Tag Archives: illness

We need to rethink how we classify mental illness | Tamara Kayali Browne

How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological?

This is essentially what a select group of psychiatrists decide each time they revise the Diagnostic and Statistical Manual of Mental Disorders (DSM), a bible for mental health professionals worldwide.

Questions like these are unavoidable and cannot be answered by science alone. This point was famously demonstrated when homosexuality was declassified as a mental illness in the DSM in 1973 by a simple vote.

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders. It’s now used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers, to name a few.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change. Over the years many of these amendments have courted controversy.

These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness.

Currently, three temper tantrums a week, negativity, irritability and anger would qualify a child to be labelled with disruptive mood dysregulation disorder. The label assumes first that the child is suffering from a problem, and second that the problem is pathological. Yet one may also question why it is the child who must be labelled and not the parents. For example, why do we not have a diagnosis called inability to discipline one’s child disorder?

What the “problem” is and who is judged to be the party “suffering” from it are value judgments which carry with them the cultural biases and assumptions of the individuals making those judgments. If we don’t examine value judgments properly, we risk making judgments that are discriminatory or harmful.

For example, although hysteria has now disappeared from official psychiatric diagnosis, there are elements of it present within other psychiatric diagnoses, most notably premenstrual dysphoric disorder (PMDD).

Commonly described as a more severe form of premenstrual stress (PMS), PMDD has been accused of labelling as a mental disorder normal and understandable reactions to the sort of stressful circumstances that disproportionately affect women in a modern society that still has not achieved gender equality.

In this way, psychiatric diagnosis could act as a way of brushing aside indicators of social injustices.

Likewise, sadness and changes in sleep, eating and so on can be normal and understandable reactions to loss (e.g. in the case of bereavement), not necessarily indicators of mental illness. In fact, behaviours like these can act as a positive sign that something is wrong, functioning as a catalyst for changing one’s situation for the better.

But the DSM only focuses on these “symptoms” and does not take into account the individual’s context. This in itself is a value judgment.

This is why our process of classifying mental illnesses should involve experts for whom examining value judgments is their bread and butter – philosophers. Bioethicists and philosophers of psychiatry are trained in bringing value judgments to light and analysing them in depth.

The way we classify mental illnesses also has broad implications for those diagnosed and for society – something that sociologists would be well placed to consider.

We could make good use of these experts by requiring each revision of the DSM to pass through an ethics assessment by an independent panel made up of philosophers, sociologists and ethicists.

Philosophers could identify and deliberate the value issues, sociologists could present the possible social consequences of proposed changes, and ethicists could make the complex harm/benefit analyses and ethical trade-offs that will inevitably be involved.

The panel also needs to have “teeth”, so it should have the power to veto or modify a category.

This might sound like a provocative proposal, but it is similar to the procedure we already have for scientific studies. Just as these studies must gain ethics approval before they go ahead in order to mitigate harm to participants and the community, having an ethics review panel would be an extra step of “checks and balances” for the DSM.

While those involved in making the DSM come from a variety of backgrounds – primarily psychiatrists, psychologists, social workers and clinicians – none have been primarily ethicists or philosophers.

And while some psychiatrists might have the training and experience that enables them to examine value judgments, it would be unreasonable to expect that to be the case, just as it would be unreasonable to expect ethicists and philosophers to be able to evaluate scientific judgments.

The solution I propose is based on the idea that psychiatric diagnosis should serve an ethical purpose – relieving certain forms of suffering and disease.

In light of this ethical purpose, we must do our utmost to consider value judgments that can cloud our view of “illness” and how it should be treated. I believe establishing an ethics review panel for the DSM can go a significant way towards achieving that goal.

We need to rethink how we classify mental illness | Tamara Kayali Browne

How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological?

This is essentially what a select group of psychiatrists decide each time they revise the Diagnostic and Statistical Manual of Mental Disorders (DSM), a bible for mental health professionals worldwide.

Questions like these are unavoidable and cannot be answered by science alone. This point was famously demonstrated when homosexuality was declassified as a mental illness in the DSM in 1973 by a simple vote.

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders. It’s now used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers, to name a few.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change. Over the years many of these amendments have courted controversy.

These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness.

Currently, three temper tantrums a week, negativity, irritability and anger would qualify a child to be labelled with disruptive mood dysregulation disorder. The label assumes first that the child is suffering from a problem, and second that the problem is pathological. Yet one may also question why it is the child who must be labelled and not the parents. For example, why do we not have a diagnosis called inability to discipline one’s child disorder?

What the “problem” is and who is judged to be the party “suffering” from it are value judgments which carry with them the cultural biases and assumptions of the individuals making those judgments. If we don’t examine value judgments properly, we risk making judgments that are discriminatory or harmful.

For example, although hysteria has now disappeared from official psychiatric diagnosis, there are elements of it present within other psychiatric diagnoses, most notably premenstrual dysphoric disorder (PMDD).

Commonly described as a more severe form of premenstrual stress (PMS), PMDD has been accused of labelling as a mental disorder normal and understandable reactions to the sort of stressful circumstances that disproportionately affect women in a modern society that still has not achieved gender equality.

In this way, psychiatric diagnosis could act as a way of brushing aside indicators of social injustices.

Likewise, sadness and changes in sleep, eating and so on can be normal and understandable reactions to loss (e.g. in the case of bereavement), not necessarily indicators of mental illness. In fact, behaviours like these can act as a positive sign that something is wrong, functioning as a catalyst for changing one’s situation for the better.

But the DSM only focuses on these “symptoms” and does not take into account the individual’s context. This in itself is a value judgment.

This is why our process of classifying mental illnesses should involve experts for whom examining value judgments is their bread and butter – philosophers. Bioethicists and philosophers of psychiatry are trained in bringing value judgments to light and analysing them in depth.

The way we classify mental illnesses also has broad implications for those diagnosed and for society – something that sociologists would be well placed to consider.

We could make good use of these experts by requiring each revision of the DSM to pass through an ethics assessment by an independent panel made up of philosophers, sociologists and ethicists.

Philosophers could identify and deliberate the value issues, sociologists could present the possible social consequences of proposed changes, and ethicists could make the complex harm/benefit analyses and ethical trade-offs that will inevitably be involved.

The panel also needs to have “teeth”, so it should have the power to veto or modify a category.

This might sound like a provocative proposal, but it is similar to the procedure we already have for scientific studies. Just as these studies must gain ethics approval before they go ahead in order to mitigate harm to participants and the community, having an ethics review panel would be an extra step of “checks and balances” for the DSM.

While those involved in making the DSM come from a variety of backgrounds – primarily psychiatrists, psychologists, social workers and clinicians – none have been primarily ethicists or philosophers.

And while some psychiatrists might have the training and experience that enables them to examine value judgments, it would be unreasonable to expect that to be the case, just as it would be unreasonable to expect ethicists and philosophers to be able to evaluate scientific judgments.

The solution I propose is based on the idea that psychiatric diagnosis should serve an ethical purpose – relieving certain forms of suffering and disease.

In light of this ethical purpose, we must do our utmost to consider value judgments that can cloud our view of “illness” and how it should be treated. I believe establishing an ethics review panel for the DSM can go a significant way towards achieving that goal.

We need to rethink how we classify mental illness | Tamara Kayali Browne

How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological?

This is essentially what a select group of psychiatrists decide each time they revise the Diagnostic and Statistical Manual of Mental Disorders (DSM), a bible for mental health professionals worldwide.

Questions like these are unavoidable and cannot be answered by science alone. This point was famously demonstrated when homosexuality was declassified as a mental illness in the DSM in 1973 by a simple vote.

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders. It’s now used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers, to name a few.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change. Over the years many of these amendments have courted controversy.

These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness.

Currently, three temper tantrums a week, negativity, irritability and anger would qualify a child to be labelled with disruptive mood dysregulation disorder. The label assumes first that the child is suffering from a problem, and second that the problem is pathological. Yet one may also question why it is the child who must be labelled and not the parents. For example, why do we not have a diagnosis called inability to discipline one’s child disorder?

What the “problem” is and who is judged to be the party “suffering” from it are value judgments which carry with them the cultural biases and assumptions of the individuals making those judgments. If we don’t examine value judgments properly, we risk making judgments that are discriminatory or harmful.

For example, although hysteria has now disappeared from official psychiatric diagnosis, there are elements of it present within other psychiatric diagnoses, most notably premenstrual dysphoric disorder (PMDD).

Commonly described as a more severe form of premenstrual stress (PMS), PMDD has been accused of labelling as a mental disorder normal and understandable reactions to the sort of stressful circumstances that disproportionately affect women in a modern society that still has not achieved gender equality.

In this way, psychiatric diagnosis could act as a way of brushing aside indicators of social injustices.

Likewise, sadness and changes in sleep, eating and so on can be normal and understandable reactions to loss (e.g. in the case of bereavement), not necessarily indicators of mental illness. In fact, behaviours like these can act as a positive sign that something is wrong, functioning as a catalyst for changing one’s situation for the better.

But the DSM only focuses on these “symptoms” and does not take into account the individual’s context. This in itself is a value judgment.

This is why our process of classifying mental illnesses should involve experts for whom examining value judgments is their bread and butter – philosophers. Bioethicists and philosophers of psychiatry are trained in bringing value judgments to light and analysing them in depth.

The way we classify mental illnesses also has broad implications for those diagnosed and for society – something that sociologists would be well placed to consider.

We could make good use of these experts by requiring each revision of the DSM to pass through an ethics assessment by an independent panel made up of philosophers, sociologists and ethicists.

Philosophers could identify and deliberate the value issues, sociologists could present the possible social consequences of proposed changes, and ethicists could make the complex harm/benefit analyses and ethical trade-offs that will inevitably be involved.

The panel also needs to have “teeth”, so it should have the power to veto or modify a category.

This might sound like a provocative proposal, but it is similar to the procedure we already have for scientific studies. Just as these studies must gain ethics approval before they go ahead in order to mitigate harm to participants and the community, having an ethics review panel would be an extra step of “checks and balances” for the DSM.

While those involved in making the DSM come from a variety of backgrounds – primarily psychiatrists, psychologists, social workers and clinicians – none have been primarily ethicists or philosophers.

And while some psychiatrists might have the training and experience that enables them to examine value judgments, it would be unreasonable to expect that to be the case, just as it would be unreasonable to expect ethicists and philosophers to be able to evaluate scientific judgments.

The solution I propose is based on the idea that psychiatric diagnosis should serve an ethical purpose – relieving certain forms of suffering and disease.

In light of this ethical purpose, we must do our utmost to consider value judgments that can cloud our view of “illness” and how it should be treated. I believe establishing an ethics review panel for the DSM can go a significant way towards achieving that goal.

We need to rethink how we classify mental illness | Tamara Kayali Browne

How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological?

This is essentially what a select group of psychiatrists decide each time they revise the Diagnostic and Statistical Manual of Mental Disorders (DSM), a bible for mental health professionals worldwide.

Questions like these are unavoidable and cannot be answered by science alone. This point was famously demonstrated when homosexuality was declassified as a mental illness in the DSM in 1973 by a simple vote.

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders. It’s now used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers, to name a few.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change. Over the years many of these amendments have courted controversy.

These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness.

Currently, three temper tantrums a week, negativity, irritability and anger would qualify a child to be labelled with disruptive mood dysregulation disorder. The label assumes first that the child is suffering from a problem, and second that the problem is pathological. Yet one may also question why it is the child who must be labelled and not the parents. For example, why do we not have a diagnosis called inability to discipline one’s child disorder?

What the “problem” is and who is judged to be the party “suffering” from it are value judgments which carry with them the cultural biases and assumptions of the individuals making those judgments. If we don’t examine value judgments properly, we risk making judgments that are discriminatory or harmful.

For example, although hysteria has now disappeared from official psychiatric diagnosis, there are elements of it present within other psychiatric diagnoses, most notably premenstrual dysphoric disorder (PMDD).

Commonly described as a more severe form of premenstrual stress (PMS), PMDD has been accused of labelling as a mental disorder normal and understandable reactions to the sort of stressful circumstances that disproportionately affect women in a modern society that still has not achieved gender equality.

In this way, psychiatric diagnosis could act as a way of brushing aside indicators of social injustices.

Likewise, sadness and changes in sleep, eating and so on can be normal and understandable reactions to loss (e.g. in the case of bereavement), not necessarily indicators of mental illness. In fact, behaviours like these can act as a positive sign that something is wrong, functioning as a catalyst for changing one’s situation for the better.

But the DSM only focuses on these “symptoms” and does not take into account the individual’s context. This in itself is a value judgment.

This is why our process of classifying mental illnesses should involve experts for whom examining value judgments is their bread and butter – philosophers. Bioethicists and philosophers of psychiatry are trained in bringing value judgments to light and analysing them in depth.

The way we classify mental illnesses also has broad implications for those diagnosed and for society – something that sociologists would be well placed to consider.

We could make good use of these experts by requiring each revision of the DSM to pass through an ethics assessment by an independent panel made up of philosophers, sociologists and ethicists.

Philosophers could identify and deliberate the value issues, sociologists could present the possible social consequences of proposed changes, and ethicists could make the complex harm/benefit analyses and ethical trade-offs that will inevitably be involved.

The panel also needs to have “teeth”, so it should have the power to veto or modify a category.

This might sound like a provocative proposal, but it is similar to the procedure we already have for scientific studies. Just as these studies must gain ethics approval before they go ahead in order to mitigate harm to participants and the community, having an ethics review panel would be an extra step of “checks and balances” for the DSM.

While those involved in making the DSM come from a variety of backgrounds – primarily psychiatrists, psychologists, social workers and clinicians – none have been primarily ethicists or philosophers.

And while some psychiatrists might have the training and experience that enables them to examine value judgments, it would be unreasonable to expect that to be the case, just as it would be unreasonable to expect ethicists and philosophers to be able to evaluate scientific judgments.

The solution I propose is based on the idea that psychiatric diagnosis should serve an ethical purpose – relieving certain forms of suffering and disease.

In light of this ethical purpose, we must do our utmost to consider value judgments that can cloud our view of “illness” and how it should be treated. I believe establishing an ethics review panel for the DSM can go a significant way towards achieving that goal.

Having a mental illness doesn’t mean you can’t work – I’m proof | Hannah Jane Parkinson

It’s official. The government-commissioned Thriving at Work report has found that many of us are not, in fact, thriving at work. About 300,000 of us with long-term mental health problems lose their job each year in the UK. For me, this is news alongside sky is blue; Liverpool FC are perpetually underachieving; David Davis understands the Brexit process as much as he does superstring theory.

We have been saying this for a long time. We the people who know. The people with mental illness; the mental health professionals; the experts and charity heads; and in some cases, the employers. It’s a positive step that Theresa May commissioned this report. It’s a travesty that it was such a long time coming.

The tactics shifted a while ago. Some of us stopped appealing to this government’s sense of altruism and began arguing that “it’s the economy, stupid.” Once again, it has been confirmed that the annual cost to the country of poor mental health is £99bn. This isn’t a revelation. I’ve been writing about it for four years, so have many others. The UK’s productivity is in the doldrums. The financial cost to employers is about £42bn.

Let me tell you about working with a severe, long-term mental illness (in my case, bipolar disorder). Bipolar disorder is a cyclical illness. Those cycles will vary, according to the illness’s subsets, from rapid cycling disorder to episodes that happen with years in between. For me, my condition is “managed” by medication and mental health services.

So it goes a bit like this: for a big chunk of each year I’ll probably spend time off. In the past couple of years that has meant stints in hospital, sometimes writing on zero sleep, or even having to tell an editor that I couldn’t file because of the small inconvenience of being sectioned. Then, the long walks to recuperate, the nurturing back to health. Then the return to work.


There’s a crisis safety net when individuals reach the nadir, and that’s it

But I’m one of the lucky ones. When I joined the Guardian, a care plan was set up. It was distributed to my line managers so they knew the score and could notice any signs of impending episodes. I have had the support of three assigned HR personnel and also my colleagues, both senior and peers, formally and informally. They took the time to learn about my illness and how they could best understand and support it. All of this is the kind of thing employers should be doing as standard, and is numbered among the 40 recommendations made in the Thriving at Work report.

Last week, on a panel, someone asked me: “Is it worth it for employers?” It’s a fair question – undoubtedly sometimes I’m a pain in the arse. But how many of us have colleagues with no mental health problems but who are also a pain in the arse: underperforming, lazy, bullying, inefficient. I don’t think I’m any of those things. In my experience people with mental health problems are incredibly hard workers – they grab hold of those periods of wellness, desperate to make the most of them. Despite an illness that is chronic, I have achieved much in my professional life. Other people won’t have such chronic illnesses but experience a period of mental ill health and make a full recovery.

But here is where I am not lucky: my recent experiences of NHS mental health care characterise, as the report put it, “a lack of speedy access to mental health services”. The trust I am under has had some incredible professionals who have cared for me, but in many ways I have been catastrophically let down. I will always remember having a conversation with occupational health at work, who were fully supportive but wanted to know what measures I had in place before I returned to work.

They were flabbergasted when I said I had no formal measures in place, and that it wasn’t for want of trying. It was because our NHS has been reduced to skin and bone. Therapy waiting lists, as in my case, can last two years. Named psychiatrists are becoming rarer, being passed around services more common. Consistent support is almost nonexistent. There’s a crisis safety net when individuals reach the nadir, and that’s it. It doesn’t take a genius to realise this is not conducive to individuals working well and staying healthy – something the report noted.

Other welcome recommendations included a shoring up of the Equality Act 2010, and I’d add to that employers becoming more creative and flexible in their recruitment. If someone has been unwell, they may well have gaps in their CV. This might not have any impact on how competent they are, or how good a potential employee. Look at the number of successful people who have been open about their mental illness, from politicians to actors to company chief executives.

Finally, we need to broaden the mental health “debate” to include illnesses other than the more commonly experienced mental health difficulties. We need to properly arm employers with the information about conditions other than the thankfully now more understood depression and generalised anxiety disorder. If I hadn’t sat down with HR and made that care plan, I doubt they would have been remotely prepared or in a position to support me. The report has recommended core standards to change this, so employers “know what to do”. Good.

Unfortunately, some people will be too unwell to work – that’s the case for both mental and physical illness. The government must provide the benefits and care packages that are required. It’s what any moral society should do. Nobody chooses to be ill, and nobody should be punished for it. But for those with mental health problems who are able to work, we must do more to recruit and retain them. That way everyone benefits.

Hannah Jane Parkinson writes for the Guardian on pop culture, music, tech, football, politics and mental health

Having a mental illness doesn’t mean you can’t work – I’m proof | Hannah Jane Parkinson

It’s official. The government-commissioned Thriving at Work report has found that many of us are not, in fact, thriving at work. About 300,000 of us with long-term mental health problems lose their job each year in the UK. For me, this is news alongside sky is blue; Liverpool FC are perpetually underachieving; David Davis understands the Brexit process as much as he does superstring theory.

We have been saying this for a long time. We the people who know. The people with mental illness; the mental health professionals; the experts and charity heads; and in some cases, the employers. It’s a positive step that Theresa May commissioned this report. It’s a travesty that it was such a long time coming.

The tactics shifted a while ago. Some of us stopped appealing to this government’s sense of altruism and began arguing that “it’s the economy, stupid.” Once again, it has been confirmed that the annual cost to the country of poor mental health is £99bn. This isn’t a revelation. I’ve been writing about it for four years, so have many others. The UK’s productivity is in the doldrums. The financial cost to employers is about £42bn.

Let me tell you about working with a severe, long-term mental illness (in my case, bipolar disorder). Bipolar disorder is a cyclical illness. Those cycles will vary, according to the illness’s subsets, from rapid cycling disorder to episodes that happen with years in between. For me, my condition is “managed” by medication and mental health services.

So it goes a bit like this: for a big chunk of each year I’ll probably spend time off. In the past couple of years that has meant stints in hospital, sometimes writing on zero sleep, or even having to tell an editor that I couldn’t file because of the small inconvenience of being sectioned. Then, the long walks to recuperate, the nurturing back to health. Then the return to work.


There’s a crisis safety net when individuals reach the nadir, and that’s it

But I’m one of the lucky ones. When I joined the Guardian, a care plan was set up. It was distributed to my line managers so they knew the score and could notice any signs of impending episodes. I have had the support of three assigned HR personnel and also my colleagues, both senior and peers, formally and informally. They took the time to learn about my illness and how they could best understand and support it. All of this is the kind of thing employers should be doing as standard, and is numbered among the 40 recommendations made in the Thriving at Work report.

Last week, on a panel, someone asked me: “Is it worth it for employers?” It’s a fair question – undoubtedly sometimes I’m a pain in the arse. But how many of us have colleagues with no mental health problems but who are also a pain in the arse: underperforming, lazy, bullying, inefficient. I don’t think I’m any of those things. In my experience people with mental health problems are incredibly hard workers – they grab hold of those periods of wellness, desperate to make the most of them. Despite an illness that is chronic, I have achieved much in my professional life. Other people won’t have such chronic illnesses but experience a period of mental ill health and make a full recovery.

But here is where I am not lucky: my recent experiences of NHS mental health care characterise, as the report put it, “a lack of speedy access to mental health services”. The trust I am under has had some incredible professionals who have cared for me, but in many ways I have been catastrophically let down. I will always remember having a conversation with occupational health at work, who were fully supportive but wanted to know what measures I had in place before I returned to work.

They were flabbergasted when I said I had no formal measures in place, and that it wasn’t for want of trying. It was because our NHS has been reduced to skin and bone. Therapy waiting lists, as in my case, can last two years. Named psychiatrists are becoming rarer, being passed around services more common. Consistent support is almost nonexistent. There’s a crisis safety net when individuals reach the nadir, and that’s it. It doesn’t take a genius to realise this is not conducive to individuals working well and staying healthy – something the report noted.

Other welcome recommendations included a shoring up of the Equality Act 2010, and I’d add to that employers becoming more creative and flexible in their recruitment. If someone has been unwell, they may well have gaps in their CV. This might not have any impact on how competent they are, or how good a potential employee. Look at the number of successful people who have been open about their mental illness, from politicians to actors to company chief executives.

Finally, we need to broaden the mental health “debate” to include illnesses other than the more commonly experienced mental health difficulties. We need to properly arm employers with the information about conditions other than the thankfully now more understood depression and generalised anxiety disorder. If I hadn’t sat down with HR and made that care plan, I doubt they would have been remotely prepared or in a position to support me. The report has recommended core standards to change this, so employers “know what to do”. Good.

Unfortunately, some people will be too unwell to work – that’s the case for both mental and physical illness. The government must provide the benefits and care packages that are required. It’s what any moral society should do. Nobody chooses to be ill, and nobody should be punished for it. But for those with mental health problems who are able to work, we must do more to recruit and retain them. That way everyone benefits.

Hannah Jane Parkinson writes for the Guardian on pop culture, music, tech, football, politics and mental health

Loneliness as bad for health as long-term illness, says GPs’ chief

Being lonely can be as bad for someone’s health as having a long-term illness such as diabetes or high blood pressure, the leader of Britain’s GPs will warn on Thursday.

Patients who visit their family doctor because they are suffering from loneliness and want some human contact are adding to the pressures the NHS is under, Dr Helen Stokes-Lampard will tell the Royal College of General Practitioners (RCGP).

But she will also urge GPs to make the time to see such patients, so that they have someone to talk to, despite being overworked because of the growing demands on their schedules.

The estimated 1.1 million Britons to be lonely are 50% more likely to die prematurely than people with a good social network, making loneliness as big a mortality risk as diabetes, the college says.

“Social isolation and loneliness are akin to a chronic long-term condition in terms of the impact they have on our patients’ health and wellbeing,” the college’s chair will tell its annual conference.

“GPs see patients, many of whom are widowed, who have multiple health problems like diabetes, hypertension and depression, but often their main problem isn’t medical, [it’s that] they’re lonely.”

Acting as a sympathetic listening ear is often more useful than giving someone a prescription for drugs or offering lifestyle advice, Stokes-Lampard will add. “The guidelines say we should be talking to them about their weight, exercise and prescribing more medication. But really what these patients need is someone to listen to them and to find purpose in life.

“Loneliness and social isolation are not the exclusive preserve of the elderly. They are not something that can be treated with pharmaceuticals or that can be referred for hospital treatment”.

Three out of four GPs say they see between one and five lonely people a day, according to research among over 1,000 family doctors undertaken in 2013 by the Campaign to End Loneliness. One in 10 said they saw between six and ten patients daily who had come in mainly because they were lonely. But only 13% felt well equipped to help them.

Lonely people are known to consult their GP more than others.

“The health impacts of loneliness can be devastating; it is worse for you than obesity, and as bad as smoking 15 cigarettes a day. Chronic loneliness is cutting lives short, and the problem is growing,” said Laura Alcock-Ferguson, the campaign’s executive director.

Recent research it undertook with the London School of Economics found that £3 in health costs was saved for every pound spent tackling loneliness. Local NHS bodies should invest in services that will stop lonely people needing to see their GP in the first place, she added.

Age UK said that about a million older people suffered from loneliness, “an often devastating state of profound unhappiness”, and that feelings of isolation could be a sign of underlying ill-health.

“Loneliness can sometime be the face of more serious underlying issues and should not be disregarded as a minor problem. GPs should be alert to any underlying mental health problems such as depression,” said Caroline Abraham, Age UK’s charity director. GPs should do more to direct lonely people to services that can support them, she added.

NHS England agreed with the RCGP chief that GPs spending time with lonely people was a good use of their time.

“Older people can sometimes decide to soldier on through illness, which can then lead to more serious health problems,” a spokesman said.

“Just having someone to talk to makes it more likely that health problems are mentioned and help sought early, which is particularly important as we move into winter, as elderly patients make up the largest number of hospital admissions.”

But Stokes-Lampard added that GPs needed to have less pressurised schedules so that they had enough “time to care” for socially isolated patients.

Other research by the Campaign to End Loneliness found that 52% of lonely people miss being together with someone, 51% miss laughing with someone and 46% miss not having a hug.

Jeremy Hunt, the health secretary, will use his speech at the conference in Liverpool to announce an extension of a scheme in which newly-qualified doctors are given £20,000 in return for becoming a trainee GP in areas of England with acute shortages of family doctors.

Loneliness as bad for health as long-term illness, says GPs’ chief

Being lonely can be as bad for someone’s health as having a long-term illness such as diabetes or high blood pressure, the leader of Britain’s GPs will warn on Thursday.

Patients who visit their family doctor because they are suffering from loneliness and want some human contact are adding to the pressures the NHS is under, Dr Helen Stokes-Lampard will tell the Royal College of General Practitioners (RCGP).

But she will also urge GPs to make the time to see such patients, so that they have someone to talk to, despite being overworked because of the growing demands on their schedules.

The estimated 1.1 million Britons to be lonely are 50% more likely to die prematurely than people with a good social network, making loneliness as big a mortality risk as diabetes, the college says.

“Social isolation and loneliness are akin to a chronic long-term condition in terms of the impact they have on our patients’ health and wellbeing,” the college’s chair will tell its annual conference.

“GPs see patients, many of whom are widowed, who have multiple health problems like diabetes, hypertension and depression, but often their main problem isn’t medical, [it’s that] they’re lonely.”

Acting as a sympathetic listening ear is often more useful than giving someone a prescription for drugs or offering lifestyle advice, Stokes-Lampard will add. “The guidelines say we should be talking to them about their weight, exercise and prescribing more medication. But really what these patients need is someone to listen to them and to find purpose in life.

“Loneliness and social isolation are not the exclusive preserve of the elderly. They are not something that can be treated with pharmaceuticals or that can be referred for hospital treatment”.

Three out of four GPs say they see between one and five lonely people a day, according to research among over 1,000 family doctors undertaken in 2013 by the Campaign to End Loneliness. One in 10 said they saw between six and ten patients daily who had come in mainly because they were lonely. But only 13% felt well equipped to help them.

Lonely people are known to consult their GP more than others.

“The health impacts of loneliness can be devastating; it is worse for you than obesity, and as bad as smoking 15 cigarettes a day. Chronic loneliness is cutting lives short, and the problem is growing,” said Laura Alcock-Ferguson, the campaign’s executive director.

Recent research it undertook with the London School of Economics found that £3 in health costs was saved for every pound spent tackling loneliness. Local NHS bodies should invest in services that will stop lonely people needing to see their GP in the first place, she added.

Age UK said that about a million older people suffered from loneliness, “an often devastating state of profound unhappiness”, and that feelings of isolation could be a sign of underlying ill-health.

“Loneliness can sometime be the face of more serious underlying issues and should not be disregarded as a minor problem. GPs should be alert to any underlying mental health problems such as depression,” said Caroline Abraham, Age UK’s charity director. GPs should do more to direct lonely people to services that can support them, she added.

NHS England agreed with the RCGP chief that GPs spending time with lonely people was a good use of their time.

“Older people can sometimes decide to soldier on through illness, which can then lead to more serious health problems,” a spokesman said.

“Just having someone to talk to makes it more likely that health problems are mentioned and help sought early, which is particularly important as we move into winter, as elderly patients make up the largest number of hospital admissions.”

But Stokes-Lampard added that GPs needed to have less pressurised schedules so that they had enough “time to care” for socially isolated patients.

Other research by the Campaign to End Loneliness found that 52% of lonely people miss being together with someone, 51% miss laughing with someone and 46% miss not having a hug.

Jeremy Hunt, the health secretary, will use his speech at the conference in Liverpool to announce an extension of a scheme in which newly-qualified doctors are given £20,000 in return for becoming a trainee GP in areas of England with acute shortages of family doctors.

Thank you, Sinéad O’Connor, for showing the messy reality of mental illness | Paris Lees

Three cheers for Sinéad O’Connor, who has this week torn down the glossy facade of the public debate around mental health. The video the Grammy-award-winner posted to her Facebook page on Monday – a motel room recording that has caused concern around the world – is not easy viewing. Seeing her desperate call for help and her honesty about suicidal feelings is excruciating. And not just because we know that she was once one of the biggest stars in the world. She expresses her pain so passionately you can almost taste it.

And I tell her this: thank you. For showing the reality of mental illness. The wailing, ranting, desperate demon that secretly tortures millions. I’ve never been to that motel in New Jersey but I have been in that room with you. Earlier this year I suffered a particularly serious mental breakdown. I have been too ashamed to talk about it publicly as I’m keenly aware of the stigma attached to pain and chaos this raw. Thank you for showing millions of us that we are not alone.

As O’Connor notes, the stigma is often worse than the mental illness itself. And while we are now used to thinking of stigma as being a consequence of mental ill-health, research shows that, in the form of prejudice and alienation, it is also a driver of morbidity. In other words, people who feel stigmatised in life are more likely to become ill and die. We know that gay, lesbian, bisexual and trans people are much more likely to suffer with poor health, as are people from minority ethnic backgrounds. Almost half of all trans kids in Britain have attempted suicide. Stigmatised already, they then face further stigma when they become ill. Talk about kicking people when they’re down.

In the past decade fantastic campaigns such as Time to Change have transformed the conversation. Matt Haig has no doubt saved many lives with his book Reasons to Stay Alive, and Bryony Gordon deserves praise for all she’s done. She landed the scoop of the year by getting Prince Harry to open up about his mental health battles. The younger royals are doing admirable work to raise awareness.

But while I applaud the efforts of these campaigners, I can’t help feeling that the conversation about mental health has, up until now, been sugar-coated and sanitised. The focus is on illnesses that seem more easily relatable – so, for example, we hear lots about depression and anxiety but no so much about schizophrenia or borderline personality disorder. Everything is past tense: battles have been overcome. The chaos is hidden.

I understand. Few people want to listen at the point when someone is struggling most. It’s too awkward for everyone involved. And who wants to show the world the depths that mental illness can take you when you’re right there at the bottom? Not me. I’ve only felt able to talk about my mental struggles in the past tense myself, as though the depression I suffered “as a student” was a neatly packaged thing I’d since tidied away. It’s not.

In addition to laudable mainstream campaigns we also need to see the reality of what mental illness can do to people up close – the same way we need to see images of people fleeing other harrowing situations for which there are political solutions if only there was the will. The world is not all roses and sunshine and Instagram filters, sadly. It is messy and, for many people, hopeless. It’s time we woke up and asked why. O’Connor has spoken openly about being abused as a child. There is no point discussing mental illness without acknowledging the circumstances that can lead to it.

I wasn’t surprised to see Annie Lennox was one of the first to voice concern for O’Connor. Lennox has spent the past 30 years expressing exquisite pain – and joy – in her music, music that has helped me find a way out of more dark tunnels than I can count. If only we were all as compassionate. I saw many people on social media dismiss O’Connor as “crazy” and an “attention seeker”, as though the solution is to just lock her up and forget about her. She needs love, support and understanding. Everyone struggling with poor mental health does.

As O’Connor rightly points out, though, many people lack her resources. I am university-educated and tenacious. Yet I know how difficult it is to access therapy on the NHS. I had to wait almost a year before I was accepted, during which time I ran up huge debts going to see a private therapist. God knows how people who are already not coping are supposed to deal with all the many hoops you’re expected to jump through. No wonder some people can feel like there is no way out. Yes, mental illness kills people. Suicide is the biggest killer of men under 50 in Britain. It is a real crisis.

Theresa May talks the talk when it comes to improving mental health services but it remains to be seen if she will deliver anything but bluster during her premiership. Maybe if watching O’Connor’s self-proclaimed “rant” makes us uncomfortable it’s because we are uncomfortable with our complicity in failing to address the things, such as abuse and poverty and stigma, that can drive people to mental ill-health.

There are millions of people suffering in their own private hells as we speak. Thank you again, Sinéad, for giving this secret misery a face – we need to see it.

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Paris Lees is a freelance journalist, campaigner and presenter

Thank you, Sinéad O’Connor, for showing the messy reality of mental illness | Paris Lees

Three cheers for Sinéad O’Connor, who has this week torn down the glossy facade of the public debate around mental health. The video the Grammy-award-winner posted to her Facebook page on Monday – a motel room recording that has caused concern around the world – is not easy viewing. Seeing her desperate call for help and her honesty about suicidal feelings is excruciating. And not just because we know that she was once one of the biggest stars in the world. She expresses her pain so passionately you can almost taste it.

And I tell her this: thank you. For showing the reality of mental illness. The wailing, ranting, desperate demon that secretly tortures millions. I’ve never been to that motel in New Jersey but I have been in that room with you. Earlier this year I suffered a particularly serious mental breakdown. I have been too ashamed to talk about it publicly as I’m keenly aware of the stigma attached to pain and chaos this raw. Thank you for showing millions of us that we are not alone.

As O’Connor notes, the stigma is often worse than the mental illness itself. And while we are now used to thinking of stigma as being a consequence of mental ill-health, research shows that, in the form of prejudice and alienation, it is also a driver of morbidity. In other words, people who feel stigmatised in life are more likely to become ill and die. We know that gay, lesbian, bisexual and trans people are much more likely to suffer with poor health, as are people from minority ethnic backgrounds. Almost half of all trans kids in Britain have attempted suicide. Stigmatised already, they then face further stigma when they become ill. Talk about kicking people when they’re down.

In the past decade fantastic campaigns such as Time to Change have transformed the conversation. Matt Haig has no doubt saved many lives with his book Reasons to Stay Alive, and Bryony Gordon deserves praise for all she’s done. She landed the scoop of the year by getting Prince Harry to open up about his mental health battles. The younger royals are doing admirable work to raise awareness.

But while I applaud the efforts of these campaigners, I can’t help feeling that the conversation about mental health has, up until now, been sugar-coated and sanitised. The focus is on illnesses that seem more easily relatable – so, for example, we hear lots about depression and anxiety but no so much about schizophrenia or borderline personality disorder. Everything is past tense: battles have been overcome. The chaos is hidden.

I understand. Few people want to listen at the point when someone is struggling most. It’s too awkward for everyone involved. And who wants to show the world the depths that mental illness can take you when you’re right there at the bottom? Not me. I’ve only felt able to talk about my mental struggles in the past tense myself, as though the depression I suffered “as a student” was a neatly packaged thing I’d since tidied away. It’s not.

In addition to laudable mainstream campaigns we also need to see the reality of what mental illness can do to people up close – the same way we need to see images of people fleeing other harrowing situations for which there are political solutions if only there was the will. The world is not all roses and sunshine and Instagram filters, sadly. It is messy and, for many people, hopeless. It’s time we woke up and asked why. O’Connor has spoken openly about being abused as a child. There is no point discussing mental illness without acknowledging the circumstances that can lead to it.

I wasn’t surprised to see Annie Lennox was one of the first to voice concern for O’Connor. Lennox has spent the past 30 years expressing exquisite pain – and joy – in her music, music that has helped me find a way out of more dark tunnels than I can count. If only we were all as compassionate. I saw many people on social media dismiss O’Connor as “crazy” and an “attention seeker”, as though the solution is to just lock her up and forget about her. She needs love, support and understanding. Everyone struggling with poor mental health does.

As O’Connor rightly points out, though, many people lack her resources. I am university-educated and tenacious. Yet I know how difficult it is to access therapy on the NHS. I had to wait almost a year before I was accepted, during which time I ran up huge debts going to see a private therapist. God knows how people who are already not coping are supposed to deal with all the many hoops you’re expected to jump through. No wonder some people can feel like there is no way out. Yes, mental illness kills people. Suicide is the biggest killer of men under 50 in Britain. It is a real crisis.

Theresa May talks the talk when it comes to improving mental health services but it remains to be seen if she will deliver anything but bluster during her premiership. Maybe if watching O’Connor’s self-proclaimed “rant” makes us uncomfortable it’s because we are uncomfortable with our complicity in failing to address the things, such as abuse and poverty and stigma, that can drive people to mental ill-health.

There are millions of people suffering in their own private hells as we speak. Thank you again, Sinéad, for giving this secret misery a face – we need to see it.

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Paris Lees is a freelance journalist, campaigner and presenter