Category: Mental Health

What is Neurotics Anonymous?

Published on by Andrew Marshall1 Comment

Introduction

Neurotics Anonymous (N/A), founded in 1964, is a twelve-step programme for recovery from mental and emotional illness.

To avoid confusion with Narcotics Anonymous (NA), Neurotics Anonymous is abbreviated N/A or NAIL.

Refer to Neuroticism and Neurosis.

Brief History

The conception of Neurotics Anonymous began with Alcoholics Anonymous (AA) co-founder Bill W. After achieving sobriety Bill continued to suffer from neurosis, specifically depression. In letters to other AA members he wrote about his personal experience with neurosis, its prevalence in AA, and how he and others learned to cope with it. Bill expressed that as he learned to let go of his dependence on people and situations for emotional security and replaced that dependence with “showing outgoing love as best as he could,” his depression began to subside. In correspondence with another AA member about neurosis and psychoanalyst Karen Horney Bill suggested how a Neurotics Anonymous fellowship might operate.

You interest me very much when you talk of Karen Horney. I have the highest admiration of her. That gal’s insights have been most helpful to me. Also for the benefit of screwballs like ourselves, it may be that someday we shall devise some common denominator of psychiatry — of course, throwing away their much abused terminology — common denominators which neurotics could use on each other. The idea would be to extend the moral inventory of AA to a deeper level, making it an inventory of psychic damages, reliving in conversation episodes, etc. I suppose someday a Neurotics Anonymous will be formed and will actually do all this. Bill W., Letter to Ollie in California, 04 January 1956.

In a subsequent letter to Ollie in June 1956, Bill suggested the inventory of psychic damages include inferiority, shame, guilt and anger. He added that the effectiveness of the inventory would come from reliving the experiences and sharing them with other people.

Neurotics Anonymous was created eight years later, 03 February 1964 in Washington, D.C. by Grover Boydston (16 August 1924 to 17 December 1996). Grover was an AA member, recovering alcoholic, psychologist, and Ed.M. Grover had attempted suicide five times before the age of 21 and, like Bill W., was neurotic. Grover believed members of twelve-step programmes shared the same underlying neuroses caused by self-centeredness, a view expressed in other twelve-step programmes. Grover went as far as to say, “All of us are, indeed, brothers, and the variations in detail are no more than if one of us likes chocolate ice cream, and the other likes vanilla.”

While in AA, Grover discovered working the Twelve Steps helped remove the neuroses underlying his alcoholism. As an experiment Grover instructed a woman who suffered from neurosis, but not alcoholism, to work the Twelve Steps. He discovered that they aided her recovery from neurosis as well. He wrote Alcoholics Anonymous World Services for permission to use their Twelve Steps with the word “alcohol” in the First Step replaced with “our emotions.” Permission was granted. Grover placed an ad in a Washington, D.C. newspaper for Neurotics Anonymous, and organised the first meeting from those who responded to it. N/A grew modestly until an article was published on it in Parade magazine. The Associated Press and United Press International republished the story, and N/A groups began forming internationally.

By 1974 the Diagnostic and Statistical Manual of Mental Disorders, at the time in second edition (DSM-II), was undergoing revision. The framework developed for the third edition (DSM-III) was no longer based on psychoanalytic principles such as neurosis. The connotation of neurosis in common language also began to change. “Neurosis” was being used, increasingly, in a facetious or pejorative sense, rather than a diagnostic sense. These combined factors could make it difficult to take an organization known as Neurotics Anonymous seriously. In current Neurotics Anonymous literature, there is not a scientific definition ascribed to neurosis. As used in N/A, a neurotic is defined as any person who accepts that he or she has emotional problems.

Demographics

Grover Boydston conducted the first demographic study of Neurotics Anonymous in 1974. Such studies are rare and samples sizes are usually small as any group following the Twelve Traditions is required to protect the anonymity of their members. While researching such groups is still ethically possible, it is more difficult given this constraint.

  • Age: Boydston’s study found the average age of N/A members surveyed to be 43.02 years. A study six years later of self-help groups for people with serious mental illness, found the average age to be 35.3 years.
  • Attendance and Tenure: Of the N/A members surveyed Boydston found they attended, on average, six meetings per month and had spent an average of 2.37 years in N/A. N/A had existed for approximately ten years at the time of the survey.
  • Employment and socioeconomic status: Boydston categorised the occupations of N/A members into four categories.
    • Professionals: Includes people who practice a profession that is so considered by scientific, academic, business, and other people. It includes physicians, lawyers, engineers, nurses, college and university instructors. These represented 38% of the members surveyed.
    • Clerical persons: Includes people who perform office work or sales work according to the classification of “clerical.” These represented 32% of the members surveyed.
    • Homemakers: A person who takes care of a home as his or her main work. These represented 16% of the members surveyed.
    • Other: Includes students and people who do not fit into the three previous categories. These represented 32% of the members surveyed.
  • According to Boydston’s results at least 70% of N/A members were employed. This is similar to a specific study of Emotions Anonymous that found most of the members were middle class. Other studies of self-help groups for people with serious mental illness found most of the members tend to be unemployed, while others found members to be predominantly working class.
  • Ethnicity: Boydston’s study, and all similar studies in the literature have found that the majority of members in N/A and other self-help groups for people with serious mental illness in the United States are white.
  • Hospitalisation: Boydston’s study of N/A members found that 42% percent had been hospitalised for psychiatric reasons. More recent studies have shown that in self-help groups for serious mental illness approximately 60% (55-75%) of members had been hospitalised for psychiatric reasons.
  • Marital Status: In Boydston’s study of N/A members he found 25% were single, 48% were currently married, 22% were divorced and 5% were widowed. This finding has not been replicated in studies of similar groups where it was found most members had never been married.
  • Religion: Boydston’s survey included not only religious affiliation, but also included a measure of religiosity. Of the N/A members surveyed he found 24% identified as Catholic, 47% identified as Protestant, 9% identified as Jewish, and 19% did not consider themselves religious. Additionally, only 19% of members identified themselves as “very religious”, 42% identified themselves as moderately religious, and 39% identified themselves as “not very religious”.
  • Specific disorders (neuroses): Boydston’s survey contained an open-ended question asking about the “main complaints” N/A members came to the programme with. He summarized them in a list of twelve. Listed below are his results, in order from the highest to lowest percentage of members reporting them. Members often presented with more than one complaint.
    • Depression (58%).
    • Anxiety (32%).
    • Fears (23%).
    • Problems in relationships (18%).
    • Psychosomatic pains (14%).
    • Confusion (13%).
    • No desire to live (11%).
    • Inability to cope (9%).
    • Nervousness (7%).
    • Loneliness (6%).
    • Feelings of hopelessness (5%).
    • Hate (3%).
  • Sex: Boydston’s study of N/A members found approximately 36% were male, and 64% were female. This ratio, of two (or more) females for every male, has been reproduced in all other studies of self-help groups for persons with serious mental illness, as well as specific studies of Emotions Anonymous groups.

Criticism

N/A members in Comalapa (a municipality in Nicaragua) believe X-ray images (radiografías) can serve as a moral diagnostic revealing information about the intent and mores of those being examined. There is, however, no evidence that they are deliberately attempting to mislead other members. Americans had similar misunderstandings of X-ray technology when it was first introduced in the United States.

Increasing Deviant Stigma

Sociologist Edward Sagarin noted that alcoholics and addicts are considered deviants because their behaviour is socially labelled as deviant. Meaning chronic substance abuse is seen as deviant, while being sober or “clean” is normal. For an alcoholic or addict, joining groups such as AA or NA immediately reduces their deviant stigma, regardless of whether or not the alcoholic or addict believes it does. There is no similar clear cut language to label the deviance of those in N/A, in the act of joining members label themselves as deviant and take on stigma by identifying as one of those in the group afflicted with the problems of the other members. Initially joining the group may prove to be more ego damaging than ego reinforcing, regardless of whether or not the group helps them overcome their problems. Therefore, social stigma would attract alcoholics and addicts to groups like AA and NA. It would, however, become a barrier preventing people from joining groups such as N/A.

In contrast, those with severe mental illness may have acquired stigma through professional labels and diagnoses as well as through other behaviours associated with their mental illness defined as deviant. This stigma may not be as easily understood as alcoholism or addiction because the behaviour is more varied and can not be explained by substance use.

The objective of NA and AA is not just to help their members stop abusing drugs and alcohol. It is acknowledged in these programs that addiction is more systemic than a “bad habit” and is fundamentally caused by self-centeredness. Long term membership in Alcoholics Anonymous has been found to reform pathological narcissism, and those who are sober but retain characteristics of personality disorders associated with addiction are known in AA as “dry drunks.”

Effectiveness

Neurotics Anonymous developed the Test of Mental and Emotional Health as a tool to help members evaluate their progress. It is a fifty question test, with each answer rated on a three level Likert scale. Possible scores range from zero to one hundred. Higher scores are thought to indicate better mental and emotional health.

In Boydston’s survey of N/A members, when asked if they had received help through the program, 100% of those surveyed said “yes.” Boydston claimed N/A had similar results to AA in terms of recovery – 50% with a desire to stop drinking do so, 25% recover after one or more relapses, but most of the other 25% never successfully recover.

Literature

From 1965 to 1980 Neurotics Anonymous published a mimeographed quarterly periodical, the Journal of Mental Health. This should not be confused with the newer journal of the same name that began publishing in 1992. Early in the development of N/A they used Alcoholics Anonymous (the so-called Big Book) and the Twelve Steps and Twelve Traditions, the two fundamental books of the Alcoholics Anonymous programme. While reading out loud at meetings, members changed instances of the word “alcoholic” to “neurotic.” Passages in the book referring specifically to drinking were ignored. Eventually, N/A began creating books from articles published in the Journal of Mental Health. There were three such books published in English.

  • Neurotics Anonymous (1968). Neurotics Anonymous. Washington, D.C.: Neurotics Anonymous International Liaison, Inc.
  • Neurotics Anonymous (1970). The Laws of Mental and Emotional Illness. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTOFYS. LCCN 76102220. OCLC 104842.
  • Neurotics Anonymous (1978). The Etiology of Mental and Emotional Illness and Health. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTON22. LCCN 76040759. OCLC 4500175.

The N/A organisations in Brazil and Mexico use translations of the English literature as well as literature written by groups in their area.

Parallel Organisation

A registered charity, known as Neurotics Anonymous and located in London, was created in the late 1960s by John Oliver Yates. Yates was prompted to create the groups after trauma he had suffered from a car accident that left him completely blind. Group membership was open to anyone, although it was recommended for people who had a nervous illness severe enough to require hospitalization. This charity differed from conventional twelve-step programmes in several ways. There was a nominal fee charged for membership. Meetings opened with a discussion of outside issues, such debate on social, political or cultural topics. The debate was followed by a personal problem forum where members brought their problems to Yates for initial comment followed by a presentation for group discussion.

What is Neuroticism?

Published on by Andrew Marshall3 Comments

Introduction

In the study of psychology, neuroticism has been considered a fundamental personality trait.

For example, in the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody and to experience such feelings as anxiety, worry, fear, anger, frustration, envy, jealousy, guilt, depressed mood, and loneliness. Such people are thought to respond worse to stressors and are more likely to interpret ordinary situations, such as minor frustrations, as appearing hopelessly difficult. They are described as often being self-conscious and shy, and tending to have trouble controlling urges and delaying gratification.

People with high scores on the neuroticism index are thought to be at risk of developing common mental disorders (mood disorders, anxiety disorders, and substance use disorders have been studied), and the sorts of symptoms traditionally referred to as “neuroses”.

Refer to Neurosis and Neurotic Personality Questionnaire KON-2006.

Definition

Neuroticism is a trait in many models within personality theory, but there is significant disagreement on its definition. It is sometimes defined as a tendency for quick arousal when stimulated and slow relaxation from arousal, especially with regard to negative emotional arousal. Another definition focuses on emotional instability and negativity or maladjustment, in contrast to emotional stability and positivity, or good adjustment. It has also been defined in terms of lack of self-control, poor ability to manage psychological stress, and a tendency to complain.

Various personality tests produce numerical scores, and these scores are mapped onto the concept of “neuroticism” in various ways, which has created some confusion in the scientific literature, especially with regard to sub-traits or “facets”.

Individuals who score low in neuroticism tend to be more emotionally stable and less reactive to stress. They tend to be calm, even-tempered, and less likely to feel tense or rattled. Although they are low in negative emotion, they are not necessarily high in positive emotion. Being high in scores of positive emotion is generally an element of the independent trait of extraversion. Neurotic extraverts, for example, would experience high levels of both positive and negative emotional states, a kind of “emotional roller coaster”.

Measurement

Like other personality traits, neuroticism is typically viewed as a continuous dimension rather than a discrete state.

The extent of neuroticism is generally assessed using self-report measures, although peer-reports and third-party observation can also be used. Self-report measures are either lexical or based on statements. Deciding which measure of either type to use in research is determined by an assessment of psychometric properties and the time and space constraints of the study being undertaken.

Lexical measures use individual adjectives that reflect neurotic traits, such as anxiety, envy, jealousy, and moodiness, and are very space and time efficient for research purposes. Lewis Goldberg (1992) developed a 20-word measure as part of his 100-word Big Five markers. Saucier (1994) developed a briefer 8-word measure as part of his 40-word mini-markers. Thompson (2008) systematically revised these measures to develop the International English Mini-Markers which has superior validity and reliability in populations both within and outside North America. Internal consistency reliability of the International English Mini-Markers for the Neuroticism (emotional stability) measure for native English-speakers is reported as 0.84, and that for non-native English-speakers is 0.77.

Statement measures tend to comprise more words, and hence consume more research instrument space, than lexical measures. Respondents are asked the extent to which they, for example, “Remain calm under pressure”, or “Have frequent mood swings”. While some statement-based measures of neuroticism have similarly acceptable psychometric properties in North American populations to lexical measures, their generally emic development makes them less suited to use in other populations. For instance, statements in colloquial North American English like “Seldom feel blue” and “Am often down in the dumps” are sometimes hard for non-native English-speakers to understand.

Neuroticism has also been studied from the perspective of Gray’s biopsychological theory of personality, using a scale that measures personality along two dimensions: the behavioural inhibition system (BIS) and the behavioural activation system (BAS). The BIS is thought to be related to sensitivity to punishment as well as avoidance motivation, while the BAS is thought to be related to sensitivity to reward as well as approach motivation. Neuroticism has been found to be positively correlated with the BIS scale, and negatively correlated with the BAS scale.

Neuroticism has been included as one of the four dimensions that comprise core self-evaluations, one’s fundamental appraisal of oneself, along with locus of control, self-efficacy, and self-esteem. The concept of core self-evaluations was first examined by Judge, Locke, and Durham (1997), and since then evidence has been found to suggest these have the ability to predict several work outcomes, specifically, job satisfaction and job performance.

There is a risk of selection bias in surveys of neuroticism; a 2012 review of N-scores said that “many studies used samples drawn from privileged and educated populations”.

Neuroticism is highly correlated with the startle reflex in response to fearful conditions and inversely correlated with it in response to disgusting or repulsive stimuli. This suggests that Neuroticism may increase vigilance where evasive action is possible but promote emotional blunting when escape is not an option. A measure of the startle reflex can be used to predict the trait neuroticism with good accuracy; a fact that is thought by some to underlie the neurological basis of the trait. The startle reflex is a reflex in response to a loud noise that one typically has no control over, though anticipation can reduce the effect. The strength of the reflex as well as the time until the reflex ceases can be used to predict neuroticism.

Mental Disorder Correlations

Questions used in many neuroticism scales overlap with instruments used to assess mental disorders like anxiety disorders (especially social anxiety disorder) and mood disorders (especially major depressive disorder), which can sometimes confound efforts to interpret N scores and makes it difficult to determine whether each of neuroticism and the overlapping mental disorders might cause the other, or if both might stem from other cause. Correlations can be identified.

A 2013 meta-analysis found that a wide range of clinical mental disorders are associated with elevated levels of neuroticism compared to levels in the general population. It found that high neuroticism is predictive for the development of anxiety disorders, major depressive disorder, psychosis, and schizophrenia, and is predictive but less so for substance use and non-specific mental distress. These associations are smaller after adjustment for elevated baseline symptoms of the mental illnesses and psychiatric history.

Neuroticism has also been found to be associated with older age. In 2007, Mroczek & Spiro found that among older men, upward trends in neuroticism over life as well as increased neuroticism overall both contributed to higher mortality rates.

Mood Disorders

Disorders associated with elevated neuroticism include mood disorders, such as depression and bipolar disorder, anxiety disorders, eating disorders, schizophrenia and schizoaffective disorder, dissociative identity disorder, and hypochondriasis. Mood disorders tend to have a much larger association with neuroticism than most other disorders. The five big studies have described children and adolescents with high neuroticism as “anxious, vulnerable, tense, easily frightened, ‘falling apart’ under stress, guilt-prone, moody, low in frustration tolerance, and insecure in relationships with others,” which includes both traits concerning the prevalence of negative emotions as well as the response to these negative emotions. Neuroticism in adults similarly was found to be associated with the frequency of self-reported problems.

These associations can vary with culture: for example, Adams found that among upper-middle-class American teenaged girls, neuroticism was associated with eating disorders and self-harm, but among Ghanaian teenaged girls, higher neuroticism was associated with magical thinking and extreme fear of enemies.

Personality Disorders

A 2004 meta-analysis attempted to analyse personality disorders in light of the five-factor personality theory and failed to find meaningful discriminations; it did find that elevated neuroticism is correlated with many personality disorders.

Theories of Causation

Mental-Noise Hypothesis

Studies have found that the mean reaction times will not differ between individuals high in neuroticism and those low in neuroticism, but that, with individuals high in neuroticism, there is considerably more trial-to-trial variability in performance reflected in reaction time standard deviations. In other words, on some trials neurotic individuals are faster than average, and on others they are slower than average. It has been suggested that this variability reflects noise in the individual’s information processing systems or instability of basic cognitive operations (such as regulation processes), and further that this noise originates from two sources: mental preoccupations and reactivity processes.

Flehmig et al. (2007) studied mental noise in terms of everyday behaviours using the Cognitive Failures Questionnaire, which is a self-report measure of the frequency of slips and lapses of attention. A “slip” is an error by commission, and a “lapse” is an error by omission. This scale was correlated with two well-known measures of neuroticism, the BIS/BAS scale and the Eysenck Personality Questionnaire. Results indicated that the CFQ-UA (Cognitive Failures Questionnaire- Unintended Activation) subscale was most strongly correlated with neuroticism (r = .40) and explained the most variance (16%) compared to overall CFQ scores, which only explained 7%. The authors interpret these findings as suggesting that mental noise is “highly specific in nature” as it is related most strongly to attention slips triggered endogenously by associative memory. In other words, this may suggest that mental noise is mostly task-irrelevant cognitions such as worries and preoccupations.

Evolutionary Psychology

The theory of evolution may also explain differences in personality. For example, one of the evolutionary approaches to depression focuses on neuroticism and finds that heightened reactivity to negative outcomes may have had a survival benefit, and that furthermore a positive relationship has been found between neuroticism level and success in university with the precondition that the negative effects of neuroticism are also successfully coped with. Likewise, a heightened reactivity to positive events may have had reproductive advantages, selecting for heightened reactivity generally. Nettle contends that evolution selected for higher levels of neuroticism until the negative effects of neuroticism outweighed its benefits, resulting in selection for a certain optimal level of neuroticism. This type of selection will result in a normal distribution of neuroticism, so the extremities of the distribution will be individuals with excessive neuroticism or too low neuroticism for what is optimal, and the ones with excessive neuroticism would therefore be more vulnerable to the negative effects of depression, and Nettle gives this as the explanation for the existence of depression rather than hypothesizing, as others have, that depression itself has any evolutionary benefit.

Some research has found that neuroticism, in modern societies, is positively correlated with reproductive success in females but not in males. A possible explanation may be that neuroticism in females comes at the expense of formal education (which is correlated with lower fertility) and correlates with unplanned and adolescent pregnancies.

Terror Management Theory

According to terror management theory (TMT) neuroticism is primarily caused by insufficient anxiety buffers against unconscious death anxiety. These buffers consist of:

  • Cultural worldviews that impart life with a sense of enduring meaning, such as social continuity beyond one’s death, future legacy and afterlife beliefs, and
  • A sense of personal value, or the self-esteem in the cultural worldview context, an enduring sense of meaning.

While TMT agrees with standard evolutionary psychology accounts that the roots of neuroticism in Homo sapiens or its ancestors are likely in adaptive sensitivities to negative outcomes, it posits that once Homo sapiens achieved a higher level of self-awareness, neuroticism increased enormously, becoming largely a spandrel, a non-adaptive by-product of our adaptive intelligence, which resulted in a crippling awareness of death that threatened to undermine other adaptive functions. This overblown anxiety thus needed to be buffered via intelligently creative, but largely fictitious and arbitrary notions of cultural meaning and personal value. Since highly religious or supernatural conceptions of the world provide “cosmic” personal significance and literal immortality, they are deemed to offer the most efficient buffers against death anxiety and neuroticism. Thus, historically, the shift to more materialistic and secular cultures – starting in the Neolithic, and culminating in the industrial revolution, is deemed to have increased neuroticism.

Genetic and Environmental Factors

A 2013 review found that “Neuroticism is the product of the interplay between genetic and environmental influences. Heritability estimates typically range from 40% to 60%.” The effect size of these genetic differences remain largely the same throughout development, but the hunt for any specific genes that control neuroticism levels has “turned out to be difficult and hardly successful so far.” On the other hand, with regards to environmental influences, adversities during development such as “emotional neglect and sexual abuse” were found to be positively associated with neuroticism. However, “sustained change in neuroticism and mental health are rather rare or have only small effects.”

In the July 1951 article: “The Inheritance of Neuroticism” by Hans J. Eysenck and Donald Prell it was reported that some 80 per cent of individual differences in neuroticism are due to heredity and only 20 percent are due to environment….the factor of neuroticism is not a statistical artifact, but constitutes a biological unit which is inherited as a whole….neurotic predisposition is to a large extent hereditarily determined.

In children and adolescents, psychologists speak of temperamental negative affectivity that, during adolescence, develops into the neuroticism personality domain. Mean neuroticism levels change throughout the lifespan as a function of personality maturation and social roles, but also the expression of new genes. Neuroticism in particular was found to decrease as a result of maturity by decreasing through age 40 and then levelling off. Generally speaking, the influence of environments on neuroticism increases over the lifespan, although people probably select and evoke experiences based on their neuroticism levels.

The emergent field of “imaging genetics,” which investigates the role of genetic variation in the structure and function of the brain, has studied certain genes suggested to be related to neuroticism, and the one studied so far concerning this topic has been the serotonin transporter-linked promoter region gene known as 5-HTTLPR, which is transcribed into a serotonin transporter that removes serotonin. It has been found that compared to the long (l) variant of 5-HTTLPR, the short (s) variant has reduced promoter activity, and the first study on this subject has shown that the presence of the s-variant 5-HTTLPR has been found to result in higher amygdala activity from seeing angry or fearful faces while doing a non-emotional task, with further studies confirming that the s-variant 5-HTTLPR result greater amygdala activity in response to negative stimuli, but there have also been null findings. A meta-analysis of 14 studies has shown that this gene has a moderate effect size and accounts for 10% of the phenotypic difference. However, the relationship between brain activity and genetics may not be completely straightforward due to other factors, with suggestions made that cognitive control and stress may moderate the effect of the gene. There are two models that have been proposed to explain the type of association between the 5-HTTLPR gene and amygdala activity: the “phasic activation” model proposes that the gene controls amygdala activity levels in response to stress, whereas the “tonic activation” model, on the other hand, proposes that the gene controls baseline amygdala activity. Another gene that has been suggested for further study to be related to neuroticism is the catechol-O-methyltransferase (COMT) gene.

The anxiety and maladaptive stress responses that are aspects of neuroticism have been the subject of intensive study. Dysregulation of hypothalamic-pituitary-adrenal axis and glucocorticoid system, and influence of different versions of the serotonin transporter and 5-HT1A receptor genes may influence the development of neuroticism in combination with environmental effects like the quality of upbringing.

Neuroimaging studies with fMRI have had mixed results, with some finding that increased activity in the amygdala and anterior cingulate cortex, brain regions associated with arousal, is correlated with high neuroticism scores, as is activation of the associations have also been found with the medial prefrontal cortex, insular cortex, and hippocampus, while other studies have found no correlations. Further studies have been conducted trying to tighten experimental design by using genetics to add additional differentiation among participants, as well as twin study models.

A related trait, behavioural inhibition, or “inhibition to the unfamiliar,” has received attention as the trait concerning withdrawal or fear from unfamiliar situations, which is generally measured through observation of child behaviour in response to, for example, encountering unfamiliar individuals. This trait in particular has been hypothesized to be related to amygdala function, but the evidence so far has been mixed.

Age, Gender, and Geographic Patterns

A 2013 review found that groups associated with higher levels of neuroticism are young adults who are at high risk for mood disorders. Research in large samples has shown that levels of neuroticism are higher in women than men. Neuroticism is found to decrease slightly with age. The same study noted that no functional MRI studies have yet been performed to investigate these differences, calling for more research. A 2010 review found personality differences between genders to be between “small and moderate,” the largest of those differences being in the traits of agreeableness and neuroticism. Many personality traits were found to have had larger personality differences between men and women in developed countries compared to less developed countries, and differences in three traits – extraversion, neuroticism, and people-versus-thing orientation – showed differences that remained consistent across different levels of economic development, which is also consistent with the “possible influence of biologic factors.” Three cross-cultural studies have revealed higher levels of female neuroticism across almost all nations.

Geographically, a 2016 review said that in the US, neuroticism is highest in the mid-Atlantic states and southwards and declines westward, while openness to experience is highest in ethnically diverse regions of the mid-Atlantic, New England, the West Coast, and cities. Likewise, in the UK neuroticism is lowest in urban areas. Generally, geographical studies find correlations between low neuroticism and entrepreneurship and economic vitality and correlations between high neuroticism and poor health outcomes. The review found that the causal relationship between regional cultural and economic conditions and psychological health is unclear.

What are Maladaptive Schemas?

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Introduction

This is a list of maladaptive schemas, often called early maladaptive schemas, in schema therapy, a theory and method of psychotherapy.

An early maladaptive schema is a pervasive self-defeating or dysfunctional theme or pattern of memories, emotions, and physical sensations, developed during childhood or adolescence and elaborated throughout one’s lifetime, that often has the form of a belief about the self or the world.

Disconnection and Rejection

Abandonment/InstabilityThe belief system involving the sense that significant others will not be able to continue providing support, connection, strength, or protection because they are unstable, unpredictable, unreliable; because they will eventually die; or because they found someone better.
Mistrust/AbuseThe belief system involving the sense that others will intentionally hurt, abuse, humiliate, cheat, lie, manipulate, take advantage, or neglect.
Emotional DeprivationThe belief that one’s standard for emotional support will not be met by others.
Defectiveness/ShameThe belief that one is defective, bad, unwanted, inferior, or unworthy. This includes the fear of insecurities being exposed to significant others, accompanied by hypersensitivity to criticism, rejection, and blame.
Social Isolation/AlienationThe belief that one is isolated from other people; the feeling of not being a part of any groups.

Impaired Autonomy and Performance

Dependence/IncompetenceThe belief that one cannot handle daily responsibilities without the help of others.
Vulnerability to Harm or IllnessThe belief system involving the exaggeration of fear that catastrophe will strike at any time; the catastrophes may be medical, emotional, or external.
Enmeshment/Underdeveloped SelfThe belief system that one must please others at the expense of self or social development.
FailureThe belief that one will fail in everything.

Impaired Limits

Entitlement/GrandiosityThe belief that one is superior to others, which allows one to have special rights and privileges.
Insufficient Self-Control/Self-DisciplineThe conflict between life goals and low self control, perhaps seeking comfort instead of trying to perform daily responsibilities.

Other-Directedness

SubjugationThe belief that one should surrender control to others, suppressing desires in order to avoid anger, retaliation, or abandonment.
Self-SacrificeThe belief system involving excessive selflessness, focused on meeting the needs of others at the expense of one’s own desire.
Approval-Seeking/Recognition-SeekingThe desire to gain approval, recognition, or attention from other people at the expense of developing a secure and true sense of self.

Over-Vigilance/Inhibition

Negativity/PessimismThe belief system involving the overemphasis on the negative aspects of life including pain, death, loss, disappointment, conflict, guilt, resentment, unsolved problems, potential mistakes, betrayal, or things that could go wrong; neglecting positive aspects of life.
Overcontrol/Emotional InhibitionThe belief system involving the inhibition of actions, feelings, or communications to avoid negative consequences.
Unrelenting Standards/HypercriticalnessThe belief that one must strive to meet very high personal standards, usually to avoid criticism, leading to hypercriticalness toward self and/or others.
PunitivenessThe belief that people should face consequences for their mistakes.

What is Andy’s Man Club?

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Introduction

Andy’s Man Club is described as:

“a talking group, a place for men to come together in a safe environment to talk about issues and problems they have faced or are currently facing”.

Background

It was formed by Luke Ambler and his mother-in-law Elaine after his brother-in-law took his own life.

The club, with its slogan “it’s okay to talk”, started in early 2016 in Halifax with a first meeting of nine men. Since then, the group has expanded across the country and by February 2020 had over 800 men attending every week. Each group meeting is led by a volunteer “group facilitator” who has been trained by the organisation.

Other similar organisations have come to exist, some with a local focus and others with a national.

In 2021 they earned the Queens’s award for voluntary service.

Similar Charities

  • It’s tricky to talk.
  • Talk Club.
  • MenSpeak.
  • Men Walk Talk.
  • Proper Blokes Club.
  • It’s Worth Talking About.
  • Man-Down.

Locations

There are a variety of locations (as of November 2021):

  • Altrincham.
  • Batley.
  • Bradford.
  • Brighouse.
  • Dewsbury.
  • Doncaster.
  • Dundee.
  • Dunfermline.
  • Edinburgh.
  • Exeter.
  • Glenrothes.
  • Gosport.
  • Halifax Central.
  • Halifax North.
  • Hartlepool.
  • Hebden Bridge.
  • Huddersfield Ainley Top.
  • Huddersfield Central.
  • Hull Central.
  • Hull North.
  • Leeds East.
  • Leeds West.
  • Manchester.
  • Newton Abbot.
  • Oldham.
  • Perth.
  • Peterborough.
  • Plymouth.
  • Porthcawl.
  • Preston.
  • Rhondda.
  • Rochdale.
  • Rotherham.
  • Scarborough.
  • Sheffield.
  • Stafford.
  • St. Andrews.
  • Sunderland.
  • Torbay.
  • Wakefield.

What is the Samaritans (UK)?

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Introduction

Samaritans is a registered charity aimed at providing emotional support to anyone in emotional distress, struggling to cope, or at risk of suicide throughout Great Britain and Ireland, often through their telephone helpline.

Its name derives from the biblical Parable of the Good Samaritan although the organisation itself is non-religious. Its international network exists under the name Befrienders Worldwide, which is part of the Volunteer Emotional Support Helplines (VESH) with Lifeline International and the International Federation of Telephone Emergency Services (IFOTES).

Brief History

Samaritans was founded in 1953 by Chad Varah, a vicar in the Church of England Diocese of London. His inspiration came from an experience he had had some years earlier as a young curate in the Diocese of Lincoln. He had taken a funeral for a fourteen-year old girl who had killed herself because she feared she had contracted an STD. In reality, she was menstruating. Varah placed an advertisement in a newspaper encouraging people to volunteer at his church, listening to people contemplating suicide.

The movement grew rapidly: within ten years there were 40 branches and now there are 201 branches across the UK and Ireland helping many, deliberately organised without regard to national boundaries on the basis that a service which is not political or religious should not recognise sectarian or political divisions. Samaritans offers support through over 21,200 trained volunteers (2015) and is entirely dependent on voluntary support. The name was not originally chosen by Chad Varah: it was part of a headline to an article in the Daily Mirror newspaper on 07 December 1953 about Varah’s work.

In 2004, Samaritans announced that volunteer numbers had reached a thirty-year low, and launched a campaign to recruit more young people (specifically targeted at ages 18-24) to become volunteers. The campaign was fronted by Phil Selway, drummer with the band Radiohead, himself a Samaritans volunteer.

Chad Varah Breaks with Samaritans

In 2004, Varah announced that he had become disillusioned with Samaritans. He said, “It’s no longer what I founded. I founded an organisation to offer help to suicidal or equally desperate people. The last elected chairman re-branded the organisation. It was no longer to be an emergency service, it was to be emotional support”. One in five calls to Samaritans are from someone with suicidal feelings. Samaritans’ vision is that fewer people will die by suicide.

Services

The core of Samaritans’ work is a telephone helpline, operating 24 hours a day, 365 days a year. Samaritans was the first 24-hour telephone helpline to be set up in the UK. In addition, the organisation offers a drop-in service for face-to-face discussion, undertakes outreach at festivals and other outdoor events, trains prisoners as “Listeners” to provide support within prisons, and undertakes research into suicide and emotional health issues.

Since 1994, Samaritans has also offered confidential email support. Initially operating from one branch, the service is now provided by 198 branches and co-ordinated from the organisation’s head office. In 2011, Samaritans received over 206,000 emails, including many from outside the UK, and aims to answer each one within 24 hours. In 2009, Ofcom introduced the first harmonised European numbers for harmonised services of social value, allocating 116 123 to Samaritans. This number is free to call from mobiles and landlines. From 22 September 2015, Samaritans has promoted 116123 as their main number, replacing the premium rate 0845 number previously advertised.

In 2014, Samaritans received 5,100,000 calls for help by phone, email, text, letter, minicom, Typetalk, face-to-face at a branch, through their work in prisons, and at local and national festivals and other events.

Samaritans volunteers are given rigorous training, and as such they are non-judgmental, empathic and congruent. By listening and asking open questions, the Samaritans volunteers help people explore their feelings and work out their own way forward.

Samaritans does not denounce suicide, and it is not necessary to be suicidal to contact Samaritans. In 2014, nearly 80% of the people calling Samaritans did not express suicidal feelings. Samaritans believes that offering people the opportunity to be listened to in confidence, and accepted without prejudice, can alleviate despair and make emotional health a mainstream issue.

Media Guidelines

In 2013, following extensive consultation with journalists and editors throughout the industry, Samaritans produced a set of guidelines outlining best practice when reporting suicide. Since its publication, the organisation has received many awards in recognition of its work influencing the way in which suicide is reported.

Samaritans Radar

On 29 October 2014, Samaritans launched the Samaritans Radar app, which Twitter users could activate to analyse tweets posted by people they followed; it sent an email alert to the user if it detected signs of distress in a tweet. However, because Twitter users were not notified that their account was being monitored in this way, concerns were raised that the service could be abused by stalkers and internet trolls, who would instantly be made aware that an intended victim was potentially feeling vulnerable.

Following concerns, the service was suspended on 07 November 2014, nine days after launch. Joe Ferns, policy director for Samaritans, said in a statement: “We have made the decision to suspend the application at this time for further consideration”. He added: “We are very aware that the range of information and opinion, which is circulating about Samaritans Radar, has created concern and worry for some people and would like to apologise to anyone who has inadvertently been caused any distress. This was not our intention”. The app was later withdrawn completely.

Confidentiality

Samaritans have a strict code of caller confidentiality, even after the death of a caller. Unless the caller gives consent to pass on information, confidentiality will be broken only in rare circumstances, such as when Samaritans receives bomb or terrorism warnings, to call an ambulance because a caller appears to be incapable of making rational decisions for themselves, or when the caller is threatening volunteers or deliberately preventing the service being delivered to other callers.

In November 2011, the Board of Trustees UK agreed a motion breaking with confidentiality in the Republic of Ireland by agreeing, “To provide confidential support to children but report to the Health Service Executive any contacts (from either adults or children) where it appears a child is experiencing specific situations such as those that can cause them serious harm from themselves or others.” In 2011, Facebook collaborated with Samaritans to offer help to people in distress. This led to ‘cold case’ calling, which some believed was an infringement on people’s privacy. An Irish journalist wrote of her experience of receiving such a communication.

International Reach

Through its email service, Samaritans’ work has extended well beyond the UK and Ireland, as messages are received from all around the world.

Samaritans’ international reach is through Befrienders Worldwide, an organisation of over 400 centres in 38 countries offering similar activities. Samaritans took on and renamed the Befrienders International network in 2003, a year after it collapsed. Some members of Befrienders Worldwide also use the name Samaritans; this includes centres in the United States, India, Hong Kong, Serbia and Zimbabwe, among others.

The Volunteer Emotional Support Helplines (VESH) combines Samaritans (through Befrienders Worldwide) with the other two largest international services (IFOTES & Lifeline), and plans a combined international network of helplines. In their roles as emotional support service networks, they have all agreed to develop a more effective and robust international interface.

See also:

  • The Samaritans Hong Kong (Multilingual Service).
  • The Samaritan Befrienders Hong Kong.
  • Samaritans of Singapore.
  • Samaritans USA:
    • This was formed in 2005 when Samaritans of Boston (established 1974) joined forces with their Framingham branch.
    • Samaritans is also a certified member of Contact USA (a Lifeline International member).
    • There are Samaritans offices in other regions of Massachusetts and the US operating independently with a common mission and philosophy.

Similar Charities

A number of other helplines exist that offer a similar service to Samaritans. These are often aimed at a specific sector/group of people.

  • One example is Nightline:
    • A student-run listening and information services, based at universities across the country, offer a night time support service for students.
    • Each service is run specifically for students at a particular university/geographical area, and most Nightlines are members of the Nightline Association, a registered charity in England, Wales, and Scotland.
  • The NSPCC’s ChildLine service is similar to Samaritans in some ways:
    • NSPCC (National Society for the Prevention of Cruelty to Children) offers support for children only, but Samaritans supports both children and adults alike.
    • The NSPCC does not usually support adults.
  • Another example is Aware:
    • A national voluntary organisation, based in Ireland, which provides supports to individuals who experience depression with their families and friends.
    • It provides a Helpline service, as well as nationwide Support Groups and monthly lectures, which seek to educate and increase awareness of depression.

What is the Richmond Fellowship?

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Introduction

Richmond Fellowship is a charity and voluntary sector provider of mental health services in England.

Established in 1959, Richmond Fellowship serves over 9000 people in England every year, and offers a range of support to people with mental health problems including supported accommodation, residential care, employment support and community based support, working with the NHS and local authorities to deliver services.

Brief History

Richmond Fellowship was founded in 1959. The aim of the service was reintegrating people with mental ill health into the community despite long periods of time in hospital.

In 1973, Princess Alexandra became a patron of Richmond Fellowship and the organisation became a registered housing association in 1976. Richmond Fellowship played a significant role in hospital re-provision during the 1980s, providing new homes in the community for people across England. At this time Richmond Fellowship expanded its services for people with mental health problems including work schemes and day centres.

In 1975 the Richmond Fellowship opened a halfway house in Morriston, New Jersey. In 1985, the organisation expanded to Hong Kong.

Throughout the 1990s, Richmond Fellowship grew and developed a widespread programme of mental health support including self contained flats, floating community support and 24-hour nursed care. It achieved Investors in People status in 1998.

Continued growth saw Richmond Fellowship adapt its mission to ‘Making Recovery Reality’ in 2006 to reassert its core values and better represent the holistic range of support it offers to people with mental health problems.

In October 2015 Richmond Fellowship joined a new national group of charities, Recovery Focus, which brought together organisations with strong individual services, innovative approaches, flexible local presence and a wide range of expertise from around England. The partnership is made up of mental health charities Richmond Fellowship, 2Care, Croftlands Trust and My Time along with substance misuse charities Aquarius and CAN.

In April 2016, Helen Edwards was appointed the new group Chair of Recovery Focus, the group which brings together a coalition of mental health and substance use charities such as Richmond Fellowship and Aquarius.

Campaigns

Richmond Fellowship is an active member of Time to Change running awareness campaigns to tackle mental health stigma. Richmond Fellowship is also a supporter of the Mental Health Crisis Care Concordat and a member of the National Suicide Prevention Alliance.

What is Role Suction?

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Introduction

Role suction is a term introduced in the United States by Fritz Redl in the mid-20th century to describe the power of a social group to allocate roles to its members.

W.R. Bion’s group dynamics further explored the ways whereby the group (unconsciously) allocates particular functions to particular individuals in order to have its covert emotional needs met; and the process has recently been highlighted anew within the systems-centred therapy of Yvonne Agazarian.

Among regularly occurring group roles are those of the scapegoat for the group’s troubles; the joker; the peacemaker; the critic/spokesperson for group standards; the idol, or upholder of the group ideal; and the identified patient. In mixed gender groups, women may be disproportionately pressured by role suction into playing a nurturing/peacemaker role.

Refer to Karpman Drama Triangle.

Driving Forces

The ease whereby people pick out those who play complementary games, and the psychological splitting of good and bad help fuel such role differentiation.

Behind role suction, such forces as projective identification and countertransference have been singled out as operating at an unconscious level in the group.

Role lock – confirming mutual suction into complementary roles, such as victim and abuser – is ensured by the intermeshing of projective identifications.

Wider Systems

The British anti-psychiatrists explored the theme of group suction in connection with role attribution in the family nexus, as well as with the allocations of roles in the wider social system, David Cooper suggesting that ‘there are always good or bad, loved or hated ‘mothers’ and ‘fathers’, older or younger ‘brothers’ and ‘sisters’…in any institutional structure”.

A wider variety of roles can however be found in organisational life, the person-in-role acting as a container for the (unconscious) group forces.

Role of the Therapist

Bion has described his experience as a group therapist when he “feels he is being manipulated so as to be playing a part, no matter how difficult to recognise, in somebody else’s phantasy…a temporary loss of insight, a sense of experiencing strong feelings, and at the same time a belief that their existence is quite adequately justified by the objective situation”. Bion’s work has also been used to illustrate the part played by role suction in the selection of group leaders – dependent groups favouring narcissistic leaders, the fight/flight group paranoids.

R.D. Laing considered that a central part of the therapist’s job was “not to allow himself to collude with the patients in adopting a position in their phantasy-system: and, alternatively, not to use the patients to embody any phantasy of their own” – to resist role suction. Later therapists however have explored how a measure of adaptation to patients’ role suction – a degree of role responsiveness – can be a useful element in the therapeutic use of the countertransference.

Criticism

From the point of view of systems-centred therapy, the debate relates to the interface between a personal system and the psycho-dynamics of social systems themselves.

Debate has arisen about how far the group imposes roles, and how far the individual’s own personality goes to meet the group halfway. Earl Hopper has used the term personification to challenge Redl’s concept, suggesting instead that group roles reflect the underlying personality of the individual involved. However, Kibel objects that in many cases the roles imposed are in fact ego-dystonic; with others pointing to how personal tendencies combine with group expectations with varying degrees of fit.

What is Psychogenic Disease?

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Introduction

Psychogenic disease (or psychogenic illness) is a name given to physical illnesses that are believed to arise from emotional or mental stressors, or from psychological or psychiatric disorders.

Background

It is most commonly applied to illnesses where a physical abnormality or other biomarker has not yet been identified. In the absence of such biological evidence of an underlying disease process, it is often assumed that the illness must have a psychological cause, even if the patient shows no indications of being under stress or of having a psychological or psychiatric disorder. Examples of diseases that are believed by many to be psychogenic include psychogenic seizures, psychogenic polydipsia, psychogenic tremor, and psychogenic pain.

There are problems with the assumption that all medically unexplained illness must have a psychological cause. It always remains possible that genetic, biochemical, electrophysiological, or other abnormalities may be present which we do not have the technology or background to identify.

The term psychogenic disease is often used in a similar way to psychosomatic disease. However, the term psychogenic usually implies that psychological factors played a key causal role in the development of the illness. The term psychosomatic is often used in a broader way to describe illnesses with a known medical cause where psychological factors may nonetheless play a role (e.g. asthma can be exacerbated by anxiety).

What is Emotional Detachment?

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Introduction

In psychology, emotional detachment, also known as emotional blunting, has two meanings:

  • One is the inability to connect to others on an emotional level; and
  • The other is as a positive means of coping with anxiety.

This coping strategy, also known as emotion focused-coping, is used by avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalisation-derealisation disorder. It may also be caused by certain antidepressants. Emotional blunting as reduced affect display is one of the negative symptoms of schizophrenia.

Signs and Symptoms

Emotional detachment may not be as outwardly obvious as other psychiatric symptoms. Patients diagnosed with emotional detachment have reduced ability to express emotion, to empathise with others or to form powerful emotional connections. Patients are also at an increased risk for many anxiety and stress disorders. This can lead to difficulties in creating and maintaining personal relationships. The person may move elsewhere in their mind and appear preoccupied or “not entirely present”, or they may seem fully present but exhibit purely intellectual behaviour when emotional behaviour would be appropriate. They may have a hard time being a loving family member, or they may avoid activities, places, and people associated with past traumas. Their dissociation can lead to lack of attention and, hence, to memory problems and in extreme cases, amnesia. In some cases, they present an extreme difficulty in giving or receiving empathy which can be related to the spectrum of narcissistic personality disorder.

In children (ages 4-12 were studied), traits of aggression and antisocial behaviours were found to be correlated with emotional detachment. Researchers determined that these could be early signs of emotional detachment, suggesting parents and clinicians to evaluate children with these traits for a higher behavioural problem in order to avoid bigger problems (such as emotional detachment) in the future.

Causes

Emotional detachment and/or emotional blunting have multiple causes, as the cause can vary from person to person. Emotional detachment or emotional blunting often arises due to adverse childhood experiences, or to psychological trauma in adulthood.

Emotional blunting is often caused by antidepressants in particular selective serotonin reuptake inhibitors (SSRIs) used in major depressive disorder, and often as an add-on treatment in other psychiatric disorders.

Behavioural Mechanism

Emotional detachment is a behaviour which allows a person to react calmly to highly emotional circumstances. Emotional detachment in this sense is a decision to avoid engaging emotional connections, rather than an inability or difficulty in doing so, typically for personal, social, or other reasons. In this sense it can allow people to maintain boundaries, psychic integrity and avoid undesired impact by or upon others, related to emotional demands. As such it is a deliberate mental attitude which avoids engaging the emotions of others.

This detachment does not necessarily mean avoiding empathy; rather, it allows the person to rationally choose whether or not to be overwhelmed or manipulated by such feelings. Examples where this is used in a positive sense might include emotional boundary management, where a person avoids emotional levels of engagement related to people who are in some way emotionally overly demanding, such as difficult co-workers or relatives, or is adopted to aid the person in helping others.

Emotional detachment can also be “emotional numbing”, “emotional blunting”, i.e., dissociation, depersonalisation or in its chronic form depersonalisation disorder. This type of emotional numbing or blunting is a disconnection from emotion, it is frequently used as a coping survival skill during traumatic childhood events such as abuse or severe neglect. Over time and with much use, this can become second nature when dealing with day to day stressors.

Emotional detachment may allow acts of extreme cruelty and abuse, supported by the decision to not connect empathically with the person concerned. Social ostracism, such as shunning and parental alienation, are other examples where decisions to shut out a person creates a psychological trauma for the shunned party.

What is a Mental Health Trust (UK)?

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Introduction

A mental health trust provides health and social care services for people with mental health disorders in England.

There are 54 mental health trusts. They are commissioned and funded by clinical commissioning groups (CCG).

Patients usually access the services of mental health trusts through their general practitioner (GP; primary care medical doctor) or via a stay in hospital. Most of the services are for people who live in the region, although there may be specialist services for the whole of the UK or services that accept national referrals. Mental Health Trusts may or may not provide inpatient psychiatric hospital services themselves (they may form part of a general hospital run by a hospital trust). The various trusts work together and with local authorities and voluntary organisations to provide care.

Services

Services provided by mental health trusts vary but typically include:

  • Counselling sessions – one-to-one or in a group.
  • Courses – such as on how to deal with stress, anger, and bereavement. Courses may also be available for carers of those with mental health disorders.
  • Resources – such as leaflets and books on mental health issues.
  • Psychotherapy – treatment sessions with a therapist. Commonly cognitive behavioural therapy.
  • Family support – providing support to the family, friends, and carers of those with a mental health problem.
  • Community drug and alcohol clinics – helping people to cope with addiction.
  • Community mental health houses – supported housing to help people live in the community.
  • Day hospitals and day centres – short-term outpatient sessions with a psychiatrist, clinical psychologist or other mental health professional, and drop-in centres for peer support and therapeutic activities.

If more specialist hospital treatment is required, Mental Health Trusts will help with rehabilitation back into the community (social inclusion). Trusts may operate community mental health teams, which may include Crisis Resolution and Home Treatment, assertive outreach and early intervention services.

The Mental Health Act 1983, Mental Health Act 2007 and Mental Capacity Act 2005 cover the rights, assessment and treatment of people diagnosed with a mental disorder who are judged as requiring to be detained (“sectioned”) or treated against their will. A mental health trust will typically have a Mental Health Act team responsible for ensuring that the Act is administered correctly, including to protect the rights of inpatients, or of service users in the community who may now be under community treatment orders. The Care Quality Commission is the body with overall national responsibility for inspecting and regulating the operation of the mental health act by the regional trusts.

Capacity

According to the British Medical Association (BMA) the number of beds for psychiatric patients was reduced by 44% between 2001 and 2017. An average of 726 mental health patients were placed in institutions away from their home area in 2016.

Children of school age are normally treated through Child and Adolescent Mental Health Services (CAMHS), usually organised by local government area. Young people who become psychiatric in-patients frequently are treated in adult wards due to lack of beds in wards that are suitable for people of their ages. Young people frequently stay in hospital wards when they are fit for discharge because the mental health support facilities they need are not available where they live.

List of MHTs
These are the mental health trusts in the NHS in England in 2017 (note that many have NHS Foundation Trust status – a type of trust that has more independence from government):

  • 2gether NHS Foundation Trust.
  • 5 Boroughs Partnership NHS Foundation Trust.
  • Avon and Wiltshire Mental Health Partnership NHS Trust.
  • Barnet, Enfield and Haringey Mental Health NHS Trust.
  • Berkshire Healthcare NHS Foundation Trust.
  • Birmingham and Solihull Mental Health NHS Foundation Trust.
  • Bradford District Care Trust.
  • Cambridgeshire and Peterborough NHS Foundation Trust.
  • Camden and Islington NHS Foundation Trust.
  • Central and North West London NHS Foundation Trust.
  • Cheshire and Wirral Partnership NHS Foundation Trust.
  • Cornwall Partnership NHS Foundation Trust.
  • Coventry and Warwickshire Partnership NHS Trust.
  • Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
  • Derbyshire Healthcare NHS Foundation Trust.
  • Devon Partnership NHS Trust.
  • Dorset HealthCare University NHS Foundation Trust.
  • Dudley and Walsall Mental Health Partnership NHS Trust.
  • East London NHS Foundation Trust.
  • Greater Manchester Mental Health NHS Foundation Trust.
  • Humber NHS Foundation Trust.
  • Isle of Wight NHS Trust.
  • Kent and Medway NHS and Social Care Partnership Trust.
  • Lancashire Care NHS Foundation Trust.
  • Leeds and York Partnership NHS Foundation Trust.
  • Leicestershire Partnership NHS Trust.
  • Lincolnshire Partnership NHS Foundation Trust.
  • Mersey Care NHS Trust.
  • Norfolk and Suffolk NHS Foundation Trust.
  • North East London NHS Foundation Trust.
  • North Essex Partnership University NHS Foundation Trust.
  • North Staffordshire Combined Healthcare NHS Trust.
  • Northamptonshire Healthcare NHS Foundation Trust.
  • North Cumbria Integrated Care NHS Foundation Trust.
  • Nottinghamshire Healthcare NHS Trust.
  • Oxford Health NHS Foundation Trust.
  • Oxleas NHS Foundation Trust.
  • Pennine Care NHS Foundation Trust.
  • Rotherham Doncaster and South Humber NHS Foundation Trust.
  • Sheffield Health & Social Care NHS Foundation Trust.
  • Somerset Partnership NHS Foundation Trust.
  • South Essex Partnership University NHS Foundation Trust.
  • South London and Maudsley NHS Foundation Trust.
  • South Staffordshire and Shropshire Healthcare NHS Foundation Trust.
  • South West London and St George’s Mental Health NHS Trust.
  • South West Yorkshire Partnership NHS Foundation Trust.
  • Southern Health NHS Foundation Trust.
  • Surrey and Borders Partnership NHS Foundation Trust.
  • Sussex Partnership NHS Foundation Trust.
  • Tavistock and Portman NHS Foundation Trust.
  • Tees, Esk and Wear Valleys NHS Trust.
  • West London NHS Trust.
  • Worcestershire Health and Care NHS Trust.