GPs to prescribe self-help books for mental health problems

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anxiety, books, Depression, GPs, library, mental health issues, prescription, self-help, well-being

GPs to prescribe self-help books for mental health problems

People in England with mild to moderate mental health concerns, including panic attacks, anxiety and depression, are to be prescribed self-help books which they can borrow from their local library.

Titles such as The Feeling Good Handbook, How to Stop Worrying and Overcoming Anger and Irritability will be among the 30 prescription titles that libraries across England will stock in an attempt to improve the wellbeing of the nation.

The scheme was announced on Thursday at the British Library and has been developed over the past year by the Reading Agency charity. Its chief executive, Miranda McKearney, said of the project: “There is a growing evidence base that shows that self-help reading can help people with certain mental health conditions to get better.”

She said 6 million people in the UK suffered from anxiety and depression, and around two thirds of those people were not receiving any treatment.

The Books on Prescription scheme is being rolled out across GPs’ surgeries and libraries in England in May and is based on a similar scheme in Wales pioneered by the Cardiff-based clinical psychologist Professor Neil Frude.

Denmark has gone down the same road and Frude said New Zealand had just become the first country in the southern hemisphere to take it up.

“It is wonderful that it’s spreading,” he said. “I’m a little disappointed it has taken this long to get to England to be honest.”

Frude first set up the scheme in Cardiff in 2003 and the Welsh assembly took it nationwide in 2005. It was borne out of frustration at knowing the value of the books, but knowing that so many people either weren’t aware of them or could not get hold of them. It was a simple idea, he said. “The doctors are already there, the books are already there and so are the libraries. It just needed joining them up.”

In Wales now, 30,000 self-help books are borrowed every year and three of the 10 most borrowed books in the country are self-help.

There is a wealth of evidence to show that prescribing such books does work, the latest being research published in the journal Plos One which showed that people who used them over a year had measurably lower levels of depression.

Of course, there are good books and bad books and hunting through them can be dizzying: typing “self-help” into Amazon brings back more than 250,000 results.

“There is no shortage of books but some of them are atrocious and some of them are absolute gold,” said Frude. He quoted the American system where self-help books are rated from five-star down to one-star and then dagger – a book that will make you feel worse.

In England the project is being led by the Reading Agency’s director of research, Debbie Hicks. She said all but two local authorities in England were behind the scheme, which had also been endorsed by the Department of Health and crucially, the Royal College.

The full list of 30 books was signed off on Wednesday and will be circulated to all the library authorities next week. The list of conditions includes anger, anxiety, binge eating, depression, anxiety, obsessions and compulsions, panic, phobias, self-esteem, stress and worry. There will also be books prescribed to people who suffer chronic pain or fatigue, or perhaps have relationship problems.

Next year the agency would like to start including books targeted at children and young people.

Hicks said: “All the evidence does suggest that it does work and we have been extremely rigorous in putting together our list, making sure there is an evidence base for each book – that they have been used and found to be effective.”

She stressed that the list would not be set in concrete. “This is a starting point and we will evolve and develop it.”

Hicks said all the authorities had committed to buying the books and some would have collections in every library, while all of them would have them available.

How many books they may need is not yet clear. “The demand is likely to build as the scheme develops,” she said.

The prescription scheme is being run in parallel with the agency’s promotion called Mood Boosting Books. It hopes that, as well as reading the self-help books, people might join reading groups or just read books such as Frances Hodgson Burnett’s The Secret Garden, or Bill Bryson’s Notes from a Small Island, and discover that that puts them in a better mood. A new list of mood boosting books will come out in May.

The use of good self-help books is endorsed by the National Institute for Health and Clinical Excellence, although Frude said Nice does not say which books should be used, whereas it would with particular drugs.

“They are not for everybody,” Frude said. “And of course we are not talking about people with serious illnesses, but one in six of us will have a diagnosable mental illness in our lifetime.”

The books on prescription scheme was announced as part of a new national approach to library services drawn up by the Society of Chief Librarians. They revealed details of four “universal offers”, or promises, that libraries will provide services in the areas of health, reading, information and digital.

The society’s president, Janene Cox, said libraries, many facing the threat of closure and budget cuts, were having to evolve more quickly than ever before. “Local authorities have never faced such challenging times and confronted with these, we do have to think innovatively, act collaboratively and manage creatively to ensure the sustainability and future development of our services.”

More: The medicinal power of literature: Books on prescription to be introduced

 

How One Charity Is Tackling Complex Mental Health Problems Using The Simple Power Of Reading

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books, Children, confidence, dementia, literature, mental health issues, MS, physical health, reading, relaxation, symptoms

How One Charity Is Tackling Complex Mental Health Problems Using The Simple Power Of Reading

It is, as one member of the Reader Organisation puts it to me, like watching a dozen tiny miracles.

Sat around a kitchen table in a mental health ward in central London, five patients are munching biscuits and taking turns to read out loud from Great Expectations.

We pause after the scene where Pip meets Miss Havisham sat alone in her cobwebbed bedroom.

Lucy, a London woman in her 30s who looks far older after years battling alcoholism, speaks first.

“It’s like me when I was drinking, that is” she tells the group with a nervous chuckle.

“I couldn’t let go of who I was. Couldn’t move on.”

We pick up the story again until Pip is humiliated by Estella, runs away and kicks a wall in frustration.

Ryan, a Scotsman with big, bunched shoulders says in an intense, slow voice that he felt exactly the same way as Pip that morning talking to his doctor.

“You can feel patronized at every stage in life, especially when you’ve got a mental illness,” he says.

“Doctors, people in shops, your children’s school teachers…” he flares up momentarily, getting angry as he tells the anecdote, then relaxes so we can carry on the story.

Up until this point Jan, a softly-spoken woman in her late 50s who has suffered for years with manic depression has remained politely quiet.

But at the group’s request she takes a turn to read in a beautiful, expressive voice which everyone compliments afterwards. She ends with a smile and begins happily nattering about how much she loves Dickens, before catching herself.

“I can’t believe I just started a conversation!” she says, blushing.

For ten years, the Reader Organisation has been helping some of the most vulnerable people in society feel better by carefully harnessing the power of reading.

In schools, care homes, psychiatric wards and local libraries across the UK, sessions held by one of over 40 trained facilitators provide a haven for troubled kids, elderly people battling dementia and people with a range of mental illness, from depression and schizophrenia to drug addiction.

The format of the sessions is very simple. Taking it in turns to read, the facilitator and the group work through a novel or short story, pausing at key moments to share their thoughts about the story and how it makes them feel. Then they end with a poem.

There is no attempt to ‘analyse’ the texts in any academic sense, just to empathize with the characters and debate the plotlines. But then there is no ‘dumbing down’ either – the reading list is resolutely classic, from Shakespeare to Steinbeck to Wordsworth and the Romantics.

The therapeutic benefits are two-fold. First as Jane Davis, the charity’s founder and a former literature tutor, puts it: “there is something about reading aloud, something rhythmical, comforting, childlike and secure that either directly or indirectly addresses that inner weather we all experience. That’s why people love it.”

The second, particularly for people suffering from mental health problems like those I meet in London, is the opportunity to share how they are feeling with others through a form of displacement.

The characters in Great Expectations or Shakespeare or any of the texts the Reader Organisation use function as vessels – or as Dr Kathryn Naylor, an Associate Specialist in Forensic Psychiatry at Ashworth Hospital puts it: “a way of expressing emotions without having to say what’s really upsetting you.”

Naylor treats men who are mentally disordered offenders, and has been using The Reader Organisation as a supplementary exercise with her patients (“it’s not therapy it’s therapeutic” she explains) for many years.

The results, she says, can be amazing.

“We had a man with us in his early 40s with paranoid schizophrenia, who was very suspicious of other people’s motives. He found it very hard to talk to people and had bad social anxiety.

“He started coming to the reading group and just sitting in the corner and listening. This happened for about 3 months, when eventually one day at the end of a session he suddenly said: ‘can I read the next page?’.

“We saw that as an incredible breakthrough, being able to read in front of other people. That was accompanied by him engaging in cognitive behavourial therapy, looking at some of the underlying reasons for his paranoia and mental illness.

“The group brought about real progress for him. He has since left the hospital. Prior to the group he felt he couldn’t even leave the ward.”

The Reader Organisation wasn’t founded with the aim of helping people’s mental health. Instead, it was born out of Jane’s belief that the great works of literature should be accessible to all, no matter their background.

“Books did something for me that helped me have a different kind of life to the one I was heading for,” she explains.

“I had been a 12-year-old run away. Someone who at a young age had been using drugs and drinking a lot. I was disturbed teenager who had a shoddy education, so when I got my degree and even my PHD I still very strongly had a sense of myself as not being properly educated.

To end up as a university lecturer, she says, felt amazing.

“But I couldn’t help thinking that out there in the wide world was someone like me in a bus shelter who needed to find the same things I’d found.”

After 15 years teaching the canon to bored undergraduates mainly from comfortable middle class homes at the University of Liverpool, Jane finally found an opportunity to try out her theory. In 2002, she was given a £500 budget to set up a reading scheme under the university’s new objective of ‘widening participation’. It would prove to be not just a turning point in her life, but go on to change many others.

“It was a one off, 5 week summer project. The idea was take some books I thought was great out of the university and out into places you wouldn’t expect to find a lot of readers. I recruited a lot of the people in that first group through friends who worked in community work. They weren’t very literate, so I just read to them.

“It was fantastic. It was like meeting up with people from my childhood – the ones I used to meet in the pub where I worked – but instead of serving up beer and vodka I was serving up Shakespeare. People loved it and realised that this was what I wanted to do. I did one more year at the university and kept the group up in my own time. Then I handed my notice in.”

The first few years were a struggle as Jane tried to find funding for a project that didn’t give anyone qualifications or get them into work. But it was as she gathered feedback from participants that Jane realised the true potential of her inclusive, accessible approach to sharing literature – not to educate, but to heal.

“We were frantically trying to gather evidence so that at the end of our year we could justify the project continuing. So we began asking the people attending the group: ‘what’s it done for you?’

“The responses were astonishing. People would say: ‘I’ve got MS, and when I come here for two hours a week I seem to get into such a state of relaxation I become unaware of my symptoms’, or ‘I have chronic pain but I forget about it here because I’m so immersed in the reading.’

“We knew that a number of the people attending had serious mental or physical health issues, but these were powerful and surprising moments. As well as giving people the confidence to read Shakespeare, we were making them feel better too.

“A woman said: ‘I’m bipolar and I’ve been bipolar for 30 years and I’ve tried everything to get better, but this is brilliant. It should be available on the NHS.’”

These early responses would send Davis’ project on a whole new trajectory, and change her entire outlook on what the Reader Organisation could achieve.

“I’d never thought of it in those terms before. But if one in four of us have mental health issues, it must really be more like two in one, because they’ll be a lot of people out there like me who have had mental health problems but didn’t bother going to see a doctor about it.

“Now I don’t think of ‘healthy’ and ‘unhealthy’ as two separate states, I think they’re on a continuum. I realised that what was true for me as young adult – that I love reading because it makes me feel great – could be true for anyone with a little help.”

If this all sounds rather anecdotal, there is a weight of academic evidence to support The Reader Organisation’s claims too.

A study carried out by the University of Liverpool in 2011 looked at the long term affects of participating in Get Into Reading, The Reader Organisation’s flagship program, on older people living with dementia.

They found that regular attendance was effective at improving the memory and concentration of patients, and had a positive long term impact on reducing symptoms such as delusion, anxiety and irritability. It concluded: “the Get Into Reading model should be extended to all care homes.”

Today, the Reader Organisation has just celebrated its tenth anniversary. It now runs 100 weekly reading group in its original home of Wirral alone, and has teams set up in ten different boroughs of London and areas of South Wales, Belfast, Durham and Glasgow – as well as sister projects in Denmark and Australia.

Speaking to anyone involved, from the nurses and volunteers who facilitate the groups to the readers themselves, what comes through is the overwhelming potential everyone feels the scheme has.

“There are a lot of areas of life where what we do could work,” Jane tells me when I ask about the future.

“The army for example. Veterans. People with post-traumatic stress – why not?”

Give it another ten years, and perhaps we’ll no longer see reading as simply as a source of pleasure or a route to education but a way to tackle diseases of both the body and mind.

To learn more about The Reader Organisation check out their website.