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Death penalty for being abused? The price is too high for society and disadvantaged young people

 

Young people who had been in the care system are far more likely to die in early adulthood than their peers, a report showed last week; indeed they are at least 7 times more likely to die prematurely, before the age of 21. The BBC story about this highlighted poor access to mental health services, the lack of general support available, and the consequent over-use of drugs, alcohol and other forms of unhealthy self-medication and attempts to manage stressors.

I have worked with children in the care system for over 30 years and at least the research is showing what we have always known clinically. Bad early experiences lead young people to use drugs, alcohol, take risks in sexual and other behaviours, but also to struggle academically, socially and in their emotional wellbeing generally. Most of my most worrying cases in the NHS have been in the care system, and major crises often occur at the age when they are supposed to become ‘independent’ at the age when most well-adjusted children from loving families in fact rely on their families more than ever.

 

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Obesity, unhappiness, and poverty: the urgent need to avoid simplistic solutions

A version of this blog can also be found on the Tavistock and Portman NHS Foundation Trust website here, 

An NHS Trust in Yorkshire recently decided to deny non-urgent treatment to obese patients and also to smokers. A recent guardian article called this a form of discrimination similar to racism. It is true that we are facing an epidemic of obesity and linked health issues including diabetes and heart conditions. The solution is not to discriminate against or blame people who in many ways are already victims. There is a danger that our discourses about food and obesity become another way of blaming the poor for their poverty and its effects. People are criticised for being lazy, greedy, lacking control or selfish, yet often what drives eating is far outside consciousness and has sensible explanations.

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Austerity, psychotherapy and worsening mental health

 

An important letter and accompanying report was published in the national press this week abhorring the effects of austerity and neoliberal politics on mental health services and on mental health generally . This is timely, not just because of the election, but because of the spiraling risks for now and for the future. Anyone working in services knows how they are being severely cut, making it harder and harder to access the kind of help that is needed. Only short-term ‘revolving door’ services are available to people in very serious need. Children’s mental health services are the most poorly funded, much less than adult mental health services which in turn have a fraction of health budgets. As an investigation by the charity Young Minds recently showed, children’s mental health services are in crisis.

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cooperating and helping others reduces stress and improves health

A couple of very interesting studies came out in the last few weeks which might surprise those who believe that monetary and material success is the best way to health and happiness. One huge new study is just published by the American Psychological Association. This was led by Lara Aknin [1] who has done a massive amount of research on altruism and wellbeing. Amazingly this found a positive relationship between personal well-being and spending on others in 120 of 136 countries covered in the 2006-2008 Gallup World Poll. The survey comprised 234,917 individuals, half of whom were male, with an average age of 38. The link between well-being and spending on others was significant in every region of the world, irrespective of factors like income, social support, perceived freedom and national corruption.

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Empathy, feeling good and healing

Empathy and its effects have been known about for a long time now, but recently a new and very large study has illustrated this in a fascinating way. The study, a collaboration between Thomas Jefferson University and some Italian researchers, looked at  a huge sample of over 20,000 patients and 242 doctors [1]. They used a validated scale to measure empathy, a scale designed especially for use in medical settings (Jefferson Scale of Empathy (JSE)) which assesses levels of understanding of a patient's worries, pain, and suffering, as well as the extent of an intention to help.  They found that significantly more patients with doctors who showed high empathy had lower blood sugar and cholesterol levels, and indeed they had considerably fewer complications leading them to be hospitalized. There have been many smaller scale studies in recent years that have shown similar results. For example a study a few years ago found that, looking at  patients  with similar symptoms and backgrounds, those with more empathic doctors recovered from the common cold on average a day quicker, and had better immune responses [2].

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Childhood adversity and adult health problems, a costly link

At times of severe cuts to services it is worth pointing out that, if not treated, early experiences of maltreatment, abuse and neglect can cause terrible problems later on, problems that have a huge cost to society. It is increasingly common knowledge that adverse early experiences, like abuse, neglect and exposure to violence, can play havoc with people’s mental health and affect them right into adulthood. For example a massive recent study from the University of Liverpool  [1] analysed findings going back some 30 years, looking at 27,000 research papers and found conclusive evidence that early childhood trauma hugely increases the risks of these children growing into adults who will suffer from schizophrenia. The risk was at least 3 times greater for those abused, but the worse the trauma the more the likelihood, in some cases extreme trauma increasing the likelihood by up to 50 times. Another recently published study [2] described how early child maltreatment, whether sexual, physical or emotional abuse, or neglect,  badly effects peoples’ later romantic relationships, leading people to feel less fulfilled in relationships, and much of the effect was mediated via serious self-criticism, as well as post-traumatic stress symptoms.

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