The Rise of Antidepressants

The BBC ran a news piece today about the massive rise in use of antidepressants in England and Wales over the last 10 years. And depending on which study you believe between 1 in 11 and 1 in 6 people in England are now on an antidepressant (though we must remember, that antidepressants can be used for other conditions like pain management and irritable bowel syndrome – IBS). In the USA, antidepressants are now the second biggest group of prescribed drugs.

 

So, what should we conclude? Well, firstly, it is good news that it has become much more acceptable for people to talk about struggling with depression, anxiety and other mental health issues. It is good that people are going to see their GP when they feel depressed and anxious, rather than just trying to cope with it. So, we mustn’t now necessarily insinuate that the increase in prescriptions is a bad thing, because firstly, that can heap shame on those who are taking them, which is unhelpful at so many levels and also, we need to remember that there is actually a good evidence-base behind anti-depressant medication. They really do work – I’ve seen that again and again for my patients, who choose to go on them, and for sure, I would love to see more psychological therapies available on the NHS, as an alternative or as an adjunct to medication. Waiting lists are currently far too long for such therapeutic interventions and many people choose medication because they cannot afford to pay for therapy or indeed to wait several months for the help they need. We don’t report the use of antihypertensives to control blood pressure negatively and so we need to be careful about taking a dim view of medications which help improve mental health.

 

However, when so many in our society are struggling with anxiety and depression to this extent (and it’s really positive that we’re talking about it and that people are getting help), we need to ask ourselves some big questions about the root causes of this and what we can do as a nation to improve our mental health. One of all time favourite quotes is that of Archbishop Desmond Tutu, when he says:

 

“There comes a point, where we have to stop just pulling people out of the river. We need to go upstream and find out why they are falling in.”

 

So, in the rest of this blog, I’m going to explore some root causes, whilst recognising that for many people, endogenous depression (i.e. a neurochemical cause in the brain) IS the root cause, and therefore their depression may not have any other roots to it.  I’ve also done this vlog (which I did for mental health awareness week) about what depression is and some of the things that can help.

 

But in looking for root causes, let’s start at the beginning. I’ve written on this blog a number of times about the impact of Adverse Childhood Experiences and the impact of Trauma on our lives. So many of us live with unhealed pain, which over time eats away at us and makes it harder for us to remain mentally well. Many of us go through trauma and are able to survive it better than others, but that is because we’ve had other things in our lives at the time which have helped us navigate the storm. However, we need to recognise more the massive reality of trauma in our lives, so that we can face it, and find healing together. This is one of the reasons why I’ve co-written ‘The Little Book of ACEs’ with some friends and colleagues, here in Morecambe Bay. There is a free PDF version of it, if you click here. You may also find this inspiring talk by Jaz Ampur-Farr, herself a survivor of significant trauma, really helpful. Jaz is joining us in Morecambe Bay very soon, to explore some of these issues.

 

We must also be brave enough to recognise that we have a complex corporate history, which shapes our identity and we have a society, which is by no means equal or fair. Prof Bev Skeggs, and Prof Imogen Tyler, two of the foremost sociology professors in the UK/world right now, are writing so powerfully about this. It’s well worth digging into their work, and I am so excited that they are here at Lancaster University, in Morecambe Bay, and will be exploring some of these issues with us in more depth over the next few months. We cannot underestimate how injustice, poverty, and inequality impacts our mental health.

 

Stress has a hugely negative impact on our mental health. Our work patterns have become so manic and busy and our weekends often so full, that we have forgotten how to rest, how to stop, how to switch off and take notice of the beauty all around us – of the things which really matter. This takes a huge toll on us. The girl guides took part in a fascinating survey about what causes them stress and feeds mental health issues. The number one factor was the pressure they feel to do well at school. Our very systems and the treadmill of the exams are making our young people unwell. The idea of slowing down and learning to switch off from our ever faster, consumerist world, seems laughable to so many of us – and yet I would argue that this is one of the greatest causes of our ill-being. We have created an economy which treats people like fodder for the economic machine and is literally killing the planet around us – another underlying huge but often unrecognised cause of our stress. We must rebuild an economy based on wellbeing. It’s why I’m so excited that we’ll be welcoming Prof Katherine Trebeck to Morecambe Bay in the next few weeks.

 

Another causative factor of our growing mental illness in society, perhaps caused by all the busyness, is loneliness and isolation. Despite our many frantic activities, and social networking, 20% of the UK population say they feel lonely, but that jumps to between 50 and 75% of people over 75. We were made to be in relationship. When we are disconnected from community, we become sad and low. We need to remember how to love people, and also to be loved. Our disconnection is leading to increased separation, suspicion of others and a rise in racism and hatred. This is in no way good for our mental health. Valerie Kaur explores this so powerfully in her incredible TED talk on revolutionary love. We need to reimagine a society in which relationship is at the core of our being together. Hilary Cottam’s work is so vital in helping us recover this. Again, Hilary is coming to the Bay in the coming months to help us dig deeper as a community into these ideas.

 

I am so glad that we are talking about mental health so much more seriously. I am glad that people are able to take medication that can help them and that the stigma is being broken. I am hopeful though that we can recognise together just how broken our society is, and how our current political and economic systems (including our beloved health system) cannot fix this. Perhaps, in learning to be together in the dark, when we cannot see the light, wrestling with the complexity of our pain, healing our trauma and reimagining our future, we might find that our need for medication decreases.

 

 

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Knife Attacks – Whose Crime Is It?

I find myself staring at the screen, unable to comprehend how utterly devastating it must be as a parent, to have a police officer knock on your door in the early hours of the morning, to be told that your darling child has been stabbed to death. My heart weeps for the senseless loss of life, young lives stolen away in this rising tide of violence. I know what it is like to break truly awful news to people and their families and my heart goes out to the police officers on the beat or the clinicians in the Emergency Department, who have to break the terrible news to the parents and the siblings, that so suddenly, a bright shining light in their lives, has been extinguished.

 

Knife attacks are a crime, there is no denying that, but the burden of guilt is not so easily apportioned. We are seeing an exponential rise of it in our streets, with a 93% increase in recent years across England, whilst in Scotland, they have seen a 64% decrease over a similar timeframe. We need to examine what has gone on in that time and ask some very uncomfortable questions. We also need to call people to account for decisions which have been made, despite knowing the evidence, and  we desperately need a ‘whole systems’ approach to tackling this epidemic.

 

The Primeminister has stated that “knife crime” is not linked to a decrease in policing numbers. The police chiefs disagree. The truth is, that it’s not only the police who have disappeared off our streets (and these are community police officers, who knew their communities well and were respected and trusted – it takes years to build up those kind of relationships) – we’ve had a perfect cocktail of cuts right across the board which is directly attributable to the mess we are now in. Ongoing austerity, which is a political choice, has also led to the closure of youth centres, more young people than ever excluded from school, (who then have a 200 times higher chance of being groomed into violent gangs) and massive cuts to public health and local government, meaning many preventative schemes have disappeared. When policy fails, it has to be called out and challenged. Everyone with a brain knows that prevention is better than cure. And for those who have lost loved ones, there is now no comfort – this could have been prevented, but has been allowed to escalate at such an alarming rate because we do not have a form of politics or leadership that listens to what is really going on in our communities, but continues to drive through ideological changes without thinking through the consequences. This is unacceptable.

 

When Heidi Allen MP came to Morecambe, she heard the testimony of my friend, Daniel, who grew up in some really tough circumstances, forced into a gang culture in order to help put food on the table and prevent harm coming to his family. Tears streamed down her face as she heard his powerful account of what it meant for him as a young person, to have his youth centre closed, his local high school closed and being told he was not a priority when he was street homeless. She told us that she had not realised the layers to the poverty that many are experiencing across England. And this is how the (perhaps) unintended consequences of remote policy decisions affect ordinary people in droves across the UK. When school budgets are cut and mental health teams are cut and social care provision is cut and youth centres are cut, children and young people from home environments which are already struggling to make ends meet, already processing significant trauma and adversity, fall prey to gangs and criminal networks who use them and abuse them for their gains across county lines.

 

And yet in Scotland, we are seeing an altogether different picture emerging, because they saw this problem 10 years ago and decided to make a difference by dealing with complex living systems, rather than tinkering clumsily with mechanistic thinking. So it is high time that England ate some humble pie and learnt from our Celtic friends.

 

Scotland, unlike the English, are not delaying on taking a serious approach to Adverse Childhood Experiences, hoping to become the first fully trauma informed nation in the world. They have taken a public health, holistic approach to the knife crime problems in Glasgow and then spread the learning across the nation, rather than making devastating cuts to their PH budgets. What they have done isn’t rocket science – it’s plain, public health common sense. They have chosen not to criminalise, label and stigmatise young people (something the hostile environment rhetoric seems to do). They have refused to see it as a race problem – because it isn’t (but some in our press in particular, and some members of the government have stirred up this nonsense anyway) and they have invested in early and effective youth intervention programmes, amongst other things.

 

One of things my work has taught me to do, is suspend my judgements of those who we would automatically and ordinarily point the finger at, the supposed perpetrators of a crime, and really listen to the truth. The truth here is complex and I’m not saying that people who commit violent acts do not need to face the consequences of their actions. They do. But what I am saying is that we need restorative justice in our communities that breaks this horrendous cycle. We also need to recognise that there has been terrible violence done to our most vulnerable children and young people across England by a series of political decisions. The government has failed those it should have protected. In my line of work, those kind of errors would lead to massive learning events and the dismissal of those who had failed in their leadership. Perhaps people have such little faith in the political system we have because there is seemingly such little accountability. Now is not the time for silly political defence of failure. Now is the time for humility, repentance and a genuine turning of the hearts of the fathers and mothers in the nation to the rising generation, far too many of whom are no longer with us.

 

 

 

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