RCPsych

Devolved psychiatries - Professor Rab Houston

In this podcast, Professor Houston talks about the psychological impact on those affected by the Aberfan disaster of 1966. The podcast expands on an interview Prof Houston gave to BBC Wales as part of a series of podcasts recently produced about the disaster. It is strongly advised that you listen to podcast 7 of the BBC series prior to listening to this podcast. https://www.bbc.co.uk/sounds/brand/p09z3n7y

Further reading:
https://www.nhs.uk/conditions/electroencephalogram/ 

Iain McLean and Martin Johnes, Aberfan: government and disasters (Cardiff: Welsh Academic Press, 2000), especially chapter 5.
Morgan, L., Scourfield, J., Williams, D., Jasper, A., & Lewis, G. (2003). The Aberfan disaster: 33-year follow-up of survivors. British Journal of Psychiatry, 182(6), 532-536. doi:10.1192/bjp.182.6.532

The 1966 Aberfan disaster

As a young woman in 17th century London, Hannah Allen suffered from severe depression or what was then known as melancholy. She wrote about the pain and despair she experienced. The way she wrote, retrospective but incorporating written fragments from the time of her collapse, and the nature of the temptations to which she was subject, as well as the cures proposed by relations, indicate a narrative of madness and depression as well as bringing out the pervasive religious belief of the age. Concentrated and painful, her frank account accepted that she had been mentally and physically ill; she wrote simply to explain what it had been like. Her writings are a vivid personal account, but they also show a poignant awareness of how her condition affected those around her.

IMAGE: [Unknown lady 2] PORTRAIT OF AN UNKNOWN LADY, of the English School 1660-1670 at Lyme Park, Stockport, Cheshire. Credit: Universal Images Group, Rights Managed / For Education Use Only

3. Depression - Hannah Allen

In the podcast I talk about my research on the biological basis of schizophrenia using brain imaging and my attempts to understand symptoms such as hallucinations in terms of brain based cognitive processes. I describe what schizophrenia is like from the point of view of clinicians and from the point of view of patients. I suggest that the experiences described by patients in history are very similar to those described today.  Finally, I discuss treatments. There has been much improvement since the discovery of drug treatments in the 1950s, but we still have not identified the causes of schizophrenia and, for the majority of patients, life remains very hard.

Chris Frith is Emeritus professor of Neuropsychology and the Wellcome Centre for Human Neuroimaging at UCL and Honorary Research Fellow at the Institute of Philosophy.

Understanding Mental Health: conditions, caring, and contexts - Prof. Chris Frith

Social workers and care in the community

Social workers have a crucial part to play in improving mental health services and mental health outcomes for citizens. They bring a distinctive social and rights-based perspective to their work. Their advanced relationship-based skills, and their focus on personalisation and recovery, can support people to make positive, self-directed change. Social workers are trained to work in partnership with people using services, their families and carers, to optimise involvement and collaborative solutions. Like community psychiatric nurses, social workers also manage some of the most challenging and complex risks for individuals and society, and take decisions with and on behalf of people within complicated legal frameworks, balancing and protecting the rights of different parties. This includes, but is not limited to, their vital role as the core of the Approved Mental Health Professional (AMHP) workforce. Social workers are central to the holistic, individualised treatment available to sufferers from mental disorders, which epitomises the goals of modern healthcare provision.
Dr Ruth Allen, Chief Executive, British Association of Social Workers

Understanding Mental Health: conditions, caring, and contexts - Dr Ruth Allen

People with learning disability were understood and treated very differently in the past from the present. While attempts were always made to help them, this was against a background of pessimism about their prospects. Much progress has been made in the past half century in positive attitudes towards this group, with closures of the large institutions in which they were often housed and better integration into the community. Nonetheless, challenges remain, including a significantly shorter life expectancy compared with the general population. Dr Fionnuala Williams clarifies misconceptions and enlightens listeners on the definition, causes, and treatments relevant to this diverse population group, where communication is key.

Understanding Mental Health: conditions, caring, and contexts - Dr Fionnuala Williams

Chief Inspector Michael Brown: ‘Police, policing, and mental health in the UK’.

Police services all over the world are essential as a de facto mental health service, especially around crisis care. All have struggled with untoward incidents involving the use of force, or deaths following police contact, which have framed – perhaps distorted - discussion. Reviews of these incidents have concluded that police officers are usually working in a context where the professional options available to them are not always adequate and that support after police decision-making is not always available. Reviews have also emphasized the need to improve police training and awareness of mental health, without necessarily specifying what that means and without taking account of contributory problems in healthcare provision by other agencies. Better police training and awareness of the mental health issues they face professionally is essential, but not sufficient. Many of the people the police encounter, where mental health is a factor in the incident, are known to have a history of mental health problems and have often been service users previously. The challenge is twofold – to reduce reliance upon the police service (and criminal justice system, including the prison service) to the extent we can; and to improve the quality of the police response where it is necessary for officers to become involved.

Understanding Mental Health: conditions, caring, and contexts - Michael Brown

In this podcast Professor Chris Williams, a researcher and teacher in the area of cognitive behavioural therapy (CBT) introduces CBT as a self-help form of therapy. It gives people the tools help themselves. Although correctly described as a form of psychotherapy, another way of conceptualising CBT is as a form of adult learning. That perspective can help make sense of recent advances in CBT where key CBT principles are communicated via CBT books, classes or websites. The key elements are a CBT structure that then builds on the therapeutic relationship and helps people both understand why they feel as they do, and also learn new skills to make changes. CBT provides a structure of how to make these changes in a planned and evidence-based way. However it also requires and effective and supportive therapeutic relationship to encourage people to keep on track as they plan changes in their lives. It is on this balance of structure and relationship that CBT aims to help achieve change.

Understanding Mental Health: conditions, caring, and contexts - Chris Williams

Professor Rory O’Connor, Suicidal Behaviour Research Laboratory, University of Glasgow

Suicide and self-harm are major public health concerns with complex aetiologies which encompass a multifaceted array of risk and protective factors.  There is growing recognition that we need to move beyond psychiatric categories to further our understanding of the pathways to both. As an individual makes a decision to take their own life, an appreciation of the psychology of the suicidal mind is central to suicide prevention.  Another key challenge is that our understanding of the factors that determine behavioural enaction (i.e., which individuals with suicidal thoughts will act on these thoughts) is limited.  Although a comprehensive understanding of these determinants of suicidality requires an appreciation of biological, psychological and social perspectives, the focus in this podcast is primarily on the psychosocial determinants of self-harm and suicide. To this end, The Integrated Motivational–Volitional (IMV) Model of Suicidal Behaviour (O’Connor & Kirtley, 2018; O’Connor, 2011) is discussed; it provides a framework in which to understand suicide and self-harm.  This tripartite model maps the relationship between background factors and trigger events, and the development of suicidal ideation/intent through to suicidal behaviour.  

In this podcast, we talk about a range of different topics including: 

•	The epidemiological context. Suicide rates.
•	The myths around suicide and self-harm
•	The determinants of suicide and self-harm
•	The IMV model of suicidal behaviour
•	The implications for the prevention of suicide 

References

O'Connor, R.C., Kirtley, O.J. (2018). The Integrated Motivational-Volitional Model of Suicidal Behaviour. Philosophical Transactions of the Royal Society B. 373: 20170268.

Steve Platt's work on inequalities and suicidal behaviour https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118903223.ch15

www.suicideresearch.info

Understanding Mental Health: conditions, caring, and contexts - Professor Rory O'Connor

This is a 50 minute audio file of a talk I delivered at the National Records of Scotland on 7 August 2019, in connection with my hugely successful exhibition that they kindly hosted: ‘Prisoners or Patients? Criminal Insanity in Victorian Scotland’. It explains the records I used and the development of the criminal justice system’s attempts to deal with those who had committed serious offences, but were found to be insane and thus not responsible for their actions. The justice system faced the same problems as today and dealt with ‘prisoner-patients’ or ‘state lunatics’ (as they were known) in a remarkably humane fashion, given the constraints of limited resources, basic medicine, and different social attitudes 150 years ago. The talk explains in depth who the offenders were and what they had done, the processes for admission to, and release from the only such specialist facility in Scotland prior to the opening of The State Hospital at Carstairs in 1948, medical and scientific understandings of insanity, and the social context of Victorian Scotland.

Prisoners or Patients? Criminal Insanity in Victorian Scotland

Prof John Crichton - Consultant Forensic Psychiatrist and 
Chair of the Royal College of Psychiatrists in Scotland.

What is a forensic psychiatrist?  Far from the media stereotypes forensic psychiatrists are not so different to other doctors but working at the most extremes of human experience.  Any one of us may have a mental health problem.  Very rarely that problem may result in an inability to control ones actions and may lead to direful consequences.  Forensic psychiatry is all about helping people recover their lives after such life changing events and by placing the care and treatment of patient at the centre ensuring everyone’s safety.

Professor Rab Houston

Understanding Mental Health: conditions, caring, and contexts - Professor John Crichton

Rab Houston was born in Hamilton, Scotland, lived in India and Ghana and was educated at the Edinburgh Academy and St Andrews University before spending six years at Cambridge University as a research student (Peterhouse) and research fellow (Clare College). He has worked at the University of St Andrews since 1983 and is Professor of Modern History, specialising in British social history. He is a fellow of both the Royal Historical Society and the Royal Society of Edinburgh (Scotland’s national academy), and a member of the Academia Europaea. He is married to a senior university manager and lives in Edinburgh. In his spare time he likes any form of active meditation.
http://www.st-andrews.ac.uk/history/staff/rabhouston.html
https://arts.st-andrews.ac.uk/psychhist/

3. Depression - Hannah Allen

History of Psychiatry Podcast Series

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