Link discovered between poverty and depression

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

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Zetetic

Quotethe suspicious absence of medication
If medication is absent from the thread so far, it's because it mostly doesn't seriously compete for resources in the same way that trying to allocate staffing (and cash for it) between competing tiers do.

In large part because meds are now mostly extremely cheap, particularly for affective stuff, barring the occasional bit of cartel behaviour or patent laundering.

(Indeed, where I've been involved with trying to argue that better resourcing for therapy might be justified on invest-to-save basis, references to medication spend have usually ended up being framed in terms of the risks of uncontrolled future price hikes rather than current spend on drugs. The doubling of antidepressant spend during the pandemic being driven by dubious sertraline shortages - and a subsequent 6x rise in the price paid by the British NHSs - is a neat example for the future...)

TrenterPercenter

Quote from: Zetetic on November 23, 2021, 03:22:27 PMIn 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.

This has improved because of things like IAPT not despite it.


Quote(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.)

SSRI's are safe; what they do in "treating" depression in the long-term is debatable; the main concern is that people become parked on drugs; tinkering with their synapses as opposed to actual improvements in their subjective wellbeing.  This is the absence of illness vs the gaining of mental health.

That parking on meds is important to your argument that talking therapies take resources away from improving the social determinants of health; something you have no evidence for because it is made up, as mentioned several times now; creating a false dichotomy of housing vs talking therapies (which is a poisonous and insincere argument).   With medication you've just bothered to total up the cost of the drugs whilst you appear to want to treat talking therapies in a much different way.

I've just calling that out is all.  I see it.


Zetetic

Quoteyour argument that talking therapies take resources away from improving the social determinants of health
That's not been my argument.

My argument has been that moving resources away from higher tier services to lower tier services takes resources away from the former (by definition) while 1) doing practically nothing to actually seriously stem the demand for the former and 2) and often failing to deliver a decent service with decent outcomes for the populations that lower tier services are meant to serve. (These two points aren't disconnected of course.)

We cannot hope to achieve the second while both social determinants and healthcare capacity remain unaddressed. But repeating the mantra doesn't change these, even while it successfully promotes the transfer of resources within the healthcare system.

Quotecreating a false dichotomy of housing vs talking therapies (which is a poisonous and insincere argument).
That false dichotomy exists elsewhere - it's not something I've created, and I don't disagree that it's false.

Zetetic

It comes back to finding a lesson in this:
Quote from: TrenterPercenter on November 09, 2021, 06:44:34 PMOf course you need to improve social policy that is the whole point.  We've known this and been saying it for years, literally decades, internationally.


TrenterPercenter

November 23, 2021, 04:52:34 PM #64 Last Edit: November 23, 2021, 05:03:59 PM by TrenterPercenter
Quote from: Zetetic on November 23, 2021, 04:15:00 PMThat false dichotomy exists elsewhere - it's not something I've created, and I don't disagree that it's false.

At last! So it is false dichotomy that you promoted but don't agree with, a bit like saying "did you know the vaccines make you more likely to get covid than not having them" then mumbling later "I don't think that is true myself".

You need to consider that people actually take on face value stuff like this for a variety of reasons.  It's not a responsible thing to be doing, especially for those people that might be perceived as trustable and informed representatives of mental health.


QuoteMy argument has been that moving resources away from higher tier services to lower tier services takes resources away from the former (by definition) while 1) doing practically nothing to actually seriously stem the demand for the former and 2) and often failing to deliver a decent service with decent outcomes for the populations that lower tier services are meant to serve. (These two points aren't disconnected of course.)

Yes you are talking about the treatment gap; literally my area of work essentially trying to get something out of nothing because basic fact is services overall are underfunded not that these funds are being nefariously syphoned off into twee talking therapies when they could be buying people houses. 

What you are missing or ignoring is interaction between tier 1 and tier 2 you are making some massive claim now that tier 1 does not prevent progression to tier 2 when the evidence more points to the problem of rising need vs underfunding of MH writ large. You've approached this as an aggression around funding between the tiering when they both just need adequate funding; getting rid of tier 1 and placing all resources in >tier 2 (there are 4 tiers in CAMHS fyi) is just moving the bottle neck further up the chain.

There is a problem here but these are not sensible ways to approaching things; the drive at the moment is to integrate services better with social care and communities not engage in silly inward arguments about whether tier 1 is hogging tier 2 funds this is the kind of shitty academic positioning and exhausted service provider bickering that does precisely fuck all about anything.

TrenterPercenter

Quote from: Zetetic on November 23, 2021, 04:20:34 PMIt comes back to finding a lesson in this:

Yes some of us literally do this for their jobs! Hence why you might just take a minute and consider why I'm disagreeing with you and why your silly meme may have "triggered" me.

I know how utterly fragile things like early intervention and prevention are; there are lots of vested interests in getting rid of it; you are completely ignoring the very positive paradigm shift that came with and continues to come with the influence of early intervention and prevention - and this seems at massive odds with any notion that the social determinants of health are actually important; it's the medical models world that would rather you just accepted that mental illnesses are "caught", conveniently by poor people and BIPOC, therefore they just need medicating and forgetting about.  You seem to need to know your EI history better; it doesn't come from happy clappy awareness programs.

That being said Time to Change was the biggest example of MH awareness in this country and I'd say on the whole it was very good; just stop counting your beans and going on about the cost of valium for a minute and think about how literally prior to 2009 depression was still barely spoken about in open conversation; now it's pretty much 'arsed mate cigs' that didn't just happen out of nowhere.  The public concept of mental health what it is and what it means in a societal sense is absolutely key to driving effective and humane public health policy  in the area; it's like you think everyone even now understands the transdiagnostic basis of mental health; they don't; this is a very narrow and myopic view of the problem.

Zetetic

Quote from: TrenterPercenter on November 23, 2021, 04:52:34 PMAt last! So it is false dichotomy that you promoted but don't agree with, a bit like saying "did you know the vaccines make you more likely to get covid than not having them" then mumbling later "I don't think that is true myself".
What?

Quotethere are 4 tiers in CAMHS fyi
Quote from: ZeteticPreviously 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.
Why do you do this?

Quotemaking some massive claim now that tier 1 does not prevent progression to tier 2
I'm making the very modest claim that early intervention - here-and-now - doesn't do anywhere nearly enough to stem the demand for services for people serious and enduring mental illness, such that the transfer of funding doesn't guarantee that those services are shit. (You don't even disagree with me, even as you try to start an argument about this!)


Quote from: TrenterPercenter on November 23, 2021, 05:02:35 PMI know how utterly fragile things like early intervention and prevention are; there are lots of vested interests in getting rid of it
This is, of course, part of the mantra.

QuoteYou seem to need to know your EI history better; it doesn't come from happy clappy awareness programs.
You're the one that brought "awareness" into this! (I've been - repeatedly - pointing at the road from 1968, at the latest.)

QuoteYou've approached this as an aggression around funding between the tiering
You're often confusing reality with "my approach" to it. I'm not the British Government for the last half-century. I can see what has happened over that time, and want to examine the actual impact of the mantra.

Zetetic

I don't think there's any serious gap between us, @TrenterPercenter, when it comes to us wanting a world where early intervention, services for the seriously unwell, and universal provision of income and basic necessities are all appropriately resourced. I don't think that's really what's up for debate between us.

What I'm specifically interested in, for almost all of this thread, is the actual effect of saying that, for the last five decades and the decades that are to come.

pancreas

Stop trying to co-opt his valid opinions into your anti-therapy fascism.

Zetetic


Zetetic

Quote from: pancreas on November 23, 2021, 05:30:44 PMStop trying to co-opt his valid opinions into your anti-therapy fascism.

(The awful truth is that I just want all the therapy for myself.)

TrenterPercenter

Quote from: Zetetic on November 23, 2021, 05:26:14 PMWhat I'm specifically interested in, for almost all of this thread, is the actual effect of saying that, for the last five decades and the decades that are to come.

It is hard to have a discussion with you because it seems quite evident to me that you don't really know what early intervention is.

Also you are posting shit like this because the BBC like to make stupid headlines

Quote from: Zetetic on November 23, 2021, 05:34:42 PMhttps://www.bbc.co.uk/news/uk-england-london-59104738
I'm not sure I can bring myself to unpack this.

Tbh though I'm too tired to bother with it all this is the 23rd consecutive day I've worked most days for atleast 11 hours.  I've no idea what your game is Zetetic, I'm surprised and a bit puzzled by your behaviour on this, but like I say too tired to really care. We do not share opinions on this far from it.  Your opinions are laced with something else - very obvious to me; probably not so much to other people not in know about these things.  I'll leave you to it.


Ferris



(Don't mind me, just here to make light of an amusing thread title.)

TrenterPercenter

Sorry I'll use this double post error just incase anyone is buying this stuff Zetetic is selling - most of the economic literature on early intervention shows the exact opposite of what he is portraying here.

I've not gone mad and I'm not trying to start an argument, I appreciate that this all looks weird from people that don't deal with this but early intervention is a cost saver (and for once one that dovetails with improved outcomes for individuals) that is what the evidence says, not the opposite.

ffs I've double posted again now!

Mr_Simnock

Quote from: TrenterPercenter on November 23, 2021, 06:48:48 PMSorry I'll use this double post error just incase anyone is buying this stuff Zetetic is selling - most of the economic literature on early intervention shows the exact opposite of what he is portraying here.

I've not gone mad and I'm not trying to start an argument, I appreciate that this all looks weird from people that don't deal with this but early intervention is a cost saver (and for once one that dovetails with improved outcomes for individuals) that is what the evidence says, not the opposite.

ffs I've double posted again now!


Your right on this. We do some limited reporting (at the moment) at the CSU for CCGs on EIP and IAPT and the feedback is the same from them, early intervention does save money and improve outcomes.

Zetetic

Nothing I've said is in disagreement with that, of course, let alone "the exact opposite".

Zetetic

Quote from: TrenterPercenter on November 23, 2021, 06:26:13 PMAlso you are posting shit like this because the BBC like to make stupid headlines
No, I'm posting "shit" like that, because it's a very public example of discussion around some specific material conditions, the effect of those conditions on someone's mental health, and what "really helped".

QuoteI've no idea what your game is Zetetic, I'm surprised and a bit puzzled by your behaviour on this, but like I say too tired to really care. We do not share opinions on this far from it.  Your opinions are laced with something else - very obvious to me
Obvious, and yet apparently incomprehensible. If you recognised that you were unable to understand my perspective or my motivations - and didn't "really care" about doing so - then it might been better to not post rather than invent some to rail against.

My "game" is that I want people to live in decent housing, spend their time decently occupied without having to worry about how they will afford their next meal or whether they can put the heating on, and to know that if they get ill that someone will care for them, even if the nature of their illness means that it's extremely hard to do so and that we may need to care for them for a long time.

The idea that I'm opposed to early intervention services, or that I don't believe them to be more efficient ("save money") or effective ("better outcomes") than treating people only when they're seriously unwell is - to me - ridiculous, given the things that I have spent my time helping people with over the years.

Pointing out that, actually, the services that we've tried to put in place are overwhelmingly unable to actually deal with demand, or that the people that they're working with are often in situations that act against what they're trying achieve, or that the opportunity cost - in practice - is better services for people who are no longer "early", isn't the same as what you're pretending I'm saying.


FiremanJim


TrenterPercenter

Quote from: Zetetic on November 23, 2021, 09:03:52 PMPointing out that, actually, the services that we've tried to put in place are overwhelmingly unable to actually deal with demand, or that the people that they're working with are often in situations that act against what they're trying achieve, or that the opportunity cost - in practice - is better services for people who are no longer "early", isn't the same as what you're pretending I'm saying.

That isn't what you are doing though; you kicked off the thread with a meme about housing and CBT buttons, you preceded to make the case against things like IAPT citing the channelling of money away from treatment, you called people "well meaning" yet ultimately destructive in their work, argued that medication "doesn't matter" in this destructive practice because it doesn't "cost as much" only factoring in the cost of drugs and not impacts beyond what this means (well left it as side note), and you explicatly said that tier 1 budgets and tier 2 budgets by "definition" are a zero sum game which is a very simplistic and wrong-headed way at looking at how things work.

I don't care because despite this approach you keep flipping to some position of agreement with me and some gaslighting shit about how I'm not understanding you or things.  People reading what you have said wouldn't be at fault if they thought early intervention and extensions of it in tier 1 were ineffective and in-place of things like better housing; and a couple of posters have even chimed in on this thread, because that is what it in the main it sounds like.

The fact you can't commit to or reassess this erroneous approach is what I can't be bothered with "I just want people to have better housing..." is utter fucking drivel no one is actually saying "CBT or housing" this is made up, it's not a conversation, you are arguing with your own made up stupid meme, it's well meaning but ulimtately destructive poppycock; yes everyone wants better conditions for individuals ffs housing and treatment are not in competition as I keep saying to you, it was you that brought in that ridiculous notion, something you eventually recognised as false and now bizarrely are retreating too.

So early intervention saves money and there is no relation between treatment (Whether talking therapies in tier 1, 2 or 100) and poverty.   That isn't what your arse about tit way of approaching this would have people believe; hence way I'm bothering again to "rail" against this virtual conspiracy theory bollocks you keep semi-commiting too (saying things like "mantra" fucksake; the evidence doesn't support your position, it is you with some "mantra" and opinions dressed up as fact and literally posting propagandist memes) - because it is harmful overall and plays into negative stereotypes about early intervention and talking therapies (which are an important treatment for early emerging serious mental health conditions).

I work in youth mental health; this is particularly important because adult early intervention is in the main actually just the wash from childhood.  50% of all lifetime mental health conditions start by age 14 and 75% of all lifetime mental health conditions by 24 years old, peak onset for anxiety disorder is 14.5 years; these are the precursors to prodromal severe mental illnesses, yet we are the worst funded area of mental health out of all of it; hence why I work weekends and evenings unpaid trying to create things from nothing for the NHS and generate funding towards programmes for the young people we work with; I've never once though "oooh IAPT is stealing my money" I've thought this fucking government has created the conditions for despair and appalling funds services. 

I don't see any merit in your approach here in tackling that, in fact it plays into rightwing notions of "bloated inefficient public services", which is not my experience in 12 years of working in the area (though sure I work in just one part of the country), it is also just wrong; conceptually, in how severe mental health conditions develop.

If you actually truly agree, then you'll take that onboard and stop talking to me as someone that doesn't know a thing or two about what I'm actually talking about. Perhaps, you know, possibly you've just approached this from an angle that you might not see a problem with but I do, rather than this being a question of 'understanding or pretending' after all you were the one that decided to report the link between depression and poverty with a meme about CBT.

H-O-W-L

Quote from: FerriswheelBueller on November 23, 2021, 06:40:26 PM

(Don't mind me, just here to make light of an amusing thread title.)

You owe me twenty quid in residuals:

Quote from: H-O-W-L on November 10, 2021, 01:04:50 AMWhat's the cunt doing there? He should be off saving Princess Zelda.


Paul Calf


TrenterPercenter

Quote from: Paul Calf Jr. on November 24, 2021, 09:45:15 AMDo we have a civil service spat on CaB? Nice.

Civil service!? I'm NHS thank you very much.

Paul Calf

Damn. I thought we were about to become noteworthy.

Zetetic

November 24, 2021, 09:55:51 AM #84 Last Edit: November 24, 2021, 10:11:15 AM by Zetetic
We're both in the NHSs.

Quote from: TrenterPercenter on November 24, 2021, 09:27:06 AMyou explicatly said that tier 1 budgets and tier 2 budgets by "definition" are a zero sum game which is a very simplistic and wrong-headed way at looking at how things work.
And yet, here we are 50 years later and MHLD spend is, roughly, the same proportion of total NHS spend now as it was in 1968.

You and I might not want it to be zero-sum game, we might recognise that this is a political decision - but we should also look at the last 50 years and learn from them.

QuoteI don't care because despite this approach you keep flipping to some position of agreement with me and some gaslighting shit about how I'm not understanding you or things.
You've literally said that you don't understand where I'm coming from! You've 'no idea what [my] "game" is".

Quoteno one is actually saying "CBT or housing" this is made up
No, no-one says it. And yet here we are - 50 years of talking about how important social determinants are, but not really doing anything about them, while shuffling resources within the NHSs.

The buttons in my silly meme reflect the implicit but manifest view of successive governments. I am sorry if the labelling of those buttons seemed to be a claim about the underlying reality.

Quotein fact it plays into rightwing notions of "bloated inefficient public services"
Actually, in practice, the line about early intervention being more efficient and effective - while entirely true - plays into this far more strongly.

It emphasises both the idea that services that we currently have for the seriously unwell are "bloated" and "inefficient", and that we must abandon these services and the people they are for. It also emphasises the idea that we can pay for a shift to early intervention within the existing funding envelope (since such services "save money").

I don't think that's what you actually want and you might want to protest that "no that's not what it means" - but again, we must look at the last 50 years as to how these things have actually been understood in government.

This isn't an argument against such services or the moral rectitude in advocating for them. It is an argument for considering how we advocate for them (and simultaneously tackling social determinants etc.).

QuoteIf you actually truly agree, then you'll take that onboard and stop talking to me as someone that doesn't know a thing or two about what I'm actually talking about.
@TrenterPercenter, I feel like I've done a lot to take you and your experiences seriously, and had absolutely nothing of the same in return.

I appreciate you feel the opposite and I don't know how to bridge that.

QuoteI've thought this fucking government has created the conditions for despair and appalling funds services.
Me too. Which is why I want to take seriously what the effects of talking about social determinants, talking about prevention and talking about early intervention actually are - and why it seems to be reinforcing those conditions, not changing them.

Ferris

Quote from: H-O-W-L on November 24, 2021, 09:31:17 AMYou owe me twenty quid in residuals:

Argh got me bang to rights there - call it 10 quid and we're square.

H-O-W-L


TrenterPercenter

@Zetetic

I agree with most of this, sorry perhaps I am over-reacting; remember I was assaulted by someone that took umbrage of my work in early intervention so perhaps its a bit triggering (I am also currently having the manage quite extreme anxiety due to workload, and currently reduced to eating yoghurt for the first part of day of the last week and a half as it has completely borked my stomach; I was prescribed anti-emetics for this before should of really gone and have got some by now).

Anyway a few thoughts

Quote from: Zetetic on November 24, 2021, 09:55:51 AM.....here we are 50 years later and MHLD spend is, roughly, the same proportion of total NHS spend now as it was in 1968.....You and I might not want it to be zero-sum game....
No, no-one says it. And yet here we are - 50 years of talking about how important social determinants are, but not really doing anything about them, while shuffling resources within the NHSs.

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.  EI, prevention, early detection and "awareness" (proper awareness not some slebs PR moves) have a symbiotic relationship in this as they operationalise different aspects of the pathway; just one example here is clearly the need for improving access to services for BIPOC communities who suffer from the health inequalities related to poorer access to services (and which access is already poor anyway); obviously my area of YMH awareness is much more important as YP are highly influenced by stigma and are dealing with all kinds of other problems that reduces help-seeking (caveat and what help is there for them really if they do - that is what I work on).

Poverty is a factor (I would argue a highly influential factor) in the causal pathway of mental health, I lived it myself, it's why I'm here doing this work now! (and what conceptually we mean by MH is important; but another debate) services and treatment didn't evolve to "manage" this; well not EI or talking therapies; the medical model and psychopharmacology does because it treats MH as an "illness" largely a genetic one which has skewed thinking towards inevitability of illness disregarding the social determinants. It is still by some way the predominate concept of MH in the UK and internationally; hence why it seems inappropriate to remove it from discussions on the basis that pills are cheap (I absolutely try not to go on about this when people are saying "get on the phets ASAP"  because I know lots of people are reliant on medications and I want people to have treatment and support whilst we continue the fight for social determinants)

Now; I'm not adverse to saying all psychotherapists down tools and strike but there are consequences to this; yet the premise that talking therapies and awareness (beyond the annoying tweeness of some aspects of it) are to be singled out in this is not fair.  I've seen more from this side of things in terms of progressing the fight for the recognition of the social determinants of health than anyone else so focusing on the them doesn't seem right or just to me.

TrenterPercenter

I think perhaps because I work in YMH and we have been at the forefront of this for the last 20 years with some massive wins under our belt that you perhaps haven't seen some of this stuff; probably the most prominent advocate for YMH is Pat McGorry who has been progressing this argument for 20 years openly saying you can no longer just be a MH professional you have to be an activist.  The problem with poverty isn't that it isn't recognised as a precedent of MH it is that improving it is beyond the power of a very poorly funded relatively new paradigm in mental health; our job is to treat and support vulnerable YP that this brutal system makes ill; we do this by demanding adequate care and infrastructure to keep YP safe; we petition the government (which I've literally been involved in doing) to create laws (for example a right to place of safety that's not a fucking police cell) and create the evidence so they can't easily ignore demands; we do this alongside fighting for the social determinants of health.  These things are even bigger than just looking at the area of MH you could level the accusation of not addressing the fundamentals at lots of different areas and describe them as complicit in allowing poverty to make people ill this isn't something specific to MH.  I'm sorry we can't turn capitalism off at source.

That is why isn't a really a thing; we can work in YMH tell people to not vote Tory; understand that MH is 80% of the time a breakdown in functioning due to toxic stress; explain the science around degeneration of the brain and why being poor makes your life more stressful, and people will still vote tory, ignore it, have blinkered views on MH, the world keeps turning in this sense....this is the world it is shit, talking therapies are trying to deal with this not manage it for vested interests.

Now, that being said I do personally think, like McGorry, that you need to be an activist as well as a MH professional.  You need to fight for better conditions and move away from medical models and the implications of diagnosis based crisis-referral care however people still need support; and things like talking therapies do work and shouldn't be seen as an inefficiency in the fight against this.  Absolutely psychology as a whole needs reforming; it is happening in my neck of the woods and I work very closely with some brilliant people that engage with this fight on daily basis - I don't know what your experience is in Wales perhaps I am just in a pocket of progressiveness here and therefore see your meme and accusations as "yeah, old news, been incorporated some time ago"

Catalogue of ills

The idea that jobs under capitalism are going to keep us well is a non-starter, if indeed that is what is being suggested. Capitalism isn't going to give us fulfilling jobs. I also don't buy Paul Mason's notion that we can all establish ourselves as micro producers in a post capitalism system, William Morris style. In whose premises Paul, and on whose land? We can't take control the means of production when land is privately owned.

Isn't this all stuff that can only really be addressed after capitalism? I think Bastani has it right - we largely don't need to work, and jobs are only needed to make profit for the ruling class. Sadly, like Bastani, I don't have any great ideas of how to get rid of capitalism though. I suspect it will require extreme crisis to usher in an alternative [climate change enters stage left]