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Link discovered between poverty and depression

Started by Zetetic, November 09, 2021, 05:51:39 PM

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Poirots BigGarlickyCorpse

Trenter and Zetetic, you both seem to be talking past each other. Isn't the solution both to improve conditions for people in poverty generally as well as to ensure better access to mental health services?

Shoulders?-Stomach!

Quote from: poirotIs it not a case that more than one thing can be true here? I

Yes, nothing exists in a vacuum, there is interplay, things feed into one another. The state of poverty itself is about more than just lack of means.

TrenterPercenter

Btw I understand the point that the brand almost "wokeness" of mental health awareness directs energy away from social policy pressure[nb]which is largely also made up[/nb] but this a superficial and small part of the whole system.

TrenterPercenter

Quote from: Poirots BigGarlickyCorpse on November 09, 2021, 10:35:11 PM
Trenter and Zetetic, you both seem to be talking past each other. Isn't the solution both to improve conditions for people in poverty generally as well as to ensure better access to mental health services?

Yes; that is what we in services are doing.

TrenterPercenter

Quote from: Shoulders?-Stomach! on November 09, 2021, 10:35:56 PM
Yes, nothing exists in a vacuum, there is interplay, things feed into one another. The state of poverty itself is about more than just lack of means.

Of course; I just went and played football with a load of lads some of whom have very backward views on mental health; they are the type of people that won't access services because of their poor understanding of what mental health is and it is this group that mostly end up killing themselves.

I've told the story before about how I was beaten up, kicked in the head and had a lump of flesh bitten out of my arm by a guy who thought mental health was a "con" and anyone with serious mental health problems should be shot for their own and societies benefit.

Zetetic

Quote from: Poirots BigGarlickyCorpse on November 09, 2021, 10:35:11 PM
Isn't the solution both to improve conditions for people in poverty generally as well as to ensure better access to mental health services?
This has now been the avowed ideological position of successive British governments when it comes to mental health for over half a century, with various degrees of acceleration.[nb]You may find that hard to connect with the other things said by those governments in different contexts. Is there a lesson here?[/nb]

It might be time to consider what this has actually bought us.

It has bought us a society where young people are less able to reliably obtain substantive employment, and if they do there is a good chance it will be in a role that they are well aware is pointless and quite possibly even despised by the people who it requires them to deal with[nb]Is this better than - for example - risking dying, in the dark, physically ruined, underground? Or coughing your lungs in your 40s? Yeah, in some ways, obviously[/nb]. They are less reliably able to obtain the most basic human necessity of shelter, for this and other reasons.

At the other end, it has bought us mental health services pivoting away from the seriously mentally unwell in order to tackle the far greater mass of people presenting with mild affective disorders, often related to the conditions in which they live. [nb]Of course health care spending in Britain has - once you account for inflation in the inputs that health care actually demands - barely doubled in real terms since the '60s. Mental health spending is pretty much the same proportion of spend now as it was then - 10-12%. Back then mental health spend mostly went on keeping the boilers and kitchens going in the asylums. How much 2021 talking therapies time does the conversion buy you?[/nb]

The mass is, of course, so great that, however hard the health service pivots, it cannot possibly keep up with this mass demand - in England it turned heavily towards heavily-manualised CBT in the hope that it could mass recruit people to deliver it without much training, and everywhere it turns towards 4-8 session 'interventions', ideally 10 or 20 or 30 people at a time - and waiting times are still often on the order of months or years (with the attrition that implies).

The health service is still crap at dealing with the seriously unwell. It's now also crap at dealing with the mildly unwell, and at a far greater scale. And the world outside its gates is still dogshit and injurious. The mantra of prevention has not worked.

This isn't saying that the words of the mantra aren't well-meaning or even that they're not sensible. But the act of repeating them over and over and over and over again for half-a-century has not worked.


bgmnts

The reason I am seriously depressed is because life is absolute shite and the conditions we are forced to endure are abysmal, even in the privileged as fuck first world.

Until that changes for the better, I'll never be well. Sorry people with a vested interest in medicine and therapy. Cant help it.

Zetetic

"Tackle poverty with CBT" isn't even a joke. It's English policy. It's what the IAPT programme was sold on, in combination with the knock-on effects for the tax base supposedly making it pay for itself.[nb]Whoops: https://en.wikipedia.org/wiki/Financial_crisis_of_2007%E2%80%932008 Do they still monitor the back-to-work target?[/nb]

Still, glad that the other option, with its ludicrous notion of the state providing housing for its citizens to alleviate the conditions that they are hurting them, proved humorous to some.

TrenterPercenter

Quote from: Zetetic on November 09, 2021, 11:04:58 PM
This has now been the avowed ideological position of successive British governments when it comes to mental health for over half a century, with various degrees of acceleration.[nb]You may find that hard to connect with the other things said by those governments in different contexts. Is there a lesson here?[/nb]

It might be time to consider what this has actually bought us.

It has bought us a society where young people are less able to reliably obtain substantive employment, and if they do there is a good chance it will be in a role that they are well aware is pointless and quite possibly even despised by the people who it requires them to deal with[nb]Is this better than - for example - risking dying, in the dark, physically ruined, underground? Or coughing your lungs in your 40s? Yeah, in some ways, obviously[/nb]. They are less reliably able to obtain the most basic human necessity of shelter, for this and other reasons.

At the other end, it has bought us mental health services pivoting away from the seriously mentally unwell in order to tackle the far greater mass of people presenting with mild affective disorders, often related to the conditions in which they live. [nb]Of course health care spending in Britain has - once you account for inflation in the inputs that health care actually demands - barely doubled in real terms since the '60s. Mental health spending is pretty much the same proportion of spend now as it was then - 10-12%. Back then mental health spend mostly went on keeping the boilers and kitchens going in the asylums. How much 2021 talking therapies time does the conversion buy you?[/nb]

The mass is, of course, so great that, however hard the health service pivots, it cannot possibly keep up with this mass demand - in England it turned heavily towards heavily-manualised CBT in the hope that it could mass recruit people to deliver it without much training, and everywhere it turns towards 4-8 session 'interventions', ideally 10 or 20 or 30 people at a time - and waiting times are still often on the order of months or years (with the attrition that implies).

The health service is still crap at dealing with the seriously unwell. It's now also crap at dealing with the mildly unwell, and at a far greater scale. And the world outside its gates is still dogshit and injurious. The mantra of prevention has not worked.

This isn't saying that the words of the mantra aren't well-meaning or even that they're not sensible. But the act of repeating them over and over and over and over again for half-a-century has not worked.

Complete and utter drivel.  It's an underfunded service; mental health services have never occupied any serious amount of the NHS budget.  The push for better services is born out of the impact of society on peoples mental health not the desire to create mental health services.  It is a complete fantasy, a dangerous and unworkable fantasy to suggest that removing mental health services would improve the lives of those that suffer with and from mental health condition.  This is counter to the all logic, reason and evidence; this is your opinion and it has nothing to do with occupying any push for housing or social improvements; they compliment each other.

CCBT is shit but it was born out of necessity because a Labour government never provided the funds for the 40,000 psychologists they pledged to hire.  This is borderline conspiracy theory bollocks.

TrenterPercenter

Quote from: bgmnts on November 09, 2021, 11:08:22 PM
Until that changes for the better, I'll never be well. Sorry people with a vested interest in medicine and therapy. Cant help it.

You seriously think this is about vested interests.  Jesus.

TrenterPercenter

Quote from: Zetetic on November 09, 2021, 11:15:24 PM
"Tackle poverty with CBT" isn't even a joke. It's English policy. It's what the IAPT programme was sold on, in combination with the knock-on effects for the tax base supposedly making it pay for itself.[nb]Whoops: https://en.wikipedia.org/wiki/Financial_crisis_of_2007%E2%80%932008 Do they still monitor the back-to-work target?[/nb]

Still, glad that the other option, with its ludicrous notion of the state providing housing for its citizens to alleviate the conditions that they are hurting them, proved humorous to some.

This is a made up dichotomy, it is deceitful and made up no one is holding up social policy by saying have CBT instead of housing. You are misrepresenting again. IAPT isn't just about CBT either it was about having mental health workers in GP surgeries prior to them being there untrained GPs were having to deal with psychiatric appointments.  This is a bizarre conspiratorial version of how these things came about and what they were planned  for.  Again I've no love or vested interest in IAPT (I'm not a fan at all) but describing things in this way is completely twisted and insincere.

Zetetic

Quote from: TrenterPercenter on November 09, 2021, 11:20:38 PM
mental health services have never occupied any serious amount of the NHS budget.
I've literally given the %s in my post. Why are you tell me what I, of course, already know?

QuoteComplete and utter drivel.  It's an underfunded service;
And it will remain underfunded for the foreseeable future. There is a sensible question here to be asked about scarce resources, and a very easy way to end up a stupid answer.

QuoteIt is a complete fantasy, a dangerous and unworkable fantasy to suggest that removing mental health services
In fairness, I've never suggested removing mental health services. At most I've said what I'd pick in a ridiculous Sophie's choice that you offered.[nb]Although some would say that gassing IAPT workers would be a mercy-killing, I think that's inappropriate and unpleasant.[/nb]

QuoteThis is borderline conspiracy theory bollocks.
On the contrary. I don't think that there is any conspiracy here. There are well-meaning people doing what they think is best and - at worst - keeping truth and consequence from meeting.

Zetetic

Quote from: TrenterPercenter on November 09, 2021, 11:26:21 PM
This is a bizarre conspiratorial version of how these things came about and what they were planned  for.  Again I've no love or vested interest in IAPT (I'm not a fan at all) but describing things in this way is completely twisted and insincere.
You're going to have to take that up with 'Baron' Layard, I'm afraid.

TrenterPercenter

Quote from: Zetetic on November 09, 2021, 11:28:33 PM
I've literally given the %s in my post. Why are you tell me what I, of course, already know?

No you gave the total mental health budget; then started going about "talking therapies" which is a considerably smaller amount of that budget.  Also ignoring any evidence about the effectiveness of these therapies and focusing on IAPT and crap CCBT.

You sound like a bean counting big pharma advocate what role do you play in the system? - I'd really like to know how close you have ever come to working in or around mental health services?

I'm off to bed but I'll happily go into much more detail tomorrow.

Zetetic

November 09, 2021, 11:57:57 PM #44 Last Edit: November 10, 2021, 12:21:03 AM by Zetetic
Quote from: TrenterPercenter on November 09, 2021, 11:32:29 PM
No you gave the total mental health budget;
???
Quote from: TrenterPercentermental health services have never occupied any serious amount of the NHS budget.
?!?!?!

QuoteYou sound like a ... big pharma advocate
Quotewhat are you some medical model zealot?
Astonishing. How do you get to that from "I think that people's access to meaningful occupation that lets them obtain shelter, other basic necessities and beyond that a good quality of life might be a major part of many people's route to mental ill-health."

QuoteYou sound like a bean counting ... - I'd really like to know how close you ever come to working in or around mental health services?
I am a bean counter. I work with various healthcare services, generally to count whatever beans they want to count. Off the top of my head:

On Monday, I co-presented, with someone from a psychology service, on working to enable other therapists to interrogate their own outcomes data in a meaningful way. And discussed the risks of benchmarking by reference to complex causal routes to illness and recovery, and the pervasive influence of variation in factors outside of health services. We talked briefly about using ecological deprivation in analysis, and how blindly pursuing risk adjustment can end up disappearing the very things that actually matter and need tackling.

Today, I presented data to senior advisors in my country's government about the impact of non-healthcare-related issues on a certain vulnerable group's health inequalities. The data emphasised access to non-health services (e.g. local authority day services), to meaningful activities, to exercise, to appropriate accommodation, to socialisation and we discussed how the data showed that health services alone were largely unable to fix these. This is data that I've helped healthcare professionals collect and interpret, that I've discussed with them, and tried to help them - with service users - force changes outside of health services.

Previously I've worked with counselling and clinical psychologists on population-needs-assessment and capacity-and-demand planning for Tier 0-4 services for swathes of my country. I've worked with psychologists, psychiatrists and other health professionals in various services on analysing their current demand and activity. I've spent 7 years working with a particular professional group in mental health services, attempting to find a way to make anyone give a shit about their chronic ubiquitous understaffing and the impact that it had on both them and the seriously unwell people they were supposed to be caring for - and frankly, post-COVID, can't imagine how I'm going to bring myself back to that because of how upsettingly hopeless it was because this was a group of people and a service that had been effectively written off in 1968.

Edit: Worked with various health professionals on trying to quantify plausible demand for a very specific, politically attractive inpatient service (and I'm presenting work related to that but also a non-health service that affects access to health services to some other bean counters quite a lot at the moment). Worked with various health professionals in emergency departments on issues around people who get stuffed in the mental health box (usually because there's everything else going wrong in their life).

Edit2: This isn't meant to show that I have deep and abiding understanding of working in mental health services. I don't think I do. I think I do, after a decade of working with people who do work in those services, working on the things that troubled them and that they wanted to change, that I have some sense of the direction of travel, prevailing ideologies and how these have butted up against material conditions over that time.



Zetetic

November 10, 2021, 12:10:44 AM #45 Last Edit: November 10, 2021, 12:23:46 AM by Zetetic
Quote from: TrenterPercenter on November 09, 2021, 11:20:38 PM
Complete and utter drivel.
The odd thing is that you've not actually disagreed with anything that I've actually written.

Do you think the health services of the UK are very good at looking after either the seriously or mildly mental unwell?

Do you think that the world outside its walls is now reliably conducive to good mental health?

QuoteI'm off to bed but I'll happily go into much more detail tomorrow.
What I'd really, genuinely, like is if you tried to understand what I'm saying and why I might have come to that view. I'm not advocating for any of the things you seem to think I am. Quite possibly that's my fault in poor communication, but I think all I can ask is you try to recognise that fault and work past it. Perhaps the Two Choice meme was too powerful, and the dichotomy taken too seriously as my perspective.

Blumf


Poirots BigGarlickyCorpse

Quote from: Blumf on November 10, 2021, 12:19:43 AM
Guys! Guys! The solution exists!


See, this is the kind of shit that will happen. A list of YouTube meditation videos. A tree for the council housing proles to look at. A box you can put over your head and cry in. And an increase in sugar tax so that the poors will choose the crying box instead of eating their problems away with junk food and chocolate.

Johnny Yesno

Trenter, you've gone off on one again. Focus on this bit:

Quote from: Zetetic on November 09, 2021, 11:04:58 PM
[The avowed ideological position of successive British governments] has bought us a society where young people are less able to reliably obtain substantive employment, and if they do there is a good chance it will be in a role that they are well aware is pointless and quite possibly even despised by the people who it requires them to deal with. They are less reliably able to obtain the most basic human necessity of shelter, for this and other reasons.

At the other end, it has bought us mental health services pivoting away from the seriously mentally unwell in order to tackle the far greater mass of people presenting with mild affective disorders, often related to the conditions in which they live.

The mass is, of course, so great that, however hard the health service pivots, it cannot possibly keep up with this mass demand - in England it turned heavily towards heavily-manualised CBT in the hope that it could mass recruit people to deliver it without much training, and everywhere it turns towards 4-8 session 'interventions', ideally 10 or 20 or 30 people at a time - and waiting times are still often on the order of months or years (with the attrition that implies).

The health service is still crap at dealing with the seriously unwell. It's now also crap at dealing with the mildly unwell, and at a far greater scale. And the world outside its gates is still dogshit and injurious.

My own non-expert opinion is that introducing UBI and rent controls now would resolve huge numbers of the stress-related conditions, leaving mental health services to deal with the people who have actual brain chemical imbalances, psychiatric disorders and the like. Which is something like what Zet is saying, I think.

Zetetic

I don't subscribe to the division you've set up there, Johnny - I'm not sure that "actual brain chemical imbalances" exist in meaningful numbers[nb]Although, yeah, some people might have gross differences in neurochemistry that predispose them or something.[/nb] and you definitely don't need one to be mentally ill, for example.

But, yeah, fix all the dogshit in many people's lives giving rise to chronic distress and hopelessness (which if you don't think count as form of ill-health in themselves, can certainly go along way towards cultivating illness) and you have a decent chance of reducing the number of people developing debilitating mental illness, enable others to better look after themselves and others, and given yet more a decent chance to recover.

I don't think that Trenter and I actually disagree very much about the causal routes to mental illness.


chveik

Quote from: Zetetic on November 10, 2021, 12:10:44 AM
Quite possibly that's my fault in poor communication...

it's not, or at the very least you're not sounding like a right-wing conspiracy theorist. hth

H-O-W-L

What's the cunt doing there? He should be off saving Princess Zelda.

Johnny Yesno

Quote from: Zetetic on November 10, 2021, 12:55:50 AM
I don't subscribe to the division you've set up there, Johnny - I'm not sure that "actual brain chemical imbalances" exist in meaningful numbers[nb]Although, yeah, some people might have gross differences in neurochemistry that predispose them or something.[/nb] and you definitely don't need one to be mentally ill, for example.

But, yeah, fix all the dogshit in many people's lives giving rise to chronic distress and hopelessness (which if you don't think count as form of ill-health in themselves, can certainly go along way towards cultivating illness) and you have a decent chance of reducing the number of people developing debilitating mental illness, enable others to better look after themselves and others, and given yet more a decent chance to recover.

I don't think that Trenter and I actually disagree very much about the causal routes to mental illness.

Fair enough. I just thought there are illnesses such as schizophrenia that can happen to people whether they are comfortably off or not, while there are mental health problems that are rooted in poor living conditions. I imagined that both could be ameliorated by removing the anxiety of being poor but that the former would be unlikely to be cured by that alone.

Kankurette

Quote from: Poirots BigGarlickyCorpse on November 09, 2021, 07:26:39 PM
Is it not a case that more than one thing can be true here? I was under the impression that mental illnesses can have several causes (genetic, environmental, traumatic experiences, injury). Living in poverty might cause depression, exacerbate depression, prevent people with depression from accessing proper treatment. In addition many people are forced to live in a way that isn't exactly conducive to mental and emotional wellness (low-paid jobs, dwindling social supports, long commutes, little or no job security all cause stress). That's why I said at best the outcome of "there's a link between poverty and depression" would be "more affordable and accessible mental health care". The current capitalist system makes too many people too much fucking money for e.g. a government to look back on the last year of working from home and say "does every job need an employee to travel two and a half hours to an office every morning and make the same journey back home in the evening, eating into time they could spend with their families and costing them money in either fuel or public transport fares?"
This. Poverty might not be the sole cause of depression but it sure as hell exacerbates it.

Zetetic

"Therapy before meds???" driving me out of my tiny mind. Constant stream of utterances that are well-meaning, even well-reasoned, but overwhelmingly destructive in their collective effect.

chveik


TrenterPercenter

Quote from: Zetetic on November 23, 2021, 01:07:32 PM"Therapy before meds???" driving me out of my tiny mind. Constant stream of utterances that are well-meaning, even well-reasoned, but overwhelmingly destructive in their collective effect.

I had written you a couple of pages worth of why your implied dichotomy at the start of this thread was wrong and part of it did highlight the suspicious absence of medication in your treatment as a distraction from the social determinant of health hypothesis.  I didn't send it in the end as it just seemed like work.

Glad that we've just cleared up that, as I suspected, you are just anti-therapy.

Zetetic

Quote from: chveik on November 23, 2021, 01:59:23 PMwho's the irresponsible cunt saying this?
This has generated a lot of noise: https://www.bbc.co.uk/news/health-59383722

The NHSs of the UK, do, of course, overwhelmingly already try to make talking therapies available as an alternative or adjunct to medication - it's just that, as touched on in this thread, it's nearly impossible to make them available as quickly as a prescription, at the scale required to make them a genuine alternative. (Where services have managed this, usually very briefly and often involving strict but clear referral criteria, GPs do end up prescribing less, unsurprisingly.)

In practice, what currently happens is that almost everyone presenting to primary care gets 1) referred to, or signposted to, a talking therapies services and 2) a prescription for a nice cheap and basically safe SSRI so that they're not waiting months and months for something and the GP has done something there-and-then.

(Basically safe, because we really should offer talking therapies alongside anything like an SSRI because it's not terribly responsible to slam stuff into people's sense-of-efficacy without talking with them about what they want to achieve other than maybe ending it all.)

Zetetic

Quote from: TrenterPercenter on November 23, 2021, 02:39:10 PMGlad that we've just cleared up that, as I suspected, you are just anti-therapy.
What? Nothing I've said even slightly suggests that.

QuoteI didn't send it in the end as it just seemed like work.
I believe the traditional excuse involves a dog.