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Ben Barr

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  • Bit of a spat between psychologists and psychiatrists, at the momentWith the American Psychiatry Association's about to release of DSM-5, Diagnostic and Statistical Manual of Mental Disorders.And the Britsh Psychological society releasing a consensus statement - A debate about whether mental illnesses are not best understood as diseasesIts was unhelpful to see mental health issues as illnesses with biological causes."On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse. I’m not really sure, whether that any illnesses physical or mental are solely biologically caused, and surely most are the result of a complex mix of social and psychological circumstance. Although this is particularly true of mental health. What is clear though is that difficult circumstances, lead to significant distress, and on tragic occasions to people taking their won lives. The involvement of medicine in that process, Im sure benefits some people. But the solution, I believe must be social, what we do as a society.
  • Poverty is disempowering
  • Employment – and mental healthUnemployment is a shock – booms and busts of the system
  • The parallels with the dying days of the communist system are striking. The collapse of the Soviet Union was characterised by a sharp increase in mortality. There were many factors involved and, as some of you know, we have shown the important role played by easy access to potent and cheap alcohol. [] But one of the causes of death that increased markedly was suicide. We showed how people living in Russian regions experiencing the most rapid rates of economic transition died in the largest numbers. [] Later, when we looked across the former communist world, we were able to show the important role played by rapid and uncontrolled privatisation, often involving state run enterprises being handed over to those who would soon become oligarchs living in London and owning football clubs. It was not so much the experience of losing one’s job, although that was bad enough. Rather, it was the anticipation of doing so in a situation where it was abundantly clear that no-one could care less. Suicides RussiaLancet privatisation
  • The recession ….
  • Iceland – imf rescue package-recomending massive austerity- cuts 30% of the health budgetReferendum 3% population took t the streets93% voted againstRejected austerity measuesThroughout the goverment
  • What government do matters –What people make governments do matters
  • I’ve mainly focused on – what can be done nationallyAnd it is right that we seek to influence national policy.
  • Transcript

    • 1. Suicides and RecessionBen BarrSenior Clinical Lecturer in Public Health.MRCDepartment of Public Health and PolicyUniversity of LiverpoolCALM presentationMay 2013
    • 2. Power and powerlessness
    • 3. Unemployment in the UK% unemployedYear
    • 4. Barr B et al. BMJ 2012;345:bmj.e5142©2012 by British Medical Journal Publishing Group
    • 5. Suicides and recession in Europe
    • 6. Unemployment and suicides10% increase in number unemployed ~ 1.4% increase in suicides.
    • 7. Conclusion:The study provides evidencelinking the recent increasein suicides in England withthe financial crisis thatbegan in 2008.English regions with the largestrises in unemployment havehad the largest increases insuicides, particularly amongmen.
    • 8. Trends in suicides in the former USSR0510152025303540451981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009Deaths/100,000Belarus Kazakhstan Russian Federation Ukraine
    • 9. Change in standardised death rate from suicide and self-inflicted injuries per 100 000 inselected Eastern European countries by change in Gini coefficient, 1989–1997.De Vogli R , Gimeno D J Epidemiol Community Health2009;63:956-956©2009 by BMJ Publishing Group Ltd
    • 10. Rising tide lifts all shifts?
    • 11. Does It Have To Be This Way.Appendix 8. Comparisons among EU countries unemployment-mortalityationsdirect correlation between rises in unemployment and rises in suicide rates. Spainusly had among the lowest suicide rates in western Europe (note y-axis in early-), but a combination of AIDS and high rates of injuries against a backdrop of economiclitical turbulence post-Franco with low social protections ($88 per head) left thetion more exposed to economic shocks.igure 8a. Direct Association of Unemployment with Suicide, Spain 1980-200510152025UnemploymentRate(LabourForceSurveys)1980 1985 1990 1995 2000 2005YearSuicide Male Unemployment RateAverage Labour Market Protection: $88 per headSpainUnemployment rates based on labour force surveys from the International Labour Organisationdicators of the Labour Market Database 2006 edition. Male suicide mortality rates (ages 0-64)m the World Health Organisation European Health for All Database 2008 edition.Web Figure 8b. No Association of Unemployment with Suicide, Sweden 19815202530SuicideRatesper100,000(under64)1980 1985 1990 1995 2000 2005YearSuicide Male Unemployment RateAverage Labour Market Protection: $362 per headSweden
    • 12. Rapid recovery in Iceland, slowmeltdown in Greece
    • 13. IFS 2010
    • 14. What can be done – locally?1. Advocate for change in nationalpolicy where this is causing harm.
    • 15. CE6&7 – 3 Social Determinants Effectiveness ReviewIncreasingcommunityparticipation,empowermentandcontrolCommunity ControlDelegated powerCo-productionConsultationInformingMoreappropriateand,accessibleservice,improveduptake.Improvedhealthstatus&reducedhealthinequalitiesServiceoutcomesIntermediate social outcomes HealthoutcomesDiagram 1: Pathways from community participation, empowerment and control to healthimprovementEnhancedcommunityempowermentImprovedsocial&materialconditionsImpactonsocialcapitalSource: J. Popay, 2006, Community Engagement, community development and health improvement.A Background Paper prepared for NICE.Research suggests that community involvement in decision-making and in the design,governance and delivery of services can improve health and well-being and make policy2. Take every opportunity to givepeople control.
    • 16. 3. First Aid
    • 17. “The poorestthat is inEngland has alife to live, asthe greatest”Thomas Rainborough 1647