,
90 tweets,
54 min read
Read on Twitter
I'm having a watch of last nights @C4Dispatches "Young, British and Depressed. I'm going to share some thoughts as I go along. The programme was on the UK's Channel 4 for any none UK folks channel4.com/programmes/dis…
@C4Dispatches First thought is: children's #mentalhealth and young adults mental health isn't the same thing. Child and Adolescent Mental Health Services and mainstream mental health services are different beasts. 'Young people' is an artificial construct here. 13 and 30 are very different
@C4Dispatches In the intro the film cuts from a video diary/vlog type bit of footage saying there's no help out there' to voice over asking 'have young people become over reliant on antidepressants?' as if these two questions were naturally linked. They aren't, unless you want to make a point
@C4Dispatches We get someone saying 'need to move away from medicalising children's problems' to side effects to 'we're promoting idea it's OK to have a mental health problem but it's made us afraid of our emotions'. Spicy random ingredient stew there. On their own, OK. Together? Not so much
@C4Dispatches Film points out 2 out of 3 people aren't getting the treatment that they need, but also that 'We are being told we have a youth depression crisis'. Sanah Ahsan makes an interesting point that getting older has changed how she deals with her mental health. I'll come back to this
@C4Dispatches It's interesting voice over positions the video diary/vlog contributions as young people being asked to 'try to explain what they're feeling' not 'we asked young people to explain what they want to happen or change.' The inclusion of other voices is good, positioning less so
@C4Dispatches According to Ahsan, there were 700,000 referrals into CAMHS services, 45% increase over 2 years. What's interesting to me is how many of those referrals were accepted and progressed into treatment. I don't think talking therapy or meds should be (or are) only support choices
@C4Dispatches Parveen, 18, speaking in the film is really powerful. She wanted to talk to someone and was offered antidepressants because the waiting list for talking therapy was five to six months in adult mental health services. Antidepressants aren't casual, folks need support with them
@C4Dispatches There's a larger issue here about the view of antidepressants as no big deal. They are a big deal. But the question of how we support people taking them, and at the point of crisis beginning to take them, isn't much discussed. You start taking them when you feel worst
@C4Dispatches Parveen's experiences also show another issue: mental health services and should stop sending shit letters. The issue of waiting lists is a life experience if you're on one; not a clinical or resource management issue. Those communications matter
@C4Dispatches Ahsan says half of children needing specialist treatment after assessment waited 4 and half months and that adult waiting times vary across the country. Services care about the service they provide, but who looks after you between referral and getting service? No one usually
@C4Dispatches Marc Bush from Young Minds making the point about historic under-investment in mental health. For me, we don't spend the money because we collectively don't want to spend the money, despite claiming we listen to the people with problems. Young Minds has been a consistent lobby
@C4Dispatches (I wrote about the ways that we accept that there isn't money for mental health five years ago: “Lack of money for mental health is not a natural fact. It is a decision taken by people” thenewmentalhealth.org/?p=90)
@C4Dispatches Ahsan now raising the issue of prevention and young people's mental health. In some ways, there was a disinvestment in traditional CAMHS services in last decade in belief that providing alternatives better. But, classically, those alternatives didn't get funds needed either
@C4Dispatches Regarding the wider issue of mental health in schools, the issue around prevention is a vexed one. What are head teachers buying? Better results. That doesn't always mean doing mental health better mentalhealthtoday.co.uk/blog/teach-me-…
@C4Dispatches Regarding the economics of prevention of mental health difficulty and young people, Paul Burstow and colleagues did a really interesting bit of work, trying to solve the problem 'if we spend on prevention we save another service money, not our own' birmingham.ac.uk/research/impac…
@C4Dispatches (hang on, need a wee)
@C4Dispatches (Back)
@C4Dispatches We talk about school a lot in relation to young people's mental health, rightly. But are we putting up the cash? No we aren't. Was on a panel other week where a teach in audience said they couldn't even get cash for mental health first aid training. Asked how much? 2k for school
@C4Dispatches The school documentary visits is doing some good things: co-location of NHS counsellor is good. But: you wouldn't get access as a film crew to a school that was doing mental health badly. You won't get a head teacher on film going 'I don't give a toss' or 'we are awful at this'
@C4Dispatches SOCIAL MEDIA KLAXON from the head interviewed, but she moves swiftly on to poverty and deprivation. Gets a good noddy from the Ahsan. I love the idea of peer support in schools, but peer support has limits. Also: not all young people are at school, but all have mental health
@C4Dispatches There's an interesting thing about this positioning of anti stigma campaigns in the documentary as being new. Ahsan says she didn't remember seeing these messages growing up, but Time to Change is over a decade old now. It's as old as austerity
@C4Dispatches Talking head from one of the vlog contributors Nizam saying that more coverage and anti stigma messages are good. Dispatches own survey of 16-30 year olds told them 57% said anti stigma campaigns had helped them talk about their mental health.
@C4Dispatches Talking head from vlog contributor Jenny echoing a sentiment I hear daily: people say you should speak up and reach out for mental health help, but when you do there's no help there. Most of my writer in residence work for @CentreforMH has been about this centreformentalhealth.org.uk/blogs/writer-r…
@C4Dispatches @CentreforMH The film says a staggering 68% of the people they surveyed said they have or have had a mental health problem' but ten minutes in hasn't suggested why this figure should be staggering or what that should mean to us.
@C4Dispatches @CentreforMH Aha! Now 'some experts who believe there may have been unintended negative consequences' of reducing shame of talking about mental health. Sami Timimi: 'saying it's ok to say we have a MH problem has made us afraid of our emotions' Says intense emotions =/= mental health problem
@C4Dispatches @CentreforMH Timimi says we're bracketing intense emotions as 'other' rather than a part of growing up, says he'd rather the message 'growing up is difficult, we're quite resilient, most people get through'. Ahsan says 'So were's saying young people aren't broken or dysfunctional or ill'.
@C4Dispatches @CentreforMH *record scratch sound* What's wrong with being dysfunctional or ill? I'm not sure why we should see considering yourself as unwell as a terrible thing unless our assumption what happens when you say you are ill is awful. Is saying 'I wanted to die' better than 'I was depressed?'
@C4Dispatches @CentreforMH This question is in part why the idea of instilling resilience is so beloved of some people in mental health and so reviled by others. As Ahsan said in her intro, how she deals with stuff has changed as she has grown. Why can't the idea of being 'ill' change, too?
@C4Dispatches @CentreforMH Timini hits his point on nose: medicalising of distress is undermining our "natural resilience". It's very much worth unpacking the multiple political and philosophical strands and implications of the idea of natural resilience. Human children require parenting for a long time
@C4Dispatches @CentreforMH Ahsan suggest that it'd be terrible if we were stopping our young people experiencing their emotions and showing it however they want to show it. Which it would be. But we do that to young people all the time without medicalising anything at all
@C4Dispatches @CentreforMH Right have hit the halfway point of @c4dispatches 'Young, British and Depressed', which is where I assume everyone got up and made a cuppa during the adverts. I'm getting up to make a cuppa, too. Might have a biscuit as well.
@C4Dispatches @CentreforMH While the kettle's boiling, a little bit about me for anyone joining this watchalong. I write about and do mental health stuff. One you might most like is this dayinthelifemh.org.uk. I am not a young person, or a mental health professional. I am also a glutton for biscuits
@C4Dispatches @CentreforMH Right back from the break with tea steaming for the second half of @C4Dispatches 'Young, British and Depressed'. Leads off survey result 58% of GPs think unintended consequence of antistigma campaigns is "more people wrongly believe they have a mental health problem"
@C4Dispatches @CentreforMH Little something I've noticed: the film uses term 'destigmatisation campaigns' over 'antistigma campaigns'. Presumably destigmatisation is about the individual feeling its OK to have a mental health difficulty, while antistigma intends to reduce prejudice? This may be significant
@C4Dispatches @CentreforMH Lucy Johnstone is now up, expressing worries that antistigma campaigns are based on the 'illness like any other model': "I find it quite upsetting to see anyone being really strongly encouraged to take on a narrative of emotional events that is about 'I have a mental illness'"
@C4Dispatches @CentreforMH Johnstone says a mental illness narrative "excludes what's going on in young people's lives, it excludes their relationships, it excludes what's going on at school. Instead of asking 'what's wrong with me, ask what's happened to me".
@C4Dispatches @CentreforMH Ahsan summarises Johnstone's ideas as the label of mental illness being a distraction from examining the causes of a person's mental health problem but also acknowledges 'many young people find a diagnosis of depression or anxiety helpful'
@C4Dispatches @CentreforMH Marc Bush of Young Minds pointing out diagnostic labels can be meaningful and also a gateway to support while also saying that services need to help before a diagnosis. This is a challenge to NHS working as much as the idea of diagnostic labelling, given NHS is a medical service
@C4Dispatches @CentreforMH One of the wider pushbacks against those who would like to remove diagnostic labels, or indeed mental illness, is a practical one. At present, a diagnosis is needed for benefits, for treatment and, sometimes, legal protections (although it shouldn't be under Equality Act)
@C4Dispatches @CentreforMH You can argue that a medical diagnosis shouldn't be needed for those experiencing distress to access legal protections, support and services, but at present many of our policies and practices rest on the idea of 'diagnosis as proof' someone isn't just making stuff up. Not great
@C4Dispatches @CentreforMH Ooo, I misplaced the adverts. The lead in to the adverts is 'are young people turning unnecessarily to antidepressants and do we know all of their effects?' Which is a very different issue for the second act to tackle.
@C4Dispatches @CentreforMH After the adverts the film states in the mental health crisis women aged 16-24 are most at risk. I wrote about this a while back and why we don't talk about it prospectmagazine.co.uk/life/mental-he…
@C4Dispatches @CentreforMH The story Parveen shares next of being prescribed antidepressants after a short conversation with the GP is a really common one. A few years back I was involved in making a tool to make those conversations work better. Give it a try if you fancy docready.org/#/home
@C4Dispatches @CentreforMH Really big problem with prescription of antidepressants without additional support. But who would provide? Your voluntary sector in your area probably depended on your Local Council for funds, who depended on central government to top up tax take. Money's gone, so have services
@C4Dispatches @CentreforMH Antidepressants are such a loaded issue, for whole range of reasons. For some people they feel like a brush off; for others they feel like the ultimate goal. Some people dislike them on principle. Some people have bad experiences. Some don't. Most aren't as good as they should be
@C4Dispatches @CentreforMH As someone who has written about mental health for a fair while, I've been asked to ask about antidepressants a fair bit. It's an area where many have strong feelings newstatesman.com/politics/healt…
@C4Dispatches @CentreforMH The film found that prescription of the only antidepressant recommended for prescription to children where the benefits outweigh the risk and that 'numbers prescribed to under 18s had its biggest yearly increase for three years'. I'm not sure what that means
@C4Dispatches @CentreforMH These are the NICE guidelines "Depression in children and young people: identification and management". The medication recommended is fluoxetine, but as part of a stepped care model. Stepped care doesn't feel like care when you're waiting to go up a step nice.org.uk/guidance/ng134…
@C4Dispatches @CentreforMH Ooooo, the documentary has come to Penrith now to see what GPs think of rise in antidepressant prescription. My Mam's ashes are scattered above Ullswater. Penrith Woolworths was the most exciting place in the world when I was a kid
@C4Dispatches @CentreforMH The 'rise in antidepressant prescribing to young people' is less of a gotcha than it might have been intended to be. GP in film explains loss of services, GP pressures but says sometimes it's 'easier to prescribe than it is to sit and listen' when what you want is to refer
@C4Dispatches @CentreforMH GP says 'it's not ideal to prescribe antidepressants but in lieu of any other option' that's what you'd do. This presumes that antidepressant prescription causes less harm than good in itself. But, of course, it may cause more harm than not having alternatives available.
@C4Dispatches @CentreforMH It's a tricky one. Debate centres on very different ideas of here and now problems. GP and young person have similar problem: what can I do today right now, to not feel awful. Going on a demo for more funds might be what's needed, but not for the person avoiding eye contact today
@C4Dispatches @CentreforMH As films own survey, finds 86% of GPs agree that increase in antidepressant prescribing across all age groups is due to lack of access to other services. If there's nowt to refer people to, what would you do? Tell them you're saving them from diagnostic labels? Be more resilient?
@C4Dispatches @CentreforMH The films survey found 39% of GPs had prescribed antidepressants to under 18s but on 1% of them thought it was the best treatment. In October 2018, Young Minds found that even extra money to CCGs for CAMHS didn't equal more services for young people youngminds.org.uk/blog/childrens…
@C4Dispatches @CentreforMH In 2017 The Royal College of Psychiatrists mapped Clinical Commissioning Group spending on CAMHS. That work is behind a paywall. Here's Health Service Journal's coverage, which may also be behind a paywall. And this doesn't cover your local charities etc hsj.co.uk/mental-health/…
@C4Dispatches @CentreforMH There definitely is a crisis of funding services and supports, including treatment, for young people's #mentalhealth difficulties. Though whether demedicalising young people's distress would alter this is an entirely different point.
@C4Dispatches @CentreforMH Film is good on effects of medication. Given intention that depression medication alters how we think and feel, we really shouldn't talk about side effects, just effects. The antidepressants we have are a bit rubbish, really. But there's slim chance of better ones any time soon
@C4Dispatches @CentreforMH In the film Peter talks about coming off antidepressants after 3 months and awful effects. Ce useful to know which meds, but I imagine legal warned off naming. There is a massive gap in good support for patients around antidepressants. That's where I'd like to see coproduction
@C4Dispatches @CentreforMH For me, in polarising a debate around antidepressants into for and against the people who lose out are the people actually currently taking them. There needs to be constructive work in the 'lesser of a number of evils' space where real people live and struggle
@C4Dispatches @CentreforMH Film says 'research last year showed more than half of antidepressant users had not been told enough about possible adverse effects'. James Davies discusses research into withdrawal, which finds symptoms of withdrawal far more common, severe, longlasting than previously thought
@C4Dispatches @CentreforMH Davies raises important issue that withdrawal from antidepressants (though again, which ones would be super good to have noted) can lead to misdiagnosis of relapse leading to reinstatement of drugs. Big issue, this, but largest in context of people's lives, not pro/anti debate
@C4Dispatches @CentreforMH Davies says "These medicines don't cure biological conditions, they alter people's states of mind in ways that may or may not be experienced as useful" This is a bigger point than the film makes it. Who defines useful? What if you want altering? It should be the user.
@C4Dispatches @CentreforMH The pay off of the film from Ahsan is "Instead of rushing to pills to treat the symptoms of our young people's distress, we need to better understand the causes of what's going on for them'. We already do. We just don't take action or we say 'yes, but not like that kids'
@C4Dispatches @CentreforMH Ahsan says "we need to acknowledge the causes in our society: loneliness, trauma, poverty and invest more time and money in young people's well being". Can't disagree, but couldn't we have started there? There's a real investigation needed to uncover why and how we don't invest
@C4Dispatches @CentreforMH The film finishes with a call that if you are worried about your mental health to seek the support that the film has spent most of its running time illustrating isn't there or from friends, family or community. And that's it for 'Young, British and Depressed' from @C4Dispatches
@C4Dispatches @CentreforMH Just putting the kettle on again, and then a few thoughts
@C4Dispatches @CentreforMH Right, so I have tea. Now a few thoughts about @C4Dispatches 'Young, British and Depressed'. First one is: I'd have loved to hear more from the young people featured who were indeed 'Young, British and Depressed'. I was more interested in what their lives were like as lived
@C4Dispatches @CentreforMH I've been trying to think of what I would have made of the film if I was a completely virgin punter. It was like a Rorschach test. I think I would have seen want I already at some level wanted to see. It was balanced in a way that scared no horses at all
@C4Dispatches @CentreforMH What I would have got from the film if I didn't have background knowledge was: lots of young people are depressed, some people think it's bad to call this depression, some feel GPs don't do enough, GPs wish there was more they could do, medication is probably horrible
@C4Dispatches @CentreforMH That's a lot to get out of 26 minutes of telly, so film packed it in tight. For me, there were a couple of interesting things. No one was doubting there are more young people not having a great time, except the man who liked natural resilience. But what should happen? Less clear
@C4Dispatches @CentreforMH Film sort of hedged between idea more young people were saying they were depressed when they were unhappy and more young people are actually in distress; traumatised but we shouldn't treat that medically. So do we need more medical services or not? Film seemed to think yes and no
@C4Dispatches @CentreforMH Like I said up the thread, if you wanted to make a film on why young people might be experiencing more distress, there's a great film to made. There's also a great film to be made about how underinvestment in services for young people happens despite central government rhetoric
@C4Dispatches @CentreforMH There's also a great thing to explore about how young people now understand the issue of mental health and what, if anything, they thing needs to change. But the rise in antidepressant prescription is only a smoking gun if you think it's a gun. It's an unstable proxy in debate
@C4Dispatches @CentreforMH As with any telly documentary, you have the problem that you can only show on film the people who are prepared to be filmed. It's like the film started with the premise 'are young people really depressed?' and then everyone in one way or another said 'yes, yes they are'
@C4Dispatches @CentreforMH In some ways, the film is an argument for greater accessibility of talking therapies without the analysis of why there isn't greater accessibility of talking therapies. That's not the sum of young people's mental distress, but is a good question to ask
@C4Dispatches @CentreforMH I thought the film managed mostly to avoid the 'war over childhood' and walked a good path through the idea of 'a snowflake generation' and 'social media has made the sky fall in'. But it left me asking 'OK, so what do I do now?'
@C4Dispatches @CentreforMH One interesting point, which I expected to be picked up again but wasn't was the film's use of destigmatising campaign over antistigma campaign. It initially implied that more young people 'thought' they had a mental health difficulty or aspired to it then walked back from that.
@C4Dispatches @CentreforMH There was a line of argument in the film that young people were using the language of mental health and mental illness to describe their difficulties, which was where the critical voices stood, but it wasn't really tied up in the overall final impression I took away from it
@C4Dispatches @CentreforMH As it stood, the structure of the film was a bit "Young people in Britain are more depressed than ever. But are they really? Really really? Yes they are. But medication is rubbish. And might be dangerous. But maybe GPs are the baddies. But they aren't. So maybe more services?"
@C4Dispatches @CentreforMH Contributions from people living this reality were great and I could have happily watched them and less of the 'some experts'. Maybe a directors cut with more of them in it @C4Dispatches? I'd love to see them address some of the conclusions of the film.
@C4Dispatches @CentreforMH But, one point I'd raise is: the opposite of medication isn't necessarily talking therapies. The opposite of medication can be anything that makes someone's life better. Sometimes medication doesn't have an opposite apart from 'things that don't work right now quick enough'
@C4Dispatches @CentreforMH Sometimes the opposite of medication that works is 'medication that doesn't work or makes you feel worse'. Distress exists. Not coping exists. Feeling terrible exists. So do things that make that happen to people. What I took away is that there's not enough that helps right now
@C4Dispatches @CentreforMH I kind of think of Dispatches as an investigative show that reveals injustice. As a virgin punter looking for what this investigation uncovered, I wonder what injustice I'd see evidence of? Would it be the injustice of unmet need or would it be something else?
@C4Dispatches @CentreforMH Right. You've probably been lucky that I watch less television programmes about mental health than I should, because just about any of them would end up with a similar length thread of me wanging on. The show is here for a month if you want to watch it channel4.com/programmes/dis…
@C4Dispatches @CentreforMH @theipaper .@guardian like the bits about overmedicalising distress theguardian.com/tv-and-radio/2…
@C4Dispatches @CentreforMH @theipaper @guardian .@TheSun liked all of it thesun.co.uk/news/9599813/c…
@C4Dispatches @CentreforMH @theipaper @guardian @TheSun Oh, one more thing, just in from @Rebeccasmt excellent @HSJnews newsletter 'Mental Health Matters' as I was wanging on: "Commons Public Accounts Committee Paper on Mental health services for children and young people" Includes spending discussion publications.parliament.uk/pa/cm201719/cm…
