Even though I know many celebrate the difference of ‘madness’ I make no apology for the use of the term that others might find offensive.
I guess we have to call it something – and to be honest – I’m using it in belligerence to those who choose to call it by the names of the self-promulgating “sciences” – like psychiatry, neuropsychiatry, neuropsychology, psychology – because this then determines the issue is no longer a person; it is an “ology” or an “iatry” of the “psyche“.
I don’t particularly begrudge each one’s right to inclusion in the search for finding solutions to these debilitating mental health conditions; but I am totally racked off with the sense of pontificating exclusivity each one brings to the dilemma.
I guess I should qualify that last sentence. This example might do it from Fans of Cognitive Neuropsychology on Facebook:
Hate Behaviorism? Feel that Nurture is a whole load of crap? Then join here because here, it is the brain – our genes – that come preprogrammed to respond to our environment. Sure we feel that experience is important, but it is that way that we are programmed by our genes that allow us to respond in the ways that we do. Cognitive Psych explains that we all have these mechanisms that process our sensations and perceptions, and that these programs are the keys to knowing how our brains process our experiences and provide output
So you see – we’re mad because our pre-programmed genes tells us to be mad.
And what’s with the patronising “Sure we feel that experience is important” – I’ll tell you I think the experience is pretty bloody important to those who are having a pre-programmed genetic reaction that causes them to cut their arms, legs and faces to ribbons. But genetically – self-harmers were pre-programmed to do that, apparently, and the fact they were systematically abused is a mere catalyst. All we need to do of course is to find out how we can stop the genetic structure of our brain thinking that self harming is a way to behave and we’ll be right.
Or then again; it could be because of any one, or indeed any combination of these studies of the mind:
Aphasiology
Biological psychology
Cognitive Science
Evolutionary neuroscience
Generative grammar
Machine Learning
Metaplasticity
Neural Networks
Neural engineering
Neuroanatomy
Neurobiology
Neurochemistry
Neuroeconomics
Neuroergonomics
Neuroendocrinology
Neuroesthetics
Neuroethics
Neuroethology
Neurogenetics
Neurogenomics
Neuroheuristic
Neuroimaging
Neurolinguistics
Neuromarketing
Neuropharmacology
Neurophenomenology
Neurophilosophy
Neurophysics
Neurophysiology
Neuroproteomics
Neuroprosthetics
Neuropsychiatry
Neuropsychology
Neuropsychopharmacology
Neurotheology (also Biotheology)
Psychiatry
Psychoneuroimmunology
Psychopharmacology
Psychobiology
(lots of neuro – which may be further defined by adding “cognitive” in front of each one for a more defined specialty of studying how the brain processes the thought – genetically; philosophically; linguistically.. etc)
(Oh.. and Behavioural before the neuro if it’s the study of how that neuro~thingy makes us behave)
(cognitive behavioural would of course be…. err… that we think then we behave… with some neuro thingy inbetween)
Not forgetting of course, theories in:
- Cognitive bias
- Cognitive linguistics
- Computational neuroscience
- Decision theory
- Decision field theory
- Educational psychology
- Heterophenomenology
- Human Cognome
- Embodied cognitive science
- Embodied cognition
- Enactivism
- Linguistics
- Neural Darwinism
- Neural network
- Neuropsychology
- Neuroscience
- Notation bias
- Simulated consciousness
- Situated cognition
- Society of Mind theory
- SP theory
- Concept Mining
- Thought
What gets me about all this science is how little science there is.
For example: fMRI can now tell us how the brain, for want of a better description, lights up like a Christmas Tree fairy lights during certain processes. Unfortunately, they can’t tell us what those lights all mean and whether they are a cause of ensuing behaviour or effect of experience. So what they do is note something happens then say “In schizophrenia lights 5 & 6 blink differently to non-schizophrenia”. They have no idea of the significance of this.
Woo
Hoo
Now I’m all about curing all diseases and illnesses (because we’re selling the health service to Branson anyhow so I would rather we didn’t need one – then we can all complain about dying of “nothing”)
Psychopharmacology/Psychiatry Interest Group:
TO ALL THE DOUBTERS AND THE ANTIPSYCHIATRISTS:
WHY IS THERE NO BIOLOGICAL TEST FOR MENTAL ILLNESSES? HERE’S WHY.
Classical illnesses such as tumours and brain infection can cause psychiatric symptoms. The diagnosis can be relatively easy to make- do a brain scan, do a blood test. But what is going on in the brain at the molecular level can be hard to interpret. Brain function also depends upon more subtle biology – specifically the pattern of neuronal connections and the robustness of neurotransmitter activity, and that problems there can also result in mental disorders.Finally, it is worth noting that the same situation exists for many non-controversial biological diseases. For example, there are many studies showing early biological correlations of Alzheimer’s disease. But none of these tests are used clinically. Instead, the diagnosis is made by history, signs, and symptoms, and by ruling out other causes – exactly how ADHD and schizophrenia are diagnosed. There are also numerous neurotransmitters which interact in a highly complex manner to produce behaviour in the individual. The way these neurotransmitters interact is coded for by many genes. One subset of genes will produce many different complex behaviours. We do not yet know all that is going on in the brain at this level, we do not have the resources fully as yet but then this is why neuroscience is working hard to find answers to these complex problems. So, rather than mocking psychiatry as a discipline, you should educate yourselves more about this fascinating organ, which we call,the human brain.
Hmm.. so we aren’t genetically programmed to be paranoid? We have a faulty anatomical or chemical balance. No reference as to how things got to be so imbalanced. Well, of course not. They’re not even sure what is out of balance – which is a cause and which is a consequence.
“If mood state x exists when neurochemical y is present then making y present will make mood x happen”. Crap. That’s hypothesising like saying “when I pull this string forward the cart will follow. So if I push the cart forward the string will remain in front”.
Even in our beloved psychiatry there exists a quandary on the principle of how some chemicals fire off and on. People behave differently according to different chemicals, so ok… let’s fiddle about with the brain chemicals. No one tablet provides the same outcome in everyone.
I see psychopharmacology as kind of, if you remember, when you put your arms through someone elses arms while standing behind them and try to make a chocolate cake while having all the ingredients and equipment for every other sort of cake and a meat pie and some 3-in-1 oil available in front of you – but they were blindfold and you are relying on someone who doesn’t know what any of the items in front of them are and trying to tell you what to grab.
So I’ve had enough.
Those of you who sit and pontificate your theories on causes and cures are annoying to those of us actually doing them.
In PE I learnt if bits of your body get broken – that bit doesn’t work right.
In computers level 1 I learnt GIGO: Garbage in – Garbage out.
And in chemistry I learnt – if you put enough shit together you can make a real mess.
Of course, I wasn’t la creme de la creme enough to enter into Doc Crippen’s elite training academy, but I learnt enough to know simple basics principles -
If people have a shit life; they feel like shit.
If you stop treating them like shit; they don’t forget – but it helps to stop them feeling so shitty.
And I can’t think of a single time I’ve come across someone with mental health issues – neurotic or psychotic – where they haven’t got a significant reason for being so: acute stress; drugs; emotionally traumatic events; infection; brain injury; etc.
If someone keeps hitting me on the forearm with a piece of 3×2 I will very likely get hurt. I might even show a bruise, or a fracture or even some external bleeding. I don’t need nor do I want someone to be telling me at what tension my arm actually broke; or to be able to explain to me why the blood is pumping out of my gaping wound. I need a support applying to hold the break; some pressure to stem the bleeding; some analgesia to provide pain relief and someone to help tie my shoes til I get use of both arms back.
Why do we care so much about how these things happen in the brain when we obviously care so little about how to simply make our society a less hurtful place?
On the subject of calling it madness: I often seem to make people really very uncomfortable by referring to myself as “slightly crazy”. Psychiatrists, OTs, psychologists, nurses – they’re all uncomfortable with me using that term, and they glare at me and try to get me to “reframe” it. But then, “depression, non-specific anxiety disorder and post-traumatic stress disorder, with tendency toward dissociative symptoms and deliberate self harm” takes a long time to say. “Slightly crazy” is faster, and everyone knows what I mean. If I’m fine with it, then so what if they got taught at university that it’s not helpful to call people crazy?
oops, apologies for the typos, still not got the hang of the keyboard on my eee pc…
“And I can’t think of a single time I’ve come across someone with mental health issues – neurotic or psychotic – where they haven’t got a significant reason for being so: acute stress; drugs; emotionally traumatic events; infection; brain injury; etc.”
“Unfortunately, they can’t tell us what those lights all mean and whether they are a cause of ensuing behaviour or effect of experience.”
Why do we care so much about how these things happen in the brain when we obviously care so little about how to simply make our society a less hurtful place?
Because some people who are hurt end up with mental illnesses and some people who are hurt don’t. And it might be nice to know why that is?
Hmm – this post prompted me to sign up.
Nature v nurture… Let’s get the nature bit out of the way. I see it like this: some people may have inherited tendencies or ‘conditions’ – let’s imagine they are the equivalent of a series of invisible hurdles. Some people may be good at jumping hurdles too – also inherited. Nurture: that’s where you inherit the pair of lead boots from your parents.
Some people who inherit a condition and are bad at coping with it might come from a good, supportive background.
Some people who inherit a condition and are good at coping with it might come from a shite background.
Etc through all six permutations. No doubt there should be 343432 permutations.
As for your last sentence – agree completely. But I’m sure the answer has something to do with money and votes.
Because some people who are hurt end up with mental illnesses and some people who are hurt don’t. And it might be nice to know why that is?
Well, to slip Laing in here – is it simply because this is sometimes how people react to the situations they are in?
Some people fall out of a tree and break a leg – some others who fall – don’t.
Some who smoke get lung cancer – some don’t.
Health policy clearly sees the cause of the event:
Falling
Smoking
Who knows, perhaps those who don’t get hurt by these traumatic events are the one’s mentally or physically deficient as they obviously aren’t “feeling” their experience sufficiently to be damaged – and perhaps we should be finding out why they don’t react – rather than why some people subjected to their stresses react in a totally normal way by going nuts?
I can agree it would be nice to know and perhaps prevent this happening at all – but I think what I was trying to get at amongst my late-night drivel was that we spend so much on this “knowledge” of cause and origin – but we spend far less on actually dealing with the problems that exist now that it makes no sense to me. I’m also very annoyed at the insular nature of all the ology-iatry that says it’s the way to go when clearly the “brain” is far more than just an anatomical-chemical organ.
Where is all the science in treatment? There is none. Since we seem unable to agree on why or how an illness develops; how can we agree on a remedy?
The current (and what I believe remains the only) preventative “cure” for mental illnesses is to reduce vulnerability and avert away from the externalised damage caused. Not by finding which part of the brain are disaffected and switching them off/on. That’s nothing more than looking to lobotomise someone and completely invalidate their life experiences. I’m sure some would like to remove their ‘faulty bits’ in the brain – whatever that may be – to get beyond the suffering.
But the demographic studies are there – how much ‘madness’ do you think could be avoided if we dealt with:
Poverty
Employment
Abuse
Why does so much time, money and energy go into looking for a scientific remedy (that will take probably a couple more generations to be of significant use) whilst we have a quite clearly sub-standard service for the present day with clearly evident and significant indicators for cause?
How many psychologists do you think are involved in all these studies?
And how many was it Layard’s “CBT 4 depression” was short?
They wanted 10,000 – the govt has gone with 3,500.
Some people fall out of a tree and break a leg – some others who fall – don’t.
Yes. And?.
Some who smoke get lung cancer – some don’t.
You had a point?
I’m also very annoyed at the insular nature of all the ology-iatry that says it’s the way to go when clearly the “brain” is far more than just an anatomical-chemical organ.
But that’s what the brain is. It’s a couple of pounds of fatty tissue in your skull. The interesting thing about it is that somehow it generates thoughts and mind and consciousness. And sure, we can talk about those things without considering the underlying structure that supports them.
But here’s the thing: All mental illness and, indeed, all human behaviour has a biological basis. We’re biological creatures with biological brains. Our thoughts, emotions, joys and grief all arise from an organ that makes up maybe one or two percent of what we think of as ourselves. So, if you want to understand them, then you have to look at the structures necessary to produce them. That doesn’t mean the thoughts, emotions, etc. aren’t important. They’re the entire reason that the brain’s worth studying in such detail.
Not by finding which part of the brain are disaffected and switching them off/on. That’s nothing more than looking to lobotomise someone and completely invalidate their life experiences.
I’m on psychiatric medication (lamotrigine currently). I don’t feel particularly lobotomised now and didn’t when I was taking Seroquel. And, you know what? I don’t feel my life experiences have been invalidated. Why wouuld I? Taking medication doesn’t make them go away. For that matter, why the hell would I look to medicine for validation of my life experiences?
Why does so much time, money and energy go into looking for a scientific remedy (that will take probably a couple more generations to be of significant use) whilst we have a quite clearly sub-standard service for the present day with clearly evident and significant indicators for cause?
Thank you. I love the opportunity to look up some statistics.
Publicly funded medical research in the UK is run by the Medical Research Council. The amount they spend on neurosciences and mental health is £108.7 million.
The budget for the NHS is currently around (pdf) £94 billion.
So, to do the maths, if all the publicly funded medical research in the UK were stopped right now and the entire budget given directly to the NHS, it would increase the NHS budget by just over a tenth of one percent. To put it another way, if all that money went to pay for psychologists to deliver CBT, it would pay for less than three thousand of them.
OK, these figures are slightly misleading since we’re not factoring in the salaries of these researchers which will ultimately be paid for via education funding. I guess if you really want to make them all redundant, they could retrain as CBT therapists.
Oo look – my navel has some fluff in it. What about YOUR navel?
Can I ask one of you mods a favour? Could you delete my previous comments on this thread? I was in a funny mood, they are knee-jerk ranting only vaguely related to the thread and I regret posting them… ta muchly…
fabulous piece – whilst being a great defender of theory in its place, I found myself losing patience when it hindered practice especially in the way in which you have so eloquently described – it’s a bit like knowing the sqaure root of a jam jar but being unable to take the lid off.
or even the square root
DeeDee : Done
beakie: You’re gonna have to be a bit more explicit.
If you’re inferring I’m being equally self-pontificating – I am; but whilst making a meaningful attempt to make a difference rather than just prove a difference.
I’m just annoyed at how many different factions there are that “claim” to be seeking a cure for schizophgrenia and the like and inject oodles of squids into attempting to do so – whilst those who are actually engaging in making the difference are cash-strapped.
Look at the cost of completing PET or MRI scans over a year – multiply it by the number of different scientific specialties.
Now how does that compare to the cost of putting a decent looking ward together? Or supplying enough therapists to actually deal with the current demand?
Let me try this analogy – cos I like them:
If the cake keeps tasting awful and bitter I know it’s good to find out where the recipe, ingredients, equipment or method is wrong – but everyone is looking at every aspect of the cake-bake at the expense of us not fixing the shit load of bitter cake we already got.
Of course, we can go back to putting the cakes in the larder to go stale until someone finds the cause of the fault – but we closed the old institutions for a good reason.
Everyone is tasting the bitter cake and not enough effort goes in to making it taste good enough to eat.
Yeah, but you can play this game of “it’s not fair” until the cows come home. Quantitative research projects get the funds. Medicine has always had the “glamour”. The press, the telly and the public will always be more interested in the latest whizz-bang wow-look technology than they will be in more bread and butter issues.
You can bash your little balled-up fists against the wall as much as you like but I can’t see that changing any time in the near future. Best to get off the cross, carefully dress one’s wounds and get on with providing as good a service as you can within the current restrictions.
Ok, let’s try this a different way:
I’m just annoyed at how many different factions there are that “claim” to be seeking a cure for schizophgrenia and the like and inject oodles of squids into attempting to do so – whilst those who are actually engaging in making the difference are cash-strapped.
Would you care to put some figures on what you consider to be the “oodles of squids” that’s spent on research into mental illnesses (some of which, of course, applies to talking therapies and identifying risk factors like abuse, unemployment, etc.) And what you think this money would be better spent on.
Because I’m pretty sure most publicly funded medical research thinks of itself as kind of cash-strapped too. And without supporting the idea that medical research takes place at the significant expense of mental health services, your argument seems levelled at a straw man.
E/C – absolutely no idea how much. It doesn’t detract from the mainstay – that services should be brought up to scratch first – then after that we can play mad scientist.
beakie – such a dismissive attitude makes me wonder why you seek to then waste your time trying to educate anyone in mental health nursing?
To return to the Chimpy one… I did some research on research – knowing full well I would be unable to pin-point anything like a figure on it – but out of curiosity I stumbeld upon this comment made by Til Wykes, from last year:
http://pb.rcpsych.org/cgi/content/full/31/4/160
Til Wykes is Professor of Clinical Psychology and Rehabilitation at the Institute of Psychiatry, King’s College London and a clinical psychologist at the South London and Maudsley NHS Foundation Trust. She is Director of the UK Mental Health Research Network.
.
.
What single area of psychiatric research should be given priority?
I am eager to discover programmes of therapy that lead to recovery in those who have the most disability, but this does not exclude many areas of research. Perhaps we do need to try to investigate some simple questions that would have immediate implications for care.
Now I feel like the Raj Persaud of mentalnurse.org
“Well, to slip Laing in here”
What a revolting thought Mr Ian.
Beakie my navel has my finger stuck in it. It is how I stop my bum falling off.
“If mood state x exists when neurochemical y is present then making y present will make mood x happen”
An easily testable hypothesis I would have thought and one when it comes to illicit drugs and alcohol would appear to be proven, add y and see if X happens. Drink alcohol, feel happy.Smoke dope feel mellow. The problem with the neurochemical hypothesis of mental illness is that it is based on proving a negative. Lack of Y causes X. From which we could just as easily conclude that headaches are caused by a lack of paracetamol in the blood.
I wonder the same too, Mr Ian, on many many many occasions. However, I don’t know how what I’ve said leads you to make that statement.
Yeah, but you can play this game of “it’s not fair” until the cows come home.
The press, the telly and the public will always be more interested in the latest whizz-bang wow-look technology than they will be in more bread and butter issues.
You can bash your little balled-up fists against the wall as much as you like but I can’t see that changing any time in the near future. Best to get off the cross, carefully dress one’s wounds and get on with providing as good a service as you can within the current restrictions
Would have been easier for me to delete the one line that didn’t lead me to that statement.
This is so defeatest of you to say and no matter how much reality you may be drawing from here – your choice to roll over and accept it being this way is quite disappointing.
What bothered me more tho was the director of mental health research network giving such a dithery answer to the direction of mental health research. You’d think the clue would be in her title as to what was expected of her – but no, she merely directs the network; what the network does in itself is up to itself I guess.
I would agree with you to the point it’s a load of bollox, which was my original post, but I’d part ways with you at your sense of futility.
BTW: while I’m still on my cross….
I can see your house from here.
It’s not defeatist, it’s realistic. You have a choice to whinge on about the unfairness of the world, or to get on with things.
Beakie, You started off as John Prescott chelping about the priveliges afforded to Royalty, J.P`s and stockbrokers. Then you became Peter Mandelson mocking the chinless wonder anaesthetists in the rugby club ( none in my rugby club BTW ). Now you`re telling people to stop whingeing and get on with it. You`re realising I`ve been right all along.
Mr Ian, I`m not in tune with your argument, I never am, but this is a fantastic post. The first ever on Mental Nurse that I`m going to print off. It illustrates, exactly, why so many snake oil salesmen are attracted to the mental health field, why so many, who are interested primarily in personal advancement, are doing so much research, why Big Pharma get away with what they do, why so many nurses are so bloody confused and why simple solutions are so neglected.
thanks, Mr Ian.
I’m lost.
So..
beakie: we do the best we can while accepting the reality is shite and for the most part a meaningless exercise in rotating beds and community caseloads while some edumacative academies consume vast (108M) amounts of funds to cut open the golden goose and rid this world of mental health issues.
Given that some of that research will actually be directly useful to immediate patient care I’ll accept that 50M might annoy me – how many decent gardens can you get in for patients to sit in? Or a clean dab of paint? Or extra psychologists (who not being in a research job might now be needing to return to the clinical floor)?
chimp: I wasn’t talking about medication – but direct neuro-intervention which is the aim of neuroscience research. To seek and redefine the ultimate cause of the brain turning experience into personality and ergo erdicate mental illness. Most recent research (which I still read despite my loathing the inadequacy of purposeful interventions at the coal face) indicates that major psychoses is associated with the types and number of neuron connections and currently they suggest several studies have suggested glutamatergic abnormalities in bipolar disorder. Well that’s fine then – we just get a glutamatergic striaghtener and we can discharge everyone home.
Some people fall out of a tree and break a leg – some others who fall – don’t.
Yes. And?.
Some who smoke get lung cancer – some don’t.
You had a point?
Educate them not to fall out of trees or to stop smoking.
The best cure is prevention and the biggest most prominent causative factors in mental health are:
poverty
stress/trauma
stigma
The superfluous MH research is like trying to tell us why, if we smoke or fall out of a tree, it does damage. Why not put more effort in to stop it at source?
OSB: How can you be not in tune with my argument yet it be the first you print off as some evidence as it’s a ‘fantastic post’?
DD: Welcome.
Mr Ian – were psychiatric research funded to the detriment of mental health services, you would have a point. But it isn’t. Were all psychiatric research neurobiological in nature, you might have a point. But it isn’t. So in effect what you are doing is little more than complaining about how unfair the world is. Yes, it is. Get over it.
Mr Ian, You spend too much time in the sun. I was in agreement with your reservations about the impact technology can have. But it`s no justification for a dumbed down, shambolic education system. Likewise, I agree with you that a lot of current mental health research is claptrap. But a lot of research needs to be done. It just needs to be better directed and even I, as the archetypal furious taxpayer, can recognise that it needs to be funded. As for the simple solutions you advocate ( I`ve banged the drum for them to the point of exhustion ) , they`re actually quite cheap. When you start burbling on about educating people not to climb trees, my head explodes. Your risk arguments are invariably nonsensical. My all time hero is Robert Falcon Scott. You should read what he wrote about risk in his journal as he lay dying. We need more tree climbing.
Your post is “fantastic” because these type of overviews of how the mental health world has fragmented are invaluable. I`m guessing Beakie has done some research, shuffling paperwork, buzzword bingo and babble with minimal meaning keep him in a job. Your overview gives more objective observers greater confidence to challenge the wafflers.
Sorry beakie I’m not over it. I’m a little more tenacious than that.
I originally complained about how insular the various research components appear to be and that I would rather see it on the wards making an immediate difference.
The monies are a side issue to my original contempt which is the way the various sciences “claim” to bring the panacea of ill mental health issues.
I think that is pretentious shite.
However, since we have digressed, to answer your rejoinder in which you so patronisingly dismiss my concerns as “too bad, too sad” – mental illness is life – is that just unfair too – do you use this philosophy in your teachings?
Mental health services are shoddy. Every aspect of it falls below standard in a significant way:
Medications are still the primary intervention in psychiatry – despite the flawed research, slip shod diagnostics and the fact it leaves the individual with worse issues than when they started (which is only taken for 18 months after discharge).
Despite multi-factorial reasons for those who present to mental health services which include social and economic issues – it’s still left to health services to fix it up with a band aid.
People with personality disorder have no consistent forms of care or responsibility – a whole category of significantly and costly diagnostic group who aren’t even well understood – and for which no clear service model exists.
Public perception is still ‘lacking insight’.
Access to community support is clogged.
Drug addictions latest and greatest innovation is to drive for treatment in the prisons using DoH money. Nothing about developing decent treatment centres and the SHA stats show an average increase in numbers in treatment ranging from 30 – 50%.
And many acute wards are, for many reasons, staffed with disinterested, disenchanted and disempowered staff.
But meanwhile… back at the lab…
Chimp: Quoting the research component of neurosciences and MH was helpful – but not when you compare it against the total figure for all NHS services. Perhaps if you could find the figure for MH services that might be more comparable?
Closest I could get on a quick search of DoH was 3.2Bn on all hospital and community services – or – the coal face.
Consider most of that goes on stuff other than mental health. If we portioned a generous 1/4 of the funds for mental health – it’d be then 800M.
108M of 800M is around 8%
I could equally suggest we spend less on any other aspect of NHS other than direct patient care needs but I intended to highlight the general impotence of such scientific study in the neurosciences that eventuates to exceedingly little improvement in the day to day care of the MH patient.
I don’t decry the usefulness of knowing the anatomical or biological sequalae of brain injury, schizophrenia and the like. But at this stage of the game it seems about as useful as the 1969 lunar landing – for the cost of billions… and then what?
(Incidentally, in my enforced reading around the topics to muster an argument… the neurosciences study a lot of mice brain and explore the neurological function in mice with schizophrenia. How the hell do they know the mice have schizophrenia?)
So what do you actually suggest Mr Ian?
OSB – stop pulling my pigtails.
Perhaps if you could find the figure for MH services that might be more comparable?
MIND give a figure of £4.5bn for mental health services. So adding on the entire mental health research budget would increase the budget for mental health services by a little under 2.5%.
I could equally suggest we spend less on any other aspect of NHS other than direct patient care needs but I intended to highlight the general impotence of such scientific study in the neurosciences that eventuates to exceedingly little improvement in the day to day care of the MH patient.
Research does not directly and immediately impact patient care, film at 11.
What is it with the vitriolic sarcasm in this place?
Anyhow, moving on from the monkey boy with the calculator for a moment….
beakie – I suggest we actually get the direct care up to the right standard so patients can actually return to the economy and then we have more money for research.
(I’m surprised OSB isn’t into this more military style
‘Action when action is seen to be needed! Intel can wait til I’ve dealt with the enemy in my face’ debate)
Mr Ian – we can and do do both. I really am struggling to see what you are saying here.
Mr Ian, I suppose your reaction to effective enemy fire will be to stand and gawp.
Beakie, in the real world I have seen a practice development nurse change the nursing process. I have seen people develop their own nursing models. In the last two units I have worked in they no longer bother with nursing models at all. I have seen a DBT and a SFT ward established, they each lasted about 5 minutes. I know, without a shadow of a doubt that if I went to any of the neighbouring units around these parts all their documentation would be new to me. As soon as I finish this comment numerous other examples will slither from the recesses of my memory.
If you question any of this an evidence base is thrown in your face. And let`s not forget questioning research is akin to heresy these days. You`re quickly labelled a troublemaker, a Luddite and desperately in need of a read of the Trust`s Management of Change policy. You can see why career progression eludes me.
Research, it seems to me, is just pulling us in any number of directions at once. It generates confusion, it erodes confidence and nurtures defensive practice. It makes those who want to focus on bedside nursing and simpler solutions feel inadequate. It gives those with an adademic leaning the opportunity to write about it rather than do it.
That`s a shame as the mental health world desperately needs some well directed, honestly conducted investigation into problems we are struggling with. What we don`t need is amateurs wandering off to every point of the compass doing their own thing.
Mr Ian is right despite his reasoning being suspect.
I have no reason. I actually posted this around 3am on the morning in question and I think I knew then I was waffling.
Nevertheless, it’s generated into something half decent.
Thanks OSB for providing a little more clarity (and grasping my debate).
beakie – I don’t know how to make it clearer than that – other than things like “cart” “horse” before” and repeating – I see little point at this time in chasing after knowledge that is of such little isolated benefit – such as which parts of the brain flash off and on in certain events – when there remains so much other stuff wrong with the actual service delivery.
Remember I am currently placed in what may be described as the most disparate service I’ve ever known. So this will enhance my argument – to me. But nevertheless, and to repeat my original angst, I’ve been finding the neuroscience and pharmacological branches to be so exclusive in their debates on origins and treatments of MH.
It is patently clear and has been for a long time that the brain does some chemically thingies and that it has a physical construct to do this. It all works together to develop thought, conscious, memory – it turns experience into stored data – and drives our forward thoughts. It also produces abnormal or maladaptive behaviours.
My bug bear is so much research going into the brain to solve the ills of MI – and not enough going into resolving the practical experience that we also know is accountable for a large prportion of MH issues.
Organic brain disorder may require specific neuroscience intervention – but we can still provide ‘care’ – if given the resources and support to do so.
The budget (thanks chimp for that light reading btw) and some other DoH material I came across clearly identifies Britain’s beneficence to encourage research.. research and research.. as an economic generator. It seems the govt is encouraging the use of NHS funds to generate that interest base and bring in more money from interested others.
Good idea for the economy – but what of the current battles at the front line and something to make that better?
If we get that right then we can get more people back to better functioning.
Unless of course you’ve only ever seen a fully staffed service, with highly trained clinicians, providing a seamless service in and out of hospital, in a purpose built therapeutic environment, delivered in a patient centered way with complaint levels down that effectively treats everyone?
OSB – I don’t know where you get the idea that questioning research is taboo. Whoever gave you that impression is a fool. Of course, you should question research. Of course you should criticise it and pull it apart and dissect it for its reliability, its validity, its usefulness for your workplace. And frankly, I don’t see how you can have the “honest investigation” you call for without allowing people to go hither and yon and research what they are interested in. If you feel pulled in all directions by research, that is an argument for BETTER research training among mental health nurses to equip you with the tools to sort the wheat from the chaff.
Mr Ian – I don’t know how you think you could distinguish wha
Oops – pressed too soon!
Mr Ian – I don’t know how you could distinguish what research was going to be useful from what research wasn’t going to be useful from the outset. You claim that the neurobiological and pharmacological research isn’t important while wards are crumbling etc etc. That is a totally spurious argument. The one does not affect the other in any way shape or form. They are funded by totally different funding streams, so how you think abandoning one would benefit the other escapes me. So you don’t like the research being done? You think there are better areas that could be looked into? Well stop bloody whining on the internet and get on and do some of your own.
I didn’t originally say the neurobiological and pharmacological research isn’t important – but this was implied from my original post. I just went with it.
I was saying the pharma and neuro exclusivity of entitlement in mental health is bloody annoying. It’s not one thing or another – it’s multi factorial and I feel aggravated that neuroscience & pharmacological groups declare themselves as the only way to cure mental illness. That was my only and original purpose of the post.
The research & funding vs decaying wards and rotting corpses in the hallways is something of an unintended spin off and I’ve become side-tracked into trying to value-increase the purpose of paying more attention to hands-on work that we currently do; thus promoting that the way we deal with mental health issues currently is not, and probably won’t be, obsolete as an important area of cause and treatment.
Even when we find the right synaptic gap to plug with what chemical or surgical knife people will still be having experiences and think it’s crap that even after all the research into how services and treatments and wards etc etc can be so much better, that we don’t seem to have followed the research we already have.
Perhaps we should spur on the neurology – since psychiatry just doesn’t know or care to apply itself to it’s own service development needs.
Much research has been done – but it seems influenced the way govt wants it to go – they don’t encourage us to investigate the “why” in the disparity of high incidence mental health in prison because they will end up with a whole different issue to deal with such as poverty or poor education – they rather we just address the “how” we deal with it when it’s there.
I can understand that that research was like taking us up a dead end. Who’s going to solve poverty or poor education? The govt can’t.
What we’ve now got is a multi-billion $$ ‘solution’ with medications. Even the govt thinks it’s easier to throw a pill at it.
But I’m not surprised since they’re in bed with the pharma to get more research carried out over here to generate economic income – that we then spend on their tablets.
I need a Nurofen (R)
(Chimp – want to find out how much we spend in prescription medicine in mental health?)
Neuroscientists and pharmacologists research neuroscience and pharmacology shocker!
If you want to research some area of social need, what’s stopping you Mr Ian?
Direct patient care needs.
No room in the ivory tower for me.
I didn’t say *I* wanted to do it. I would like to see it done tho.
Was going to leave it there… but…. I did say I was tenacious (or annoyingly pedantic)…
There’s been social research done.
It’s not applied. Cos the driving force isn’t there.
Latest I heard about applying research on the wards was “protected therapeutic time” – and what is it?
Time especially put aside to talk to patients.
It gets better – it entailed assuring one nurse was allowed a 45 minute no paperwork, no telephone opportunity to spend exclusively with their patient…. once a week.
(Chimp – want to find out how much we spend in prescription medicine in mental health?)
Sure. The document you’re looking for is the NHS Prescription Cost Analysis 2007.
The cost of all the psychiatric medications (not counting medications for organic brain disease and things like mood-stabilisers that are primarily used as anti-convulsants) is around £640m. Most of this (about 85%) is split fairly evenly between anti-psychotics and anti-depressants, with the remainder spent on uppers and downers (hypnotics, anxiolytics and stimulants).
The single biggest expense is Venlafaxine (Efexor) which accounts for more than 18% of the total cost. It’s closely followed by Olanzapine (Zyprexa), but add in Quetiapine (Seroquel) and Risperidone (Risperdal),so the three big antipsychotics are getting on for a third of the budget. The SSRI’s as a class account for about 15%.
I didn’t say *I* wanted to do it. I would like to see it done tho
Yes, by that ubiquitous person Someone Else. So basically, this IS little more than a whine.
Latest I heard about applying research on the wards was “protected therapeutic time” – and what is it?
Time especially put aside to talk to patients.
And? Surely this is exactly the kind of “coal-face” development you should welcome with open arms?
It gets better – it entailed assuring one nurse was allowed a 45 minute no paperwork, no telephone opportunity to spend exclusively with their patient…. once a week.
And on your average acute ward, that’s a big deal. And of course, “from little acorns” etc.
Beakie, there is little point in you vehemently protesting that you don`t live in an ivory tower and then giving us graphic illustrations of the extent to which you are divorced from “coalface” reality.
Moving on, if we`re spending £115,200,000 a year on venlafaxine then Mr Ian`s argument is starting to look even more compelling than it originally did.
ok… so I looked for the research – According to Uncle Louis Appleby – I AM wrong!
http://www.dh.gov.uk/en/Public...../DH_074241
Mental health wards had become neglected places, physically and therapeutically impoverished. Now there are modern wards in many parts of the country, providing single rooms, bright surroundings and outdoor space, and a programme of work is in place to replace or refurbish all remaining unsuitable wards. Between 2001 and 2005, £1.6 billion capital was spent by mental health trusts on improvements. In addition, specific sums have been allocated, such as £130 million in 2006-7 to improve psychiatric intensive care units and the safety of female patients.
..and we ARE doing something about the other stuff…
In the first few years of reform, much of the progress was in specialist mental health services. However, the focus has now shifted towards the mental health of the community as a whole. The emphasis of policy is on breaking down traditional boundaries – between professional groups, between primary and secondary care, between the NHS and the independent sector, between health services and other agencies such as education and employment.
..and it HAS NOT gone unnoticed…
No-one would dispute that problems remain in mental health care, often reflecting the previous neglect of the service. But recently Dr Matt Muijen, WHO head of mental health in Europe, said publicly that England has the best mental health services in Europe and that this is acknowledged in other countries. Interestingly, he also said we had a “culture of criticism” that prevented it from being acknowledged here.
And what’s more … this was all back in April 2007.
So why have you been kidding on and not telling me it was all fixed? You little trickers you…..
Beakie, there is little point in you vehemently protesting that you don`t live in an ivory tower and then giving us graphic illustrations of the extent to which you are divorced from “coalface” reality.
And what would those be OSB? A defence of the usefulness of research? I suspect you might find, were you ever to open your eyes for a moment, that not everyone on the “coalface” is a dinosaur like you.
Or was it a defence of “protected therapeutic time” that so rankled with you? Again, most of the crappest, most office-bound nurses I’ve ever met have been old-skool bin nurses who resist anything that wasn’t in their nurse training back in 1974.
Or perhaps it was the defence of people doing all sorts of research that you didn’t like? Well, frankly, that’s just daft. Unless you want to actively prevent nurses and other healthcare professionals from researching things you personally don’t approve of, what are you going to do?
I don’t live in an ivory tower. No nurse lecturer does. We are all too aware of how crap things are at the coalface – the appalling mentorship our students receive suggests as much.
Beakie, I was nine years of age for the majority of 1974. I wasn`t the first person to identify the theory – practice divide. I didn`t coin the phrase. I`m not even confirming its existence – it needs no confirmation. Any type of suggestion that protected therapeutic time needs to be proven to be a good idea and that only research ( as opposed to the bleedin` fuckin` obvious ) can legitimately identify it as such is a capitulation to Mr Ian`s original argument. If I have any more queries about issues that are as plain as the hand in front of my face I will hail you by semaphore.
Take the brick out of your handbag!
See, this mentality kind of supports my argument – the relationship between theory and practice has never been resolved, and I don’t think it’s that difficult. More liaison between uni and ward; a bit of quid pro quo – uni lecturers would gain a lot more ground if they were able to engage with the qualified staff aswell in development and research. How about a post beakie on the academic perspective of the theory practice gap?
Personally I’m a die hard mentor/preceptor and unfortunately I find the theory they teach here is of little to no use in mental health (its generic training only here and mental health excperience amounts to a whole two weeks in 3rd year).
I wonder how many fresh flowers you can get for £115,200,000 a year?
OSB – whatever. This is a tedious argument, especially given your incredibly boring and boorish habit of caricaturing me in the way you do.
Beakie, I will concede that it`s tedious. However, I am genuinely bewilderded how anyone could possibly consider whether or not protected therapeutic time is worthwhile, to be a question worthy of research. The question is, in fact, irrelevant. The important issue is how on God`s earth did we ever end up in a position where the question was able to arise.
Of course it’s worthy of research. What’s bizarre to me is that you should think it isn’t. There are a number of questions that arise. What do patients think of it? Do they welcome it? What is their experience of it? What effect does it have on length of stay, if any?
What do staff DO with that time? Is it thought worthwhile by patients? Is it valued by staff themselves? Do they feel properly equipped to provide therapeutic time? Do they know what to do with it, for instance? What is the effect on staff? Is morale better in a ward with protected time? Does it happen consistently? What are the barriers to its implementation?
And so on. Of course, you will probably dismiss this all as if it were just blue-skies nonsense, or that they could be answered by “common sense”. Whatever, no wonder the nursing profession is where it is if we cringe about examining our own practices.
I don’t think it’s the examining of practice we cringe at – it’s the processes involved, the excitement (usually) of one or two off-ward examiners and a real sense of time-wasting in regards cost-benefit.
The nurse research issue is something that may evolve in time and more may actually get into the art (shit) ,, science of doing some. But some that makes sense and can be compared. Hopefully the MH research network will pervade all levels of staff – but especially the hands on workers – so it isn’t just another isolated body of people doing their own thing.
As for tediuous – I hypothesise there’s a directly proportional reciprocal increase in the vitriol and personal insult according to the level of tedium?
Let’s put it to bed then and you two go wash your hands and get ready for supper.
What processes do you cringe at? Whose time is being wasted? How can nursing research evolve if nurses whine about it being a waste of time? What makes you think current nursing research doesn’t make sense? Have you read any recently?
I know of no other profession that views research in the same way as nurses do. Doctors, physios, OTs, radiographers – all welcome research into their discipline and celebrate it.
I agree with you on how nursing seems to view research differently.
I think what lets nurses and research down so badly is the need to actually do something – and how it can change what we actually do. Nursing is one of the few profession that undertakes ‘doing’ in a practical sense of their job and in a substantial way – more research means more doing – or doing it different. And we know how well nurses take to change. Sometimes research has led to a lot of change for a little benefit. I also think that change is extremely badly managed by NHS managers.
To be honest; I have not read a lot of nursing research lately – not useful stuff anyhow. Bad methodology usually lets it down or lack of versatility or even usefulness to other areas. The areas I work in doesn’t throw up a lot of useful research and the most research I see is perfunctory – not designed for its optimum usefulness but to further the needs of the individual practitioner who has to turn in a research paper.
I’ve focused more on psychology lately as that seems to lend itself to more useful generalised theories – particularly Beaumister and ego-depletion (at which Ted scoffs).
I’ve tried to implement an “ego-rejuvenation” study that re-establishes patient’s ability to self-regulate and ergo avoid violence, manage symptoms and optimise positivity – simply by giving simple pleasures like happy vibes, good food and a pat on the back for when patients show signs of decompensating or escalating in order to give them an emotional boost. (Any nursing research you have on that would be appreciated).
Thing is I’m not well versed in actually doing research so lack confidence in all areas of methodology. Despite seeking support – I have not found enough as yet as it requires a certain amount of change for the medical/nursing staff to not jump on the PRN.
[...] was previous discussion (originally discussing the waste of the ology and iatry in mental health) which developed into suggesting we should be focusing more on the actual wards rather than [...]