Blog

Here it comes — another email about “physician wellness,” advertising mindfulness training, an ice cream social, or a volunteer day. As a psychiatrist, I can attest to the importance of tending to one’s own mental and physical health in order to strive for wellness. However, the trend of implementing physician wellness programs throughout the U.S. […]

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A little ways back, I was at a gathering of friends and family and was in the kitchen setting out a dish of black bean and quinoa dip. Suddenly, I heard someone from behind me exclaim: “What is that? If that’s something healthy, I am not eating it.” Although somewhat intended as a joke, there […]

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We have all seen and heard the story: a patient who is overweight and has heart problems (or arthritis, diabetes, low back pain or any number of other chronic conditions) is told by their doctor that they need to exercise. The patient agrees, “Yes, I really will try to start an exercise program.” Six months […]

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I first noticed this phenomenon while watching the world news on a weekday after work.  It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life.  How different this was from my day in the wound clinic, where I saw patient after patient with obesity, […]

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It’s no doubt that the health care conundrum our nation is facing is fraught with high-risk hypotheses and their unpalatable consequences. Complicating this further is the business-minded nature of many lobbyists and policy-makers influencing our government’s decisions, including President Trump’s. This is particularly timely given the recent executive orders Mr. Trump has unilaterally implemented that […]

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Until genuine rights are extended to all patients, the ongoing health-care-reform saga perpetrated by Congress and executive leadership will continue to fail the American people. Many Americans have suffered and died because of a broken health-care-delivery system. One of us lost a 19-year old son due to lack of certain patient rights – specifically the […]

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes […]

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Diana Feliz Oliva, a 45-year-old transgender woman who grew up outside Fresno, Calif., remembers being bullied when she was younger and feeling confused about her gender identity. She was depressed and fearful about being found out, and she prayed every night for God to take her while she slept. “I was living in turmoil,” said […]

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Polly Ross, 32, was allowed the leave unit in Hull to buy cigarettes despite having made many earlier suicide attempts

A mother who killed herself while suffering from postnatal depression died as a result of a “very serious failure” that allowed her to leave a mental health unit unchaperoned, a coroner has ruled.

Despite having made multiple attempts to kill herself, 32-year-old Polly Ross was allowed to leave the Westlands mental health unit in Hull at about 8.30am on 12 July 2015, telling nurses that she was going to buy cigarettes. She was hit by a train at 11.10am and died instantly.

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We’d like to speak to people who have suffered serious loneliness in the past, but have found ways to reconnect

There’s no doubt loneliness is a serious problem – in 2014, Britain was named the loneliness capital of Europe, with a significant proportion of us having no one to rely on in a crisis, and suffering from a lack of friends and contacts in our local area. It’s an issue that affects people of all ages, races and classes, and can have serious consequences for both our mental and physical health.

Related: Loneliness is harming our society. Your kindness is the best cure | Rachel Reeves

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More than a quarter of new fathers in a new study showed significant levels of depression – what are the causes, and what can they do about it?

Men don’t go through pregnancy or childbirth. Their hormone levels don’t nosedive. They don’t get sore nipples. What exactly have they got to be depressed about? Quite a lot, according to research from Sweden showing that, over the past 10 years, a significant number of men have struggled with the transition to fatherhood.

This latest research tries to quantify just how many men get postnatal depression. Previous studies have found between 4% and 10% of men, while, in this smallish sample of 447 Swedish fathers who volunteered (and may therefore not represent your average dad), a surprising 28% of men had symptoms that scored above mild levels of depression. Overall, 4% had moderate depression. Fewer than one in five fathers who were depressed sought help, even though a third of those had thought about harming themselves. While women in the UK are often asked a series of questions that screen for postnatal depression (which affects up to 13% of women), the mental health of fathers is rarely assessed.

Related: Postnatal depression less...

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The former Newcastle and England striker’s investigation into links between brain damage and heading the ball is fascinating yet inconclusive. Plus: more Blue Planet II and The Queen’s Favourite Animals

In comes the cross from the right: who’s there for it? Alan Shearer, who else. Unchallenged, he braces himself, heads the ball cleanly, down to his left, the net bulges, goal!

So now he’s presumably going to peel away towards the corner flag, with a Cheshire cat grin and his right arm raised, palm open, while adoring black-and-white-clad geordies chant: “Shearer, Shearer!”

Related: Football is heading for trouble over brain injuries caused by the ball

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Thousands treated away from home region in practice seen as expensive and potentially harmful to vulnerable people

Mental health trusts are being forced as part of an NHS England crackdown to reveal how many patients they are sending elsewhere for treatment because they have too few beds.

Health service bosses want to compel the 54 NHS mental health trusts in England to start publishing details every month on the number of adults they have to arrange inpatient care for outside their own area.

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Colette McCulloch was hit by a lorry last year while in the care of a private residential home – her mother and father say a full inquest is needed

A grieving family has demanded the replacement of the coroner investigating the death of their autistic daughter, who they say was let down by the authorities charged with keeping her safe.

Colette McCulloch, who had high-functioning autistic spectrum disorder, died aged 35 after being hit by a lorry while walking along a dual carriageway in the early hours of the morning of 28 July 2016. Diagnosed with anorexia and OCD as a child, her autism wasn’t discovered until she was 33.

Related: MPs urge action on lengthy wait for autism diagnosis

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It was the oldest asylum in the Balkans. Now the doors are unlocked and patients are living new lives in the community

High walls still surround the oldest asylum in the Balkans, an 18th-century building pocked with the artillery scars of last century’s civil war, but the gates are no longer locked. Handles have been replaced on internal doors and bars removed from windows.

“The jail,” said Darko Kovaoic, a 53-year-old poet with schizophrenia who lives here, “has broken open.”

‘Love was not allowed in the institution. Now we are outside we have our own keys and take a bus. We are happy’

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A specialist NHS centre in London is helping thousands of young people who are having difficulties with gender identity

At a time when transgender issues occupy the centreground of today’s culture wars, a clinic in an unpreposessing 1920s office block in north-west London has found itself on the frontline.

The Gender Identity Development Service (GIDS), based at the Tavistock and Portman NHS foundation trust, is the only NHS-run clinic that specialises in helping young people experiencing difficulties with their gender identity.

It is a gender identity service, not a gender transition service. Many children will benefit from talking therapies

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There are good reasons to be cautious about a new study claiming computer-based training can reduce the risk of dementia. But what does work?

More than 30 million people worldwide live with Alzheimer’s disease, and while researchers are pushing hard to find a cure, their efforts so far have met with failure. With no effective treatment on the horizon, prevention has become the only game in town. But what can be done to reduce the risk of dementia, now the leading cause of death in England and Wales?

In research published on Thursday, US scientists claim that a form of computer-based brain training can reduce the risk of dementia by 29%. The training was designed to speed up people’s visual information processing, for example by having them spot a car on a screen, and a truck on the periphery of their vision, at the same time. Those who are claimed to have benefited trained for an hour, twice a week, for five weeks, and some went on to have booster sessions at the end of the first and third years. To see if the training made any difference, the participants sat tests up to 10 years later.

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A study says that anorexic people feel less to blame for their condition after reading feminist theory. In my case, I have Susie Orbach to thank

According to a new study, feminist theory can help treat anorexia. That comes as no surprise to me, based on my own experience of trying to vanish, one skipped meal at a time. Researchers at the University of East Anglia trialled a 10-week programme with seven inpatients at a centre in Norwich. They used Disney films, social media, news articles and adverts to talk about the social expectations and constructs of gender, how we view women’s bodies and how we define femininity. They spoke about the way we portray appetite, hunger and anger, as well as the ways we objectify women’s bodies.

Researchers published a paper in the journal Eating Disorders that suggested patients improved because they felt less to blame for their own condition. This makes complete sense. When I was 15 years old, I spent six weeks in an eating disorders clinic in Sydney. Staring at those pallid pistachio-coloured walls on my own in a cell-like room, I felt as though I may never recover. My emaciated companions and I were under the care of a former prison warden...

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Choir members, including people with mental health problems, say their wellbeing and connectedness have improved since singing together

“I think there’s something physical about singing in a choir that does you good,” says Kaye Brown*. “For me it’s coming together, and the wellbeing I feel as a result of it. There’s a general improvement in my mental health. I feel better for singing.”

Brown, who is in her 60s and has a history of depression, anxiety and obsessive compulsive disorder, has been a member of the HarmonyChoir in Edinburgh since it began over a year ago. The choir was originally started by Liesbeth Tip, a clinical psychologist who is doing a PhD at the University of Edinburgh, as a two-month research project to explore the impact of singing on wellbeing and views of mental health. Due to popular demand, it is still going.

What I find great is that we had no idea what it was going to be like and we’re quite good

Related: 'Without this, I would have killed myself': gardening helps heal refugees' trauma

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Charity helping people suffering from anorexia and bulimia reveals people waiting up to five years to start treatment

People with an eating disorder are waiting as long as five years to start treatment on the NHS, putting their recovery in peril, according to a report.

Beat, a charity which helps people suffering from anorexia and bulimia, warns that delays to access vital care can have a “devastating” impact on those with eating disorders.

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A new study claims a link between screen time and increased rates of depression and suicide in US teens. But what do the data actually say? And how can we move towards a more rational debate about digital technology?

Screen time is one of the more divisive contemporary issues in psychological science. In a sense, this is no surprise – smartphone use, particularly among children and adolescents, has consistently increased in recent years. And as with any new form of disruptive technology, there are questions around what constitutes healthy and maladaptive use, both at an individual and societal level.

The problem with the debate about screen time, however, is that very often the arguments devolve into overly-simplistic scaremongering claims. This peaked back in August, with the publication of an opinion piece in the Atlantic by Jean Twenge, professor of psychology at San Diego State University. Under the headline Have Smartphones Destroyed a Generation?, Twenge argued that teenagers are on the verge of a catastrophic mental health crisis, and the culprit was the smartphone.

Related: Screen time guidelines need to be built on evidence, not hype

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Dear alternative medicine, Hi, it’s HD again. You may remember me from the last time we entered the squared circle, “Endocrinology vs. Naturopathy: Steel Cage Death Match.” I had hoped that you might internalize a couple of the lessons I tried to teach you: “Know your assay” and “know your pre-test probability” — but, shocker, […]

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Brain-computer interface (BCI) has been a topic of interest for several decades, and many discoveries have been made. The role of BCI has been monumental and significantly impactful in the field of medicine. It has been gaining much progress in recent decades with inventions such as the encephalophone, in which a person can create music […]

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old man is evaluated for a 2-month history of upper abdominal discomfort after eating. He has recently returned from working in a rural area of a developing country. He takes no medications. There is no family history of esophageal or […]

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Have you ever wondered why your computer often shows you ads that seem tailor-made for your interests? The answer is big data. By combing through extremely large datasets, analysts can reveal patterns in your behavior. A particularly sensitive type of big data is medical big data. Medical big data can consist of electronic health records, […]

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During a 15-minute recess, the elementary school students trooped from the playground toward nurse Catherin Crofton’s office — one with a bloody nose, a second with a scraped knee and a third with a headache. Kids quickly filled a row of chairs. Staffers brought paper towels for the bleeders and tried to comfort the crying. […]

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I have written about both issues before: freestanding ERs and retail clinics. Two recent studies continue to show how useless they both are in helping create a better more efficient health care system. The freestanding ER study  examined the number of these facilities and population characteristics where they locate. They identified 360 freestanding ERs, mostly in Texas, […]

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Personal Independence Payments – the points-based system for disability claims – only works for people with physical disabilities, say campaigners. We meet some of those who feel they have slipped through the net

Kloey Clarke, 28, from Devizes in Wiltshire, has had severe anxiety and type II bipolar disorder for six years. “I’m scared to leave the house,” says Clarke, who does not feel emotionally or physically stable enough to hold down a job and relies on her husband for care and support. “I have a constant fear of dying. I can’t socialise and I can’t communicate outside [the house].” For four years, Clarke depended on a Disability Living Allowance (DLA). The DLA was replaced by Personal Independence Payments (PIPs) in 2012 – and phased in from 2013 – but she was receiving them for less than a year before she was reassessed by the Department for Work and Pensions (DWP) and told she no longer qualified.

Clarke believes that the assessment for PIP is aimed at people with physical disabilities and does not account for mental illness. “I was asked if I could walk 200 metres unaided. No, I don’t need a stick or an aid, but I do need my husband or someone with me. Can I talk to...

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Delayed report recommends broad reforms to police, justice system and health service in England and Wales to cut risk of death

Far-reaching reforms to the police, justice system and health service in England and Wales are needed to reduce the risk of people dying in custody, a long-delayed report has concluded.

The report, ordered by Theresa May in 2015 while she was home secretary, contains 110 recommendations for overhauling the way in which the police and health authorities deal with vulnerable people, and how the police complaints watchdog investigates such incidents when they occur.

Related: Mental health services are in crisis and we police struggle to pick up the slack

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Ignoring the body’s natural rhythms can affect our physical and mental wellbeing – and even the outcome of surgery

Our bodies have many clocks that control sleep, health and performance. If we do things at the wrong times, there can be dangerous consequences. This year’s Nobel prize was awarded to the three scientists who discovered the key genes in circadian (24-hour) body clocks. Their discovery enabled other scientists to discover the thousands of circadian times that control our health, our genes and even when we should have treatments: it can make the difference between life and death.

Major heart surgery is common, but fraught with dangers. The most significant is the magnitude and duration of interrupting and restarting the body’s oxygenated blood supply. On Friday a study was published on the complications arising from morning and afternoon heart surgery. The time of surgery made a significant difference: 54 (out of 298) patients who had surgery in the morning experienced complications (18% of all patients) compared to 28 (of 298) patients who had surgery in the afternoon (9%). Heart surgery appears to be safer in the afternoon.

The links between mental health problems and...

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According to Age UK, half of adults over 55 have experienced common mental health problems. The good news is the stiff-upper-lip approach to problems is breaking down – now all we need are widely available treatments and facilities

I’m getting increasingly frightened lately. About anything and everything, whether it’s happening or not, because I’m sure it will. Especially when I’m awake at night, feeling sick and sweaty and knowing for certain that the worst will happen. Perhaps my mental health is a bit dicey. Why not? I’m getting on and, according to Age UK, half of adults over 55 have experienced common mental health problems, often depression and anxiety.

No surprise there, then. We have plenty to be browned off or petrified about. Here I am, 75, with numerous chums going down like ninepins, struck with horrible illnesses, or, if we manage to keep going, there’s the looming possibility of dementia, or relegation to a nursing home, like the two friends I visited last week. Or nuclear war. Or I may drop dead, just like that.

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Psychiatric diagnosis must serve an ethical purpose: relieving certain forms of suffering and disease. Science alone can’t do that

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

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

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

Related: Why it's time to investigate the overlap between autism and ADHD

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Psychologist leading response says at least 11,000 people may have been affected, and that 1,300 have already been seen

The mental health response following the Grenfell Tower fire is the biggest operation of its kind in Europe, a doctor has said, with the number of people affected likely to exceed 11,000.

The unprecedented need following the blaze has transformed the Central and North West London NHS Trust (CNWL) into “the largest trauma service in the UK”, according to Dr John Green, the psychologist leading the mental health response to the tragedy.

Related: Mental health services are in crisis and we police struggle to pick up the slack

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The Line of Duty star knew she had to take on a new role after her grandmother was diagnosed

When the Bafta award-winning actress Vicky McClure agreed to open a small fundraising event for dementia seven years ago, she knew very little about the condition. A year later, her grandmother was diagnosed with it and the suffering it caused over the next three years had a far-reaching impact on McClure, best known for her role as detective sergeant Kate Fleming in the BBC police drama Line of Duty.

McClure, 34, from Nottingham, is now using her experience, personally and professionally. She supports the Alzheimer’s Society charity, attending its annual Memory Walks that raise millions across the country. And she has appeared in dementia-friendly theatre performances. There is even a hint she is creating her own drama on the subject.

Related: Vicky McClure webchat – your questions answered on fry ups, Motown and Shane Meadows

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Ajibola Lewis, whose son died in a hospital in London, supports Labour MP’s bill requiring record-keeping on use of force

The mother of a man who died after prolonged restraint by police in a mental health hospital has given her support to a bill to make police and medics more accountable for the use of force against patients.

Ajibola Lewis, whose son Olaseni died after he was subjected to what an inquest described as “disproportionate and unreasonable” restraint at Bethlem Royal hospital in London, said if the new law could help other vulnerable people then her son’s death would not have been in vain.

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Stressed? Depressed?The medical magazine show urged us to get out in the fresh air and eat our greens. Plus: culinary delights on the Italian coast

Last night’s Trust Me, I’m a Doctor (BBC2) gave us a special edition on the great (non-political, at least not directly) concern of our age: mental health.

The format remained the same – a sort of medical magazine show, whizzing through various aspects of a condition – the speed and superficiality of which approach is mitigated, at least somewhat, by the fact that everything on screen represents the distilled essence of the current state of research on the issue. Experts of various kinds present. Last night it was Michael Mosley (who trained in psychiatry before turning to medical journalism), surgeon Gabriel Weston, geneticist Dr Giles Yeo, GP Dr Zoe Williams and psychiatrist Dr Alain Gregoire and his moustache. I have to mention the moustache. It is a really big moustache – a statement moustache – and I would be inclined to put Dr Gregoire on the couch himself to find out what exactly he thinks it is saying. A documentary for another time, perhaps.

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Readers reacted to Emma Freud’s article on regret with emotion, humour and a deep sense of introspection

Regrets: we’ve all had a few. When Guardian columnist Emma Freud explored themes of regret spoken about on social media – with “devastating honesty” – we received thousands of responses in the comments.

Related: What is your biggest regret? Here are people's devastatingly honest answers

Not telling my husband more often when he was alive just how much I loved him. I mean, he absolutely knew, but however often I tell it to his photo now, it's hardly the same.

Hurting my wife when I had a stupid affair with a girl way younger than me.I was completely thick and thought what I had was not enough,I very nearly lost everything.Its taken me 10 years to regain my wifes trust and for her to not want to kill me for the hurt I caused her.
i have 2 children who are now adults I would never have that bond or love that I have now if I"d left.I've ended up with a loving family which I had along.1 friend pointed me in the right direction.

The night I screamed "You're a piece of shit" to the only man I ever loved, and probably the only one who ever loved me. I was just drowning in personal...

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From Trump’s tweets to EU uncertainty and the threat of nuclear war, the stress-inducing headlines keep coming. Therapists share tips on how to cope

In the immediate aftermath of the EU referendum and the US presidential election, it became common, on the losing side, to compare the experience to a death in the family. First came the punch to the gut, the thunderbolt of disbelief. Then came the days when you would find yourself going about your business as if nothing untoward had happened, only to recall, each time with a fresh wave of nausea, that it had.

In one major respect, however, this analogy has turned out to be wrong. By this point, following a “normal” bereavement, you might expect the process of recovery to be underway. The wound may never heal, but things reorder themselves around the injury and life moves on. To put it mildly, this is not how things seem to be unfolding on the leafy Greenwich Village block in New York where Paul Saks keeps his consulting room.

Before, we thought: ‘We’ll hang in and governments will sort things out.’ Now, it’s clear governments aren’t doing that

All this is greatly exacerbated by social media, which makes every new development, however...

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As a trial for a radical schizophrenia treatment begins, the link between biological factors and some mental illnesses is becoming clearer than ever

Descartes’s notion of dualism – that the mind and body are separate entities – is wrong, but has proved surprisingly persistent, and until recently dominated attempts to understand mental illness. When the brain stopped working properly, a psychological origin was sought.

Undoubtedly, life’s experiences and our personalities shape the way our brains function. But there is now a compelling body of evidence that brain disorders can also originate from things going awry in our basic biology.

Related: Radical new approach to schizophrenia treatment begins trial

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Exclusive: as evidence emerges that schizophrenia could be an immune system disease, two-year trial will use antibody drug currently used for MS

British scientists have begun testing a radically new approach to treating schizophrenia based on emerging evidence that it could be a disease of the immune system.

The first patient, a 33-year old man who developed schizophrenia after moving to London from Cameroon a decade ago, was treated at King’s College Hospital in London on Thursday, marking the start of one of the most ambitious trials to date on the biology of the illness and how to treat it.

Related: Recognising that mind and body are not separate opens door for new treatments

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I am plagued by a sense that my loneliness might be terminal and that love and romance will pass me by. Annalisa Barbieri advises a reader

My relationship with my girlfriend, whom I met as an undergraduate at university, ended a few years ago, largely because of mental health issues I was going through. It was my first and, to date, only relationship and lasted less than two years. I was devastated for a long time.

Since then, I have recovered from the psychological problems I was having. I have worked in a lot of jobs, got an MA and moved to a small town to complete a PhD on a topic that I am passionate and excited about. For the first time in a while, I am cautiously optimistic about my future.

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Was it conceived as a necessary bulwark to a moribund, failing capitalism, or is it an active creator of destitution, or something to be cherished? Guardian readers discuss

Comforting as it may be to think otherwise, the welfare state was not conceived as a gesture of munificent goodwill to the indigent, or even as a system from which we all benefit, but as a necessary bulwark to a moribund, failing capitalism (The ‘welfare state’ should be something to be proud of, 1 November). It was a preventive measure against revolution and rooted in the politics of the day. Well-educated, well-housed and healthy workers were likely to be not only less radical but also more productive. Supported by policies aimed at maintaining full employment, the social security system was mainly intended to bridge the short gaps between periods of employment, its costs met by a system of national insurance.

There was also a measure of synergy in the system. Educated and secure workers were less likely to be unhealthy. They were even likely to be more thoughtful, knowledgeable consumers, wary of the wiles of the marketplace and its purveyors of snake oil. So those great props of the welfare state –...

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As policy experts cling to pay-for-performance (P4P) as an indicator of health care quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark.  At first, glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job.  Unfortunately, the parental vaccine hesitancy trend […]

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Medical care and understanding have changed since separation of physical and mental health made much sense. We know now that mental state and internal physiology influence one another and that social factors affect disease risk more powerfully than genetic ones. Still, as a health care system, we perpetuate a culture of division, and limit our capacity to help people […]

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Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week — eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93. If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes […]

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I have spent three days at the Society to Improve Diagnosis in Medicine. Whenever I come to this meeting, I have insights from listening to talks and many conversations with leaders in the field. When one considers diagnostic errors, one must consider two important factors: physician factors and system factors. We have a major system […]

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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly […]

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Long ago, I represented a doctor who was … difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy — not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about two years from the […]

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NSPCC reports 15% rise in calls to children’s helpline as concerns grow over long waiting times for mental health services

A children’s helpline conducted more than 60 counselling sessions on suicide every day last year with children as young as 10 reporting suicidal thoughts, according to the NSPCC children’s charity.

The figures from Childline represent a 15% increase on the previous year.

Related: Judge attacks mental health provision after approving care plan for suicidal girl

Related: I almost lost my daughter because of her mental health problems

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Mike Adamson would like to see more services that prevent, reduce and delay loneliness, and Susan Daniels says it is not just a problem for older people

We welcome the focus given by Professor Helen Stokes-Lampard on the toll that loneliness is placing on our healthcare system (Loneliness as harmful as diabetes, says top GP, 12 October).

Every day our staff and volunteers see the devastating impact that social isolation is having on people’s lives, and the additional strain placed on our public services when these impacts are left untreated.

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About this site

Mental health is a level of psychological well-being, or an absence of a mental disorder; it is the "psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment".