What about the mental health of kids with intellectual disability?

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By Richard Hastings, University of Warwick; Bruce Tonge, Monash University; Glenn Melvin, Monash University; Kylie Gray, Monash University, and Vaso Totsika, University of Warwick

High-quality epidemiological research shows children and adolescents with intellectual disability are four times more likely to have diagnosable mental health problems compared to others their age. This mental health inequality clearly needs attention.

Part of the problem is a process called diagnostic overshadowing: symptoms are incorrectly assumed to be related to the child’s disability rather than an underlying mental health issue. This often makes it difficult to identify mental health problems in children with intellectual disability.

After we account for the impact of diagnostic overshadowing through the use of specialised assessment tools, Australian research shows over 40% of children with intellectual disability have mental health problems that may be serious enough to lead to a psychiatric diagnosis.

The importance of early intervention

Birth cohort studies follow the development of groups of children that are representative of the population. Data from such studies in the United Kingdom and Australia show the inequality in mental health between children with intellectual disability and those without emerges early.

By the time children with intellectual disability are three years old, they have more mental health problems than other children. What’s more, the mental health problems in these children and adolescents persist over time.

A 2006 Australian study of over 400 children and adolescents with intellectual disability found only a small reduction in mental health problems over its 14-year follow-up. It seems that once mental health problems emerge, children with intellectual disability are likely to suffer from them for a long time.

But despite the high level of mental health problems in this group of children, access to treatment is poor. Recent UK research on over 600 children with intellectual disability who also have autism, for instance, showed less than a quarter of those with mental health problems had any contact with relevant services in the previous six months.

Similar results have been found in Australia. In the Australian study mentioned above, researchers found only 10% of their sample had received specialised mental health treatment from an expert in intellectual disability and mental health.

Clearly, effective early intervention for these children is needed. It could target factors shown to influence their mental health, including improving parent-child relationships, reducing family poverty and other deprivation, and increasing parental mental well-being.

A mainstream issue

A significant proportion (35% to 40%) of children with intellectual disability may have mental health problems. Put another way, 14% of all children with a mental health problem will also have an intellectual disability. This figure represents large numbers of children with significant needs: approximately 85,000 in England and 50,000 in Australia.

So this has to be accepted as a mainstream issue rather than a specialist area. These children represent a high-risk group whose needs have to be addressed by mental health services generally. There are a number of key issues.

Even where there are specialist child intellectual disability mental health services available, such as in many areas of the United Kingdom, practitioners have only a very small evidence base from which to draw.

There are few assessment tools to help clinicians identify mental health problems in these children, especially in those with more severe disability. The evidence base for treatment options is also very small.

Children with intellectual disability are often excluded from mainstream trials of mental health treatments, and specialised research focused only on them has been rare.

We need to invest in developing methods for identifying mental health problems in children with intellectual disability, and to test treatment approaches. And we need a greater understanding of the barriers to accessing mental health services faced by them and their families.

A combination of better evidence and improved access to treatment should help ensure that the mental health problems of children with intellectual disability are recognised and treated.

The ConversationRichard Hastings receives funding from Cerebra and several government health research funders in the UK. He is affiliated with the charities Mencap, Sibs, Cerebra, and Ambitious about Autism.

Bruce Tonge receives funding from Commonwealth research bodies( NHMRC, ARC) and Philanthropic research foundations eg. Pratt foundation, beyond blue, Dara foundation. He is a member of the Board of AMAZE (Autism Victoria) a not for profit peak body NGO.

Glenn Melvin receives funding from beyondblue, NH&MRC, Disability Donations Trust, & Endeavour Foundation.

Kylie Gray receives funding from federal funding bodies in Australia (NHMRC, ARC). She also receives funding from a range of philanthropic organisations e.g. the Disability Donations Trust, Endeavour Foundation, Mental Health Australia, Financial Markets Foundation, APEX, and SFARI and the NIH in the US.

Vaso Totsika receives funding from UK research councils and voluntary organizations.

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Teachers key to getting early help for children with mental health issues

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By Richard Slinger, Lancaster University

Mental health services for children and adolescents in the UK are beset by “serious and deeply ingrained problems”, according to a new report from the Health Select Committee. Referral rates are increasing year on year against a background of funding cuts and efficiency savings. This has resulted in severe difficulties around accessibility, waiting times and highly restrictive criteria for accepting referrals. Some 263 children sectioned under the Mental Health Act in 2012-13 were held in police cells, according to the report.

MPs have made a range of important recommendations, including to give teachers more and better training on child mental health.

Demand rising

The most recent general population figures from 2004 show that 10% of children and young people will experience a mental health issue in any given year. By contrast, more than three-quarters of the children in the same survey who identified difficulties received no input from specialist mental health services.

More recent research suggests that prevalence rates are rising. Yet as the MPs’ report highlights, new population research into the prevalence of child mental health difficulties in the UK is long overdue. We should not be basing our commissioning and models of service delivery on information that is ten years out of date.

While previous surveys have used a validated mental health screening tool (the Strengths and Difficulties Questionnaire), simply categorising mental health difficulties into broad groups such as anxiety, depression and behaviour problems may not show a true picture of the scale of the problem.

General screening tools need to be supplemented by other methods that look at contextual factors – the impact of poverty, racism, family breakdown or parental mental health – and look at a wider range of difficulties such as the prevalence of self-harm or eating disorders. Only this way will we get a more accurate picture of children within our society – and the mental health needs we should be addressing.

Investment across the board

Further investment is needed in order to make adequate provision for young people and their families experiencing mental health difficulties, whatever the severity or complexity of the problems. The report makes clear recommendations about increasing funding for specialist out-patient and in-patient mental health services. Yet, providing investment to increase services at the specialist level alone is unlikely to solve the current difficulties around demand and accessibility.

Investment is needed across the spectrum, particularly at an early intervention stage, to both identify and manage difficulties earlier and to reduce the load on specialist child mental health providers. “Upstream” investments that are aimed at preventing difficulties developing or worsening to a stage that require specialist intervention are likely to be most cost-efficient in the long term. Yet government policy has been mainly aimed at investing “downstream” when problems have already developed or become entrenched. The report highlights how many preventative services, especially in the voluntary sector, have been cut as a consequence of reduced local government funding.

Importance of schools

The committee highlights schools as key settings in which many of their recommendations can be implemented. Their findings support a body of research demonstrating that teachers often do not feel skilled or well-enough equipped to understand or manage children’s mental health difficulties.

Recent initiatives such as the MindEd E-learning portal aimed at providing mental health information are steps in the right direction. So too are the recommendations from MPs in the report around child mental health training for new teachers and continuing training for qualified teachers.

Give teachers support

Yet it is unclear whether increasing teachers’ knowledge about mental health issues alone would result in changes in practice in schools. Training alone does not address common structural and systemic barriers in schools around prioritising staff time to deliver support.

Further recommendations are needed around how training is delivered and implemented in schools. This could be by providing time for supervision or reflective discussion for staff, having nominated “champions” in schools as part of senior leadership teams and schools having direct access to appropriately qualified specialists for advice and consultation.

Teaching has long been recognised as one of the most stressful UK occupations, with burn-out and career change frequent consequences. Among the most common causes of teacher stress are children’s behaviour in school and feeling ill-equipped for the role. Further training around child mental health is needed to help school staff feel better skilled and prepared for the diverse range of issues that children bring with them into school.

The ConversationRichard Slinger does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

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Explainer: what is seasonal affective disorder?

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By Caitlin Millett, Pennsylvania State University

It’s that time of year again – the end of daylight savings and the beginning of the dark season. While many of us look forward to seasonal festivities, millions can also expect feelings of depression, fatigue, irritability and poor sleep. This form of mental illness, commonly known as the “winter blues”, is Seasonal Affective Disorder (SAD).

SAD occurs most frequently in populations furthest from the equator. It is estimated that 1-2% of North Americans have a mood disorder with a seasonal pattern, with 10% of New Englanders versus 2% of Floridians affected. Symptoms include feelings of hopelessness, low concentration, sluggishness, social withdrawal, unhappiness and irritability.

Circadian rhythms

Decades of research has uncovered the culprit behind SAD: lack of sunlight and disruption of circadian rhythms.

Trapped by our body clocks.
Elliott Brown, CC BY


A circadian rhythm is a process the body goes through following a 24-hour cycle. Circadian rhythms are entrainable, that is, they can be reset based on an external influence like light. The human sleep cycle is an example of a circadian rhythm and is shifted based on light levels.

This is why we experience jet lag after travelling across time zones. Similarly, seasonal changes can affect circadian rhythms, due to shorter days and loss of daylight in winter months.

Daylight and your brain

Although most people are able to adapt to the change in seasonal light levels, what makes some vulnerable to seasonal depression? To understand how sunlight affects mental health, we need to first understand how our brains use sunlight to modulate certain behaviour and hormonal processes.

The pineal gland.


In humans, the hormone melatonin is an marker of external darkness. When darkness descends, melatonin is secreted from a structure called the pineal gland, a pine cone-shaped endocrine gland located in the center of the brain. This gland modulates sleep patterns in both circadian and seasonal rhythms. The secretion of melatonin from the gland corresponds to the length of darkness; as the nights get longer, melatonin secretion follows suit.

The timed production of melatonin is controlled by another area in the brain – the suprachiasmatic nucleus (SCN) of the hypothalamus. The hypothalamus is the primary hormone-producing structure of the brain, controlling body temperature, sleep, circadian rhythm, moods, sex drive, thirst, hunger, and the release of other hormones. The SCN is the “pacemaker” of the brain, consisting of about 20,000 neurons. It maintains an autonomous signal which operates on an approximate 24-hour cycle. Even outside the body, as seen in the laboratory, SCN neurons will continue their circadian cycling. The SCN regulate sleep cycles, alertness, hormone levels, digestive activity, body temperature and immune function.

The eyes have it

Many studies have cited disruption in the circadian control center as a contributing factor to several mood disorders, including major depressive disorder and bipolar disorder. Even though these illnesses are not necessarily seasonal, both entail loss of consistent sleep/wake cycles as seen in SAD.

The light therapist is in.
Light therapy image via www.shutterstock.com


However, unlike depression and bipolar disorder, the major form of therapy for SAD is the use of artificial light, which alleviates symptoms in 50-60% of people.

Light boxes provide relief to many, and come in a few varieties. Typically light boxes are advertised as broad spectrum light sources, which is pure white light. Some light boxes can also give full spectrum light, which has a broader range of wavelengths, including infrared to near ultraviolet light, and everything in between.

Although full spectrum light boxes provide a source closest to that of natural sunlight, they usually come with a screen to protect against UV rays. In this way, it is often preferable to use a broad spectrum light box to avoid UV ray exposure.

The use of light as a treatment indicates that it is not only the SCN implicated in the onset of this disorder, but there may be a contributing cause related to how we process light in the eye. In fact, various studies have pointed to mutations in a retinal pigment called melanopsin as a source of SAD.

More than meets the eye.
Laitr Keiows, CC BY-SA


Melanopsin is a molecule which absorbs light in the eye, and through a chemical change, can translate external light levels into messages for the brain. Unlike rod and cone cells, melanopsin is found in specialized cells of the eye which react slowly to changes in light, and are known to regulate the timing of circadian rhythms. Whereas rods and cones are responsible for the detection of motion, color, images and patterns, studies have shown that melanopsin-containing cells contribute to various unconscious responses of the brain to the presence of light, including circadian rhythms.

Overall, melanopsin can translate messages directly from the eye to the SCN. This in turn influences the production of melatonin. The SCN not only projects to the pineal gland, but has wide-ranging connections to other important areas in the brain. So if there is disruption in melanopsin in the eye, which is passed on to the SCN, the potential exists for many areas to be affected.

Though SAD is not fully understood, genetic research into melanopsin, as well as hypothalamic genes associated with serotonin production, holds promise.

In the meantime, the use of antidepressants, therapy, and artificial light may help SAD sufferers through the upcoming dark months. And with holidays approaching, spending time with family, friends and good food is something we can all benefit from.

I have no conflicts of interest to disclose.

This article was originally published on The Conversation.
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SANE Forums: connecting people across Australia

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saneforums_circleA new national online community is reaching out to all Australians affected by mental illness, wherever they live.

Using the power of the Internet, and a partnership with mental health organisations around Australia, SANE Forums are providing a peer-to-peer support service for carers and families, as well as people living with mental illness.

‘The forums are connecting many people who were previously isolated,’ explained Paul Morgan, SANE Australia’s Director of Communications, who was speaking in Albury at the 6th Australian Rural & Remote Mental Health Symposium, hosted by the Australian and New Zealand Mental Health Association.


‘With professionally-trained moderators, people can feel confident to join the conversation online on an anonymous basis, share their stories and knowledge, and find support.’

‘Isolated we are alone, connected we have a voice.’

‘(The SANE Forum) gives us the courage to talk about mental health more openly.’

‘These are just a few snippets of the conversations taking place on the SANE Forums,’ said Morgan. ‘We’ve had almost 5,000 posts and more than 162,000 page visits since the launch of the Forums four months ago.’

‘Even though people in rural and regional Australia are on the whole incredibly supportive of one another and remarkably resilient, we know that they face particular stresses and when you add a mental illness to the situation, it can be really tough to deal with.

‘We know far too many Australians aren’t accessing the help they need. We have to be savvy in delivering support to more people, when they need it. Late help will always be expensive help. The SANE Forums can reduce mental health costs by encouraging people to seek help early on,’ he added.

According to Morgan, mental health communities around the globe are increasingly tapping into the internet and new technologies and platforms, to more effectively communicate with each other, provide information and support, and identify new ways of designing and delivering treatment of mental health issues and illnesses.

The SANE Forums are partnering with more and more mental health organisations around Australia. Each of these organisations can now provide the people they help with another valuable source of support, accessed through their existing websites. And as more people join, a stronger community of mutual support is built.

‘Being part of a community doesn’t remove the problem, but it can ease the burden and help us start to put the pieces back together,’ concluded Morgan.

Check out the SANE Forums at: www.saneforums.org.

Deconstructing schizophrenia among Australia’s First People

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“Two Angels” by Suzanne Schneider

By Dr Paul Brown, The Pierre Janet Centre, Melbourne.

In my sojourn as a locum psychiatrist in rural and remote Australia, I was astonished at the rate of diagnosis of schizophrenia in indigenous populations. That condition is characterised by, “abnormal social behaviour and failure to recognize what is real,”[1] and with symptoms that include confused thinking, hallucinations, delusions, social withdrawal and emotional blunting. It is associated with increased rates of suicide and homicide. Schizophrenia is said to have been rare in the pre-colonial era. Today, in indigenous communities, mental disorder is still frequently identified as spiritual disorder.[2] It is treated by traditional healers, often concurrently, alongside Western medical practitioners.

Today schizophrenia is said to be at least as common in Aborigines as in white Australians, if not more so. It and mental illness in general, is said to be under-estimated.[3] A not insignificant proportion of psychosis is to be found in prisons. Indigenous people represent around one-quarter of Australia’s custodial population. In recent prison surveys of Aboriginal prisoners, [4] [5] the 12-month prevalence of psychotic disorders was: men, 8%; and, women, 23%. The overall prevalence of mental disorder was: 73% among men and 86% among women. Non-psychotic conditions comprised: anxiety disorders (men, 20%; women, 51%); depressive disorders (men, 11%; women, 29%); and substance misuse disorders (men, 66%; women, 69%).

Read the full article by The Stringer Independent News, 9 November 2014

Rural residents need more than a quick-fix approach to mental health

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One in five Australians in the past year encountered a mental health condition of some type. Photo: Angela Wylie

Field days and agricultural shows are big events in country Australia. Farming families travel for hours to see the latest in tractor technology, soil seeding, or water conservation techniques. They mostly travel just to meet others and have a chat.

In recent years, new exhibitors have established themselves among the livestock and paddock demonstrations also wanting to have a chat. These exhibitors, such as the Royal Flying Doctor Service, are providing mental health and wellbeing checks.

For some country residents, a mental health check at a field day may be the only face-to-face mental health care they encounter. The Council of Australian Governments’ Reform Council data tells us only half of remote area residents needing mental health care actually receive it, when compared to people accessing mental health care in cities.

One in five Australians in the past year encountered a mental health condition of some type, according to a June report of the Australian Institute of Health and Welfare. Myth suggests a disproportionate number of these one in five people live in rural and remote areas, fuelling incorrect assumptions that the act of living in a rural or remote area contributes to the risk of mental illness.

Read the full story by Martin Laverty, The Age, 12 November 2014.

Calling All Rural and Remote Mental Health Social Media Enthusiasts #RuralMH

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Social media buttonsAre you a social media enthusiast?

Do you tweet? Are #hashtags apart of your everyday communication?

We want to hear from you!

Tomorrow marks the start of the 6th Australian Rural & Remote Mental Health Symposium in Albury, we encourage you to connect and communicate with your networks online.

Join the Australian Rural & Remote Mental Health Symposium conversation:

Twitter: @RuralMental_Hth

Facebook: https://www.facebook.com/AustralianandNewZealandMentalHealthAssociation

Conference Hashtag: #RuralMH

Blog Updates: http://mentalhealthaustralia.org.au/

Social Media not your thing? Why not write an article for the Australian and New Zealand Mental Health Association Blog, send your story to communications@mentalhealthaustralia.org.au we would love to hear from you.

Videogame addiction – fact or fantasy?

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By Gemma Lucy Smart, University of Sydney

I am a Warcraft widow, an affectionate term given to those who have “lost” a partner to World of Warcraft (WoW) as a result of excessive game-playing.

I have first-hand experience of the way games such as WoW can be so engaging that entertainment becomes a way of life. Which leads me to the question: was my partner an addict?

If so, was he any different to the thousands, if not millions, of gamers across the world spending what some would deem “excessive” amounts of time online managing virtual farms or defeating dragon gods intent on destroying the world? Were all these people addicts, too?

It seems currently that anything pleasurable we do to excess is described as an addiction – from the traditional drug addictions to behavioural addictions such as shopping, gambling, sex, eating and even reading.

The addiction narrative regularly features in popular culture. One gamer even made a documentary about his “bittersweet” journey through WoW. In Real Life (see below) is Anthony Rosner’s personal look at the effect of what he saw as addiction to the game.

But there are dangers in this kind of self-diagnosis. Identifying oneself as an addict may mask the alternative causes of problem-gaming including, but not limited to, social anxiety and depression. Some gamers are even at risk of addiction becoming a self-fulfilling prophecy.

Problem videogaming does not fit neatly into our existing understanding of addiction – indeed, our understanding of the neuroscience of behavioural addiction is very limited and mostly focused on gambling.

Unlike videogaming, gambling has been described by Professor Don Ross at MIT as a basic form of addiction. The combination of reward and failure in gambling tasks disrupts the balance between the mid-brain dopamine system (which encourages reward-seeking behaviour) and our ability to control this behaviour through the pre-frontal and frontal serotonergic system.

A recent survey of the academic literature on internet gaming addiction makes the following point:

while a minority of game players do experience symptoms normally associated with addiction including mood modification, tolerance and salience, it’s unclear in most cases whether an individual’s apparent addiction is the cause of these symptoms rather than a symptom itself of another (co-morbid) disorder they may have, the most common being depression.

Daniel Conway


The scope of games and gamers is partially the limiting factor to our understanding of computer game addiction. It could be said there are as many types of games as there are types of gamers, and the research is yet to reflect this adequately.

The supposed “average” gamer is not who he or she used to be, and the tasks games present players with are growing increasingly complex and varied.

To view games as either helpful or harmful is far too simple. Though there might be links between violent media content and aggression this hasn’t been proven, and there are reasons to argue that games could provide a great array of psychological and physiological benefits.

Violent videogames such as Call of Duty and Grand Theft Auto are considered most problematic because of their violent content. But it’s actually the “simple” games, such as Angry Birds and Bejeweled that are most similar to gambling.

They balance failure with reward in a way that takes advantage of neural systems associated with pathological gambling.

Other games are more complex. The epic fantasy role-playing game (RPG) Skyrim provides a sandbox (open) world in which players can do almost anything, from saving the world to catching butterflies to clearing out dungeons for loot.

Gamers are given control over their in-game character, the goals they achieve and how they achieve them. This is somewhat different to a traditional addictive substance or behaviour that does not necessarily offer the range of new skills and tasks associated with cognitive development and collective action.

WoW… it’s all about love.

We’re all in this together

Massive Multiplayer Online Role-Playing Games (MMORPGs) such as WoW employ a large social component.

Gamers come together and engage in complex teamwork and collaborative behaviour to achieve goals, developing wide networks and strong relationships. Players often know each other in “real life” and even when they only know one another via the computer screen, their relationships can be committed and meaningful.



This is not to deny there are potential problems that can result from excessive gaming – such as antisocial behaviour or, in extreme and rare cases, death. This was seen in the tragic case of a child in Korea dying while her parents played Second Life.

So did my partner play WoW to excess? In my opinion, yes: he played the game to the detriment of other parts of his life. But that doesn’t mean addiction is the only, or best, way to think about his behaviour.

The playground of videogame worlds is decidedly different to the playgrounds of the past, for better or for worse.

The bottom line is that more informed and substantial research needs to be done into problem gaming. In the meantime, describing “excessive” gamers as addicts may simply do more harm than good.

The ConversationGemma Lucy Smart does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
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The Addiction 2015 conference will feature gaming and screen addiction presentations – register today!

Women ‘feel more stressed than men’, which is taking a toll on our mental health

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Mental health

Mental health … A new survey found 2014 was a tough year for women, reporting significantly higher levels of stress in their day-to-day lives. Picture: News Limited

A MAJORITY of Australians say stress is affecting their mental health, while there’s a widening wellbeing gap between the sexes, a new mental health report says.

The Australian Psychological Society’s survey of stress and wellbeing also found 2014 was a tough year for women, with many reporting significantly higher levels of stress in their day-to-day lives.

More than 70 per cent of Australians reported their current stress levels had an impact on their physical health.

But worryingly, 64 per cent reported current stress levels had an impact on their mental health.

“Stress can have an extremely detrimental effect on a person’s mental and physical health,” APS executive director Professor Lyn Littlefield said.

Read the full story by News.com.au, 9 November 2014

FIFO workers’ mental health problems exacerbated by ‘macho’ attitudes

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Fifo Mental Health

A generic FIFO Image. Source: news.com.au

THERE is a “toughen up princess” attitude on work sites that prevents some fly-in fly-out workers from seeking help for mental health problems, a union says.

The West Australian government’s education and health standing committee is conducting an inquiry into the mental health impacts of FIFO work and heard from several speakers on Wednesday.

Construction, Forestry, Mining and Energy Union state secretary Mick Buchan said in a statement there was a macho attitude on sites, so workers were often too scared to raise concerns for fear their employment would be threatened.

Mr Buchan said there needed to be independent support structures, shorter roster lengths, better communication services, more regulation and a pathway back to work for those who had experienced a mental health issue.

FIFO Families founder and director Nicole Ashby says people don’t realise the impact the lifestyle can have on workers’ mental health and the pressure on their families who live without them for extended periods.

Read the full story by news.com.au, 6 November 2014

Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14 or MensLine Australia on 1300 78 99 78.