion. But recent research has discovered that as many as three-quarters of therapists may have wiped away a tear when listening to their patients.

The study was carried out by Amy Blume-Marcovici, a clinical psychologist at Alliant University in San Diego in the United States.

She found herself with tears in her eyes during a therapy session with a female patient.

“I worried mostly that I had harmed her, or that she would feel ‘can this person handle what I’m talking about?’ And then I also worried that I’d been unprofessional.”

In her study Blume-Marcovici says it’s not a case of therapists sobbing: “Most often this was people describing themselves as ‘tearing up’… for the large majority the tears were beyond their control. Most of the time they did not regret their tears and they said that their client was not aware of their tears.”

The therapists who took part in the survey encompassed beginners through to the most experienced.

Among those who admitted to crying, 30% had done so in the last four weeks. So crying is not a rare occurrence.

Even though women cry more in daily life, it wasn’t reflected in the therapists’ reporting of their own tears. Men cried just as often as women. Blume-Marcovici suggests that women might “hold back tears” more than men, to control how they behave in the sessions.

Susie (not her real name), who herself underwent therapy is horrified at the thought of therapists crying.

She saw a therapist in her 30s because an abusive childhood made her into “an angry control freak” that needed careful handling.

“If my therapist had cried I’d have never returned. I needed a therapist who was in control of their emotions… at the start I needed to feel that my therapist was a superhuman who could fix me, so seeing any wavering would have demolished my confidence in them. I was terrified of my own emotions and I think I would have felt enormous guilt that I had made them sad.”

Simon Wessely, a professor of psychological medicine at the Institute of Psychiatry at King’s College London agrees.

“You’re supposed to be a professional,” he says. “It’s perfectly okay to empathise with people when they’re in distress. But there’s a big difference between that and then bursting into tears.

“You could also say for example, what you just told me made me feel angry and to prove that I’m now going to slap you. That wouldn’t be very good, would it? I don’t like the idea that at some point the patient might push the box of tissues back to you.”

Continue reading the main story

Bedside manner

There is little known about therapists crying, however doctors have been the subject of considerable scrutiny in this area.

Empathy “is something student doctors think about”, according to Dr Graham Easton, who trains medical students at Imperial College, London.

He said: “They worry about being unprofessional, that it’s a sign of weakness or emotional instability rearing its head.

“But a lot of us feel it can be an expression of compassion and of empathy, which is increasingly promoted in medical training and in fact required by professional bodies.”

Conducting a consultation in a professional, yet caring manner requires a blend of skills – everything from a doctor’s body language to a comforting hand can communicate a range of signals to the patient that can help put them at their ease.

Medical professionals are human too. In some areas of medicine, where sharing bad news with patients on a regular basis is part of the job, it can have an effect on individuals.

What makes a therapist cry?

In the therapy sessions patients are at their lowest ebb, often recounting tales which are distressing to listen to.

Consultant clinical psychologist Gillian Colville knows this only too well. She helps to support the families of very sick children in paediatric intensive care at St George’s Hospital in London.

Some of her patients are in deep distress after a child has died.

“I glisten,” she admits. “Certain things that people say – you can’t fail to be moved by.”

It’s happened a couple of times recently and the clients noticed. “One caught their breath and changed the subject… the other continued what they were saying. But I don’t do it on purpose, I wouldn’t know how to.”

In the American survey just over half of those who cried believed it didn’t have an effect on their client and close to a half thought it had changed their relationship for the better. Less than one per cent felt it had harmed their client.

Amy Blume-Marcovici noted that older, more experienced therapists were more likely to cry. She suggests that this could be because they are more comfortable with expressing their emotions.

Gillian Colville uses professional support at work to cope with the pressures. She says she sometimes cries during sessions with her supervisor. “I do weep… a child dying is unutterably sad. I would be worried if I wasn’t moved, but I have to take note and look after myself too.”

Susie said she would have been distressed if her therapist had cried during her sessions but confesses: “Now, as a relatively sane person, I can see that there’s actually nothing wrong with a therapist crying, because they are human.”

Mindscapes: The woman who can’t recognise her face

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prosopagnosia

Mindscapes: The woman who can’t recognise her face

Heather Sellers has prosopagnosia, more commonly known as face blindness. “I can’t remember any image of the human face. It’s simply not special to me,” she says. “I don’t process them like I do a car or a dog. It’s not a visual problem, it’s a perception problem.”

Heather knew from a young age that something was different about the way she navigated her world, but her condition wasn’t diagnosed until she was in her 30s. “I always knew something was wrong – it was impossible for me to trust my perceptions of the world. I was diagnosed as anxious. My parents thought I was crazy.”

The condition is estimated to affect around 2.5 per cent of the population, and it’s common for those who have it not to realise that anything is wrong. “In many ways it’s a subtle disorder,” says Heather. “It’s easy for your brain to compensate because there are so many other things you can use to identify a person: hair colour, gait or certain clothes. But meet that person out of context and it’s socially devastating.”

As a child, she was once separated from her mum at a grocery store. Store staff reunited the pair, but it was confusing for Heather, since she didn’t initially recognise her mother. “But I didn’t know that I wasn’t recognising her.”

Chaos explained

Heather was 36 when she stumbled across the phrase face blindness in a psychology textbook. “When I saw those two words I knew instantly that was exactly what I had – that explained all the chaos.”

She found her way to Harvard neuroscientist Brad Duchaine who diagnosed her as having one of the three worst cases of the disorder that he had ever seen.

So what’s it like to not recognise anyone you know? Heather says the biggest difficulty with the disorder is recognising people who she is close to – the people that are most important to recognise. In the school where she teaches English she is fine, because she recognises people by their clothes or hair and asks her students to wear name badges.

But it can be harder in social settings. Once she went up to the wrong person at a party and put her arm around him thinking he was her partner. And at college men would phone her angry that she had walked straight past them after they had had a date. “At the time I was thinking ‘I didn’t see you, why is everyone making my life so difficult?’”

It’s not just other people Heather doesn’t recognise – she can’t identify her own face either. “A few times I have been in a crowded elevator with mirrors all around and a woman will move, and I will go to get out the way and then realise ‘oh that woman is me’.” She also finds it unsettling to see photos and not recognise herself in them.

Face processing

To try and understand the condition, Duchaine and his colleagues recorded brain activity while 12 people with prosopagnosia looked at famous and non-famous faces. The team found that part of the brain responsible for stored visual memory was activated in six people when they saw the famous faces.

But another component of brain activity thought to represent a later stage of face processing wasn’t triggered. “Some part of their brain was recognising the face,” says Duchaine, but the brain was failing to pass this information into higher-level consciousness (Brain, doi.org/fzmqgz).

“There may be training where we give people feedback and say ‘look you recognise that face even though you’re not aware of it’,” says Duchaine.

Now Zaira Cattaneo at the University of Milano-Bicocca in Italy and colleagues have identified the specific brain areas that allow us to recognise our friends. The team used transcranial magnetic stimulation to block two vital aspects of face processing in people without prosopagnosia. Targeting the left prefrontal cortex blocked the ability to distinguish individual features like the nose and eyes, and blocking the right prefrontal cortex impaired the ability to distinguish the location of those features from one another (NeuroImage, doi.org/mff).

“We made performance worse,” says Cattaneo. “We want to make it better.” Now the team are trying to activate these areas of the brain. “The aim is to enhance face recognition abilities by directly modulating excitability in the prefrontal cortices,” says Cattaneo.

Would Heather want a cure, should one be found? “I can’t imagine what you see when you see a face, and it’s scary,” she says. “I go back and forth on what I’d do. I’ve done so much work in figuring out how to chart my world, I’d need to do a whole new rewrite. But it would be fascinating.”

The Diagnostic and Statistical Manual of Mental Disorders has been updated but should we beware this manual’s diagnosis?

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DSM, mental health issues

The Diagnostic and Statistical Manual of Mental Disorders has been updated but should we beware this manual’s diagnosis?

Next month, the latest edition of a book will be published in America that, according to its critics, will give you a starring role in your own private performance of One Flew Over the Cuckoo’s Nest – by turning aspects of your normal behaviour, such as checking Twitter a little too often, into a new mental disorder.

Many see its publication as part of a continuing attempt to create order out of the chaos of the human mind by updating a set of common criteria for mental disorders that encourages research as well as helping in the diagnosis and treatment of patients.

Yet the debate is so polarised that the American Psychiatric Association (APA) is publishing the $200 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) into a maelstrom of controversy. Indeed, two of the DSM’s fiercest critics, Dr Allen Frances and Dr Robert Spitzer, are former chairmen of the task forces that composed previous editions.

Now, just two weeks before the new edition appears, the National Institute of Mental Health, the world’s largest mental health research institute, has announced that it is withdrawing support for the manual as “it lacks validity” due to the unscientific basis of its classifications.

The DSM classifies psychiatric disorders and provides a checklist of symptoms for each separate disorder. The first edition was published in 1952 following research by the US military during the Second World War; since then there have been three more revised editions, the last 20 years ago: the fifth is due out on 31 May. The DSM has grown substantially in size: from 130 pages and 106 mental disorders in 1952 to 492 pages and 265 disorders in 1980. And it is expected that the new DSM-5 will be even larger.

An alternative – and free – publication, International Statistical Classification of Diseases (ICD), issued by the World Health Organisation, provides an official international classification system of mental illness that the DSM sometimes borrows. The ICD is used in Europe for clinical treatment in preference to the DSM and without the lurid headlines. The DSM, though, is increasingly influential on our way of thinking about mental health.

For writer and broadcaster, Jon Ronson (pictured right), attitudes to the DSM “have changed”. Ronson’s bestselling book, The Psychopath Test, has helped to bring the DSM to the attention of a UK audience.

“When DSM first came out people were really excited. There was something alluring about it because people loved nothing more than mental health checklists. It was also a change from the pseudoscience that had gone before.”

Now people hate it for the same reason. “They feel that there is an ivory tower elite trying to turn normal human behaviour into disorders and they don’t want to be told what they are feeling isn’t normal.”

The former chairman of the work party for DSM-IV, Dr Allen Frances, was once one of this elite, and he is clear why he is not looking forward to the new edition of the DSM. He believes it threatens to unleash what he has called a “diagnosis hyperinflation” by “greatly expanding the number of people considered mentally ill, and reduces the ranks of the normal”.

“Grief becomes Major Depressive Disorder; worrying about being sick is Somatic Symptom Disorder; temper tantrums are Disruptive Mood Dysregulation Disorder; gluttony is Binge Eating Disorder; and soon almost everyone will have Attention Deficit Disorder.”

For Chris Lane, a case in point is the transformation of Social Anxiety Disorder from something that did not “formally exist” before the 1980s to what Psychology Today called “the disorder of the decade in the 1990s”. Lane is author of Shyness: How Normal Behaviour Became a Sickness, and to write the book he was given access to the DSM archive of unpublished material.

In 2010, more than 24.4 million prescriptions for generic formulations of Prozac were filled in the US alone, yet the two psychiatrists who had first identified Social Anxiety Disorder in the late 1960s, Isaac Marks and Michael Gelder, were adamant in calling it “rare and mostly innocuous”. They were “steamrolled over”.

Dr David Kupfer, chair of the DSM-5 taskforce, unsurprisingly, does not think DSM-5 is about redefining what is normal.

“DSM has been periodically reviewed and revised since it was first published in 1952. The previous version of DSM was completed nearly two decades ago; since that time, there has been a wealth of new research and knowledge about mental disorders that is not reflected in the current [DSM-IV] text.”

In DSM-5, the revisions to autism spectrum disorder and substance use disorders are particularly important, he believes.

However, he accepts that “criticism is an inherent part of any robust scientific discussion”.

“It is understandable that patients and their loved ones would feel impassioned about ensuring that people with mental disorders are diagnosed accurately and correctly. So at every step of development, we sought to make the process as open and inclusive as possible and did so to a level unprecedented for any area of medicine.”

As a result, more than 13,000 comments on the proposed diagnostic criteria were received and reviewed.

For professor Michael Owen this consultation made the process “so conservative” that “many possible changes were not incorporated”. Owen is a psychiatrist and researcher from Cardiff University’s School of Medicine, who has been involved in putting together DSM-5, and has been at the forefront of looking at the genetics behind mental illness.

The polarisation of the debate, he accepts, comes in part “from the fact that in recent years many, milder conditions such as mild depression, anxiety and stress” have come under the “remit of medicine” and without a better understanding of the mechanism of psychiatric diagnosis “the designation of something as a psychosis sometimes seems unacceptably arbitrary”.

“There are better arguments for demedicalising these than for severe disorders such as schizophrenia, bipolar disorder or autism.”

However, Owen feels strongly that the suspicions of some critics that Big Pharma is somehow “in cahoots” with the APA are wrong. “I saw no evidence of this in DSM-5.”

In fact, he says “we need them if we are to have new treatments. Unfortunately many of the major companies are leaving the neuroscience area because they see it as unprofitable.”

But Peter Tyrer, interim head of the Centre for Mental Health at Imperial College London, thinks there may be some truth to the criticisms of diagnosis inflation. Tyrer jokes that “DSM” really stands for “Diagnosis as a Source of Money, or Diagnosis for Simple Minds”, since all profits go to the APA and it can encourage a tick-box approach to diagnosis.

More seriously, he believes that the problem is that it is a “precocious adolescent” that dominates psychiatric classification.

The issue is that there is “no biological basis” for the classifications so “their status is pretty dodgy”, and this has led, Tyrer believes, “to allegations of over-diagnosis”, reinforced by drug companies pushing for new diagnoses that allow them to promote their products.

In the end, this could be the last edition of the DSM as we will no longer need checklists to define who is not normal.

Although professor T W Robbins, from the Behavioural and Clinical Neuroscience Institute at the University of Cambridge, believes that the DSM “will still be a useful clinical instrument when DSM-5 is launched”. Indeed without it, he says, there would be “chaos”.

“Much of the future will depend on advances in neuroscience, including cognitive neuroscience”.

“It is particularly important to identify ‘endophenotypes’, which are more accurate descriptions of deficits in such functions as the processing of reward and punishment, the ability to make rational and also empathic decisions, and the ability (in certain contexts) to inhibit inappropriate automatic and habitual behaviours.”

If this happens along with understanding how they go wrong in mental disorders, then the future debate may be less about defining normality, and more about how far should we go.

“It will enable us to detect disorders in the vulnerable, at-risk state and treat or intervene with drugs or cognitive therapy before the damage is done,” says Robbins, “as once things start going wrong they are much harder to treat”.

Stroke survivors and their families left to deal with the emotional impact alone, says report

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anxiety, carers, confidence, Depression, family, relationships, stress, stroke, support

Stroke survivors and their families left to deal with the emotional impact alone, says report

Stroke survivors and their families feel abandoned by health and social services after being left to deal with the emotional impact of stroke alone, a report reveals today.

The report, ‘Feeling Overwhelmed’, published by the Stroke Association, marks the beginning of Stroke Month and details the emotional strain of strokes on survivors and families after they have left the hospital.

More than half of survivors experienced depression and two thirds anxiety, in addition to lack of confidence and fear of recurrent stroke, the association says.

A high percentage of stroke carers are also reported to have experienced depression, stress, anxiety and frustration. Relationships are proven to suffer, with almost three in ten couples separating or considering it following stroke.

Of more than 2,700 people surveyed at the end of last year, 79 per cent claimed to have received no information or advice on how to cope with the emotional consequences of strokes.

Claire Whitehouse, 23, from Bournemouth, suffered a stroke when she was 19. Following her release from hospital, Claire suffered from depression and anxiety which also led to anorexia. She said:  “I wish someone, when I was in hospital, gave me a big leaflet with everyone I’d need to contact and said This is what you’re going to experience and this is the group you need to go to’. We need some information to tell us what’s going on.

“I can push myself to become physically able, but emotionally it’s much harder.”

In response to the findings, the Stroke Association is calling for psychological and emotional support to be as integral to recovery as the physical rehabilitation. It wants information and support to be accessible to everyone, survivors and carers, who have been affected by the illness.

Thousands Of Children At Risk Of Sexual Abuse Claims NSPCC

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Bullying, Children, missing persons, risk, sexual abuse, sexual exploitation, Teens

Thousands Of Children At Risk Of Sexual Abuse Claims NSPCC

Thousands of children repeatedly went missing from care homes last year, leaving them at risk of sexual abuse, a leading charity has said.

The NSPCC revealed that 7,885 teenagers and children vanished from care in England and Wales last year, with at least 2,959 going missing more than once, some 35 times.

Around 40% of the youngsters were aged 13 to 17, but some were as young as six.

Tom Rahilly from the charity said: “The state needs to be a parent for these children. If any other child went missing their parents would move heaven and earth to find them and to understand why they did it. It should be no different for young people in care.

“Repeatedly going missing should be a big warning sign as this kind of behaviour can put them at serious risk of harm such as grooming or sexual exploitation. But we have to understand why they are doing it.

“Children go missing for many reasons – they’re being bullied, they’ve been put in a home miles from their family and they miss them and their friends, or they just don’t trust staff enough to tell them where they are.

“Many will have been abused before being placed in care and they need a lot of attention and protection. Going missing for just an hour or two can be long enough for them to come to harm.”

The charity is calling for repeatedly going missing from care to be fully acknowledged as sign that a child is at greater risk of harm.

It also wants care staff to make sure that they listen to children about why they have gone missing rather than simply punishing them, and to work with police to stop children going missing and to return them to safety as quickly as possible.

The NSPCC made a Freedom of Information request to all the police forces in England and Wales to obtain the figures, and 29 out of 43 responded in full.

However the charity said that it is estimated that less than half of all missing cases of this kind are reported to police.

Figures from the Department of Education also differ drastically to those supplied by police, putting the number of missing children at fewer than 1,000, the NSPCC said.

Last month concerns were raised by children’s charities about changes to the way that police deal with missing people.

The plans could see the number of cases where officers are called out drop by a third.

Call handlers will class cases as either “absent”, when a person fails to arrive somewhere they are expected, or the more serious as “missing”, where there is a specific reason for concern.

Police deal with around 327,000 reports of missing people each year, the equivalent of around 900 a day, two-thirds of which involve children.

There is often a link between a child frequently going missing and falling prey to sexual abuse.

The NSPCC warned that the changes could put children at risk of being sexually exploited, while the Children’s Society claimed that pilots carried out were too short to prove the plans were safe.

A Department for Education spokesman said: “We welcome the NSPCC’s findings. It is simply unacceptable that some residential care homes do not respond immediately when young people go missing. That is why we are taking immediate action to reform the system, so all homes are safe and secure places where vulnerable children can get the support they need.

“We have already changed the rules so that Ofsted can share the names and addresses of care homes with the police to better protect children who go missing. For the first time, we will also begin collecting national data on all children who run away, not just those missing for 24 hours.

“Decisions about whether to place children at a significant distance from their local community will be taken at a much more senior level as a result of a new duty on local authorities.

“Additionally a new regulation will mean children’s homes should not be open in areas that are unsafe, and children’s home providers will be required to work with the police and LA to consider the risks. We are also taking steps to improve the skills of care home workers so they are better able to identify risks and take action before children run away.”

Chief Constable Pat Geenty from the Association of Chief Police Officers said: “We know that regularly going missing from home can be a warning sign of child sexual exploitation.

“It can also signify that children and young people may be at risk of other forms of abuse, becoming a victim of crime or involved in criminal activity.

“This is why we have acted to improve our response to risk assessing and responding to missing person cases.”

I’ve had the surgery of my life: Patients choose to watch relaxing classic films during theatre

I’ve had the surgery of my life: Patients choose to watch relaxing classic films during theatre

Patients at Peterborough City Hospital are being given the chance to watch their favourite films and TV programmes to help them relax during surgery.

Cinema classics such as The Sound of Music,Cabaret, West Side Story and South Pacific have proven the most popular choices among older patients, who are more likely to be given a local anaesthetic when going under the knife.

Dirty Dancing is currently the most popular film with older female patients, while BBC documentary series The Blue Planet is is another favourite, apparently chosen because of David Attenborough’s soothing voice.

The scheme is being led by consultant anaesthetist Dr Richard Griffiths, who says the approach is beneficial to older patients who carry an increased risk of reacting badly to general anaesthetic.

Iris Quirolo, 75, recently chose to watch The Sound of Music during a hip operation.

She said: “It was a good experience and a much better way to have an operation. I never expected this would be an option and I have vowed that if I ever need another operation like this I will ask to be able to watch TV again!”

Dr Griffiths, who got the idea from a private hospital in Glasgow, said: “I am pleased that this idea is proving popular with patients as it means we can reduce the number of general anaesthetics given to older patients.

“If they are happy to be awake and watch the TV, I am happy that they are going to have a better experience.”

Parkinson’s sufferers ‘face abuse’ because of symptoms

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abuse, discrimination, drunkenness, Parkinson's disease, prejudice, symptoms

Parkinson’s sufferers ‘face abuse’ because of symptoms

Parkinson’s disease sufferers are being subjected to “intolerable levels of prejudice”, a charity has warned, after it was found that two in five of those afflicted with the disease have experienced discrimination because of their symptoms.

Parkinson’s UK said that 41 per cent of sufferers say they have been discriminated against because they suffer from the disease.

And 8 per cent said they have experienced hostility or have been verbally abused in public because of symptoms of the neurological condition , according to a new poll conducted by Parkinson’s UK on 2,900 sufferers.

The degenerative disease affects 127,000 people across the UK, and symptoms can include shaking, slowness of movement and rigidity.

The research, undertaken to highlight Parkinson’s Awareness Week, also found that one in five Parkinson’s sufferers have had their symptoms mistaken for drunkenness.

And almost a quarter of sufferers admitted they avoid going out at busy times of the day because they are wary of people’s reactions to them.

Steve Ford, chief executive at Parkinson’s UK, said: “Our research confirms that far too many people with Parkinson’s are having to battle against intolerable levels of prejudice.

“Life with Parkinson’s can be challenging enough, but when that is coupled with feeling scared to even go out in public for fear of freezing in a busy queue and being tutted or stared at – as over half the people we spoke to do – life can feel incredibly cruel.

“Time and again people with Parkinson’s have to fight against the old stereotype that the condition is just a tremor. This basic misunderstanding has sentenced people with Parkinson’s to a life of hurtful comments, being refused service in shops and even being shouted at in the street all because people have mistaken their speech or movement problems – a common symptom of the condition – for drunkenness.”

Sufferer Ruth Martin, a mother of two from Holmfirth, west Yorkshire, said that since her diagnosis in 2008 she has struggled to deal with how people react to her condition.

The 41-year-old said: “I’ve experienced all sorts of discrimination since I’ve had Parkinson’s, but one incident really stands out. I was having a bad day and was waiting in a queue in a pharmacy. The man standing behind me with his wife said really loudly to her “just stand back a bit love, the woman in front has been drinking”.

“I felt like crying but even so I told him that I had Parkinson’s. The whole shop was listening and there was part of me that wanted to scream out – I felt like I couldn’t go anywhere.

“People have been very confrontational towards me, and I have even been followed round a supermarket by a security guard who obviously thought I was acting suspiciously. I just wish that if people saw others staggering or struggling that it would cross their minds to wonder if they’ve got Parkinson’s.”