News and Media, December 2009

Child welfare and immigration control

Clinical psychologists have called on the UK government to reverse its policy of detaining children whose families are seeking the legal right to remain in the country. Dr Kimberly Ehntholt, who works at the Traumatic Stress Clinic, part of Camden and Islington Foundation Trust, raised the issue after research she conducted with colleagues identified alarmingly high rates of mental and physical ill health among children and their carers detained at Yarls Wood Immigration Removal Centre in Bedfordshire (Child Abuse and Neglect: http://bit.ly/SJYpA).

In the first study of its kind in the UK, Ehntholt assessed the mental health of 11 detained children aged three to eleven years and found high rates of depression, anxiety, sleep problems, somatic complaints, emotional symptoms and behavioural difficulties. Assessments by paediatricians also identified numerous physical health issues including follow-up medical appointments that had been missed since detention. The findings echo similar observations about detained children's mental health made recently in Australia, although participants in the current study were different in that they had been living in the community some time prior to detention.

The study had no control group for comparison, but Ehntholt explained to The Psychologist why she and her colleagues believe the detention experience was responsible for the children's problems: 'It might be argued that we were assessing a very vulnerable group of children who were highly likely to be experiencing mental health difficulties regardless of whether they were in detention,' she said. 'However, when we compared this detained group's scores on a standardised measure, 73 per cent met criteria for psychiatric "caseness" compared to 27 per cent in a sample of 101 asylum-seeking children who were living within the community [assessed by a previous study].'

Moreover, Ehntholt added that she only reported symptoms of psychological distress that had started or increased since the children were detained. 'Also, none of these children had been seen by CAMHS [child and adolescent mental health services] or counselling services whilst living in the community as they were doing well in their day-to-day lives,' she said.

Another potential limitation of the findings is that the participating families were recruited by a charity offering free legal assistance to help challenge detention, thus raising the possibility that the participants may have feigned symptoms to increases their chances of release. However, the study authors, led by Ann Lorek of the Mary Sheridan Centre for Child Health, said this was unlikely, especially since they had directly observed many symptoms in the assessment sessions.

Ehntholt told us: 'We can only say that our findings suggest or indicate that detention was the cause. But as these findings are in line with those in Australia we believe it is important that the UK government works with us to conduct a proper well-designed and larger-scale study comparing the health of children in detention with a community sample.'

She added: 'The detained children's mental health is likely to have been negatively affected by a combination of factors including a recent deterioration in their parent's mental health; increased fear after being suddenly placed in a detention facility, which children often believe is a prison; anxiety over returning to their country of origin, where they may have previously experienced traumatic events; as well as the abrupt loss of home, school and friends.'

Professor Peter Kinderman chairs the British Psychological Society's Standing Committee for Psychologists in Health and Social Care. He said: 'Comprehensive, independent research into the physical and psychological health of children and adults detained under immigration procedures should urgently be commissioned. On the basis of this evidence, the UK government must urgently review their policy of detaining children in immigration removal centres.'

A pilot scheme that avoids the need for detention was launched in Glasgow in June this year by the UK Border Agency, Glasgow City Council and the Scottish Government. The 'Family Return Project', as it's known, provides families who have been refused asylum with intensive support to make sense of their stay in the UK, and to help prepare for voluntary return to their country of origin. The Glasgow pilot builds on a similar alternative to detention project that took place in Millbank, Kent from 2007 to 2008, and other such schemes implemented overseas, including Australia.

'These schemes are much more cost-effective,' Ehntholt told us, 'are in line with international obligations set out within the UN Convention on the Rights of the Child, and in my opinion are more humane. There must be ways of working with families while they remain living in the community to prepare them to return to their country of origin and to ensure that they have had reputable legal representation so that correct decisions have been made under immigration law and all rights to appeal have been exhausted before attempts are made to deport them from the UK.'
 

Recession boosts placement courses

University psychology departments are experiencing a surge in demand for their four-year placement courses, The Psychologist has learned.

Applications to Cardiff University's 'Psychology with Professional Placement' course, for example, have more than tripled from 100 last year to 350 this year. Aston University in Birmingham told us that they are experiencing a similar phenomenon, with more than 95 per cent of this year's cohort opting to go on placement. It's possible the economic downturn has made students more conscious of the need to develop hands-on skills and experience before competing in the job market 'Students are very aware of the need for soft skills in the current world of work and the placement year gives them just that,' says Dr Carl Senior at Aston University.

Students on Cardiff's placement course work in a range of forensic, clinical, educational and business settings, from the Centre for Vision Research, York University, Toronto, to HMP Holloway, to Meadowbank special school. At Aston, students are also placed with partners all over the world from Harvard University to the Maudsley Hospital. Other institutions that offer psychology placement courses include the Universities of Bath, Kent and Middlesex, with the latter having also confirmed a rise in placement demand to The Psychologist. The University of Surrey, where all students go on a placement year, have experienced a 100 per cent increase in applications since 2006.

Lecturer Dr Rob Hughes at Cardiff University says students gain a great deal from their placement experiences: 'They are introduced to the practical application of psychological skills and may also gain communication and team-working skills, data gathering, time management and organisational skills, have the opportunity to develop their initiative, independence and capacity to take on responsibilities.'

One consequence of the rising demand for placement courses is that psychology departments are seeking more placement partner organisations. And according to Hughes, potential partners can benefit a great deal from getting involved: 'Organisations that volunteer will have someone join their team who is typically very motivated and hungry to put the two years' worth of grounding they will have already received in psychological knowledge and skills into practice. Indeed, feedback from placement organisations about students' performance has been almost universally very positive.'

Updated guidelines on depression

The National Institute of Health and Clinical Excellence (NICE) has issued updated guidance on managing and treating depression in adults. The guidance was prepared by the National Collaborating Centre for Mental Health, of which the British Psychological Society is a partner member with the Royal College of Psychiatrists.

A key change from the 2004 guidelines is the use of the American Psychiatric Association's DSM-IV diagnostic criteria rather than the World Health Organization's ICD-10, thus allowing greater attention to persistent sub-threshold depression (fewer than five symptoms) – a category not recognised by ICD-10. Another change is an emphasis on recognising the particular vulnerability to depression of people with chronic physical illnesses. Research shows that such people are at two to three times greater risk of depression, and the new guidance recommends that health professionals are especially alert to this increased risk.

Cognitive behaviour therapy (CBT) receives a strong endorsement from the updated guidance. In particular, it is recommended that people with persistent subclinical depression or with mild or moderate depression are offered CBT-based self-help or computerised CBT, or group physical activity programmes, in favour of drug treatment. Following a stepped-care approach, if these low-intensity interventions are ineffective, clients should be offered a drug-treatment or a high-intensity psychological intervention; for example, either CBT or interpersonal therapy (IPT). For clients who decline these treatments, the guidance endorses counselling or short-term psychodynamic psychotherapy, but notes that uncertainty about the effectiveness of these approaches should be discussed.

For people with more severe depression, the guidance recommends a combination of drug treatment with a high-intensity psychological treatment, such as CBT or IPT. St John's wort is specifically not endorsed by the new guidance because of concerns about variations in potency between different preparations and potential interactions with other drugs such as oral contraceptives.

Professor Steve Pilling, Director of the National Collaborating Centre for Mental Health and the Centre for Outcomes Research and Effectiveness, University College London, said: 'Depression is a complex disorder which for many people can become chronic with serious long-term consequences for their mental and physical health. This is clearly acknowledged in the guideline, which recommends an increased range of effective treatment options.'

The release of the new guidelines coincided with news that antidepressant prescribing nearly doubled in the UK between 1993 and 2005. Although new cases of depression showed an overall slight reduction during this period, there were small increases in patients with chronic or recurrent depression who were being prescribed drugs long term. Michael Moore at the University of Southampton and his colleagues made their finding after analysing anonymous data collected through GPs' surgeries. They said their results begged the question: 'Does this represent appropriate prescribing according to current guidance or does it arise from a failure to discontinue antidepressants in those with milder illness, or both?'
 

Declaring for mental health research
The Mental Health Foundation and King's College London's Institute of Psychiatry are leading the campaign to treble mental health spending within five years (see www.researchmentalhealth.org.uk). The call is made in a 'Declaration' issued to the government, the NHS, funding bodies, research institutions, the pharmaceuticals industry and the third sector, and also in an Early Day Motion supported by all parties.

Andrew McCulloch, chief executive of the Mental Health Foundation, said: 'Our understanding of mental illness is moving  at a snail's pace. Whilst treatments have improved, we have not yet seen the breakthroughs needed to significantly reduce the massive economic and social damage caused by mental illness.'

Til Wykes, Professor of Clinical Psychology at the Institute of Psychiatry, said 'Research into the causes, prevention and treatment of mental ill health currently is about 5 per cent of the UK research spend whereas the disability associated with mental health problems is 15 per cent. Investment is also cost-effective as the Academy of Medical Sciences recently showed that every £1 invested in mental health research has a return of 37p each year so after three years
it will pay for itself.'

Experts and advocates in mental and physical health are also collaborating on a European policy initiative – the Mental and Physical Health Platform – to improve the understanding of the interaction between body and mind in disease. The chairman of the initiative, John Bowis, said: 'It is time to bridge the gap between mental and physical health by taking actions across policy areas and countries.'

 

Baby Einstein a NO-NO
A North American pressure-group with several psychologists among its members has claimed a significant victory in its long-running campaign to stop the Walt Disney-owned Baby Einstein company from making educational claims about its products.
Baby Einstein produces DVDs for infants and toddlers and announced in October that anyone who purchased a DVD between 5 June 2004 and 4 September 2009 was entitled to  a refund. The company's offer comes after a long-running crusade by the Campaign for a Commercial Free Childhood (CCFC), which started three years ago with a complaint filed with the Federal Trade Commission. 'There is no credible evidence that any screen media is educational for children under two,' said CCFC's director, psychologist Susan Linn.

 

Cardiff University: A psych odyssey

This one-day conference, organised by six trainee educational psychologists at Cardiff University, offered fellow trainees across the UK the opportunity to consider 'the future directions of educational psychology'. It included two keynote speakers; Professor Tommy MacKay and Professor Brahm Norwich, and a choice of seven afternoon workshops.

The conference was opened by Professor Dylan Jones (Head of the School of Psychology) who welcomed the delegates and, using the tag-line from the Stanley Kubrick film that had been used to create the conference title, he urged them to create a day which would be 'an epic drama of adventure and exploration'.

The drama began with a keynote presentation from Professor MacKay (research consultant to the West Dunbartonshire Literacy Initiative) which was both inspiring and affirming. His central theme emulated the conference premise and the notion of exploring new horizons. He challenged the trainees to take the lead in developing the role of the educational psychologist (EP), commenting that 'the present experience of an educational psychologist is what past psychologists have made it'. He encouraged delegates to value their expertise and to cherish their contribution to a profession that is central to all human affairs (as they support people to learn, behave, develop and relate). Professor MacKay continued by highlighting that the psychological well-being of young people (the 'heartland' of the EP) is both an important social and political issue (and one which is at the centre of the government agenda). Professor MacKay discussed some 'new horizons' (such as the West Dunbartonshire literacy project and post-school interventions) and demonstrated the substantial influence that an EP can have through the development of highly effective services.

Professor Norwich (University of Exeter) took up a similar theme, exploring whether educational and child psychologists do have a privileged position in applying psychology. Professor Norwich challenged trainees to consider the dilemma of whether to adopt a systemic or an individual perspective and questioned how we can create a distinctive professional identity. Through offering a 'positive vision tempered by realism' Professor Norwich suggested that the way forward is to transform the existing educational and child psychologist role into a new role of child and youth psychologist, which can offer 'new and useful' psychology.

In the afternoon, trainees had the opportunity to select from a diverse selection of workshops. A human givens approach workshop, presented by Lisa Hales (Family and Education Support Team, Milton Keynes), outlined how this individual, group and system intervention has had a positive impact upon the emotional health and well-being of service users with whom it has been applied. Dilanthi Weerasinghe (Waltham Forest Educational Psychology Service) presented a workshop on practical ways of ensuring that children and young people have their say in service reviews, and how this approach has affected the way that Waltham Forest EPS works. Bill Hardy and Mary Morris from The Family Institute subtly demonstrated the useful devices employed in family therapy, including: connecting with everyone in the room, curiosity, finding the key question, making no assumptions and possibly most powerful of all, generating a jazz metaphor for 'syncopating' with a family or group. Dr Lynn Moore (Independent Child Psychology Service) led a thought-provoking workshop on discourse analysis and the variety of positions individuals can adopt in a therapeutic context. In his workshop, Laurence Hime (Lambeth EPS) discussed the educational implications of working in an inner-city area and the importance of ensuring that all young people have an equally rewarding experience in school. Interestingly, the statistics reveal that Lambeth appears to be bucking the trend of underachievement for some ethnic minorities, and the workshop group discussed some of the strategies that appear to be contributing to this result, such as creating an inclusive, positive ethos in schools (which celebrates their culture-rich communities), changing reward systems in schools and working alongside parents. Dr Michael Hymans (Head of Educational Psychology, Brent EPS) presented methods to take a class through the stages of group development (orientation, establishing norms, coping with conflict, productivity and endings) for the purpose of teaching children and young people respect and empathy. He also noted the potential for psychological services to more frequently apply knowledge of group dynamics to their own services. And finally, Deborah Page (Senior Educational Psychologist, Derbyshire EPS) provided a fascinating workshop outlining the advantages of functional assessment in writing multi-element plans for children with very challenging behaviour. Deborah Page shared the practical strategies and tools which she has developed and successfully applied to reduce exclusions and improve the outcomes for children in care.

The conference was a resounding success which provided a useful opportunity for networking, the chance to reflect upon the profession's future development and the ability to acquire knowledge which can be applied to practice.

Emily Jackson, Megan Greenway, Dermot Bergin, Ian Smillie,
Rob Smith and Juliet Whitehead

 

When parents part

October saw the publication of a major review of the research on relationship breakdown and the consequences for parenting, parent–child relationships and child well-being. The review, When Couples Part: Understanding the Consequences for Adults and Children, was authored by Dr Lester Coleman and Society member Fiona Glenn for One Plus One, a team of researchers, practitioners and information specialists whose aim is to enhance understanding of how family relationships contribute to the well-being of adults and children.

It finds unequivocal evidence highlighting the detrimental impact of adult relationship conflict and distress on children. The research also indicates that it is not necessarily whether parents are in conflict but how this conflict occurs and is managed. Good parenting – warm and authoritative – can protect children from the effects of relationship breakdown. Unfortunately, when the parents' relationship is in trouble, their parenting is likely to be impaired.

Writing in the foreword of the report, Professor Sir Michael Rutter said: 'Many people hold strong views about marriage and divorce based on religious belief or ideology but One Plus One sought instead to approach the topic of the effects of couple relationship breakdown on the basis of a dispassionate, thoughtful, critical assessment of the evidence.'

- The executive summary is available to download from www.oneplusone.org.uk

Immersive VR for dummies

Somehow Jonny Wilkinson and other master tacklers of the rugby world are able to see right through the feints and dummies of an attacking opponent. Psychologists at Queen's University in Belfast and the M2S lab at the University of Rennes are using immersive virtual reality (VR) to investigate for the first time the perceptual and deceptive processes involved in these kinds of one-on-one rugby situations (www.qub.ac.uk/virtualreality).

Dr Cathy Craig and Seb Brault have collaborated with Ulster Rugby to investigate what elite players do differently from novices. 'What we're finding', Craig told The Psychologist, 'is that the experts are not so fooled by exaggerated actions, such as head and shoulder movements, that occur in the opposite direction to which the attacker will eventually run.'

The use of immersive VR allows the researchers to carefully control the exact events and stimuli in a player's field of view and to record where they look and how they respond. For example, does the defending player attend to the exaggerated body movement of the attacker's head and shoulders or do they focus on the attacker's centre of mass? (see video at http://bit.ly/6P57D).

The results are being fed back to the coaches at Ulster Rugby. 'This research may provide a novel means of helping coaching staff identify player weaknesses and, with a better understanding of what lies behind decision making, create virtual training scenarios that may improve decision making in a real match setting,' Craig said. 

Final demand for debt first aid

The Royal College of Psychiatrists, in association with the charity Rethink, has published what it believes is the 'first review of the available evidence on the relationship between debt and mental health'. Whilst a causal link has not yet been established, the review identified longitudinal data showing that indebtedness is often followed by mental health problems, and cross-sectional evidence showing that the more debts a person has, the more likely they are to also have a mental disorder (see www.rcpsych.ac.uk/debt).

Lead author Dr Chris Fitch, a research fellow at the Royal College of Psychiatrists, and his colleagues made several recommendations on the basis of their findings, including that health and social care professionals should ask 'patients about financial difficulties in routine assessments', that such professionals should receive basic 'debt first aid' training, and that where debt is reported, primary care professionals should routinely assess for depression and other common mental disorders. 'Whilst it is important that new research is commissioned and undertaken to improve the evidence base, this is not a reason to delay action and intervention,' the authors concluded.

Funded by the Money Advice Trust and the Finance & Leasing Association, the review involved an extensive literature search for the terms 'mental health' and 'debt' across 14 databases covering the medical, business, legal and social science/policy fields between 1980 and 2008. Fifty-four relevant and available papers were identified.

The findings come after the Royal College of Psychiatrists disseminated a special booklet earlier this year called Final Demand, Debt and Mental Health to thousands of mental health professionals (see insert with this month's Psychologist or online).

 

Reviewing primary education

Three psychologists are among the authors of the final report of the most comprehensive independent review of primary education for a generation, the Cambridge Primary Review. Society members Linda Hargreaves and Ruth Kershner, together with Julia Flutter, all members of the Faculty of Education at the University of Cambridge, contributed to the 640-page report, which draws heavily on psychological research findings.

'There are clear theoretical underpinnings in most of the different chapters, such as those referring to pupil voice, children's lives beyond the school, children's development and learning, diversity and inclusion, dialogic teaching, etc.,' Dr Hargreaves and her colleagues told us. 'Some of the areas in which psychological views have particular influence relate to what we have said about the importance of young children's classroom talk and collaboration, the application for teaching and learning of up-to-date knowledge on neuroscience, and the value of "pupil voice" –  engaging children in thinking about learning and consulting them in making educational decisions about their learning.'

The report makes 75 recommendations for policy and practice, but perhaps unsurprisingly the headlines that followed its publication tended to focus on issues relating to the school starting age and the formal testing of children's attainment. Although media coverage implied that the report had recommended delaying the school start age, it in fact calls on the government's Early Years Foundation Stage (from birth to five years) to be extended, thus delaying formal teaching, whilst merely recommending that a debate is needed on the school starting age. Similarly, several media accounts implied that the report had called for formal testing to be scrapped, whereas the reality is that the report recommended broadening assessment to reflect the full curriculum, not solely literacy and numeracy.

The government issued a swift response to the report's publication. 'It's disappointing that a review which purports to be so comprehensive is simply not up to speed on many major changes in primaries,' said the schools minister Vernon Coaker. 'The report is at best woolly and unclear on how schools should be accountable to the public.'

The review's Director, Professor Robin Alexander, told The Psychologist 'The review's findings on early years and starting age were widely misreported, and politicians followed the media account rather than checking the report text.' Dr Hargreaves and her colleagues said they were surprised by the speed of some of the initial reactions to the report, especially given the depth of material contained in its two volumes. 'Inevitably, perhaps, a few issues received most attention and were covered inaccurately in the press,' they said. 'However, there continues to be a great deal of interest in the full set of review evidence and recommendations, and we would hope and expect that this will engage and inform politicians of all parties as educational policy is developed with reference to local community interests and professional expertise.'

Conferences to allow professional leaders in schools, local authorities, teacher training and research to discuss the report are being held through to February 2010. See www.primaryreview.org.uk for the report and information.

 

Half-retirement… more health

Many of us spend our adult lives dreaming of the day we can finally bin the suit, don the slippers and relax in the sweet liberty of retirement. Unfortunately, that fantasy may be in need of some revision. Rather than packing up entirely, a new study by psychologists in the United States suggests that when retirement age comes, it's better for our mental and physical health to only half retire – taking on temporary, self-employed, or part-time duties in what they call 'bridge employment' (Journal of Occupational Health Psychology: http://bit.ly/2fkXu9).

Yujie Zhan at the University of Maryland and her colleagues used data collected from over 12,000 participants between the years 1992 and 1998. They found that people who transferred to bridge employment of any kind enjoyed better physical health than people who retired completely, even after taking baseline health into account. Moreover, those people who specifically took up bridge employment in the same field as their main career also enjoyed superior mental health to that of full retirees and those who stayed in full employment.

Zhan's team said the physical health benefits of bridge employment could come from sustained levels of physical activity. Meanwhile, the mental health benefits of bridge employment in the same field as one's career could come from not having to endure sudden role transition, whilst also enjoying freedom from full working responsibility. The lack of a benefit to mental health of working in bridge employment outside of one's career field may reflect the fact that many such people had been compelled to work for financial reasons rather than out of choice.

'From a practical perspective,' the researchers wrote, 'the current findings showed us a way to maintain the health status of older people. For retirees and prospective retirees, the current study suggests that carefully considering whether to engage in bridge employment and if so, what types of bridge employment, is quite important.'

STAR billing

At a moonlit ceremony on the Danube, during this year's Stress and Anxiety Research Society (STAR) conference in Budapest, Professor Michael Eysenck was awarded the Society's Lifetime Achievement Award. The award is given every year to honour a member of the STAR society who has a long and distinguished history of scientific contributions in the field of stress, coping, emotions or health.

Michael Eysenck is currently Director of Research for the Department of Psychology at Royal Holloway. As well as developing the theory of the 'hedonic treadmill', Professor Eysenck's research has, over the years, focused mainly on the cognitive factors associated with anxiety; attempting to integrate theories of trait anxiety in normal and clinical populations. Specifically he is interested in the cognitive factors of memory and attentional functions, as well as personality and mood, while considering modular approaches to trait anxiety.

 

RESEARCH FUNDING NEWS
The National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre under a Health Technology Assessment programme is seeking research proposals on various topics including:
09/109 Efficacy of diversion and aftercare programmes for offenders using class A drugs
09/117 Intervention programmes for children of parents who have a severe mental illness
The closing date for applications is 8 January 2010.
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