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27 NOVEMBER 2007

Depression: From the shadows into the light

MENTAL HEALTH

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The condition nobodywants to think aboutDepression is treatable, it affects up to one in five of us. We know that withthe right treatment people recover and also if left it can get worse. Yet it isstill a struggle to get help and support.

People tell us time and again that it isstigma, lack of information and diffi-culties in getting services that preventthem from getting the help they need.

At any given time 1 in 20 people isexperiencing a serious major depres-sion. A similar number will have aless serious depression. In any oneyear about three in every tenemployees will have a mental healthproblem, with depression being themost common.

It makes people less productive atwork, is responsible for high rates ofsickness and unemployment and ishugely distressing for the peopleinvolved.

Depression is responsible for 70 percent of recorded suicides (Faulkner1997) and is estimated to cost Englandand Wales in the region of £8 billionannually in terms of lost productivity(Thomas 2003).

Up to 35 per cent of people whoneed incapacity benefits cite mental

health problems (including depres-sion) as their core disability.

It is the third most common reasonfor GP visits and 80 per cent of depres-sion is managed in primary care.

We know maintaining well being,employment, exercise and a support-ive network of friends can have a bigimpact on beating depression and get-ting back to recovery. Yet hardly anyofficial effort goes into providing thissupport structure.

Currently much of the care offeredthrough primary care services isfocused on the assessment of severityof depression and does not address thebigger picture.

People need help to find and main-tain employment, to explore alterna-tives to medication and to getinvolved in exercise, sport and a rangeof social activities that match differentage groups and cultures.

InformtionThose with depression often face along road to recovery and need tohave easy access and information on arange of different treatment options.

Depression Alliance has been inexistence for over 25 years. As theleading, and longest-established, UKcharity devoted to people with depres-sion we provide understanding, sup-port and information.

We also campaign to raise aware-ness, and understanding, of depres-sion amongst the general public andkey players in mental health.

Depression Alliance is founded onthe principles of self-help and mutualsupport and believes that there shouldbe no divide between physical andmental health. The charity places equalemphasis on identifying people’s needs

and meeting them and every individ-ual’s capacity for recovery.

Depression is a feeling of persistentsadness, involving feelings of help-lessness and hopelessness. It is not justa mood disorder; depression affectsthe whole person and their function-ing at all levels. The commonly heldview that depression is not a “severeand enduring mental illness” furtherblights the provision of care.

The condition is not adequately pri-oritised (given how common place itis) within the contract GPs have. Con-sequently services in primary care aresporadic and not necessarily readilyaccessible to all across the UK.

The vast majority of people suffer-ing depression will make a full recov-ery after appropriate treatment. Suc-cessful treatment can involve a varietyof different approaches, includingself-help and mutual support,” talk-ing” treatments, and/or medication.

At Depression Alliance we offerpeople information about the

CONTENTS

Baby/Winter Blues 4

Drug Treatments 6

Alternative remedies 7

Bipolar affective disorder 8

Help Associations 10

Legal Assistance 11

MENTAL HEALTHA TITLE FROM MEDIAPLANET

Project Manager: Cheryl Jeans, 020 7563 8879Production Editor: Katherine WoodleyEditor: Tom RowlandDesign: Jez MacBeanPrint: News International

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IntroductionDEPRESSION

options available so that they canwork with their healthcare providerto make their own informed deci-sions about treatment.

We have sister organisations inScotland and Wales and co-ordinate anational network of self-help andmutual support groups. These activi-ties enable people with depression toshare experiences and coping strate-gies with others in similar situations.

Our publications provide informa-tion on depression and related topicsand are free to our members and indi-viduals in need.

Through our campaigning and lob-bying work we seek to inform publicunderstanding around the nature andmanagement of depression and influ-ence policy-makers.

Working in partnership with statu-tory, voluntary and commercialorganisations we extend the reach ofour work and try to minimise unnec-essary duplication of effort.

We focus on sharing and promotinggood practice, providing support,practical advice and activities that canmake a difference to people who do orhave experienced depression.

We have a national network ofuser-led support groups as well as afull range of leaflets that provideinformation on depression and relatedtopics. Our quarterly magazine, A Sin-gle Step, is circulated to all members.

DA TALK is a self-help chat roomopen to our members; Pen friend: ascheme whereby people with similarinterests write to each other.

� Emer O’Neill, chief executive ofDepression Alliance.

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For most women, giving birth to anew baby is one of the happiesttimes of their lives. There are alwaysfeelings of anxiousness and ‘babyblues’ are considered normal, butwhat if these blues don’t fade away?Post-natal depression (PND) canleave many new mothers feeling likethey have nowhere to turn.

“Unfortunately, stigma and dis-crimination are still a problem forwomen with post-natal depression,”says Marcus Roberts, Head of Policyat mental health charity Mind.

“Lots of mothers can be afraid toadmit how they are feeling, for fearof being branded 'bad mothers'. If

we want women to come forwardand seek much-needed help andsupport, it's vital that they canapproach health services withoutfeeling judged,” he adds.

Symptoms of PND include lethar-gy, feeling despondent, immenseguilt and feeling hostile towardsyour partner and baby.

Other symptoms include: losinginterest in sex, panic attacks,insomnia, extreme highs and lows,losing your appetite and lack ofconcentration.

PND can strike anyone at anytime, although first-time mothersare more susceptible to it.

Studies have suggested that lackof support is one of the primarycauses in post-natal depression. It isoften supposed that motherhood isinstinctive, but like most things inlife, parenting skills need to belearned.

Other factors include a difficultand traumatic labour; the appear-ance of your body after childbirthand a hormonal imbalance.

For mothers trying to come toterms with PND, Marcus Robertsstresses the importance of talkingthings through: “Although it can bedifficult to talk about these feelings,it's important to feel understood andsupported. Love and nurture fromfamily and friends can help you tocope,” he says.

Ensuring that you look after your-self and eat properly is very impor-tant for your energy levels. However,lack of appetite is a common symp-tom of depression so you might findit very hard to eat. Not eating willmake your condition worse as youwill be lacking in the essential vita-mins and minerals so it is worth tak-ing supplements to ensure that youare getting your daily allowance.

Lack of sleep can also add to youranxiety. The sooner your baby hasroutine, the easier life will be for you.

Post-natal depression should betreated as soon as possible in orderto reduce the distress to both moth-er and child. Contact your GP, mid-wife or health visitor - there is helpout there.

Briege Coyle from the NHS tradeunion Unite/CPHVA said: “Support-ing good mother and baby attach-ment in the first year of life is key…with long lasting benefits intoadulthood”. The Unite/CPHVA is asection of the Unite trade union that is

the third largest union in the NHS andwas formed by an amalgamation ofthe Community Practitioners andHealth Visitors Association withUnite. PND is curable and just becauseyou suffer from it once does not meanthat it will return every time you havea baby.

A one-day conference on mentalhealth problems suffered during theperinatal period will be organised bythe Royal College of Midwives’ on12th February 2008 in London.

If you are interested in attending,you can book a place online at:www.rcmonline.co.uk.

Battling babyblues takes afresh turnOne woman in every ten will experience someform of post-natal depression but there is stillstigma attached to the condition as well as a lackof awareness and knowledge of how to cope.

It seems both obvious and also thesort of thing that the medical profes-sion would dismiss out of hand; asthe nights draw in, the days getshorter and the weather moreunpleasant, then people become pro-gressively more miserable.

In fact the medicine is well estab-lished: the shortage of light triggershigher production of melatonin (thehormone that produces feelings oftiredness at night) and an accompa-nying reduction in the levels of sero-tonin, that now famous neurotrans-mitter that regulates our moods.

There is less agreement aboutwhether SAD, which often comeswith feelings of lethargy and carbo-hydrate cravings, is a separate dis-order or just an extreme form ofwinter misery. But it is real enough,probably stems from primeval urgesto hibernate and hunker down for theduration of the winter; and the

strategies to fend it off are numerousand diverse.

The most effective cure is probablyto bury any recent inhibitions youhave acquired about extending yourcarbon footprint, buy a first class ticketfrom a long-haul airline and jet off to aboutique hotel set on a beach in thetropics for a month; preferably onewith a state-of-the-art health club, ahuge and virtually empty swimmingpool and a chef who is a genius at cre-ating exotic salads and fruit cocktails.

The drawback is the obvious costand the unfortunate fact that many ofus have to battle through the Britishwinter without extended r&r (rest andrelaxation) breaks as part of the con-tract with our not so long-sufferingemployers.

Most experts agree that if you can’tescape then the best strategies are totry and recreate parts of that tropicalhotel experience where you are.

Which means a regime with plentyof exercise, healthy eating and ofcourse lots of light.

Getting extra light rays really doeshelp it seems.

“SAD is difficult to treat with con-ventional antidepressants althoughthere is evidence that serotonin selec-tive reuptake inhibitors (SSRIs) may beuseful in some patients and light ther-apy has been used successfully bymany although it remains controver-sial and difficult to obtain on theNHS,” says Dr John Birtwistle at theAldermoor Health Centre, Universityof Southampton.

Two winters ago the Dana Centre atLondon’s Science Museum gave peo-ple the chance to try out its LightLounge, an area where you could sam-ple light therapy for free.

“We wanted not only to debate theissue,” said Kat Nillson, the Dana Cen-tre programmes manager, “but to offerpeople who may be suffering fromSAD the chance to test out one of themost popular treatments available.”

The Light Lounge featured four spe-cially installed light boxes and a big,comfortable round sofa where visitorswere encouraged to just relax.

Lightboxes are one of the mosteffective treatments for SAD, andmany therapists have been recom-mending them for years.

“They can be spectacularly effec-tive; they have a very high successrate at reducing symptoms and insome people they can banish the syn-drome completely,” said Marcel Ban-nister, a therapist from north London.

He says dietary alterations can fendoff the winter gloom as well. A menuwith high levels of fruit, vegetables

and nuts will keep you well nourishedwhile taking vitamin B and D supple-ments can boost levels of that allimportant mood-enhancing sero-tonin.

Vitamin B is naturally found inbread, cereals and pasta, while vitaminD is produced naturally in the body -but only when the skin is exposed tosunlight.

But comfort food is off the menu:“Cravings for sugary, stodgy foodare a survival mechanism for copingwith the cold weather, but we’ve allgot central heating now and wedon’t need to lay down fat for win-ter, so it’s important not to give in tothem,” he says.

Light relief from winter bluesSeasonal affective disorder (SAD) is the mostcommon form of depression with around half amillion in Britain likely to succumb at this time ofyear. Tom Rowland looks at the survival options.

Baby/Winter BluesDEPRESSION

� The shortage of light in winter triggers higher production of melatonin

� Post-natal depression is most likely tostrike first-time mothers, although anymother can be susceptible

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NIMHE DEPRESSION

Quite often their problems signifi-cantly disable them but they find ithard to get treatment because spe-cialist mental health services focuson those with more severe andenduring conditions.

In practice, 90 per cent of peoplewith mental health problems aretreated by family doctors and theirteams. This accounts for one third ofall GP consultations, more than 90million of them a year.

For some people, medicationalone works well, but for those whoneed more GPs have traditionallyfound themselves unable to accessspecialist support and criticised forwriting too many prescriptions andsick notes.

That is not good for patients andGPs – nor for society as a whole,which sees three in 10 working agepeople have sick leave in any oneyear for mental health problems.

The result is 91 million lost work-ing days and more than a million ofthese people end up on long term sickleave, receiving Incapacity Benefit.

The £170 million expansion ofpsychological therapies is thereforea landmark decision.

It will enable major developmentsin an area of mental health that hasnot previously had much attention,despite the strong evidence base forpsychological therapies andincreasing demand from people tohave them.

It also means the National Insti-tute for Clinical Excellence (NICE)guidelines for treating depressionand anxiety will be followed, offer-ing different steps of care for differ-ent levels of condition. Evidencebased therapies will be on offer, par-ticularly, but not solely, cognitivebehavioural therapy (CBT).

The Improving Access to Psycho-

logical Therapies (IAPT) Programmewill be coordinated on behalf of theDepartment of Health by the Nation-al Institute for Mental Health InEngland (NIMHE).

Primary Care Trusts and StrategicHealth Authorities will graduallyroll out these services in a way thatreflects the best evidence base andthe practical experience at the Don-caster and Newham pilots.

IAPT has already stimulated majorinterest in how local services can beredesigned so a new workforce canput NICE models of care in place.Some 70 per cent of PCTs expressedinterest earlier this year in becomingone of 10 psychological therapyPathfinder sites across England.

These sites will shortly becomeoperational and the learning fromthese will add to that from the twolarger demonstration sites inNewham and Doncaster.

Some of the new services are like-ly to come from expanding currentNHS provision but there will have tobe a major growth in training exist-ing and new staff.

Primary Care Trusts will decidehow best to respond to the needs oftheir local communities, but it is

one in four of us will be significantlyaffected in our lifetime.

That makes such conditions ascommon as heart disease and threetimes more common as cancer.

Keeping this in mind may encour-age all of us to press for furtherdevelopments in mental health careso that we get the high quality ofcare we would want for our family,our friends and ourselves.

NIMHE is part of the Care Servic-es Improvement Partnership (CSIP).For more information about NIMHE

see www.nimhe.csip.org.uk andabout the Improving Access to Psy-

chological Therapies Programmesee www.mhchoice.csip.org.uk

When the ‘worried well’are really worried sickPeople with common mental health problems arestill sometimes dismissively called the “worriedwell” – when, in fact they are more frequentlyworried sick about a range of issues.DR IAN MCPHERSON, DIRECTOR, NATIONAL INSTITUTE FOR MENTAL HEALTH IN ENGLAND

likely the voluntary and independ-ent sectors will provide some servic-es, offering people a choice and tak-ing different needs into account.

People are often still reluctant toacknowledge that they are experienc-ing mental health problems, althoughthey are likely to respond more readi-ly to treatment at an early stage.

But the stigma associated withsuch problems and fear about thepotential reaction from others, par-ticularly employers, tempts peopleto keep quiet. This is a challenge toall of us, not just those who work inmental health.

We need to move away from theview that mental health problemsare unusual and recognise that theyare very common: a sixth of thepopulation suffers from a mentalhealth problem at any one time and

� Health Minister Ivan Lewis chats withpeople who use psychological therapies ata conference about expanding the service.

Relieving misery, transforming lives

Results of a year’s work in two verydifferent places – Doncaster inYorkshire and Newham in east Lon-don – have been so impressive that20 more places across England willget new services next year andthousands more therapists will betrained over the next few years.

Mental health charities warmlywelcomed Health Secretary Alan

Johnson’s recent announcement ofextra annual funding, rising to £170million by 2011, to “build a ground-breaking psychological therapiesservice in England”.

The Doncaster and Newhamprojects replicated clinical trials inachieving measurable recovery inmore than half the people theytreated.

And, for the first time, they rou-tinely collected information onwaiting times, amounts of treatmentand – crucially – measurableimprovements in people’s health.

They helped people stay in jobsand get off statutory sick pay. Othersbecame involved in volunteering,education or training, regaining asense of purpose after weeks,months, or sometimes years, of feel-ing hopeless.

Doncaster GPs referred more than4,000 people to the new service in itsfirst year and some waited only twoor three weeks for treatment.Around the country, six to ninemonths wait is quite usual and some-times it can be as long as 18 months.

In Newham, the most diverse bor-ough in the country, people don’ttend to use the NHS in a traditionalway and some of the languages spo-ken there don’t even have a word fordepression.

But encouraging people to seekhelp direct from the new servicedoubled the number of people seen.Previously unmet need was uncov-ered and met.

Those who took themselves alongwere not the ‘worried well’ but atleast as ill as those sent by GPs.Many had been ill for twice as longbut recovery levels were as good.

Often, people do not seek helpbecause of worries about medica-tion or long waiting lists. But evi-

dence shows therapy, whichaddresses the negative thought pat-terns that create deep personal mis-ery, can be as effective as drugs inthe short-run and is more long last-ing in the long-run.

Improving Access to PsychologicalTherapies programme is sponsored

by the Department of Health and theCare Services Improvement Partner-

ship. Email: iapt@dh.gsi.gov.uk

Thousands of people who have felt crushed bymisery – and their families – are having their livestransformed. That’s the power of a Department ofHealth programme to make evidence-based psy-chological therapies more widely available thanever before.

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Drug TreatmentsDEPRESSION

Mike suffered a breakdown in his lateteens and was diagnosed with bi-polar disorder, a mental illness inwhich a person's mood can swingdramatically from deep depression tointense highs. The illness can seri-ously affect the lives of everyonewho encounters it, includingpatients, their families and friends.

“I was admitted to hospital on anumber of occasions when I was firstill. Since then I have managed my ill-ness through recognising when I’mfeeling stressed and under pressure. Ihave occasional bad days when Ineed to be aware of how I am, but Ispend lots of quality time with myfamily and friends and enjoy theirsupport and encouragement.

I also take regular breaks to makesure the batteries are recharged. Ithelps when you develop someinsight into your illness. I have learntto recognise the symptoms of whenI’m feeling unwell and take steps tostop it escalating.

“Now, rather than an illness I seethis as part of my personality. It’ssomething I manage and it certainlyhasn’t stopped me short in my career.I’m a successful NHS Chief Executivewho is planning to make Notting-hamshire Healthcare a successfulNHS Foundation Trust. I think insome ways being a service user givesme an insight into some of the diffi-culties that people face engagingwith mental health and learning dis-

ability services. If my experience canmake a difference then that’s some-thing I’m keen to share.”

Trust Vision and Anti StigmaIn September this year, Mikelaunched a new vision for the Trustwhich forms the basis for futuredevelopment, giving the organisa-tion a strong foundation to moveforward. He also launched an anti-stigma campaign. The campaignaims to help reduce the stigma sur-rounding mental health and learning

disabilities, spreading the messagethat ‘It’s OK to talk about it’. Thecampaign includes postcards andposters which have been distributedat events and across Trust sites,encouraging people to send the post-cards to their friends to help tospread the message and raise aware-ness.

Vision Nottinghamshire Healthcare is com-mitted to being recognised as theleading provider for mental health

and learning disability services –locally relevant, nationally important.

We will continually improve ourservices and our patient, serviceusers and carer experience and at thesame time reduce the stigma associ-ated with mental illness and learningdisabilities.

We will be a great place to workfor all our staff and a valued partner,with clear service standards createdtogether with our Commissioners,service users and our staff.

Mike’s journeyMike Cooke was appointed Chief Executive ofNottinghamshire Healthcare NHS Trust in June2007 and very early on, was open about his roleboth as a Chief Executive and as a service user.

ABOUT NOTTINGHAMSHIRE HEALTHCARE NHS TRUST

Nottinghamshire Healthcare NHS Trust is one of the largest mental health andlearning disability service providers in the UK, employing over 6000 staff across100 sites. It provides a range of services in settings that vary from the communi-ty, through acute wards and residential units. The Trust also manages two medi-um secure units, Arnold Lodge in Leicester and Wathwood near Rotherham, aswell as the high secure Rampton Hospital near Retford. To find out more visit thewebsite at www.nottinghamshirehealthcare.nhs.uk

� Mike Cooke, Chief Executive of Not-tinghamshire Healthcare NHS

The SSRI family of drugs includesLustral, Seroxat, Cipralex andProzac. Selective serotonin reuptakeinhibitors, to give them their fullname have without doubt made thebrain chemical serotonin famous.

Serotonin is a neurotransmitter, acompound that is used to carry sig-nals between neurons, the electrical-ly active cells in the central nervoussystem.

Only doctors and pharmacists hadheard of serotonin 20 years ago,now you can hardly visit a coffeeshop without hearing its namebandied about.

The millions taking Prozac fordepression might not be aware thatEli Lilly’s patent on its active con-stituent, fluoxetine, expired in 2001prompting an influx of genericdrugs onto the market.

The patent has also expired on oneof the other SSRIs, citalopram but

there are other more modern design-er versions now more commonlyprescribed for different forms ofdepression and associated illnesses.These are escitalopram oxalate, flu-voxamine maleate, paroxetine, ser-traline, and dapoxetine - althoughyou have to look beyond the brandname to see which has been pre-scribed.

The majority of psychiatristsargue the risk of not taking an anti-depressant when suffering depres-sion far outweighs any risks of tak-ing them.

For many of those who take thepills, they can mend, even save,lives. Though depression appears tobe on the increase, in this SSRIenriched era the UK suicide rate - 8.5deaths per 100,000 - is actually at itslowest level since records began.

In the 1970s, when the compoundthat became Prozac was developed,

depression was rarely discussed andantidepressants largely restricted tothe psychiatric unit. People went totheir GPs with ‘anxiety’ and ‘nerves’.Tranquillisers such as Valium were alikely response.

SSRIs were the first class of psy-chotropic drug to be rationallydesigned and in many countries arenow the most widely prescribedchemical antidepressants.

Historically drugs were developedby trial and error testing of theirchemical constituents on animalsand then lining up the observedeffects into treatments. Rationaldrug design starts with an under-standing of a specific chemical reac-tion in the body and tailoring pack-ages to fit treatment.

There is debate about exactly howSSRIs work; the orthodox view fromthe pharmaceutical companies isthat it helps rebalance messengerchemical levels in the brain.

Cells in the brain communicatewith each other via electric signalsand by using messenger substances,the “neurotransmitters”. Serotoninis one of a variety.

“It has been shown that a certainmessenger level is required to main-tain good communication betweenthe cells of the central nervous sys-tem. If there are too few neurotrans-mitters, communication is disrupted,which causes the symptoms ofdepression and anxiety”, explainsone company that makes some ofthe most successful modern SSRIs.

“These messenger substances areusually “recycled” after they havedone their work in the brain. So-called “serotonin transporters” actlike small vacuum cleaners to collectthese messengers so they can beused again later. A special class ofmedications, the “Selective Sero-tonin Reuptake Inhibitors (SSRI)”have been designed to block thetransporters so that the messengerscan work a little longer and moreefficiently, than normal,” it says.

The underpinning theory ofrebalancing chemical levels inthe brain is open to thecriticism that withoutcontinuously moni-toring the neuro-transmitter lev-els in a patientduring the courseof administration of thedrug it is not possible to know if adeficient transmitter is being accu-rately targeted. Without knowing

Perpetual sunshineBetween 1991 and 2001 antidepressant prescrip-tions in the UK rose from 9 million to 24 million ayear and a new vocabulary was born.

where the fulcrum is, how do youcorrectly balance anything?

While there can be no doubt thatSSRIs are hugely successful they stillattract criticism, partly because it isargued by some therapists that theyare over prescribed as an easy fix bydoctors in cases where there is only amarginal cause for their use.

In 2004 there was much publicitygiven to suggestions that there was alink between SSRI prescribing tochildren and an increased incidenceof juvenile suicide. In the US thedrug watchdog the FDA now insiststhat parents are warned that the riskof juvenile suicidality is estimated tobe twice that of placebo.

But even if there are some ques-tion marks over the mechanism bywhich they operate, the overwhelm-ing body of evidence points to SSRIssaving lives and much misery.

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Homeopathic treatmentsclaim to offer new hope

Alternative Remedies DEPRESSION

Some who suffer from depression and arelooking for alternatives to conventional medi-cine believe the holistic approach of homeo-pathic treatments can help them recover.

According to The Society of Home-opaths over 30 million people inEurope benefit from homeopathictreatment, which it says can be usedalongside many traditional antide-pressants in the treatment ofdepression.

Holistic and homeopathicapproaches to all illnesses, butespecially depression, claim totake the entire mental and physicalwell-being of an individual intoconsideration as well as symptomsof the illness.

Clinical research is still minimaland there need to be a lot more testsconducted before it is widely accept-ed as a credible treatment by mostscientists and medical professionals.

“While... the mechanism of actionof homeopathic medicines has yet tobe proven scientifically, the evidenceremains that they work. There aremany things that science cannot yetexplain. But let’s not dismiss theexperience of the millions of peoplewho benefit from homeopathy”, saysPaula Ross, chief executive for TheSociety of Homeopaths.

Homoeopathy works on the theo-ry of “like curing like” which wasdeveloped by a German doctor bythe name of Samuel Hahnemann inthe early 19th century.

He was studying Cinchona bark,which was used as a treatment formalaria. Part of his studies includedtrying out the bark that resulted inhis experiencing similar symptomsto the symptoms of malaria.

These findings prompted Hahne-mann to carry out more studies thatled him to the conclusion that allsuccessful drugs cause symptoms inhealthy people which are similar tothose of the diseases that they treat.This theory became known as the“law of similars”. He started to test arange of substances to see whatsymptoms they cause – a processthat became known as “proving”.

He found out that the natural sub-stances needed to be diluted in orderto help relieve symptoms, and wrotean overview for his book “Organonof the Medical Art,” still used byhomoeopaths today.

Since Hahnemann’s initial find-ings, trained homoeopaths claim tohave gained a much deeper insight

into natural medicine; meaning thateach individual can have a medicinalprogramme designed just for themwhich takes into account their gener-al fitness and condition.

Natural remedies are made fromplants or other herbal substances,ground down and dissolved inalcohol or water. They are dilutedmany times, which has led to thetreatments being criticised for con-taining virtually none of the origi-nal substance.

In reaction to this criticism, anumber of concepts have beendeveloped and introduced such asthe “memory of water”.

The theory of water memory sug-gests that water is actually capable ofpreserving a memory of particleswhich have at some time been dis-solved in it. This in turn ensures thatwater retains the properties of theoriginal solute – even when there isonly a minimal amount of the origi-nal substance left in the solution.

Homoeopathic remedies are safeand free of side-effects because theyare so dilute and work by directlyaffecting the “Vital Force”. Jacob I.Mirman, MD describes this in hisbook, Demystifying Homeopathy, assomething which “controls all of thebody’s natural processes and pre-serves balance. When it becomesinactive, we die”.

He then goes on to explain that“Homeopathic remedies directlyaffect the Vital Force” by effectivelymirroring the illness already present.It is believed that the Vital Force canonly handle one disease at a time sowhen homeopathic treatment isintroduced, it prevents the newlyintroduced irritation from takinghold and as a result also fights off theactual disease which has the samesymptoms.

In the case of depression, the VitalForce is already suffering from thesymptoms of the condition so whenhomeopathic treatment is intro-duced, it begins to repel all symp-toms. There are a number of differentholistic remedies which can help toalleviate the symptoms of depres-sion. Each drug is specific to certaincauses of depression, unlike antide-pressants which are used universally,regardless of the type of depression.

Common treatments include:Arsenicum album Actually madefrom white arsenic, this treatmentis believed to be especially effec-tive for those who have unneces-sary concerns about their health aswell as those who are overly-criti-cal about themselves, physicallysuffer in cold weather and are verysensitive to pain. Aurum metallicum Made from gold,and said to be useful for those suf-fering from feelings of despair aswell as those who have sufferedfrom failure at work. Those who useAurum metallicum will feel betterafter walks outside in the fresh air. Ignatia amara This treatment shouldbe taken by those left with depres-sion after suppressing a period ofintense grief and emotion. It is oftenused after bereavement. Kali phosphoricum Helps individualswho have suffered from severeexhaustion and have become intro-vert and anxious. Lachesis muta Made from snakevenom and is supposed to help thosesuffering from depression which iscaused by jealousy. It can also betaken for menopausal depression. Natrium carbonicum Used whentreating people who deeply care forfriends and family and may havesuffered a loss. People of this naturewill often try to hide their feelingsand may isolate them surroundingthemselves with reminders of friendsand family. Often they will also suf-fer from weak digestive systems anddairy intolerance. Natrium muraticum Said to benefitthose individuals who a very sensi-

tive and may suppress intense angeror fear. The depression they experi-ence is caused by the suppression.They will often ask to be left alone inorder to cry and let their emotionsout. Migraines and fatigue are com-mon symptoms with this form ofdepression. Pulsatilla nigricans Helps those whoare emotional and ultra-sensitive.They can often appear childlike withtheir mood-swings and need thesupport of friends and family. It isoften given to women after child-birth and during the menopause. Sepia Comes from cuttlefish ink andis used to help cure depression inpeople who are irritable and draggeddown by their responsibilities. Theirloved ones are often targets for theiranger. It is commonly used whentreating post-natal depression. Staphysagria Used to help peoplewho have an underlying anger prob-lem. They are often workaholics whoexperience intense rage in betweentimes of calm. A high sex drive iscommon and headaches are a com-mon symptom.

You can take many of these reme-dies in conjunction with other drugsand while you do not always need toconsult your GP, you should let themknow of any herbal treatments youare taking. They come in either tabletor liquid form, both of which areeasy to take.

The United Kingdom Homoeo-pathic Medical Association or theSociety of Homoeopaths can pre-scribe holistic treatments or you canbuy many of them in health foodshops and a limited number of phar-macies throughout the UK. Youshould always visit your doctor ifsymptoms persist.

For more information, visit theSociety of Homeopaths atwww.homeopathy-soh.org or TheUK Homoeopathic Medical Associa-tion at www.the-hma.org.

BACH ORIGINAL FLOWER REMEDIES

The Bach Original Flower Remedies were developed in the 1930s by Dr EdwardBach a Harley Street doctor who was unhappy with the way doctors wereexpected to concentrate on diseases and ignore the people who were sufferingfrom them. He was inspired by his work with homoeopathy but wanted to findremedies that would be purer and less reliant on the products of disease. Afteridentifying 38 basic negative states of mind and spending several years exploringthe countryside, he created a plant or flower-based remedy for each one whichhe grew in an Oxfordshire garden. Today the system of 38 flower remedies are stillmade according to his methods from plants that grow in the gardens of the BachCentre in Oxfordshire. They are safe and used world-wide by millions of peopleincluding complementary health practitioners. “During the winter a lot of peoplefeel down for various reasons. With its short dark days and unsociable weather itis no wonder that many of us get a bit miserable when winter descends,” saysJudy Ramsell Howard, Director of the Bach Centre.

For that constant Monday morning feeling when people doubt their ability toface the day and feel life is stale she recommends hornbeam. “It can uncover yourreserves of energy and once you get going the tiredness will melt away,” she says.For feelings of gloom that descend from nowhere she recommends mustard “tolift the gloom and restore a natural sense of happiness”.

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Official figures estimate that one percent of the population will sufferfrom bipolar disorder at least onceon their life.

There is a heightened risk if italready exists in the family, so it isimportant to be aware of the signs tolook out for. The highs and lows canlast for several months at a time withno abnormal behaviour occurring inbetween. It is a very serious illnesswhich needs therapy, but it can betreated.

The actual cause of the conditionis unknown but medical profession-als believe that the genetic make upof an individual makes them moresusceptible to developing it whilestress and certain illnesses arethought to significantly increase thechance of having an attack.

The Highs and the LowsEveryone has their off days; feelingdown for no apparent reason, butfor those who suffer from bipolardisorder, the depression will be a lotmore severe - to the point where itcan be extremely difficult to carryon with daily life. This depressioncan last for months and is often

accompanied by an overwhelmingsense of sadness, lack of interest ineverything, indecision, weight loss,insomnia or extreme fatigue, no sexdrive, restlessness, excessive guiltand suicidal thoughts.

At the other end of the scale,mania can be just as disruptive andvery frightening for friends andfamily.

The symptoms of mania developvery quickly and see all rationalthought disappear. It is common tofeel extremely happy and have veryhigh energy levels to the point ofhyperactivity. A lack of judgementcould lead to highly embarrassing,inappropriate and even dangerousbehaviour.

Sufferers may feel very self-important and will certainly be self-obsessed, making very illustriousand inappropriate plans. If leftuntreated, mania can develop intopsychosis which can see the personbecoming delusional and sufferingfrom hallucinations.

There is no way of knowing howoften these episodes will take placeand no way to know how long theywill last. After the initial episode,

depression or mania will almost cer-tainly recur. Over half of reportedcases will see a recurrence within ayear while 7 out of 10 people will seeit return after five years.

Are you affected?If you or a loved one is showingsigns of the illness, it is very impor-tant to get medical help as soon aspossible. Once the condition hasbeen diagnosed, you can begin tolook at suitable treatment andhopefully avoid any futureepisodes. Recognising the symp-

toms early and getting the neces-sary help and advice will ensurethat the depression or mania doesnot threaten the safety of you oranyone around you.

A doctor will diagnose the condi-tion after assessing any symptomswhich are present as well as anysymptoms which have been sufferedin the past. Once it has been diag-nosed, it is possible to begin takingsteps towards recovery. Treatment iscomplex as the conflicting symp-toms of depression and mania needto be controlled.

The treatment for depression con-sists of antidepressants and psy-chotherapy. Mania is treated withantipsychotic medication (such ashaloperidol and chlorpromazine).Unfortunately, antipsychotic drugscan cause side effects which include:stiff joints, constipation, shakyhands and a very dry mouth.Patients may need to take othermedication alongside the drugs tocounteract any side effects.

When suffering from seriousdepression or mania, patients are pre-scribed mood-stabilising medication,

The pendulum in the pitBipolar affective disorder, otherwise known asmanic depression, is a condition which causesextreme mood swings; far beyond what is regard-ed as being ‘the norm’. People suffering from itwill experience intense highs, known as mania,followed by periods of severe depression.

Bipolar Affective DisorderDEPRESSION

16.7 million people in the UK will expe-rience a mental health disorder eachyear, and the Department of Healthlaunched MHRN in 2004 in recognitionof the fact that mental health researchis essential to patient care. The networkprovides national support for goodquality research that will inform mentalhealth policy and improve healthcarein the NHS. MHRN is also committed toachieving a programme of researchthat reflects the needs and views ofpatients and the public.

MHRN has over 70 trained and ded-icated staff based in eight NHS teams

across the country. They provideassistance to clinical research teams,and collaborate with partner net-works in Wales, Scotland and North-ern Ireland.

Currently the network supports 65well designed studies across the spec-trum of mental health conditionswhich have been funded by govern-ment agencies, charities and the phar-maceutical industry. These studiesreceive assistance in a number of waysincluding help with project adminis-tration, the recruitment of patientsand study publicity.

Professor Til Wykes, MHRN Director(pictured right), who is based at theInstitute of Psychiatry, King’s CollegeLondon says: “MHRN can benefitresearch teams greatly - our objective isto be a central resource to support themto complete research studies to targetand on time.”

“I liked being part of newdevelopments and aiming

towards improving treatmentfor myself and others”A patient's view about participating in an

MHRN depression study

Depression researchMany of the studies supported byMHRN are on depression and these aimto answer a range of different ques-tions. For instance: • What do we know about the treatmentof depression in a less researched grouplike adolescents: is psychological inter-vention better than drug treatment?

• Are people with depression whoattend exercise schemes more likely torecover from their illness?• Moderate depression occurs inwomen after having a baby – but iscounselling a more effective treatmentthan antidepressants?

• Anti depressants treatments work, butare there genetic and clinical factorsthat predict who is going to respondwell to a particular type of drug?

All the studies running on MHRNaddress current issues in mental healthtreatment that need to be resolved, andthe success of them and the networkdepend on close collaboration with arange of health professionals as well aspatients and the public.

To find out more about the work ofMHRN, please go to www.ukmhrn.info

E-mail: mhrn@iop.kcl.ac.uk Tel: 020 7848 0699.

Providing the NHS infrastructure to improve mental health research

UK Mental Health Research Network (MHRN) provides an opportunity to widen participation inresearch and help reshape mental health practice,including the treatment of depression.

• A mental health problem is the most common reason for someone claimingIncapacity Benefit in the UK

• GPs spend more than a third of their clinic time on mental health issues• More than 2.9 million people in the UK are diagnosed as having depression

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Bipolar Affective Disorder DEPRESSION

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which is also used to prevent furtherattacks. This medication will workunless the condition becomes verysevere, in which case a patient mayneed to be hospitalised.

The most commonly prescribedstabilising medication is lithium,although carbamazepine and sodi-um valproate are also used. Thosewho take lithium will need to haveregular blood checks to monitorlithium levels in the body as highlevels can be harmful and low levelswill not help the condition.

What does the future hold?The future for someone sufferingfrom bipolar disorder is not alwaysclear. Every case is unique, withsome people only ever sufferingfrom one or two attacks in their lifewhile others switch from beingmanic to being depressed frequently.

It may be possible to prevent fur-ther episodes with medication aswell as by making some changes tolifestyle such as trying to avoidstressful situations, avoiding alcoholand recreational drugs and byexplaining the condition to familyand friends so that they can help byrecognising the symptoms.

There are a number of ways inwhich friends and relatives can help.

While cases of mania can be particu-larly distressing to watch, it isimportant to be understanding andpersuade a loved one to get profes-sional help. If they have experiencedmania or depression in the past,contact their doctor who is involvedwith their care and ask them foradvice. If this is the first time that aloved one has suffered from the ill-ness, it is important to contact theirGP as soon as possible.

Helping the helpers Finally, it is very important that youlook after yourself because you canget very distressed and exhaustedcaring for someone with this condi-tion. You should make sure you getplenty of rest, exercise and eat regu-lar meals. Neglecting your ownhealth will not help anyone.

If you suspect that you or a lovedone is suffering from bipolar affec-tive disorder, it is very important tovisit your GP immediately. The doc-tor will be able to diagnose whetherit is or isn’t and can then prescribethe appropriate treatment.

For more information on the con-dition, MDF The Bipolar Organisa-tion offers help and advice on theirwebsite which can be found at:www.mdf.org.uk.

WHEN BEING OVERWEIGHT MAKES YOU DEPRESSEDThere are risks associated with very low calorie diets but they can do wondersfor a state of mind, if properly managed.

LighterLife is the UK industry leader in clinical obesity management. Since its launch in 1996, LighterLife has pioneered aweight-loss and weight-management programme for people with a BMI of 29 or over that works effectively, quickly and safe-ly. The LighterLife Programme offers a unique opportunity to help people lose weight, addressing the underlying issues thatled to obesity in the first place, with healthy, long-term weight-maintenance the goal. For eleven years men and women haveused the programme to successfully lose weight, keep off the weight and benefit from the long-term associated healthimprovements, by changing the way they eat, think – and live.

In this feature, LighterLife Founder Director Bar Hewlett and Professor Iain Broom outline the concept of Very Low CalorieDiets as a treatment for obesity.

LighterLife uses a very low calorie diet (VLCD) to initiate safe, effective and rapid weight loss, alongside cognitive behaviour-al therapy and transactional analysis techniques to encourage long-term weight maintenance.

“Research has shown that the use of VLCDs to achieve rapid weight loss can lead to better long-term outcomes whenweight maintainance methodology is simultaneously used, than other lifestyle changes involving diet. Small group coun-selling, including behavioural modification, helps clients establish long-term healthy eating and activity habits, and providesthe psychological support necessary for them to make the changes necessary for successfully managing their weight in thefuture. “ Bar Hewlett

“The guidelines from the National Institute for Health and Clinical Excellence (published 12/2006) advocate very low caloriediets (VLCD’s) as a treatment option for obesity. NICE also recognises and recommends the use of cognitive behavioural ther-apy (CBT) for the treatment of eating disorders and recommends that the NHS should work with commercial weight-manage-ment programmes like LighterLife. LighterLife supports and complies with the NICE recommendations, and these have beenintrinsic to the programme since its inception in 1996. “ Professor Iain Broom

Professor John (Iain) Broom is a consultant in Clinical Biochemistry and Metabolic Medicine at Grampian University Hospi-tals NHS Trust, Professor of Clinical Biochemistry at The Robert Gordon University in Aberdeen, and Director of CORE (The Cen-tre for Obesity Research and Epidemiology). He is also Clinical Professor of Metabolic Medicine, University of Aberdeen and cur-rently Chairman of the Aberdeen Consortium on Energy Regulation and Obesity (ACERO). Bar Hewlett is a Director and Co-founder of LighterLife. With a science background she has worked in the field of obesity since 1988. She has presented at Inter-national Obesity Conferences, Guild of Healthwriters Awards and has also contributed to the International Journal of Obesity.

Stephen Fry was among the Britishwinners at the International Emmyawards in New York last week (19November).

He scooped best documentary forThe Secret Life of a Manic Depres-sive, an account of his and otherpeople's struggle with bipolar disor-der for the BBC.

The comedian and filmmaker metand talked with celebrities andmembers of the public who talkedfrankly about the impact the condi-tion had on their lives.

Stephen Fry recounted his suicideattempt after walking out of theWest End play Cellmates in 1995,and the continuing severe moodswings he has to endure.

Stephen interviewed othercelebrities with bipolar, includingStar Wars actress Carrie Fisher, Hol-lywood star Richard Dreyfus and

British comedians Tony Slattery andJo Brand. He also met ordinary peo-ple and their families coping withthe condition and talks to themabout some of the possible triggers.

“I'm in a rare and privileged posi-tion of being able to help address thewhole business of stigma, and why itis that the rest of society finds it soeasy to wrinkle their noses, crossover, or block their ears when con-fronted with an illness of the mindand of the mood”, he explained.

“I approach it from the point ofview of one who suffers, accordingto a psychiatrist at least, fromcyclothymia which is sometimescalled 'bipolar light'.

“I take that to mean I have most ofthe benefits of hypomania, a slightlyless psychotic form of energy, vitali-ty and exuberance and some, onehopes, creativity. There are certainly

spending sprees but happily very lit-tle promiscuity. That's just my goodfortune in this regard.

“I'm fortunate enough not to bemedicated or, so far as I can tell,need medication. But the idea thatonce you start on medication andeach time you go off it you seem toget worse is a very grim one. It reallyis a very serious condition.

“We've tried to approach the con-dition from all kinds of angles. We'velooked at the issue of self-medica-tion. How so many people try and dothe one thing they can in our culturethat allows them to control theirmoods, however detrimentally in theend, with street drugs and alcohol.

The programme also looked at thewhole aspect of sectioning and visit-ed hospitals in some of the mostdeprived areas in Europe, such asHackney and Tower Hamlets.

"It's rather splendid to think of allthose great men and women whoappear to have presented symptomsthat allow us to describe them asbipolar, whether it's Hemingway,Van Gogh, Robert Schumann hasbeen mentioned ... Virginia Woolf,Sylvia Plath ... some of them withrather grim ends."

Research into bipolarDuring the documentary Stephen Fryparticipates in a bipolar mood disor-der study. He talks to Professor Crad-dock and his research team at theuniversities of Cardiff and Birming-ham. It's the largest study of individ-uals with bipolar disorder in theworld. You can find out more aboutthe research and how to take part on

the Cardiff University website. Youmay also be interested in the Nation-al Bipolar Twin Study being carriedout at the Institute of Psychiatry,King's College, London. Thisresearch is looking at the geneticand environmental factors thatinfluence bipolar disorder. It's cur-rently looking for more twin volun-teers to take part

Prize highs and lows Bipolar affective disorder, otherwise known asmanic depression, is a condition that causesextreme mood swings; far beyond what is regard-ed as being ‘the norm’. People suffering from itwill experience intense highs, known as mania,followed by periods of severe depression.

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Depression Alliance is the leadingcharity devoted to people affectedby depression in England.

“Many GPs are excellent when itcomes to providing support to peo-ple with depression, however someare not”, explains Emer O’Neill,director of the charity.

“Often GP’s simply do not allocatethe time needed to make an effectivediagnosis nor do they have theknowledge about the range of treat-ment available,” she adds.

“Although medication is extreme-ly effective for the majority of peo-ple it has an increased effect whencombined with talking therapies,particularly Cognative BehaviouralTherapy (CBT)” she adds.

Exercise, diet, employment andclose relationships are essentialcomponents to maintaining well-being and preventing relapse.

The stigma that is attached todepression prevents people fromgetting help.

Depression Alliance believes thatcomputer based Cognitive Behav-ioural Therapy (cCBT) is an impor-tant advance and that sessions canbe a real help to many with mild tomoderate depression.

SupportDepression Alliance is the leadingUK charity dedicated to offeringsupport to anyone suffering fromdepression or caring for somebodywith depression.

It provides information andadvice about the condition and cam-paigns to raise awareness among thegeneral public about the realities ofdepression.

Its aims are to both treat and pre-vent depression through informa-

tion available via their web site andby having a network of self-helpgroups around the country.

The stigma surrounding all formsof depression prevents those in needfrom seeking out help.

“Early intervention and informa-tion is crucial in enabling thoseaffected by depression to recoverquickly and – critically – in prevent-ing further episodes,” it says.

Over the past 25 years DepressionAlliance has organised a number ofcampaigns and initiatives in order tohelp raise awareness. These includeDepression Awareness Week, spon-sored walks, television interviewsand volunteer days.

Depression Awareness Week isheld every April and has the supportof individuals who know what it islike to suffer with depression or carefor someone with depression, as wellas celebrities, politicians, healthcareprofessionals and the media.

Each year, the campaign focuseson a specific aspect of depressionwith awareness raising and fund-

raising events taking place all acrossthe country. The aim of this week isto highlight “the realities of depres-sion and to reduce the stigma associ-ated with it”.

Previous years’ focuses haveincluded: “Depression and suicide”,“Depression in the workplace”, and“Myths and misunderstandings sur-rounding Depression”.

Fund raising events during theweek take place all around the coun-try such as street collections, volun-teer days and concerts.

Alongside these annual events,Depression Alliance also carries outthorough research, independentlyand with the help of universities andvoluntary organisations into thecauses and treatments of depression,

and to improve its understanding ofwhat services people need.

They use their findings to: “edu-cate and inform healthcare profes-sionals, government, and the gener-al public via the media” and also toimprove their own services.

They have a selection of publica-tions available which cover everyaspect of depression offering helpand advice to those who are most inneed.

All of the publications offer usefulcontact numbers, web sites andother details of organisations whichcan help.

If you would like to find out moreabout anything in this article, please

visit www.depressionalliance.org.

Depression Alliance offershope at a time of despairIf you or someone you know is suffering fromdepression, you may feel that you have nowhereto turn. This does not have to be the case.

More than half of England’s mentalhealth trusts have seen moneydiverted away from them to pay fordeficits in other local health servic-es, according to a survey by theSainsbury Centre for Mental Health.

This is because where they have achoice the main funding committeesunder the NHS reform programme,tend to cave in the face of publicdemands to give extra cash to sur-geons and physicians and they takeit away from the psychiatrists,whose patients are less articulateand pushy. It is hard to fight yourcorner when you feel depressed,uncared for and miserable.

The survey reveals that 63 percent of mental health trusts wereasked by commissioners to spendless than they had planned in2006/07, on average by three percent of their budgets.

“The most common reason for sav-ings to be sought was overspending in

other local NHS bodies, such as pri-mary care trusts and acute hospitals,”says the Sainsbury Centre report.

“It is very worrying that mentalhealth trusts are being squeezed topay for the overspends of acutetrusts using the new Payment byResults system…. It is essential tomaintain the principle that the needsof mental health service users andtheir families are not compromisedby financial pressures elsewhere inthe system,” said Angela Greatley,chief executive of the SainsburyCentre.

The Henderson Hospital is an NHSspecialist centre serving the needs ofpeople with enduring emotional andbehavioural problems that are diag-nosed as moderate and severe per-sonality disorder.

It is more than four times as com-mon as schizophrenia and covers awide range of behaviours and a highproportion of those with the diagno-

sis report physical, emotional andsexual abuse during childhood.

Many have alcoholic mothers andviolent or absent fathers. The girlsare susceptible to a cycle of eatingdisorders and self-harm the boys todrugs, alcohol and crime. They canoften all end up as revolving doorconsumers of prison and psychiatricservices, trapped in a vicious circleof depression, chaotic lives and frac-tured relationships. The hospitaloperates as a democratic therapeuticcommunity with the responsibilityfor the daily running of the serviceshared between staff and residents.

Collaboration“This collaboration is essential to thetherapy and for many residents it isthe first time that their views havebeen respected and taken seriously,”explains Dr John Stevens, the con-sultant psychotherapist.

Large numbers of doctors want torefer patients to the centre but thereferrals are increasingly beingknocked back because local trusts donot have the funding, he explains.

“The threat of closure is looming Iam afraid because the current fund-

ing regime in practice discriminatesagainst services like ours,” he said.

Research shows that the cost oftreatment will be recouped in twoyears from a reduction in psychiatricadmissions, says Dr Stevens.

Treatment at the centre is volun-tary and a vehicle for change ratherthan a total cure. Those most likelyto benefit will demonstrate somemotivation to address their problemsand to co-operate in the group life ofthe community.

The Henderson is a 24-hour seven-day a week residential unit with anintegrated programme of group ther-apy throughout each weekday thatincludes group psychotherapy, psy-chodrama, art therapy and work-centred groups.

The structured programme is com-plemented by socio-therapy, whichinvolves residents exploring theirproblems within everyday living, andby making relationships with others.

Together this combines to formwhat Dr Stevens calls “a living-learning” experience.

“Through mutual feedback theylearn how to co-exist and graduallyto assume responsibility for the day-

to-day running of the community,”he explains.

Each month three residents areelected to act as a bridge betweenstaff and resident, carrying outimportant tasks including conduct-ing the meetings.

At any time of day or night theytogether with the duty staff mayconvene an emergency meeting todeal with any crisis occurring withinthe community.

By accepting the treatment regimeresidents agree to keep the rules, themain points of which are not to beviolent to themselves, the staff, oth-ers or to property, to keep off illicitdrugs, limit alcohol intake, attendthe therapy groups, respect bound-aries and carry out the jobs to whichthey have been elected. Fellow resi-dents can throw them out.

Referrals are welcome from allparts of the UK and come from awide range of professionals, agen-cies and services including psychi-atric services, forensic, addiction oreating disorder services, socialservices or probation. The treat-ment takes place without psy-chotropic drugs.

It is hard to be pushy when depressedOne unpredicted consequence of reforms to makehealthcare more democratically accountable hasbeen to squeeze some psychiatric care. We look atthe Henderson Hospital, in Sutton, Surrey.

Help AssociationsDEPRESSION

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Legal Assistance DEPRESSION

Being mentally ill has always putpeople at a huge disadvantage whenfaced with legal processes, which iswhy special provisions are made forthem.

The mentally ill have had somesort of legal protection sincemedieval times even before therights of Edward III to confiscatetheir property were curbed.

But recent developments shouldmake some feel more secure thanthey have until now.

The new Capacity Act of 2005 isan important milestone. It set up anew Court of Protection, which isdesigned to safeguard some of theinterests of vulnerable people.

One of the ideas behind the legis-lation is to balance more sensiblysomebody’s ability to make deci-sions against the relative importanceof those decisions.

So for example, an individual suf-fering from a form of bipolar disordercharacterized by periods of elatedmania followed by bouts of depres-sion, might well be ultimately grate-ful for a legal constraint which pre-vented them giving all of their wealthto a shady business enterprise with atrack record of defaulting on loans.Especially if they had the idea whilein the thrall of manic excitement.

But the same individual couldlegitimately argue that they wereperfectly entitled to withdraw suffi-cient funds from a trust fund toallow them to escape the worst ofthe English winter and live modestlyabroad at a time of year when theymight otherwise be vulnerable towinter blues.

The Act enables patients withfluctuating disorders, includingdepression, to make Advanced

Directives, including the ability torefuse certain forms of treatment ifthe Directive was made in a period of“capacity”; although this does notauthorise a right to suicide.

The issue of nursing homepatients is also to be addressed in anew Mental Health Act.

This follows a recent ruling by theEuropean Court on Human Rightswhich held that some patients innursing homes were subject todetention.

However, unlike patients detainedin hospital, they have until now nothad the right to periodic independ-ent review. Now in some cases it willbe possible to instruct a lawyer totake their cases to the Court of Pro-tection. The law is expected to befully in force by October 2008.

The criminal law applicable tomental heath also has medievalroots. For centuries there has been anotion that those suffering frommental disorder should not bear fullresponsibility for their acts.

Although recent legal changeshave forced some mentally unwelldefendants convicted of more seri-ous offences into prisons rather thanthe secure hospitals where they

belong. Even when no criminaloffence is involved, a small propor-tion of those suffering from anyform of mental illness can findthemselves “sectioned” and sent tohospital for compulsory treatment.

“The far-reaching powers of com-pulsory medication and detentionare accompanied very properly byjudicial scrutiny through MentalHealth Review Tribunals,” says part-ner Sam Polson. “Detention can befor 28 days, six months or longer.Legal representation under legal aidis available.”

For the majority of sufferers frommental disorders who are in the

community important legal issuesinclude the quality of services pro-vided by local health trust and localauthorities.

With the charity Mind indicatingthat as many as 1 in 4 now sufferfrom depression, the law, andlawyers, will play an ever-expand-ing role in this area.

Kaim Todner is a 7 partner firmwith offices in London and in Kent.Partner Richard Charlton is current-ly listed as a leader in the field inChambers Law Directory; wasselected as the first “Mental HealthLawyer of the Year” in 2004 andchairs the Mental Health LawyersAssociation. Together with fellowpartner Sam Polson he leads a teamspecialising in representing thosewith legal issues in most areas ofmental health law, including capaci-ty issues and challenges to publicauthorities; they work closely withthe firms’ family, criminal, prisonersand public law teams as required.Sam or Richard can be reached on0207 704 9292 or via the websitewww.kaimtodner.com.

How the law can be there to helpThere have been important changesin the way in which the law oper-ates in relation to people sufferingfrom mental illnesses, explainsRichard Charlton partner at solici-tors Kaim Todner.

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The Disability Discrimination Act2005 that came into force in October2006 strengthens protection givento those with mental illnesses andgives people new rights in the areasof employment, education, access togoods and facilities and requirespublic bodies to promote equality ofopportunity for those who suffer.

The Government has specificallyincluded people with moderate tosevere forms of depression in thenew Act.

Disabled“Someone with a mild form ofdepression with only minor effectsmay not be covered, while someonewith severe depression with sub-stantial effects on their daily life islikely to be considered as disabledunder the Act,” says the explanatoryGovernment leaflet.

“Essentially less stringent proof isrequired than was the case before forsomeone with a mental health prob-lem to be covered. Previously a con-dition had to be well advancedbefore it was clear that discrimina-tion was going on,” explainsRichard Charlton partner in chargeof the mental health law departmentat solicitors Kaim Todner and chair-man of the Mental Health Lawyers’Association.

IllegalIt is now illegal for employers to dis-criminate against people becausethey suffer from mental health prob-lems and this most definitely coversdepression, he says.

Although it is early days for thenew Act people with depressive dis-orders who have been discriminatedagainst either in the workplace or as

applicants for jobs have a clear casewhich they can bring to law, he says.

Section 3 of the new Act intro-duces a new duty on public authori-ties requiring them, when exercis-ing their functions, to have dueregard to the need to eliminateharassment of and unlawfuldiscrimination against dis-abled persons, to pro-mote positive attitudestowards disabledpersons, to encour-age participationby disabled per-sons in publiclife, and topromote equal-ity of opportunity.

Section 15 makes it unlawful forgeneral qualifications bodies to dis-criminate against disabled personsin relation to the award of prescribedqualifications.

While Section 18 of the new Actspecifically amends the definition ofdisability in respect of people withmental illnesses and goes on to clar-ify that there is no implied limita-tion to the scope of the regulation-making power which enables peopleto be deemed to be disabled.

A second new law will also poten-tially make life easier for those with

depressive illnesses. TheCapacity Act 2005 has extend-ed the powers of the Court ofProtection.

Those suffering from bipolar dis-orders or cyclical mental illnessessometimes find their affairs regulat-ed by the courts and these functionswill now be concentrated into theCourt of Protection.

The roll of the courts variesaccording to how ill someone is and

it will now be easier for them to getlegal representation to have ordersvaried and powers altered, althoughit is highly advisable to seek legaladvice on how to bring a case.

The Court of Protection willalso have a much stronger role inregulating Powers of Attorney .

Deciding on the rights ofthose who have previouslyexpressed wishes regardingmedical treatment will alsocome under the orbit of the

extended court.

AdviceMental health lawyers can also offerhelp and advice as well as supporton most aspects of employment lawas it applies to those suffering fromharassment and other forms of dis-crimination.

Legal protectionYou do not need a physical or sensory impairmentto be considered disabled and people with mentalhealth problems have extra protection under twonew Acts.

� Samuel Polson, partner

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Motor neuron synapse formation

Lundbeck is an international pharmaceutical company uniquely focused

on diseases of the central nervous system.

Our mission is to improve the quality of life for people with psychiatric

and neurological illness, through the discovery and development of

new treatments.

As specialists, we continually strive to understand and meet the needs

of people suffering from mental illness and those who care for them.

We also understand that our treatments and support contribute only a

part of the picture in the recovery of a better quality of life for people

suffering from mental illness.

The CNS specialists