Mental Health Bill success – the end of the beginning
A NEW Mental Health Bill has finally passed through all its parliamentary stages and at the time of writing awaits only the formality of Royal Assent before becoming law.
The British Psychological Society has worked hard over the years to ensure that the new legislation reflects its concerns. These concerns have mostly been met, and the Society is pleased that this a much better piece of legislation than the bill originally introduced by the Department of Health. The BPS Parliamentary Officer, Dr Ana Padilla, told us the British Psychological Society was extremely happy to see the bill get through following ‘serious, constructive compromises’ made by the government.
Conditions for the imposition of community treatment orders (CTOs) are more restricted than in previous draft bills. The changes come after representations from several groups including the Society. CTOs will now only be applied to prevent risk of harm to the patient’s health or safety, or to protect other people. The intention
of any CTO must also be to alleviate, or prevent further deterioration of, a person’s mental condition. The original bill had instead placed the emphasis on behaviour management and movement restrictions, which carried the danger of some CTOs being used principally to control antisocial behaviour.
People detained for compulsory treatment under the existing legislation are placed under the care of a ‘Responsible Medical Officer’ (RMO), invariably a psychiatrist. The forthcoming Act replaces the RMO with ‘Responsible Clinician’, using a competency-based approach, drawn from the ranks of ‘Approved Clinicians’. This person could be a psychologist or other mental health professional.
The new legislation also includes powers by which people with a mental illness can be detained in hospital against their will, even if they have not committed a crime. The Society, through the new Mental Health Coalition (see News, June 2007), had argued for an ‘impaired decision making’ clause, whereby such detention could only be imposed on those who lacked a genuine ability to make decisions in their best interest. Unfortunately the government did not accept the Coalition’s arguments on this aspect.
But overall there are many welcome provisions in the legislation. These include a guarantee that within two years, patients under the age of 18 will be treated on age-appropriate wards; age limits for electroconvulsive therapy; new independent advocacy services for patients detained under the Act; and new rights for the victims of convicted mentally disordered patients to know when offenders will be released, and to make representations about their discharge.
Chartered psychologist Professor Peter Kinderman (University of Liverpool), speaking on behalf of the Mental Health Coalition, said:
‘I am delighted that the Department of Health has listened and responded positively to the concerns of the Coalition. Most mental health professionals are committed to developing genuine multidisciplinary care. We feel that the new Act will much better reflect the way that ethical, high-quality, person-centred care should be delivered.’
Work will now begin on implementation, developing a code of practice, forming links with other professional groups, and the training and accreditation of Approved
Clinicians and Responsible Clinicians. The Society says it intends to play a major role in these processes. PDH/CJ
A PROGRAMME of intensive psychological treatment for mentally ill offenders was nominated for June’s Medical Futures Innovation Awards, for mental health and neuroscience innovation.
Psychologist Katie Bailey (Head of Psychology, North West Region, Partnerships in Care) was nominated for Life Minus Violence, a joint initiative care programme with the NHS. It is an intensive groupwork programme aimed at male patients for whom aggression is often the major barrier to their progress through mental health services, and hence inclusion back into society.
The programme is now available within secure psychiatric care, and interest has been shown by HM Prison Service, the Probation Service, National Offender Management Service, other independent and NHS hospitals, learning disability services and women’s mental health services.
Katie Bailey said: ‘We are very pleased with the programme. The interest from so many organisations, as well as forensic services in other countries such as Japan and Canada, shows that the programme is something truly worth sharing to help benefit patient care.’
Professor Jane Ireland, Violence Treatment Lead at Ashworth Hospital, Merseycare NHS Trust, saw clear benefits in including and working with the private sector on this important initiative. She said: ‘When I was first tasked by the NHS to lead the development of aggression treatment with Ashworth High Secure Hospital, I was keen to include the private sectors as partners in this, to recognise the importance of treatment being streamlined across services.’
Although it was unsuccessful in the main category, the programme was awarded the Medical Futures Best Public–Private Partnership. JS
THE Qualifications and Curriculum Authority have published their draft GCSE subject criteria for psychology. Consultation is open until 14 September.
However, although psychology will become a science A-level from next year, the situation at GCSE level is far from clear.
To download the consultation and respond via questionnaire, see www.qca.org.uk/609_18640.html.
NORTH EAST THERAPISTS NETWORK LAUNCHED
CHARTERED psychologist Dr Dorothy Rowe delivered a public lecture in June to mark the launch of a new network of psychological therapists and counsellors in the north east of England. The University of Sunderland psychology department has launched the scheme to help improve mental health in the area. Practitioners from a wide variety of agencies including Relate, Action on Addictions, and the NHS are participating.
The lure of neuroscience
THESE days, it can feel as though a psychological finding is inadequate unless it draws on the tangible wetness of neuroscience: the chemicals and brain areas. To discover, say, that a given activity is enjoyable is not enough. To reveal that it activates our reward pathways – now that’s science. To paraphrase the scepticism of philosopher Jerry Fodor: We always knew there was a difference between verbs and nouns, but once somebody showed they were associated with activity in different brain areas, well then we knew they were different ‘scientifically’.
Now Deena Weisberg and colleagues at Yale have formally tested the effect that adding neuroscience jargon has on people’s satisfaction with explanations of psychological findings. Naive participants, neuroscience students and neuroscience experts were presented with descriptions of psychological phenomena, such as mutual exclusivity and the attentional blink, together with both good and poor (i.e. circular) explanations of these phenomena.
Everyone, including the naive participants, found the bad explanations less satisfying than the good explanations. Crucially, however, among the naive participants and neuroscience students, those who read bad explanations containing gratuitous neuroscience references, reported being more satisfied with these bad explanations, than did the others who read bad explanations containing no neuroscience. By contrast, the presence or not of neuroscience content had no effect on the neuroscience experts’ satisfaction with the bad explanations, but irrelevant neuroscience did reduce their satisfaction with the good explanations.
The researchers surmised there could be several reasons why references to neuroscience make a bad explanation more satisfying for non-experts. For example, physiological analysis, though irrelevant, could give the impression that the explanation is connected with a wider, more insightful, explanatory system. Or, as brain-imaging expert Rik Henson has noted, perhaps people’s judgement is distracted by the seductive visual imagery – such as pictures of blobs on brains – with which neuroscience is associated.
The researchers said their findings could have serious implications for the application of neuroscience to social issues, such as when presented as evidence in court. ‘Even if expert practitioners can easily distinguish good neuroscience explanations from bad, they must not assume that those outside the discipline will be as discriminating,’ they wrote. The findings are in press at the Journal of Cognitive Neuroscience. CJ
The journal Nature is calling on experienced researchers to help young scientists become better peer reviewers. Its 14 June editorial outlines the key elements of good peer review: an attitude of constructive objectivity; a summary of the paper’s strengths and significance; constructively and collegially expressed critical comment; and, in response to experimental weakness or alternative explanations, suggestions for further experiments that might strengthen the case or resolve ambiguities should be given. ‘This may all seem obvious to the experienced reviewer,’ the journal says. ‘But it is only by careful oversight of a young scientist’s attempts at reviewing real papers that the benefits of this experience can be passed on.’ (See http://blogs.nature.com/peer-to-peer for more.)
Dual brain imaging
BRAIN-imaging technology has taken a leap forward with the publication of the first scans captured simultaneously via positron emission tomography (PET) and magnetic resonance (MR) technologies. The images were presented in June at the 54th annual meeting of the Society for Nuclear Medicine in Washington, DC. ‘The PET/MR system allows simultaneous measurement of anatomy, functionality and biochemistry of the body's tissues and cells, enabling researchers to correlate MR and PET data in a way not previously possible before,’ said Bernd J. Pichler, associate professor and head of the Laboratory for Preclinical Imaging and Imaging Technology in the Department of Radiology at the University of Tuebingen in Germany. It’s hoped the hybrid technology will help further our understanding of the pathologies and progression of disorders like Alzheimer’s, Parkinson’s, epilepsy, depression and schizophrenia. CJ
Psychologists and abusive interrogation
THE nature of psychologists’ involvement in American national security interrogation practices has come under renewed scrutiny. The cause is a newly declassified August 2006 report by the Office of the Inspector General (OIG): ‘Review of DoD-Directed Investigations of Detainee Abuse’. In an open letter to APA president Sharon Brehm, more than 40 psychologists claim the report demonstrates indisputably that psychologists helped develop abusive interrogation techniques for use in Guantánamo, Afghanistan, and Iraq (tinyurl.com/2qpmv8).
If the signatories’ claim is true, this would appear to undermine the APA’s stated position that psychologists ought to remain involved in interrogation practices, so as to ensure they remain safe, legal and ethical (see News, October 2006). Another claim made by the letter is that the OIG report shows three psychologists who were directly involved in developing abusive interrogation techniques, then went on to become members of the APA’s own task force set up to investigate the ethics of psychologists’ participation in interrogation. CJ
Psychometric tests for learner drivers
LEARNER drivers should be given psychometric tests to assess their attitudes to risk. That’s according to Robert Gifford, Executive Director of the Parliamentary Advisory Council for Transport Safety (PACTS). He told BBC Radio Five Live that testing learners’ knowledge of the highway code wasn’t enough, and that questions about their proclivity for jumping red lights and other risk taking would help pick up on their underlying values.
In fact, psychometric assessments of this nature already exist. Chartered psychologist Dr Lisa Dorn has developed a Driver Risk Index for novice bus drivers at Arriva Bus UK. She told us the purpose of the index was not to act as a test, but rather to help learners reflect on how their attitudes will affect the decisions they make during their driving career. ‘If people stopped to think about the risks they run when they’re speeding to a meeting, or getting angry with other road users and tailgating – perhaps we would see fewer people being killed and injured on the roads,’ she said.
The Driver Risk Index incorporates scales to detect socially desirable responding, but Dorn pointed out that attempts to answer the assessment dishonestly would be pointless when its aim is to make learners safe rather than to catch them out. Indeed, crash rates among Arriva’s bus drivers have reduced significantly following the introduction of the index, and Dorn and colleagues are now evaluating the approach with learner car drivers. The news comes as the Driving Standards Agency is undergoing a full review of the driving test process. CJ
EARLIER this year, a Festschrift was held at the Royal Society in London to celebrate the outstanding contributions that Professor Uta Frith has made to psychology over the past 40 years. A series of talks were given by many of Professor Frith’s collaborators – themselves prominent in developmental psychology and cognitive neuroscience.
The Festschrift showcased new data that provided refined insights into Frith’s three main research areas – dyslexia, autism and conduct disorder. The Festschrift was broad in scope, touching on the nature and relevance of the phonological deficit in dyslexia, refinements to extant theories of autism cast against typical development, and new perspectives on the conceptualisation of conduct disorder and psychopathy.
Professor Maggie Snowling (University of York), Professor Dorothy Bishop and Dr Sarah-Jayne Blakemore organised the conference. Professor Snowling said it was ‘a fitting celebration of Uta’s lasting influence. The Festschrift made clear the exciting and tangible possibilities for future research, which will impact upon our understanding of the origins and trajectories of developmental disorders.’ JS
- To read a full account by Lisa Henderson and Fiona Duff, go to www.thepsychologist.org.uk and click on this month’s issue for an online-only article.
Schizophrenia in developing countries
TWENTY-five million people with schizophrenia live in low- and middle-income countries, where they receive little or no formal treatment. What can be done to help when these countries have so few mental health professionals?
The answer, according to Dr Vikram Patel of the London School of Hygiene and Tropical Medicine, lies with community-based mental health workers. Writing in PLoS Medicine (tinyurl.com/yv6jhw), he argues they should be tasked with raising awareness about the disorder and should identify probable cases of schizophrenia to be referred to the local health practitioner for formal diagnosis and drug treatment.
Pointing to the positive work of the UK-based organisation Basic Needs, Dr Patel says: ‘The model I have outlined is not a pipe dream. It is an affordable prescription for a commitment to ensure that people with schizophrenia receive the basic minimum package of evidence based care…that meets their human rights.’
Writing in the same article, Professor Saeed Farooq of the Lady Reading Hospital, Peshawar, Pakistan, advocates introducing ‘directly observed therapy’ for people with schizophrenia. This approach, which has been used to treat TB in low-income countries, would involve health workers or family members observing
and recording schizophrenia sufferers swallowing freely-distributed drug treatments.
Dr R. Thara, director of the Schizophrenia Research Foundation in India agrees that it is only by ensuring people with schizophrenia receive effective treatments that stigma towards the illness will be reduced in low-income countries. ‘When patients’ conditions improve,’ she wrote, ‘especially in the restoration of their social functioning, the community’s explanatory model of schizophrenia often shifts from a magico-religious to a medico-social viewpoint.’ CJ
Time to rethink the central executive?
FINDINGS from a new brain imaging study have challenged established cognitive psychology models of attention and self-control. Whereas cognitive models postulate a unitary ‘central executive’ or ‘supervisory attentional system’ at the top of the command hierarchy, neuroscientists at Washington University in St Louis, USA, say their research shows there are two separate control networks in the brain, not one.
Using fMRI, Nico Dosenbach and colleagues scanned the brains of 74 healthy young adults who were asked to do nothing but relax and stare straight ahead. The researchers used graph theory – a branch of mathematics that has been used to characterise complex systems like the USA power grid – to look for brain areas where activity levels rose and fell in approximate synchrony. ‘You might think that everything is connected to everything, and you would get a sort of big mess and not much information. But that’s not at all what we found,’ says Dosenbach. Instead the researchers found two distinct networks: a cingulo-opercular network and a fronto-parietal network. There was a great deal of interconnectedness between brain regions within these networks, but little or no cross-talk between the two networks.
To establish the role the two networks play, the researchers referred to earlier functional brain scans they’d taken of 183 participants performing 10 different tasks, including visual search, reading and tests of timing. This showed the fronto-parietal network operates over shorter time scales and is involved in online, adaptive control, adjusting for errors. By contrast, the cingulo-opercular network shows more sustained activation, works over longer time scales, and appears to be responsible for stability and tuning out distractions.
‘It appears as if the human has not only one but two supervisory attentional systems, that implement control in parallel and via dissociable mechanisms,’ says Nico Dosenbach. ‘This was a big surprise,’ says co-author Professor Steven Petersen. ‘We knew several brain regions contribute to top-down control, but most of us thought we’d eventually show all those regions linking together in one system, one little guy up top telling everyone else what to do.’
But Dosenbach explains: ‘With additional reading and thinking we realised that this type of control network architecture [with two separate control systems] is actually highly consistent with theories about the structure of complex adaptive systems. For example, in ecology and economics, complex systems that are both resistant to perturbations yet rapidly adaptive have multiple controlling variables, or controllers, that act via different mechanisms and often over different time scales. A simple physiologic example for such control architecture would be balance, which is supported by the inner ear, joint position sensors and the visual system. Having multiple controllers will increase the system’s resilience to damage. Having both rapidly acting and longer-term accumulating controllers allows the system to be both flexible and stable.’
The researchers believe cognitive models of attentional control will need to be reworked in light of their findings, but they point out their results are not relevant to the apparent unity of consciousness. ‘In no way do our findings suggest that the “self” may be split or dual,’ Dosenbach says. ‘It is quite possible, for example, that one’s conscious intentions are unitary, but that they are implemented and adjusted via two parallel channels. Conversely, the human sense of a unitary self may be the emergent property of the function of both the fronto-parietal and cingulo-opercular control networks.’ Their findings are published in the Proceedings of the National Academy of Sciences, USA (tinyurl.com/2o2gr3).
Meanwhile, in a related development, psychologist Petroc Sumner at Cardiff University and colleagues, have also reported new insights into the neural correlates of self-control, thanks to two patients with unusually specific patterns of brain damage. Patients CB and JR have tiny lesions to the supplementary motor area and supplementary eye fields, respectively: regions found at the front of the brain and previously associated with voluntary motor control. Now for the first time these brain regions are revealed to be critically involved in inhibiting movements automatically triggered by visual stimuli – such as in the way the sight of a mug handle automatically triggers neural activity associated with reaching for the mug.
Co-researcher Professor Masud Husain of the Institute of Neurology at UCL and the Institute of Cognitive Neuroscience, says: ‘It was previously thought that the supplementary motor area was important for internally guided actions – things that you decide to do – rather than externally guided actions, things that are stimulated by objects around you. What we’re saying is that part of the internal guidance action depends on inhibiting these automatically activated habits we all have. It’s more sophisticated than the previous argument and it goes against the idea that it’s all internally generated. This research strongly indicates that part of the voluntary control of our actions is actually overruling these automatically activated motor plans.’ The findings are published in Neuron (tinyurl.com/2g3ttr). CJ
A flicker of light in a sea of darkness
THERE’S a scene in John Bayley’s memoir of the late, great Iris Murdoch, in which he recalls her saying to a friend ‘I see an angel. I think it’s you.’ Murdoch had recently developed Alzheimer’s disease, and the friend in question was helping her shower. Such moments of lucidity can be like a flicker of light in a sea of darkness to the relatives and friends of people with dementia. They are also of interest to scientists and clinicians seeking to understand how the mind is affected by the ravages of disease.
Now David Hawkins and Neill Graff-Radford at the Mayo Clinic have reported (in the journal Neurocase) the case of an 81-year-old woman presenting with probable Alzheimer’s disease, who despite severe cognitive difficulties and widespread brain atrophy, has retained the ability to pun.
For example, in response to hearing her son say ‘Dad, let’s charge up the battery for your new phone’, the patient said ‘Are you going to charge him for that?’ After her son said ‘That dinner was great, but I’m really full’, the patient replied ‘It was a very fulfilling meal’. These and many other examples were recorded by the woman’s son over a period of three hours and were said to be representative of her conversational style. Moreover, the woman seems to realise she’s being witty – she laughs after making these remarks and admits to being very good at punning.
Prior to her illness, although she was humourous and quick-witted, her verbal humour was nowhere near so prolific. It’s almost as though the disease has unlocked this ability in her. ‘Interactions with patients such as the 81-year-old female discussed in this report serve to remind professionals working in this area that each individual is unique and may possess abilities that are remarkable in the presence of extensive degenerative neurological findings,’ the authors said. ‘Focusing on such positive attributes can be helpful not only for the patient but also for the family members in dealing with the difficulties of AD.’ CJ
Uncovering lies, and the lying liars who tell them
THE general public and the police alike are notoriously poor at spotting when people are lying. But now psychologists have shown that asking suspects to tell their story backwards could significantly aid lie detection. Professor Aldert Vrij and colleagues say the technique works because lying requires more mental effort than telling the truth, so liars are more affected than truth-tellers by the extra cognitive demand of telling their story backwards.
In an initial experiment, 80 undergraduate students were interviewed by a police officer about the theft of a wallet. Half the students had earlier seen the wallet being taken while they played a game of Connect Four, and they were to tell the truth about this in the interview. The remaining students, following a scenario set up by the researchers, had in fact taken a wallet earlier on in the day. They were to lie in the police interview, claiming that they, like the other students, had been playing Connect Four. Half the liars and truth-tellers were required to tell their story forwards, the others told their story backwards.
The demands of telling their story backwards exposed significantly more differences between the liars and truth-tellers than did the task of telling their story forwards. In the reverse story condition, the liars gave fewer auditory details, gave less contextual embedding, made more speech hesitations, and spoke more slowly, all of which are signs of increased cognitive load. They also moved their feet more and blinked more, which are signs of nervousness. By contrast, among the students who told their stories forwards, the liars differed from the truth-tellers only in the fact that they moved their hands and fingers less, probably because of a deliberate effort to appear calm.
In a second experiment, 55 police officers watched video clips of the students being interviewed. Of the students who told their stories forward, the police correctly identified 42 per cent of the liars, which is no better than if they had just guessed. By contrast, of the students required to tell their stories backwards, the police spotted 60 per cent of the liars – better than would be expected by guessing.
Writing in a paper to be published in the journal Law and Human Behaviour, the researchers commented: ‘We believe that the present findings are useful for professional lie detectors and can be adapted for police interviewers.’ Indeed, Professor Vrij told The Psychologist that he has been in contact with several police officers who are willing to try out the technique, and to date feedback from them has been positive. But if this approach became widespread, would it be undermined by criminals practising telling their stories backwards? Vrij acknowledged this is something that remains to be investigated. There also other ways of increasing cognitive load – for example by requiring suspects to maintain eye contact – that the researchers plan to test. CJ
THE skies are crowded with planes, our sclerotic roads clogged with millions of cars – when will we wake up to the urgency of climate change? Spreading the word about the effect climate change will have on human health, that could be the key.
A group of Swedish psychologists asked 621 participants aged from 18 to 75 whether 44 statements about climate change were true or false. These were arranged into several domains: facts about the state of the climate, the causes of climate change, and the consequences for the weather, sea, glaciers and human health.
For example, a true statement about human health consequences stated: ‘It is probable that mortality by lung oedema and heart problems during heat waves in Sweden will increase in the next 50 years.’
It was specifically the participants’ knowledge about the consequences for human health that most strongly predicted how worried they were about climate change, and how likely they thought it was that serious negative consequences would affect Sweden and other countries in the future. Knowledge of the causes of climate change had a weak association with the participants’ perception of risk, but not their concern about that risk.
‘A practical implication is that in order to change people’s behaviour, more research and focused educational programmes about health consequences should be beneficial,’ Eva-Lotta Sundblad and colleagues wrote in the Journal of Environmental Psychology.
To the researchers’ surprise, although women were more worried than men, most demographic factors did not predict participants’ worry or sense of risk surrounding climate change. For example, parents were no more concerned than non-parents.
Meanwhile, a new study has suggested that health information campaigns might struggle to preach to the relatively converted. The research, by Gert-Jan de
Bruijn (Utrecht University) and colleagues, found that people who already eat fruit (though not enough) habitually might not benefit from interventions that seek to up their intake.
The Dutch psychologists applied the Theory of Planned Behaviour to the fruit eating tendencies of 521 participants, but unlike most prior research, they added in a measure of habit – that is, whether the participants said they often ate fruit automatically, without thinking about it.
They found that among the participants who had either a weak or medium fruit-eating habit, their self-reported intentions to eat fruit were predictive of their fruit consumption measured five weeks later. Crucially, however, this wasn’t true for those who had a strong fruit-eating habit. The strongest predictor of their subsequent fruit consumption wasn’t their prior intentions, but their sense of how easy it would be to eat fruit.
‘Health behavioural change for those with strong habits may be more dependent on environmental manipulations – making healthy foods more readily available,’ the researchers said. CJ
- These studies were originally reported in the Society’s free Research Digest. For more and to subscribe, see www.researchdigest.org.uk/blog.
RESEARCH FUNDING NEWS
The BBSRC is offering Targeted Priority Studentship doctoral training grants. One of the two targeted areas is ageing research. There are 20 four-year studentships available. The closing date for applications is 6 September 2007.
- Further details: www.bbsrc.ac.uk/funding/training/calls.html#priority
Building on the success of previous competitions, UK Research Councils are offering the 2007/08 Business Plan Competition. This provides researchers who have ideas with commercial potential the opportunity to access skills and the support needed to develop a business plan. The closing date for applications is 14 Sep
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