English councils handing huge extra care bills to disabled and mentally ill adults

Charities draw up list of charges they describe as ‘care tax’ resulting from national underfunding

By Robert Booth

Adults with a disability or mental illness are receiving extra care bills running into thousands of pounds that they say could force them to cut back on food and heating and threaten their social independence.

Amid a care funding crisis, some English councils are quietly increasing charges to people with learning disabilities and mental illness, in effect clawing back welfare payments and leaving some working-age adults with little more than £3 a day to spend.

People facing the charges fear they will be unable to afford enough clothes and worry that basic pleasures like swimming trips will have to stop. One single man living with bipolar disorder said he may have to put down his dog because he will be unable to afford to look after it.

Care charities have drawn up dossiers of charges they describe as a new “care tax” and say it is a result of national underfunding of social care. The Health Foundation has estimated that at least an additional £6bn a year is needed to meet growing demand, rising to £14bn if the country wants to improve access to care and pay more to staff, many of whom earn minimum wage.

Mencap, the learning disability charity, said it had received dozens of “concerning” calls to its helpline about the issue, and its chief executive, Edel Harris, said it was “causing huge distress for them and their families, ​and leaving many without enough money to cover their additional needs”.

Some people are refusing to pay and are considering legal challenges. Care Act guidance says charges must be “reasonably practicable” for people to pay and that the approach to charging should promote “independence, choice and control”.

One of the councils levying increased charges, West Sussex county council, said that while it had previously charged working-age care recipients less than Whitehall rules allowed, increases were now necessary because of “decreased funding from central government”.

Care recipients in the county have seen weekly charges rise sharply, in one case from £5.59 to £83 a week, and in another from £40 to £151 a month. Matthew Welch, 22, who has cerebral palsy, has seen his care contribution more than double to £77, leaving him with just £23 a week from his welfare benefit, a move his mother, Sarah Welch, described as “appalling”.

Sue Livett, the managing director of the Aldingbourne Trust, a charity in West Sussex that provides care for people with learning disabilities and autism, said at least 50 families had complained about increased charges.

A council spokesperson said: “Our charging arrangements follow national guidance and are based on an individual assessment of a person’s financial circumstances. We have asked people to contact us if they will find it difficult to pay so we can work with them on an individual basis.”

A parent in Staffordshire said their family had been hit with a backdated bill exceeding £20,000 for their adult children with learning disabilities.

“It’s disgraceful,” they said, requesting anonymity. “They have no opportunity to go out and earn money on their own. They rely completely on benefits.”

Also in Staffordshire, a young adult with complex learning difficulties who needs round-the-clock care was sent a bill demanding he pay £88 a week towards the costs, equivalent to £4,500 a year. It has to be taken from his universal credit payments and leaves him with just £25 a week for other expenses.

His mother, a hairdresser unable to work during the pandemic, said she was “absolutely furious” and it meant they would not be able to afford enough clothes for her son, which is a particular issue owing to his incontinence, plus it could prevent him from going to the cinema or the swimming pool with his carers.

“It’s a huge effect on his quality of life,” she said. “He won’t have any variety in his day. We are not acknowledging that people are individuals and have needs in their lives.”

Dr Richard Harling, the director of health and care at Staffordshire county council, said the amount people were asked to contribute was “based on what they can afford to pay while still being left with income to meet their living costs”.

He added: “If a person feels they are contributing too much, they can contact us to appeal their financial assessment.”

Social Care Futures, a coalition of care givers and receivers, has received more than 150 reports of rising charges. “Escalating charges must be capped and there must urgently be a significant investment in social care, our lives and freedom,” said Anna Severwright, the coalition’s convener.

The Department of Health and Social Care has been contacted for comment.

David Jones, 60, lives alone in West Sussex with bipolar disorder, which 10 years ago rendered him unable to work.

The former newspaper subeditor relies on two hours of support a week to help him keep his flat in order but is facing an increase in his contribution for this from £40 to £151 a month. The money would have to come from his personal independence payment (Pip) and would take up a third of that budget. He said that would leave him choosing between “heating and eating” and it would affect his budget so much that he will have to consider putting down his 14-year-old dog, Megan, which he said would be “beyond awful”.

Pip is supposed to help people with illness, disabilities and mental health conditions maintain norms of everyday life. He said clawing this money back was “just ridiculous”.

“I simply can’t afford it,” Jones said. “This extortionate demand represents 20% of my monthly income from benefits. It has to be outright unfair and a national scandal that the Department for Work and Pensions awards us Pip with one hand, and the county council takes up to a third of it away with the other.

“I would have to cut my food budget drastically and might end up having to go to a food bank,” he said. “I have a dog and if I was going to try and budget for the amount of money [I have left] the dog would have to go.”

He said Megan had been a “lifeline to sanity” during the pandemic and had been “incredibly helpful for my mental health”.

“This [demand] has caused me incredible distress and anxiety,” he said. “There are people in an even more vulnerable position than me suffering with mental health illnesses, autism and learning disabilities and it must be extremely difficult for them to cope with this. It’s really heartless and cruel. I don’t think it’s going to raise an awful lot for the county council but it’s a vast amount for us.”

The council has said central government cuts precipitated the increased charges and it has asked “people to contact us if they will find it difficult to pay”.

https://www.theguardian.com/society/2021/apr/08/english-councils-huge-extra-care-bills-disabled-mentally-ill-adults

Coronavirus: Return of benefit sanctions in middle of pandemic ‘is barbaric’

By John Pring

Disabled campaigners have described the government’s decision to reintroduce benefit sanctions – in the middle of a pandemic – as “barbaric” and “life threatening”.

The decision meant an end to the three-month suspension of benefit sanctions and conditionality* in England, Scotland and Wales, which had been introduced in March as part of the COVID-19 lockdown measures.

Jobcentres will start re-opening this week in England, but not in Scotland and Wales, where claimants will only receive services online and by phone.

This means that some claimants in England will now begin to have face-to-face discussions with work coaches in jobcentres.

But there has been little information on exactly how these steps will work and how they will affect disabled and other claimants.

Work and pensions secretary Therese Coffey said restoring conditionality and the threat of benefit sanctions was “an essential part of the contract to help people start to reconsider what vacancies there are”.

But it came as the government continued to ease the lockdown that has been in place across England since March, while also imposing a local lockdown in Leicester after a spike of infections.

Millions of disabled people – many of them on out-of-work benefits and now potentially subject to the threat of sanctions – are still shielding from the virus.

Yesterday, work and pensions ministers also removed a crucial line from guidance for claimants of universal credit (UC) that previously assured them: “You will not get a sanction if you cannot keep to your Claimant Commitment because of coronavirus (COVID-19).”

This suggests that UC claimants will no longer be able to use the fact that they are shielding, or have COVID-19 symptoms, as a reason for breaching their claimant commitment (the agreement that sets out what they have to do to continue to receive UC).

DWP refused to comment on the removal of this line, or even to confirm that sanctions would now apply again to all claimants previously at risk of having one imposed, including those in the work-related activity group of employment and support allowance (and the equivalent universal credit group).

Instead, the department attempted to persuade journalists, including Disability News Service (DNS), that the move to restore sanctions was “compassionate” and “understanding”, that sanctions would not be imposed “for no good reason”, and that the re-imposition was “rooted in a new normal” and their use would be “more compassionate” and “reasonable” than pre-pandemic.

The decision to re-impose sanctions and conditionality from 1 July after a three-month pause was greeted with anger and disbelief by disabled activists.

Disabled People Against Cuts (DPAC) held an online action yesterday to protest at the re-imposition.

DPAC said in a statement: “Claimants have been left both anxious and uncertain.

“There is now overwhelming evidence of both the serious harm that the sanctions regime inflicts on the most disadvantaged members of society and the fact that sanctions are punitive and counter-productive to the aim of getting people off benefits and into work.”

It also appealed to disabled people and allies to join the new Scrap Universal Credit Alliance.

Pam Duncan-Glancy, a disabled Labour parliamentary candidate at the last general election, said the decision to reintroduce sanctions was “barbaric”.

She said on Twitter: “The standard to which I hold the Gov in this regard is low. Even by that standard, this is off the scale.

“Brutal at the best of times, but in these times this policy on sanctions is a death sentence.”

Kerena Marchant, a Deaf campaigner who stood for Labour at the last general election, said in a video that restarting sanctions would place Deaf and disabled people “in an impossible situation”.

She said: “They will have to choose between the life-threatening risk of the hostile environment of the DWP and that of the pandemic. They both are life-threatening.

“We’ve already had DWP suicides and deaths and this could lead to more.”

Paula Peters, a member of DPAC’s national steering group, described in a video some of the personal testimonies of disabled people who have had universal credit sanctions imposed on them.

One woman, who was unsuccessful in four job interviews, was sanctioned because DWP said she was not happy enough, even though she had depression and anxiety.

Another woman was told by the jobcentre not to mention that she was disabled because such a term was “political”.

This woman was also accused of lying about her seizures, until she had a seizure in the jobcentre.

She was still sanctioned for three months and had to rely on friends and family for food, said Peters.

Another disabled activist, Andy Mitchell, said in a video to support the action: “We are still in the middle of a pandemic, we still have people shielding, we still have people self-isolating, we still have families home-schooling their children because they cannot go to school.

“We know that hundreds of thousands of people are about to lose their jobs, we know that the homeless are about to be released from hotels because the contracts have ended and the money has run out. And we have this situation in Leicester.

“We are still in the middle of a pandemic, yet DWP have dug in their heels and refused to extend the ban. This is wrong.”

Debbie Abrahams, Labour’s former shadow work and pensions secretary, also spoke in support of DPAC’s campaign, saying: “We know sanctions don’t work. In fact they can make things worse, dehumanising people and creating mental health problems.”

Ian Blackford, the SNP leader at Westminster, told Boris Johnson at prime minister’s questions yesterday that the decision was “heartless”, “cruel” and “unnecessary”.

Johnson asked Blackford “to think that he may be mistaken”.

Disability Rights UK said this week that the decision to reintroduce conditionality and sanctions was “appalling” and “must be reversed”.

Ken Butler, DR UK’s welfare rights and policy adviser, said: “Conditionality and sanctions actively harmed disabled people before both were lifted in March.

“To reintroduce them with no discussion, in the environment of an economic recession, with millions more universal credit claimants and amid a viral pandemic, shows a scant regard for the welfare and safety of disabled people.”

He also pointed out that the PCS union had warned that reopening jobcentres so soon “could create a perfect storm as staff and customers are faced with lack of social distancing, inadequate personal protective equipment and the real risk of COVID-19 being brought into workplaces”.

Coffey told MPs this week: “It is important that as the jobcentres fully reopen this week, we reinstate the need for a claimant commitment.

“It is an essential part of the contract to help people start to reconsider what vacancies there are, but I know that I can trust the work coaches and jobcentre managers, who are empowered to act proactively with people.”

A DWP spokesperson added: “We’ve been there for those who have lost jobs or have reduced hours in this pandemic, promptly processing new claims and getting money into the accounts of those in urgent need within days.

“Now our focus is rightly switching to getting Britain back into work.

“From July, people can make an appointment with their work coach if they can’t get the help they want online or over the phone and work coaches will be calling all claimants to help them get ready for the world of work.”

*Under conditionality, the rules claimants have to meet in order to avoid losing some or all of their out-of-work benefits through sanctions can include pledging to carry out a certain number of hours looking for and applying for jobs, networking, updating a CV, or attending training

Coronavirus: Return of benefit sanctions in middle of pandemic ‘is barbaric’

Blue badge parking permits to cover ‘hidden disabilities’ in England

Blue badge parking permits are to be made available for people in England with “hidden disabilities” such as autism or mental health problems.

The Department for Transport said people with non-physical disabilities would have an equal right to free parking from next year.

Currently the rules do not explicitly exclude hidden disabilities, but councils’ interpretations can vary.

Similar changes have come into effect in Scotland and Wales.

When the changes to the blue badge scheme in England are introduced, they will extend eligibility to:

people who cannot make a journey without “a risk of serious harm to their health and safety” or that of others, such as young children with autism
people for whom travel causes “very considerable psychological distress”
and those with considerable difficulty walking, meaning “both the physical act and experience of walking”
About 2.4m disabled people in England currently have a blue badge.

The scheme, first introduced in 1970, allow holders to park for free in pay-and-display spaces and for up to three hours on yellow lines.

The badges cost £10 and in London they also provide an exemption from the congestion charge.

Thousands share invisible disabilities
Transport Minister Jesse Norman said: “Blue badges are a lifeline for disabled people, giving them the freedom and confidence to get to work and visit friends independently.”

The change follows a consultation launched in January which saw 6,000 responses.

Three in four disabled people say they would go out less often without the parking permit, the DfT said.

‘Overwhelming anxiety’
Jane Harris, director of external affairs at the National Autistic Society, said the change would “make a massive difference to the lives of many of the 600,000 autistic people in England, and their families”.

Many autistic people experience major challenges in travelling, making detailed preparations and suffering “overwhelming anxiety” about things going wrong, she said.

She said that some can be unaware of the dangers of the road while others can feel panic in busy or loud environments.

Scotland and Wales have already changed their eligibility criteria for the Blue badge scheme to include some mental impairments, where people cannot follow the route of a journey without assistance, but the rules are yet to be altered in Northern Ireland.

https://www.bbc.co.uk/news/uk-44993036

Blue Badge (disabled parking) scheme eligibility review

Summary

Proposals to extend Blue Badge eligibility to people with non-physical conditions.

This consultation closes at
11:45pm on 18 March 2018

Consultation description
We are proposing changing the eligibility criteria for the Blue Badge scheme to include people with non-physical conditions.

This is part of the government’s objective is to ensure that those people with the greatest need have access to badges, whilst ensuring the scheme remains sustainable.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/675301/blue-badge-scheme-consultation-on-eligibility.pdf

https://www.smartsurvey.co.uk/s/R2OF6/

or

Complete a response form and either

Email to:
bluebadge.consultation@dft.gsi.gov.uk

Write to:
Vida Browne-Campbell
Department for Transport
Traffic and Technology Division
3/27 Great Minster House
33 Horseferry Road
London SW1P 4DR

https://www.gov.uk/government/consultations/blue-badge-disabled-parking-scheme-eligibility-review

Tories ‘shifting the goal posts’ on disability benefit entitlements, say Labour

Government has rewritten the law to deny higher benefit payments for more than 150,000 disabled people.

Callous Tory ministers have been accused of “shifting the goal posts” on disability benefit entitlements, after it was revealed that the UK Government has rewritten the law to deny higher payments for more than 150,000 disabled people.

Two social security tribunal cases resulted in the government being told to ensure more disabled qualify for Personal Independence Payments (PIP), which would better recognise how their condition affects their ability to live as independently as possible.

PIP consists of two separate components – a daily living component and a mobility element – each paying a standard or enhanced rate, with the enhanced rate paying more than the lower rate.

Claimants are awarded points in each component, depending on how their disability or long-term illness affects them on a daily basis, through an assessment system campaigners have likened to a “tick-box exercise”.

A minimum of eight points are required to qualify for the standard rate of each component, while claimants need to secure at least 12 points for the enhanced rate.

The first tribunal said those who experience “overwhelming physical distress” when outdoors alone, a common and debilitating symptom of severe psychological disorders that can leave sufferers trapped in their homes, should be awarded more points for the PIP mobility component.

An estimated 143,000 sick and disabled people would have benefitted from the ruling, with around half of these qualifying for the enhanced higher rate of £57.45 per week.

The other half would have qualified for the standard rate, currently £21.80 a week. A further 21,000 would have been moved from the standard to the enhanced rate.

A second tribunal said more points should be awarded in the daily living component for those who need help taking medication and monitoring their condition. More than 1,000 people would have benefitted from this decision, if the DWP had accepted it.

The DWP argued that adhering to the tribunal’s recommendations would cost the department an extra £3.7bn by 2022, the Daily Mirror reports.

So rather than accepting the Tribunal’s recommendations, and recognising how those affected incur extra costs as a direct consequence of their illness or disability, the DWP has instead decided to rewrite the law – yes, you read that correctly – thus denying tens of thousands of sick and disabled people the additional financial support they desperately need.

Labour’s Shadow Work and Pensions Secretary, Debbie Abrahams MP, blasted the decision: “Instead of listening to the court’s criticisms of PIP assessments and correcting these injustices, this government have instead decided to undermine the legal basis of the rulings”, she said.

Abrahams added: “This is an unprecedented attempt to subvert an independent tribunal judgement by a right-wing government with contempt for judicial process.

“By shifting the goal posts, the Tory Government will strip entitlements from over 160,000 disabled people, money which the courts believe is rightfully theirs. This is a step too far, even for this Tory government.”

http://www.welfareweekly.com/tories-shifting-the-goal-posts-on-disability-benefit-entitlements-say-labour/

Ken Loach: Tory government ‘callous, brutal and disgraceful’ and ‘must be removed’

Accepting the award for best British film at the Bafta awards in London, the veteran director says politicians speak for corporations – and film-makers must stand with the poor and vulnerable.

Ken Loach has launched an uncompromising attack on the UK government at the 70th British Academy Film Awards.

Speaking as he picked up his award for outstanding British film for I, Daniel Blake, which is conceived as a critique of the current state of the benefits system, Loach touched on accusations by some that his film failed to reflect reality.

Loach thanked his cast and crew, the people of Newcastle and the academy for “endorsing the truth of what this film says, which is that hundreds of thousands of people – the vulnerable and the poorest people – are treated by the this government with a callousness and brutality that is disgraceful.”

Loach continued by making reference to the Tory government’s apparent U-turnon its promise to accept thousands of unaccompanied children fleeing danger in Syria and elsewhere.

“It’s a brutality,” he said, “that extends to keeping out refugee children we promised to help.”

“In the real world,” added Loach, “it’s getting darker. And in the struggle that’s coming between the rich and the powerful, the corporations and the politicians that speak for them, and the rest of us on the other side, the film-makers know which side they’re on.”

Speaking at the press conference afterwards, Loach went further, saying that the government “have to be removed”. He hoped that voters would see his film, but there was little point politicians doing so as “the people actually implementing these decisions know what they’re doing. It’s conscious.”

Their welfare policies, he said, harked back to the Victorian workhouse ethos of telling people that poverty was their fault. “They know they’re doing. We have to change them; they have to be removed.”

https://www.theguardian.com/film/2017/feb/12/ken-loach-governments-treatment-of-refugee-children-callous-brutal-and-disgraceful

I, Daniel Blake review – a battle cry for the dispossessed

Ken Loach crafts a Cathy Come Home for the 21st century, the raw anger of which resonates long after you leave the cinema.

Mark Kermode

Ken Loach’s latest Palme d’Or winner, his second after 2006’s The Wind that Shakes the Barley, packs a hefty punch, both personal and political. On one level, it is a polemical indictment of a faceless benefits bureaucracy that strips claimants of their humanity by reducing them to mere numbers – neoliberal 1984 meets uncaring, capitalist Catch-22. On another, it is a celebration of the decency and kinship of (extra)ordinary people who look out for each other when the state abandons its duty of care.

For all its raw anger at the impersonal mistreatment of a single mother and an ailing widower in depressed but resilient Newcastle, Paul Laverty’s brilliantly insightful script finds much that is moving (and often surprisingly funny) in the unbreakable social bonds of so-called “broken Britain”. Blessed with exceptional lead performances from Dave Johns and Hayley Squires, Loach crafts a gut-wrenching tragicomic drama (about “a monumental farce”) that blends the timeless humanity of the Dardenne brothers’ finest works with the contemporary urgency of Loach’s own 1966 masterpiece Cathy Come Home.

We open with the sound of 59-year-old Geordie joiner Daniel Blake (standup comic Johns) answering automaton-like questions from a “healthcare professional”. Having suffered a heart attack at work, Daniel has been instructed by doctors to rest. Yet since he is able to walk 50 metres and “raise either arm as if to put something in your top pocket”, he is deemed ineligible for employment and support allowance, scoring a meaningless 12 points rather than the requisite 15. Instead, he must apply for jobseeker’s allowance and perform the Sisyphean tasks of attending CV workshops and pounding the pavements in search of nonexistent jobs that he can’t take anyway.

Meanwhile, Squires’s mother-of-two Katie is similarly being given the runaround, rehoused hundreds of miles from her friends and family in London after spending two years in a hostel. “I’ll make this a home if it’s the last thing I do,” she tells Daniel, who takes her under his wing, fixing up her flat and impressed by her resolve to go “back to the books” with the Open University. Both are doing all they can to make the best of a bleak situation, retaining their hope and dignity in the face of insurmountable odds. Yet both are falling through the cracks of a cruel system that pushes those caught up in its cogs to breaking point.

“We’re digital by default” is the mantra of this impersonal new world, to which carpenter Daniel pointedly replies, “Yeah? Well I’m pencil by default.” Scenes of Blake struggling with a computer cursor (“fucking apt name for it!”) raise a wry chuckle, but there’s real outrage at the way this obligatory online form-filling has effectively written people like him out of existence. Yet still Daniel supports – and is supported by – those around him; from Kema Sikazwe’s street-smart China, a neighbour who is forging entrepreneurial links online (the internet may alienate Daniel, but it also unites young workers of the world), to Katie’s kids, Daisy and Dylan – the latter coaxed from habitual isolation (“no one listens to him so why should he listen to them?”) by the hands-on magic of woodwork. Having lost a wife who loved hearing Sailing By, the theme for Radio 4’s Shipping Forecast, and whose mind was “like the ocean”, Daniel carves beautiful fish mobiles that turn the kids’ rooms into an aquatic playground. Meanwhile, their mother is gradually going under.

A scene in a food bank in which the starving Katie, on the verge of collapse, finds herself grasping a meagre tin of beans is one of the most profoundly moving film sequences I have ever seen. Shot at a respectful distance by cinematographer Robbie Ryan, the scene displays both an exquisite empathy for Katie’s trembling plight and a pure rage that anyone should be reduced to such humiliation. Having seen I, Daniel Blake twice, I have both times been left a shivering wreck by this sequence, awash with tears, aghast with anger, overwhelmed by the sheer force of its all-but-silent scream.

“They’ll fuck you around,” China tells Daniel, “make it as miserable as possible – that’s the plan.” For Loach and Laverty, this is the dark heart of their drama, the use of what Loach calls the “intentional inefficiency of bureaucracy as a political weapon”, a way of intimidating people in a manner that is anything but accidental. “When you lose your self-respect you’re done for,” says Daniel, whose act of graffitied defiance becomes an “I’m Spartacus!” battle cry that resonates far beyond the confines of the movie theatre. Expect to see it spray-painted on the walls of a jobcentre near you soon.

https://www.theguardian.com/film/2016/oct/23/i-daniel-blake-ken-loach-review-mark-kermode

Mindfulness for mental wellbeing

It can be easy to rush through life without stopping to notice much. Paying more attention to the present moment – to your own thoughts and feelings, and to the world around you – can improve your mental wellbeing.

Some people call this awareness ‘mindfulness’, and you can take steps to develop it in your own life.

Good mental wellbeing means feeling good about life and yourself, and being able to get on with life in the way you want.

You may think about wellbeing in terms of what you have: your income, home or car, or your job. But evidence shows that what we do and the way we think have the biggest impact on wellbeing.

Becoming more aware of the present moment means noticing the sights, smells, sounds and tastes that you experience, as well as the thoughts and feelings that occur from one moment to the next.

Mindfulness, sometimes also called “present-centredness”, can help us enjoy the world more and understand ourselves better.

Being aware is one of the five evidence-based steps we can all take to improve our mental wellbeing. Learn more about the five steps for mental wellbeing.

What is mindfulness?

Mark Williams, professor of clinical psychology at the Oxford Mindfulness Centre, says that mindfulness means knowing directly what is going on inside and outside ourselves, moment by moment.

Professor Williams says that mindfulness can be an antidote to the “tunnel vision” that can develop in our daily lives, especially when we are busy, stressed or tired.

“It’s easy to stop noticing the world around us. It’s also easy to lose touch with the way our bodies are feeling and to end up living ‘in our heads’ – caught up in our thoughts without stopping to notice how those thoughts are driving our emotions and behaviour,” he says.

“An important part of mindfulness is reconnecting with our bodies and the sensations they experience. This means waking up to the sights, sounds, smells and tastes of the present moment. That might be something as simple as the feel of a banister as we walk upstairs.

“Another important part of mindfulness is an awareness of our thoughts and feelings as they happen moment to moment.

“Awareness of this kind doesn’t start by trying to change or fix anything. It’s about allowing ourselves to see the present moment clearly. When we do that, it can positively change the way we see ourselves and our lives.”

How mindfulness can help

Becoming more aware of the present moment can help us enjoy the world around us more and understand ourselves better.

“When we become more aware of the present moment, we begin to experience afresh many things in the world around us that we have been taking for granted,” says Professor Williams.

“Mindfulness also allows us to become more aware of the stream of thoughts and feelings that we experience and to see how we can become entangled in that stream in ways that are not helpful.

“This lets us stand back from our thoughts and start to see their patterns. Gradually, we can train ourselves to notice when our thoughts are taking over and realise that thoughts are simply ‘mental events’ that do not have to control us.

“Most of us have issues that we find hard to let go and mindfulness can help us deal with them more productively. We can ask: ‘Is trying to solve this by brooding about it helpful, or am I just getting caught up in my thoughts?’

“Awareness of this kind also helps us notice signs of stress or anxiety earlier and helps us deal with them better.”

Studies have found that mindfulness programmes, where participants are taught mindfulness practices across a series of weeks, can bring about reductions in stress and improvements in mood.

How you can be mindful

Reminding yourself to take notice of your thoughts, feelings, body sensations and the world around you is the first step to mindfulness.

“Even as we go about our daily lives, we can find new ways of waking up to the world around us,” says Professor Williams. “We can notice the sensations of things, the food we eat, the air moving past the body as we walk. All this may sound very small, but it has huge power to interrupt the ‘autopilot’ mode we often engage day to day, and to give us new perspectives on life.”

It can be helpful to pick a time – the morning journey to work or a walk at lunchtime – during which you decide to be aware of the sensations created by the world around you. Trying new things, such as sitting in a different seat in meetings or going somewhere new for lunch, can also help you notice the world in a new way.

“Similarly, notice the busyness of your mind. Just observe your own thoughts,” says Williams. “Stand back and watch them floating past, like leaves on a stream. There is no need to try to change the thoughts, or argue with them, or judge them: just observe. This takes practice. It’s about putting the mind in a different mode, in which we see each thought as simply another mental event and not an objective reality that has control over us.”

You can practise this anywhere, but it can be especially helpful to take a mindful approach if you realise that, for several minutes, you have been “trapped” in reliving past problems or “pre-living” future worries. To develop an awareness of thoughts and feelings, some people find it helpful to silently name them: “Here is the thought that I might fail that exam”. Or, “Here is anxiety”.

Formal mindfulness practices

As well as practising mindfulness in daily life, it can be helpful to set aside time for a more formal mindfulness practice.

Several practices can help create a new awareness of body sensations, thoughts and feelings. They include:

meditation – participants sit silently and pay attention to the sensations of breathing or other regions of the body, bringing the attention back whenever the mind wanders
yoga – participants often move through a series of postures that stretch and flex the body, with emphasis on awareness of the breath
tai-chi – participants perform a series of slow movements, with emphasis on awareness of breathing

More steps for wellbeing

There are other steps we can all take to improve our mental wellbeing. Learn more about the five steps for mental wellbeing.

You can also learn more about the other four steps for wellbeing:

Connect for wellbeing
Get active for mental wellbeing
Give for mental wellbeing
Learn for mental wellbeing

http://www.nhs.uk/conditions/stress-anxiety-depression/pages/mindfulness.aspx

By treating depression, do we also treat suicidality? The answer is far from straightforward

By guest blogger James Coyne.

Edgar Allan Poe’s fictional detective C. Auguste Dupin warns against tackling questions that are too complicated to test, but too fascinating to give up. Whether psychotherapy or medication can reduce suicidality is probably such a question. Particularly if we are really interested in whether treatments can reduce attempted suicides, not whether they change patients’ answers in an interview or on a questionnaire.

There is no doubt about the clinical and public health significance of the question. After all, psychotherapy and medication are treatments of choice for suicidal patients. The logic is that many, even if not all, suicidal persons are depressed; we know about effective treatments for depression; and so we can generalise from knowledge about what works for depression to what works for suicidality. However, we must hope for more definitive evidence, and a new study attempts to provide it.

The authors include suicide expert Ad Kerkhof, and Pim Cuijpers, who has done some of the most influential meta-analyses and systematic reviews on the treatment of depression. Together with doctoral student Erica Weitz and depression expert Steven Hollon, they analyzed data from the US National Institute of Mental Health Treatment for Depression Collaborative Research Project (TDCRP). Conducted in the 1980s, it was then the largest ever comparison of psychotherapy and medication for treatment of depression. Two hundred and fifty patients with major depression were randomized to cognitive therapy, interpersonal psychotherapy, antidepressant medication, or a pill-placebo plus clinical management as a control group.

The original study did not specifically target suicidality. It actually excluded patients with moderate to severe suicidality. However, the two primary depression outcome measures for the study, the self-report Beck Depression Inventory (BDI) and the interview-administered Hamilton Rating Scale for Depression (HRSD), each contained a single item inquiring about suicidal thoughts and behaviour:

Suicidal ideation/suicidality is rated on the HRSD on a 5-point scale:
0—absent,
1—feels life is not worth living,
2—wishes he were dead or any thoughts of possible death to self,
3—suicide ideas or gesture.
4—attempts at suicide (any serious attempt rates a 4).
The suicidality question on the BDI is measured on a 4-point scale:
0—I do not have any thoughts of killing myself,
1—I have thoughts of killing myself, but I would not carry them out,
2—I would like to kill myself,
3—I would like to kill myself if I had the chance.

The new analysis required that patients have at least some suicidal ideation on either measure. Of the 250 patients, 146 met this criterion. At the start of treatment, patients scored a mean of 1.15 on the HRSD suicide item and .74 on the BDI’s item. The sample included one person who had made a suicide attempt. This case proved to be an outlier and was removed from the analysis. Thus, this study captures mostly mild to moderate suicidal thoughts.

Based on measures taken pre- and post-treatment, the authors found that all treatments, including the pill placebo with clinical management, significantly reduced scores on both the interview and self-report measures of suicidality, with all having a medium effect size. According to the interview measure, interpersonal psychotherapy and antidepressant medication reduced suicidality more than the pill placebo with clinical management. No differences were found between treatments using the self-report measure.

The authors recognised that because the comparison-control group (pill placebo plus clinical management) significantly reduced suicidality, no conclusions could be drawn about specific components of the treatments being essential. It is important to note that pill placebo plus clinical management was not an inert control condition. Neither patients nor therapist knew that any antidepressant was not given, and there were considerable positive expectations, support and encouragement. I am sure that outcomes would have been better in this group than for a waiting list control condition, but there was none included the study.

Recall that the items measuring suicidal ideation were part of depression scales. Did these specific items decrease simply as a result of overall improvements in depression? The authors state they ruled that out with complex multivariate analyses, but I was left unconvinced.

Suicidal ideation is a surrogate outcome. That is, it serves as a proxy for the more interesting, but less frequent outcomes of suicide gestures and attempts and completed suicides. However, the problem with a proxy outcome is the treatment can have a positive effect that is insufficient to change the clinical variables of interest. There was a time when pharmaceutical companies relied on surrogate outcomes like reduction in blood pressure when rates of heart attack were the actual variable of interest. In that context, many treatments affected surrogate outcomes without changing the real variables of interest. The same could be happening here.

Overall, the study demonstrates a dilemma. Mild suicidal ideation is common among depressed patients seeking treatment, but overall is a poor predictor of suicide attempts, which are comparatively infrequent. While many of the patients who ultimately attempt suicide present with serious suicidal ideation, most of them start off with signs of only mild to moderate suicidality. The seeming paradox is due to having to predict later infrequent events from imperfect and nonspecific risk indicators.

We can certainly study treatment of patients at high risk because of a recent suicide attempt, but what we learn then is not readily generalisable to the more common clinical situation of patients expressing only mild to moderate suicidality when they enter treatment. On the other hand, if we study the treatment of this moderate suicidality seen in the clinic, we can’t measure the impact on actual attempts or death by suicide, because to do so would involve a prohibitively large sample.

We are left with the uncomfortable situation of attempting to address a clinical problem in studies with poor measures and inadequate sample size. Or simply having to settle for answering the question “Do depression treatments reduce suicidality?” with “Probably: they reduce depression.”

Weitz E, Hollon SD, Kerkhof A, & Cuijpers P (2014). Do depression treatments reduce suicidal ideation? The effects of CBT, IPT, pharmacotherapy, and placebo on suicidality. Journal of affective disorders, 167C, 98-103 PMID: 24953481

Post written by James Coyne (@Coyneoftherealm) for the BPS Research Digest. James Coyne, PhD is Professor of Health Psychology, University Medical Center, Groningen and the 2015 Carnegie Centenary Professor at University of Stirling.

Posted by Research Digest at 9:59 am 1 Comment
Labels: Mental health, Suicide/ self-harm

http://bps-research-digest.blogspot.co.uk/2014/07/by-treating-depression-do-we-also-treat.html

 

What are teens hoping to feel when they self-harm?

The number of teenagers deliberately hurting themselves is on the increase. For example, the latest data for England show that over 13,000 15- to 19-year-old girls and 4,000 boys were admitted to hospital for this reason in the 12-month period up to June this year, an increase of 10 per cent compared with the previous 12-month period. More than ever we need to understand why so many young people are resorting to this behaviour.

A common motivation teenagers give is that non-suicidal self-harm provides a way to escape unpleasant thoughts and emotions. Another motive, little explored before now, is that self-harm is a way to deliberately provoke a particular desired feeling or sensation. A new paper from US researchers has explored this aspect of self-harm, known as “automatic positive reinforcement” (APR).

Edward Selby and his colleagues gave 30 teenagers who self-harm (average age 17; 87 per cent were female) a digital device to carry around for two weeks. Twice a day, the device beeped and the teens were asked to record their recent thoughts of self-harm, any episodes of self-harm, their motives, their actual experiences of what it felt like, as well as answering other questions.

Just over half the sample reported engaging in at least one instance of self-harm that was motivated by wanting to experience a particular sensation (and 35 per cent of all self-harm behaviours had this motive). The most common sensation the teenagers sought was “satisfaction” (45 per cent of them), followed by “stimulation” (31 per cent) and “pain” (24 per cent). Those were the hoped for sensations. In fact, pain was experienced more often than it was sought; stimulation was experienced as often as it was sought; and satisfaction was experienced less often than the teenagers wanted.

There were differences between the teenagers who self-harmed in order to produce a particular feeling and those who didn’t have this motive. The former group self-harmed more often during the study (and in the past) and they thought about self-harm more often and for longer. Those seeking a particular feeling from self-harm also engaged in more other risky behaviours including using alcohol, binge eating and impulsive spending. Zooming in on the different sensation motives, those teens seeking pain and stimulation tended to self harm more than those who sought satisfaction.

This study has made an important contribution to an under-researched aspect of self-harm, although it leaves many questions unanswered. For instance, one explanation for the more frequent self-harming observed among those who say they self-harm because they want to experience pain, is that the act triggers pain-relief mechanisms in the brain – a form of euphoria. And yet, self-harming was less frequent among those who said they self-harmed for satisfaction. This potential contradiction could be due to vagueness in the meanings of the words used – is the pursuit of euphoria (via pain) different from the pursuit of satisfaction? Such ambiguities will have to be addressed by future research.

Despite this, and the small sample size, Selby and his team said their novel findings already have clinical implications. “If alternative healthy behaviours can be identified that might induce a similar reinforcing sensation, then those healthy behaviours may be able to be harnessed as a more effective alternative to non-suicidal self-injury (NSSI),” they concluded. “For example if one purpose of NSSI is to derive pain, then exercise might function as an effective alternative as moderate levels of exercise might have a similarly painful or distracting effect that can help cope with upsetting emotions.”

Edward A. Selby, Matthew K. Nock, and Amy Kranzler (2013). How Does Self-Injury Feel? Examining Automatic Positive Reinforcement in Adolescent Self-Injurers with Experience Sampling. Psychiatry Research DOI: 10.1016/j.psychres.2013.12.005

http://bps-research-digest.blogspot.co.uk/2013/12/what-are-teens-hoping-to-feel-when-they.html