The Oscars: Suffering on and off screen
This week’s Academy Awards highlighted the lack of diversity in the film industry, but mental health is being portrayed rather well says Harold S. Koplewicz, founder and president of The Child Mind Institute. He writes in The Hollywood Reporter:
This year, Hollywood made major strides in recognizing the importance of mental health through the accurate portrayal of psychiatric disorders in film. Reese Witherspoon gave a riveting performance in Wild as a woman healing from the emotional trauma of losing her mother by walking the Pacific Coast Trail and reconnecting with herself. Whiplash showed the stress that's an inevitable part of striving to be the best, and the strong impact teachers can have on their students — for better or worse. In The Imitation Game, Benedict Cumberbatch portrayed genius code breaker Alan Turing in a way that showed just how isolating genius can be. Meanwhile, The Theory of Everything depicted not only how ALS has affected Stephen Hawking, but also the emotional burden on his wife and family. For many, movies are the first vehicle through which they see and begin to understand mental health issues, which is why it is so important that these films reflect reality.

• Meanwhile, the Oscars acceptance speeches were filled with political activism, as usual, the best being from Graham Moore, who was presented with the Academy Award for Best Adapted Screenplay by Oprah Winfrey, then divulged he’d attempted suicide at 16 because “I felt weird and I felt different and I felt like I did not belong” (you can watch Moore’s speech here). For his speech and his “stay weird” message to outsiders everywhere, Moore received a standing ovation. From ABC News:
Graham Moore, who won the Oscar for best adapted screenplay for “The Imitation Game,” said in his acceptance speech that he had tried to kill himself as a teenager.
“When I was 16, I tried to kill myself because I felt weird and I felt different and I felt like I did not belong,” he said. “I would like this moment to be for the kid out there who feels like she's weird and different and feels like she doesn't belong. ... Yes, you do.”
Backstage, Moore said he saw the public moment as a rare opportunity for a writer and figured that “I might as well use it to say something meaningful.”
Earlier in the ceremony, Dana Perry mentioned that her son had killed himself. Perry made her comments in accepting the Oscar for best documentary for “Crisis Hotline: Veterans Press 1.”
“We should talk about suicide out loud,” she said.

• More Hollywood chatter: Oh no! Just when you thought the global news couldn’t get any worse, OK! Magazine reports that less than a year into their marriage, a generic American celebrity and her American footballer husband are having problems: Jessica Simpson and Eric Johnson attending marriage counselling. This comes on the heels of couples counselling too for famous-for-being-famous Khloe Kardashian and Lamar Odom, and Black Eyed Pea Fergie and Josh Duhamel. And someone called Kandi Burruss, who apparently appears on something called “Real Housewives,” apparently wants marriage counselling, too. Do we detect a trend; a new celebrity fad? Out with the macrobiotic diet and Scientology, in with couples counselling?

U.K. news
Mental health deaths in detention ‘avoidable’
From BBC News:
The deaths of hundreds of people with mental health conditions who were held in detention could have been avoided, an inquiry in England and Wales found.
It focused on adults detained on psychiatric wards, in police cells and prisons between 2010-13.
The Equality and Human Rights Commission said a host of problems including basic errors and a failure to involve families were to blame.
Officials are calling for the NHS to work towards a "zero suicide" approach.
The wide-ranging report looked at people detained for a variety of reasons - for example patients admitted to hospital when their own was safety was considered to be at stake.
It included those detained in police cells and looked at people in prisons with mental health conditions too.
Between 2010-13 the analysis shows 367 adults with mental health issues died of "non-natural" causes while detained on psychiatric wards and police cells.

Putting UK mental health services on the road to recovery
From the RAND Corporation:
Patients in the UK with a diagnosis of cancer and certain other physical conditions can expect to be given access to a range of services within specific waiting times, whereas patients with a mental health condition can find themselves in a long queue for limited treatment options. Before throwing money at the problem, UK Government departments would do well to look at how they can work together to implement evidence-based and cost-effective interventions for mental ill-health.
The disparity in the treatment of physical and mental ill-health in the UK was highlighted by a recent report from the British Association of Counselling and Psychotherapy (BACP). The Government recognises the problem. The Health and Social Care Act of 2012 put a commitment in place to provide parity of esteem for physical and mental health. In 2014, new waiting times standards were announced for patients accessing therapy through the Improving Access to Psychological Therapies programme.
Nonetheless, mental health patients often have poor access to services, little choice in the services that they receive, and endure long waiting times in their hour of need. The BACP report highlights that mental illness is the UK's most common “disease,” yet only 24 percent of people with a common mental health condition receive treatment. This leaves millions of people to suffer, with knock-on effects to society more widely.

Mental health and learning disabilities statistics: monthly report
From Gov.UK:
At the end of November 2014:
• 964,627 people were in contact with mental health or learning disabilities services. Of these, 923,938 people were in contact with mental health services and 52,336 people were in contact with learning disabilities services. These two figures combined are higher than the total, as a person may be in contact with both services.
• 23,849 people were inpatients in hospital (2.5%). 1,866 people were in hospital on wards for people with learning disabilities. The remaining 21,983 people were in hospital on wards for people with mental health needs.
• 16,864 people were subject to the Mental Health Act 1983 and of these 12,466 were detained in hospital (73.9%) and 4,259 were subject to a Community Treatment Order (25.3%).
• 59.3% of people aged 18-69, who were being treated under the Care Programme Approach, were recorded as being in settled accommodation, while 6.8% were recorded as being employed.

During November 2014
• 69,924 new spells of care began.
• There were 9,983 new admissions to hospital.
• Of those who were discharged from hospital during the month, 74.5% received a follow up within 7 days from the same provider. This is an important suicide prevention measure.

Between the start of April 2014 and the end of November 2014
• 1,560,812 people have had contact with secondary mental health and learning disability services and of these 80,281 (5.1%) had spent at least one night as an inpatient in hospital.

Key findings from the special feature on the use of restraint include:
• 105,270 people spent time in hospital in 2013/14 and of these 6,022 (5.7%) were subject to at least one incident of restraint during the year; 57.4 % of these people were men and 42.5% were women.
• These inpatients experienced a total of 23,094 incidents of restraint in 2013/14. Most people who were restrained were restrained once during the year but 960 people were restrained five or more times during this period.
• 1,618 people aged 20-29 were restrained (26.9% of the total number restrained) with 7,285 separate incidents of restraint recorded for this group.
• The ethnic group with the highest proportion of inpatients experiencing restraint per 1,000 inpatients was the Mixed ethnic group having 101 incidents of restraint per 1,000 inpatients.

Computers to replace counsellors?
The NHS is funding an initiative that could further improve access to psychological therapies, eliminate waiting lists, and do away with unnecessary burdens such as consulting rooms, salaries, staff: Get computers to provide counselling instead of people! Report from the University of Roehampton:
Professor Mick Cooper, one of the UK’s foremost academics in psychology and counselling research, has been appointed by software company ProReal Ltd to evaluate the use of the of its software with young people. The company has been awarded Phase two funding of £970,000 by NHS England’s Small Business Research Initiative Healthcare.
ProReal has developed an immersive, avatar-based virtual world software platform which helps users put thoughts and feelings into pictures. ProReal enables clients to create a visual representation of their world, and uses cameras to enable this world to be experienced from multiple perspectives. Using avatars (digital representations of people) and other features, the user can gain new insights which build stronger relationships and improve psychological well-being.
Professor Cooper leads the Centre for Research in Social and Psychological Transformation (CREST) within the Department of Psychology at the London-based university. CREST specialises in the evaluation of counselling and psychotherapy in schools and with young people.
He said: “Helping young people affected by mental health issues to explore their difficulties through an avatar-based programme could be a leap forward in understanding their actions, and a worthwhile tool for counsellors to improve the quality of support we give them.
“It would bring therapeutic support to young people via the online world, where many will be comfortable and experienced in communicating with others. This is a potentially very welcome development, but we must be sure it will work, which is why the evaluation we carry out will be key to developing the product. As professionals, we can’t afford to try new methods of support until we’re absolutely confident they are as good as they can be and will genuinely make a difference.”

World news
Australia: New app to prevent suicides among youth
From International Business Times UK:
A mobile phone app i–bobbly designed by Australian developers to help youth at risk of suicide is making a difference after a trial, say its makers.
The self-help tool targeting a generation constantly on their phones or iPads and shut off from speaking to people gets them to talk through a series of questions.
The replies provide insight into their mental well-being.
Going through each screen and answering simple day-to-day questions give an outline of how the person thinks, feels and behaves.
When the need to talk to somebody arises, there are people to call.
The users come back after six weeks and go through the same process when the changes are noted.
The app has a diary to check back on how a user felt at certain times or on days and what led to it.
The data is analysed by the counselling team who talk with the app user.
Interestingly, the suicide prevention group Alive and Kicking Goals began on a football field in Kimberley a few years ago.
The coordinator came up with the concept of counselling a few years ago after concerns of poor mental health among many players.

Mexico: Women with mental health problems pressured into sterilisation
From the Guardian:
Mexican women with psychosocial disabilities are suffering systematic abuse of their sexual and reproductive rights, according to a new study..
The study, carried out by the Washington-based group Disability Rights International, found that 42% of the women interviewed had been pressured by their families and health professionals into being sterilised, with some subjected to operations without their knowledge. The women’s disabilities include depression, schizophrenia and bipolar disorder.
It also revealed that 43% of the sample reported suffering some form of emotional or physical abuse during visits to gynaecologists, ranging from hurtful comments to rape.
“These are egregious human rights violations perpetrated against women with disabilities,” said Priscila Rodríguez, who headed the study. “They are violations of sexual and reproductive rights that have long been ignored.”

China: Chongqing counseling center helps marriages recover from affairs
Hardly anyone in the West has ever heard of the Chinese city of Chongqing, unofficially the biggest municipality in the world with 32 million inhabitants, almost as many as all of Canada. Lots of people to have affairs with! A new agency has been formed to try to preserve the marriages after one partner has strayed. From Want China Times:
In Chongqing, an organization made up of lawyers, marriage experts and psychological counselors, has successfully persuaded more than 100 couples not to divorce over an affair over the past two years, the local Chongqing Morning Post reports.
Intervention of a third party was cited as the reason in fewer than 2,000 of 100,000 divorce cases in the municipality last year, less than 2%, but the actual figures are far higher, says Yu Feng, director of the Chongqing marriage and family counseling service center, the city's first organization to help marriages recover from an affair. "I say without exaggeration that half of divorce cases come about because of a third party," Yu said.
Yu said about 70% of couples proceed to divorce, while 30% decide to give it another go after their reconciliation efforts.

Last words
Psychotherapy now and in the future
OUPblog provides an extract from the new book Psychotherapy: A Very Short Introduction, by Tom Burns and Eva Burns-Lundgren, in which they discuss the future of psychotherapy:
The 20th century has been called ‘the century of psychiatry’, and in many ways one could read that as ‘the century of psychotherapy’. A hundred years ago, at the onset of World War I, psychotherapy had touched the lives of only a tiny number of people, and most of the population had simply never heard of it. Since then it has reached into almost every aspect of our lives—how we treat the mentally ill, how we understand our relationships, our appreciation of art and artists, and even how we manage our schools, prisons, and workplaces. Our culture has become one quite obsessed with understanding how people feel and our daily language is peppered with psychotherapy language.
What does the future hold? Have we witnessed the flowering of a cultural movement that is tied to just one unique time and place, or is it a fundamental step forward in human thinking and relationships? In our increasingly global world will it spread ever more widely or perhaps fade away altogether? Have the various changes in its practice made it more relevant to modern man or less so? Will the enormous advances in medicine, neuroscience, and psychology, and our move into the digital age of social media, render it obsolete?

The most famous, most iconic tortured artist—the original—is Vincent van Gogh. Today, he would probably be diagnosed as bipolar, or possibly schizophrenic. He had psychotic episodes, he was sectioned, and he allegedly cut off part of his ear (though some believe Gauguin was the slasher). Van Gogh spent his final year in an asylum. He committed suicide. His paintings seem to telegraph his inner turmoil. The stars on the canvas burn too brightly. Each brushstroke appears laden with madness.
      Does a true artist have to be a tortured genius? Must there be some psychological crossed wiring, some gaping brain lesions, or a too-hot neurotransmission system to allow such acute sensitivities to the outer world and the inner world of the imagination? Or is the torture the effect of heightened creativity rather than the cause—does it all take its toll? Do creators see and feel too much? Is art a gift—or a curse, consigning the artist to drown in angst and absinthe in a lonely garret? Is art only good if its creator suffered?
     On her Brain Pickings site, Maria Popova writes on the relationship between creativity and mental illness, quoting extensively from the book The Creating Brain: The Neuroscience of Genius by Nancy Andreasen, which casts a forensic eye over such evidence as Van Gogh’s letters or Sylvia Plath’s journals or Leo Tolstoy’s diary of depression or Virginia Woolf’s suicide note. In a study of the Iowa Writers Workshop, Andreasen found the majority of the writers “described significant histories of mood disorder that met diagnostic criteria for either bipolar illness or unipolar depression.” She concluded that psychological distress is indeed allied to creative genius (but to be successful it must be overcome). And that creative people are in fact different, superior beings. She writes: “Although many writers had had periods of significant depression, mania, or hypomania, they were consistently appealing, entertaining, and interesting people. They had led interesting lives, and they enjoyed telling me about them as much as I enjoyed hearing about them.”
     I don't agree on either count. Creativity is not some kind of special neurosis bestowed on the chosen few. It is instead like love—a good, healthy and universal part of being human. Anyone can access that incandescent, transcendant energy that can fuel our waking moments—and lots of our sleeping moments, too. You don’t need to be a genius—nor class A drugs—to see with kaleidoscope eyes.
     “No matter what your age or your life path, whether making art is your career or your hobby or your dream, it is not too late or too egotistical or too selfish or too silly to work on your creativity,” writes Julia Cameron in The Artist’s Way, which argues that accessing creativity is akin to a spiritual awakening—anyone can plug into some kind of cosmic or divine grid of “spiritual electricity.”
     For Betty Edwards, author of Drawing on the Right Side of the Brain, becoming creative is simply learning how to see. “You may feel that you are seeing things just fine and that it’s the drawing that is hard. But the opposite is true ... By learning to draw you will learn to see differently and, as the artist Rodin lyrically states, to become a confidant of the natural world, to awaken your eye to the lovely language of forms.”
      There are plenty of sane, ordinary, even rather boring people who are also highly creative artists, writers and poets. (Conversely there are also plenty of people who suffer who don’t create anything.) Years ago, one example of a seemingly untortured artist, the novelist Kurt Vonnegut, told a packed auditorium that every person in the room probably had the imagination to write a serviceable novel. The only difference, Vonnegut said, is motivation: very, very few actually do it. (Probably just as well—the world hardly needs more mediocre novels.) So why do those that create do what they do? Why does anyone spend months or years labouring over many thousands of words that almost certainly will never have an audience? Where does the motivation come from?
     It is here that a little bit of madness can give us a push. It’s possible that being a little unhinged or conflicted, with a slightly cracked heart, can provide a call to create, to search for meaning, to try to make sense of it all. Freud regarded art as another “royal road to a knowledge of the unconscious activities of the mind,” like dreams. Creative pursuits can be enormously therapeutic for dissatisfied, distressed or damaged souls. It is an outlet, a form of expression for those without a voice. And there have also been studies linking creativity with bipolar-type people, the intense exhilaration of manic highs perhaps providing not only the raw materials to build a palace in the sky but also the energy to put it all together.

UK news
Alastair Campbell: I urged couples counselling for Blair and Brown
Herald Scotland:
The former Downing Street spin doctor said consulting mental health professionals would improve how they dealt with stress and make them better leaders.
Mr Campbell also revealed that he urged Tony Blair and Gordon Brown to seek couples counselling when their working relationship disintegrated in government - but the prime minister rejected the idea.
• The Independent: You don't have to seek psychiatric help if you're a politician, but why wouldn't you?

Psychotherapy provision in the UK: time to think again
A marvellous riposte to the waiting-list-then-brief-CBT model of mental heath care, from The Lancet:
If a patient with cancer had to wait up to a year for treatment, health-care professionals and the general public would think it dangerous and wrong. If their treatment was then limited to six doses of radiotherapy, regardless of the pace of recovery, there would be disbelief. And if one treatment approach did not work when alternative therapies were available, it would be scandalous for a clinician to then say “there is no more we can do for you”. Yet this is often the experience of people suffering from psychological distress trying to access therapy on the NHS. 

Armed forces suffering crisis as 28,000 are diagnosed with problems since 2007
Mirror.co.uk:
More than 28,000 members of the armed services have been diagnosed with mental health problems since 2007.
The rocketing numbers sought help from Ministry of Defence services for a wide range of conditions in that time.
Charities and MPs tonight branded the figures “alarming” and demanded defence chiefs act to tackle the crisis.
Kevan Jones, Labour’s shadow armed forces minister, told the Sunday People : “This highlights the need to concentrate on military mental health and also ensure the NHS deals with service veterans.
"The rise is partly because of the wars in Afghanistan and Iraq. But it’s also because personnel are more aware of the help available and ask for diagnosis – which is a good sign.
“It’s vital to ensure there’s a joined-up connection between the military’s mental health and the NHS so when troops leave service they get vitally needed help.”
The figures, revealed after a question in Parliament last week, show that in 2014 about 5,159 troops were diagnosed with mental health problems at specialist centres – up from 3,560 in 2007.

Suicide in Wales
BBC News:
A man who says he has lost 19 friends to suicide over three decades has spoken out so that other people might think twice about killing themselves.
Filmmaker Andrew Jenkins, 52, from Blaenau Gwent, plans to make an educational film about the issue.
This comes as the latest figures show a sharp rise in suicide rates in Wales, particularly among men.
In 2013, 393 suicides were recorded in Wales, up from 334 in 2012.
The number of men taking their own lives has risen from 21.4 in 2012 to 26.1 per 100,000 population in 2013, which is the highest figure since 1981.
The rate for women in Wales is 5.8, down from 5.9 in 2012.
The Welsh rate of suicide is higher than the UK figure of 11.9 deaths in 2013. 

International news
Where are the mental-health providers?
Wall Street Journal:
Millions of Americans with mental illness are hearing a loud and clear message: Get help. There’s still one question: Who is going to treat them?
The shortage of mental-health providers in the U.S. has long been considered a significant problem. But it is becoming more acute as people are encouraged to seek treatment, or find they are able to afford it for the first time as a result of new federal requirements that guarantee mental-health coverage in insurance plans.

      The article comes with a map of the top-10 and bottom-10 states for service provision. The message is clear: Have your breakdown in New England, not the South:

Funding for mental health services in Australia to quadruple
The Guardian:
Funding for mental health services will quadruple as the government prepares to transition service providers to the national disability insurance scheme (NDIS).
The federal government has set aside $1.8bn in the NDIS for mental health services. It currently spends $450m on community care programs, many of which will fall under the NDIS umbrella when the program is fully operational.
The chief executive of Mental Health Australia, Frank Quinlan, said he was “delighted” by the funding allocation, but wanted certainty for a number of programs whose funding is due to expire on 1 July, 12 months before the NDIS will be fully operational.

     Too bad we don’t have news like this in the U.K.

Mental health care in Nepal
Conflict and Health:
Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal ... Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin.

Most memorable headline of the week
From The Rakyat Post: Non-married couples on motorcycles will not be arrested, but given counselling.

We’re in the middle of the U.K.’s first-ever Children’s Mental Health Week, launched by the charity Place2Be, which for 20 years has provided counselling in schools. According to Place2Be:
• One in 10 children aged between 5 and 16 years (three in every classroom) has a mental health problem, and many continue to have these problems into adulthood. Half of those with lifetime mental health problems first experience symptoms by the age of 14.
• Among teenagers, rates of depression and anxiety have increased by 70% in the past 25 years.
• One in five children have symptoms of depression and almost a third of the 16-25-year-olds surveyed had thought about or attempted suicide.
• Ten years ago, detailed estimates put the costs of mental health problems in England at £77 billion, including costs of lost productivity and the wider impacts on wellbeing. More recent estimates suggest the costs may be closer to £105 billion.
     As if all that wasn’t bad enough, recent research shows child adversity and psychological troubles may speed up aging leading to poor health and earlier death.
     The 7-month-pregnant Duchess of Cambridge, Kate Middleton, 33, lent her support to Children’s Mental Health Week in this video message. "Both William and I have seen that many young people are struggling to cope with the impact of bullying, bereavement, domestic violence, family breakdown and more," Middleton says. “Without support, the effects of these challenges can be traumatic, leading to serious issues such as anxiety, depression, addiction, and self harm.”
     We should all support the work of organisations like Place2Be. The 30 percent of parents who are “embarrassed” by the idea of child counselling need to get over themselves.
     The Government, too, claims to be committed to improving mental health provision and services for children and young people. A recent report sets out the current situation, recent funding commitments, and identifies new initiatives, including new guidance for teachers on mental health, access to schools-based counselling, and recommendations for mandatory mental health education on the national curriculum. You can download the report here.
     But what governments say and do, as we know, can be quite different. Sometimes they are exact opposites. So in Children's Mental Health Week, we learn of the children’s mental health “timebomb” caused by massive budget cuts (£50 million slashed from child and adolescent mental health services since 2010), the shocking, ballooning number of children showing up at A&E in the grip of a psychological crisis, and the generally toxic climate we have created for the next generation. Writes the Mirror: “We revealed how savage cuts to early intervention services had led to alarming numbers of mentally ill youngsters falling seriously ill with rising numbers being hospitalised ... Today’s new A&E figures highlight why children’s mental health services urgently need a cash injection
     “They show there were 17,278 admissions at A&E involving patients aged 18 and under with a diagnosis of ‘psychiatric conditions’ in 2013/14 - an 85.2% increase from 9,328 in 2010/11.
     “Of the 17,278 young patients, only 5,367 were admitted to a hospital bed within the same trust or provider. Others had to be shunted to other hospitals because of a lack of specialist mental healthcare at the hospital where they were admitted to A&E.”
     The legacy of former education secretary Michael Gove, reviled by parents, teachers and commentators across the land (and even described as a “monster” by admirers), is taking its toll. With relentless testing and pressure to meet ever-changing targets, we are robbing our youth of their right to be youthful, turning children into stressed academic battery hens instead. Childline has witnessed a dramatic rise in the number of children receiving counselling for exam-related anxiety—a tripling in just one year, with 43 percent under the age of 11.
     Perhaps the government will belatedly realize it’s continue-flogging-until-morale-improves approach to education might not be working that well. A report released today announces an attempt to paper over the gaping stress fractures by introducing weekly “happiness” lessons. Writes the Telegraph: “Former ministers and Government advisors are calling for radical changes in the way British pupils are brought up, with accusations of a ‘grossly inhumane’ failure to care for children’s wellbeing. Their report, due to be presented to a global health summit this week will say mental health problems among children and teenagers have become ‘a massive problem’ with one in 10 now suffering from diagnoses such as anxiety and depression.”
     The report proposes that school pupils from the age of 5 would spend at least one hour a week discussing their emotions, setting positive life goals, and learning how to cope with everyday pressures and social media. “Increasingly in many countries, schools are becoming exam factories,” the report warns.
     Happiness lessons? Fine. But this feels like much too little, much too late. Children need to be allowed to be children—to play, to make a mess, to be spontaneous, to create (grown-ups should try it sometime, too). And above all, starting long before school, what children most need is love.

When a child is born
When you look into the eyes of a baby, you see not a blank slate but a kind of ancient wisdom and intelligence. More than 20 involuntary reflexes have been identified in newborns; we have subjective and intersubjective skills from birth. Then the brain more than doubles in weight in the first year of life. Says Sue Gerhardt in the classic “Why Love Matters”: “What needs to be written in neon letters lit up against a night sky is that the orbitofrontal cortex, which is so much about being human, develops almost entirely post-natally.” And that development occurs through social interaction.
     The development of the architecture of the infant brain is a kind of ongoing process of downloading software from the environment. Even a simple smile from a parent can set off a biochemical chain reaction of physiological pleasure, and the creation of new neural pathways in the young brain. So love your children. It doesn’t cost anything. Babies who are loved develop better brains than those who aren’t.
     There is a small window of opportunity for optimal brain growth to occur. The right hemisphere in particular shows a dramatic growth spurt during the first year and a half of life as the preverbal, emotional landscape is defined. Early trauma can flood the system with stress hormones that can lead to a “developmental overpruning” of the corticolimbic system, compromising that person’s ability to respond to stress in later life. Studies of Romanian orphans, deprived of early human interaction, show they had gaps in their brains—their orbitofrontal cortexes did not fully develop. They never will.
     But these patterns are not ccompletely immutable. The brain—with a hundred billion neurons which together form a million billion connections—retains a degree of plasticity, an ability to develop and grow, like a muscle, throughout life. Software upgrades—and learning—are always available through good experiences, which can come from education, practising skills, overcoming challenges, or, above all, through relationships—including counselling and psychotherapy. The brain continually changes in response to the people and the environment it meets, and so do you. The branching, connecting and withering of dendrites in brains, through lifelong interactions within and between individuals, families and communities, is what makes our world.
     How are you with love? Maybe you haven’t had enough of it in your life. Maybe you’ve experienced the opposite of love. Well, it’s not too late. It is never too late to love, be loved, and to grow. 

It’s Valentine’s Day. The day when there is some kind of Big Brother (or Big Sister) command from on high that today you must be romantic, offer cards and pink fluffy things to the person of your dreams, make grand gestures intended to demonstrate the extent of your commitment, and perhaps go out for an evening meal in a red rose-strewn restaurant offering a “special” (ie. monumentally overpriced) menu. For many couples, Valentine’s Day is a day of judgment—a day spent feeling bad that their relationship does not measure up to how love “should” be (Christmas can have a similar effect). One study found that relationship breakups were significantly higher around Valentine’s Day than at other times of the year. Some couples resent the obligation, the command to conform, and all the crass mass marketing of love that goes with it, and deliberately do nothing at all to observe the day. For people in the early, fledgling days of a new relationship, Valentine’s Day can unhelpfully raise the stakes. For people who are suffering from loneliness, it can make you feel 10 times worse. Crisis hotlines will see a spike in calls today.
     Valentine’s Day can be great of course, a start, or a celebration, a renewal. But love, romance and sexual arousal don’t tend to respond to command. Perhaps overall, on the balance sheet of human joy versus human misery, Valentine’s Day is a net contributor to the latter rather than the former.
     Neverthless, with love I offer here a humble buffet table with some Valentine’s Day morsels and delicacies about love, sex, relationships etc.

Some headlines
• Dealing with love, romance and rejection on Valentine's Day
• The psychology of why Valentine's Day ruins relationships
• 7 science-based tips to make you sexier on Valentine’s Day
• A Valentine's Day look at sex through the ages
• Happy couples are probably deluding themselves
• What straight couples can learn from gay couples
And good advice from The Guardian’s Oliver Burkman: All dating advice is as terrible as the people who give it.

Your relationship demystified
The key to happiness is love and understanding. The more you know someone, the more you can love them; the more you love them, the more you know. Attachment style—mine and yours—is the scaffold upon which a relationship is built. To understand the dynamics of your relationship—past, present or future—check out the 6 relationship types. What colour is yours? (This is far and away the most popular, most viewed thing I've written on this blog.)

Marriage guidance
The latest news 
Shocking to hear that Black Eyed Pea Fergie and Josh Duhamel are in marriage counseling after six years together—if those two beacons of togetherness are struggling, what hope is there for the rest of us ... the Ministry of Social Affairs in Saudi Arabia is implementing a mandatory pre-marital couples counselling program ... a similar mandatory scheme has recently been proposed in Colorado ... a voluntary government-funded marriage counselling program in Australia was recently dumped after attracting just 10 per cent of the expected participants ... pre-marital counselling in Jamaica ... domestic violence can sometimes be perpetrated by women against men as this report from Ireland points out.

From Relate
• 42% of UK marriages end in divorce
• Almost half of divorces involve children under 16
• In 2011, 66% of divorces were on petition of the wife
• Of every divorce in 2011 - it was the first divorce for both partners in 70.1% of cases, while in 19.7% one party had been divorced previously, and in 9.6% of cases both had divorced previously
• Second marriages are more likely to be successful than first marriages. If one or both partners are remarrying they have a 31% chance of divorce, compared to 45% if it is both partners’ first time
• 34% of marriages are expected to end in divorce by the 20th wedding anniversary
• 16% of marriages reach the 60th wedding anniversary without separation or death
• Those who marry younger are more likely to divorce. Having children or staying childless has no clear effect on risk of divorce
• While divorce rates are falling—people are getting married at older ages and are increasingly cohabiting beforehand—the number of divorces among the 60+ has significantly increased from 1991 to 2011
• Reasons proven for legal divorce:
--36% of divorces granted to men and 54% of divorces granted to women were due to unreasonable behaviour
--32% of divorces granted to men and 22% of divorces granted to women were granted following 2 years of separation and consent
--16% of divorces granted to men and 9% of divorces granted to women were granted following 5 years of separation
--15% of divorces were granted for adultery, same across genders
--Less than 1% of all divorces were granted due to desertion
• In 2010-11, one third of all children aged 16 and under were not living with both of their birth parents
• Almost 25% of families in the UK are lone parent families
--44% of resident parents said their child either splits their time equally, or sees their other parent at least weekly
--29% of resident parents said that their child never sees their other parent
--20% of all resident parents said that their child has not seen their other parent since separation
• There are 7.7 million families with dependent children:
--4.7 million (60%) are married couple families
--1.2 million (15%) are unmarried opposite sex couple families
--1.9 million (24.5%) are lone parent families (8.8% of lone-parent families are lone-father families, the remainder are lone mother families)
--8,000 (0.001%) are civil partnered couple families
--5,000 (0.001%) are same-sex cohabiting couple families
• The first UK civil partnership was on the 5th December 2005: approximately 120,908 individuals entered civil partnerships between 2005 and 2012
• The number of civil partnership dissolutions granted in 2012 was 794, an increase of 20% on the 2011 numbers. By the end of 2012, 3.2% of male and 6.1% of female civil partnerships in England and Wales had ended in dissolution

Relate also offers 6 secrets of how Relationship Counselling works, and from the Huffington Post: Everything You Need To Know About Premarital Counseling.

The top-10 nations for divorce
It’s nice for Belgium to have something to be famous for: It’s the country with the highest divorce rate in the world.
     According to The Richest: “A first glance, Belgium appears an example of European modernity: a nation with a rich history and splendid architecture which is the centre of power for the European Union and Parliament. Dig a little deeper, however, and you’ll realise that all is not well in the nation so famous for its chocolate. Politically, Belgium is fiercely divided between the French speaking south, which includes the capital Brussels, and the Flemish speaking north, close to Holland. The nation is so divided that successive elections have resulted in collapsed governments with Belgium going a record 535 days without a government as a result. Against this backdrop divorce levels have been climbing, with the decline of the Church cited as a key factor in these figures.”

Three poems
Love poem
I live in you, you live in me;
We are two gardens haunted by each other.
Sometimes I cannot find you there,
There is only the swing creaking, that you have just left,
Or your favourite book beside the sundial.
—Douglas Dunn

To a stranger
Passing stranger! you do not know how longingly I look upon you,
You must be he I was seeking, or she I was seeking, (it comes to me,
as of a dream,)
I have somewhere surely lived a life of joy with you,
All is recall'd as we flit by each other, fluid, affectionate,
chaste, matured,
You grew up with me, were a boy with me, or a girl with me,
I ate with you, and slept with you- your body has become not yours
only, nor left my body mine only,
You give me the pleasure of your eyes, face, flesh, as we pass- you
take of my beard, breast, hands, in return,
I am not to speak to you- I am to think of you when I sit alone, or
wake at night alone,
I am to wait- I do not doubt I am to meet you again,
I am to see to it that I do not lose you. 
—Walt Whitman

On Raglan Road
On Raglan Road on an autumn day I met her first and knew 
That her dark hair would weave a snare that I might one day rue; 
I saw the danger, yet I walked along the enchanted way, 
And I said, let grief be a fallen leaf at the dawning of the day. 

On Grafton Street in November we tripped lightly along the ledge 
Of the deep ravine where can be seen the worth of passion's pledge, 
The Queen of Hearts still making tarts and I not making hay - 
O I loved too much and by such and such is happiness thrown away. 

I gave her gifts of the mind I gave her the secret sign that's known 
To the artists who have known the true gods of sound and stone 
And word and tint. I did not stint for I gave her poems to say. 
With her own name there and her own dark hair like clouds over fields of May 

On a quiet street where old ghosts meet I see her walking now 
Away from me so hurriedly my reason must allow 
That I had wooed not as I should a creature made of clay - 
When the angel woos the clay he'd lose his wings at the dawn of day.
—Patrick Kavanagh (sung here by Sinead O’Connor and here by Van Morrison and here by Mark Knopfler)

My Funny Valentine
Chet Baker sings it in 1959, 29 years old, already a hardened heroin addict, but with the sweet voice of an angel. You can see the ravages of time and hard drugs when he plays it again 28 years later in concert in Tokyo. A year after that he fell to his death from a hotel room in Amsterdam.

Obligatory quote from Gandhi
“Where there is love there is life"

The NHS: “The psychiatric system is in meltdown”
According to recent research by the Mental Health Policy Group, mental illness accounts for 23 per cent of the total impact of ill health but only gets 13 per cent of the NHS budget. The number of beds for mental-health patients has fallen by 8 per cent since 2011, according to a Care Quality Commission report, and last year, 236 young people with mental-health problems were placed in police cells because of a shortage of beds.
     Even more are treated miles from their homes because of chronic shortages of beds for in-patient care.
     “The psychiatric system is in meltdown due to the long-term relentless agenda to close psychiatric beds to save costs and treat everyone, however severely disturbed or in crisis, under the care of already overstretched and demoralised community home- treatment teams,” says Marjorie Wallace, chief executive of the mental health charity Sane. (Telegraph.co.uk)
• NHS: Number of children in A&E suffering from mental ill-health DOUBLES

Mind responds to “Policing and mental health"
The Home Affairs Committee of the House of Commons has today published its report, “Policing and mental health.” The report found that the prevalence of people with mental health illness in the criminal justice system is too high, and calls for changes to be implemented to ensure that nobody who has reached crisis point should be put in a police cell or be transported in a police van because appropriate health services aren’t available. Sophie Corlett, Head of External Relations for the mental health charity Mind, said:
     “We welcome the findings of today’s report, which highlights some of the real problems for people when they experience a mental health crisis. Nobody who has reached crisis point should be put in a police cell or be transported in a police van because appropriate health services aren’t available. We welcome the emphasis over the last year on addressing this, particularly through the Crisis Care Concordat which Mind is co-delivering. (Mind)

More online abuse cases for charity
The number of children being counselled through ChildLine about online sexual abuse has more than doubled, according to the charity.
ChildLine said it carried out 2,842 counselling sessions on the matter in 2013-14, a 168% increase from 2012-13.
he findings follow a separate report, carried out by the NSPCC late last year, which found that social workers are struggling to keep pace with emerging types of child sex abuse like sexting and revenge porn. (Daily Mail)

UK detention policy worsens migrants' mental health
This month, the UK parliament is due to release findings of an inquiry into the detention of migrants and asylum seekers, prompted by high profile incidents of sexual abuse and deaths. Unlimited immigration detention contributes to – and can even cause – lasting mental health problems among detainees, according to IRIN interviews with former detainees, aid and advocacy groups and UK court decisions.
Several studies have examined the impact of immigration detention on mental health. A review of 10 of these studies by specialists who gave evidence to the inquiry found that they all “reported high levels of mental health problems in detainees. Anxiety, depression and post-traumatic stress disorder were commonly reported, as were self-harm and suicidal ideation. Time in detention was positively associated with severity of distress.” (IRINnews.org)

Annual report on US college students' mental health
The Center for Collegiate Mental Health (CCMH), founded by and housed at Penn State’s Counseling and Psychological Services, Thursday (Feb. 5) released its sixth annual report, which describes more than 100,000 college students seeking mental health treatment at 140 colleges and universities.
Easily the largest and most representative of its kind, the report summarizes trends in college student mental health during the last six years. Among its findings, the report indicates that rates of self-injury and suicidal thoughts are on the rise
Highlights from the report’s data, encompassing college students who have been seen in college and university counseling centers, note that:
◦   1 out of 2 have been in counseling;
◦   1 out of 3 have taken a psychiatric medication;
◦   1 out of 4 have self-injured;
◦   1 out of 3 have seriously considered suicide;
◦   1 in 10 have been hospitalized for psychiatric reasons;
◦   Nearly 1 in 10 have made a suicide attempt;
◦   1 out of 5 have experienced sexual assault;
◦   1 out of 3 have experienced harassment or abuse; and
◦   1 out of 3 have experienced a traumatic event.
Trends of note include the following:
• Rates of self-injury and serious suicidal ideation appear to be increasing; and
• Rates of sexual assault, harassment and treatment for drug/alcohol abuse appear to be decreasing slightly.
As judged by thousands of counselors nationwide, the top 10 primary presenting concerns of students, listed in descending order, are:
1. Anxiety
2. Depression
3. Relationship problems
4. Stress
5. Academic performance
6. Family
7. Interpersonal functioning
8. Grief or los
9. Mood instability
10. Adjustment to a new environment. (Penn State News) 

Higher mortality linked with mental ill-health
Individuals with mental health disorders have a risk of mortality that is two times higher than the general population or than individuals without such disorders, according to a study published online by JAMA Psychiatry.
     The link between mental health disorders and mortality is complicated because most people with those disorders do not die of their condition. Also, mental health disorders are associated with risk factors for mortality. Quantifying and understanding mortality among people with mental health disorders can inform approaches to address the issue, according to the study background. (Medical Xpress)

Stress caused by discrimination linked to mental health issues among Latino teens
Latino adolescents who experience discrimination-related stress are more likely to experience anxiety, depression, and issues with sleep, according to research led by NYU's Steinhardt School of Culture, Education, and Human Development. These mental health outcomes were more pronounced among Latino teens born in the U.S. to immigrant parents, as opposed to foreign-born teens. (Medical Xpress)

Indian helpline in UAE receives 70000 calls in 4 years
DUBAI: A toll-free helpline set up by India to deal with problems of 20 lakh [2 million] Indians in the UAE especially the blue-collar workers has received almost 70,000 calls since its inception four years ago.
The Indian Workers Resource Centre, an outsourced facility, was inaugurated by then president Pratibha Patil during her visit to the UAE in November 2010. (Times of India)

New Zealand: High demand for new online counselling service
The 0800 What’s Up online counselling pilot for young New Zealander’s is exceeding expectations with demand doubling since its launch last October.
The service is the first of its kind in New Zealand and is a response to the changing needs of young people and their preferred method of gaining support.
0800 What’s Up counsellors have completed over 1400 online chat sessions since the launch of the pilot. 0800 What’s Up Manager Rhonda Morrison says the service needs more resources to manage demand as almost half (42%) of children who want to chat to a counsellor online do not get their chat answered. (Scoop.co.nz)

Psychotherapy works, but not for everyone
Writes Allen Frances: There is no doubt that psychotherapy works for most of the mental disorders. If the interventions we use are potent enough to create positive change, it should not come as a surprise that they are potent enough to damage people as well. It is estimated that as many as 15 % of patients get worse following treatment.
Negative effects come in two major forms: 1) worsening of problems already present, such as hopelessness or depression; and 2) new problems might emerge, such as becoming dependent on the therapist, marriage issues, or reduced self-image.
Often the patient is blamed when therapy doesn't work, labelled as "treatment-resistant" or "unable to profit from therapy". This is sometimes true, but is the least fruitful approach for explaining negative outcome. Sometimes the therapy technique is dangerous. Recovered-Memory Techniques and Dissociative Identity Disorder-Oriented Psychotherapy should come with a warning sign.
And most important is the therapist. Some therapists are empathic and intuitive, ask for feedback, evaluate the therapy, and share the goal and process continuously with the patients. Others fall short on one or all of these critical dimensions. It may not be the technique that is harmful, but rather the wrongful use of it. (Huffington Post)

Three days after Christmas, at 2.30 in the morning, 17-year-old Leelah Alcorn was walking along Interstate 71, a few miles from her home in Ohio. She stepped out onto the tarmac, was hit by a truck, and killed.
     She had arranged for her suicide note to be posted on her Tumblr account that evening. “I’m never going to be happy with the way I look or sound,” the note said. “I'm never going to have enough friends to satisfy me. I'm never going to have enough love to satisfy me.” Alcorn described in the note how she had felt “like a girl trapped in a boy's body” since the age of four, and at 14 came to identify herself as a transgender female, when she discovered, to her immense joy, that such people existed, and she was not alone.
      In the aftermath of Alcorn’s death, a lot of criticism was levelled at her parents, described as conservative Christians who could not accept their little boy’s sexuality and desire to be a girl. It's understandable that such a scenario would be difficult, potentially devastating, for any parent. But Alcorn's parents responded to her coming by taking her out of school and enrolling her instead in an online academy, cutting off all her access to social media, and taking away her phone.
      The note continued: “Either I live the rest of my life as a lonely man who wishes he were a woman or I live my life as a lonelier woman who hates herself. There's no winning. There's no way out.”
      The suicide note went viral—until the family asked for it to be removed from social media a few days later. It inspired vigils for Alcorn in cities across America and internationally, too, including in Trafalgar Square last month. It sparked a general raising of consciousness of the plight of transgendered people the world over.
     The facts:
• Although the word “transgender” wasn’t invented until 1971, transgenderism is not some contemporary fad—it’s as old as humanity. Elagabalus, Roman Emperor from 218 to 222, was said to be transgendered, and in ancient civilisations, “two-spirit” people were often called on to perform religious or cultural ceremonies;
• An estimated 2 to 5 percent of the population experience some degree of gender dysphoria;
• About 1 in 12,000 males and 1 in 34,000 females undergo gender reassignment;
• 90 percent of transgendered adults have experienced discrimination at work;
• 50 percent have been raped or assaulted by a partner;
• 41 percent have attempted suicide;
• 20 percent are homeless;
• Trans women have a 1 in 12 chance of being murdered—or 1 in 8 for trans women of colour.

Dire straits
One of Alcorn’s despairing parents’ strategies to make their child “normal” was to send her for “conversion therapy,” which claims to be able to change a person’s sexual orientation.
     This kind of thing was quite common back in the day, when techniques included hypnosis, testicular transplants, electric shocks to the genitals, masturbatory reconditioning, spiritual damnation, and prayer. It was as effective then as it is today, which is to say not at all. It’s a practice that’s fuelled by a certain kind of religious fundamentalism and has been derided as a ridiculous and doomed attempt to “pray the gay away.” A consensus has finally emerged that homosexuality is not some kind of aberrant pathology, an abnormality in need of a cure, though this took a long time: It was only removed from the Diagnostic and Statistical Manual of Mental Disorders as recently 1973, and even made a brief reappearance—“ego-dystonic homosexuality”—in 1980.
     Says the American Psychological Association: “The idea that homosexuality is a mental disorder or that the emergence of same-sex attraction and orientation among some adolescents is in any way abnormal or mentally unhealthy has no support among any mainstream health and mental health professional organizations ... efforts to change sexual orientation through therapy have been adopted by some political and religious organizations and aggressively promoted to the public. However, such efforts have serious potential to harm young people because they present the view that the sexual orientation of lesbian, gay and bisexual youth is a mental illness or disorder, and they often frame the inability to change one’s sexual orientation as a personal and moral failure.”
      Conversion therapy is already illegal in New Jersey and California; attempts to ban it in other states—Virginia, Illinois, Maryland, Minnesota, New York, Washington, Ohio, Florida, Wisconsin, Hawaii and Rhode Island—have thus far been voted down or withdrawn. Oklahoma has recently been vying to position itself as the nation’s most homophobic state by proposing a law that would protect the right of its citizens to waste their money on attempting to force their children to stop being gay.
     Even China is more enlightened: a court in Beijing recently ordered a private counselling center in Chongqing to apologise and pay compensation to a 30-year-old man for providing him with “gay cure” treatment, and ordered all ads for similar services to be removed from Baidu, China’s equivalent of Google.
     In the U.K., an alarming 2009 study found that out of 1,328 therapists surveyed, 222 (17 percent) had attempted to change the sexual orientation of at least one client, and 55 of them would continue to do so. The issue received much greater attention with the case of Leslie Pilkington, a Christian counsellor who attempted to “cure” undercover journalist Patrick Strudwick; in 2012 she was struck off the register of her professional body, the British Association for Counselling and Psychotherapy. The following year, health minister Norman Lamb called conversion therapy “abhorrent,” something that has “no place in a modern society,” but said there were no plans for a ban.
      Last month, NHS England and more than a dozen leading organisatons released a memorandum of understanding on conversion therapy. Guidelines will be published—GPs are not to refer patients for conversion therapy and no-one employed by the NHS can provide it. And just this month, a consensus statement was released, a unanimous condemnation of thee practice from all the leading counselling, psychotherapy and psychology bodies. Lord Black, the Executive Director of the Telegraph Media Group, has campaigned for a ban, and a 2013 motion calling for a government ban on conversion therapy for under-18s was signed by 55 MPs.
      Some more stuff:
• Stephen Fry meets the founder of the National Association for Research & Therapy of Homosexuality, Dr. Joseph Nicolosis: click here.
• “Pray the gay away—exposed”: Amusing sex education vlogger Laci Green speaks out: “Gender and sexual orientation exist on a broad spectrum,” she says. “There’s no normal. There’s only more common. Failure to accept this simple fact has serious consequences”: click here.
• Some experiences of conversion therapy in the U.K.: “It’s really sad I spent three years of my life trying to do something that was impossible”: click here and click here.
 
Fix society
Leelah Alcorn’s suicide note ended: “My death needs to mean something. My death needs to be counted in the number of transgender people who commit suicide this year. I want someone to look at that number and say ‘that's fucked up’ and fix it. Fix society. Please.”
     Alcorn’s story does mean something. So do recent stories like the gender reassignment of Olympic gold medal decathlete Bruce Jenner, and former boxing promoter Frank Moloney, and the stories of famous trans people like Chaz Bono, Eddie Izzard, Danny La Rue, Chelsea Manning, Jan Morris and Grayson Perry—to name just a very few.
     On January 20, 2015, Barack Obama became the first American President to mention transgender people in the State of the Union Address: “Condemn the persecution of women, or religious minorities, or people who are lesbian, gay, bisexual, or transgender.”
     If you or someone you know might need help with transgender issues, there is now plenty of good information online, starting with the NHS, the American Psychological Association; for further information, here’s a list of useful resources.
     As for conversion therapy, a change.org petition to ban it in America—called “Leelah’s Law”—now has more than 340,000 signatures; another White House petition received more than 100,000 signatures in January, meaning President Barack Obama’s administration must formally respond to the request. The #BornPerfect campaign took their case to the United Nations Committee Against Torture. One way or another, conversion therapy seems to be inexorably heading for retirement in the therapeutic curio cabinet, along with skull drilling, lobotomies, leeches, and various treatments for “female hysteria.”
     Therapy (and life) isn’t about trying to make yourself become someone you’re fundamentally not. It’s not about trying to change other people, either. Better to be who you are—and let other people be who they are, too, as opposed to who you think they should be. Whether we’re part of the mainstream or we live more towards the margins of one bell curve or another, we all want acceptance and freedom. We all want to live in a fair, inclusive and peaceful society rather than a prejudiced, oppressive and violent one. A society that doesn’t condemn some of its teenagers, consigning them to life and death on a very lonely highway.

Despair goes digital
Therapy is 50 minutes spent sitting (or lieing) in a sombre room talking to a mysterious chin-stroking professional. Right? No! Sometimes therapy does actually manage to break out of the consulting room. There is counselling at home, in schools and in workplaces. There are drop-in counselling centres, counselling cafes near and far, therapy in taxi cabs, sidewalk psychotherapists. And then of course most counselling takes place quite naturally, for free, in the community, from family, friends, colleagues, spiritual leaders—or strangers in the checkout queue.
     Increasingly, too, technology is providing new, alternative forms of help. You don’t have to call the Samaritans—these days you can email or text if you’d prefer. There are some really good online resources including websites offering self-administered help. There are mental health apps. And there is social media—a global audience of fellow travellers to support and be supported by.
    Two stories from this week:

• #timetotalk: Is social media helping people talk about mental health?
More people than ever before are talking about mental health online.
Whether through blogs, videos or tweets, candid conversations about mental illness can be found across the spectrum of social networks we interact with on day-to-day basis. According to a survey by Time to Change, released for Time to Talk Day, 47% of people aged 21 and under said they find it easiest to talk about their mental health problems online (compared with 49% who said face to face and 4% who said over the phone).
Mental health charities have long known the benefits of social media. Mind has its own social network called Elefriends, Time to Change regularly hosts blogs on its site and, just last week, a new platform for videos on mental health called It Gets Brighter was launched. (The Guardian)

• R U There? A new counselling service harnesses the power of the text message
Depression is common among teens, and its consequences are volatile: suicide is the third leading cause of death for Americans between the ages of ten and twenty-four. In that same age group, the use of text messaging is near-universal. The average adolescent sends almost two thousand text messages a month. They contact their friends more by text than by phone or e-mail or instant-message or even face-to-face conversations. (The New Yorker)

Other stories
• Suicide in America
Over 40,000 Americans took their own lives in 2012—more than died in car crashes—says the American Association of Suicidology. Mondays in May see the most incidents. The rates are highest in Wyoming and Montana, perhaps because guns—which are more effective than pills—are so common there (see chart). Nationally, guns are used in half of all successful suicides . . . Making it slightly harder to kill yourself is also surprisingly effective. American pharmacists still sell painkillers loose in pots, enabling people to pour the whole lot down their throats in one movement. This is unwise. After Britain switched to blister packs in 1998, which require you to punch pills out one by one, deaths from overdoses of paracetamol (the active ingredient in Tylenol) dropped 44% in 11 years. (The Economist)

• Corrie star “abandoned by friends over mental health”
Coronation Street star Beverley Callard has revealed how friends distanced themselves and 'abandoned' her after learning of her battle with depression.
The actress, who plays Liz McDonald on the ITV soap, said people battling mental illness should be encouraged to share their fears with those close to them.
The 57-year-old, who has fought depression and attempted suicide in the past, told BBC Radio Manchester it was easy for sufferers to feel isolated and alone. 
‘I had one person say to me, and we'd been friends for a long time, "I don't think we should see each for a while because you're not yourself and you're not good for me",' she said.
'We actually got way beyond that, but at that time I felt abandoned by lots of people - and I think many people do.'
Beverley said she believes the stigma attached to mental health issues can prevent people discussing their problems with family and friends.
She said: 'We say to someone "how are you?" but more often than not we actually don't wait for the answer.
'If you just get the feeling that someone you know is suffering is sad say, "how are you? Do you want to talk about it?" (Daily Mail)

• “Meaning-Centered” group therapy beneficial in advanced cancer
Meaning-centered group psychotherapy (MCGP) is effective for reducing psychological distress and improving spiritual well-being in patients with advanced cancer, according to a study published online Feb. 2 in the Journal of Clinical Oncology.
William Breitbart, M.D., from the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues examined the efficacy of MCGP to reduce psychological distress and improve spiritual well-being among 253 patients with advanced cancer. Participants were randomized to manualized eight-session interventions of MCGP or supportive group psychotherapy (SGP). Patients were assessed for spiritual well-being and overall quality of life as well as secondary outcome measures before and after completing treatment and at two months after treatment. (Doctors Lounge)

• Bicycles aid counselors at Kakuma refugee camp
Kakuma refugee camp hosts more than 170,000 refugees from about 12 African countries, with the largest populations having fled Somalia, South Sudan and Sudan to avert violence and famine. Jesuit Refugee Service has provided services in Kakuma since 1994, and is currently the only organization in the camp that provides psychosocial support.  
Jesuit Refugee Service Eastern Africa provides individual and group counseling, runs a specialized facility for the protection of women and children suffering from sexual and gender based violence (SGBV) and implements a mental health program that provides education and life skills for refugees with learning disabilities.
As part of JRS psychosocial services in Kakuma, 540 refugees serve as peer counselors for more than 2,000 fellow refugees. In addition to the direct service provided those being counseled, the peer counseling program also serves as leadership development for counselors as they strive to improve their own community. This is in line with our mission of accompaniment, working with instead of for refugees, empowering them to lead their own communities, transforming their own realities. 
Despite efforts of peer counselors, one of the biggest issues they face, especially women, is lack of safety when traveling to and from the counseling site in the sprawling refugee camp. Peer counselors, many female, walk long distances through what is essentially a large town to reach refugee families needing psychosocial care. Bicycles allow counselors to travel more quickly and safely around Kakuma and to reach many more families. (Jesuit Refugee Service)

• Mental health in Lebanon
 “There is tremendous need for mental health services in Lebanon. What’s changing is that people are more open to receiving psychiatric care,” says LAU’s new head of psychiatry, Dr. Elias Rizkallah Abou Jaoude, who is helping set up the School of Medicine’s new psychiatry service and residency program . . .
What is somewhat unique to Lebanon, however, says Abou Jaoude, is medication addiction and post traumatic stress disorder (PTSD) “because of the ease with which people can buy medication without prescription and the endless traumas that people in this population are subjected to.” (Lebanese American University)

In the 66-year history of the NHS, the number of beds available for psychiatric patients has declined spectacularly. It stood at about 150,000 in the 1950s—when the U.K. population was considerably less. Today—accelerated by the current austerity drive—it has sunk to around 16,000. Given that about 30 percent of ill-health in the U.K. is characterised as mental ill-health, and 1 in 4 people will experience some kind of mental health problem in the course of a year, that’s scandalously low. Vulnerable people are left to languish on waiting lists, sometimes for a year or more. Recently, a 16-year-old with mental health issues was sectioned but since there were no beds available, she was kept in a police cell for almost two days. Seven mental health patients have killed themselves in England since 2012 after being told there were no free hospital beds.
     Similarly, in the U.S., 560,000 patients were cared for in state psychiatric facilities in 1955; today—with a population that has doubled—that number has fallen 45,000. In our advanced, sophisticated societies, a large, powerless swathe of the population has been abandoned.
     Is it time to reconsider the asylum? A new paper published in the Journal of the American Medical Association (JAMA) says, well, yes.
     But first, a potted history: Bethlem Hospital, founded in 1247, was for centuries a dumping ground for London’s dispossessed. “Bedlam,” and the other asylums that followed, were places where those already suffering were warehoused and often cruelly punished for being “mad.” Then along came William Battie, author of “A Treatise on Madness” in 1758, who argued that asylums should be places of refuge, of healing, of rehabilitation. Some attempted to live up to that utopian vision. Many did not.
     In 1961, then-health minister Enoch Powell made a controversial speech (another one!) in which he pronounced that mental hospitals had become prisons, and their inmates “institutionalised”—they’d be much better served, he said, by “care in the community.” He may have been motivated more by economics than ethics, but it coincided with the development of powerful new antipsychotic medications, and emerging ideas around patient’s rights from the civil rights movement. The 1960s saw the “antipsychiatry movement” develop, led by the likes of R. D. Laing, Thomas Szasz and Jacques Lacan—they argued that mental illness was a construct, that psychiatric treatments were often damaging and oppressive, and that people had the right to be different and not be locked up and forcibly sedated.
     There were horrendous revelations in the 1980s of gross misconduct, abuse and brutality at places like Broadmoor, Rampton and Ashworth (a recent TV documentary on Broadmoor presented an altogether more uplifting story). Films like “One Flew over the Cuckoo’s Nest” played into—and added to—a culture of fear and loathing of asylums. They fell out of favour, squeezed by both sides of the political divide. A few criminal, high-security asylums like Broadmoor remain, but the rest—at one time there were 120 in England and Wales alone--were closed, the grand Victorian buildings sold off to developers. The money largely did not go towards mental health service provision. The former residents often found there was no care, no community.
     In the U.S., it was a similar story. Says the JAMA paper:

Social, political, and economic forces coalesced to move severely mentally ill patients out of psychiatric hospitals. The opening of the “back doors” of state hospitals in the 1940s and 1950s marked the first phase of deinstitutionalization, as long-stay chronically ill patients were discharged. In the 1960s and 1970s, the civil rights movement propelled deinstitutionalization. Shocking reports about abuses at hospitals, such as Massachusetts’ Bridgewater State Hospital, offended the public consciousness and added momentum to closures of psychiatric hospitals. Formerly institutionalized patients who self-identified as “psychiatric survivors” had developed alternative models of peer-facilitated community treatment such as Fountain House in New York City. These models seemed like viable alternatives to institutions. New drugs, especially chlorpromazine, made outpatient options and the ability to live independently seem both liberating and promising.

     The reality has been somewhat different. Continues the report:

Deinstitutionalization has really been transinstitutionalization. As state hospitals were closed, patients with chronic psychiatric diseases were moved to nursing homes or to general hospitals where they received episodic psychiatric treatment at significantly higher costs. Others became homeless, utilizing hospital emergency departments for both care and housing . . . Most disturbingly, US jails and prisons have become the nation’s largest mental health care facilities. Half of all inmates have a mental illness or substance abuse disorder; 15% of state inmates are diagnosed with a psychotic disorder.

     Concludes the report:

For persons with severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community-based treatment, the choice is between the prison–homelessness–acute hospitalization–prison cycle or long-term psychiatric institutionalization. The financially sensible and morally appropriate way forward includes a return to psychiatric asylums that are safe, modern, and humane.

     “It’s really not as radical as it sounds,” the report’s lead author, Dominic A. Sisti, told Quartz. Psychiatrists have been making arguments for expanding long-term inpatient care for some time, he says. Politically, economically and emotionally, there’s probably little appetite for the return of lots of asylums. And a lot of Community Mental Health Teams do an excellent job, despite ever-dwindling resources. But there is something appealing about an array of psychiatric services that includes the possibility of refuge in “safe, modern, and humane” patient-centred facilities, somewhere to go besides A&E, prison or the street, where the focus is on care rather than confinement, development rather than detention, rehab rather than restriction. Where the original meaning of the term asylum—a place of sanctuary, support and treatment—is honoured. Where the staff aren’t like Nurse Ratched.
      More than a quarter of a millennium ago, Battie wrote that we have the pleasure “to find that Madness is, contrary to the opinion of some unthinking persons, as manageable as many other distempers, which are equally dreadful and obstinate, and yet are not looked upon as incurable: and that such unhappy objects ought by no means to be abandoned.”