Mental illness must not become a political football – The Guardian

The HR manager across the desk looked at me as if I were a bomb about to go off.

I suspect it was the first time she’d had to deal with a real-life “mentally ill” employee.

She was there to assist my transition back to work after a near five-month absence, battling a crippling episode of anxiety and depression.

I’d recovered and was eager to return, but the paperwork left me cold.

One form asked which duties I could carry out – stating this was to secure not only my safety but the safety of my colleagues. The implication was I posed a risk to those around me.

That was six years ago.

I had hoped we’d moved past outdated notions that people experiencing mental illness are inherently bad, erratic or dangerous.

But the tawdry events of the last month in federal parliament have not only reinforced stigmatizing stereotypes, but they’ve also seen them politicized.

This week, Liberal MP Andrew Laming was granted paid mental health leave to seek counselling and empathy training after media reports revealed complaints that he had harassed two women online – one who said it pushed her to the brink of suicide. Laming denied any impropriety in taking a photo of another woman’s bottom as she bent over with her underwear visible above her shorts, claiming it was a “completely dignified” picture of a woman in her workplace as she was stacking a fridge.

But while the Queensland backbencher has announced he won’t contest the next election, the prime minister, Scott Morrison, has refused to call for Laming’s resignation, saying he will remain in parliament and that he “needs to seek help to change his behaviour”. A statement from the Liberal National Party on Sunday said Laming would receive “clinical counselling for as long as is required.”

The language here is important.

For decades, seeking help is something that people who are struggling have been urged to do.

It’s been part of a concerted push by the mental health sector to save lives by removing the culture of shame, discrimination and stigma historically associated with mental illness.

Framing Laming’s actions through the lens of “needing help” invite us to view him as unwell, and deserving of sympathy, not condemnation.

I’m not here to judge his emotional state. I make no assumptions about whether he does or does not experience mental health issues.

And I acknowledge that counselling and empathy training have a place in men’s behavioural change.

But what impact does conflating possibly illegal or improper behaviour with mental illness have on efforts to change community attitudes to those who live with mental health conditions?

It would be profoundly troubling if the public’s take-home message from these events is to draw a direct line between mental illness and antisocial behaviour.

One in five Australians will experience a mental health condition in any given year.

As one of them, I can confidently say that my anxiety or depression has never caused me to act in a manner so nakedly offensive that it would require me to issue a public apology and face calls to quit my job in disgrace.

By attributing this kind of behaviour to mental health issues we legitimise stigma by perpetuating the myth that people living with such conditions are a risk to society and have no control over their actions.

And it ignores a stark reality – that people experiencing mental illness are far more likely to be victims of crime than perpetrators.

It’s not the only misconception about mental ill-health that’s been peddled during the broader and highly triggering a public debate about sexual assault and the treatment of women.

A low point was the publication of personal diary excerpts from a woman who alleged she was raped as a 16-year-old in 1988 by Australia’s former attorney general Christian Porter when he was 17 – a claim he stridently denies. The woman is reported to have taken her own life last year.

The journal entries were accompanied by a write-off from journalists – one of whom was open about the fact he is a close personal friend of Porter’s – suggesting that some had speculated the complainant’s experience of bipolar disorder meant she may have imagined being raped.

It then invited readers to “judge for themselves” the veracity of her account.

The article prompted national mental health charity Sane Australia to issue a statement calling the publication in The Australian “stigmatising, harmful and offensive.”

They said it reminded people who have experienced mental health issues, trauma or distress of having their experiences invalidated because of their mental illness.

“… their [journalists’] suggestion that the general public should judge her on the basis of her experience of mental ill-health fails every single ethical test,” Sane CEO Rachel Green said.

This weaponizing of mental illness has made a traumatising period more distressing for many people who grapple with mental ill-health.

Lifeline experienced the highest call volume in its history in the days after the story broke of Brittany Higgins alleged rape at Parliament House.

It made me reflect on the contents of my own journals, which I’ve kept since 2014 as part of my therapy.

These private diaries are a safe space to dump my fears and stop me from falling into the dark rabbit holes my mind sometimes takes me down. But if they were to be read by others I’m sure I could be perceived as “unstable”. Does that make my lived experience less credible? Does it make me a risk to society?

This is the danger of using mental illness as a political football.

It sends a clear message to people who are struggling that they are fundamentally damaged.

It’s a message that can cost lives.

Jill Stark is an author and mental health advocate

 

In Australia, the crisis support service Lifeline is 13 11 14. If you or someone you know is impacted by sexual assault, family or domestic violence, call 1800RESPECT on 1800 737 732 or visit www.1800RESPECT.org.au. In an emergency, call 000. International helplines can be found via www.befrienders.org.

 

Continue Reading Mental illness must not become a political football – The Guardian

Can drinking cocoa protect your heart when you’re stressed?

Increased consumption of flavanols — a group of molecules occurring naturally in fruit and vegetables — could protect people from mental stress-induced cardiovascular events such as stroke, heart disease and thrombosis, according to new research.

Researchers have discovered that blood vessels were able to function better during mental stress when people were given a cocoa drink containing high levels of flavanols than when drinking a non-flavanol enriched drink.

A thin membrane of cells lining the heart and blood vessels, when functioning efficiently the endothelium helps to reduce the risk of peripheral vascular disease, stroke, heart disease, diabetes, kidney failure, tumour growth, thrombosis, and severe viral infectious diseases. We know that mental stress can have a negative effect on blood vessel function.

A UK research team from the University of Birmingham examined the effects of cocoa flavanols on stress-induced changes on vascular function — publishing their findings in Nutrients.

Lead author, Dr. Catarina Rendeiro, of the University of Birmingham’s School of Sport, Exercise and Rehabilitation Sciences, explains: “We found that drinking flavanol-rich cocoa can be an effective dietary strategy to reduce temporary impairments in endothelial function following mental stress and also improve blood flow during stressful episodes.”

“Flavanols are extremely common in a wide range of fruit and vegetables. By utilizing the known cardiovascular benefits of these compounds during periods of acute vascular vulnerability (such as stress) we can offer improved guidance to people about how to make the most of their dietary choices during stressful periods.”

In a randomized study, conducted by postgraduate student Rosalind Baynham, a group of healthy men drank a high-flavanol cocoa beverage 90 minutes before completing an eight-minute mental stress task.

The researchers measured forearm blood flow and cardiovascular activity at rest and during stress and assessed functioning of the blood vessels up to 90 min post-stress — discovering that blood vessel function was less impaired when the participants drank high-flavanol cocoa. The researchers also discovered that flavanols improve blood flow during stress.

Stress is highly prevalent in today’s society and has been linked with both psychological and physical health. Mental stress induces immediate increases in heart rate and blood pressure (BP) in healthy adults and also results in temporary impairments in the function of arteries even after the episode of stress has ceased.

Single episodes of stress have been shown to increase the risk of acute cardiovascular events and the impact of stress on the blood vessels has been suggested to contribute to these stress-induced cardiovascular events. Indeed, previous research by Dr Jet Veldhuijzen van Zanten, co-investigator on this study, has shown that people at risk for cardiovascular disease show poorer vascular responses to acute stress.

“Our findings are significant for everyday diet, given that the daily dosage administered could be achieved by consuming a variety of foods rich in flavanols — particularly apples, black grapes, blackberries, cherries, raspberries, pears, pulses, green tea, and unprocessed cocoa. This has important implications for measures to protect the blood vessels of those individuals who are more vulnerable to the effects of mental stress,” commented Dr. Rendeiro.

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Materials provided by University of Birmingham. Note: Content may be edited for style and length.

Continue Reading Can drinking cocoa protect your heart when you’re stressed?

Borderline personality disorder and intimate partner violence

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This paper looks at the relationship between borderline personality disorder (BPD) and intimate partner violence (IPV) (Munro and Sellbom, 2020). It compares the DSM-V traditional categorical personality disorder (PD) model, with the DSM-5 Alternative Model of PD (AMPD). (I know – an ELFel lot of acronyms!).

The traditional DSM-V personality disorder model is categorical in its approach – a yes/no approach to diagnosis. An alternative model was added because there were a few challenges with the original model. The alternative model understands BPD as a mix of dimensional (existing on a spectrum) and categorical (separate and distinct) constructs, on the bases of two criterion. Criterion A is impairment in personality functioning, and criterion B being dimensional personality traits.

Intimate partner violence (IPV) refers to any act of abuse (physical, emotional, sexual, financial) towards another within an intimate relationship. The office of national statistics reported that in England and Wales in the year ending March 2020, an estimated 5.5% of adults aged 16 to 74 years (that is 2.3 million people) experienced domestic abuse in the last year (Office for National Statistics, 2020). IPV is associated globally with poorer physical and mental health outcomes (Potter et al., 2020), including suicide (Rahmani et al., 2019) and Post Traumatic Stress Disorder (Dekel et al., 2020), and so should be an area of global health priority.

Borderline Personality Disorder (BPD) is the most commonly recognised personality disorder and people with a BPD diagnosis can experience difficulties in their emotion regulation, patterns of thinking and impulse control (NHS England, 2019). These difficulties are also observed in individuals who perpetrate intimate partner violence, and research has explored the relationship between BPD and IPV for decades (Jackson et al., 2015). However, it is important to note that these vary, and each individual who has a BPD diagnosis will have their own unique experiences.

The aims of the study were to elaborate on BPD and IPV perpetration by including the alternative model of personality disorder (AMPD) dimensional perspective. Authors aimed to examine the relationship between IPV perpetration and BPD using the DSM-5 AMDP dimensional operationalisation of BPD (criteria A & B) and directly compare those findings to traditional BPD – (comparing the new with the old). The authors wanted to find out whether BPD is differently associated with physically sexual and psychological forms of IPV and to see whether the association between BPD and IPV perpetration varied by gender. Individual APMD traits were also of interest, and the authors wanted to investigate their importance in relation to IPV perpetration.

There are two approaches to conceptualising borderline personality disorder – traditional and alternative. This paper explores these and their relationship with intimate partner violence.

There are two approaches to conceptualising borderline personality disorder – traditional and alternative. This paper explores these and their relationship with intimate partner violence.

Methods

250 participants were recruited from ‘Prolific Academic’, a well-established online crowdsourcing platform for academic research.

Inclusion criteria:

  • 18 years or older
  • English speaking
  • In a relationship of at least 4 months

Participants completed the online survey, self-reporting on the following measures:

  • The Revised Conflict Tactics Scale (CTS-2). This uses 5 scales to assess the use of violence and negotiation tactics in intimate relationships. The 5 scales are: Negotiation, Psychological Aggression, Physical Assault, Sexual Coercion, and Injury
  • The Personality Inventory for DSM-5 Short Form (PID-5-SF), which uses four items to assess each of the 25 DSM-5 AMPD Criterion B personality trait facets
  • Level of Personality Functioning Scale (LPFS-BF), which measures the levels of personality functioning scale of the DSM-5 AMPD model
  • The McLean Screening Instrument for Borderline Personality Disorder, which assesses traditional BPD symptomology according to the DSM-IV/DSM-5 diagnostic criteria
  • Structured clinical interview for DSM-IV Axis II Disorders Questionnaire, which assessed PD according to the DSM-IV/DSM-5 Section II diagnostic criteria.

The authors carried out correlational analyses and multiple regression analyses.

Results

The final sample included 239 participants, 116 of which were female and 119 male. The mean age was 30.25 years and ranged from 18-90. The results are summarised below.

Traditional vs alternative model of personality disorder, borderline personality disorder and intimate partner violence perpetration

  • Traditional and AMPD BPD scores were significantly correlated with all measures of IPV
  • Both traditional and AMPD scores were significantly correlated with almost all measures of psychological and physical injury and sexual IPV
  • Physical IPV was most strongly associated with BPD, with correlation magnitudes of 0.27 to 0.35
  • There was no difference between traditional and AMPD BPD in relation to IPV types. The only exception was psychological IPV, which had a significantly stronger correlation with traditional BPD compared with AMPD
  • Gender affected the BPD-IPV association. Male BPD scores were significantly correlated with considerably more IPV variables than female scores, with just under half showing medium effect sizes.

Alternative model of personality disorder, borderline personality disorder dimensions and IPV perpetration

  • Impairment in personality functioning was associated with nearly all CTS-2 IPV perpetration variables (CTS-2 measures violence and negotiation tactics in intimate relationships)
  • There were a number of significant gender differences in the AMPF personality traits associated with IPV perpetration, with a larger correlation magnitude for men
  • AMPD personality trait facet hostility was significantly associated with greater odds of having inflicted all types of IPV within the last year, with the exception of sexual IPV.

Traditional and alternative models of borderline personality disorder appear to be pretty much equal in relation to intimate partner violence.

Traditional and alternative models of borderline personality disorder appear to be pretty much equal in relation to intimate partner violence.

Conclusions

This study aimed to expand on BPD and IPV perpetration research and compare the existing BPD model, with the AMPD.

  • Overall, the study found that traditional BPD and the AMPD were approximately equal in relation to IPV perpetration
  • The study also found that BPD is individually associated with psychological, physical and sexual forms of IPV, and that there were gender differences in the BPD-IPV association
  • In terms of the AMPD trait facets, hostility was the most influential AMPD trait in relation to psychological and physical IPV
  • Risk taking and suspiciousness were the most important predictors of IPV.

There is little difference between the traditional BPD model and the alternative BPD model in terms of interpersonal violence perpetration

There is little difference between the traditional BPD model and the alternative BPD model in terms of interpersonal violence perpetration

Strengths and limitations

This paper addresses an important issue. As discussed before, IPV affects a large amount of people, and that is just the figures we know about. This paper raises important issues around IPV and conceptualisation of BPD and provides novel information to the field of BPD research. Another strength of the research is within its methodology. Validity questions were used throughout the study questionnaire, and the measures that were used had good reliability and validity across the board.

This survey captures responses from across the globe. This serves as a strength and a weakness. The results state that of the participants, 23.8% reside in a variety of ‘non English speaking countries’ and 17.5% reside in ‘other non-speaking English countries’ (other than Canada, United Kingdom and the United States). These countries are not specified, and should be to have an understanding of differences across the globe. Whilst the inclusivity across the globe and a broad representation is a strength, the limitations lie within variance of the cultural understanding and acceptance of intimate partner violence in different parts of the world. Culture is an extremely important factor to take into consideration when looking at not only intimate partner violence, but also how BPD and mental health difficulties in general are conceptualised and understood.

This study did not explore interpersonal violence within the context of same gendered or same sex relationships. A recent review of the literature found that despite IPV being a prevalent issue in same sex or same gendered relationships, there is a distinct lack of studies that explore this violence (Rollè et al., 2018).

Furthermore, in this study, only three participants identified as transgender. Given that male BPD scores were correlated with more IPV variables than female scores, gender is clearly an important factor in understanding IPV. Therefore, it is important we understand the role of IPV in relationships where there are people who identify as transgender. The author’s acknowledge that the small sample size is likely to have led to attenuated statistical power for the gender comparison analysis. A recent systematic review and meta-analysis found that Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth (Peitzmeier et al., 2020). People who identify as lesbian, gay, bisexual, transgender and intersex (LBGTI +) have significantly worse mental health outcomes than their heterosexual counterparts and so this is an important area of research that should be explored (Klotzbaugh & Glover, 2016). The authors provide some relationship demographics, however there was also no data on the types of relationships, for example monogamous; polyamorous, open etc.

Support for the new…and the old (models of borderline personality disorder)

Does this research support the new…and the old models of borderline personality disorder?

Implications for practice

This research demonstrates a clear association between IPV perpetration and AMPD, comparable with the traditional BPD. This study provides support for the construct validity of the DSM-V AMPD dimensional model conceptualisation of BPD. This study supports that the AMPD operationalisation of BPD does capture the relevant IPV criterion variables. Therefore, this study supports the transition from a categorical conceptualisation, to the integration of a dimensional conceptualisation of BPD in clinical practice. This builds on existing evidence that both traditional and AMPD operationalisations of BPD are built on the same constructs, and therefore the transition will have minimal disruption to clinicians and their practice.

This is the first study of its kind to examine the relative associations of traditional and AMPD dimensional conceptualisations of BPD, with external criterion variables. The findings of this study indicate that there are specific BPD traits that influence IPV perpetration. This has implications for clinical practice and research in terms of BPD traits and symptoms, with regards to their inclusion on IPV risk assessment tools. At present, most current IPV risk assessment tools assess for a general history of mental health concerns, however BPD symptomology is not specifically considered.

The findings of this study indicate that there are specific BPD traits that influence IPV perpetration. This has implications for clinical practice and research in terms of BPD traits and symptoms, with regards to their inclusion on IPV risk assessment tools.

The findings of this study indicate that there are specific BPD traits that influence IPV perpetration. This has implications for clinical practice and research in terms of BPD traits and symptoms, with regards to their inclusion on IPV risk assessment tools.

Statement of interests

None.

Links

Primary paper

Munro, O. E., & Sellbom, M. (2020). Elucidating the relationship between borderline personality disorder and intimate partner violencePersonality and mental health.

Other references

Dekel, R., Shaked, O., Ben-Porat, A., & Itzhaky, H. (2020). The interrelations of physical and mental health: self-rated health, depression, and PTSD among female IPV survivors. Violence against women, 26(3-4), 379-394.

Jackson, M. A., Sippel, L. M., Mota, N., Whalen, D., & Schumacher, J. A. (2015). Borderline personality disorder and related constructs as risk factors for intimate partner violence perpetration. Aggression and violent behavior, 24, 95-106.

Klotzbaugh, R., & Glover, E. (2016). A lesbian, gay, bisexual and transgender dedicated inpatient psychiatric unit in rural New England: a descriptive analysis in demographics, service utilisation and needs. Journal of clinical nursing, 25(23-24), 3570-3576.

NHS England. Overview. Borderline Personality Disorder. Available from Borderline personality disorder – NHS (www.nhs.uk). Last accessed 20th Dec 2020.

Office for National Statstics (2020). Domestic abuse in England and Wales overview: November 2020. Available at: .

Okada, M., & Oltmanns, T. F. (2009). Comparison of three self-report measures of personality pathology. Journal of Psychopathology and Behavioral Assessment, 31(4), 358-367.

Peitzmeier, S. M., Malik, M., Kattari, S. K., Marrow, E., Stephenson, R., Agénor, M., & Reisner, S. L. (2020). Intimate partner violence in transgender populations: systematic review and meta-analysis of prevalence and correlates. American journal of public health, 110(9), e1-e14.

Potter, L. C., Morris, R., Hegarty, K., García-Moreno, C., & Feder, G. (2020). Categories and health impacts of intimate partner violence in the World Health Organization multi-country study on women’s health and domestic violence. International Journal of Epidemiology.

Rahmani, F., Salmasi, S., Rahmani, F., Bird, J., Asghari, E., Robai, N., … & Gholizadeh, L. (2019). Domestic violence and suicide attempts among married women: A case–control study. Journal of clinical nursing, 28(17-18), 3252-3261.

Rollè, L., Giardina, G., Caldarera, A. M., Gerino, E., & Brustia, P. (2018). When intimate partner violence meets same sex couples: A review of same sex intimate partner violence. Frontiers in psychology, 9, 1506.

Photo credits

At present I am a Senior Research Assistant in the academic department at Midlands Partnership Foundation Trust. I am also the Patient and Public Involvement and Engagement lead for research. I graduated with a BSc in Psychology Counselling and Therapies from the University of Bedfordshire in 2016 and went on to complete an MSc Psychology in Clinical Practice at Nottingham Trent University in 2017. I have since worked in forensic services as a psychosocial substance misuse practitioner and an assistant psychologist. I am hoping to complete the Doctorate of Clinical Psychology in the future.
Continue Reading Borderline personality disorder and intimate partner violence

Living Right: The Genes of Mental Illness – 9 & 10 News – 9&10 News

Hearing voices, paranoia, irrational and angry thoughts, these are just some of the symptoms people with schizophrenia deal with.

More than 2.6 million Americans are living with it right now.

There is no cure. Treatment involves medication and therapy, but more than 40% of people living with it do not seek help.

There are many questions as to what causes it.

One woman’s family is speaking out about their lifelong journey through mental illness and how they’re helping researchers get to the root of the problem.

We have their story in Living Right.March 30 5pm Lr Genes Of Mental Illnessmp400 00 00 12still001

Continue Reading Living Right: The Genes of Mental Illness – 9 & 10 News – 9&10 News

We can do so much more to help people with mental illness – The Globe and Mail

Bill Wilkerson is executive chairman of Mental Health International. Stanley Kutcher is a child psychiatrist and a member of the Senate of Canada.

With the recent passage of Bill C-7, Canadians eligible for medical assistance in dying (MAID) will include, in two years’ time, those whose end-of-life journeys are characterized by intolerable suffering solely because of an irremediable mental disorder – not just those afflicted by other forms of pain.

The next two years will allow time for medical and nursing educators to update and accredit their MAID training in light of this development, and for governments and regulators to consider protocols and additional safeguards.

Plans to amend the criminal code to recognize the constitutional rights of those who live with mental disorders have cast a stark light on the inequities they experience in this country.

Inarguably, as it is a matter of Charter-protected rights and freedoms, MAID should be available equally to all those who qualify to receive it – but for those who live with mental disorders, access to effective care and preventive interventions should also be provided equitably.

This cannot be ignored any longer. The federal government could take a number of steps to address this inequality.

First, it must substantially improve rapid access to the best evidence-based and culturally appropriate mental health care for populations under its policy authority and jurisdiction: Indigenous peoples, the military, the RCMP and federally incarcerated persons. This has to include improving the social determinants of health/mental health for Indigenous people.

The federal government could also consider legislation such as amendments to the Canada Health Act or the introduction of a mental health parity act to encourage improvements in care. Alternatively, conditional funding for these improvements – as part of federal transfer payments – may be an appropriate “carrot” to help encourage provinces and territories to act.

Supporting evidence-based self care and mental health literacy would help improve Canadians’ understanding of how to identify mental disorders and what to do in response to early signs and symptoms. The federal government could continue to improve its own workplace mental health strategy and lead by example.

Of immediate value will be breaking down the mythology that mental health and physical health are distinct and unrelated entities. What is good for one’s bicep is also good for one’s brain.

Another key priority is creating a national database to provide robust, valid and useful information on the mental health status of the population; prevalence and distribution of mental disorders; and access to and use of services. This would help inform policy development and mental health care interventions at both national and local levels.

Mental disorders make up a large proportion of the global burden of disease and years lived with a disability. Yet Canada’s funding for research into effective therapeutics and prevention strategies is unaligned with this reality. Targeted funding enhancements through existing bodies such as the Canadian Institutes of Health Research is needed urgently.

While promising technologies are emerging to help improve outcomes for people who experience existential distress and some types of mental disorders, our knowledge about what works best and for whom is in its infancy. Developing a regulatory framework to ensure that marketed products and services are actually effective and safe is a needed safeguard in the dynamic new world of digital technology.

Finally, when we look at the needs of struggling Canadians, we know what needs to be done to provide enhanced, rapid access to mental health care, but we are not doing it. For this reason, an ombudsperson for mental health care or even a separate federal ministerial portfolio focused on mental health and substance abuse is worth serious consideration.

Whatever steps the federal government chooses to take for better access to improved mental health care, the time to take those steps is now.

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Continue Reading We can do so much more to help people with mental illness – The Globe and Mail