News, May 2006

Mental Health Bill withdrawn - contention continues

 IN March the Department of Health (DoH) announced that the government would not be proceeding with the draft Mental Health Bill published in 2004. Instead a shorter piece of legislation, amending the 1983 Mental Health Act, will be introduced in the autumn to deal with what it regards as the more important reforms; these include some of the most contentious proposals.
Mental health charities and the Mental Health Alliance (MHA), of which the BPS is a member, have been campaigning for the last eight years to get the best possible outcome for proposed reforms of mental health legislation. But many are now concerned that the decision to jettison the draft bill in favour of more streamlined legislation will keep much of the bad and lose most of the good.
There is not going to be any further official consultation, but at a DoH briefing on 3 April it was said that channels of communication with the DoH would be open. It is not clear what opportunities this leaves interested parties to influence outcomes. Paul Farmer, chair of the MHA, reiterated: 'The Mental Health Act is one of the few pieces of legislation that can deprive people of their freedom without their having committed a crime. It must be amended with care and with the full involvement of all those who will have to live with it in the coming years.'
The decision to abandon the bill in its current form seems to have been made because ministers felt that its 450 clauses made it too long and unwieldy for enough parliamentary time to be found to enact the legislation.
The new bill will retain the provision for the removal of the 'treatability test', to be replaced by a wider concept of 'appropriate treatment'. This is perhaps the most controversial aspect of the planned reforms. Critics say that this unnecessarily risks increasing the compulsory powers of practitioners to force treatment on people who would derive no benefit from it.
Supervised community treatment (the new term for what the original bill called 'community treatment orders') will be introduced, and, according to Professor Louis Appleby, the DoH's National Director for Mental Health in England, it will now be restricted to those who have already been detained as inpatients under the Mental Health Act. However, Dr Tony Zigmund, Honorary Vice-President of the Royal College of Psychiatrists, said that this could still cover patients whose assessments were carried out years ago.
The right to independent advocacy that would have been guaranteed to patients in the draft bill looks likely to go. It is unclear what, if any, legislative measures will replace the advocacy provisions. This risks 'leaving people alone to negotiate the maze of mental health services and the law', as Cliff Prior of Rethink put it. However, Professor Appleby told the recent AGM of the Division of Clinical Psychology that the Mental Health Act would be brought into line with modern human rights practice.
Plans to give young people aged 16 and 17 the right to refuse treatment are also likely to go, though ministers say that similar protections will be offered by amending the Children Act 1989. Critics have said that it is not clear when such amendments would be legislated for. But we understand through the BPS parliamentary officer that consultations on this are taking place at the moment – with the DfES and others – and that the timetable is scheduled to run in parallel with the Mental Health Act amendments.
More welcome to mental health campaigners is that it appears that any new mental health legislation will retain the draft bill's provision that people will not be detained solely because of drug and alcohol problems or just because they have a learning disability.
Commenting on these developments, BPS President Ray Miller said: 'The BPS has been strongly supportive of the need for change in the 1983 legislation but was concerned at some aspects of the proposed new bill. While welcoming the government's recognition of the problems, we must work to ensure that the process of consultation, review and improvement continues.'    PDH

Cardiff imaging centre opens

ANOTHER state-of-the-art brain-imaging centre for use by psychologists has opened, this time in Cardiff. Financed largely by the Department of Trade and Industry, the £10 million Cardiff University Brain Repair and Imaging Centre (CUBRIC) boasts a 3-T fMRI scanner and MEG (magnetoencephalography) scanner under the same roof.
The new director of CUBRIC, chartered psychologist Professor Peter Halligan, told us that the new centre was unusual in that it is housed in the department of psychology, whereas most facilities of this kind are based in medical institutions. 'Another distinctive aspect is the focus on cognitive and social cognitive neuroscience research, including developmental work regarding normal learning and educational neuroscience,' he said. 'We have also installed the largest computer cluster in Europe dedicated to neuroimaging,' he added. 'This will allow us to decrease the significant lengthy period of data analysis  – several hours to minutes – and if used on a single subject, may be used to approximate to real-time analysis.'    CJ

Phonics crucial

THE government's Independent Review of the Teaching of Reading led by Jim Rose, former Ofsted Director of Inspection, was published in March. The report stresses that good teaching, attention to speaking and listening skills and the systematic learning of phonics are all crucial to raising standards. The importance of early intervention to prevent children from falling behind is also brought out.
Specific recommendations made in the report include:
l    High-quality systematic phonic work should be taught discretely and within a broad curriculum, and for most children this should start by the age of five.
l    Phonic work should be given appropriate priority in teaching beginners, with ambitious targets set for the end of Key Stage 2.
l    Phonics should be a central part of both in-service and initial training of teachers.

Education Secretary Ruth Kelly welcomed the report, calling it 'a clear roadmap for reading'. She has accepted all of the recommendations and has announced that the government would be revising the National Curriculum to require phonics to be the prime approach used in teraching children to read. She has already launched a rigorous programme of training for teachers through the Primary National Strategy and has instigated changes to initial teacher training led by the Training and Development Agency for Schools.    PDH
o The report is available online at www.teachernet.gov.uk/publications.

Giving birth to anxiety

IF you're planning on being there while your partner gives birth, make sure you put on a brave face – psychologists have found that when a birth partner reports feeling more fearful during a caesarean birth, the mother tends to experience more post-operative pain.
Dr Ed Keogh at the University of Bath and colleagues asked 65 women how much fear and/or pain they were experiencing before, during and after giving birth by caesarean. Birth partners were asked how fearful they were feeling before and during the caesarean. Both maternal fear and birth partners' fear during the operation were associated with maternal post-operative pain. But when entered into a statistical analysis together, only birth partners' fear remained linked with maternal post-operative pain. 'This suggests that birth partner's fear is a mechanism by which mother's fear is related to her post-operative pain experiences,' the researchers concluded in their report on the work that appears in Psychosomatic Medicine.
'One clue to why we found this association comes from a question we asked that wasn't reported in the published study,' Keogh told us. 'When we asked mothers what their main concerns were during the birth, they listed the baby first, their birth partner second, and placed themselves third. There's clearly an interesting interaction between the emotional responses of the mother and birth partner and their experience of the birth.' The finding also tallies with research showing how anxiety can delay post-operative recovery.
'Now we need to find out how to reduce the birth partner's anxiety.' Keogh said. 'We're certainly not suggesting that dads be banned from the birth – there's plenty of evidence that birth partners also play a very positive role.'     CJ

Shortage of addiction psychologists in Northern Ireland

THERE are no psychological addiction services for young people in Northern Ireland, according to findings from the Review of Mental Health and Learning Disability (N. Ireland). 'We have some excellent counselling services, but no specialist doctors, nursing staff or psychologists, and no facility to admit young people for treatment,' Dr Diana Patterson, a consultant psychiatrist in addiction at Shaftsbury Square Hospital, Belfast, and a co-author of the report, told the BBC.
Dr Gerry Cunningham, a chartered psychologist and head of psychology at Foyle Health and Social Services Trust, said he was aware of only one half-time dedicated addiction psychology post in the whole of Northern Ireland. 'It's one of those areas that's always being talked about but nothing's ever done,' he told us. 'It's a disgrace…it's an area that's long been neglected in Northern Ireland. We have a real need for a lobby to put the issue on the map so that it is discussed.'
Mr Jack Houlihan is working on the government's new drugs and alcohol strategy for Northern Ireland. He told us that historically, psychology as a profession in Northern Ireland hadn't specialised in addiction. 'On the statutory side we have nurses, social workers and psychiatrists,' he said, 'and in the voluntary sector we have social workers and counselling services. What's missing is psychotherapy.'     CJ

Close encounters of the meaningful kind

Christian Jarrett reports from the fifth joint BPS/British Academy Lecture, held in March in London.

THE evening headline 'GUNMEN STORM BRITISH CENTRE' on every newsagent's billboard – a reference to the day's disturbances in Gaza and Ramallah – lent an urgency to Professor Miles Hewstone's promised talk on 'the role of intergroup contact in social integration' at the British Academy.
'They don't want to hear my optimistic message,' Hewstone began, as he lamented psychology's absence from media debates on racism in Britain. 'Cross-group friendship is the single most powerful tool for improving relations.'
In more than 20 years of research into the 'contact hypothesis', with surveys conducted in Bradford, Northern Ireland and India, Hewstone has found that if a person has the opportunity for contact with members of another social group, they are more likely to have positive attitudes towards that group. An unpublished longitudinal study has confirmed the association is not merely due to people with more positive attitudes being more likely to make contact, rather contact really does improve attitudes, although Hewstone said more longitudinal research was desperately needed.
But how does contact lead to improved attitudes? Intergroup contact helps reduce anxiety, it alleviates the 'discomfort of strangers', Hewstone explained. Also, when someone has a friend from another group, they share intimacies – what psychologists call 'self-disclosure' – and so learn to identify with each other as real people experiencing the same ups and downs of life. Consider Jesminder and Juliette's teenage friendship in the 2002 hit film Bend It Like Beckham.
Further analysis has shown it's vital that the friend or friends from the other group are identified as belonging to, and being representative of, that group in order for contact with them to have a positive influence. Promisingly, it's also been shown that just having a friend who has a friend from another social group – so-called 'extended contact' – can help improve a person's attitudes. Moreover, positive attitudes derived from actual contact have been shown to be stronger than attitudes that aren't based on any first-hand experience. And a Northern Ireland study found contact still had a positive influence even among a subgroup of participants who had experienced high levels of sectarian violence.
In other work that's taken his research from 'neighbourhoods to neurones', Hewstone measured the surface electrical activity of white people's brains while they looked at black and white faces. The more intergroup contact a participant had had, the less difference there was in their brain activity when they looked at black versus white faces.
So far, so good. But what about Yugoslavia, where ethnic cleansing occurred among members of ethnic groups who had lived and worked together side-by-side? Hewstone remains convinced of the benefits of intergroup contact, in spite of such atrocities. The Serbs were often under great pressure from their leaders to go along with the killing, he said, with their own families' lives under threat if they disobeyed. Commentators had written of an 'invisible psychological wall' between the communities, such that the situation was more a case of 'desegregation' rather than 'integration'. Yugoslavia reinforces the notion that 'contact has to be meaningful', Professor Hewstone concluded   
o In the online Prospect magazine, read the (free access) 'Close encounters' article on this topic by David Lammy, minister for culture and MP for Tottenham (tinyurl.com/zehr8).

Lottery winners

MENTAL health organisations are among 20 charities that received research awards totalling nearly £5 million in March from the Big Lottery Fund. The awards bring to over £51 million the amount of lottery funding that has gone into research since 1998.
Sir Clive Booth, Chair of the Big Lottery Fund said: 'Our research grants show the wide range of ways in which lottery funding can help all groups of society. Research into mental health to help find better methods of treatment and support is crucial to those who are most vulnerable.'
Mind, the National Association for Mental Health, has been awarded £374,655 for a project to compare different types of care for people with long-term depression, provided through GPs' surgeries. Researchers will measure the effectiveness of an additional structured care approach, involving regular follow-up by practice nurses, compared with the usual GP care.
Health in Mind will use its £174,465 award to document the experiences of male survivors of childhood sexual abuse and the impact on their mental health and personal relationships. The NHS has identified the improvement of mental health and well-being of male survivors of childhood sexual abuse as a priority area.
Also awarded funding is the Museums Association who will use £54,875 for a 'Museums of the Mind' project to examine how museums can contribute to mental health and emotional well-being in the UK.
The Cornelia de Lange Syndrome Foundation, UK has been awarded £306,247 to study behaviour disorders in children with three rare disorders, Cornelia de Lange, Angelman and cri du chat syndromes. This project, the first of its kind, will evaluate the extent to which the behaviour disorders seen in these children are learned or associated with genetic factors and will develop strategies to help families and carers cope with some very challenging behaviours. Three research groups will work on this project, all led by BPS members, at the University of Birmingham (Professor Chris Oliver), the University of Wales Bangor (Professor Richard Hastings) and St George's Hospital Medical School (Professor Pat Howlin).
The Big Lottery Fund distributes half of all National Lottery good-cause funding in the UK. These latest awards were made under the Fund's Research Grants Programme, the aim of which was to fund high-quality medical and social research in health and social well-being. The scheme is now closed as the Fund is opening a new research programme in June this year that will distribute up to £25 million over the next three years. The aim of the new programme will be to influence local and national policy and practice by funding the production and sharing of evidence-based knowledge.    PDH
o For up-to-date information on the Big Lottery Fund's new programmes, go to www.biglotteryfund.org.uk.

Movement therapy for unexplained chronic pain

PATIENTS who have suffered medically unexplained symptoms such as back pain, headaches or irritable bowel for more than two years are being offered a novel type of therapy, a kind of 'counselling in movement', by researchers at the University of Hertfordshire.
'All the patients who have been referred to us have been through secondary care. They've had X-rays and so on, but no explanation has been found for their debilitating symptoms. Our approach fosters a change in belief system – so that instead of focusing on the idea that something must be wrong with them, we encourage people to embrace their symptom, to see it as a message from their body, an expression of some repressed emotions or feelings within,' said Dr Helen Payne, a reader in counselling and psychotherapy, who is heading the research.
'Earlier interviews with the patients revealed many of their symptoms began at around the same time as some kind of trauma, such as the loss of child,' she said. 'We teach patients expressive exercises 0so that they can become more mindful…we don't tell them exactly how to move, rather we encourage them to let go, so that the movement just emerges without being willed, but is simply noticed.'
The therapy is the first of its kind to be available within the NHS. Following success with an initial group earlier in the year, Payne's team were set to begin a second group in April and planned to use a combined qualitative and quantitative methodology to assess patients' experience of the therapy. 'This course is ideal for what we call the "revolving door patient" for whom no treatment seems to work and has been told it's all in the mind. It is not all in the mind; it is manifesting in the body,' Dr Payne said.     CJ

Can too much TV cause ADHD?

AN American study published in the journal Paediatrics in 2004 suggested it might. Professor Dimitri Christakis, director of the Child Health Institute at the University of Washington, and colleagues studied data on 1200 seven-year-old children, and found they were 10 per cent more likely to have attentional problems for every hour of television they watched daily between the ages of one and three. 'Limiting young children's exposure to television as a medium during formative years of brain development, consistent with the American Academy of Paediatrics' recommendations, may reduce children's subsequent risk of developing ADHD,' the study concluded.
But this March, a new study entitled 'There is no meaningful relationship between television exposure and symptoms of ADHD' was published in the same journal, prompting news headlines such as 'TV ruled out as cause of ADHD symptoms'(The Guardian) and 'Don't blame TV for ADHD' (Yahoo). Among 5000 children, the study found those who watched more TV when they were five years old were no more likely to have attentional problems when they were six, and concluded: '…the results of the present study do not indicate the presence of an important relationship between television exposure and subsequent attention problems, which is in contrast to the recent results of Christakis et al.'
Unlike the 2004 study, the new research used a continuous measure of attentional problems and a structural equation modelling technique to gauge the causal association between TV viewing and later attentional problems. 'I have a one-year-old so I had a personal interest in this topic,' lead researcher Dr Tara Stevens told us. 'Even if we'd used a cut-off measure of attentional problems as the 2004 study did, I still don't think we would have found an association between TV and ADHD,' said Stevens, an educational psychologist at Texas Tech University.
Pointing to the importance of genetic factors, the new study concludes: 'It may be that exhausted parents of very active and inattentive children resort to using the television as a "babysitter" more commonly than do parents of less active and more attentive children. Thus the relationship between early television viewing and later attention problems may be linked to child temperament as much as or more than television causing children to be inattentive.'
Responding to the new study's findings and the associated media coverage, Professor Christakis (author of the 2004 study) told The Psychologist: 'This is a fundamentally different study. It doesn't even attempt to replicate our findings. We said that television viewing may have a detrimental effect during the critical window of brain development that occurs before the age of three. But whereas we looked at TV viewing before the age of two years, the new study looked at TV viewing at age five. More research is certainly needed, and we're endeavouring to complete a longitudinal, experimental study of the effects of an intervention to reduce how much TV children watch, but in the meantime parents should still limit how much TV children watch during their first two years, in line with American Academy and APA guidelines.'    CJ

In pursuit of happiness

LABOUR peer Lord Richard Layard, professor emeritus at the London School of Economics, has renewed his call for psychologists to receive more funding to help redress the chronic shortage of therapists in the UK. Speaking at the event 'Tomorrow's People: The Challenges of Technologies for Life Extension and Enhancement' at the James Martin Institute for Science and Civilisation, Lord Layard described the current situation, in which many GPs are unable to follow NICE guidelines by referring depressed patients for CBT, as a 'ground-breaking, extraordinary event'. He said:'Never before have we had [NICE] guidelines that simply aren't applied at all in any way because it's quite impossible for GPs to refer people to CBT.' (See also 'Pressing for more psychological therapists' on p.266.)
The 'Happier?' symposium, at which Lord Layard spoke, sought to answer 'What makes us happier and can it be bottled?' Lord Layard said: 'Large-scale surveys have shown family is most important to us for our happiness, then friends, then work, and yet we're sacrificing our most important sources of satisfaction for economics… Mental illness is the major unaddressed problem in our society.'
Earlier, Baroness Susan Greenfield, director of the Royal Institution, had drawn a distinction between four different types of happiness: 'technoism', which she described as the 'blow your mind' type happiness of ravers and drug takers; 'fundamentalism', in which 'the collective narrative of cults and religions brings collective fulfilment at the expense of personal individuality'; 'consumerism', the 'unfulfilling pursuit of individuality'; and finally 'the Eureka moment', that 'Aha! feeling when you suddenly have an insight and see something differently from how everyone else sees it'. Greenfield said she thought tomorrow's technologies should be used to cultivate the Eureka moment for a happier society.
Dr Nick Baylis of Cambridge University, the only psychologist speaking at the symposium, said we were 'horribly wrong in deifying happiness and demonising painful feelings of shame, guilt and loss'. Instead, our priority should be to progress and improve 'in our relationship with life, with ourselves, with the world and other people, and in controlling our body with our mind'. Baylis dismissed the notion that beyond a modest level money cannot bring further satisfaction. 'Money works fabulously well if well-earned and well-invested,' he said. But he warned that we're currently misusing technology to consume happiness faster, leaving us exhausted and diluting our relationships. 'Let's use technology to become net producers, not net consumers,' he said. 'Let's do something about it. Take deep breaths, put down the remote, put down the vodka, enjoy being in reality sober, and start trying to partner up with other people.'
Meanwhile Professor David Nutt of Bristol University condemned the media's use of the term 'happy pills' to describe antidepressants. 'They alleviate suffering, they don't make you happy,' he said. 'Actually a side-effect of the drugs is that they're emotionally blunting.'
Nutt said that pharmacological companies weren't investing in the search for true 'happy pills' to enhance the mood of healthy people because they wouldn't be able to sell or market them. 'They would be recreational, and would therefore be banned like other illegal recreational drugs,' he said. 'That's why, although we could have created an alcohol-like drug that was much safer, we haven't done
so because it could never be legally sold.' 
- All the symposia at the event, including a discussion of what the future holds for human fairness and intelligence, can be watched via webcast at the James Martin Institute website www.martininstitute.ox.ac.uk/jmi/forum2006.

Babylab opens in Manchester

MANCHESTER University has set up a new BabyLab to investigate how infants learn. 'We particularly want to address the huge debate in psychology about looking-time data,' lead researcher Dr Sylvain Sirois told The Psychologist. 'Many studies make inferences about babies' understanding by measuring how long they look at something, but on that basis many studies are attributing levels of understanding to babies that would suggest they're more intelligent than toddlers,' he said.
By studying babies at the critical age of between five and six months, when the control of their behaviour shifts to the cortex, the new BabyLab hopes to focus on why babies look at things and how they look at them, to find out how they learn about the world. 'Many psychologists have suggested that infant learning is all about the activation of internal knowledge – whether it's the concept of number, object permanence, theory of mind – triggered by outside events,' Sirois told us. 'Unfortunately the alternative isn't sexy…the fact is babies don't know much…just looking longer at something doesn't mean they understand it.'