Guatemalan war rape survivors: ‘We have no voice’

Tags

femicide, Genocide, Guatemala, human rights abuses, international courts, Mayan, rape, Sexual Violence, soldiers, Spain, stigma, Torture

2011:

Guatemalan war rape survivors: ‘We have no voice’

“When the soldiers found me they grabbed me, took me to the river, and raped me. ” Teresa Sic recalls. “On the same day, they raped other women in the village. They burned everything. They tied me up, but I freed myself aided by my five-year-old daughter. I went to seek help. I was hungry and afraid, but nobody would take us in.”

Horrific as it sounds, the 58-year-old’s story is not a one-off. Between 1960 and 1996 more than 100,000 women were victims of mass rap in the Guatemalan civil war, between CIA-backed rightwing generals and leftwing insurgents, that evetually left 200,000 dead. After General Jose Efraín Ríos Montt grabbed power in a 1982 coup, it reached fresh peaks of brutality.

Many victims, such as Sic, were indigenous Mayans, who were caught in the crossfire, accused of collaborating with the guerrillas or targeted simply because their ethnic group became seen as the enemy. More than a decade ago Spain’s national high court, which has a long history of taking on international human rights cases – including pursuing Augusto Pinochet and jailing Argentine military officers involved in death squads – began investigating claims of genocide. Yet Guatemala not only refuses to try or extradite Ríos Montt, despite an international arrest warrant issued in Madrid, but he is now a congressman.

As for the rapes, the state refuses to acknowledge them – leaving the attackers to walk freely through the streets and live in the same villages as their victims. “We want the state to acknowledge the truth. We have no voice, and officially the rapes during the conflict never happened,” says Feliciana Macario, one of a group of women who have worked for 20 years to bring the rapes into the public arena. Patricia Yoj, a native Mayan lawyer, says that “even the representative of the National Indemnity Programme that was established to make reparations to victims of the conflict has said that he doesn’t believe in the rapes”.

But many of the women have refused to be silenced – giving evidence to the genocide trial in 2008, and now, for the first time, their voices will be heard; Spain’s national court has agreed to investigate the mass rapes and gender violence as part of the generals’ alleged strategy to wipe out a large part of the Mayan population. The investigating magistrate Santiago Pedraz said on Wednesday the rapes appeared to be part of a campaign of terror designed to destroy Mayan society – with soldiers instructed to carry them out.

Campaigning lawyer Almudena Bernabeu, of the US-based Center of Justice and Accountability, says rape, mutilation, sexual slavery and the killing of foetuses were all part of a plan to eliminate the Mayan people. “Gender violence has been used as a weapon to eliminate ethnic groups, and that’s genocide,” she says. The army and the members of the paramilitary “civil self-defence patrols” tortured the women they didn’t kill in order to stigmatise them. Teresa tells how days after she was raped, she was forcibly taken to a military barracks, raped for 15 days by countless soldiers and given bulls’ blood and raw meat to eat.

“To eliminate all the Mayans is a very difficult task, but if you destroy the women you make sure that the population is reduced and eventually disappears – it’s one of the cruellest ways of getting rid of an entire people,” says Paloma Soria, a lawyer working for the Women’s Link Worldwide NGO, which is backing Bernabeu.

Many of the women also endured being abandoned by their husbands as a result of the rapes. One of them was Maria Castro, now 59, who was with her two children – one just a baby when she was horrifically assaulted. “The soldiers ambushed me. My little girl was with me. She was very frightened and she cried, but the soldier threw me to the ground. I remember there were three of them who raped me, but I don’t know how many more because I lost consciousness. When I came to, I saw them pick up their guns and leave hurriedly for some other place. My daughter helped me by carrying her little brother, but she was still crying. She saw everything.” When Maria made it home and told her husband, he rejected her, saying that if she had come back alive, it was because she had let the soldiers rape her.

Others have faced horrific retributions from their attackers for their willingness to give evidence. “They point their fingers at us, they insult us, and some of the men who raped us now laugh at us,” one victim says. Castro breaks down as she tells how her son was murdered after she travelled to Spain to give evidence.

María Toj, 70, another victim, says the violence hasn’t stopped, but she is still determined to speak out. “They tortured me and my son. They burned everything, leaving me with nothing but my dead husband and my pain. I hope our efforts will stop this from ever happening again.”

Jacinta Guarcas, 65, lost seven of her eight children in the conflict, when they were forcibly displaced. One was killed by soldiers and the rest starved when they were forced to flee into the mountains after their crops were burnt: “First I buried my one-year-old son since I didn’t have enough milk for him because we had nothing to eat.”

The effect of the impunity for the rapes and killings can be seen in the deep scars on Guatemalan society. In 2010 alone, 685 women were killed. So far this year there have been 120 cases of rapes, torture and even dismemberment. “This trial will help open a debate about femicide, because the lack of justice actually contributes to increasing gender violence,” says Bernabeu. Only about 1% of these cases go to trial in Guatemala. “There are times when foreign or international courts are the only recourse for victims, since they can get no justice in their own country,” she says.

The lawyer will bring Patricia Sellers, the woman who succeeded in having rape defined as a weapon of war at the trials for genocide in the former Yugoslavia and Rwanda, to be an expert witness.

While Spain may be unable to extradite the accused, international arrest warrants at least prevent them leaving Guatemala. Pressure from Madrid has forced Guatemalan courts to start trying human rights cases from the war. They may eventually be persuaded to investigate the rapes. In the meantime, the courage of these women, who face rejection for speaking the truth, will help others who suffer rape as a weapon of war to become more visible.

“This sets a precedent for national courts around the world. Hopefully we will now see how it spreads to other countries from Spain,” says Soria. “Society puts the rape and torture of woman on a par with stealing cattle or burning crops. This must change, and these women have to stop being invisible.”

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Mental health discrimination is coming from the top, not the public

Tags

anxiety, discrimination, employment, government, mental health issues, stigma, suicide

2011:

Mental health discrimination is coming from the top, not the public

The government, together with Comic Relief, has announced £20m further funding for the Time To Change campaign against mental health stigma and discrimination, extending it until 2015. But the big question is, why is the government supporting an anti-discrimination campaign when its rhetoric in relation to welfare reform is saying something very different?

Eighty per cent of people in the Time To Change campaign’s own recent survey said they had experienced stigma and discrimination at some time; 60% say that the stigma people face is as bad as, or worse than, the symptoms, while nearly a third say that stigma has made them want to give up on life. The campaign’s view is that it has “achieved a lot in the last four years”. It says that its campaign is “based on robust evidence from other international campaigns to show what works to change public attitudes and behaviours; and it has been shown to be a cost-effective way of delivering behaviour change on a mass scale”.

There is no reason to question this. But a larger point looms. Is a public education campaign really what is needed, when the principle shapers of negative public opinion actually seem to be the government and the tabloid media?

Speaking as a long-term user of mental health services myself (who has been fortunate to escape some of the extremes of stigma and discrimination), the point that seems important to make is that it may be less a matter of educating the public, than of the government educating itself and the tabloid media. A major lead in stigmatising this group of disabled people seems to have been coming from government and its stereotyping of mental health service users in its campaigns to get people off benefits. Mental health service users are particularly targeted and recent research highlights the negative role of the media and government policy in this.

As one mental health service user, anxious to maintain her anonymity, said to me recently: Institutionalised discrimination runs through the highest levels of government and their departments. People cannot access legal aid or Citizens Advice Bureaux through cutbacks for welfare representation at tribunals. That money could fund charity/human rights lawyers to contest what’s happening to people in higher courts, or an entire advocacy service – but now, instead, it will fund this campaign.

The welfare reform programme of the coalition government has focused particularly on getting disabled people off welfare benefits, particularly the old incapacity benefit and the new employment and support allowance (ESA). In this policy, it is following the last government, which promised to get one million people off incapacity benefit. Sadly, we know that this arbitrary and unevidenced policy hits disabled people very hard. We also know that the group of disabled people it seems to hit the hardest are mental health service users – because they don’t necessarily use wheelchairs, have white sticks or clear signs of impairment. This at least sometimes means that the Benefits Agency and the Department for Work and Pensions have to acknowledge that people are not in a position to get and maintain a job in the often inflexible, discriminatory and poor-quality labour market that is out there.

This shift towards trying to force people into jobs – jobs that increasingly don’t exist and remove them from benefits – has been associated with the most harsh, cruel and inaccurate scapegoating and stigmatising of mental health service users on benefits. We know that the processes of so-called medical assessment are fiercely discriminatory. We know that many mental health service users are feeling increasingly anxious and desperate because of this, with emerging reports of suicide when people are facing the loss of benefits but no prospect of employment. Challenging mental health stigma and discrimination is one policy that needs to come from the top down, rather than the bottom up, and this is a key message for the Time To Change campaign if it is truly to punch its weight.

The politics of mental health

Tags

anxiety, Depression, discrimination, employment, isolation, mental health issues, OCD, post, relationships, stigma, stress, suicide

The politics of mental health

Charles Walker starts to sit down next to me, rises and pulls up another seat. “Let’s have this fourth chair here,” he says, and pulls it up between us. I think he is joking. But he isn’t: without the fourth chair it would be very hard for him to do this interview, maybe impossible.

A week before we meet, the Conservative MP stood up in the House of Commons TV cameras and the Hansard scribes who record Parliament’s proceedings,and talked about living with obsessive compulsive disorder for more than three decades. “I am delighted to say that I have been a practising fruitcake for 31 years,” he began. “On occasions it is manageable and on occasions it becomes quite difficult. It takes one to some quite dark places.”

One of the most obvious manifestations of his condition is his compulsion to do everything in fours: wash his hands, switch lights on and off, go in and out of a room. “My wife and children often say I resemble an extra from Riverdance as I bounce in and out, switching lights off four times.”

Walker is a compelling orator and his speech was full of poignant detail and humour. But as we chat it becomes obvious that he is painfully serious about that fourth chair. “You train yourself not to give in to it, but it’s agony: it’s like fingernails …” he trails off, the image of the chalkboard left hanging.

Walker was speaking at a debate on mental health in the House of Commons one slack Thursday afternoon, when few reporters were watching carefully. But somewhere between fellow MP and former Labour defence minister Kevan Jones putting down his notes and admitting for the first time in public that he had a history of serious depression, and Walker explaining that he leaves crisp packets lying around because he can’t face having to wash his hands multiple times, the outside world began to listen.

Two more Tory MPs also spoke: former GP Sarah Wollaston, who has experienced depression, postnatal depression and severe anxiety attacks, and ex-City banker Andrea Leadsom, who has also gone through postnatal depression. The subject #mentalhealthdebate soon began trending on Twitter. Many of the responses echoed my own: admiration and thanks for what the MPs had done from those with their own mental health issues – in my case clinical depression and anxiety.

The purpose of the debate, tabled and led by Conservative MP Nicky Morgan, was to raise the profile of mental health as an issue, and address the stigma and isolation felt by the vast majority of patients. Morgan opened with some statistics: one in four people will experience a mental health problem at some point in their life; it is the largest cause of disability and accounts for 23% of the “disease burden” on the NHS, yet only 11% of its budget is spent treating it. And despite all that, the general topic of mental health had not been debated in the main chamber for at least four years. “Just imagine if this were a physical health condition,” she added. It is hard to imagine there would be so little attention.

During the next couple of hours MPs raised important issues: advocates accompanying mental health patients when they discuss their treatment with professionals, Criminal Records Bureau checks, funding, cuts to social services and complaints about assessments of whether they are fit to work. Tory MP Gavin Barwell talked about his new private bill, supported by all parties, that will remove laws that institutionally discriminate against people who have had serious mental health problems – for example, barring them from being jurors. Health ministers, Conservative Simon Burns and Lib Dem Paul Burstow, noted some concerns, and individual MPs no doubt plan to keep campaigning on the other points they raised in the debate, until they succeed or retire.

But if the afternoon has any lasting impact on those with mental health concerns, it will be because of the unsentimental but unsparing personal stories of those four MPs. And I wondered how these courageous people felt afterwards: did they wake up full of regret the next morning or in the following days? How did their family, colleagues, friends and constituents react? “Whether it affects how people view me, I do not know,” Jones said. “And frankly I do not care because if it helps other people who have depression or who have suffered from it in the past, then good.”

Once we are both seated next to the two empty chairs, and start talking, Walker points out his local newspaper, the Cheshunt & Waltham Mercury. The front page headline is: “‘Fruitcake’ MP praised for bravery.” Does he regret using the word? “Absolutely not,” he says. “I have been involved in mental health for the best part of seven years: part of the problem is people are terrified of it and they shouldn’t be. That’s why I thought it was important to show a lightness of touch.

“Since it’s talking about my own condition, I can talk about it how I like. If we didn’t laugh in my own home about my own particular manic phases, life would be so much more difficult.”

Walker and Jones both spoke of guilt driving them to speak out, and of feeling like frauds if they did not. “Actually, I felt better for it,” says Jones when we meet later. Once the emotional high of the debate had subsided, however, did they regret what they had done? “Yes,” admits Jones, “but the response afterwards shows it was the right thing to do.” Walker says he had “little twinges” when he saw the Mercury, but says that strikingly his health was good in the days afterwards: if he had made a big mistake, the stress would have manifested itself in stronger symptoms. “This is my driving passion and I hope it’s given me more credibility to talk about it, and more of a platform,” he adds.

Aweek after the debate, the four MPs between them have had more than 1,000 emails, letters and phone calls. Many colleagues have thanked them: among 650 MPs, there must be more than four who have personal experiences of mental health – especially given that politics attracts driven people who have to live under the stress of constant scrutiny and frequent criticism. Others will know of it through parents and siblings, sons and daughters, partners and friends.

Most of the responses, though, are from ordinary people: MPs see many who are struggling with mental health problems at their weekly surgeries. The debate seems to have have encouraged them to open up, or simply thank the MPS for “helping make it OK”.

Jones tells me about a woman he met in his North Durham constituency. “In her late 50s to early 60s, a middle-class lady came up to me and said she’d had depression for 10 years, and was an alcoholic for seven. She said: ‘What you have said has given me strength.’ If I’d passed her, I’d never have guessed. If you walk down the street, you can’t tell who has mental health issues.”

The hidden nature of most mental illness is a large part of the problem: it is ubiquitous, yet those who admit to their condition feel that they are treated differently, isolated or even ostracised. Or fear they will be.

Research by Time to Change, a charity tackling the stigma surrounding mental illnesses, suggests four out of five people with mental health problems experience stigma and discrimination, and half of those said it happened every day, every week or every month. This stops a great many from socialising, looking for or returning to work, or having a relationship. Perhaps the most powerful testimony was from the 35% of respondents who said stigma had “made them give up on their ambitions, hopes and dreams for their life”, and one in four who said it had “made them want to give up on life”.

Even before she spoke out in parliament, Wollaston had been more open than most with patients and constituents about her experiences of postnatal depression and panic attacks, perhaps because of her background as a GP. By contrast, Walker had only told one person in politics about his illness since being elected MP for Broxbourne in 2005, and Jones, an MP since 2001, had not even told most of his family. “I come from a very traditional background: my father was a miner, and I was a full-time trade union official, so we don’t talk about these things,” he says.

There are other more common pressures though. “You don’t want to be defined as a ‘mental health person’,” continues Jones. “Also you have this fear about what is perceived as a weakness: will it affect people’s views of you, but also make you vulnerable? Actually my depression has made me stronger.”

In her speech, Wollaston spoke about how “at the happiest time of my life” after the birth of one of her three children, she was sometimes left feeling “your family would be better off without you”.

“I am absolutely sure,” she said, “that my own experiences of depression and recovery – recovery is very important – caused me to become a much more sympathetic doctor, and I hope that it made me a more sympathetic and understanding MP, able to recognise the issues in others and respond to them appropriately.”

By speaking out, the MPs all hope to help others by showing the world that most – not all, they stress, but many – people with mental health experiences can lead interesting and fulfilling lives when they have had help controlling and dealing with their issues. As well as having had early careers, getting elected and campaigning for mental health charities among other causes, all four MPs have made their mark on politics. Jones was a minister of defence for one of the world’s military superpowers; Walker last year won the Spectator’s speech of the year award for his intervention in the debate about a referendum on the European Union: “If not now, when?”. Wollaston became the first Conservative prospective MP selected, not by the usual route of a panel of local party loyalists, but through an “open primary”, in which every registered voter in the Totnes constituency could vote for who they wanted as their Tory candidate, and she more than doubled the party’s majority in 2010; while Leadsom is one of the party’s most active thinkers, already strongly tipped to be promoted into government. They follow in a dignified tradition, begun in recent memory by the Norwegian prime minister, Kjell Magne Bondevik, who took time off the country’s top job for depression in 1998.

“A lot of people will be saying: ‘If MPs can talk about it, maybe I can start being a bit more open,'” says Walker.

If you judged the world on advertising, you wouldn’t know disabled people exist

Tags

advertising, disability, Downs Syndrome

If you judged the world on advertising, you wouldn’t know disabled people exist

A Spanish designer, Dolores Cortes, has chosen a baby girl with Downs Syndrome, Valentina Guerrero, to appear on the cover of her US catalogue.  It’s a bold move guaranteed to generate a little extra publicity and I welcome her decision; personally I find the image refreshing, it makes me smile to see a cute, happy young child regardless of her disability and it’s constructive to stir up the conversation about disability in advertising again.

I began modelling back in 1994 after winning the UK’s first competition to find a disabled model; this was four years after breaking my neck and acquiring my disability, paraplegia. Though I’ve had countless jobs for dozens of large international organisations and hundreds of press interviews it wasn’t until 2010 that I was finally booked for a mainstream advertising campaign for a high street fashion store, Debenhams, and only then with the backing of Gok Wan and the How to Look Good Naked team.

Advertising and marketing is about generating publicity for a product, encouraging consumers to purchase said product generating income for their client; the industry is about making money, not charity and social change unless there is a possibility to make a profit. Advertisers are generally reluctant to use a disabled model unless the product is targeting disabled customers, disability isn’t deemed suitable or aspirational for mass appeal.

However, they’re happy to take our money; high street stores and supermarkets know they have customers with disabilities, accessible changing rooms and specially adapted trolleys are provided to make our lives a little easier. There aren’t statistics for the number of disabled shoppers online, there isn’t a box to tick upon payment yet a vast number of disabled people shop online for ease; to avoid transport and access issues, to avoid changing rooms being used as hanger storage and to avoid negative attitudes.

Designers and advertisers aren’t naïve, they realise how much free publicity this drums up for their product, let’s be honest how many of us had heard of Dolores Cortes until she used Valentina in her catalogue? Now her brand is being discussed on websites throughout Europe and the US. I don’t know her motivation, extensive publicity, financial gain or promoting social inclusion but I support the decision in the same way that I support most brands that choose to promote equality and inclusivity by using models with disabilities. This week I noticed a wheelchair user in an advert for Barclay’s Bank and a blind woman is currently featuring in a Dove advert; again both positive moves that I welcome, but I ask that it’s consistent, not sporadic, as only then can it bring us closer to inclusion as the norm, not something deserving of press fanfare.

The Paralympics games have made disability very visible throughout 2012, but it’s a particular image of disability, the healthy, athletic hero or heroine; what about those who don’t fit that mould? Where’s the dad with a disability driving his kids to school? The wife with a disability shopping supermarket aisles for dinner? The son or daughter with a disability playing with their computer console?

I accept that people may find it hard to believe that simply including disabled actors and models in advertising could change attitudes, but if it couldn’t then why is it such a lucrative industry which spends millions researching exactly how to change consumers preferences from one brand to another? We are frequently subject to subtle messages from advertisers, everyone can remember an advert that struck a chord, that made them laugh or cry; there are even television programmes dedicated to ‘The 100 Greatest TV Adverts’. We are inundated with advertising all day, on websites, in magazines, on radio, in television commercials, on public transport; yet to see them you would hardly know disabled people existed. Cadbury’s, Sainsbury’s, Kellogg’s, Cow & Gate, Proctor & Gamble, M&S, Johnson & Johnson, Heinz and Ikea; well known brands you’ll find in most homes, but will you find disability in their advertising? No. Yet disabled people and their families are consumers too, we pay to purchase these brands, we eat, bathe and wear clothes just like the rest of the population.

Representation in media is a form of acknowledgement by society; consider Cherylee Houston’s character, Izzy, in Coronation Street or Cerrie Burnell presenting on CBBC, both received press attention because of their difference, but now that is barely mentioned, they are simply accepted by viewers as performers on television like their able bodied colleagues. I welcome the day when we might have a kick ass Disney heroine who just happens to have a disability so disabled children can see representation from a young age.

I hope other brands eventually choose to acknowledge their disabled customers and use disabled models; I had a great time, worked with some amazing people and hopefully changed a few attitudes along the way. Did I ever harbour ambitions to roll down the catwalk in couture week in Paris? No, I’m disabled, not deluded.

The Channel 4 Goes Mad season challenges mental health stigma

Tags

Depression, discrimination, employment, mental health issues, stigma, suicide, workplace

Perhaps somewhat controversial:

The Channel 4 Goes Mad season challenges mental health stigma

There’s a moment in Channel 4’s World’s Maddest Job Interview where three employers pause and consider whether they would like to give a job to someone who has repeatedly felt suicidal.

“You’d want to work with someone who has depression, something I as a layman would think of as an illness that can be controlled and managed, but something like suicide … that’s so on the edge, so serious that I wouldn’t really know how to cope with it at all,” Claude Littner, a colleague of Lord Sugar, who has appeared as an interviewer on The Apprentice, says, before concluding firmly: “I would be sad for them and I would not employ them.”

The twist in this show is that Littner doesn’t know which of the eight potential employees that he spends five days interviewing has been suicidal, nor which one has hidden a chronic mental health condition for the past 30 years, nor which one has spent eight months sectioned in a psychiatric unit, leaving the ward every morning in a suit to go to work. Viewers are invited to make their own judgment, as they watch potential employers and psychiatrists observe candidates and try to determine who is the most employable, without any knowledge of their health history.

Channel 4 Goes Mad begins next week, hoping to get a mass audience engaged in thinking about the nature of mental health problems. Throughout the week eight volunteers will appear in Channel 4’s most popular primetime programmes, from Come Dine With Me to Location, Location, Location; some of the eight have serious mental health conditions, some of them have none.

At the end of the week all eight will be brought together in World’s Maddest Job Interview, where employers will assess them to decide who make the most attractive employees. The conclusions of the programme remain a secret, but in the end the interviewers found many of those with mental health conditions to be very appealing prospective staff members. The psychiatrist and psychologist who were observing the process were not always able to tell who had been diagnosed with some form of mental health disorder in their past.

Camilla Lewis, executive producer of the series, says the programmes are about forcing mainstream audiences to think about an issue that affects one in four people, but that remains a huge taboo. They focused on the workplace, because discrimination around mental health at work is a particularly persistent problem. She shied away from documentary, because she wanted to attract bigger numbers to confront the issues.

“We asked: how can we get the most difficult message told in the most popular way?” she says. “We were keen to make sure we get the widest impact to make sure that not just a few people watch it, the few people who were already enlightened. We’re playing deliberately on the grammar of reality television. It feels a touch Big Brother, a touch Apprentice, it’s got hints and overtones of Dragon’s Den in it. That’s deliberate because we want to play on that grammar to engage the largest audience we can.”

Determined to push the issue into mainstream viewing, she persuaded the channel to infiltrate the eight stars of World’s Maddest Job Interview, into Countdown, Million Pound Drop and Superscrimpers, among other C4programmes. The volunteers will be “hiding in plain view throughout the week in the programmes”, she says. She isn’t sure yet precisely what the promotional trail says, but thinks it will run along these lines: “Some of these people have had very serious mental health conditions. Can you tell by looking at them?”

“We play along with the popular sense of: ‘Can I tell by looking at someone what their mental health condition is?’ To which the answer is, as the programme proves quite clearly, no.”

Channel 4 has caused controversy a couple of times recently by appearing to engage with difficult themes – Travellers and disability, for example – and ending up accused of insensitive handling of its subjects and “crass branding” when My Big Fat Gypsy Wedding and The Undateables were aired. It is hard to tell from the very rough preliminary edit sent by the programme-makers Cineflix how sensitively the issues will be handled, but both Lewis and Alessandra Lemma, psychologist and psychoanalyst professor at the Tavistock and Portman care centre, who appears on the programme and advised on its creation, are passionate about the issues they want to highlight and adamant that the volunteers have been treated with care and respect.

“If my programme makes you consider what a mental health issue looks like and how it manifests itself, then that will have been the most powerful thing that I have done. There’s a real opportunity here to make you see the person and not the condition. If we’ve used tabloid mechanisms to do that, then we’re clever,” Lewis says.

Lemma says she hopes the programme will help people “consider their prejudices”. “The prospect of losing control over one’s own mind is terrifying, and therefore one way of dealing with that is to create a distance, a barrier, an us-and-them mentality which allows us to protect ourselves from having to contemplate the possibility that this could happen to us. It feeds into prejudice, because prejudice is born out of fear of that which we don’t want to know about,” she says.

“The individuals who took part in the programme had had very serious mental health conditions; these were not people who were just mildly depressed. We had individuals who had been admitted to hospital for very long stretches of time, people who had self-harmed, someone who had lived with a serious mental health problem for 30 years, but all of them had managed to work, to maintain families and relationships. What they demonstrate is that we can carry inside our minds a terrible turmoil, that this doesn’t mean we can’t function as good citizens and colleagues at work,” she says.

One of the volunteers (who can’t be named, or the surprise gets spoiled) had bulimia for 32 years, but never told her employers, and has held down a high-powered position. Relatively recently she discovered a way of ridding herself of bulimia, and has been free of the condition for the past two years. She wanted to appear on the programme because she thought she would never get completely over it, and wanted to show that it was possible to recover from the condition. Another volunteer who spent eight months on a psychiatric ward, away from his family, but who still managed to get dressed in a suit and go to work every morning, said he hoped the programme “will change perceptions”.

Lemma says: “One of the things that I hope the programme conveys is that there is a continuum between emotional distress which we all experience … at some stage in all of our lives we will have periods of stress and strain, that are on a continuum to eventually, on the other end, getting a formal diagnosis of depression or OCD. We talk about the one-in-four statistic, but the one-in-one statistic is very important too. That’s an important message to get across as we try to destigmatise mental illness – to see that these things are in all of us to different degrees, and different life events may trigger in us different reactions.”

At the end of the programme, there are tears as someone who has had a severe mental health condition since she was five is told by psychiatrists that they can’t spot anything in her behaviour and by employers that they rank her as highly employable. But one employer still admits that if he had simply been told in an interview the bare facts about her illness, he would have had “serious concerns” about employing her.

It is clear that finding the correct moment to reveal a history of mental illness is not easy and huge stigma remains. But mental health charities are happy that the subject will be tackled on primetime television.

“We know people think like this, and that discrimination happens,” says Kate Stringer, from Time to Change, the mental health anti-stigma programme run by Mind and Rethink Mental Illness, which advised the programme-makers. “We would like people watching to realise that some of the assumptions that they make about mental health are incorrect, that it doesn’t stop you from being perfectly employable.”

The World’s Maddest Job Interview is on C4, Wednesday 25 July at 10pm. The 4 Goes Mad season starts on Monday 23 July. 

Free access to British scientific research within two years

Free access to British scientific research within two years

The government is to unveil controversial plans to make publicly funded scientific research immediately available for anyone to read for free by 2014, in the most radical shakeup of academic publishing since the invention of the internet.

Under the scheme, research papers that describe work paid for by the British taxpayer will be free online for universities, companies and individuals to use for any purpose, wherever they are in the world.

In an interview with the Guardian before Monday’s announcement David Willetts, the universities and science minister, said he expected a full transformation to the open approach over the next two years.

The move reflects a groundswell of support for “open access” publishing among academics who have long protested that journal publishers make large profits by locking research behind online paywalls. “If the taxpayer has paid for this research to happen, that work shouldn’t be put behind a paywall before a British citizen can read it,” Willetts said.

“This will take time to build up, but within a couple of years we should see this fully feeding through.”

He said he thought there would be “massive” economic benefits to making research open to everyone.

Though many academics will welcome the announcement, some scientists contacted by the Guardian were dismayed that the cost of the transition, which could reach £50m a year, must be covered by the existing science budget and that no new money would be found to fund the process. That could lead to less research and fewer valuable papers being published.

British universities now pay around £200m a year in subscription fees to journal publishers, but under the new scheme, authors will pay “article processing charges” (APCs) to have their papers peer reviewed, edited and made freely available online. The typical APC is around £2,000 per article.

Tensions between academics and the larger publishing companies have risen steeply in recent months as researchers have baulked at journal subscription charges their libraries were asked to pay.

More than 12,000 academics have boycotted the Dutch publisher Elsevier, in part of a broader campaign against the industry that has been called the “academic spring”.

The government’s decision is outlined in a formal response to recommendations made in a major report into open access publishing led by Professor Dame Janet Finch, a sociologist at Manchester University. Willetts said the government accepted all the proposals, except for a specific point on VAT that was under consideration at the Treasury.

Further impetus to open access is expected in coming days or weeks when the Higher Education Funding Council for England emphasises the need for research articles to be freely available when they are submitted for the Research Excellence Framework, which is used to determine how much research funding universities receive.

The Finch report strongly recommended so-called “gold” open access, which ensures the financial security of the journal publishers by essentially swapping their revenue from library budgets to science budgets. One alternative favoured by many academics, called “green” open access, allows researchers to make their papers freely available online after they have been accepted by journals. It is likely this would be fatal for publishers and also Britain’s learned societies, which survive through selling journal subscriptions.

“There is a genuine value in academic publishing which has to be reflected and we think that is the case for gold open access, which includes APCs,” Willetts told the Guardian. “There is a transitional cost to go through, but it’s overall of benefit to our research community and there’s general acceptance it’s the right thing to do.

“We accept that some of this cost will fall on the ring-fenced science budget, which is £4.6bn. In Finch’s highest estimation that will be 1% of the science budget going to pay for gold open access, at least before we get to a new steady state, when we hope competition will bring down author charges and universities will make savings as they don’t have to pay so much in journal subscriptions,” he added.

“The real economic impact is we are throwing open, to academics, researchers, businesses and lay people, all the high quality research that is publicly funded. I think there’s a massive net economic benefit here way beyond any £50m from the science budget,” Willetts said.

In making such a concerted move towards open access before other countries, Britain will be giving its research away free while still paying for access to articles from other countries.

Willetts said he hoped the EU would soon take the same path when it announced the next tranche of Horizon 2020 grants, which are available for projects that run from 2014. The US already makes research funded by its National Institutes of Health open access, and is expected to make more of its publicly funded research freely available online.

Professor Adam Tickell, pro-vice chancellor of research and knowledge transfer at Birmingham University, and a member of the Finch working group, said he was glad the government had endorsed the recommendations, but warned there was a danger of Britain losing research projects in the uncertain transition to open access publishing.

“If the EU and the US go in for open access in a big way, then we’ll move into this open access world with no doubt at all, and I strongly believe that in a decade that’s where we’ll be. But it’s the period of transition that’s the worry. The UK publishes only 6% of global research, and the rest will remain behind a paywall, so we’ll still have to pay for a subscription,” Tickell said.

“I am very concerned that there are not any additional funds to pay for the transition, because the costs will fall disproportionately on the research intensive universities. There isn’t the fat in the system that we can easily pay for that.” The costs would lead to “a reduction in research grants, or an effective charge on our income” he said.

Another consequence of the shift could be a “rationing” of research papers from universities as competition for funds to publish papers intensifies. This could be harmful, Tickell said. For example, a study that finds no beneficial effect of a drug might be seen as negative results and go unpublished, he said.

Stevan Harnad, professor of electronics and computer science at Southampton University, said the government was facing an expensive bill in supporting gold open access over the green open access model.

He said UK universities and research funders had been leading the world in the movement towards “green” open access that requires researchers to self-archive their journal articles on the web, and make them free for all.

“The Finch committee’s recommendations look superficially as if they are supporting open access, but in reality they are strongly biased in favour of the interests of the publishing industry over the interests of UK research,” he said.

“Instead of recommending that the UK build on its historic lead in providing cost-free green open access, the committee has recommended spending a great deal of extra money — scarce research money — to pay publishers for “gold open access publishing. If the Finch committee recommendations are heeded, as David Willetts now proposes, the UK will lose both its global lead in open access and a great deal of public money — and worldwide open access will be set back at least a decade,” he said.

Europe may be following suit:

European Commission backs calls for open access to scientific research

Not just a boy thing: how doctors are letting down girls with autism

Tags

aggression, anxiety, Depression, Eating Disorders, emotions, gender, mental health issues, misdiagnosis, OCD, relationships, social exclusion, stress, tics, vulnerability

Not just a boy thing: how doctors are letting down girls with autism

Annette Lewns has more experience than most of the different ways in which boys and girls with autism are treated. Her 14-year-old son, Ryan, was diagnosed when he was three and a half. But doctors refused to diagnose her 12-year-old daughter, Rachel, until she was nine.

“What angers me is that for years I was dismissed by doctors purely because Rachel was a girl. Ryan was spotted very quickly because the autism symptoms that doctors look for are so male-orientated,” said Lewns. “But Rachel’s autism was hidden unless you knew where to look for it.

“Rachel could express herself, she had a couple of friends and understood emotions if someone was at an extreme: really upset or really happy. But you didn’t really have to look too hard to see she didn’t genuinely understand emotions or relationships: she was just mimicking scripts and scenarios from TV.”

“The doctors failed time and time again to see through her coping strategies. I fought for years but I was confronted with a wall of disbelief and scepticism. They were simply unable to understand that a girl might present differently to a boy.”

While Ryan’s condition was acknowledged by their local authority, and he is now at a specialist school, Rachel continues to struggle at a mainstream school. “Ryan is being taught all sorts of tools and techniques to cope with his condition but Rachel is not,” said Lewns.

Estimates of the ratio of females to males diagnosed with Asperger’s syndrome or high-functioning autism varies from 1:4 to 1:10. No one understands this gender disparity: whether women really are less likely to be on the spectrum than men – or whether doctors are failing to spot the disorder in women.

Opinions are divided: Richard Mills, director of research at the National Autistic Society (NAS) says he “would not be surprised” if the true ratio was twice as high, with one woman on the spectrum for every two men. Dr Judith Gould, director of the NAS’s Lorna Wing Centre, thinks the ratio could be even narrower, with 1:1.5 female:male.

We may soon have an answer. Mills is leading the UK arm of a two-year international programme, Autism in Pink, which will look at the condition in women, focusing on the stress, social exclusion, vulnerability and misdiagnosis they suffer.

It follows concerns about reluctance to diagnose women. One recent survey by NAS found girls may wait longer than boys for a diagnosis and are more likely to be misdiagnosed: just one-fifth of girls with Asperger’s syndrome who responded to the survey were diagnosed by the age of 11, compared with half of boys.

The UK is leading the research side of the programme. Last week, Mills signed up the first two of the 12 women with Asperger’s he needs to work with researchers over a two-year period.

“I hope the programme will be the first step to ending the current trend for gender to be a barrier to diagnosis and post-diagnostic support,” he said. “Because research in the past has largely concentrated on males, the way we understand autism tends to be very much based on the experiences of men and boys with the condition. People are reluctant, for some reason, to make a diagnosis in girls and women.”

This reluctance is exacerbated by the fact that girls and women with Asperger’s or high-functioning autism can be more adaptive than boys: they are commonly better at hiding things or seeming more sociable, masking what doctors traditionally think of as the signs of autism.

But the strain of trying to appear “normal” can be immensely stressful. Gould said it results in “many of the girls we see having developed secondary problems such as anxiety, eating disorders or depression”.

This can also mean that misdiagnosis of girls and women is also a problem. The survey found 42% of females had been wrongly told they suffered psychiatric, personality or eating disorders, compared with 30% of males.

There is also the problem that the gender difference becomes a self-fulfilling prophecy: because more males are diagnosed than females, it is their symptoms and behaviours that experts have studied. The so-called screening tools, developed to help diagnosticians spot the syndrome, focus on culturally “male” interests, such as computers, trains and cars, rather than things more likely to appeal to a girl, such as animals, soap operas or fashion. Gould is rewriting the NAS’s diagnostic interview for social and communication disorders to include “gender-neutral” cues.

Even when an accurate assessment is given, however, it is no guarantee that the necessary support and help will materialise: the NAS survey found women continue to struggle after diagnosis, with half of females with Asperger’s or high-functioning autism – compared with 39% of males – saying it made no difference to the support they received.

Lucy Clapham, 25, spent years being turned away by doctors who insisted “girls don’t get autism” and told her to simply “act normal and read female magazines”. “I am certain that my diagnosis was delayed because of the fact that I am a girl,” she said. “My mum first noticed something when I was about six but our GP laughed at the suggestion. I’ve gone to counsellors, doctors and psychiatrists but all of them, including my teachers, refused to see I had classic autism even though I had casebook symptoms: almost no speech until I was five, no friends, hours spent staring at the washing machine, lining toys up and flicking my fingers in front of my eyes.”

When she was 12, Clapham became violent, aggressive and developed multiple tics, obsessions and compulsions. “I stopped talking outside of the house and sunk into an inner world,” she said.

After two more years and about eight counsellors, Clapham’s GP referred her to a child psychiatrist. “She was adamant that girls didn’t get autism, they just had ‘traits’,” said Clapham. “She claimed that I just needed to ‘act normal’ and that by buying nice clothes and reading women’s magazines I could learn to be ‘normal’. The only diagnosis I received from her was depression and anxiety.”

After leaving the children’s mental health service “none the wiser and possibly with more mental health problems than when I had arrived”, Clapham was sent to the adult mental health service and, after a long battle, to the Maudsley hospital in London, where she was finally diagnosed with autism, Tourette syndrome and obsessive-compulsive disorder.

“I was still refused services, however, partly because there were none available and partly because our local authority was not willing to fund an out-of-town, specialist autism service,” said Clapham. “I ended up getting sent to a college for the blind where I developed more mental health problems and became very aggressive because no one understood me or my autistic behaviour.

“When I was 20, I ended up in care because my mother couldn’t cope with my aggression and anxiety.”

Clapham stayed there for three years but still struggles. “Despite my diagnoses, some people still seem to believe that autism is a ‘boy thing’,” she said.

There is no clear understanding about how many girls and women are being missed – or wrongly diagnosed – and for how long. But that may soon change: the first neuroimaging analysis of women and men, with and without ASD, has been under way for the past two and a half years at King’s College’s Institute of Psychiatry (IoP) and the Autism Research Centre at the University of Cambridge. It’s hoped this research could provide the clues. The final stage of the project is about to begin, with results expected in months.

“It’s very exciting,” said Dr Michael Craig, a senior lecturer and honorary consultant at the IoP’s department of forensic and neurodevelopmental sciences. “We could well be looking at gender-specific treatments for Asperger’s being developed in quite a short period of time.”

What is autism?

First identified in the 1940s, autism is a developmental disability that lasts a lifetime and affects someone’s interaction with other people – how they communicate with and relate to them. It is a spectrum condition, affecting some more seriously than others. While some lead fairly independent lives, others suffer serious learning disabilities and need extensive support. Many who have an autism spectrum disorder can be badly affected because they have trouble processing sounds, sights and smells.

Around half a million people in the UK have autism, according to the National Autistic Society (NAS). What causes it is still unclear. “There is strong evidence to suggest that autism can be caused by a variety of physical factors, all of which affect brain development. It is not due to emotional deprivation or the way a person has been brought up,” the NAS says. Genetic factors are assumed to be responsible, and scientists are trying to pin down which genes are involved. Genetic testing to enable earlier diagnosis is therefore still a long way off.

Many people are not diagnosed until they reach adulthood. A recent NAS study of more than 8,000 people with autism, parents and carers found 52% were initially misdiagnosed. One in three adults with the condition say they have developed serious mental health problems because they have not received enough support to help them cope with the difficulties autism brings.

We tell boys not to cry, then wonder about male suicide

Tags

Depression, men, mental health issues, sports stars

We tell boys not to cry, then wonder about male suicide

I’m not sure how old I was when I was first instructed that boys don’t cry – at a guess, maybe six or seven. Once it began, it came at me from all angles: family, teachers, friends, the myriad voices of media and culture. Like pretty much all boys, I learned that tears and sobs were markers of failure. Whether facing up to playground beatings, bullies or teachers, the rules of the game were simple: if you cry, you lose. As little boys begin to construct the identities of grown men, the toughest lesson to learn is toughness itself. Never show weakness, never show fragility and above all, never let them see your tears.

With such beliefs (literally) beaten into us from an early age, it is easy to be shocked by the candour of the former footballer Dean Windass. In a heartbreaking interview on Sunday he described two suicide attempts in the past few days. “Everyone thinks that Dean Windass is a laugh and a joke and a kid blah blah blah, and got loads of money and his wife and kids are lovely,” he told the People. “But that’s all a mask. I was in pieces, I couldn’t stop drinking or crying. I’ve cried every day for the last two years.”

Coming just weeks after the dreadful loss of Wales manager Gary Speed, the interview has again focused attention on the mental health of sports stars. Professional athletes undoubtedly face unique problems, but it would be a mistake to think this is just football’s problem. One out of every 5,700 men will kill themselves in any given year. The rate is between three and four times higher for men than for women, and highest among men under 35. In recent years, suicide has become the single largest cause of death for young men, overtaking even road traffic accidents. In the UK, more people die from suicide every decade than have ever died from HIV/Aids.

We are looking at an epidemic, and worse, an epidemic that society seems content to accept. There is little apparent concern that men underuse primary healthcare, and are consequently less likely to be referred to mental health services. With most psychiatric professionals accepting a causal link between suicide rates and socio-economic conditions, worklessness, poverty and insecure employment, prospects of these statistics improving in the near future look bleak.

While politicians and health services could certainly do more, surely we have a wider responsibility as a society to examine how we implant and enforce the damagingly rigid, insular stoicism that underpins our understanding of what it means to be a man. Most of us recognise that women’s sexual continence has been traditionally policed by prevailing social attitudes, but it’s less often observed that men’s emotional continence is policed in a very similar way.

As I’ve written before, attempts by men to address their own gender-specific issues are often greeted with hostility and disdain. Last year, the deputy prime minister, Nick Clegg, revealed that he sometimes shed a tear listening to a moving piece of music, and that he took personal attacks to heart. The response from some journalists, such as Christina Odone in the Telegraph, was vicious attacks on a “blubbing big boy”. Jane Powell of the brilliant charity Calm, who knows more about this issue than most, responded: “Telling men that they should at least pretend to be invincible, shouldn’t show feelings, should be strong and silent if they want to be a ‘real man’, is destructive, selfish and plain nasty.” Even the Guardian is not immune. Recently one professional attempted to bring a successful Australian scheme to the UK, which uses the imaginative hook of garden sheds to get men discussing and addressing their own mental health and wellbeing. The response was an article mocking the very idea that men might need help, and demanding to know why it wasn’t being offered to women instead.

There is no single, simple solution to the suicide epidemic. The first stage must be to acknowledge the problems, at both an individual and societal level. It takes immense courage and strength for men to speak about their own mental health, flouting our deepest conditioning. For that reason, we should not only wish Windass a full recovery from his current illness, but recognise that in speaking up and seeking help he did something more courageous, more important and, perhaps, more truly manly than anything in his distinguished career on the pitch.

Girls petition for Teen Vogue to put an end to airbrushed photos

Tags

airbrush, Depression, Eating Disorders, magazines, photoshop, Self-esteem, sexualisation

Girls petition for Teen Vogue to put an end to airbrushed photos

Teenagers Carina Cruz and Emma Stydahar delivered a 28,000 signature petition to Teen Vogue today to express their distaste for the common magazine practice of airbrushing images.

A group of approximately 10 girls staged a protest fashion show outside the Condé Nast building in Times Square to deliver the petition. Smiling for the cameras, the teenagers walked up and down a makeshift runway (which consisted of a 15-foot long red carpet produced by one of the activists and rolled out on Broadway) holding placards like “Let’s get real – all girls are beautiful” and “Teen Vogue #KeepItReal.”

“I don’t think girls should grow up in a world where beauty magazines dictate they should have a low self-esteem,” said Emma Stydahar, 17, a high school senior from Croton-on-Hudson, New York.

According to Stydahar, 75% of girls get depressed within three minutes of shuffling through a beauty magazine’s pages because the beauty patterns they convey as ideal are unattainable.

“Images that have been photoshopped have a bad effect and can really hurt young girls. We’re looking for more diversity of girls and body types [in these publications],” added Stydahar, whose younger sister, Hanah, 14, was also at the protest and said she wants to follow in her older sister’s footsteps.

The girls were part of a similar fashion shoot outside the offices of Seventeen magazine in May, when a 15,000-signature petition requesting the magazine to promise one un-photoshopped spread a month was delivered to the magazine’s editor-in-chief Ann Shoket.

Julia Bluhm, 14, along with Stydahar and Cruz, is a member of Sparksummit, an activist movement demanding the end to the sexualization of girls and women in the media. Bluhm’s petition quickly gained support after the Seventeen magazine action and ended with more than 84,000 signatures.

In Seventeen’s August issue, the editor promised to limit photo-editing to things like stray hair and zits, but not bodies. She also said the magazine would post before and after pictures on the magazine’s Tumblr.

“We’re focusing on Teen Vogue now, and then we’ll see what happens,” said Stydahar.

To organize the action, Stydahar started a petition on Change.org, an online social action platform, with activist friend Carina Cruz, 16.

“They are one of the lead mags on teen fashion, and if we can accomplish something with them then hopefully we can keep going,” said Cruz.

Teen Vogue has an audience of more than 3.5 million readers, 93% of whom are female. Outside their offices on Wednesday, the makeshift photoshoot was meant to show the magazine what kind of girls they would want to see on the cover of the popular fashion magazine.

In an official statement, Teen Vogue said: “Teen Vogue makes a conscious and continuous effort to promote a positive body image among our readers. We feature healthy models on the pages of our magazine and shoot dozens of non-models and readers every year and do not retouch them to alter their body size. Teen Vogue pledges to continue this practice.”

The magazine’s adult-targeted inspiration, Vogue, announced in May that it would only use models who are aged over 16 years and who, based on the editor’s judgment, do not have eating disorders.

Stydahar’s mom, Sheila Kelly, 54, attended the protests and told the Guardian: “I think it’s wonderful what they’re doing. They’re constantly bombarded with images that are overly sexualized and unattainable, and that clearly don’t contribute to their self-esteem.”

Kelly was a feminist activist in the late 70s in Chicago, where she went to DePaul university.

“I think young women are very active again, and with social media you can get your message out much quicker,” said Kelly.

Suicide on the rise among older men

Tags

Children, Depression, mental health issues, older men, recession, relationships

Suicide on the rise among older men

The number of suicides and prevalence of suicidal tendencies is rising faster among older men than in any other age group, according to research released in the week the government postponed its suicide prevention strategy.

Data from the Office for National Statistics (ONS) shows that the number of suicides among men aged over 55 has risen by 12% over the past decade, while suicides by men aged under 34 dropped by 30%. The mental health charity Calm said men aged 45 to 54 were still most likely to seriously consider taking their own life.

Charities and mental health experts are concerned that across all age ranges there are far more male than female suicides.

Jane Powell, the Calm chief executive, speculated that the recession might be having more of an impact on older men.

“If you are middle-aged just now and your job and life prospects are diminishing then this is tough,” she said. “There is work to show that the impact of unemployment hits men harder, and later on in life; that it’s easier for women whose lives are not necessarily defined by work and for whom part-time or temporary work isn’t by definition bad.

“Our research shows that thinking about suicide is more common than we realise, and that men and women are almost equally liable to feel suicidal. What is significant is that more men actually go on to take their lives.”

Official statistics show that 4,517 people in England and Wales killed themselves in 2010, of whom 75% were men.

Powell said there were two reasons for the discrepancy. “First, because men are by default supposed to be in control, in charge at all times and so therefore needing help is by definition unmanly.

“And second because all too often men don’t recognise what the problem is – they’ll feel out of control, angry with everything, find that their life is out of focus, not be interested in what’s happening around them – and they won’t recognise that they are depressed. And because as a man they’re supposed to be invulnerable, then suddenly the options they have of getting out of their situation start to look very slim.”

Calm, which began as a Department of Health initiative in 1997 and became a charity in 2006, has traditionally focused on reducing suicide among young men. Now it is changing its remit to include the older generation.

According to a YouGov survey carried for Calm of adults who had considered taking their own lives, a key driver was relationship status. The number of children in a household was also a factor with 18% of men with one child expressing suicidal thoughts, compared with 27% with three or more children. The government planned to launch its suicide prevention strategy last week but postponed the initiative until September.

Catherine Johnstone, chief executive of Samaritans, said: “There is strong evidence to show that interventions to support people at risk of suicide make a difference. However, it is often the case that services are failing to reach and engage men, which is why Samaritans launched a campaign in late 2010 to target working-class men who are the most at risk.

“Suicide is preventable and requires the action of multiple government departments. We welcome the forthcoming suicide prevention strategy for England and hope that it will continue to be a catalyst for change. To make a real impact, however, the strategy requires commitment from the public, private and voluntary sectors, as well as government.”

Last week it emerged that people in Manchester were more likely to kill themselves than in any other city. At a public meeting called by Manchester Users Network, a group for people with mental health issues, participants criticised cuts to services, in particular community centres, which act as lifelines to people with depression.

A Department of Health spokesperson said: “The government is taking strong action on suicide prevention. We have been listening to families who have sadly been bereaved following a suicide, and have called upon experts in healthcare, criminal justice and transport to help us put together a new suicide prevention strategy for England to help save lives. We have considered all the responses received, and intend to publish our plans in September.”