Last week I posted about a course I started entitled Psychology and Mental Health: Beyond Nature and Nurture. Last week's class provided a general introduction to the subject matter and what we should expect from the course over the next few weeks. I was keen to get started.
This week we discussed the role of biological factors - nature - in the development of mental health problems. We heard from Professor John Quinn, who outlined some ways in which neurotransmitter activity affects our moods, and is itself affected by events.
We looked at Eric Kandel's 'new intellectual framework for psychiatry'. Eric Kandel is a Nobel prize winning neuroscientist. In addition to his work on memory, Kandel was the author of a very influential and important paper setting out a robust biological account of psychiatry. He argues that all human behaviour, thought and emotion has its roots in the functioning of the brain. Consequently it is to brain-based, neuroscientific, explanations that we should look to for solutions to mental health problems. Kandel argues, in the abstract of his paper, that:
”…In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behaviour…”
Kandel then sets out five principles that he believes should provide the underpinnings of a ‘new intellectual framework for psychiatry’.
“This framework can be summarized in five principles that constitute, in simplified form, the current thinking of biologists about the relationship of mind to brain.”
“Principle 1. All mental processes, even the most complex psychological processes, derive from operations of the brain. The central tenet of this view is that what we commonly call mind is a range of functions carried out by the brain. The actions of the brain underlie not only relatively simple motor behaviors, such as walking and eating, but all of the complex cognitive actions, conscious and unconscious, that we associate with specifically human behavior, such as thinking, speaking, and creating works of literature, music, and art. As a corollary, behavioral disorders that characterize psychiatric illness are disturbances of brain function, even in those cases where the causes of the disturbances are clearly environmental in origin.”
“Principle 2. Genes and their protein products are important determinants of the pattern of interconnections between neurons in the brain and the details of their functioning. Genes, and specifically combinations of genes, therefore exert a significant control over behavior. As a corollary, one component contributing to the development of major mental illnesses is genetic.”
“Principle 3. Altered genes do not, by themselves, explain all of the variance of a given major mental illness. Social or developmental factors also contribute very importantly. Just as combinations of genes contribute to behavior, including social behavior, so can behavior and social factors exert actions on the brain by feeding back upon it to modify the expression of genes and thus the function of nerve cells. Learning, including learning that results in dysfunctional behavior, produces alterations in gene expression. Thus all of “nurture” is ultimately expressed as “nature.””
“Principle 4. Alterations in gene expression induced by learning give rise to changes in patterns of neuronal connections. These changes not only contribute to the biological basis of individuality but presumably are responsible for initiating and maintaining abnormalities of behavior that are induced by social contingencies.”
“Principle 5. Insofar as psychotherapy or counseling is effective and produces long-term changes in behavior, it presumably does so through learning, by producing changes in gene expression that alter the strength of synaptic connections and structural changes that alter the anatomical pattern of interconnections between nerve cells of the brain. As the resolution of brain imaging increases, it should eventually permit quantitative evaluation of the outcome of psychotherapy.”
Kandel does not deny that social events are important, but he maintains that social events have their impact on people by affecting the brain:
“Viewed in this way, all sociology must to some degree be sociobiology; social processes must, at some level, reflect biological functions. … Nevertheless, it is important to appreciate that there are critical biological underpinnings to all social actions.”
Not all psychologists and not all psychiatrists agree with his conclusions, but the paper was definitely worth reading.
Next we looked at Nick Craddock and colleagues' 'wake up call for British psychiatry'. Nick Craddock and colleagues drew up a manifesto for the future of psychiatry based at least in part on a biological model of mental health. This 2008 paper was entitled a “Wake-up call for British psychiatry”, and was written by a group of influential and senior psychiatrists. It sets out how a biological model of mental health - the idea that our mental health is determined by our biology - can influence how we design services.
Nick and colleagues, in the summary to their paper, argue that:
“The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty’s future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialty’s core values and renew efforts to use psychiatric skills for the maximum benefit of patients”.
They begin by arguing that:
“… British psychiatry faces an identity crisis. A major contributory factor has been the recent trend to downgrade the importance of the core aspects of medical care”.
They argue that this has led to problems:
“… In many instances, this has resulted in services that are better suited to delivering nonspecific, psychosocial support rather than a process of thorough, broad-based diagnostic assessment with formulation of aetiology, diagnosis and prognosis followed by specific treatments aimed at recovery with maintenance of functioning…”. and state that: “…Our contention is that this creeping devaluation of medicine is damaging our ability to deliver excellent psychiatric care. It is imperative that we specify clearly the key role of psychiatrists in the management of people with mental illnesses…”
Later on, they suggest that:
“…In order to follow clinical guidance (such as that provided by the National Institute for Health and Clinical Excellence (NICE)) to develop excellent ‘mental health’ care (for those with mental illness), it is important to recognise that a biomedical component, with access to appropriate facilities and appropriate service pathways, is usually crucial…”.
For Nick and colleagues, this is an optimistic vision:
“…Major advances in molecular biology and neuroscience over recent years have provided psychiatry with powerful tools that help to delineate the biological systems involved in psychopathology and impairments suffered by patients. We can be optimistic that over the coming years these advances will facilitate the development of diagnostic approaches with improved biological validity and enhanced clinical utility in terms of predicting treatment response. We can expect that completely novel treatments will be developed based on detailed understanding of pathogenesis…”. … “…Psychological and social interventions will, of course, continue to be crucially important in managing psychiatric illness (as they are also in non-psychiatric disorders). However, in addition, patients have the right to expect that biological factors are fully considered and, where appropriate, evidence-based interventions delivered…”.
Thirdly, we looked at 'Chemical imbalances'. One powerful idea in the area of mental health is the suggestion that mental health problems result from ‘chemical imbalances’ and that the psychiatric drugs that are commonly prescribed help people because they ‘correct’ these ‘imbalances’. In fact, if you search online for information about mental health problems that is sponsored by pharmaceutical companies, this idea is very common. Dr Joanna Moncrieff is a psychiatrist who has criticised this approach. In essence, her argument is that psychiatric medication has well-recognised effects on the brain, which affect our moods, behaviours and even thoughts, and which can - sometimes - be helpful for people in great distress.
But Jo does not support the idea that these drugs are correcting chemical imbalances; and she describes this as the ‘myth of the chemical cure’. Jo advocates that we adopt what she describes as the ‘drug-based’ model of the action of psychiatric medication, rejecting the ‘disease-based’ approach.
This does not mean that she believes that the medication is ineffective. She recognises that the medication has a clear effect on our neurotransmitters, and therefore on our emotions and behaviour. But Jo does not believe that this necessarily means that the medication is correcting an underlying abnormality.
Finally we concluded with a brief critique of this weeks’ discussions. We are taught that the science and the logical arguments are both strong: we know that the functioning of our brains lies beneath all our behaviours, thoughts and emotions, and so biological approaches cannot be dismissed. And yet, many psychologists and social psychologists think that biological approaches alone cannot fully explain our experience of mental health problems. Next week, we will be looking at social perspectives on mental health. We are challenged, over the course as a whole, to consider how these different approaches can be integrated and to consider the strengths and weaknesses of the biological component of the ‘biopsychosocial model’.
I’ll see you again next week…
“A child can live through anything provided they are told the truth and allowed to share the natural feelings people have when they are suffering” Eda Le Shan.
I am currently supporting a family where a parent has a life limiting illness. Devastatingly, it is expected that the parent has only a couple of weeks left with them. In preparation I have been identifying support services in the area that can assist the children, aged six and eighteen, during the difficult time before and after the parents passing.
During my research I have found that following a survey carried out by Winston's Wish, it is estimated that:
Most children and young people will experience loss, mainly due to bereavement. Bereavement is described as the loss that people experience when someone close to them dies. This could be a close relative, family member or friend. Alternatively the loss could be due to family difficulties such as separation and divorce.
Grief is the combination of feelings that are experienced as a result of the loss of something or someone close to them. Everyone experiences grief differently – there is no “right” way to feel. Feelings can include: shock, despair, intense sadness, guilt, depression, relief, fear and anger. It can sometimes feel that people move backwards and forwards between feelings. It is not unusual to feel numb, feeling that you have no feelings at all. Grief is a normal and natural response to loss.
Children and young people will go through a range of the feelings described above. However, the ways in which they respond to their loss will be determined by their age, their understanding of death/loss, their relationship with the person they have lost, the circumstances surrounding the event and the way the situation is dealt with by others around them.
The following information describes some of the common reactions that children and young people may experience following a loss, what they may need and what parents and professionals can do to help. This is not an exhaustive list and reactions will vary with each individual.
Children need reassurance that whatever has happened is not their fault; permission to express their feelings and be a child, in a constructive way; honest explanations; help and support to express their feelings; and, to be included in the funerals and rituals, if appropriate.
Great Answers to Difficult Questions about Death explores children's thoughts and feelings on the subject of death and provides parents and other caring adults with guidance on how to respond to difficult situations.
Grief in Young Children explores the common misconception that pre-school children are not capable of experiencing grief in the same way that older children do. This book challenges this assumption, demonstrating that although young children may not express grief in the same way as older children, they still need to be supported through loss.
There are a number of organisations that can offer support to children and their carers during a time of bereavement. The following are some that I have found to be particularly good and are available nationally or in the Greater Manchester area.
Manchester Office – 2nd Floor, Gateway House, Piccadilly South, Manchester, M60 7LP
Tel: 0800 58 58 58 (Monday - Friday 17:00hrs – 03:00hrs)
CALM works to tackle depression amongst young men (aged 15-35) across Manchester, Merseyside and Bedfordshire. It exists to help them deal with the problems they are facing, no matter what is troubling them
1 Sickle Street, Manchester M2 1DL
Tel: 0870 336 2920
Fax: 0870 336 2921
Chips Programme – North West Contacts:
Sue Tabner: 0870 336 2924
Maria Molloy: 0870 336 294
Childline provides a free, 24-hour, helpline for children in distress or danger. Trained volunteer counsellors advise and protect children and young people who may feel they have nowhere else to turn. Childline also offers an outreach programme, to schools, through its CHIPS programme, focussing on a range of areas including loss and bereavement
Riprap is a website that can help young people (12-16yrs) cope when a parent has cancer. There are stories from other young people going through similar situations and information to help them to understand and deal with what is going on in their family.
RD 4 U
Freephone: 0808 808 1677
This is a website designed for young people by young people as part of CRUSE Bereavement Care’s Youth Involvement Project. Offers support for young people after the death of someone close. There is a specific area for boys.
Clara Burgess Centre, Bayshill Road, Cheltenham, GL50 3AW
General Enquiries: 01242 515157
Helpline: 0845 20 30 40 5
Fax: 01242 546187
This is one of my favourites. I have used them in the past following the sudden death of a foster carer I was working with. The support they were able to offer both the 9 year old birth child and 13 year old foster child was amazing and it really did make a difference.
Winston’s Wish supports bereaved children and young people. The website explains how professionals can help bereaved young people and offers ideas for resources and activities.
They offer face to face work to all children and families bereaved of a parent, primary care-giver or sibling through suicide, murder and manslaughter and military deaths, living anywhere in the UK. For families who have been bereaved through an accident or illness, this service is only available for families living in Gloucestershire, South Gloucestershire, West Sussex and Greater Manchester. They have a variety of options available to families including:
A home visit by their practitioners will assess the needs of each bereaved family. Individual work may be offered to parents and children before, after or instead of a group activity.
Practical and creative activities encourage teamwork, building confidence and self-esteem. This sets the scene for the young people to begin sharing their own stories, to untangle and express a range of feelings, increase their knowledge about death and to continue their individual journeys towards understanding their grief.
Under 5’s (C.U.B.S)
Winston’s Wish offers a six-week play and grief support group programme for children aged between 3 and 5 years who have experienced the death of someone important.
The Outward Bound teenage groups combine challenging outdoor activities, team work and opportunities to talk and think about bereavement experiences with other teenagers. The programme of activities and small group work were created to empower, challenge and motivate, and to help teenagers in living with their bereavement.
A community outreach bereavement support service for vulnerable children and young people aged between 8-14 .
The Winston’s Wish Drop-ins for the North West region run weekly in Wigan and Leigh:
Tuesday Drop-in sessions are held every Tuesday from 11am-1pm at Compassion in Action, Patrick House, 58 Leigh Rd, Leigh, WN7 1QR
Wednesday Drop-in sessions are held every Wednesday from 3.30-5.30pm at Sunshine House, Wellington Street, Wigan, WN1 3SA
Grief Encounter Project, PO Box 49701, London, N20 8XJ
This organisation helps bereaved children and young people rebuild their lives after a family death. The project aims to improve resources available to bereaved children and their families
Childhood Bereavement Network
8 Wakley Street, London, EC1V 7QE
Tel: 020 7843 6309
Fax: 020 7837 1439
The Childhood Bereavement Network aims to provide all children and young people in the UK, together with their families and other caregivers, including professional carers, easy access to a choice of high-quality local and national information, guidance and support to enable them to manage the impact of death on their lives.
If you require any further help identifying services in your area. Please do get in touch through my contact page.
I’ve just started a new course entitled Psychology and Mental Health: Beyond Nature and Nurture by Professor Peter Kinderman (University of Liverpool). The course is largely built on foundations laid down in his two recent books: ‘New Laws of Psychology’ and ‘A Prescription for Psychiatry’.
A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing builds from a psychosocial approach to mental health and well-being to recommend a wholesale revision of our mental health services. Arguing that the origins of distress are largely social, and that therefore we need a change from a ‘disease model’ to a ‘psychosocial model’, the book argues that we should reject traditional psychiatric diagnosis, significantly reduce our use of psychiatric medication, tailor help to each person’s unique needs, invest in greater psychological and social therapies, and place mental health and well-being services within a social rather than a medical framework.
New Laws of Psychology: Why Nature and Nurture Alone Can’t Explain Human Behaviour proposes a common-sense, cognitive, account of human behaviour - arguing that our thoughts, emotions, actions and therefore mental health can be largely explained if we understand how people make sense of their world and how that framework of understanding has been learned. This approach challenges notions such as ‘mental illness’ and ‘abnormal psychology’ as old-fashioned, demeaning and invalid, argues that diagnoses such as ‘depression’ and ‘schizophrenia’ are unhelpful, and proposes that psychological accounts offer a more helpful way to address emotional distress.
This week we are looking at one of the fundamental questions about our mental health; nature or nurture? That could simply mean something like are mental health problems the result of biological processes (nature) or social in origin (nurture)? Are they the result of biological abnormalities or are they the result of life events or other environmental factors? Or, to be a little more specific, is the variance that we see in terms of mental health a result of variance in biological or social factors? That is, can we explain the differences between people’s mental health in terms of differences in biology (different people having different genetics, or different biochemistry) or differences in the experiences they’ve been exposed to?
Mental Health featured heavily in the political parties manifestos ahead of the general election in May and it’s right that this area of study and service is given greater priority. As a Social Worker I am acutely aware of the interplay that exists between mental health services and children’s safeguarding.
Young Mind is Mind’s youth division. Its website provides the following key statistics about children’s and adolescents mental health:
I’ll post again following next week’s session. Please follow me on facebook so you don't miss it! I can already tell that this is going to be a really interesting and useful course.
On Friday I posted an article asking 'is Social Work on the political agenda in run up to the general election?' My post gave a general overview of the parties main pledges with regards to social care and my take on it. Chief executive of the British Association for Adoption and Fostering, Caroline Selkirk, has also responded to the key general election manifesto pledges for looked after children from the Labour, Conservative and Liberal Democrat parties. Here's what she had to say:
We will increase support for children in kinship (family and friends) care and their families, a group too often overlooked and undervalued
"We have been campaigning alongside the Family Rights Group to raise the profile of kinship care, and we'd like to see a commitment from all parties to support kinship care. We are delighted that the Labour Party has taken this first step."
"Kinship care is currently the Cinderella care option – kinship carers are not eligible for the same support as adopters or foster carers, and they are also penalised by the benefits system. For example, many have fallen foul of the spare room subsidy and availability to work rules. As a result, it is crucial that any additional support for kinship carers should enable free access to legal and advice services."
We will introduce regional adoption agencies, working across local authority boundaries to match children with the best parents for them
"Introducing regional adoption agencies would be a major change to the way in which adoption services are currently delivered. It is vital that any such reorganisation will focus on a child and their need for a family for life. We need to see greater clarity on these proposals."
"At present there are nine Regional Adoption Boards reporting to the Adoption Leadership Board, who are focused on improving performance at a regional level. This is still a fairly new initiative and needs further time to become established."
"We agree that there are benefits for children when local authorities work co-operatively, together with Voluntary Adoption Agencies in their region, to identify suitable matches for children in their care. There are already some well-established regional consortiums, where local authorities are developing new ways of working together and we would support further development of these models."
Continue to make it easier for children in care to find a loving home, through the national Adoption Register and the new national gateway for adoption, a first point of contact for potential adopters
"Recent reforms to adoption have reduced delay in the time it takes for a child to be placed. However, for children from ethnic minority backgrounds, older children, those with a disability and sibling groups it is still a challenge to find the right match. The decision by the Liberal Democrats to maintain momentum on the current measures, like the Adoption Register, and the new national gateway for adoption, provide continuity and is welcome."
Tackle delay and instability in foster care, with better support and training for foster carers, including on mental health issues
"Providing better support and training for foster carers, and focussing on mental health issues will be essential to the development of foster care. A further step in the right direction would be a government commitment to driving forward best practice in the sector, ensuring increased support and funding of foster care, alongside the emphasis on support and training for both foster carers and social workers."
"There are over 90,000 looked after children- that's children in the care system in the UK. It is paramount that the next government provides appropriate support for these children and their carers. Any failure to do so risks condemning some of our countries' most vulnerable children to an unstable and uncertain future."
Community Care reported on Wednesday that UKIP would seek wholesale reform of Britain's "clearly failing" child protection services, if elected. If I may overlook the fact that this is from UKIP for a second; if this policy was coming from any of the political parties I would be very interested in hearing more. Highly skilled and able practitioners are working in a very challenging environment with many systematic failures. If any party was to take an open and unbiased review of child protection services I would be very pleased because they would see what many of us have known for years. However, I am rather sceptical about any of their motives. In my experience politicians are too quick to scapegoat practitioners rather than look at the impossible system within which they are expected to practice safely and invest the necessary capital; because that is what is needed - INVESTMENT.
When politicians refer to Child Protection Services what they are actually talking about is Children's Social Care. The problem with this choice of rhetoric is that it leads the majority of voters to believe it is not a service that they will ever need and therefore, whilst they may be interested and concerned, they would not prioritise spending in this area. This is a false dichotomy. Children's Social Care encompassed a whole host of services for a diverse demographic of children and young people. We are not just talking about front-line Social Workers but also the preventative services that are bearing the brunt of cuts; support and care for looked after children; services and respite for families of children with additional needs. Social Workers do not only work with 'troubled families' but also families experiencing crisis whatever their background. Leading the often complicated array of professionals and services are Social Workers. It is when Social Workers are overstretched and unable to do the job they love that the system falls apart and children are put at risk. Serious Case Reviews often cite poor multi-agency working - Social Workers, when sufficiently resourced, are the glue that holds it all together and should be valued for the job they do.
I have worked with an incredibly mixed demographic of clients in my time. Some would have fitted the governments definition of a 'troubled family' others would not. My role has involved safeguarding children from physical, sexual, and emotional harm. It has also included working with parents who need support and assistance as a result of redundancy, homelessness, illness and disability. One family in particular springs to mind as I write this; they were a young professional family who had fallen on hard times as a result of redundancy. Dad had lost his job and, as result of the economic downturn, was finding it difficult to bridge the gap. He was extremely conscientious, hard working and proud. He found it very difficult asking for help but when he was unable to pay the rent and they lost their home, without any extended family to offer assistance, he turned to Children's Services to help him, his wife and their two young daughters. It was only a month until he found employment again but I am sure he would say that we offered him a much needed lifeline. This was not his fault and I am sure a year or two earlier he would not have envisaged a time when he and his family would have ever needed the help of a Social Worker. This is my point: you never know when you will fall on hard times; this is why Social Care should be on the political agenda; and why voters should be interested in what party manifestos have to say about it.
So, lets take a look at what the main parties have to say in their manifesto's.
Labour would avoid "extreme" social care cuts and continue to fund the Frontline fast track training scheme for Children's Social Work according to their manifesto. They would also:
The Conservatives would create regional adoption agencies that work across local authority boundaries, the party manifesto has pledged. "Far-reaching powers" over social care would also be devolved to large cities that opt to having an elected mayor, like Greater Manchester. Their party manifesto also said they would:
The Liberal Democrats have pledged to "radically transform mental health services" if they are elected to government. Their manifesto states that a Liberal Democrat government would build on the work of the coalition to establish parity between physical and mental health services. They also say they would:
The Greens have pledged free social care and health care for all older people at a cost of "around £8bn a year" and an end to "failed" austerity. Their manifesto also promises:
As mentioned earlier, UKIP would seek wholesale reform of the "clearly failing" child protection services in Britain, if it were to win the next general election. They would hold an open review of all childcare and child protection services, with a view to reforming the system. The cited concerns over "misplaced sensitivity to issues of race and religion", "forced adoptions" and professionals "letting serious cases of abuse and maltreatment slip through the net". In their manifesto UKIP said that they would:
The Greens win for me but as we don't have a visible candidate in my area this is a mute point. What party impresses you the most? Why? I hope that the next government values Children's Social Care enough to invest in it. I hope that they realise it is not only a bad workman that blames his tools. It is impossible for Social Workers to produce good outcomes 100% of the time when they have sky high caseloads and dwindling preventative services.
I'm a Qualified Children's Social Worker with a passion for safeguarding and family support in the UK.