Rehabilitation and Social Psychiatry Section Newsletter

Rehabilitation and Social Psychiatry Faculty Newsletter

Issue 7 Autumn 2006 Editor: Lindsey Kemp

A word from the editor Welcome to another edition of the faculty to break down some of these inter- newsletter. The current aim is to publish speciality barriers. three times a year with the third being just Contributions for the newsletter seem to after the residential meeting so that we be a little thin on the ground so please put can share the highlights with those who pen to paper (or fingers to keyboard) and could not attend. That’s not an excuse not send your letters, jokes, cartoons and to go, as we cannot include everything in articles of a more serious nature for the conference in a newsletter, principally inclusion in the next issue. I look forward the opportunity to network and catch up to hearing from you. with old friends. We are priviledged to We also welcome an article from one of share our conference with the Faculty of our service user representatives on the General and Community Psychiatry Executive and would be please to publish giving both faculties a chance to widen other such articles of interest. their perspective and understanding and

Contents Page 1 A word from the editors Page 5 Letters Chair’s Report – Testing times for A Psychiatrist visits Moscow Psychiatric rehabilitation Page 8 More date for your diary Page 2 Advanced diary dates Page 9 Top Tip Page 3 Douglas Bennett Prize Social Inclusion – is it up to you? Impaired Neuronal Glucose Uptake In Page 11 Help needed. Pathogenesis Of Schizophrenia Page 13 Useful websites and other information

Chairman’s Report

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 1 of 13 Testing times for Psychiatric of the consultant workforce in Assertive Rehabilitation: Outreach and performing crucial roles within the widening range of longer-stay provision “We have no money, therefore we must that has grown up to replace the traditional think” Lord Rutherford mental hospital, much of which is in the independent sector. At the same time some No-one can be unaware of the financial commissioners are learning to draw on the difficulties currently being experienced by the expertise of local rehabilitation practitioners to NHS and Social Services Departments. We manage Out of Area Treatments and non- live in a world of “cash-releasing efficiency hospital placements more effectively. Well savings” (cuts), service modernisation and managed mental health services take an redesign (often a prelude to cuts) and interest in people who are becoming stuck on “contestability”, which requires providers to acute inpatient wards and invest in targeted bid competitively for areas of activity (and interventions to address their needs. There is may lead to the unsuccessful provider making evidence of genuine local commitment to the cuts). Agenda for Change, New Ways of social inclusion of people with a severe Working and Modernising Medical Careers mental illness and much interest in exploring challenge existing styles of practice and the implications of recovery-oriented practice. training in potentially exciting ways, but are Providing effective physical and psychosocial being implemented against a threatening interventions for people with schizophrenia is financial background that has this year seen a clear policy requirement. Attention is at last the NHS disinvest massively in training in being paid to the quality of inpatient order to balance its books. There is a strong environments and the training needs of staff perception that rehabilitation services, working within them. particularly those not catering for a Forensic clientele, are receiving more than their fair There is a challenging agenda ahead for the share of disinvestment, at a time when Out of Faculty. Four large and interlinked themes Area Treatment expenditure has been rapidly have emerged form this year’s strategy day. rising. First is clarification of what the rehabilitation psychiatrist can uniquely contribute to mental Given this threatening background it is health services: our raison d’être. Second is perhaps surprising that the latest Strategy how to train the next generation of Day for the Faculty Executive and Regional rehabilitation psychiatrists. Third is how we Representatives was distinctly positive in support rehabilitation psychiatrists who are tone. The negatives were there: participants often working in isolation. Finally we need to described some services as “fighting for work towards developing clear standards for survival”, lamented the lack of managerial rehabilitation services. We hope to work on capacity within local rehabilitation services these, and of course many other, issues and noted the alarming lack of a developed during the coming year. central policy for rehabilitation and inept commissioning arrangements. But there are enormous positives too. Rehabilitation psychiatrists now work in a wide range of Frank Holloway, Chair, Rehabilitation and settings and services, forming the backbone Social Psychiatry Faculty

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 2 of 13 ADVANCE WARNING - Dates for your diary

The Royal College of Psychiatrists

Joint Annual Residential Meeting of the Faculty of Rehabilitation and Social Psychiatry

15th – 16th November 2007

Dublin (venue to be confirmed)

Dear Colleague,

NOTIFICATION OF THE REHABILITATION & SOCIAL PSYCHIATRY DOUGLAS BENNETT PRIZE AND CALL FOR POSTER PRESENTATIONS FOR FACULTY RESIDENTIAL MEETING

This is awarded annually for the best paper on rehabilitation psychiatry. It will be awarded to the psychiatrist, working in rehabilitation as a trainee, in a non-career grade post or as a consultant within 2 years of appointment, who presents the best original work at the Faculty Residential Meeting.

This is a call for papers to be short-listed for presentation at the next Residential Meeting in Southampton, on the 15th – 16th November 2007. Initial submissions will be no more than 2000 words. The best submissions will be presented to the Prize Adjudication Committee on Friday morning (16/11/07) and the Prize Winner announced at the conference.

We are also looking to encourage trainees, staff grade psychiatrists and new consultant colleagues to submit a Poster Presentation, for the forthcoming Southampton meeting. You may wish to send details of the Call for Posters to your local Training Programme Directors to increase the uptake.

We hope that many of you will be busy over the next few months, and aiming to present your work either for the Douglas Bennett Prize or as a poster at the residential conference.

Please send an electronic copy of your submission to [email protected], or on a disc to Sally Fricker, Conference Office, The Royal College of Psychiatrists, London, SW1X 8PG.

Yours sincerely,

Dr Frank Holloway

Chair, Faculty of Rehabilitation and Social Psychiatry

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 3 of 13 IMPAIRED NEURONAL GLUCOSE UPTAKE IN PATHOGENESIS OF SCHIZOPHRENIA - CAN GLUT 1 AND GLUT 3 DEFICITS EXPLAIN IMAGING, POST-MORTEM AND PHARMACOLOGICAL FINDINGS?

Emma McDermott, Prasanna de Silva

Summary symptoms. Unfortunately, these drugs would also raise systemic glucose levels, increasing The largely empirical dopamine theory has the risk of diabetes, as observed in longer limited value in clarifying the pathogenesis of term studies of clozapine in particular. schizophrenia, due to its inability to explain consistent imaging findings, such as cortical We summarise potentially useful research grey matter loss, reduced frontal and strategies, including studying the genotype of thalamic activity, and, reduced D1 receptor GLUT proteins with respect to schizophrenia load. Furthermore, the most effective drug phenotypes, activation studies involving fMRI for treating positive and negative symptoms - using deoxyglucose as a substrate, and clozapine - has minimal dopaminergic investigating clinical features of schizophrenic activity. patients prior to and following treatment for co-existing diabetes. We present an alternative hypothesis centring on presumed deficits in membrane Reprinted from Medical Hypothesis (2005) bound glucose transporter proteins GLUT 1 65, 1076-1081, with permission from and GLUT 3, either in absolute numbers or Elsevier. A full version of this article is functional capacity. In situations of high available online at www.sciencedirect.com. demand, intracellular hypoglycaemia in neurones and astrocytes will produce acute Further Comments (post publication) symptoms of misperceptions, misinterpretations, anxiety and irritability - the We wrote up this idea following Emma’s usual features of prodromal and first onset attachment in Whitby as a fourth year schizophrenia. medical student. Her special study module was on the association between untreated Furthermore, reduced glucose uptake will schizophrenia and systemic hyperglycaemia - disrupt production of glutamate - functionally initially described in 1919 (pre similar to the schizophrenia-like syndrome chlorpromazine) and replicated in 2003 in first produced by PCP, a glutamate antagonist. In onset patients. the longer term, reduced neuronal growth and poor synaptic contacts will produce The current version of the dopamine theory chronic cognitive difficulties and perpetuate explains delusions and hallucinations as acute symptoms. stemming from excess delivery of dopamine to the limbic/cingulate areas with a marked A backlog effect due to reduced brain uptake reduction of dopamine to the prefrontal areas. of glucose would produce systemic We believe that our hypothesis involving hyperglycaemia observed in drug naïve poorly functioning GLUT 3 glucose subjects. Rat studies have shown that transporters (largely specific to the brain and clozapine and similar compounds block predominantly present in the frontal areas) GLUT proteins in the brain and peripherally, can explain the reduced dopamine supply, more so than selective dopamine blockers. resulting in “hypofrontality”. The lack of By blocking GLUT proteins, clozapine would frontal inhibition can “release” activity of the break malfunctioning circuits, resulting in the brain stem, producing excess dopamine and disappearance of cognitive and perceptual noradrenaline resulting in the behavioural

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 4 of 13 features (over-arousal, flight/fight) we see in diabetes or glucose intolerance. Does tight first onset schizophrenia. control of blood sugar levels improve cognition, motivation and general I was surprised to find that all effective rehabilitation? antipsychotics (especially clozapine) block GLUT proteins. This is an interesting area for Prasanna de Silva therapeutics research in terms of partial Consultant Psychiatrist agonism, so that the balance between efficacy and side effects can be tilted towards Tees, Esk and Wear Valleys NHS Trust the former. The Anchorage, 11 Byland Road, Whitby North Yorkshire YO21 1JH We are interested in hearing from colleagues about their experiences in treating e-mail: schizophrenic patients with co-morbid [email protected]

Letters

I am a member of the Rehab Faculty and between clinicians and managers at provider would like to contribute the following : level.

Diversity Current College norms for Rehab focus on sector services. The equivalent is needed for I very much enjoyed and learnt from Alison expanding tertiary, out of area services. Not Gray's article on equity and access for Deaf least because some of the most people and Deaf culture. disenfranchised and vulnerable patients are potentially out of sight and out of mind in Any sub-specialty that considers itself derived such settings, and the current NHS financial from "Social" theory and based on engaging pressures will drive purchasers to focus on the totality of patients' needs and experiences price alone rather than "best value" in its true should have Diversity at its core. sense."

I suggest we review our overall Diversity Minh Alexander practice as a Faculty and also benchmark against the main College ethnic monitoring Consultant Rehabilitation Psychiatrist, stats. Northampton

Working in male slow stream secure services Trainees and New Consultants at present, I have a selfish interest in seeing clearer guidance on achieving gender There is a rehabilition special interest group for sensitivity for men and cultural sensitivity for psychiatric trainees with a Yahoo e-mail group. the ethnic minorities who are over For more information contact: represented amongst secure populations. The latter are more likely to end up as "new [email protected] long stay" and be left stranded in areas of low diversity through OATs processes. Please let trainees and newly appointed colleagues know. College guidance on service specifications to meet such need would help in lobbying Commissioners to purchase responsibly and with resource negotiations

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 5 of 13 A Psychiatrist visits Moscow - June 2005

I went to Moscow to find out more about the repair. There we met Professor Vassily mental health services in preparation for a Yastropov and Tatiana Solokhina of the visit to The Retreat, York by Tatiana National Mental Health Research Centre of Solokhina, Vera Balabanova (academic Russian Academy of Medical Sciences, psychiatrists) and Alexey Odollamsky through whom the visit had been arranged. (psychologist). They are all members of a non-governmental organisation called ‘Family I had been asked to prepare a talk about and Mental Health’ www.familymh.org which mental health services in Britain and in has set up a number of initiatives in Moscow particular the role of nurses. Vera had stayed including psycho education for families, ‘Club up all night translating the acetates into Anima’ – a once weekly activity and social Russian (after a day that included a long wait club, psychosocial intervention training (PSI) for us at the airport due to the bureaucratic and the development of a therapeutic immigration system) and still did a wonderful community project. Through their interest in job of translating as I spoke. I described the humane care and therapeutic communities role of the named nurse and shift patterns, they had made links with The Retreat in 2004 the size of caseloads, how multidisciplinary and this had led to an invitation for them to teams work and other feature of our services. spend the month of September 2005 visiting During the presentation there was laughter at our Psychosis and Recovery Unit (which a number of points - when I described the uses both therapeutic community principles shift system and the size of inpatient and PSI) and to offer them some specific PSI caseloads for named nurses especially. In training during their stay. Hospital number 14 and in most Russian state hospitals nurses work a 24-hour shift Day one: Visit to Moscow State (when they are expected to be awake for the Psychiatric Hospital Number 14. entire shift) once or twice a week. The Chief Doctor asked me to explain the benefits of On a warm June morning I was driven having 3 shifts throughout the 24 hours but through the Moscow suburbs with my friend did not see how this could be implemented in and fellow psychiatrist Vera, by her car- his hospital. He explained that there was a owning psychologist colleague Anna, to shortage of money to pay nurses a hospital number 14. There was a painted reasonable wage and that they were in any concrete wall surrounding the site with an case hard to find. Many nurses lived a long entrance where an official checked who we way from the hospital and could not afford to were and then rolled back iron gates to let the travel there on a daily basis so a 24-hour shift car in. In the grounds there were people was more economical for them. In one of the wandering about in dressing gowns in an wards the nurses had an allocation of 11 staff atmosphere that was calm but perhaps a little but had chosen to work with 10 so that and downcast. The buildings were old and each could get paid a little more. finished in uneven plaster painted a russet brown. There were women painting the After the talk (which with translation and kerbstones in the same colour, very slowly. questions lasted 2 hours) I was taken on a Hospital Number 14 has a large catchment tour of the hospital and visited an acute male area for the west and south administrative ward and a rehabilitation ward. The acute area of Moscow covering a population of ward had 77 patients with 2 trained nurses on 1,800,000 with 1100 beds and 14 shift, a ‘procedures’ nurse (who gave departments. injections and set up intravenous antidepressant infusions, but not ECT which We went into the research centre, a group of is no longer used in this hospital) and 6 or 7 small offices entered through an anteroom nurse assistants. The patients slept in 3 where the floor and the wall tiles were in poor rooms with beds arranged ‘army style’. Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 6 of 13 There appeared to be little or no personal college and work, housing, confidentiality, space or privacy, no screens or curtains and legislation, support groups and wanted to no lockers. The men were at lunch when I know if they could have email contact with visited and all dressed in pyjamas, a practice service users in the UK. It was a stimulating I had not seen for many years. In the and moving session. Despite the constraints rehabilitation ward the patients wore their of the language and the differences in the own clothes, there was more space between health systems, it was striking how similar the the beds and more room for personal issues were to those that would have been possessions; it reminded me of admission raised by a group of service users and carers units where I had worked in London in the here. The main difference in services that 1970s. was reflected in the questions was the lack of community facilities and the poor state of the Day two: A visit to ‘Family and Mental hospital provision. For these service users Health’ Social club. and their families there was a real fear of returning to in-patient care, especially if there The day after the hospital visit it was raining. were no relatives to care for them at home. It We went, via Red Square, by metro and on was clear to me from discussions with foot to the other side of the city where in an professionals afterwards that the issues of unassuming local public library a group stigma and the vulnerability of the patients in service users, family members and dedicated the community are more likely to be laden professionals meet together each with serious threat than they are here in the Wednesday afternoon. This organisation UK. (Family and Mental Health) is made up of 56 family members, 71 service users and 28 This was a small group of self-selected professionals. They are actively working to service users and their families, many of provide a more psychological approach to the whom travel some distance to come to this management of psychoses. At the library group each week, who welcome the more they had a room where a craft group was enlightened psychosocial approach being taking place, followed by art and then drama. taken by this dedicated organisation. They After brief introductions and greetings I was are a registered charity and are supported by whisked away to another room to have a grants but have no premises of their own. seminar with the professionals where we Their regular meeting in the library came shared experiences of working with families. about through the enterprise of one of the We returned to join the group for what was carers and the willingness of the head called a ‘press conference’, no real ‘press’ librarian to be as socially inclusive as but I was in the hot seat being asked possible. questions by service users and carers about mental health care in Britain. After this they Trying to put these two visits into some performed a ‘play’ - the plot of which I context we asked our colleagues to give us a understood only a little but whose fun and presentation about the Russian Mental cooperative spirit were inspiring. It was Health Service when they visited The Retreat greatly enjoyed by audience and participants. and the following notes are drawn from this. (Solokhina T. 2005 personal communication). The two visits could not have been more different. Here the service users and carers The Russian mental health service covers a were an animated, articulate group many of large geographical area and is a largely whom spoke good English. One young man, hospital based service. a translator by profession, gave a simultaneous translation of the session (a For the total population there are 277 virtuoso performance which conveyed Hospitals with 165,000 beds (34.8 per 30,000 intensity, humour and the individuality of each approx); 15,300 Day hospital places (3.21 per questioner). They asked about patients’ 30,000); 17,100 Workshop places (3.6 per rights, medication, stigma, opportunities for Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 7 of 13 30,000). Forensic services are provided work also mean that multidisciplinary team separately. working just does not happen.

Russian psychiatry remains dominated by Russia: statistical data rigid institutionalised systems with a high number of beds per head of population, low investment and little government support for change. And yet there is the beginning of a service user support group movement and of Population: 89 territories 142.5 million a carer support movement (families) 4.1 million people with mental Mean life expectancy – supported by professionals. There are now 65.9 years disorders People with schizophrenia- greater opportunities for dialogue with about 600 000 western groups and a sharing of common concerns.

Invalids as a result of mental illness – about 1 million. I was struck by the dedication of the Among them 4.6% are professionals that I met. Their desire to find working a more humane way of care and their courage in trying to make improvements to Dispensaries, which are arranged by territory, their services was inspiring. It was also clear provide an outpatient service but this is a that for the service users the issues are all separate service with different personnel from too familiar: stigma persists, supported the hospital service so continuity of care is accommodation is lacking, poverty and difficult. Each Dispensary has a District unemployment threaten, Human Rights may psychiatrist: 1 per 20 000 – 30 000 be ignored, medication is often all that is on (depending on the patient group); District offer, admission wards are not always nurses – similar numbers to psychiatrists; therapeutic and access to work and college is Procedure nurse – there is establishment for difficult. two shifts a week but there are often unfilled posts. There are now established new We have continued the dialogue with our positions for clinical psychologists, colleagues and hope to support their psychotherapists, social workers; specialists development of further training in a more in social work (with higher education) and psychologically orientated approach to the lawyers, but there are not always people in management of psychosis. They spent a post. Dispensaries tend to be busy and not month with us in September 2005 and able to give much time per patient so there returned to Russia with new energy and tends to be an emphasis on prescribing ideas. We hope there may also be medication and not much else. opportunities to explore links with the Global Initiative on Psychiatry (GIP) which has long Psychiatry in Russia has a strong biological established links with the College and was tradition in which medical training does not described recently by Shooter (2005) as ‘a include obligatory training in psychotherapy brave, committed, independent and entirely and clinical psychology training does not altruistic organisation dedicated to usually include psychotherapy either. Due to galvanising the international conscience’. the biological nature of psychiatry the gap The Global Initiative on Psychiatry www.gip- between psychiatrists and psychologists is global.org has been working with the former often marked and one of the issues that I was Soviet Republics and Eastern European frequently asked about by professionals was countries for 25 years. The mission of GIP is how we work together here in a team. The to promote humane, ethical, and effective low status of the nursing profession with little mental health care throughout the world and opportunity for nurses to work to support a global network of individuals and psychotherapeutically, the poorly developed organizations to develop, advocate for, and roles for other professionals, especially social carry out the necessary reforms. Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 8 of 13 Shooter M (2005) Mental Health in Motion, Susan Mitchell, Medical Director, The Newsletter of the Global Initiative on Retreat, York. Psychiatry, Editorial, 2nd Edition, September 2005 May 2006.

Dates for next years Diary

College AGM 19-22 June 2007 at the Edinburgh International Conference Centre Faculty of Rehabilitation and Social Psychiatry Residential Meeting 15-16 November 2007 in Dublin College AGM Summer 2008 Liverpool

TOP TIP

Having difficulty remembering why your patients won’t engage?

Caroline Cupitt, Consultant Clinical Psychologist working in AOT @ Oxleas MHT has developed a one page team formulation document to prompt us prior to CPAs or reviews. The main headings are:

What is/are the most significant event/s in the person’s past and how have they affected them? what is/are the most pressing issue/s in the person’s life and how are we working on these issues? and what is/are our goals? Caroline runs an excellent workshop on “A formulation approach to engagement.” (AOT conference. 2005)

The government is particularly interested in enabling more adults withmental health Social Inclusion – is it up to you? problems to enter and retain paid employment whichthey feel is the key to Maurice Arbuthnott – Service user and inclusion.However the Department of Works Rethink representative on the Faculty and Pensions found that less than 40% of the Executive Committee writes: employers want to recruit people with mental health problems, whereas 62% are pleased to recruit those with physical disablilties. The DWP also found that ledd than a quarter of Now that the large asylums have been shut people with mental health problems are in down and the majority of the mental health work. The main barriers to srvice users service users live in the community, it is entering work is this attitude of employers as declared government policy that the stigma well as the fear of losing benefits, the and discrimination that society aims against fluctuating nature of mental illness and the service users should become a thing of the low expectation of health professionals who past. It is the government’s statedintention that people with mental health problemsshould be socially included instead do not encourage the service user to seek of being locked away in the virtual asylum employment. that has erected barriers to their participationin the mainstream of society. There is exclusion in other areas of society: people with mental health problemsare not Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 9 of 13 eligible to be a juror or a school governor; IIs social inclusion what service users really there are lowlevels of participation in further want? Whilst on the one hand it is good that education and leisure activities; there can stigma and discrimination should be also be discrimination from housing eradicated, service users also have a right to providers; financial services are hard to choose the life style that they want – as does access and also people with mental illness every other honest citizen. Some feel that the find it socially difficult to form emotional and government’s social inclusion programme is sexualrelationships and are indeed often nothing more than a menas of coercing discouraged from doing so by health service users into work in order to cut professionals. expenditure on Incapacity Benefit – especially as the government has clearly Service users become isolated, only mixing in stated their policy to reduce the numbers of the community of other service users at those claiming this benefitand to make mental health day centres or clinics. They substantialsavings on payouts. The service find it difficult to engage in the mainstream of user should always be allowed the right to society and become institutionalised within decide whether he/she wants to work or not. the community – within the virtual asylum of community care. People with mental health Whilst entering the work place might be a problems can be “ unwell some of the time – pathway to social inclusion, work can also excluded all of the time.” create more roblems than it solves. The work place can be brutal and competitive. People Stigma and discrimination, lack of social can feel degraded, belittled anddissatisfied networks and social activities to take service with the work they are asked to do – users into the social mainstream, the financial especially as most service users are usually limits that living on benefit impose and also offered only the sort of work that isdemeaning the lack of confidence and opportunity that and erodes selfrespect. The stress of work such elements create, compound sociall and the friction and tension of work politics isolation behind the transparent walls of the can be a certain pathway back to a long stay virtual asylum. in a psychiatric ward and a rather uncertain pathway into greater social inclusion in the The government set up the Social Exclusion community. Unit which published a report entitled Mental Health and Social Exclusion. The Sainsbury Society breaks down into small units and Centre for Mental Health has also published many service users already enjoy the Working for Inclusion – Making social satisfaction of inclusion within these small Inclusion a Reality for People with Severe segments without entering the work place. Mental Health Problems. Between them they Such segments include religious groups, have stated that action on inclusion is a creative and artistic groups, ethnic minority “moral imperative” and there is a vision of a groups and the subculture of male future where people with mental health homosexual and lesbian society. problems have the same opportunities to work and participate in the community as any There are also service users who are happy other citizen. to be diengage from the mainstream of society as a way of coping with their condition The National Institute for Mental Health in and who also feel secure with minimum help England (NIMHE now called CSIP) also has from mental health services who they put in place their Social inclusion consider intrusive to their life. They may Implementation Programme. They are giving spend the day in their accommodation priority to eradicating stigma and watching television for most of the time, discrimination and are promoting equality in broken by visits to the supermarket and atrip employment, income and benefits, education, to the post office to collect their benefit. They housing, community participation and social feel safe, happy and secure with the networks. minimum of social engagement, apart

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 10 of 13 perhaps from contact with their immediate in order that they too can make choices about family. Society is diverse and the way they want to be socially included. accommodating enough to make space for those service user who prefer to disengage Maurice Arbuthnott as much as possible as a way of coping with their mental condition – after all they are (First published November 2005 in socially included on their terms. “Perceptions”)

We all have the right to choose about what If you want more information about current social opportunities we want to take. trends in the social inclusion programme, the Ratherthan expecting everyone with mental following websites will help; health problems to now enter the work place in order to be socially included, the NIMHE www.nimhe.org.uk government should make adequate benefit Social Exclusion Unit provisions for those who are not able to work www.socialexclusionunit.gov.uk Sainsbury Centre for Mental Health www.scmh.org.uk

Extra help needed

Additional help is needed for the Equivalence Committee (dealing with Article 14 applications etc.) If you feel able to assist please contact Lena Hartley at the College.

Useful websites

For service users:

Rethink- severe mental illness AKA National Schizophrenia Fellowship: www.rethink.org or national information helpline 0845 456 0455

MIND: www.mind.org.uk Mindinfo line:020 8522 1728 if you live in Greater London, or 08457 660 163 if you live elsewhere (9.15-4.45, Mon, Weds and thurs).

Depression alliance: www.depressionalliance.org.uk

Hearing voices network: www.hearing-voices.org.uk, e-mail: [email protected] 91 Oldham Street, Manchester M4 1LW, tel: 0161 834 5768. A user led group, helping people with their voices. Information pack and mailing list of self help groups around the UK.

Medication: the drug info site for service users www.nhmhct.nhs.uk/pharmacy/

UK psychiatric pharmacy group- medication helpline for psychiatric medicines. 020 7919 2999, 11am-5pm, weekdays only.

Mental health concerns and issues- run by people with mental health problems. www.btinternet.com/~synom.price/index.html

BBC Online: Mental Health: www.bbc.co.uk/health/mental Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 11 of 13 Benefits: free guides to welfare benefits, especially good for DLA: www.bhas.org.uk/index.html

Department of Health, directory of over 160 organisations providing help and information www.doh.gov.ukmentalhealth/contact.htm

Department of work and pensions: www.dss.gov.uk Benefits enquiry line: 0800 882200, free information

EPPIC Early Psychosis Prevention and Intervention Centre: www.eppic.org.au/resources.html

IRIS- initiative to reduce the impact of schizophrenia: www.iris-initiative.org.uk

ISPS- The International Society for the treatments of the Schizophrenias and other Psychoses. More for professionals but very informative newsletters: www.isps.org.uk

Manic Depression Fellowship: www.mdf.org.uk

UK Advocacy Network: 0114 272 8171 10am-4pm on weekdays.

Zito Trust, for improvements in the provision of community care for people with severe mental illness, to support victims of failures of care, research and training in this field: www.zitotrust.co.uk

For carers: Rethink- severe mental illness AKA National Schizophrenia Fellowship: www.rethink.org or national information helpline 0845 456 0455 Carers- government information for carers: www.carers.gov.uk/index.htm Good on carers’ assessments. Mental Health Foundation www.mentalhealth.org.uk MIND: www.mind.org.uk Mindinfo line:020 8522 1728 if you live in Greater London, or 08457 660 163 if you live elsewhere (9.15-4.45, Mon, Weds and thurs). Beacon of Hope Mental Illness, help for spouses and carers: www.lightship.org/index.htm Carers UK, used to be called the Carers National Association: www.carersuk.demon.co.uk CarersLine: 0808 808 7777 Crossroads- Caring for carers, respite breaks in carers’ home www.crossroads.org.uk 01788 573653 Holiday care: www.holidaycare.org.uk 01293 774535 Schizophrenia Home Page, set up by a carer: www.schizophrenia.com The Princess Royal Trust for Carers, over 100 carers centres in UK: www.carers.org/new/html/default.asp

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 12 of 13 Young carers: www.youngcarers.hants.org.uk/index.html

Royal College of Psychiatrists info

Information factsheets as leaflets and some on website e.g. schizophrenia, Manic depression/bipolar disorder, depression, ECT, cognitive therapy, depot medication, patients’ rights and monies, the mental health team, what is a psychiatrist/what is a psychologist? Write to : Help is at hand, The Royal College of Psychiatrists, 17 Belgrave Square, London, SW1X 8PG. Tel: 020 7235 2351 Ext 259. Or download from website: www.rcpsych.ac.uk

Books Down with gloom! (or how to defeat depression) Living with a stranger: A ‘survival kit’ for carers of people with depression. From: Book sales, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. £5 each.

Information packs: checklists for patients, carers and psychiatrists Questions to ask your psychiatrist: a checklist for people with mental health problems Questions to ask your psychiatrist: a checklist for families of people with long-term mental illness A checklist for psychiatrists: what to tell the family: issues of concern to families of people with long-term mental illness Free of charge, with an A4 S.A.E. from the External Affairs Department, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG (1st class- 96p, 2nd class- 76p).

Newsletter Contact Details E-mail: [email protected] Write to: Dr Lindsey Kemp, Editor of the Newsletter, Faculty of Rehabilitation & Social Psychiatry, Priority House,Hermitage Lane,Barming, Maidstone ME16 9PH. Website: www.rcpsych.ac.uk Click on The College, then Click on College Structure, then click on Sections.

We warmly welcome contributions to the newsletter. These could include letters (up to 200 words), articles (300 – 700 words) short tips, cartoons etc.etc. Suggestions for articles include topical issues, recent developments, personal views, career experiences, articles from users and carers, book reviews or summaries of conference presentations. If possible, please send contributions to the above e-mail address with the article as an attachment in a Word document. Alternatively, send a hard copy to us by post at the above address, preferably with a copy on disc as a Word document. Thanks. This is a publication of the Faculty of Rehabilitation and Social Psychiatry. The views expressed here are not necessarily those of the Royal College of Psychiatrists.

Newsletter of Faculty of Rehabilitation & Social Psychiatry. If you would like to contribute to the newsletter, please e-mail us at [email protected] Page 13 of 13