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From Urban Psychosis to Urban Death

Last Wednesday I was thrilled to welcome Professors John Read and Rhiannon Corcoran to the Holden Gallery, who at the invitation of my colleague Dr Kat Taylor, gave two quite remarkable presentations to coincide with the final days of the Holden Gallery exhibition, Urban Psychosis.

The Psychosis in Context event brought together people with experience of the ‘mental health system’ alongside psychologists, artists and interested others, and both speakers shared a passion for understanding the rich texture of the human condition. Whilst Rhiannon focused on a very real and unfolding research project, the Prosocial Place Project*, John gave a sweeping critique of the systems in place that label people, and the ways in which the prevailing model of psychiatry is focused on narrow biological factors, regardless of the lack of statistical significance in the evidence base.      

“For every British psychiatrist who thinks schizophrenia is caused primarily by social factors there are 115 who think it is caused primarily by biological factors.”

Focusing on the impact of adverse life experiences on our mental health, John questioned the motives of both biological psychiatrists and the pharmaceutical industry. He vociferously challenged the ‘evidence’ that schizophrenia is a’brain disease’ 

His presentation was entitled - Can Poverty Help Drive You Mad? - and the answer was an unequivocal yes! 30 years ago the relationship between ‘schizophrenia’ and poverty was described as ‘one of the most consistent findings in the field of psychiatric epidemiology’ (Eaton, 1980). 

Focusing on the impact of ethnicity, race and negative childhood experiences, he stressed that ‘deprived children are four times more likely to develop ‘non-schizophrenic psychotic illness’ but eight times more likely to grow-up to be ‘schizophrenic’ (Harrison, Gunnell, Glazebrook, Page, & Kwiecinski, 2001). Even among children with no family history of psychosis the deprived children were seven times more likely to develop ‘schizophrenia’,

Above all, John suggested that the redistribution of social power, the rejection of prejudice and bigotry and increased social justice, are central to public mental health. 

It was an inspiring evening that provoked debate and beautifully echoed the themes of the exhibition. My thanks to everyone who contributed

*I recommend this little film that shows how a simple intervention to disrupt our regulated lifestyles and introduce uncertainty, is liberating, unifying and ultimately very practical. https://www.youtube.com/watch?v=-vzDDMzq7d0 

URBAN DEATH PROJECT

Because death is momentous, miraculous, and mysterious

Because the cycles of nature help us grieve and heal

Because our bodies are full of life-giving potential

We propose a new option for laying our loved ones to rest.

Although I don’t know the people who are developing this work, I have to share this website with you. It would be interesting to know what you think.

‘The Urban Death Project is a compost-based renewal system. At the heart of the project is a three-story core, within which bodies and high-carbon materials are placed. Over the span of a few months, with the help of aerobic decomposition and microbial activity, the bodies decompose fully, leaving a rich compost. The Urban Death Project is not simply a system for turning our bodies into soil-building material. It is also a space for the contemplation of our place in the natural world, and a ritual to help us say goodbye to our loved ones by connecting us with the cycles of nature.’  

You can find out more about this vision and its instigator Katrina Spade, by clicking on the image above. 

Lord Richard Attenborough

This weekend Lord Attenborough died aged 90. The actor, director and film-maker has been a good friend to Arts for Health and for many years was its patron. In 1999 he gave the opening adress to the first world symposium on arts and health (CHARTS), here at MMU and set the course on this rapidly expanding agenda. 

‘The arts in all their glorious manifestations are essential prescriptions for all those who are in pain, despair or in recovery. Creativity and imagination stimulate the spirit and, in so doing, speed the healing process. They are a powerful medicine indeed.’ 

Lord Attenborough; Culture, Health and the Arts, World Symposium at MMU

Lost is Found Theory

Friend of Arts for Health and artist on the I AM project, Leon Jakeman has work on exhibition at The Brink in Liverpool. Click on the image above for more information.

Take the Critical Spaces Survey - A Critical Catalyst for Socially-Engaged Art

Critical Spaces is a new and FREE web-based platform for socially-engaged artists, launching in Autumn 2014. It has been designed by artists, for artists.

17 workshops have been held across the UK to research and develop this platform. This survey is your opportunity to support the fine-tuning of Critical Spaces. You will also be given the opportunity to pre-register for the beta launch.

Critical Spaces will:

• Increase artist visibility - by featuring a UK map and directory of artists.
• Facilitate new artist connections - by allowing you to search for artists, both geographically and by practice.
• Support critical thinking - through advocacy, resources and arranging ‘Critical Gatherings’.

To complete the survey click 'Take the Survey' or copy and paste the following web-address into your browser: https://www.surveymonkey.com/s/criticalspaces

The success of Critical Spaces relies on your support - please share this survey with other socially-engaged artists. The survey will close on Friday 19th September 2014. Critical Spaces is an initiative by Hannah Hull in partnership wih ixia public art think tank.

Funding for Projects that Address Urban & Rural Deprivation 

The Trusthouse Charitable Foundation has announced that capital and revenue funding is available to support the work of local and national charities and not-for-profit organisations that address rural and urban deprivation. Within these two main headings, the Trust is interested in helping established projects which work in the fields of:

• Community SupportArts, 
• Education & Heritage
• Disability & Health Care. 

The type of projects the Trust are interested in funding include projects providing transport for the elderly, disabled or disadvantaged; contact networks for the young disabled; projects which encourage a sense of community such as community centres and village halls; employment training schemes especially those promoting local, traditional crafts; projects addressing issues such as drug/alcohol misuse or homelessness.

The Foundation also provides funding to support capital projects at hospices throughout the UK; and on local projects providing support for mothers and babies in the first two years of life. The Grants Committee meets quarterly to consider applications at the beginning of February, May, September and November. The deadlines for submitting applications are generally 2 months before the date of a meeting. Read more at http://www.trusthousecharitablefoundation.org.uk/

♍

Today is the singer Shirley Mansons birthday, as it would be Agnes Gonxha Bojaxhiu, if she were still alive. Better known as the Nobel Prize winning nun, Mother Teresa, Agnes had some pretty queer ideas, best summed up by Christopher Hitchens:

“Mother Teresa was not a friend of the poor. She was a friend of poverty. She said that suffering was a gift from God. She spent her life opposing the only known cure for poverty, which is the empowerment of women and the emancipation of them from a livestock version of compulsory reproduction.” 

Williams’ death reminds us that a patient’s relief might be a warning sign

By
H. Steven Moffic, MD

One
of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by
exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name.
Sometimes, I played the audio over and over, as if it could promise a good day.
As he did so often, he found a way to not only lighten the sadness, but to do
it in such a way that might be constructively critical.

Surely,
the real life mornings were not often happy ones, as so many of our troops died
or ended up with post-traumatic stress disorder (PTSD) from that war. It is a
lesson we are still learning, so that movie and his role is worth seeing again
soon.

Now,
after his reported suicide, that good morning seems more like a final good
night.

Although
he is probably best known for his manic comedy, he also played many serious
roles. Most ironically now, he won an academy award in 1997 for playing an
empathic therapist in the film “Good Will Hunting.”

Indeed,
beloved entertainers like Robin Williams have a therapeutic role of sorts for
society in the sense that they provide some relief—even if briefly—for the
grief and stress of everyday life. For playing that societal role, such people
become a repository for our hopes, dreams and demons. As we know for so many
famous entertainers, it is not easy for them to have a successful private
life—a private life that the public also tries to invade, as if they were
related to us.

What
we do know publicly is that Williams suffered from chronic depression and
intermittent substance abuse. It is reported that he received treatment,
including entering rehab just last month. Obviously, money to get the best
treatment was not an issue, though how good the treatment was will remain
unknown. We do know, however, that wealthy VIPs often receive treatment just as
poor as low-income folks without resources. We also know that occasionally
depression is a terminal illness, though that ending is not predictable.

Beyond
the public information, and despite the understandable curiosity, this is not
the time, nor should it ever be the time, to speculate about his diagnosis and
reasons for committing suicide. In fact, the so-called "Goldwater
Rule," called that for the inappropriate professional speculation about
presidential candidate Barry Goldwater, ethically prohibits such speculations
on the part of psychiatrists like myself.


Given
this professional ethical principle, as well as the family's request for
privacy, is there anything we can still learn from this apparent tragedy? The
most intriguing detail that caught my attention was his last tweet and
Instagram on July 31. Reportedly, he had wished his daughter a happy 25th
birthday.

Why
might this positive communication be of importance to us?

It
reminded me of the only patient I ever had who committed suicide, long ago,
when I was a resident in training. In the second session, the depression of
this elderly man seemed to be less severe, but after that session he walked
into Lake Michigan and drown. In the psychological autopsy, I never forgot the
warning that when a depressed patient starts to seem better, they actually can
be at higher risk for suicide.

Risky
time

Why
is that time of apparent improvement a risky time? The person can have more
energy, then plan and complete a suicide. They may also feel relief at their
decision, causing others to paradoxically feel relief. That is one of the
reasons why it is so common to hear of the genuine surprise that the suicide
occurred, as the person seemed to be happier.

What
this means, not only for professionals, but for the public, is not to take at
face value if a depressed person seems better. Be sure there is a sound
explanation for the apparent improvement. 

Our
only consolation must be that entertainers like Robin Williams keep on living
in the form of their life’s work, like the movie “Good Morning, Vietnam,” that
is so ubiquitously available nowadays. Even so, it would not be surprising if
at the times we laugh once again at Robin William's humor, that the laughter
will also be accompanied by some tears of grief.

Bio

H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral
Healthcare, and The Hastings Center's Over 65.



This blog was originally published in Behavioral Healthcare.
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Spreading Hope!

By Matt Goldenberg
D.O.

@docgoldenberg 

“You treat a disease, you win, you lose. You treat a person,
I guarantee you, you'll win, no matter what the outcome.” 

I whole-heartedly agree with that statement. However, I
cannot take credit for those words. Those are the words of Robin Williams, or
more specifically, the words of his character in Patch Adams.



I want to discuss the disease called depression. I will start by first
discussing the diagnosis and the signs and symptoms of depression. I will then
follow up with my thoughts on the various treatment options for depression and
the strategies I employ with my patients to improve their outcomes. None of my
thoughts and suggestions should serve in place of a formal consultation with a
mental healthcare provider. However, I hope shedding light on mental health
diagnoses like depression will lift the veil and social stigma on these chronic
diseases that impact so many people.



Psychiatry has come a long way in the last decade. This is a time of continued
discovery and increasing public awareness. The leaders of our professional
organization, the American Psychiatric Association (APA), have suggested that we
as mental health professionals are under a microscope. I agree that we are
and I also strongly believe that we are up for the challenge. School shootings
and celebrity suicides and overdoses have increasingly put a focus on mental
health. Psychiatry has significantly improved the outcomes, treatment options
and the prognosis of patients with mental illness. However, we still are unable
to decrease the prevalence of the diseases we treat or prevent them. We know that
the brain changes during an episode of depression and our treatments help it to
return to normal (see the image below). Although we are getting closer, we
still currently do not have widely accessible blood or imaging tests that can
confirm our diagnosis or localize the area of disease.

I can say with certainty, however, we are able to accurately
diagnose patients. We are able to identify medications, psychotherapies and
other treatments that patients with a specific diagnosis or cluster of signs and
symptoms often benefit from. There is strong evidence that our treatments
decrease symptomatology and disability and improve quality of life, clinical
outcomes and a patient’s prognosis.



Psychiatrists are trained to view the patient as a “whole person”. Psychiatry
is a field of medicine whose assessment by definition includes all of the
biological, psychological and social aspects of a patient’s life. We listen for
the psychological and social factors that can contribute to disease.
Oftentimes, the “whole story” can be more telling than only focusing on
specific symptoms of a given disease. There is a saying, throughout all fields
of medicine, that “most patients have not read the textbook.” In other words,
patients usually do not present exactly as the textbook says they should.
Stress and psychological factors can mimic chest pain, shortness of breath,
gastrointestinal problems and a whole host of other diseases. If we do not step
back and get the whole story, we can miss the root cause or the exacerbating
factors of many manageable diseases which are of the mind.



Many of the diseases we treat, such as depression, are chronic illnesses which
require lifelong treatment. Our treatments can improve a patient’s mental
health and coping skills and decrease their symptomatology and substance use.
We know through decades of research that these are modifiable risk factors for
suicide. Therefore, Psychiatrists have the training and tools necessary to
decrease a patient’s risk of attempting suicide. Our treatments have the
potential to not only significantly improve the lives of our patients, but also
the lives of their families and everyone who comes into contact with them.
Anyone who tells you otherwise is misleading, misinformed or both.

I
hope this information and the blogs to follow will give you hope. Mental
illness can include symptoms which can be devastating and complications which
can be life-threatening.
However, it is important to state again, these are treatable diseases. If you
or someone you know, would like to talk to someone, call your primary care
doctor or your insurance company for a referral to a Psychiatrist. A true
multi-disciplinary team also includes therapists, psychologists, nurses and
social workers. You are never alone. You can call the national suicide helpline
24 hours a day, seven days a week (1-800-273-TALK (8255) or visit www.suicidepreventionlifeline.org).
There are also local crisis lines likely available in your area and are an
internet search away. If you are ever feeling unsafe, or fearing for the safety
of a loved one, you can call 911 or go to the nearest emergency department.

It is time for everyone to understand that there is no shame in getting help
for depression, much as there is no shame in getting help with diabetes or high
cholesterol. Even if you have never suffered from depression, there is
a lot you can learn.

Together we can raise awareness and spread truth and hope. I know that if we
spread knowledge, and ignore the misinformation, we will overcome the
complacency and ignorance that is so pervasive today. That is how we can best
honor those we have lost. That is how we can best prevent the next death from
mental illness and addiction.

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Science + Culture = Beautiful Chaos

PSYCHOSIS IN CONTEXT

An Urban Psychosis event

Holden Gallery

20 August 6 - 8pm

The North West Arts and Health Network and Liverpool Psychosis Research Group, Institute of Psychology Health and Society, University of Liverpool presents: 

CAN POVERTY HELP DRIVE YOU MAD?

Professor John Read will summarise the research showing that, contrary to the prevailing ‘wisdom’ that psychosis is a genetically based ‘brain disorder’, poverty - and relative poverty - are powerful predictors of who ends up experiencing psychosis and being diagnosed with ‘schizophrenia’. Professor Rhiannon Corocoran will share initial research from the THE PROSOCIAL PLACE PROGRAMME exploring the relationship of the urban environment to mental health and wellbeing.

After working for nearly 20 years as a Clinical Psychologist and manager of mental health services in the UK and the USA, Professor John Read joined the University of Auckland, New Zealand. There he published over 100 papers in research journals, primarily on the relationship between adverse life events and psychosis. He also researches the negative effects of bio-genetic causal explanations on prejudice, and the role of the pharmaceutical industry in mental health. John is on the Executive Committee of the International Society for Psychological and Social Approaches to Psychosis www.isps.org and editor of the ISPS’s scientific journal ‘Psychosis’. In May 2013, John took up the post of Professor of Clinical Psychology at the University of Liverpool.

There are very limited tickets available for this free event:

https://www.eventbrite.ca/e/psychosis-in-context-tickets-12632653607

THE RACE FOR THE PRIZE

As scientists race for the ultimate publicity prize - a vaccine for ebola - it’s interesting to see that squeaky-clean GSK are up-front in the race - or at least - being up front! 

“Meeting this goal will place an unprecedented timeframe on GlaxoSmithKline, the drug maker which runs the research programme in collaboration with the National Institutes of Health. The WHO has acknowledged that there is not enough time for the vaccine to undergo the standard, years-long clinical trials process, but has concluded that in this case it would be ethical to make it widely available with much less testing.”

With the WHO declaring the outbreak an international public health emergency,  it reminds me that a whole raft of viruses are out there, conveniently ignored whilst they are at arms length, in some far-off country. Whilst we live side-by-side with animals, farm them in terrible conditions, live in abject poverty on one hand, and travel the globe on the other, the Corona, Hendra, Ebola and the predicted and much feared mutation of H5N1, H7N9 (avian flu) and H1N1 (swine flu) will inevitably travel too. The book Spillover by David Quammen provides unsensational and essential reading around our relationship with animals and the inevitable zoonosis. 

Whilst the president of Liberia has very practically called for three days of prayer and fasting, as “the ultimate solution” to the Ebola virus, apparently a couple of boxes of the experimental drug ZMapp (not a GSK product) are winging their way to Africa, as I type. That in itself is interesting, as it’s already been given to Americans and a European, but not yet to Africans. Is that a continuation of colonialism, or perhaps a fear of ‘using’ African people as guinea pigs? Hmm, that doesn’t seem to have previously stopped big pharma exploiting large numbers of chemically-clean communities in developing countries as virgin-lab-rats.

Working with the Asia Europe Foundation on their Accurate Scenarios, Active Planning pandemic preparedness, public health project, has been hugely beneficial to me, but I will be curious to see how relevant and useful this foresight work has been, in the current situation. I recently watched the TV series UTOPIA which, far-fetched though it seemed, ran a storyline of government, big-pharma, conspiracy, eugenics and virus manipulation. It was equally potty, violent and compelling. Hoorah for popular culture, but somehow the current crisis in Africa and our incorruptible pharmaceutical industry have been conjoined in my mind - I feel a little unrest.

MEDICINE UNBOXED: FRONTIERS

We will explore the fact of human life and consciousness within a wider universe; our shared human matter and frailty; the flesh and margins of our bodies and minds; the sea and the land; the migrant, outsider and underprivileged; the lines that separate life from death; the development and grounds for moral thought; the separation between suffering and illness; the interface between the individual and society and the frontier between imagination and fact in our understanding of humanity, illness and medicine. Click on the image below for more info.

Funding for Digital Projects with a Social Impact 

The Nominet Trust which provides funding and support to imaginative social technology ventures has announced that the next funding round of its Social Tech Seed Investment Programme will open for applications in September 2014. Social Tech Seed is an investment programme that offers early-stage investment of between £15,000 and £50,000 to entrepreneurs who are looking to develop new ventures using digital for social impact. This programme provides funding and support to help entrepreneurs nurture, develop and test their ideas. The Trust is looking for applications that demonstrate the potential of technology to tackle some of the big social issues in sectors including education, employability, healthcare and the environment. Click on the full face swimming mask for more info.

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TWEET...
What with no holidays planned this summer, I find myself busily occupied, catching up with all things written whilst the university is in ‘sleep mode’ - end of project reports, new project outlines and in overdrive with the first printed iteration of the Recoverist Manifesto, which all being well, will be published next month. After over a year of meticulous planning and complex ethical minefields successfully navigated, the Dementia and Imagination research project has started in earnest around the UK and Arts for Health’s own research site within the NHS in Derbyshire, has begun thanks to the drive and commitment of my colleague Kat Taylor, to whom I extend the biggest thanks. You can keep up to date with the project by clicking on the image.

From our own correspondent

In the second of our regular hook-ups with Victoria Hume in South Africa, her latest blog entry is an interview with Catherine Burns at WiSER, the Wits Institute for Social and Economic Research at Wits, the University of the Witwatersrand. 

“No-one is saying this research is not worthwhile, or it’s not dignified, or it’s too – Ivory Tower-ish; and why? Because we’ve had 15, 20, 30 years of people researching, let’s say, the harder social, political, economic questions related to, say, mining, and we’re making very little headway {…} I didn’t feel this 15 years ago at all. People would have said oh that’s just a waste of money … this is just playing at the edges of the critical need – we have to feed children. The choices were: do we feed children? do we inoculate? … do we work out … resources for an AIDS vaccine? Or do you … play around with drama? I don’t think people are making those kinds of distinctions any more.”

Read the full interview by clicking on the image by Marna Hatting.

Matchbox City takes on the Giants of Liverpool

Matchbox City has had a spectacular time in Liverpool since the launch of their site-specific installation at the Brink as part of Independents Biennial 2014. 

They made it on to the cover of the Big Issue in the North, whose vendors sold the magazine amidst an army of little matchstick people who had popped up in the businesses and bollards along Bold St. Matchstick Lilliputians even braved the enormous crowds who flocked to the city to see the magnificent Giant Spectacular. They welcomed visitors to our exhibition at the Brink to join in with free workshops co-facilitated by members of Crisis Skylight Merseyside. They created matchstick figures and matchbox buildings and had some incredible responses including matchstick minions and even giraffes! August sees Connecting Threads take Matchbox City to the good people of Rochdale and Manchester. Artists Emily Hayes and Becky Waite are working creatively with people affected by homelessness in the North West

Project Manager, Arts + Cultural Commissioning

Are you passionate about the role arts and culture can play in building healthy lives and communities? NHS Gloucestershire Clinical Commissioning Group (CCG) and Create Gloucestershire are looking for an exceptional project manager to work with them and key local authority partners to realise a radical vision for how arts and culture are commissioned to improve health and well-being outcomes across Gloucestershire. This post is offered as an 18 month freelance contract. The fee is fixed at £35,000 inclusive of VAT and expenses. We anticipate the post holder will work approximately 3 days a week. The post will be jointly managed by Create Gloucestershire and NHS Gloucestershire CCG. The post will be based at Sanger House, Gloucester Business Park. All details by going to: http://www.creategloucestershire.co.uk/news/2014/8/6/job-project-manager-arts-cultural-commissioning 

Arts for Health friend and collaborator Vic McEwan embarking on a weeks residency in a juvenile prison in Wagga and playing the razor wire that surrounds the prison.

Eranda Foundation

Deadline: 31 August 2014

The Eranda Foundation Grant is for charities undertaking projects for research into medicine and education, encouraging the arts and supporting social welfare in the UK. It was created by Sir Evelyn de Rothschild in February 1967 to support the advancement of learning in the arts and sciences and in particular for the promotion and development of medical and scientific research including:

• Promotion of original research and supporting the continuation of existing research into medicine and education, primarily medical and scientific education.
• Encouraging the arts, primarily education and outreach work.
• Supporting social welfare.

For social welfare projects, priority will be given to national activities, or if local, the priority will be Buckinghamshire and Bedfordshire. For more details, email eranda@btconnect.com

Healthy Hearts Grants 

Heart Research UK has announced that its Health Hearts Grants Programme is open for applications. Heart Research UK Healthy Heart Grants support innovative projects designed to promote heart health and to prevent or reduce the risks of heart disease in specific groups or communities. Grants of up to £10,000 are available to community groups, voluntary organisations and researchers who are spreading the healthy heart message. The closing date for this funding round is the 31st August 2014. Read more by clicking on the love hearts.

Garfield Weston Foundation

The Garfield Weston Foundation helps small, local community organisations and covers a wide range of charitable activity. Areas funded include: education, arts, health, environment, community, youth, religion and welfare. Grants of up to £50,000 are available. There are no formal deadlines for submitting applications. Read more at http://www.garfieldweston.org/

Yesterday evening I had the most wonderful solitary night-time walk in the hills above my town. Of course, whilst I’d been working, the day had been sunny and now the evening was stormy, but the air was beautiful and clean and the grey churning skies were charged with electricity. In that half-light, the fields seemed far greener than I’d ever seen in the daylight and amongst the thrashing bracken, the heather more vivid than any migraine I’ve experienced. I felt quite lucky to be alive and immersed in thoughts of multiple parallel universes, (where other versions of this experience of being, might be rolling out). I was only brought back to reality by the calling of an owl. There she was, just looking at me - haughty and beautiful. We looked at each other for the longest moment. Eye to eye. Then she was gone. Quite beautiful. 

I rushed home and made this small film...

How does your primary care doctor coordinate with your psychiatrist?

By Pierre
Gingerich-Boberg, Medical Student

Reviewed by Claudia
Reardon, MD



I’m stuck in behaviors
that are making me unhealthy.  My smoking
makes my asthma worse, and I don’t want to end up with emphysema like my dad.  I smoke when I’m anxious, and my finances, my
teenager, my boss, and my increasing weight all make me anxious.  Now to top it off, my chronic headaches are
getting worse.  My problems are physical,
but I know they’re also mental.  But the
idea of seeing a psychiatrist makes me even more anxious!  What should I do?



Patients need primary care doctors who can comprehensively
address the varied aspects of their physical and mental health. Health systems
are starting to recognize that multi-disciplinary teams (sometimes called patient-centered medical homes) can be
an effective way to provide integrated
care.  How might this look for our example
patient?

First, it’s worth noting that traditional primary care doctors
already spend a lot of effort helping patients with a wide spectrum of behavior
issues.  We saw this for our example patient.
 Her anxiety is an example of a classic mental health problem—others
might be depression, panic attacks, and addictions. Primary care docs refer some
of these patients to psychiatrists, but primary care docs are treating the
majority directly.  Our patient’s
headaches are likely a functional
ailment. Like irritable bowel syndrome and general aches and pains,
headaches are real problems that often defy simple solutions.  Standard treatments focus on limiting symptoms
while helping patients cope with the stressors and psychological distress that often
contribute.  Finally, our patient faces
problems with health-related behaviors including
tobacco use, diet, and stress management. 
These and other common behaviors are hugely important for the development
of chronic diseases.  

Our patient’s picture might seem complex, but primary care
doctors face such complexity (and more) every day! Frankly, patients often are
dealing with too much for their doctors to address optimally in a 15-20 minute
time slot. One approach is to triage—to ask what’s treatable and doable, and
what can wait until the next appointment. The limited time
available for counseling tends to push primary care doctors toward relying on
treatment with psych meds. A second approach is to refer the patient to
a psychiatrist.  But psychiatrists in
many communities are spread too thin, so patients often wait weeks or months
for an appointment. Then there’s stigma--our example patient’s anxiety around
psychiatric care is actually pretty typical. 
This helps push up no-show rates for first visits with a psychiatrist to
30 or 40%.  It’s no wonder that careful
studies show that only a fraction of the mental health problems in our
communities are ever diagnosed, and fewer still are adequately treated.

A third option returns us to the medical
home concept.  At the VA and increasingly
in federally qualified health centers (FQHCs), mental health services are being
brought into the primary care setting. 
Here, behavioral health consultants
(BHCs) share space with primary care doctors. 
These are generally psychologists or social workers, that is,
non-physicians. BHCs’ schedules are intentionally left mostly open, so that they’re
available to see patients immediately after a non-threatening ‘warm handoff’
from the primary care doc.  The BHC can offer
expert counseling for the patient, and advise the primary care provider on
diagnosis and treatment.  BHCs arrange
for a small subset of their patients to get a subsequent visit with a psychiatrist
(a specialist physician), who is also in-house. 
 All the BHC patients get
systematic evaluation and follow-up by phone or with visits to make sure their
needs don’t fall through the cracks.

When a behavioral health consultation system is in place,
problems of waiting times, missed appointments, and incomplete records are
eliminated for most behavioral health visits. 
Primary care docs have more time to focus on medical issues, while
getting the expert consultation they need to optimize behavioral health care
for their patients. Finally, because most behavioral issues can be addressed efficiently
by BHCs, specialty psychiatrists are not so swamped, and waiting times can be
greatly shortened for the small group of patients needing psychiatric care beyond
what can be managed in the primary care setting.
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木 漏 れ 日

...when sunlight filters through the trees

Thank you for reading this blog, contributing to its content, (knowingly or unknowingly) and for the occasional lovely email. I’m taking a little time out to focus on the more important things in life, so a short and sweet blog this week. I wasn’t going to bother posting anything, but am compelled to let you know that this months blog statistics have been the highest since it first began! We must be doing something right! So this month a big thank you, ačiū, ви благодарам, спасибі, спасибо, дзякуй, 謝謝, dank u, danke, diolch i chi, dziękuję, go raibh maith agat, gracias, grazie, આભાર, merci, ありがとう, tack, tak, takk, terima kasih, teşekkür ederim, 감사합니다 and хвала.

Thoughts that might have been in a longer blog (and that may be expanded another time): the raising of the Palestinian flag in Preston - smiling - the link between Utopia, Ebola and the flu - pain - gratitude - friendship - and the conjoined reality of obesity, comfort and poverty 

For those of you wanting a summer read, click on the image below for the notes of the All Party Parliamentary Group on Arts Health and Wellbeing held on the 2nd July.

Clore Poetry & Literature Awards 

The Clore Duffield Foundation has announced that the seventh funding round under its £1 million programme to fund poetry and literature initiatives for children and young people across the UK is now open for applications. Through the programme, schools, FE colleges, community groups, libraries and other arts/cultural organisations can apply for grants of between £1,000 and £10,000 to support participatory learning projects and programmes focused on literature, poetry and creative writing for under 19s. The closing date for applications is the 6th March 2015. Read more at: http://www.cloreduffield.org.uk/Grant_Programmes/Clore_Poetry_and_Literature_Awards.htm

Help transform participatory arts in the UK: an invitation

Artists, arts organisations, policy makers, funders, employers, commissioners and training providers across the UK are part of a rich and thriving tradition of participatory arts. Between now and spring 2015, ArtWorks, a Paul Hamlyn Foundation initiative, will publish the final findings from five years’ research to show how, together, we can build on this tradition and reap new benefits by strengthening support for the artists involved. We are driven by a passion for participatory arts and a belief that collaborating to strengthen support for artists will lift the practice to a new level of confidence, recognition and ambition, leading to higher quality experiences for participants. 

Our work draws on the learning of five ArtWorks pathfinder partnerships which have spent the last three years conducting research, building on the wealth of existing good practice and exploring potential solutions to support artists to work in participatory settings. ArtWorks covers the critical roles of all stakeholders in developing practice in participatory settings – from employers and commissioners to training providers, policy makers, funders and artists – by focusing on three key areas of understanding:

• The training and development needs of artists
• Methods for promoting quality across all aspects of the work
• Creating the conditions needed to make change happen

Whether you’ve been actively involved in the supporting artists conversation, or are new to the debate and are interested in improving support for artists, please join us as we prepare to publish our final report and recommendations next spring. You’ll be able to take part in debate through our website and access what we have learned up to now. You’ll also receive regular ArtWorks briefings and comment as we publish findings on everything from learning methods to a code of practice principles, quality benchmarks and research on the ‘demand side’. There’ll be material of interest to all stakeholders. You can download the first of these briefings, covering the headline findings of a unique survey of 1,000 artists at http://www.artworksphf.org.uk/wp-content/uploads/2014/07/ARTWORKS-BRIEFING-ONE.pdf Read more at: http://www.artworksphf.org.uk/