Mental Health During Pregnancy and Postpartum

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Pregnancy is a life changing condition.  Physically and mentally, there are many changes that happen with new life growing within.  These changes during the perinatal and postnatal periods often put new mothers and mothers-to-be at high risk for developing anxiety and depression.  Less common but worse conditions may include bipolar disorder and postpartum psychosis.

Women may develop a mental health problem during pregnancy or may have a recurrence of such a problem if she had such issue before pregnancy.  Women on medication for some mental disorder may have to stop taking their prescriptions when they get pregnant.  Unfortunately, they form a high risk group for recurring symptoms.  Seven out of ten women who stop their antidepressant medication for instance fall back into depression or anxiety during their pregnancy.

In the U.K., about 10-15 out of 100 pregnant women become clinically depressed or anxious.  The cause is not singular but it is usually a mix of factors and it can happen to anyone.  These factors may depend on:

  • Degree of recent or ongoing stress in one’s life such as a death of a loved one, divorce or separation, etc.
  • Attitude toward pregnancy.  The thought of raising a child, for instance, may put undue worry on a person especially one with a difficult childhood.  Changes in weight and shape may take an emotional toll especially if the mother has an eating disorder.
  • Whether one is on treatment or medication.  Stopping treatment could make one fall ill again.
  • Type of mental illness one has experienced

Postpartum Depression and Anxiety

As pregnancy and post pregnancy are times of great changes, depression symptoms may not be so easy to identify.  Depression signals may come when there are big changes in everyday routines or habits such as short sleeping hours, increase in appetite, etc.

If you are experiencing some of these symptoms for more than two weeks, get some help:

  • Feelings of hopelessness, worthlessness, emptiness, sadness, and other feelings of inadequacy
  • Very low moods; extreme sadness
  • Feeling numb
  • Easily irritated, angry, or resentful
  • Unfounded fears for the baby or of motherhood
  • Loss of interest in things that were normally enjoyable
  • Withdrawal from social contact
  • Not taking care of self
  • Insomnia
  • Poor concentration and decision making
  • Harbouring thoughts of harming the baby or one’s self; thoughts of suicide
  • Decreased energy; extreme lethargy

Anxiety is a common partner of depression.  When experiencing these symptoms, you need to see your GP or health professional who may test your degree of depression and anxiety using the Edinburgh Postnatal Depression Scale (EPDS).  The EPDS is a questionnaire which assesses your feelings if these fall outside the normal range and into the depression/anxiety scope.  This test may be conducted twice during pregnancy and once after childbirth.

Seeking Help

A pregnant woman, who has had prior history of mental illness such as schizophrenia, bipolar disorder, anorexia, or severe depression, must make a wise decision to talk to her GP.  Consultation with a specialist, even if she feels very good about herself and her pregnancy at the moment, is important because there is a high enough risk for her mental illness to recur during pregnancy or after childbirth.  One needs a care plan drawn up by a GP in order to head off or at least lessen the effects of the illness.

Medication During Pregnancy

Since many pregnancies are usually unplanned, some women may be under medication at the time of conception.  If you are under medication but suspect a pregnancy, do not stop medication suddenly but go see your doctor immediately.  He will assess whether to change or gradually take you off your medicines.  Stopping medications suddenly can quickly cause a relapse of your symptoms or cause undesirable side-effects.  If the doctor sees no harm to the foetus with the drugs you were prescribed with, he may insist that you continue with your medicated treatment.

While many medications are unsafe for pregnancy, selected antidepressants such as a few serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are considered safe for pregnant women.  These few have not been associated with birth defects and pass at very low levels through breast milk.

The decision of your doctor on whether to continue or not to continue medication may rest on the ff. factors:

  • the likelihood that you may not be able to take care of yourself when off medication
  • your tendency to turn to drugs or alcohol because you feel unwell without medication.  This tendency is harmful for both you and the developing foetus.
  • your tendency to develop postpartum depression which will affect your nurture and care for your baby
  • you are at a high risk for a relapse.  A relapse may require more medication, usually a higher dose or a supplementary drug, both situations that can be very harmful to the baby.
  • if talking therapies are not enough to mitigate your mental health issues.  Mental health problems like depression must be addressed because these can cause a host of problems from low birth weight to infant development.

Talking Therapies

Talking therapies or psychological treatments may be imperative treatments for pregnant women afflicted with depression or anxiety.  Cognitive behavioural therapy (CBT) for one can help you cope with your feelings by changing the way you think and behave.  Talking therapies help people identify the problem and ways to change their thinking and behavioural patterns so that the effects of the triggers are significantly lessened.  Some people may do away with medication and get by very well with talking therapy alone.

Talking therapy may be done as a one-on-one consultation or as a group event.  This type of therapy may also be conducted online as e-therapy through e-mail or video sessions.

postpartum blues

Alzheimer’s Disease : The Most Common Form of Dementia

 

alzheimer's diseaseThe term Alzheimer’s Disease often strikes dread in anyone given such a diagnosis… and with just cause.  Alzheimer’s is a progressive disease of the brain with no definite cure yet in sight.  This mental disease is fatal.  Alzheimer’s causes dementia, a set of progressive symptoms marked by memory loss, difficulties with problem solving and vocabulary, and other cognitive issues.  At present, there are more than 520,000 people in the U.K. who are afflicted with Alzheimer’s.

This degenerative neurological disease gets its name from its discoverer, Dr. Alois Alzheimer.  Although its greatest risk factor is old age with the majority of patients at 65 or older, Alzheimer’s is not a natural offshoot of aging.  The disease can manifest its symptoms in people belonging to the 40 or 50 year old age bracket.  Aside from advancing age, other high risk factors include:

  • Hereditary propensity for acquiring the disease
  • Previous severe head injuries
  • Lifestyle factors and health conditions also associated with cardiovascular diseases — smoking, bad diets, and sedentary habits that cause obesity, diabetes, high cholesterol levels, and hypertension
  • Down’s syndrome

What precisely causes Alzheimer’s is not known.

Symptoms

Alzheimer’s develops gradually through the years, with its symptoms progressing from mild to severe.  The disease attacks the brain’s cognitive and emotional functions thus compromising reasoning, focus, memory, emotional, and spatial abilities.  Alzheimer’s signals its early onset with the following signs:

  • Memory problems: Lapses in memory such as forgetting the names of certain places and people with whom one has frequent contact with.  Patient may also have difficulty remembering recent events and conversations.  The patient can also misplace important things like keys and documents.  Memory loss is to a degree that usually interferes with daily life.
  • Mood changes:  As the disease starts affecting parts of the brain that control emotions, patients may feel anxious, depressed, irritable, suspicious, or confused.  They are not themselves.  Small deviations from routine or their comfort zone can upset them at work and at home.
  • Problems with communication and language:  People with the disease often forget some terms or object names.  During conversations, they may find themselves unable to remember the right word or phrase and get frustrated just trying to express themselves.

As Alzheimer’s progresses and more brain cells get damaged, the symptoms worsen.  The patient may exhibit:

  • Increased memory loss:  At this stage, the person is more forgetful than ever and may ask for information repeatedly.  Toward the advanced stages, he may stop recognising familiar faces of family and friends.  It could be very painful for the spouse, children, or close friend if the patient forgets who and what they are to him/her.  The patient may also find himself increasingly misplacing his things.  He may feel anxious and be in denial about this disability that he may turn suspicious and accuse others of stealing his lost items.
  • Deterioration of problem-solving and reasoning skills:  Focus deteriorates and so do the abilities to follow instructions, think logically, and calculate everyday mathematical problems like balancing budgets.
  • Disorientation / confusion:   The patient may forget familiar routes so that he may not even know where he is or he arrived at a place.  He may also lose track of time, dates, and even seasons.
  • Decline in visual and spatial relationships:  People with Alzheimer’s may have problems determining depth, size, distance, colours, and contrasts.  This can interfere with driving skills and the ability to operate equipment.
  • Decline in verbal and written skills:  As the disease progresses, vocabulary becomes affected so much so that in the effort to express themselves, they call things by different names.  For example, they may call the TV, a moving picture box; a key may be called a lock stick.  The patient may also have a difficult time following conversations and may talk about something far from the conversational topic.  They may also keep repeating themselves because they have forgotten that they had already mentioned what they want to convey twice before.
  • Increasingly making poor choices and bad judgements:  Alzheimer’s patients are great targets for scammers, unscrupulous salespeople, and the like.  Because of their declining cognitive skills, patients are apt to fork over large sums for things they do not need or give consent to things they normally would not have.
  • Worsening moods:  Patients can become increasingly depressed, fearful, panic-stricken, confused, and paranoid from the results of cognitive decline.  Losing one’s memory and perception can be very scary for a person so he is apt to be embroiled in very negative emotions.  In some cases, patients can hallucinate or have delusions.
  • Withdrawal from society:  Cognitive decline brings about a decreased interest in hobbies or activities previously loved.  It also brings about deterioration in one’s social skills and even self-care abilities such as personal hygiene and remembering important events.  As such, the patient withdraws from social company.

As all these symptoms point out, Alzheimer’s changes a person’s character and personality as it erodes the brain cells.  The average life expectancy after diagnosis is 8-10 years.  In aggressive cases, disease can run the course of 3 years.  In slow progressing cases, a patent could live 20 or so more years.

How Alzheimer’s Works

ALZHEIMERS_DISEASEWhen Alzheimer’s starts attacking the brain, it may take a decade before a person experiences any symptoms.  Alzheimer’s first attacks the hippocampus, the part of the brain responsible for memories.  Abnormal deposits of proteins create tau tangles and amyloid plaques that destroy the neurons.  As these deadly proteins spread, they cut neuronal connections, leaving once healthy neurons to die out and parts of the brain to shrink.  As disease progresses into its final stages, the brain should show extensive damage, enough to have shrunk it significantly and fatally.

 

What Can Be Done?

There is no cure for Alzheimer’s disease but there are medications and therapies available that could slow down the progression of the symptoms.  A healthcare professional such as a GP or psychiatrist and social care services can work out a long-term health and social care plan which should cover the following:

  • What support the patients needs to help them remain independent for as long as possible
  • What physical changes are needed in the home to support patient independence or making his home easier to live with
  • Financial assistance needed

Patients and their caregivers should look into therapies such as cognitive stimulation which helps improve and stave off declines in memory, language skills, and problem solving skills.  Cognitive Behavioural therapy (CBT), arts therapy, and meditation can significantly help manage emotional problems such as depression, hallucination, paranoia, and the like which Alzheimer’s is apt to compound if left to run untreated.

Arts Therapy

art therapy session

Arts therapies are constructive non-verbal approaches that allow mental health patients to adequately express themselves through the creative process.  Painting, composing music, and writing a poem are different artistic ways through which patients may communicate feelings when verbal expression just seems too inadequate or just not preferable at the moment.

Arts therapy is also known as expressive therapy or creative arts therapy.  The emphasis of this therapy is on the creative process rather than on the resulting work of art.  This is why people with no artistic background can still benefit from arts therapy because the final artwork is not judged by its aesthetic value.  Instead, the therapist helps the patient find his voice about his personal issues by letting him go through the creative process, one which gradually helps him understand himself better.

How Is Arts Therapy Conducted?

After completing your project, your therapist will help you think about your creation and about how it relates to your feelings and experiences.  For some people though, the mere exercise of creating art somehow is enough therapy in itself.  The artistic activity allows them to discover many things about themselves and helps them process these revelations as well.

Art therapy may be conducted in a group session or on a one-on-one basis.  This type of therapy lends itself well to many forms of mental illnesses.  It is often used in conjunction with other kinds of therapy like talking therapies.

Art therapy has proven to be a successful form of treatment because it has helped many learn to deal with, and in some cases even bounce back, from their mental health issues.

Who is Best Suited for Arts Therapy?

Arts therapy is recommended as treatment for many behavioural, emotional, and mental problems.  They have proven to be particularly helpful with patients experiencing:

  • detachment from their feelings
  • resistance to talking therapies because relating their experiences may be too painful at the moment

People with these mental problems may benefit from art therapy:

  • Schizophrenia
  • Schizoaffective disorder
  • ADHD (Attention Deficit Hyperactivity Disorder)
  • Eating disorders (i.e. bulimia, anorexia)
  • PTSD (Post Traumatic Stress Disorder)
  • Depression
  • Anxiety
  • Stress-related issues
  • Traumatic brain injury
  • Developmental disabilities
  • Social challenges

Types of Arts Therapy

Art Therapy has varied modalities:

Music Therapy

Communication with one’s therapist or group members is through playing, listening, or singing a musical piece.  It may involve playing instruments such as the drums, maracas, chimes, bells, and wood blocks.

During a music therapy session, the therapist listens to the music you create or present and tries to understand the emotions you are trying to convey.  In response, they play their own music which is geared toward making positive changes in the way you feel.  Music is the medium the therapist uses to help you explore your feelings and think about the way you relate to people and your environment.

Dance Therapy

When body movements are a more comfortable mode of expression for a patient, then dance therapy is recommended.  Dancing can help a patient express emotions he may find difficult to talk about.

Dance therapy is also beneficial for those who:

  • are feel disconnected from their emotions and from things in daily life
  • have been sexually or physically abused as the experiences show in the way a person holds and moves his or her body
  • have a difficult time with physical contact
  • have physical symptoms from their mental illness.  Ex. Depression manifests as pain
  • have negative perception of their body and therefore have eating disorders such as anorexia or bulimia

Dramatherapy

Dramatherapy involves participating or creating skits or plays in which one needs to act out, use body movements, facial expressions, role play, or mime to express what one feels or wants to convey.  For those who are not particular about acting, dramatherapy also offers behind-the-scenes roles such as lighting, directing, costume or scenery creation, or even being the audience.

Art Therapy

Art therapy involves using art materials and other physical objects to help the patient connect with the world around them.  Clay, paint, pebbles, and crayons are just a small portion of art materials a patient may use to express himself through artwork.  A camera may also be used to take photos as glimpses to your past emotions and memories.

Finding an Arts Therapist

Arts Therapy is regulated and therefore has certain regulations about how this type of therapy must be conducted.  Make sure that your art therapist is registered with the Health and Care Professions Council (HCPC).

art therapy

Neurosurgery for Mental Disorder (NMD)

brain-surgery-treatmentNeurosurgery for Mental Disorder (NMD) is the modern name for psychosurgery.  NMD is a very controversial medical field that has not yet undoubtedly proven its merits.  The whole medical process is a collaboration between psychiatrists and neurosurgeons in which the goal is to remove or destroy a small piece of the brain to mitigate severe depression or acute obsessive-compulsive disorder (OCD).

Important Facts about NMD

NMD is a very high risk procedure and recommended only if all therapies, including psychiatric drugs and electroconvulsive therapy (ECT), have been totally unsuccessful.  Because of the high risk of adverse effects, a few doctors usually recommend this treatment as a very last resort.  Patients with this recommendation need to give their consent before NMD can be performed on them.

Other key factors to be knowledgeable of before considering NMD:

  • NMD is not a cure.  The surgery is done just to decrease the symptoms of the acute mood disorder or OCD but the patient still has to go through psychotherapy and other psychiatric treatments.
  • NMD cannot be reversed.  The surgery is permanent and therefore whatever side effects there may be can become permanent as well.
  • NMD is an extremely rare surgical procedure.  Only 4 people in the U.K. received this treatment in the years 2013-2014.
  • There are two alternative treatments to NMD:  deep brain stimulation (DBS) and vagus nerve stimulation (VNS).  While NMD involves taking out a small part of the brain, DBS stimulates parts of the brain with implanted electrodes.  DBS has proven to work with severe depression and OCD however in some cases, symptoms come back when the stimuli is removed.  VNS involves surgery where a device is planted into your chest.  The device’s electrodes are connected to the vagus nerve located at the neck where it sends timed pulses through the nervous system.
  • NMD is not done to change or modify a person’s behaviour.  If there are any changes, these are usually side effects, not a procedural aim.
  • In the U.K., NMD is not recommended for anorexia, personality disorders, and schizophrenia.
  • NMD is not a lobotomy, a type of neurosurgery done in the past to treat schizophrenia.  Lobotomy had been a controversial procedure and is not, or perhaps very rarely, done today.  Although a small percentage benefited from the procedure, most patients were left mentally dull, vacant, and incapacitated.

The NMD Procedure

The purpose of NMD is to break the connections between the nerves in small parts of the limbic system which is thought to be creating the mental issues.  The frontal lobes of the brain hold the limbic system which is responsible for emotional responses and some involuntary physical responses such as blood pressure regulation and heart rate changes.

The operation involves drilling a small hole through your skull to allow a fine probe controlled by special imaging software to be guided to a specific area of the frontal lobe.  Once in the right spot, an electrical current is pulsed through the probe to destroy a miniscule area of brain tissue.  After this, the probe is then removed and the skull cuts are either stitched or glued.

Effects to Mental Capacity and Personality

Since cases are very few, there is no conclusive evidence of the effectiveness or ineffectiveness of NMD.  To glean data from just the few, these are the findings of its post operative effects.

No evidence has surfaced to claim that NMD causes any loss in mental or thinking ability.  In fact, the operation itself may have dampened or relieved patients of symptoms so that it allows them now to think more clearly and have better concentration.

There are, however, very few patients that have undergone personality changes from the operation.

Side Effects of NMD

NMD can cause:

  • Apathy or disinterest.  Some patients who went through surgery for severe depression were reported to be indifferent to their issues which used to upset them before the operation.
  • Weight gain
  • Headaches which can be severe and last for several days

High Risks of NMD

Because NMD touches the brain, it carries high risks common to most brain surgeries:

  • Confusion
  • Epileptic seizures
  • Damage to blood vessels which may cause stroke
  • Feeling of pressure in the frontal area.  This pressure is caused by fluid build-up by the brain tissues as part of the healing process.  Confusion may also result from this fluid build-up and the condition can last for a month after surgery.

The Law on Patient Consent to NMD

The law on patient consent differ between the England-Wales territory and Scotland.  The Mental Health Act allows NMD for patients in England and Wales if all conditions are true:

  • The patient consents to NMD treatment.
  • A Second Opinion Appointed Doctor (SOAD) and two other appointees by the Care Quality Commission in England or the Healthcare Inspectorate Wales certify that (1) the SOAD approves of the treatment; (2) the patient has the capacity to consent; (3) the patient does consent.

It is very important to note that in England and Wales, patient consent is an absolute requirement for treatment, even if the patient does not have the capacity to give his consent.  In other words, if the patient lacks the capacity to consent, he cannot receive NMD treatment within England and Wales.

Scotland, however, has a different ruling.  NMD can be applied if all conditions are true:

  • An appointed medical practitioner by the Mental Welfare Commission has given his approval of NMD’s benefits for the patient.
  • A further two lay appointees by the Commission certifies whether the patient has the capacity of giving his consent or not.
  • If the patient is capable of consenting, then he is asked for his formal consent.  If the patient is incapable of consenting, he should not be objecting to the treatment.

Under Scottish law, as long as the patient does not object to the surgery, the patient can be given the NMD treatment even if he lacks the capacity to give his permission or consent.

LGBT Mental Health

gay relationships

Jared was fifteen when he fell into a depression and contemplated ending his life several times.  He knew he was gay but loathed himself for it.  His traditional Catholic upbringing frowned on gay, lesbian, bisexual, and transgender (LGBT) orientations.  Because of his mental illness, he pulled out of school, slogged through home school, hardly had a friend, and was under a lot of medication. At 18, he opted to go abroad to study and start a new life.  There he found his sense of belongingness with Mark and his circle of gay friends.  His depression gradually eased up as he accepted his sexual orientation.

LGBT mental health is a problem.  Straight Jacket author, Matthew Todd, writes “Society treats everyone from birth as if they are heterosexual.  If you’re not heterosexual and/or cisgendered (where your gender aligns with the sex you are assigned at birth) then there is huge pressure to suppress that part of yourself.”

A five year survey commissioned by PACE, an LGBT mental health charity, discovered that 34% of lesbians, gays, and bisexuals under the age of 26 have attempted suicide at least once.  About 48% of young transsexuals have also made some suicide attempt at one point in their lives.  Their mental health issues have largely stemmed from homophobic prejudice and bullying within their own families and schools.

LGBT people have to deal with a lot of rejection and hostility from different areas of society in the forms of:

  • Unaccepting demeanour and attitudes from family and friends
  • Bullying or shaming at school
  • Damnation from many religions
  • Danger of violence or embarrassment from strangers in public places
  • Harassment at work
  • Casual homophobic comments
  • Negative portrayals of LGBTs in media

…and a lot more.  With such an onslaught of antipathy from several quarters, it is no wonder LGBT persons have a very difficult time picking up their self-esteem and finding any belongingness in a world that largely ostracises them.

In this regard, many LGBT individuals wrestle with their identities which leave them subject to mental health issues such as:

  • Alcohol and substance abuse and addiction
  • Self-harm; suicide attempts
  • Low self-esteem
  • Major depression
  • Post traumatic stress disorder from bullying
  • Damaged relationships especially within the family circle
  • Generalized anxiety disorder
  • Bipolar disorder

Why is LGBT Mental Health Important?

The mind and body are intrinsically tied.  If the mind is unhealthy, the body also falls into sickness or weakness.  Improving LGBT mental health may ensure the general well-being of LGBT individuals.  If gay, lesbian, bisexuals, and transgenders get the opportunities to bolster their self-esteem by being accepted by their peers and family, health concerns may be decreased in the areas of:

  • Costs for physical and psychiatric care
  • Disease (ex. HIV) transmission and progression
  • The number of psychologically unfit individuals
  • Suicides, self-harm, and self-abuse

Selecting a Therapist for LGBT Issues

Not all therapists are qualified to treat LGBT patients.  Those who are usually have a lot of experience dealing with LGBT issues and may be an LGBT individual himself.  However, there are not many therapists like these that are available in every community.

The good news is that some LGBT specialized therapists have opted to provide distant therapy services through the internet or over the phone.  People considering sex change surgery are usually required to attend therapy first before surgery.  Therapy over the net may answer the availability of such required treatment.

Selecting the right therapist or mental health care provider is crucial for an LGBT patient to get the most out of his treatment.  When talking to the therapist, one needs to:

  • be comfortable with his therapist
  • know the background of his therapist’s experience working with LGBT individuals
  • have confidence about giving out personal information or details about one’s sexual orientation or preferences.
  • be open about thoughts and feelings about anxiety, fear, suicide, self-harm, and depression

Safety and Support When Going Online

online support

For many seeking help for mental illness, the web is a complex goldmine of information.  With a wealth of facts just a mouse click away, it is but natural for those seeking to understand their type of mental illness to turn to online for answers and later for support.  Unfortunately, the net is also a vat of disinformation and a playground for hostile individuals and groups.  In this regard, the internet user must know what sites to trust and what social networks, support groups, and chat rooms to be on the lookout for questionable members and activities.

When trawling the net, one must look after his privacy and his well-being especially when using the internet to look for support.  One must learn to deal with cyber abuse and be cautious with online advice from just any support group.  Not everything published on websites are a hundred percent reliable either because anyone, whether they be experts in their field or a common Joe just giving his two cents worth, can post just about anything they want online.

Where to Go For Reliable Information?

If you want to understand more about your mental issue, go to sites that have been certified to carry reliable content.  Ask yourself these questions before deeming any content you read as factual:

  1. Does the content have verifiable factual information or is the content written from just someone’s personal opinion or experience?
  2. Is the content written by an expert in the field?  Are they certified professionals?
  3. Is the content current?  When was it written?
  4. Is the content relevant to your mental health issue or circumstances?

It may be difficult to discern the legitimacy or illegitimacy of many sites.  Fortunately some sites have been certified as reliable by the Information Standard, a mark of accreditation by the National Health Service (NHS England) that certifies the content reliability of certain websites concerned with health and care.  A site marked with the following logo ensures trustworthy information for your guidance:

information-standard-member-logo-positive_full_1

Mind and NHS are good examples of sites that host very dependable, informative health content.

Finding Support Online

If you are thinking of finding a therapist online, it pays to do a little background search on his or her qualifications first?  The mental health therapist, psychologist, or psychiatrist must be accredited by a professional body such as the BACP (British Association for Counselling & Psychotherapy).

Chat groups or forums also exist that deal with specific mental health issues.  There are forums for bipolar patients and support groups for depressed people.  These are online communities with the ideal goals of providing as much factual information and as much support to their members.  Being part of these groups may help you discover new coping strategies and give you a sense of belongingness.  Sometimes, knowing that you are not alone can be a big help.

As much as support groups are beneficial, bear in mind the following:

  • Not all information you glean may be applicable to you.  If a group member swears by a certain medication, it does not mean this medication will work or will have fewer side effects for you as well, even if you and that member share the same diagnosis.  It is always wise to refer the information you get with your GP instead of acting on it on your own.
  • Other people’s comments can trigger some emotional issues.  Your comments may trigger theirs as well.  For example, if someone is saying that he feels like harming himself, you start feeling the same because of the suggestion.  If you feel this is happening, don’t pursue the thread.  Go to some other site.
  • Manage your online relationships.  People you have met online are not ones you have built a relationship with face-to-face; so be careful about giving personal information.  In addition, respect other people’s feelings and opinions even if you don’t agree with them.  Moreover, do not tolerate online mistreatment such as bullying by nipping any first attempts in the bud.
  • Manage expectations.  Do not believe what people write about 100% because it could just be their opinion, not fact.  Furthermore, other people’s experiences are circumstantial to them and may not be relevant to your own situation.

As much as the internet is a great tool for helping you manage your illness, there is still no substitute for face-to-face therapy or consultation with your psychiatrist or general practitioner (GP).  Having said that, online support from a licensed mental health professional through webcam talking therapies or email therapy is the next best thing.  Just be fastidious in establishing your online therapist’s credentials with the BACP, BPS (British Psychological Society), or other accrediting bodies.

Stopping or Coming Off Medication: Can I or Can’t I?

Psychiatric medications are prescribed to help people cope with emotions they cannot do so on their own.  These drugs may be a good or bad thing, depending on how one’s body reacts to them and what side effects these engender.  Although prescription medications have helped people who really need them, these sometimes exact their price from other areas of our health.  Some drugs could cause weight gain, a drop in libido, or loss of focus, among many other major and minor ramifications.  It is for these reasons that people decide to stop or gradually lessen their intake of medication.

Coming off or stopping medication altogether is not as easy or consequence-free as one may think.  It is not a simple “stop the drug; stop the side effects” scenario.  In fact, there are risks, some dangerous, to suddenly coming off the drug as well as being on it.  Much like being “between the devil and the deep blue sea,” the decision to discontinue taking medications that one has been taking for quite some time needs thorough thinking and awareness of the disadvantages.

stop-your-meds

Why People May Want to Stop Taking their Medications

People often mistake psychiatric drugs as cures when these simply hold the fort, so to speak.  Although they are a big help, psychiatric medications function as symptom reducers, not exactly recovery tools.  Over time, people can become dependent on these medications and have difficulty managing without them.  In other situations, the drugs don’t effectively block the symptoms but seem to enhance their degree.  For others, the side effects can be debilitating such as sleep deprivation, forgetfulness, excessive weight gain, feelings of detachment, and many more.

Some people would simply want to live a drug-free life.  While a no-drugs personal policy is ideal, it is not always workable or even safe.  In cases where the mental illness has become critical to the safety of the person and others around him, prescribed medication can be obligatory under the Mental Health Act.

Why Coming Off or Stopping Medications is a Risky Business

If you have been taking your prescription for three months and over, it is unwise to suddenly stop taking them.  Coming off psychiatric drugs may introduce withdrawal symptoms which may put you back to where you started in the first place.  While people who have been taking the drug for a very short time may sometimes safely stop cold turkey, this is not the case with people who have been following their prescriptions for months or years.

Because the brain has adapted to the presence of a drug, stopping its intake could cause severe withdrawal consequences.  One cannot simply say they will weather the withdrawal storm or hope to steel their minds to the physical and emotional aftermath.  In some cases, even gradual reduction of intake can lead to repercussions, ranging from moderate to severe, such as suicidal or violent behaviour.  This is why even gradual coming off a psychiatric drug must be a supervised situation.

The decision to come off or stop taking your medication altogether must be done after knowing your risks.  Your psychiatrist or general practitioner is the best person to consult on the matter as he is more knowledgeable of the drug.

Coming Off Gradually

The brain and body needs time to adjust to the reduction of intake.  Sudden dosage decreases may throw your body off-kilter and make you very sick from withdrawal symptoms.  Your mental illness, for which your drug was originally prescribed for, may also surface and pile on more symptoms.  Sometimes, it may be difficult to weed out whether the symptoms come from coming off or from the mental illness itself.

If you have been taking a drug for over six months, then expect a six-month or more timetable to get yourself completely weaned off the prescription.  If you have been taking the drug for ten years, then the reduction should be very slowly, spanning a period of years before being free of the medication.

Some people have prescriptions of two or more psychiatric drugs.  Coming off has to be done one drug at a time.  Since drugs affect how other drugs in your prescription work, your psychiatrist or GP must suggest which drug to reduce first and what other dosages need to be adjusted because of the change.

Alternative Support for Coming Off Drugs

Aside from your doctor, you may turn to these alternatives to help you deal with withdrawal symptoms for coming off your medications.

Talking Therapies

Medications can suppress emotions and creativity; so, coming off drugs can trigger these emotional issues.  Cognitive Behavioural Therapy (CBT), psychotherapy, and other forms of counselling may be very helpful in dealing with emotional upheavals.

Alternative Therapies

As further support to dealing with withdrawal symptoms, your doctor may recommend alternative therapies such as exercise, acupuncture, yoga, meditation, and aromatherapy.

Art Therapies

Art, music, dance, and writing can become invaluable and enjoyable ways of expressing one’s emotions.  The art therapist’s job is to encourage you to express yourself in whatever medium you feel comfortable doing.  You do not need to possess a painting talent, for instance, to engage in painting sessions because the main goal here is not to create good art work but use art therapy as a venue to deal with difficult feelings or memories.

You may use what you created to talk to your therapist about your work’s relation to your feelings.  For some people, art therapy in itself is a healing process that helped them deal with or even recover from their mental illness.

 

The decision to stop or gradually come off medications is something one must consider very carefully by weighing both one’s risks and benefits from the move.  Never stop taking or reducing your intake on your own.  With a decision like this, seeking your doctor’s medical advice becomes doubly imperative.

Community Treatment Order (CTO)

In November of 2008, the CTO or Community Treatment Order was inserted into the Mental Health Act 2007.  Applicable in both England and Wales, the CTO is a law that provides power to a responsible clinician to decide whether to psychiatrically treat an individual outside the hospital.

ctoIf a patient has been mandatorily sent to a hospital for psychiatric treatment, a Community Treatment Order may be issued by an approved clinician to get him out of hospital care, if patient is not harmful to himself and others, provided he agrees to certain conditions for community treatment.  If the agreed conditions are violated, the responsible clinician may make an order to return the patient to the hospital.  A patient under CTO is known as a community patient.

Criteria for Community Patient Eligibility

A patient may be granted a Community Treatment Order only if the following requirements are met:

  • The individual must have a diagnosed mental health disorder
  • The patient requires treatment in order to be safe from himself or to protect those he comes in contact with
  • The required treatment can be administered outside hospital bounds
  • The required treatment is available in the community or outside the confines of a hospital
  • The responsible clinician must be able to order the patient back under hospital care when necessary.

Duration of a CTO

From the date the order was issued, a CTO can last for about six months.  The order is renewable for another six months and thereafter on a twelve-month basis on the conditions that the patient:

  • has been available for examination under the conditions set by the CTO
  • has visited a second opinion appointed doctor (SOAD) when required to.  SOADs give their opinion on whether they agree with the current treatment the patient is receiving.

Conditions of a CTO

All CTOs have the above two conditions stipulated in every agreement.  Other conditions may apply but these will be influenced by your circumstances.  Examples of other conditions may include:community treatment order

  • place to stay during therapy
  • testing for alcohol or illegal drugs
  • attending scheduled therapies
  • cooperating with treatments such as taking the prescribed medications

These other conditions must involve a patient’s participation in planning his treatment after discharge.  If this is not applicable, then his nearest of kin or guardian must be fully aware and agreeable to the conditions under the CTO.  All these conditions should be based on the necessity behind the patient’s recovery and protection of other people around him.

Any condition in the CTO may be contested for unlawfulness if it unnecessarily restricts the patient’s freedom or if such condition is impractical in light of a patient’s circumstances.

Can Changes to Conditions of a CTO be Made?

The responsible clinician may change or stop the application of the conditions.  One may request for changes in the conditions through written or verbal communication with his clinician.  If the clinician refuses the request, the patient may have recourse by:

  • lodging his complaints using the hospital’s complaint procedure.
  • bringing his case to the Care Quality Commission
  • applying for a judicial review.  In this case, one would need special legal advice.

When a CTO Ends

A Community Treatment Order is limited by a timeframe.  When a CTO ends, a patient is no longer required to follow the conditions or compelled to be recalled for hospitalization by the responsible clinician.  A CTO ends when:

  • It expires and is not renewed.
  • It is revoked.  If a patient has been hospitalized, a CTO revocation can mean he is no longer eligible for treatment outside the hospital and must be detained in the hospital.  This is usually done when the responsible clinician deems he is of danger to himself and others.
  • The responsible clinician believes there is no more legal necessity to keep the patient under CTO and therefore discharges the patient.
  • The patient’s application to the Mental Health Tribunal is approved with a discharge.
  • A discharge comes from a hearing by the hospital managers.
  • A request for a discharge by the nearest relative or kin is approved.

What the Law Says on Disability Discrimination

Discrimination is a reality for many people and is based on a number of reasons:  gender, race, creed, religion…the list is sizable.  Physical and mental infirmities are part of the list rendering disabled persons unfortunate targets of society’s prejudices.  Disabled people may encounter discrimination at the workplace, school, or even in business dealings such as buying or renting property.  Disability does not only refer to physical impairment but includes mental infirmities as well.  People with mental health problems are considered disabled and are therefore entitled to the same disability rights and protections under U.K. law.

disability discrimination

Disability Discrimination Act 1995 (DDA)

The DDA or the Disability Discrimination Act of 1995 was a civil rights law which made discrimination of disabled persons unlawful when it came to provision of goods and services, education, and employment.  It demanded that disabled persons be accorded some reasonable adjustments with regard to their infirmities.  Modifications to the DDA have since been enforced when this law was repealed and replaced by the Equality Act 2010.

The Equality Act 2010

Injustice, unfairness, prejudice, harassment, and mistreatment of mentally ill people is categorised as discrimination.  Discrimination against the mentally ill and people with other types of disability is illegal and therefore can be challenged in court as per the Equality Act 2010.

Under the Equality Act 2010, any individual who is physically or mentally compromised to a point where there is a long-term negative effect on these person’s normal daily functions (such as driving, answering phone calls, talking with colleagues) is considered disabled.  This law provides protection from discrimination in many areas such as:

  • Employment — during an application for a job; leaving a job; or being currently employed
  • Education — when applying for and studying at a school or university
  • Business dealings — buying and renting property
  • Clubs — joining private clubs or organizations
  • Dealings with public functions such as crime investigations, tax collections, etc.
  • Services – hospitals, gyms, restaurants, etc.

When fighting on legal grounds, it is important to establish in court that a particular mental problem you are inflicted with is truly a disability.  The Equality Act can cover the conditions of autism, depression, dyslexia, schizophrenia, bipolar disorder, and many others.

Categories of Discrimination

Direct Discrimination

When a disabled person is prejudiced from receiving the same treatment as the average individual because of his infirmity, he is being directly discriminated.  To illustrate:   Joe who has been diagnosed with clinical depression has been bypassed for promotion in favour of a colleague who has fewer qualifications for the position.  Because of his mental illness, Joe has been discriminated from advancing in his career despite the fact that his condition can be lived with and controlled.  Joe has the right to turn to legal advice under the Equality Act 2010.

Discrimination by Association

When a person is discriminated against because he is associated or related in any way to a disabled person, then discrimination by association occurs.  For example, Catherine, who despite her mental illnes discriminationobvious qualifications, was rejected after a job interview for the sole reason that she has a schizophrenic mother at home.  The rejection was on the grounds that possible emergency situations in the future could hamper her work.

Discrimination by Perception

A 40-year old pilot has been bypassed for captainship just because he looks 15 years younger.  People’s perception of his young age was used as basis for impeding the pilot’s career advancement.

Indirect Discrimination

A rule or criteria applied to everyone but is unreasonably prejudiced to a certain individuals because of their disability.  A rule that all employees in a certain department must begin work at 7 a.m. may be discriminatory for an employee under long-term medication.  The 7 a.m. rule may not be feasible because the drug makes him less alert early in the morning.  If the company can afford to simply shift this particular employee’s schedule to 9 am and allow him to end his shift at a later time than his colleagues, but just unreasonably refuses to, then the company commits indirect discrimination.  The company has refused to make reasonable adjustments.

Victimisation

A person who made a complaint or supported a complaint made against circumstances violating the Equality Act 2010 may be treated badly.  Such discrimination is typed as victimisation.

Harassment

Harassment by one’s employers or colleagues occurs when unwanted behaviour from these individuals are directed toward person or persons with “the purpose or effect of violating an individual’s dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment for that individual.”

A company may also be liable for harassment even if the perpetrators are not employed by the company.  For instance, if a client constantly pokes fun at a mentally ill employee of the company and management has not done anything to address this customer’s behaviour, then the company is liable for discrimination under the Equality Act.

What Do Reasonable Adjustments Mean?

The law requires companies to make reasonable adjustments where disabled workers are concerned. Reasonable adjustments refer to small changes in the workplace that allow disabled employees to do their jobs well.  The term reasonable is important because the company is not obliged to make unaffordable changes that would qualify as an “unjustifiable hardships” for the company.  If the required changes arising from the employee’s disability will cost the company some significant expenses or be detrimental to other employees, then the company has the right not to make any adjustments as these are no longer reasonable.  For instance, should adjusting the end working hours for a disabled person require the company to hire additional security for his safety,  the court may rule this requirement as an unreasonable change and may uphold the company’s right to keep its working hour rules despite being detrimental to the disabled person’s personal schedule.

About Community Care and Aftercare

 

U.K.’s Community Care Program

Community Care or Domiciled Care is the British government’s health policy for home treatment of the mentally and physically disabled.  The system does away with the practice of institutionalization in which patients were placed under the care of an institution.  Before the 80s, mentally ill people were given over to the care of mental institutions.

Presently, community care refers to various health care services available to the public.  These services are available through clinics, home therapy, day care centres, social work support, and counselling, among others.  The system by which specific types of care or treatment is delivered to a patient is called care planning which is usually arranged by the Community Mental Health Teams (CMHTs).

community care

Establishment of U.K.’s Community Care Policy

Institutionalisation of the mentally and physically disabled was a British medical practice for decades.  In the 1960s and 1970s however, the practice gained widespread criticism after the media focused on allegations of malpractice and mismanagement of care under these huge institutions.  Criticism reached its peak when a nurse exposed the brutality and inhumane treatment of mental patients in Ely Hospital in Cardiff.  Other scandalous stories surfaced, prompting official investigations into institutions.

Under then Prime Minister Margaret Thatcher, Community Care policy was established in the 1980’s.  The aim was to maintain and provide care for people in their own homes rather than being put away in large institutions.  The move was also a more budget-friendly alternative for the government.

Community Care for Mentally Ill Patients

Community care for mentally ill individuals has two types of caring systems:  health care and social care.

Health care is concerned with support for managing both physical and mental ailments.  This includes medications; talking therapies (Cognitive Behaviour Therapy, psychotherapy, and other types of counselling); support from a psychiatrist, a community mental health team (CMHT) or a community psychiatric nurse; crisis services; and preventative care to help people be aware of mental health problems.

Social care involves patient assistance in managing their everyday tasks which may be compromised by mental illness.  Examples for social care services may be help in obtaining transportation for attending therapies and group supports; financial management of personal finances; cleaning, cooking, and general housework; and managing relations with family and friends, among many other services.

Depending on individual needs, a patient may opt to receive only mental health care or just social care or both.  Ideally, community-based care should be able to give the opportunity for mentally ill individuals to integrate as much normalcy in their lives as they can.

How to Access Community Care

The most common point for accessing community-based care is through a general practitioner (GP) who will assess the patient’s needs and may refer him to other services.  For instance, if the GP feels a mental health problem is complex, he may refer the individual to a community mental health team (CMHT) which may provide the network of support he needs.  A CMHT is a group of various mental health providers such as psychiatrists, nurses, social workers, etc. who all work in tandem to deliver the necessary care.

If a person’s mental health situation warrants more support, the CMHT may put the patient under the Care Programme Approach (CPA).  The CPA is a system by which a patient is entrusted to a care coordinator responsible for managing both mental health care and social care assessments and services.  The patient is given a Care Plan which details the specific support and provider the patient needs.  The Care Plan should also include a crisis plan as a guide to patients hitting a low point during their care (ex. contemplation of self-harm or suicide).  This crisis plan details what to do, whom to contact, where to go, etc.

care chart

 

Aftercare

Mental health aftercare is a free service the government mandates under Section 117 of the Mental Health Act of 1983.  Free aftercare service is further government support given to mental patients under these circumstances:

  • Obligated by law to be detained in a hospital as per Section 3 of the Mental Health Act.
  • Sentenced to detention in a mental/psychiatric hospital by a criminal court
  • Transferred to a psychiatric hospital

Aftercare involves outpatient treatment, access to a psychiatric nurse, counselling or therapy, employment support, assistance with personal financial management, use of day care centres, and the like.

If one has been deemed eligible for aftercare, an evaluation of his needs should be outlined and provided before the patient is released from the hospital.  The patient will receive a plan detailing specific services he will need and expect from the aftercare program.