The Observer front page on Sunday last ran the headline:

Four psychiatric patients dying every day in NHS care

In the safety conscious NHS culture, every time something untoward happens an incident form is filled in.  An incident form should be completed if, for instance, a patient was given  by mistake 10mg of Olanzapine rather than 5mg.  Sometimes the incident can actually be quite trivial.  I have filled in incident forms on three occasions, once when patient had a heart attack in my office, once when  patient scarpered before I’d finished assessing him and once when, on the side of a table, I ripped a brand new pair of trousers on the first day I wore them.

The National Patient Safety agency  collect details of these patient safety related incidents (my third incident wouldn’t be included in this).  These are published on their website on a trust by trust basis.  According to the Observer, The Liberal democrats have added up the number of deaths across the country 2007-08 and have come up with a figure showing that 1282 people died in patient safety incidents in mental health settings.  The Observer reports what Normal Lamb, the Liberal Democrats Health spokesman, has to say about their calculation:

These figures are shocking. It’s a scandal that four people a day are dying while under the care of the NHS, and nearly three a day are ending up seriously harmed. It’s an appalling indictment of NHS psychiatric care.

These deaths are the result of inadequate attention and resources being given to mental health, despite the patients being among the most vulnerable and needy in the whole health system

Now, I’m not about to argue that mental health care in the NHS is ideal, nor that it’s not underfunded.  However without further breakdown as to the circumstances surrounding each death or serious injury I don’t think that it’s fair to reach these conclusions.  A proportion of these deaths will be due to suicide and, although the numbers of these have reduced, they will be difficult to stop entirely.  But there will also be a large number due to natural cause.  A lot of people work within difficult mental health settings at only small personal gain; their care will not be perfect but this represents a disservice to their hard work.

Celebrity watch:

Ronny O’Sullivan who defends his world snooker championship title next week talks in the Guardian about the problems he has encountered with depression.  Seemingly an extremely intense man, he appears to have discovered that running helps him cope. 

O’Sullivan is a fanatical runner and its impact on helping him cope with depression is profound. “Running clears my mind, and gives me a reason to get out of bed in the morning. Once I’ve had a run I can hit some balls for a couple of hours and by then it’s the afternoon and I think, ‘Yeah, it’s been a positive day, really.’”

Sublimation was Freud’s name for it.

Phil Spector, 1960s pop supreme inventor of the ‘Wall of Sound’ and dubbed the ‘first tycoon of teen’ by Tom Wolfe has been convicted of the murder of B movie actress turned nightclub hostess Lana Clarkson.  Spector had a reputation for eccentricity and talked during his trial about being on psychiatric medication.  My web searches haven’t come up with anything particularly illuminating concerning his mental health, although these people claim him as bipolar with this quote from the Observer. 

I consider myself a disturbed human being, but I’m under control. I’ve been blessed with a genius, but I’ve been punished with insomnia and manic depression. I’ve fought the devil for 20 years

I’m sorry I’m not writing much at the moment, I’ve got another bloody exam, but in the meantime:

Britain’s highest decorated serving soldier has criticised the provision of mental health care for UK soldiers: BBC: Veteran mental care ‘a disgrace’ and Ex-soldier’s battle for mental health 28 February 2009 / Guardian: Minister defends care given to war veterans 1 March 2009 / Independent: Soldiers rally to VC hero’s defence 2 March 2009 / Mirror: Young war veterans are three times more likely to kill themselves than civilians – exclusive / Independent: Dr Walter Busuttil: Some veterans have traumas from four conflicts 28 February 2009.  What interests me the most is that PTSD is always referenced in press and in popular discourse uncritically as if its validity were established beyond doubt, which illustrates how willing British society has become to describe our difficulties in terms of psychological disorders. 

Whilst I am on the subject, it may soon be quicker to list the things that don’t give you PTSD than the things that do.  Here the the Guardian website reports, with the help of the BMJ Strokes can give you post traumatic stress 27 February 2009

AstroZeneca is in trouble with its antipsychotic medication Quetiapine regarding when the company knew this medication increased the risk of developing diabetes.  Nine thousand US citizens are taking court action, saying that they have been harmed by the medication.  The Wall Street Journal reports that there are allegations that the company sought to suppress unflattering studies.  The Times reports on 27 February that concern about AstraZeneca’s conduct over Quetiapine has cost the company 7% of its share price.

In mid February, it was speculated that psychiatrists might recommend that Peter Sutcliffe the Yorkshire Ripper could be realised – Ripper’s fit to be released from Broadmoor – Sun February 17 2009  Since the only UK prisioner less likely to be released is Ian Brady, one wonders why they didn’t save their breath.  And so it turned out:  Yorkshire Ripper Peter Sutcliffe likely to spend rest of life in jail Times 18 February 2009

As a science/medicine blogger, it’s sometimes difficult to find something current to write about that Ben Goldacre at Bad Science and Vaughn at Mindhacks haven’t already covered better than you.  Goldacre has an acute ear for folly, and is an expert at exposing bullshit.  Vaughn at Mindhacks is a powerhouse of intellect.  It’s been phasers on kill for them both against the article Well connected?: the biological implications of social networking Riposte: “Facebook causes Cancer” – Bad Science / Facebook causes marble loss – Mind Hacks.  Also try Age Concern backs social networks but Ben Goldacres blood pressure still rising – Technology blog Guardian 25 February 2009 and Facebook: it’s not neuroscience – Guardian Comment is Free 25 February 2009

Schizophrenia is the modern leprosy – Times 5 Feb
A man with a father and sister who suffer from schizophrenia criticizes the Time for change campaign as it considers all mental health disorders equally – commented on in letters Feb 7

What makes an arsonist? - Times Feb 10
There is a rising death toll from bush fires in Australia.  Some of the fires appear to have been started deliberately…

If we had turned away Churchill – BBC 9 February
On Newsnight last night, former spin supremo Alastair Campbell talked about his mental health problems and his contribution to the Time to Change Campaign

Woman in Mind, Vaudeville Theatre, London – FT 9 February
The FT has a review of this play by Alan Ayckbourn about a vicar’s wife and the aftermath of her head injury.  Apparently the main protagonist’s difficultly in understanding her peers once injured is illustrated to the audience by the play being in gibberish itself.  Sounds like an interesting device!

These nice people have mentioned me on their list 101 Fascinating Brain Blogs

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From the Independent, more reasons to keep teenagers at home Ketamine tops cocaine as new drug of choice. The day before they reported that coffee causes hallucinations

The great obesity myth in the Guardian Dr David Ashton argues that it is inappropriate that obese people are psychiatrically assessed before they have gastric banding surgery. He may be right, I don’t know, but the article didn’t point out that he was writing on behalf of his own weight loss company. He is thus bias with an interest in framing obesity as an addiction and anything that gets in the way of his approach (presumably anything psychological or psychosocial) as inappropriate.

And whilst I was looking into obesity, I happened upon a new condition that someone has made up. Orthorexia Nervosa which appears to apply to those people who have an anorexia type disorder and they will only eat healthy food. Sounds to me like you would need a fine pair of scales to distinguish it from common and garden variety anorexia nervosa. But what do I know?

Finally, in a week where there has been speculation about whether there will soon be a test for autism, and whether this will deprive us of the gifted. Anya Ustaszewski writes in the Guardian I don’t want to be cured of autism thanks. This one, as they say, will run and run.

Did anyone else see anything in the newspapers?

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Added 21 January 2009

Read about the ‘coffee causes hallucinations’ headlines on Bad science blog

In his classic examination of the 1929 Wall Street crash John Galbraith disabuses us of a widely held notion:

In the week or so following Black Thursday, the London penny press told delightedly of the scenes in downtown New York. Speculators were hurling themselves from windows; pedestrians picked their ways delicately between the bodies of fallen financiers.

In the United States the suicide wave that followed the stock market crash is part of the legend of 1929. In fact there was none. For several years before 1929 the suicide rate had been gradually rising. It continued to increase in that year, with a further and much sharper increase in 1930, 1931 and 1932 – years when there were many things besides the stock market to cause people to conclude that life was no longer worth living (chapter 8).

Galbraith goes on to say that in the two months following the crash the number of suicides in New York were actually comparatively low. There were in fact only two suicides on Wall Street, but these were undoubtedly dramatic. On Nov. 5, Hulda Borowski, a clerk who had been working at a Wall Street stock brokerage house for 28 years, leapt off a 40-story building; on November 16, three days after the market had taken another dive, G.E. Cutler, the head of a produce firm, climbed onto the ledge of his lawyer’s office and similarly plunged to this death.

Thankfully you can’t open the windows on tall buildings these days.

On the day Lehman Brothers was wound up I took a bus through the city and looked up once or twice from my book to see if there was anyone standing on any ledges. To my relief there was no one to be seen. Although vast sums of money have been lost, the crisis we are currently experiencing is nothing like as severe as the 1929 crash. Furthermore, thinking more broadly, predicting suicide is difficult; especially at the primary care level as depressive symptoms are common, but suicide rare. In 1998 Jenkins contended that in the UK every week 10% of 16-65 year olds report suicide depressive symptoms and 1% admits suicidal ideation, but set against this, only 0.01% will kill themselves. Previous attempts and self harm are risk factors for subsequent successful attempts; around a quarter of suicides are preceded by non-fatal self harm in the previous year (Owens and House 1994) and suicide incidence in those who have committed recent non fatal self harm is 1 in 100 over the next year, rising to 1 in 15 during 9 or more years.

The BBC has an interview with the grandson of a man who killed himself during the crash

There is one report of a banker taking his life.

Wall Street Suicides Slate

Time Magazine 80 days that changed the world – 1929

In a new report – ‘OECD (2008), Growing Unequal? : Income Distribution and Poverty in OECD Countries’ – by the Organisation for Economic Co-operation and Development, the UK has been found to have income inequality and poverty which is falling faster than any other OECD country.

Why is this interesting? Some people have plotted the prevalence of emotional distress present in the populations of different nations* against the income inequalities also present and found there to be a positive correlation between the two. The USA, which is a nation that has built its prosperity upon a high tolerance for inequality, is top of the pile, with both the greatest income inequality (ratio of top 20% vs bottom 20% of incomes) and highest presence of emotional distress; a more socially democratic nation like Germany has much lower levels of both inequality and emotional distress. So, if the UK is becoming less unequal, will we see an improvement in our levels of emotional distress the next time they are measured?

Alas it’s unlikely to be that simple. The causes for emotional distress are multi-factorial; two other possibilities for a nations’ distress are a lack of social mobility and highly invasive, dissatisfaction creating, advertising cultures. Indeed this latter influence has a name: ‘The Hello! magazine effect’, whereby despite being increasingly better off, people compare themselves with celebrities and celebrities wealthy chums and feel relatively impoverished as a result.

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Talking of celebrities and their chums, reality Queen Kerry Katona was on This Morning this morning and caused a stir ‘looking distracted and at times confused, slurring her words and almost unable to string a cogent sentence together ‘. You can watch her here and here. She said that she was taking Chlorpromazine and this was the reason for her slurred speech. I can’t be bothered to write a full post about this, but she actually didn’t seem too bad to me. Perhaps I’ve spent too much time hanging out with crack addicts in Hackney.

What did anyone else think?

* The measurement of this sort of thing is open to some debate of course.

Links for OCED

Guardian article Wealth gap narrows faster in UK than other developing countries 21 October 2008

OECD report Growing Unequal? : Income Distribution and Poverty in OECD Countries

This is Oliver James’ hobby horse

Hello Magazine effect discussed on Today 0709 and 0816