Emotional Abuse in Women and Girls Mediated by Patriarchal Upbringing and Its Impact on Sexism and Mental Health: A Narrative Review

Sexism is a type of structural discrimination that can manifest as the subjugation of woman in familial and social roles. Gender-based violence often occurs in societies where patriarchal norms exist. Violence against women and girls (VAWG) includes physical, sexual and psychological/emotional abuse directed towards females. Emotional violence against women and girls is usually underestimated, if not overlooked. Patriarchal upbringing can predominantly result in the emotional abuse of female children. This narrative review will discuss the impact emotional abuse in women and girls mediated by patriarchal upbringing has on sexism and mental health. This paper will also explore how gendered upbringing can contribute to the normalization of VAWG and the victim-blaming of females.

Innovative Interventions to Reduce the Stigma Attached to Intellectual Disabilities: A Narrative Review

The stigma attached to intellectual disabilities (ID) can have profoundly adverse effects on the lives of people who suffer from these conditions. Stigma is also a major barrier to accessing specialist services and consequently many people with ID continue to suffer in silence. A confidential inquiry into the premature deaths of people with ID in England and Wales revealed the median age at death of individuals with this condition was 13 years (for males) to 20 years (for females) younger than the median age at death of the general population. It has been posited that stigma is a factor that contributes to the mortality gap between those with ID and those who don't have this condition. The COVID-19 pandemic has created new challenges for people with ID and has further fortified the barriers to specialist services. To reduce stigma, improve the quality of healthcare that is provided to people with this condition and to break down the barriers to specialist services, we must pioneer innovative interventions that leverage the power of technology and 'virtual' contact with people who live with these conditions.

Pioneering an Innovative Intervention to Reduce Mental Health Related Stigma in Muslim Communities: A Protocol

Despite the prevalence of mental health related stigma in Muslim communities, there are only a limited number of intervention studies reported in the literature. Digital interventions (i.e., YouTube clips, videos) are relatively cheap, highly accessible and easily disseminated and are increasingly being used to improve mental health literacy and reduce mental health related stigma. However, as far as the authors are aware, there are no stigma reduction programmes targeting Muslim communities that leverage digital interventions reported in the literature. This paper outlines a protocol for a digital intervention to challenge mental health related stigma in Muslim communities. The proposed intervention will be a 5 to 10-minute YouTube clip/video the active ingredients of which will be: [1] an interview with a Muslim expert by lived/living experience, [2] an Imam (Muslim faith leader) and [3] a psychiatrist. We will recruit members of Muslim communities living in Muslim minority countries in the Global North (United Kingdom, Unites States of America, Canada, Australia and New Zealand) to participate in the study (inclusion criteria: adults aged 18 years and over, Muslim background). The study will be comprised of two groups: an active group that will be exposed to the Muslim faith appropriate digital intervention and a control group that will be exposed to a digital intervention that is not Muslim faith appropriate. We will administer validated psychometric stigma scales on participants in both groups before and after exposure to the interventions. We hypothesize that viewing an anti-stigma clip/video that is Islamic faith appropriate will be associated with greater reductions in mental health related stigma in members of Muslim communities compared to viewing an anti-stigma clip/video that is not Islamic faith appropriate.

Patriarchal Upbringing in the 21st Century: The Impact Emotional Abuse Related to Parental Styles Has on the Genesis of Gender Inequality and the Development of Unresolved Trauma in Children

BACKGROUND

Violence Against Women and Girls (VAWG) (physical, sexual, and psychological/emotional) is a type of structural discrimination that violates the basic human rights of females on a global scale. Cultural norms that glorify male dominance, power imbalances, and abuse of authority are the most encountered reasons for VAWG. Emotional abuse, which can start in childhood, is widely recognised as the most prevalent form of VAWG. However, although victims of emotional abuse usually suffer terribly, perpetrators often evade accountability. Emotional abuse is underestimated in part because it is normalized by victims who are mostly women and girls. The normalization of VAWG is contributing to the propagation and perpetuation of biased perceptions of sexism. The intergenerational transmission of parenting styles - which is an important contributory factor for child development - often includes gender-stereotyping norms, or patriarchy. Hitherto, limited focus has been directed towards the consequences that emotional abuse related to patriarchal upbringing has on children. Aim - to investigate if emotional abuse related to patriarchal upbringing influences the perception of sexism and gender stereotyping across genders, and the development of unresolved trauma in children.

METHODS

Participants were recruited via social media platforms to complete online questionnaires assessing parental emotional abuse, control, trauma, misogyny, and perceptions of sexism. Parametric analyses were conducted on the 188 participants (158 women and 30 men) recruited. Trauma and perceptions of sexism were statistically analysed using correlation and multiple linear regression.

RESULTS

Our findings show that parental emotional abuse and control in females predicted for unresolved traumatic experiences (16.6%). Misogynistic culture and male gender predicted for hostile sexism (9.9%), whereas emotional abuse predicted for benevolent sexism (40%).

CONCLUSION

Emotional abuse related to patriarchal upbringing contributes to the genesis of gender inequality and unresolved trauma in children. Given that parental styles are transmitted from one generation to the next, to reduce sexism and improve mental health outcomes, the patriarchal parental cycle must be broken.

'Paris Thin': The Mental Health of Models

Surprising it may seem, the mental health issues remains largely overlooked in the highly competitive and unforgiving industry of modelling and fashion. A substantial number of models experience mental health issues due to the nature of their occupation, however, most avoid speaking out due to fear of stigma and losing out on future work. Moreover, problematic eating behaviours in attempts to improve body image can have profoundly adverse effects on mental and physical health, even leading to death in extreme cases, yet these behaviours are being reinforced and rewarded with success and career progression. Indeed, the term 'Paris Thin' was used in relation to the deaths of models from starvation who were in pursuit of 'the perfect body' whilst working in France, the epicentre of the fashion world. Although improvements have been made over the past decade, conversations surrounding common mental disorders such as depression and anxiety remain minimal at best and discussions about other serious mental illnesses such as schizophrenia and bipolar affective disorder are virtually absent. Campaigns that amplify the voices of models living with a mental health condition must therefore be supported to reduce mental health related stigma in the industry and encourage those who are suffering and struggling to seek professional help. Research in this area is urgently needed to yield new insights that will help to improve the mental health of models.

Trauma and the role of the wounded healer

Abstract Body

Carl Jung used the term, ‘The Wounded Healer’ as an archetypal dynamic to describe a phenomenon which may take place in the relationship between analyst and analysand. Jung discovered the Wounded Healer archetype in relation to himself. For Jung, ‘It is our own hurt that gives the measure of our power to heal‘. Indeed, recurrent themes in the autobiographical narratives of Wounded Healers is that their experiences living with trauma inspired them to become more empathetic, driven and insightful. Many report that debilitating though the symptoms of mental illness are, the stigma is far worse. In this paper we describe the inception of an innovative anti-stigma programme, ‘The Wounded Healer’ that blends the power of storytelling and the performing arts with psychiatry and how The Wounded Healer helps to heal the wounds that were afflicted by the trauma of stigma.

Disclosure

No significant relationships.

Reducing Mental Health Stigma in Medical Students and Doctors towards their Peers with Mental Health Difficulties: A Protocol

Mental health problems are over-represented in doctors and medical students. However, stigma and 'a culture of shame' are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment. Indeed, a recent study on over 2100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma. Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken). Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psychotic episode. An independent inquiry into Dr Emson's death concluded that she was the victim of stigma in the National Health Service. The mental health of medical students and doctors, in all of its aspects, must therefore be addressed with the urgency that it demands. Stephanie Knaak and colleagues conducted a data synthesis of evaluative studies on anti-stigma programmes for healthcare providers and identified six key ingredients one of which was a personal testimony from a trained speaker who has lived experience of mental illness. In this paper we outline a study protocol with the aim of answering the following research question, 'Does attending an anti-stigma programme comprised of a medic with first-hand experience of a mental health condition cause immediate and sustained reductions in mental health stigma from medical students and doctors towards their peers with mental health difficulties?'

A World Psychiatric Association Initiative to Increase Interest in Psychiatry as a Career in Qatar Medical Students: A Pilot Study

INTRODUCTION

The World Health Organization identified a chronic shortage of psychiatrists in Low- Middle- and High-Income Countries. In Qatar, the situation is dire with reports there is one psychiatrist per 170,000 people in the population. A one-day, student-led mental-health conference was held in Doha, Qatar under the auspices of the World Psychiatric Association with the aim of increasing interest in psychiatry as a career.

SUBJECTS AND METHODS

In this single-arm, pre-post comparison study, a questionnaire assessing interest in psychiatry as a career was administered on participants before and after attending the conference. Demographic information was obtained and response items were on a 5-point Likert scale. Statistical analysis was performed using a two-sample t-test with a significant p-value set at <0.05.

RESULTS

The conference was attended by 102 individuals. Fifty-four attendees completed the pre-conference survey (53% response rate) and 36 participants completed the post-conference survey (35% response rate). Data for the 36 matched pre-post responses were included in our analyses. The average age of respondents was 22 years and 81% were female. There was improvement in post-conference results however these changes were not statistically significant.

CONCLUSION

To the best of our knowledge this is the first intervention study on increasing interest in psychiatry as a career carried out in Qatar. It is likely that psychiatry enthusiasts attended the conference and therefore their interest in this medical specialty was already high as corroborated by the favorable pre-conference survey results. This might explain why there was a lack of statistical significance in comparison to post- intervention scores. We recommend that such an event be integrated into the medical school curricula throughout Qatar to include students with low baseline interest in psychiatry. Further research in this area with more robust methodology is urgently needed to help narrow the pervasive treatment gap.

Improvement of Saccadic Eye Movements after Head-Eye Vestibular Motion (HEVM) Therapy and Neuro-Psychiatric Considerations

INTRODUCTION

Eye movement pathology can assist in the identification, diagnosis and treatment of mental health disorders. Eye-tracking paradigms have been utilized to provide greater ecological validity, and directly capture the detailed sequence of processes in perception and attention, while quantifying classifiers in mood, anxiety, and psychotic disorders. Saccadic eye movements serve as an endophenotype for various mental health disorders.

SUBJECTS AND METHODS

Patients suffering from post-concussive syndrome and mental health concerns performed saccadic eye movements that were quantified for amplitude, velocity, latency and accuracy before and after Head-Eye Vestibular Motion therapy (HEVM).

RESULTS

HEVM therapy is associated with statistical and substantive significant improvements in mental health and in saccadic metrics.

CONCLUSIONS

Oculomotor dysfunction is related to the symptom dimensions of mental health disorders that may be treated with physical rehabilitation modalities. We feel it reasonable to suggest that psychiatrists and others involved in the treatment of mental health disorders quantify eye movements and use them as biomarkers in the evaluation of the outcomes of varied therapies.

Hajj and the Mental Health of Muslim Pilgrims: A review

Mass gatherings occur in different situations and settings around the world. A mass gathering can range in size from thousands to millions and in nature from recreation (i.e. concerts) to religious festivals (i.e. the Hajj pilgrimage). Such mass gatherings can result in high rates of morbidity and mortality from communicable and non-communicable diseases, 'accidents' and, over recent years, terror attacks. Disproportionately lower consideration has been given to the mental health and wellbeing of people during mass gatherings compared to that given to physical health during such events. Hajj is a religious pilgrimage to Mecca in Saudi Arabia that all Muslims are Islamically obliged to fulfil at least once in their lifetime. With up to 3 million pilgrims attending Hajj annually, it has been described as, 'The largest and longest-standing mass gathering event on Earth'. Although Hajj is a spiritual experience that is considered enlightening by many pilgrims, it can also be highly stressful which can have adverse effects on both physical and mental health. Few studies have been published hitherto on the impact that Hajj has on the mental health of pilgrims. This review article provides a narrative summary of studies conducted on Hajj and the relationship that this mass gathering has with the mental health of pilgrims.

Lifestyle Factors and Mental Health

A number of lifestyle factors have been recognised to play an important role in positively modifying medical and psychiatric diseases and their associated morbidity and mortality. These include, eating healthy food, greater physical activity, cessation of smoking, avoidance of alcohol and illicit substances. Additional lifestyle factors for healthy living include, safe and peaceful environment, optimal sleep, de-stressing and enjoyable activities, social connections/support and healthy mental activities. Physicians from the ancient times, through the middle ages to the early 20^th century have recommended adoption of healthy lifestyle factors such as diet and exercise to manage medical and psychiatric disorders without really understanding their scientific basis. In this short paper, we discuss the important role lifestyle factors play in morbidity and mortality related to many important and common medical and psychiatric diseases. We explore how and if positively modifying lifestyle factors can help to improve and or prevent medical and psychiatric disorders with particular emphasis on food, diet and exercise.

Gender differences in the portrayals of depressive illness in popular culture: a comparison of literary texts

Gender differences in the prevalence, experiences and presentations of mental illnesses are well-known and are reflected in research findings, clinical practice, society and popular culture. This paper will compare and contrast the role that gender and other factors play in the portrayals of depressive illness in two acclaimed texts, 'The Bell Jar' by Sylvia Plath and, 'Darkness Visible' by William Styron.

Using Experts by Personal and Professional Experience (EPPE) to increase interest in Psychiatry as a Career at Sixth-Form Level

BACKGROUND

Psychiatrists play a multifaceted and critical role in improving the lives of people with mental illness. However, despite how rewarding, important and thrilling a career in mental health is, there continues to remain a shortage of psychiatrists in Low-, Middle- and High-Income Countries. There has been resurgence in interest in improving the image of psychiatry over recent years and several initiatives have been launched to increase recruitment into the specialty at Sixth Form level in the UK.

DESIGN

We conducted a single-arm, pre-post, comparison study with Sixth Form students at an inner-city school in London. Students were invited to complete a survey before and after exposure to an assembly on mental health that was delivered by an Expert by Personal and Professional Experience (EPPE). Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if there was an increase in interest in pursuing this profession as a career in this group.

RESULTS

63 out of 123 participants completed the before and after survey (51% response rate). Following exposure to the assembly, there were statistically significant improvements between the pre- and post- intervention means for, "Psychiatry has a positive impact on peoples' lives" (p value <0.0001), "People with mental illness can achieve success and be the best at what they do" (p value <0.0001) and, "I would consider psychiatry as a career" (p value <0.0001).

CONCLUSION

Notwithstanding the limitations of this pilot study, our findings suggest that an assembly on mental health delivered by an EPPE (i.e. 'Wounded Healer') might be effective at increasing interest in psychiatry as a career at Sixth Form level. We suggest that assemblies on mental health and psychiatry be delivered by 'Wounded Healers' in schools and colleges nationwide to help drive recruitment into psychiatry.

Leveraging Digital Technology to Challenge Mental Health Stigma in West Bengal: A Protocol

Mental health related stigma is a pernicious phenomenon that permeates and pervades our world. As stigma continues to evolve so too must our approach to reduce it. This paper outlines a protocol that leverages the power of virtual contact and digital technology to challenge mental health related stigma in West Bengal, India.

The prevalence of Lyme disease and associated co-infections in people with a chronic post-concussive syndrome

INTRODUCTION

There is increasing awareness that Lyme borreliosis (LB) and traumatic brain injury (TBI) may cause mental health symptoms. TBI and Lyme disease compromise the health and activities of millions of patients per year. The chronic symptoms and disability of TBI and Lyme disease share a similar clinical presentation. We have identified an alarming number of individuals suffering from post-concussion syndrome (PCS) that are refractory to care and that have serologically tested positive for Lyme disease.

SUBJECTS AND METHODS

A single-center retrospective review of patient charts that were symptomatic a minimum of one year after a TBI that were tested for Lyme disease to ascertain if there was a relationship.

RESULTS

217 PCS patient records (93 females with a mean age of 34 years, 120 males with a mean age of 40 years and 4 individuals with unknown gender) were included in the review. 38% had a positive Western Blot Igenex IgM. There was a statistically significant relationship of a positive Western Blot Igenex IGM predicting chronic PCS Pearson χ²(1)=6.8866, P=0.009, Fisher's exact score p=0.015 and φ=0.2813 representing a moderate effect size.

CONCLUSIONS

Long term PCS over one year's duration is associated with undiagnosed Lyme disease. There was statistical and substantive significance between individuals with chronic PCS having a positive Western Blot Igenex IgM. Males were more likely to have a positive Western Blot Igenex IgM than females.

The Federation of Student Islamic Societies Programme to Challenge Mental Health Stigma in Muslim communities in Scotland: The FOSIS Glasgow Study

INTRODUCTION

A recent study commissioned by the Scottish Government on the prevalence of mental disorders in Muslims in Scotland revealed that over 50% of the sample met the diagnostic criteria for a mental illness. Stigma is a major barrier to mental health services and despite the availability of effective treatment, many Muslims in Scotland with mental health difficulties continue to suffer in silence. The Federation of Student Islamic Societies (FOSIS) Scotland branch organized a mental health conference in Glasgow to improve Mental Health Literacy and challenge mental health related stigma in the Scottish Muslim community. The conference was comprised of: A counsellor with a background of Islamic psychology, a psychiatrist and an Imam (a Muslim religious leader).

DESIGN

We conducted a single-arm, pre- post- comparison study on Muslims who attended the FOSIS mental health conference in Glasgow, Scotland. Validated psychometric stigma scales measuring knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviours (Reported and Intended Behaviour Scale (RIBS)) were administered on participants before and immediately after exposure to the programme.

RESULTS

34 out of the 55 participants who attended the conference responded (response rate 62%). 34/34 (100%) of the respondents were Muslim and the mean age was 22.7 years (Std. Dev. 6.04, min. 18, max. 49). There were no statistically significant changes in stigma across the domains of knowledge, attitude and behaviour in respondents following exposure to the event.

CONCLUSION

Previous FOSIS anti-stigma conferences in England and Ireland featuring an Expert by Lived Experience were associated with statistically significant reductions in mental health related stigma. The results of the FOSIS Glasgow study supports the, 'Power of contact' with an Expert by Lived Experience at reducing mental health related stigma in the Muslim community. More robust research in this area is urgently required.

Metrological Performance of Instruments used in Clinical Evaluation of Balance

Clinical assessment of a patient, monitoring the progress of a condition, and/or titration of a therapy is dependent on the metrological characteristics of diagnostic equipment. While metrological performance of instruments is commonly assessed in research, it is not so often done in clinical practice. Physical rehabilitation applications may benefit individuals with mental health concerns and are associated with an accurate analysis of balance and gait. There is a paucity of published data regarding the metrological characteristics of commonly used clinical instruments used in posturographic measurements. We desired to assess the accuracy, trueness, precision and resolution of four posturography systems that we use clinically in practice: a Bertec BP-5050, a Vestibular Technologies CAPS® Professional and a Vestibular Technologies CAPS® Lite threecomponent balance platforms, and a NeuroCom® Balance Manager SMART EquiTest®. Metrological performance by posturography instruments was recommended in 2013 by the International Standardization Committee for Clinical Stabilometry of the International Society for Posture and Gait Research (ISPGR). Clinical and research findings may be erroneous, or at the least misleading, if the instruments used to make clinical decisions are associated with significant error. We suggest that there is a strong need for posturographic instrumentation with appropriate metrological characteristics used in clinical applications. The ISPRG recommendations appear to be reasonable and appropriate, and our results show they are obtainable. Physical measurements and functional testing used to correlate and design mental health and physical based rehabilitation strategies are often dependent upon the accuracy and metrological integrity of diagnostic instruments used in posturography.

A King's College London Global Health Society Event discussing Global Mental Health to increase interest in Psychiatry as a Career: A Pilot Study

INTRODUCTION

Despite the launching of multiple initiatives to increase recruitment into psychiatry, the profession continues to remain undersubscribed. Studies have shown that teaching on global mental health can improve attitudes toward psychiatry in medical students. To the best of our knowledge, no studies have been published hitherto that evaluate if a brief teaching session (i.e. 60 minutes in duration) on global mental health improves perceptions of psychiatry and increases interest in this specialty as a career.

SUBJECTS AND METHODS

We conducted a single-arm, pre- post- comparison study on participants who attended a King's College London Global Health Society event on Global Mental Health. Participants completed a survey before and after exposure to the event. Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if a brief teaching session on global mental health would increase interest in pursuing psychiatry as a career.

RESULTS

71 out of 90 participants responded (77.8% response rate). Following exposure to the event, there were statistically significant improvements in the scores for, "Psychiatry is interesting" (pre-event score 4.41, post-event score 4.66 p value <0.001), "I would talk positively about psychiatry to other people" (pre-event score 4.02, post-event score 4.48 p value <0.00001), and, "I would consider psychiatry as a career" (pre-event score 3.24, post-event score 3.72 p value <0.001).

CONCLUSION

The results of our pilot study suggest that a brief lecture on global mental health may improve perceptions of psychiatry and increase interest in this specialty as a career. We recommend that global mental health be introduced into the medical school curriculum since this may help to increase recruitment into psychiatry.

Innovative approaches to improving the image of psychiatrists and psychiatry amongst medical students and doctors in the UK

In this paper we identify some of the critical factors that contribute to the ongoing shortage of psychiatrists in the UK. We discuss initiatives that have been launched to try and encourage more medical students and trainee doctors to choose psychiatry as a career. We describe the innovative anti-stigma Wounded Healer programme that was pioneered in the UK with the aim of improving the image of psychiatry and psychiatrists and that was subsequently scaled up and rolled out to over 65,000 medical students and doctors in 14 countries in five continents worldwide. We conclude, with some suggestions that we believe will help recruitment efforts into psychiatry.

The Treatment of Autism Spectrum Disorder With Auditory Neurofeedback: A Randomized Placebo Controlled Trial Using the Mente Autism Device

Introduction: Children affected by autism spectrum disorder (ASD) often have impairment of social interaction and demonstrate difficulty with emotional communication, display of posture and facial expression, with recognized relationships between postural control mechanisms and cognitive functions. Beside standard biomedical interventions and psychopharmacological treatments, there is increasing interest in the use of alternative non-invasive treatments such as neurofeedback (NFB) that could potentially modulate brain activity resulting in behavioral modification.

Methods: Eighty-three ASD subjects were randomized to an Active group receiving NFB using the Mente device and a Control group using a Sham device. Both groups used the device each morning for 45 minutes over a 12 week home based trial without any other clinical interventions. Pre and Post standard ASD questionnaires, qEEG and posturography were used to measure the effectiveness of the treatment.

Results: Thirty-four subjects (17 Active and 17 Control) completed the study. Statistically and substantively significant changes were found in several outcome measures for subjects that received the treatment. Similar changes were not detected in the Control group.

Conclusions: Our results show that a short 12 week course of NFB using the Mente Autism device can lead to significant changes in brain activity (qEEG), sensorimotor behavior (posturography), and behavior (standardized questionnaires) in ASD children.

Working in psychiatry in New Zealand: Experiences of International (non-New Zealand) Medical Graduates

On the 11^th of February 2016, the Health Secretary in the United Kingdom (UK) Jeremy Hunt announced his plan to impose the Junior Doctor Contract despite thousands of healthcare professionals storming the streets of Westminster in defiant protest. A leading member of the Royal College of Psychiatrists Psychiatric Trainee Committee described the Junior Doctor Contract as 'poisonous', exclaiming that it would be a 'disaster for mental health' and that it would 'disincentivize doctors to work in an already desperately under-resourced specialty'. The number of doctors who applied for documentation to work abroad surged by over 1000 per cent on the same day that the Health Secretary made the Junior Doctor Contract announcement. Not surprisingly, Jeremy Hunt was accused of acting as 'a recruiting agent' for hospitals in Australasia. This paper provides background information about working conditions for Junior Doctors in the National Health Service in the UK and the anticipated effects that the Junior Doctor Contract will have on their morale, well-being and occupational functioning. Our paper then provides a brief overview of mental health services in New Zealand with a focus on a Maori mental health service provider in the North Island. We conclude our paper by offering insights from International Medical Graduates from the UK and from South Africa working as a Royal Australian and New Zealand College of Psychiatrists Psychiatric Registrar and Consultants in Waikato District Health Board (DHB) in Hamilton, New Zealand, respectively.

The Federation of Student Islamic Societies programme to challenge mental health Stigma in Muslim communities in England: The FOSIS Birmingham study

BACKGROUND

1 in 4 people experience mental health problems at some point during their lives and Muslims are no exception. Exacerbating the morbidity and mortality associated with mental health problems in Muslims is Islamophobia. Stigma and shame are major barriers to accessing and using mental health services and many Muslims with mental health problems do not receive the treatment they need. The Federation of Student Islamic Societies (FOSIS) United Kingdom branch organized a mental health conference to challenge the stigma attached to psychological problems in Muslims and to encourage care seeking in this group.

DESIGN

We conducted a single arm, pre-post comparison study on Muslims who attended the FOSIS mental health conference in Birmingham Medical School, England. Validated stigma scales measuring knowledge, attitudes and behavior were administered on participants before and immediately after exposure to the programme. Participants were also asked to respond to statements, the items of which were on a 5-point Likert scale, about the role that Islam plays in Muslim mental health, stigma as a barrier for Muslims with mental health problems to accessing and using mental health services and if they felt inspired to challenge stigma.

RESULTS

50/250 (20%) of participants completed the study. There were statistically significant improvements in the 'Reported and Intended Behavior' score (p=0.0036), the 'Inspired to Take Action' Score (p=0.0202) and the 'Incorporating Islamic Principles into Mental Health Treatment for Muslims is Beneficial' score (p=0.0187).

DISCUSSION

The findings of our study suggest that a 'bespoke' Muslim mental health conference comprised of talks delivered by experts in Islam and mental health and a Muslim who has first-hand experience of psychological distress might be effective at reducing mental health stigma in the Muslim community. Our results should help to inform the design, development and delivery of future Muslim mental health conferences however more robust research in this area is needed.

'A Labour of Love': A King's College London Psychiatry Society Event to challenge the stigma attached to mental health problems in post-natal women

BACKGROUND

On the 9^th October 2000, Dr Daksha Emson, a London based psychiatrist with bipolar affective disorder, tragically killed herself and her three-month-old baby daughter during a psychotic episode. An independent inquiry into Dr Emson's death concluded that mental health stigma in the National Health Service was a factor that contributed to her death. Despite the morbidity and mortality attributed to the stigma attached to post-natal mental health problems there are very few programmes that have been developed to challenge it. King's College London Undergraduate Psychiatry Society organized an event entitled, 'A Labour of Love': Perinatal Mental Health to address this issue. The event included a talk from an expert by experience, a mother who developed post-partum mental health problems.

DESIGN

We conducted a single-arm, pre-post comparison study on participants who attended the KCL Psych Soc event. Validated stigma scales on knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviour (Reported and Intended Behaviour Scale (RIBS)) were administered before and immediately after exposure to the event.

RESULTS

27/27 (100%) of participants recruited responded. There was a statistically significant difference in the pre-MAKS score compared to the post-MAKS score (p=0.0003), the pre-RIBS score compared to the post-RIBS score (p=0.0068) and in the pre-CAMI score compared to the post-CAMI score (p=0.0042).

DISCUSSION

There were statistically significant reductions in stigma in the domains of knowledge, attitude and behavior following exposure to the KCL Psych Soc event and no adverse effects were reported. Our study revealed that a brief intervention made a highly significant impact and maybe useful in challenging the stigma around post-natal mental illness. However, more research in this area is required to determine if the changes are sustained before we can consider rolling out and scaling up such an initiative nationally and internationally.

Part II: Muslims perceptions of British cobat troops

BACKGROUND

On the 22^nd May 2017, suicide bomber Salman Abedi detonated an improvised explosive device (IED) in the Manchester Arena killing 22 people and injuring 116 others. Following the 'massacre in Manchester', the leader of the Labour Party, Jeremy Corbyn, linked UK foreign policy with terrorism on British soil. Controversial and contentious though Corbyn's claims may be, the terrorists themselves have also reported that what motivates them to carry out their abominable atrocities are British military operations in Muslim majority countries. Indeed, on the 22^nd May 2013, British serviceman, Lee Rigby, was brutally attacked and killed by Michael Adebolajo and Michael Adebowale near the Royal Artillery Barracks in Woolwich, southeast London. The perpetrators of this heinous act told passers-by at the scene that they wanted to avenge the killing of Muslims by the British Armed Forces.

METHODS

We conducted a cross-sectional, mixed-methods study on Muslim perceptions of British combat troops and UK foreign policy. Participants were selected by purposive sampling. We crafted a survey that explored Muslim perceptions of the British military and the government's foreign policy. Response items were on a Likert-scale and there was white space for free text comments which were subjected to thematic analyses.

RESULTS

75/75 (100%) of the participants recruited responded. (75/75 (100%) Muslim participants, 43/75 (57.3%) female participants, 32/75 (42.7%) male participants, mean age 20.5 years, (Std. Dev. ±2.5)). 66/75 (88%) of respondents either agreed or strongly agreed that British military operations in Muslim majority countries have negatively influenced perceptions towards combat troops. 42/75 (56%) of respondents either agreed or strongly agreed that contact with a combat troops or veterans would positively influence their perceptions towards them. Themes of free text comments included the role that the media plays in demonising Muslims, the transcendental bond that Muslims around the world have for each other and 'the brainwashing' of British combat troops by the Government.

DISCUSSION

The fact that many of the participants in our sample agreed or strongly agreed that social contact with service personnel or veterans would positively influence perceptions towards them is encouraging. The results of our survey lend support for future intervention studies investigating whether contact between Muslims residing in the UK and British combat troops would promote unity and community cohesion.

Barriers to accessing and consuming mental health services for Palestinians with psychological problems residing in refugee camps in Jordan

BACKGROUND

The Baqa'a refugee camp is the largest in Jordan, home to some 104,000 Palestine refugees. Barriers to accessing and consuming mental health services in Arab-refugees are well documented in the literature however few studies have been conducted hitherto to identify barriers for Palestine refugees with psychological problems residing in refugee camps in Jordan.

AIM

To identify the barriers to accessing and consuming mental health services for Palestine refugees with psychological problems residing in Baqa'a refugee camp in Jordan and to formulate policy recommendations to overcome those barriers.

METHODS

16 qualitative, semi-structured interviews were conducted with healthcare professionals working at health centres for Palestine refugees in Jordan, 14 of which were in health centres at Baqa'a refugee camp and the remaining two at the Field Office of the United Nations Relief and Works Agency (UNRWA) in Amman, Jordan. All the interviews were recorded and transcribed and thematic analyses conducted. Ethical approval was granted by the University of Leeds and UNRWA.

RESULTS

16/16 (100%) respondents reported that resource and financial deficits were the most common barriers that contributed towards the treatment gap. Sex (15/16, (94%)), stigma and religion (12/16, (75%)) and culture (10/16, (63%)) were other major barriers identified.

DISCUSSION

Our findings help to elucidate the contributory factors towards the treatment gap between Palestine refugees with psychological problems residing in Baqa'a refugee camp in Jordan and mental health services therein. Policy recommendations based on our results are formulated and are discussed in this research paper.

The performing arts and psychological well-being

Although psychotropic drugs have been hailed as, 'One of the success stories of modern psychiatry' the prescribing of these medicines has not been without commotion, concern and controversy. Moreover, the President of the World Psychiatry Association Professor Dinesh Bhugra and colleagues, after conducting a recent large-scale study (n=25,522) on psychiatric morbidity in the UK, collectively issued the clarion call that, 'The mental health of the nation was unlikely to be improved by treatment with psychotropic medication alone'. The provision of mental healthcare services may likely benefit from a holistic approach that includes a variety of treatment options that prioritizes patient safety and preference. The performing arts is gaining popularity among service users as an adjunctive form of treatment for mental illness. There is a growing body of evidence that provisionally supports the claim that art therapy, 'Possesses the power to heal psychological wounds'. The North American Drama Therapy Association defines drama therapy as, 'The intentional use of drama and/or theatre processes to achieve therapeutic goals' and that it is 'active and experiential'. This review article discusses and describes the merits of dramatherapy and how this treatment modality can contribute to a patient's recovery from psychological distress.

Part I: Muslims, social inclusion and the West. Exploring challenges faced by stigmatized groups

The rise of radicalisation, the 'demonization' of Muslims in the media and the immigration crisis in Europe have all contributed and colluded to heightened levels of Islamophobia in the West. The stigmatisation of Muslims can and has resulted in negative outcomes in this group such as elevated levels of psychological distress and an increase in hate crime and terrorist attacks perpetrated against Muslims from members of the far right. There are 1.6 billion Muslims on the planet and Islam is the fastest growing religion in the world. Now, more than ever it seems, is a critical time to learn about what the true message of Islam is and who the blessed prophet Muhammad peace be upon him (PBUH) was from reliable and authentic sources. This paper aims to challenge the stigma attached to Muslims through the following means: 1. It contains information to educate people about Islam, debunk myths and challenge negative stereotypes; 2. It utilizes the power of 'story-telling' to engage readers and to equip them with facts and the necessary skills to combat Islamophobia. Part I includes a brief introduction of Islam and concludes with a concise description and evaluation of an anti-Islamophobia programme that was piloted in Cambridge University (UK) and delivered as a Keynote Address at the Carrick Institute for Graduate Studies International Symposium of Clinical Neuroscience in Orlando, (USA). Our hope is that through this initiative we can create a critical mass and inspire and empower people, Muslims and non-Muslims alike to stand in solidarity and collectively challenge extremism in any of its many forms. Our hypothesis is that this will result in better outcomes such as reductions in radicalization and Islamophobia.

The Wounded Healer film: A London College of Communication event to challenge mental health stigma through the power of motion picture

BACKGROUND

There is a preponderance of mental health problems in students on a global scale which can have a considerable effect on their academic performance and a profound impact on their quality of life. Many universities offer free counselling services however despite this a recent study in the US revealed that up to 84% of students who screened positive for depression or anxiety did not receive any treatment. There are many obstacles that students with mental health problems encounter that prevents them from receiving care, foremost among these is stigma. Film based interventions are showing promise at challenging stigma which can subsequently lower the barriers to accessing and using mental health services for students who need them.

DESIGN

We conducted a single-arm, pre-post comparison study on arts students from the London College of Communication. Participants were exposed to the Wounded Healer film, a motion picture featuring a protagonist who is a doctor with first-hand experience of psychological distress. Validated stigma scales on knowledge (Mental Health Knowledge Schedule (MAKS)), behaviour (Reported and Intended Behaviour Scale (RIBS)) and attitudes (Community Attitudes towards the Mentally Ill (CAMI)) were administered on participants before and immediately after exposure to the intervention.

RESULTS

21/28 (78%) of the participants recruited for the study responded. The mean age of respondents was 22 years (Std. Dev 2.20). There was an increase in the MAKS score after students viewed the Wounded Healer film indicating lower levels of stigma in mental health knowledge however this change was not statistically significant.

DISCUSSION

A previous study on the Wounded Healer film demonstrated a reduction in stigma among healthcare students. The results of this pilot study, however, suggest that a film featuring a protagonist who is not from the same background as the audience may not be effective at reducing mental health stigma in that group. This is consistent with the results of recent research that revealed that an anti-stigma intervention that is effective in one group may not necessarily be effective in other groups. Our findings, however, must be interpreted with caution due to the limitations of this study. Future research with a prospective study design, a larger sample size and a control group exposed to a film with a protagonist who shares the same background as the audience is needed.

A King's College London Undergraduate Psychiatry Society event to challenge the stigma attached to psychological problems in healthcare professionals and students

BACKGROUND

There are higher levels of psychological distress in healthcare professionals and students compared to the general population. Yet, despite the availability of effective treatment, many in this group continue to suffer in silence. Fear of exposure to stigmatization has been identified to be a major barrier to accessing and using mental health services. King's College London Undergraduate Psychiatry Society (KCL PsychSoc) organized an event entitled, 'What does bipolar disorder even mean? Psychological distress: How can we challenge the stigma?'. Healthcare professionals who themselves recovered from psychological problems and a mental health advocate with first-hand experience of psychological distress were invited to deliver talks followed by an interactive question and answer session.

DESIGN

We conducted a single-arm pre-post comparison study. People who attended the KCL Psych Soc event were recruited to participate. Validated stigma scales on knowledge (Mental Health Knowledge Schedule (MAKS), attitudes (Community Attitudes towards the Mentally Ill) and behavior (Reported and Intended Behavior Scale (RIBS)) were administered on participants before and immediately after exposure to the event.

RESULTS

44/44 of the participants recruited completed the study (100% response rate). There were statistically significant changes in the respondents' scores for all 3 stigma scales (p value MAKS<0.0001, p value CAMI<0.0001, p value RIBS=0.0011).

DISCUSSION

As far as the authors are aware, this is the first study to date of an anti-stigma intervention comprised of healthcare professionals with first-hand experience of psychological distress. The KCL PsychSoc event was associated with statistically significant changes in the respondents' scores in all three of the stigma scales. More robust research in this area is needed before scaling up similar anti-stigma initiatives.

The Federation of Student Islamic Societies programme to challenge mental health Stigma in Muslim communities in Ireland: The FOSIS Dublin study

BACKGROUND

Mental health problems are common in Muslim communities however due to fear of exposure to stigmatization many people in this group continue to suffer in silence despite the availability of effective treatment. The Federation of Student Islamic Societies (FOSIS) organized the first ever Muslim mental health conference in Ireland to challenge the stigma attached to mental health problems in Muslims and to encourage care seeking in this group. As far as the authors are aware there are no intervention studies on mental health stigma in Muslim communities reported in the literature.

DESIGN

We conducted a single arm, pre-post comparison study on Muslims who attended the FOSIS mental health conference in University College Dublin, Ireland. Validated stigma scales measuring knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviour (Reported and Intended Behaviour Scale (RIBS)) were administered on participants before exposure to the programme and immediately afterwards.

RESULTS

18/150 (12%) of participants completed the pre-post RIBS scale and pre-post MAKS scale and 16/150 (10.5%) of participants completed the pre-post CAMI scale. There were statistically significant differences in the pre-RIBS score compared to the post-RIBS score (p=0.0262) and the pre-MAKS score compared to the post-MAKS score (p=0.0003) but not in the pre-CAMI score compared to the post-CAMI score (p=0.6214).

DISCUSSION

To the best of our knowledge, the FOSIS Dublin Study is the first intervention study on mental health stigma in Muslim communities to be published. The results of our study provide provisional support that a 'bespoke' Muslim mental health conference comprised of talks and workshops by experts in mental health, scholars in Islam and a lecture delivered by a Muslim with first-hand experience of a mental health problem are associated with reductions in stigma. More robust research with a longitudinal study design, larger sample sizes and a control group are needed to determine if such events can cause a sustained reduction in mental health stigma in Muslim communities.

Harnessing the Power of Film to Combat Mental Health Stigma. A University College London Psychiatry Society Event

AIMS

To conduct a pilot study on a motion picture based, anti-stigma programme entitled, "The Wounded Healer film" to measure if it is associated with any changes in stigma variables in healthcare students and if it encouraged care seeking in this group.

BACKGROUND

The 2008 Stigma Shout Survey of almost 4000 people using mental health services and carers revealed that healthcare professionals are a common source of stigma reported by people with mental illness. Psychological problems are common in medical students and doctors, however, thelevel of care seeking in this group is low. Fear of exposure to stigmatization is a crucial barrier to accessing and using mental health services. Recent research has revealed that film-based interventions can be used to challenge mental health stigma and encourage care seeking.

METHODS

We conducted a single-arm, pre-post comparison study on students who attended the Wounded Healer film at a University College London Psychiatry Society event (n=11). Before and after exposure to the film, students were asked to complete validated stigma scales that measured mental health-related knowledge, attitudes and behaviours. Responses were on a Likert scale and participants also provided free free-text comments which were subjected to thematic analyses.

RESULTS

There was a statistically significant difference in the mental health-related knowledge pre-intervention score compared to the post-intervention score (p=0.0322). All participants either strongly agreed or agreed with the post-evaluation statement, "I feel inspired to raise awareness of the importance of mental health and to take action to challenge stigma."

CONCLUSION

This pilot study provides provisional support that The Wounded Healer film may be associated with reductions in stigma variables in healthcare students and encourage them to seek care for their own psychological problems. More robust research in this area is needed before we can scale up such an initiative.

Head-Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients

Context

Approximately 1.8–3.6 million annual traumatic brain injuries occur in the United States. An evidence-based treatment for concussions that is reliable and effective has not been available.

Objective

The objective of this study is to test whether head–eye vestibular motion (HEVM) therapy is associated with decreased symptoms and increased function in postconcussive syndrome (PCS) patients that have been severely impaired for greater than 6 months after a mild traumatic brain injury.

Design

Retrospective clinical chart review.

Setting and participants

Tertiary Specialist Brain Rehabilitation Center.

Interventions

All subjects underwent comprehensive neurological examinations including measurement of eye and head movement. The seven modules of the C3 Logix Comprehensive Concussion Management System were used for pre- and postmeasurements of outcome of HEVM therapy.

Materials and methods

We utilized an objective validated measurement of physical and mental health characteristics of our patients before and after a 1-week HEVM rehabilitation program. We included only PCS patients that were disabled from work or school for a period of time exceeding 6 months after suffering a sports concussion. These subjects all were enrolled in a 5-day HEVM rehabilitation program at our Institutional Brain Center with pre- and post-C3 Logix testing outcomes.

Results

There were statistical and substantive significant decreases in PCS symptom severity after treatment and statistical and substantive significant increases in standardized assessment of concussion scores. The outcomes were associated with positive changes in mental and physical health issues. This is a retrospective review and no control group has been included in this study. These are major limitations with retrospective reviews and further investigations with prospective designs including a randomized controlled study are necessary to further our understanding.

Conclusion

Head–eye vestibular motion therapy of 5 days duration is associated with statistical and substantive significant decreases of symptom severity associated with chronic PCS.

Randomized Controlled Study of a Remote Flipped Classroom Neuro-otology Curriculum

CONTEXT

Medical Education can be delivered in the traditional classroom or via novel technology including an online classroom.

OBJECTIVE

To test the hypothesis that learning in an online classroom would result in similar outcomes as learning in the traditional classroom when using a flipped classroom pedagogy.

DESIGN

Randomized controlled trial. A total of 274 subjects enrolled in a Neuro-otology training program for non-Neuro-otologists of 25 h held over a 3-day period. Subjects were randomized into a "control" group attending a traditional classroom and a "trial" group of equal numbers participating in an online synchronous Internet streaming classroom using the Adobe Connect e-learning platform.

INTERVENTIONS

Subjects were randomized into a "control" group attending a traditional classroom and a "treatment" group of equal numbers participating in an online synchronous Internet streaming classroom.

MAIN OUTCOME MEASURES

Pre- and post-multiple choice examinations of VOR, Movement, Head Turns, Head Tremor, Neurodegeneration, Inferior Olivary Complex, Collateral Projections, Eye Movement Training, Visual Saccades, Head Saccades, Visual Impairment, Walking Speed, Neuroprotection, Autophagy, Hyperkinetic Movement, Eye and Head Stability, Oscilllatory Head Movements, Gaze Stability, Leaky Neural Integrator, Cervical Dystonia, INC and Head Tilts, Visual Pursuits, Optokinetic Stimulation, and Vestibular Rehabilitation.

METHODS

All candidates took a pretest examination of the subject material. The 2-9 h and 1-8 h sessions over three consecutive days were given live in the classroom and synchronously in the online classroom using the Adobe Connect e-learning platform. Subjects randomized to the online classroom attended the lectures in a location of their choice and viewed the sessions live on the Internet. A posttest examination was given to all candidates after completion of the course. Two sample unpaired t tests with equal variances were calculated for all pretests and posttests for all groups including gender differences.

RESULTS

All 274 subjects demonstrated statistically significant learning by comparison of their pre- and posttest scores. There were no statistically significant differences in the test scores between the two groups of 137 subjects each (0.8%, 95% CI 85.45917-86.67952; P = 0.9195). A total of 101 males in the traditional classroom arm had statistically significant lower scores than 72 females (0.8%, 95% CI 84.65716-86.53096; P = 0.0377) but not in the online arm (0.8%, 95% CI 85.46172-87.23135; P = 0.2176) with a moderate effect size (Cohen's d = -0.407).

CONCLUSION

The use of a synchronous online classroom in neuro-otology clinical training has demonstrated similar outcomes to the traditional classroom. The online classroom is a low cost and effective complement to medical specialty training in Neuro-Otology. The significant difference in outcomes between males and females who attended the traditional classroom suggests that women may do better than males in this learning environment, although the effect size is moderate.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov, identifier NCT03079349.

“The Wounded Healer”: An anti-stigma program targeted at healthcare professionals and students

Introduction

“The wounded healer” (TWH) is an innovative method of pedagogy that blends art with science that is delivered by an award-winning doctor with first-hand experience of a mental health condition. The aim of this study is to evaluate the effectiveness of TWH at reducing stigma from healthcare professionals and students towards their peers with a mental health condition.

Background

TWH has been delivered to more than 30,000 people in 9 countries on 5 continents worldwide and has been integrated into the medical school curricula of 4 UK universities. TWH also featured in the 2015 iMed Congress in Lisbon, Portugal, the largest medical student congress in Europe (n = 1000).

Methods

We conducted a cross-sectional, mixed-methods study on participants who attended TWH in venues across the UK. Paper questionnaires containing stigma constructs with response items on a Likert-scale were hand distributed to participants. Free-text comments were subjected to thematic analyses.

Results

Two hundred and nineteen over 256 participants recruited responded (85% response rate); 207/219 (94%) of respondents agreed or strongly agreed that TWH made them realise that medical students and doctors who experience mental distress can recover and achieve their goals.

Themes that emerged from analyses of free-text comments included, “inspirational”, “merits of blending art with science”, and “benefits of receiving a talk from a doctor with first-hand experience of a mental health problem”.

Discussion

Our findings suggest that TWH might be effective at reducing stigma from healthcare professionals and students towards their peers with mental health problems. More robust research in this area is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

'Craziness' and creativity: Psychopathology and Poetry

Not all poets have experienced psychopathology. Conversely, not all those who have experienced psychopathology become poets. The notion, nonetheless, of there being an association between 'craziness' and creativity, contentious though it may be, remains a seductive one. Poetry is both beneficial for the person who is composing or reciting it as well as the person who may be reading or listening to it. Poetry Therapy, which falls under the remit of Art Therapy, is increasingly being recognised as an effective form of adjunctive therapy for the treatment of mental health problems. The main aims of this paper are to explore (and to attempt to elucidate) if there is indeed a relationship between the artistic temperament and mental illness and to comment on the rise and recognition of Art Therapy.

Cinematherapy and film as an educational tool in undergraduate psychiatry teaching: a case report and review of the literature

Film possesses an extraordinary power and offers an unrivalled medium for entertainment and escapism. There are many films that revolve around a mental illness theme and the medical specialty that most commonly features in motion picture is psychiatry. Over the last few decades films have become increasingly used as an educational tool in the teaching of psychiatry topics such as mental state examination to undergraduate students. Above and beyond its utility in pedagogy, film also has the power to heal and the term cinematherapy has been coined to reflect this. Indeed, there are case studies of people with first-hand experience of psychopathology who report that watching films with a mental illness theme has contributed to their recovery. We provide a first person narrative from an individual with schizophrenia in which he expounds on the concepts of cinematherpy and metaphorical imagery in films which theme on psychosis.

Islam, mental health and being a Muslim in the West

The allegation that, 'Being Muslim means that you cannot be British' is often made. In view of this, we conducted a small survey (n=75) utilising purposive sampling on Muslims residing in the United Kingdom. Participants were recruited in a King's College London Islamic Society event in November 2014 in Guy's Hospital, London. 75/75 (100%) of the participants recruited responded. 69/75 (94%) of respondents either disagreed or strongly disagreed that, 'Being Muslim means that you cannot be British' (75/75 (100%) Muslim participants, 43/75 (57.3%) female participants, 32/75 (42.7%) male participants, mean Age 20.5 years, (Std. Dev. ±2.5)). This paper broadly seeks to answer two related questions. Firstly, 'What is the relationship between Islam and the West?' and secondly, 'What is the relationship between Islam and mental health?' In relation to the former, the rise of radicalization over recent years and the Islamophobia that has ensued have brought Islam and Muslims under intense scrutiny. Hence we feel it is both timely and important to offer a brief background of Islam and its relevance to the Western world. In relation to the latter, for many people religion and mental health are deeply and intimately intertwined. For example, religion can enable a person to develop mental health resilience and Islam has been reported to be a protective factor against suicidal behaviour. We conclude our paper by illustrating how the two questions are interrelated. We do so by offering an autobiographical narrative from a Muslim healthcare professional residing in the UK who developed a mental health problem precipitated by war in the country of his origin. His narrative includes descriptions of the role Islam that played in his recovery as well as his attempts to reconcile seemingly disparate aspects of his identity.

Global strategies targeting the recruitment crisis in psychiatry: the Doctors Academy Future Excellence International Medical Summer School

BACKGROUND

The World Health Organization has identified a chronic shortage of psychiatrists worldwide whereas the demand for mental health services is on the rise. Indeed mental health problems are projected to be a leading cause of morbidity by 2020 according to the Global Burden of Disease study. Bhugra et al, under the auspices of the Royal College of Psychiatrists and the World Psychiatry Association, spearheaded an international study across 22 countries and identified myriad factors that can influence career choices at pre-medical school, medical school and postgraduate levels. The enthusiasm and passion of mental health educators and the quality of psychiatry placements were identified as factors that can attract medical and students and graduates to a career in psychiatry. The Future Excellence International Medical Summer School (FEIMSS) is a 5-day event for medical students held yearly in Manchester, UK. FEIMSS is the largest event of its kind in the world; the 2013 cohort was comprised of 244 students from 40 countries representing 80 universities.

AIMS

To improve the image of psychiatrists and the perception of psychiatry in general with 2 brief contact-based lectures from a consultant and an early-career psychiatrist. The lectures incorporated references to the humanities (literature, poetry, history, film, drama and art).

METHODS

A mixed-methods study was conducted. Paper evaluation forms were hand-distributed to participants who attended the psychiatry talks. Items to constructs relevant to the talks were on a Likert-type scale. Participants were given the choice of anonymity. There was space for free-text comments which were subjected to thematic analyses.

RESULTS

25/25 of the participants responded (response rate 100%). The heterogeneous sample was comprised of participants representing 11 countries from Japan to Kosovo. The written feedback was exceptionally positive. For the, 'The psychiatry talks were interesting' and, 'Attending FEIMMS improved my understanding and respect for other cultures' constructs, 23/25 (92%) of respondents agreed or strongly agreed.

DISCUSSION

Notwithstanding the limitations of our evaluation--which to our knowledge is the first of its kind on such an ethnically eclectic sample--our results suggest that a brief contact-based intervention incorporating the humanities may positively influence the perceptions of psychiatry and psychiatrists that medical students from diverse cultural backgrounds have. We contend that FEIMSS provides a platform to recruit medical students into psychiatry from all over the world and enables them to develop cultural competency.

The Wounded Healer: an effective anti-stigma intervention targeted at the medical profession?

AIMS

To investigate whether a brief, contact based anti-stigma interventionentitled, 'The Wounded Healer' can positively influence participants' views towards mental health challenges in medical students and doctors. We also wanted to raise awareness of the importance of registering witha General Practitioner (GP) and consulting him/her when under mental distress.

BACKGROUND

Despite the perception that medical students and doctors should be 'invincible', mental health challenges are common in this population. Doctors and medical students have low levels of help-seeking for their own psychiatric problems often only presenting to mental health services once a crisis arises. Fear of exposure to stigmatization is a critical factor contributing to symptom concealment and is a major barrier to accessing mental health services.

METHOD

The Wounded Healer was delivered to participants in 6 cohorts across the United Kingdom (UK): Cambridge Medical School (n=97), Manchester Medical School (n=36), Manchester University International Society (n=25), Sheffield Medical School (n=21), Foundation Doctors in the North West of England (n=54) and Southampton Medical School (n=23) (total sample size n=256). Immediately following the intervention, we hand distributed paper questionnaires that contained stigma constructs to each individual participant.Answers were on a Likert-type scale and there was also space for free-text comments which were subjected to thematic analysis.

RESULTS

174/219 (79.5%) of respondents agreed or strongly agreed that their views towards mental health issues were more positive after the talk. 172/219 (78.5%) of respondents agreed or strongly agreed that the talk made them more understanding and accepting of medical students and doctors with mental illness. 156/219 (71.3%) of respondents agreed or strongly agreed that the talk made them more aware of the importance of registering with a GP and consulting him/her if they felt they were under mental distress.

CONCLUSION

Following the delivery of the anti-stigma Wounded Healer intervention a majority of respondents stated that they viewed mental health challenges in medical students and doctors in a more positive way. A majority of respondents also demonstrated a better awarenessof registering and consulting a GP if they develop mental distress. Further research which incorporates validated assessments of stigma (at baseline and at follow-up points after the intervention has been delivered), a control group and larger sample sizes are needed to determine if the Wounded Healer intervention can cause a sustained reduction in the stigma associated with mental health challenges in healthcare professionals and encourage help-seeking behaviour for mental health challenges.

Should Ramadan be prescribed after Christmas? Obesity in the healthcare profession and the health benefits of fasting

Obesity is an important risk factor for cardiovascular morbidity and mortality. In the UK, one in four people are considered overweight or obese and that number is expected to rise to one in three by 2020. Employees of the National Health Service (NHS) are no exception with up to half of healthcare workers considered overweight or obese. Religious periods such as Christmas and Ramadan are associated with weight changes. Weight gain has been reported during the Christmas period albeit not as much as was traditionally believed according to the results of recent research. Conversely, weight loss has been reported in Muslims who fast during the Islamic month of Ramadan; however, this amount tends to be modest and weight gradually returns to pre-Ramadan status according to a meta-analysis of the literature. We report a case of an NHS healthcare worker - which is the first of its kind that illustrates the role that fasting and other factors have played a role in causing dramatic oscillations in his weight.

Lessons from psychiatry in the Arab world--a Lebanese trainee psychiatrist's qualitative views on the provision of mental healthcare services for Palestinian refugees in Lebanon and an interview with a consultant psychiatrist on the effects of the Arab spring on the mental health of Libyans

In this manuscript, a Lebanese trainee psychiatrist qualitatively analyses and discusses the provision of mental healthcare services for Palestinian refugees in Lebanon. There are more than 250,000 Palestinian people sporadically dispersed in the refugee camps in Sidon, Beirut and other major cities in the Levant. Displacement, conflict, trauma, unemployment and poverty are but some of the myriad factors that influence Palestinian refugee mental health. This article traces the historical, political and socioeconomic determinants of health for Palestinians exiled in Lebanon and describes the pivotal role that the non-Govenmental Organisation Medical Aid for Palestinians is playing in helping to alleviate the psychiatric distress of Palestinian sufferers of mental illness. The latter half of the manuscript contains an interview with a consultant psychiatrist about his experiences volunteering in the war-torn lands of Libya post Arab Spring. He expounds on how he feels mental healthcare services in Libya are woefully inadequate and broaches on his perception of how the resilience and the 'family-centric' model of the Libyan people has conferred a certain degree of protection towards developing severe psychiatric illness.

Prevalence of depression and anxiety in adult patients with β-thalassemia major and intermedia

OBJECTIVE

To evaluate and compare the prevalence and risk factors for anxiety and depression in adults with beta-thalassemia major (TM) and intermedia (TI).

METHOD

A cross-sectional study of TI and TM patients at a Chronic Care Center in Lebanon. A total of 80 patients agreed to participate (32 TI (median age 24 years) and 48 TM (median age 23 years)). The Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) questionnaires were used to assess the depression and anxiety levels of patients, respectively. Data on patient demographics, clinical complications, and socioeconomic status were also collected.

RESULTS

Patients with TM had a significantly longer median duration with a known thalassemia diagnosis than patients with TI (p < 0.001). A considerable proportion of patients had depression (35.0%), State (S)-anxiety (22.5%) or Trait (T)-anxiety (36.2%). Patients with TI had a higher median S-anxiety score compared with TM (p = 0.035), although the median T-anxiety and depression scores were similar. On linear regression analysis, the significant association between the thalassemia diagnosis (TM versus TI) and S-anxiety score (beta: 5.740; 95% CI: 0.201 to 11.278; p = 0.042) was no longer observed upon adjustment for the co-variate duration with a known thalassemia diagnosis (beta: 3.162; 95% CI: -2.949 to 9.274; p = 0.306).

CONCLUSIONS

A considerable proportion of adult patients with TM and TI show evidence of depression and anxiety. Patients with TI are more liable to state anxiety than TM patients of a similar age, which is attributed to a shorter duration of living with a thalassemia diagnosis.

Jung's archetype, 'The Wounded Healer', mental illness in the medical profession and the role of the health humanities in psychiatry

Carl Jung used the term, 'The Wounded Healer' as an archetype to describe doctors who have suffered from an illness. Reading and writing autobiographical narratives of the 'Wounded Healer' is gaining popularity among doctors with mental illness as an effective form of adjunctive therapy. Moreover, reading autobiographical narratives of psychopathology sufferers can 'augment' service providers' humanity by offering valuable qualitative insights into minds afflicted with a psychiatric disorder. The primary author, a doctor of Middle-Eastern descent practicing in the UK, composed an autobiographical narrative about his personal experiences with oscillations in his mood in an attempt to illustrate the cultural, religious and psychosocial factors that influence disease detection, progression, treatment and outcome. An inordinate amount of misconceptions about mental illness abound. We hope that this manuscript will help to lessen the stigma associated with those who suffer from psychopathology (particularly doctors) and encourage sufferers to engage with the appropriate services.

An exploration of how film portrays psychopathology: the animated documentary film Waltz with Bashir, the depiction of PTSD and cultural perceptions

With the inauguration of the UK's first ever Medical Film festival MedFest in 2011 there has been resurgence in the interest of the association between psychiatry and film. The festival in 2012 was titled "HealthScreen": Understanding Illness through Film and its aim, according to the founder Dr Kamran Ahmed, was, 'To stimulate debate of the social, political and ethical implications of portrayals of health and illness on our screens' (1). Waltz with Bashir is a 2008 Israeli animated documentary film written and directed by Ari Folman. It portrays the protagonist (Folman) in search of his lost memories of his experience as a soldier in the 1982 Lebanon War and his attempt to both decipher them and reconcile himself with them. 2012 marks the 30th year commemoration of the Sabra and Shatilla tragedies. Waltz with Bashir vividly depicts the massacres of Palestinians in the Sabra and Shatilla refugee camps in Beirut through the lens of an ex-IDF serviceman and the harrowing effects that PTSD has on him. Waltz with Bashir was nominated for an Academy Award for Best Foreign Language Film however despite the popularity of the film and much critical acclaim it is officially banned in Lebanon. The authors are mindful of the devastating effects that the atrocities have had on the mental health of all those who were involved, the Lebanese, Palestinians and also the Israelis. The purpose of this presentation is to explore how the film Waltz with Bashir portrays PTSD and how it has influenced cultural perceptions.