Link discovered between poverty and depression

[Cloud]

So can we put to bed the "money can't buy you happiness" bollocks that the rich always tell the poor then?

[Zetetic]

@TrenterPercenter

I appreciate the discussion, and I can only say that I note what you have been through and are going through. I don't think either of us are terribly mentally well right now, and that's not ideal for a conversation about stuff that we are both so emotionally invested in.


I really don't think this is about people in health services not being "progressive" enough or being "complicit". I've not described anyone as "complicit".

Here we have a branch of Psychologists for Social Change, for example, and they and others have the ear of the relevant Ministers, and they say the things you'd expect, stuff like this gets produced, and so on. Being generous I might even say that some of the schools-related stuff in this might be partly driven from that quarter (but mostly it's down to very different quarters).

Here, of course, the constraints are more explicit - the block grant is what it is, spend in every sector including health is pretty what it must be, and MHLD spend within that is locked within a %-point or so - and so, perhaps, the consequences are more obvious too. We too drain resource from one bit of the service to another, in an entirely earnest drive for greater efficiency and effectiveness. How else does one morally allocate scarce resources except in the way you think will do the most good?

What we try to run is never anywhere near enough, of course, and this is perhaps more obviously inevitably true here than almost anywhere else in Britain thanks to history and geography.

Yes but what has things like IAPT got to do with this? This is an overly simplistic view of the last 50 years; it was the Northwick Studies of 1986 that were the real catalyst for EI, prior schizophrenia was seen as a degenerative disease that needed to be contained rather than something that could be improved which lead onto the fact that it could potentially avoided.

I would say that both IAPT and EIP are still part of the same journey from 1968 - they're underpinned by new evidence and changing beliefs around specific conditions and interventions, but those fundamentally fit neatly into the broad convictions that "prevention is better than cure" and intervening sooner is always the alternative to a "long, difficult and expensive process" (to quote a DES textbook from 1968), and consequently that the right thing to do with scarce resources is to move them upstream - always away from the "seriously broken down" and towards the greater number of people who might yet end up in that state without intervention.

New evidence told you how to do that, what you should be spending on - but the conviction that you shouldn't be spending it on looking after the already seriously unwell is long-standing.

(I do think that that England's IAPT - distinct from work to improve access to talking therapies elsewhere in the UK - is openly tied up with a very specific, and slightly different and more obviously ideological move, about the directionality of the relationship between mental illness and poverty. But I also think that's a somewhat separate conversation.)


I should be clearer that my views come in large part from frustration at my own failures, of working with services on the wrong side of the future and seeing them made worse and worse, for both the people within and subject to them, because of the overwhelming implicit conviction that, really, these services and these people shouldn't exist and - somehow, soon enough - wouldn't.

When I said "Being an activist that undermines their own aims is shameful, and I want to move beyond this.", I really, really did mean me at least as much as anyone else.

[TrenterPercenter]

@Zetetic

@TrenterPercenter
I appreciate the discussion, and I can only say that I note what you have been through and are going through. I don't think either of us are terribly mentally well right now, and that's not ideal for a conversation about stuff that we are both so emotionally invested in.

Got a few moments to reply to this yes you are absolutely right; I'm letting my emotions get the better of me because I'm struggling a bit at the moment and I absolutely should be more considerate that you might be in a similar position. Sorry about this Z, I hope you are looking after yourself!

A few further thoughts.

I really don't think this is about people in health services not being "progressive" enough or being "complicit". I've not described anyone as "complicit".

I guess I'm pointing out that regardless of whether you think, what you were saying could be interpreted in somekind of functionalist manner of psychologists inventing illnesses to give them a living out of treating.  We know there are significant problems with DSM-IV, it's interactions with the US insurance model of care and the over-prescribing of medications.  Progressivism to my mind is to fight for the social determinants alongside treatment; for the fact that the social determinants are real in causing the need for treatment.

Here we have a branch of Psychologists for Social Change, for example, and they and others have the ear of the relevant Ministers, and they say the things you'd expect, stuff like this gets produced, and so on. Being generous I might even say that some of the schools-related stuff in this might be partly driven from that quarter (but mostly it's down to very different quarters).

I wouldn't subscribe to any coalition of psychologists for social change; but this is all good stuff if applied.  The work I do is quite similar only not talking but actively working in communities to create mental health infrastructure that can expand the delivery of early intervention in the community (without taking from existing NHS budgets - I've not been "paid" by the NHS 7-8 years, despite working for them; I bring my own money in through research grants and working with local government).  This is very difficult there is no magic button here but the work does overlap massively with building an informal coalition with community partnerships to view mental health in terms of it social determinants; which can then bring about political and purchasing power to community provision (and not just mental health treatment).  I don't see talking therapies and mental health awareness (as long as genuine) as problematic here; they are in fact useful to this cause imo.

Here, of course, the constraints are more explicit - the block grant is what it is, spend in every sector including health is pretty what it must be, and MHLD spend within that is locked within a %-point or so - and so, perhaps, the consequences are more obvious too. We too drain resource from one bit of the service to another, in an entirely earnest drive for greater efficiency and effectiveness. How else does one morally allocate scarce resources except in the way you think will do the most good?

But this isn't the real issue; I don't see the benefit in playing off parts of an underfunded system against each other.  To me that seems like playing into powerful interests hands.  I completely agree adult MH care is rubbish  (not my area) but through a lot of hard work we managed to get our youth mental health services commissioned on a 0-25 basis about 5 years ago; this was to stop YP being sent to adult wards when they were just 14 and to create better care for them through the peak risk age for MH onset.  Of course this isn't helpful to people that are >26 with poor outcomes but this is a problem of overall funding; preventative, early intervention for youth mental health is working on an underfunded budget too it is just that due to then linear passage of time and development course of most mental health conditions, outcomes will be better with people receiving early treatment (which is feature of youth).

I would say that both IAPT and EIP are still part of the same journey from 1968 - they're underpinned by new evidence and changing beliefs around specific conditions and interventions, but those fundamentally fit neatly into the broad convictions that "prevention is better than cure" and intervening sooner is always the alternative to a "long, difficult and expensive process" (to quote a DES textbook from 1968), and consequently that the right thing to do with scarce resources is to move them upstream - always away from the "seriously broken down" and towards the greater number of people who might yet end up in that state without intervention.

But I don't really see what you are suggesting; you want to move resources down stream to crisis care? Allowing more people to eventually become iller.  I understand the premise of working with the hardest to help but most costings go towards inpatient staff and tier 3 and 4 treatment; you were citing IAPT but its universal level treatment is CCBT exactly because it is cheap and keeps the cost of low level treatment down; sparse low intensity work being again based on doing something as cheaply as possible.  We know that universal tier 1 EI and prevention strategies have to be cost effective and scalable - that is what makes creating them so challenging. I can't see how removing IAPT translates to better care for more embedded illness; it might create some extra resources at first but soon it just collapses back into the the same problems as numbers rise.  Early intervention and prevention as the evidence shows are the best buy for this exact problem; they save money that can then be directed into higher levels of care.  The problems we have is there is poor low level treatment; we know that 75% of referrals with not meet clinical threshold and therefore will be rejected often after long waiting period; the fact they don't meet clinical threshold today doesn't mean they will not tomorrow.  You can get a stark example of this from eating disorder in which is common practice for GPs and MHPs to tell children that they haven't got a low enough BMI to meet threshold - (which of course is a completely inappropriate thing to say to someone with a developing eating disorder).  Rationing of care isn't a phenomena confined to higher tiers.

As mentioned there are solutions to this but they effectively require more social models of thinking and dare I mention that terrible word "innovation".  This is what I do and there were very few people doing it until quite recently.  I left the frontline because it was a never ending revolving door of people of very ill people in very bad situations and wanted to try and change this further upstream (btw I wrote my MSc basically trashing the emerging New Labour approaches to mental health and work calling out the very obvious fact that Black report didn't specify the type of job and social protections it brought with its claim that all work improves health - so I do have historic skin in this game as it happens).

When I said "Being an activist that undermines their own aims is shameful, and I want to move beyond this.", I really, really did mean me at least as much as anyone else.

I think you are being a bit fatalistic and idealistic; I thought I'd throw myself into this all and change the world back in my late 20s, now 10 years I understand the monolithic problems that exist and the size of the challenges. This is much wider than issues of funding; we have massive problems with the types of people that go into positions in psychology (and psychiatry for that matter) to can wield the power to change things; working class people are severely under-represented in decisions of a service that impacts them the most.  There are things that can be done here, but it all about a paradigm shift that is occurring but is being fought on multiple fronts with multiple opponents.  Like I say I just don't see how criticising talking therapies and even most of awareness campaigning (Which is hardly massive amounts of money) is the solution here; much better to unite and fight the real enemy together.