Molly. Oh Molly!

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When I look back I can clearly see we were headed this way. But once again, it has taken the shocking death of 14 years old Molly Russell, to call the big bad media companies to account. They claim to be helpful and in some ways they are but their algorithms aren’t.

A few weeks back I was researching base-ball caps for a piece of writing and now I can’t log on to the internet without someone trying to sell me one such cap. I feel like I am being hounded, sitting alone in my study. It’s all about unabashed, indiscriminate, aggressive marketing. “We’ll give you want we think you want and more”, they scream.

In the last week of January, Ian Russell shook the media world by naming and blaming Instagram directly for making a major contribution to the death of his lovely Molly, by her own hands, in November 2017. Even after she had passed, she was being sent inappropriate images and material in response to her previous search for ‘Depression’ and ‘suicide’. The heart-break was written all over him. The very next week, Instagram was hauled up by the Parliament and its CEO agreed to take responsibility for removing and monitoring harmful content. Google and Facebook are yet to follow suit.

As indicated by this data from the ONS, there has been a worrying rise in female suicides, at either end of the age spectrum. The rise has been consistent in young women, 10 to 29 years of age, since 2013.

Last week, at the National Suicide Prevention Alliance Annual Conference, there was much discussion on the same subject. The minister for Suicide Prevention, Jackie Doyle-Price spoke briefly, trying to convince us that she would do everything she can to tackle the issue and we are watching. Like hawks.

Project Eighty-four and more

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84 life-size statues of men were seen standing at the edge of tall buildings in central London in late March representing the same number of men lost to suicide every week in the UK – a hard hitting visual project aiming to bring this tragic loss out into the open from behind closed doors.

Common threads emerged from articles published in April:

“Students more likely to kill themselves” in the Times: Researchers from a Hong Kong University analysed the ONS figures and found that the number of university students in Britain increased by 5 per cent between 2012 and 2016. The total number of suicides among students increased by 32 per cent, from 139 to 183 deaths. A think tank said that a law banning universities from contacting the friends and family of students who are struggling should be revisited.

The number of first year university students reporting mental health problems in UK Universities has risen five fold in 10 years. A combination of increasing awareness of mental health issues, a lowering of the taboo previously attached to mental health services, mounting debts, homesickness, loneliness and a greater sense of anxiety about the future may be some of the reasons for it. Some vice-chancellors still think that mental well being is not the business of universities and it’s just about developing the mind. But developing minds means nothing unless students settle down well in their new environment and be ready to learn.

According to recent ONS statistics on loneliness, people between 16-24 are at the epicentre of the loneliness epidemic in the UK. More so than the elderly. Women were found to be lonelier than men. Other variables were renting a home rather than owning one, being single or widowed, having poor health and feeling disconnected from the local community.

In an article entitled “Doctors knew my son was suicidal. I should have been told before he died” in the Guardian, I raise this question yet again: Is confidentiality more important than helping someone at risk to stay alive? Is it correct for a father to be informed by doctors after the death of his son,”Now that he is dead I can tell you that this was not his first attempt”?

Is it?

It’s everywhere.

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A few decades ago, cigarettes were everywhere. It was normal for men and women to smoke. Physicians were known to recommend smoking. The advertising machinery glorified it.

Today, Electro-Magnetic Fields (EMFs) are everywhere. They wrap us all in multiple layers of invisible weaves of radiations arising from cell-phones, baby monitors, cordless phones, bluetooths, wi-fi routers, smart meters and microwave ovens. There is very little information out there about the effect these gadgets have on our bodies and minds.

According to Dr Mercola’s research these EMFs cause a significant oxidative stress on our cells leading to the release of free radicals which in turn cause serious mitochondrial damage. Mitochondria are “powerhouses” of each cell, breaking down fuel molecules and creating the energy the cells need to perform their functions. Children are at greater risk of such damage than adults. Damaged mitochondria have been held responsible for anxiety, depression, autism, Alzhiemer’s disease, rhythm disorders of the heart and infertility. Dr Mercola also gives practical suggestions on how to minimise the damage.

In 2008, a Danish study involving more than 13,000 mothers revealed some sobering potential effects. Children born of mothers who used cell-phones during pregnancy as compared with children born of mothers who did not, experienced a :

49 % increase in behavioral problems
35 % increase in hyperactivity
34 % increase in peer-related problems
25 % increase in emotional issues

These findings indicate a huge impact on public health and need for further research. Mobile phones are now essential to our lives. Our days begin and end with them. Some people have it right beside them even when they sleep. Lack of one is considered odd. Not being able to locate one’s phone can induce a state of panic. ‘Low battery’ is a highly undesirable state. There is an official term for fear of being without a phone, NoMoPhobia (No Mobile Phobia). I think our generation was the last one to have reached adulthood without cell-phones. Now, they are everywhere.

Jo is a dear friend and mother to a 9 year old who is on the Autistic spectrum. Here she shares what it’s like to advocate for her son and how hard it is to ensure that he receives appropriate care. Thanks Jo.

PS: Incidentally all antipsychotic medications are known to cause severe mitochondrial damage too.

I am not my diagnosis.

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While I continue to struggle to figure out Twitter, forget how to update my website, get confused while recording podcasts, consistently get my innumerable passwords mixed up, stay oblivious about Instagram and Snapchat, the digital world gallops ahead.

Digital Interventions in mental health Conference 2017 was recently held in London. It explored topics across psychiatry, technology and culture to identify innovative ways of addressing mental health needs.

Dr Becky Inkster is a Neuroscientist, passionate about digital interventions in mental health, social media data analysis, genomics, molecular biology, and neuroimaging. She co-founded Hip-Hop Psych as she is passionate about working with hard-to-reach, disadvantaged groups and youth culture.

‘Views from the street’, ‘Prison transition tools’, ‘Beyond the bullets’ and ‘The Digital Psychiatrist’ are some of the workshops that were conducted at the above conference. The range of topics was rather fantastic. It was aimed at improving our understanding of how social media is helping to create and facilitate new spaces for mental health practices and support, exploring the benefits of social media and social networking to improve a sense of identity, self-expression, community building and emotional support through examining a few popular international examples. Participants and facilitators engaged in interactive sessions to understand how new tools for self-expression via pictures, videos, captions and short personal narratives can help break down the stigma surrounding mental health and perhaps even lead to more people seeking help. They explored how to empower young people to use social networks in a way that promotes their mental health and wellbeing, how to harness the power of social media to nurture mental health innovations that the future holds.

Impressive stuff. I carry on doing what I do. I write another article for the Huffington post – Darkness to light. I talk about my darling Saagar and emphasise the importance of us, the people, educating and empowering ourselves so that we can help ourselves and each other through the light of knowledge and empathy. I continue to speak with ordinary people living extra-ordinary lives. Here is a conversation with Sara Muzira, mother of the beautiful Simba. Both, mum and son are artists. She talks about the state of inpatient mental health services in her experience and things that can be made better for patients and their families. Thank you Sara.

Day 991

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Light and day and night.

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The longest day of the year is behind us.

It’s well known that lack of sunlight has an adverse effect on our brains. It might stop a part of the brain called the hypothalamus from working properly:

Production of melatonin – Melatonin is a hormone that makes us feel sleepy. The hypothalamus may produce it in higher than normal levels.
Production of serotonin – Serotonin is a hormone that affects our mood, appetite and sleep. Lack of sunlight may lead to lower serotonin levels, which is linked to feelings of depression.
Body’s internal clock (circadian rhythm) – Our body uses sunlight to time various important functions such as the time we wake up. So, lower light levels may disrupt our body clock, mood and alertness.

A recent study by Klaus Martiny of the Psychiatric Centre in Copenhagen shows that people being treated for severe depression were discharged almost twice as quickly if their rooms faced south-west in comparison to those whose rooms had a north-west orientation. Depending on time of the year, the intensity of daylight in the south-west rooms was 17-20 times brighter. The results support findings in previous studies of the importance of architectural orientation providing natural daylight as a factor for improvement. “We don’t know the precise mechanism, but I think it’s to do with exposure to the morning light, which advances and stabilises their sleep-wake cycle,” says Martiny.

Light acts as a powerful reset switch, keeping the clocks in our brain synced with the outside world. This clock can weaken as part of ageing, Parkinson’s disease, strokes and depression. To tackle this problem several hospitals are installing dynamic ‘solid state’ lighting which changes like daylight over the course of the day : whitish-blue in the morning, growing warmer and dimmer through the day and turning orange or switching off at night.

Light can be a drug.

Day 963

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Wysa

A young couple, committed to making a difference used their love and intellect to create Touchkin, Artificial Intelligence for proactive care, integrating behavioural health into medical practice.

Tom Insel, a psychiatrist from National Institute of Mental Health (NIMH), the world’s largest mental-health research institution, spoke frankly about how MH services and research were failing to help the mentally ill. He openly dismissed the DSM (Diagnostic and Statistical Manual of Mental Disorders). At any given moment, roughly one in seven of the world’s 7.5 billion people is struggling with mental illness. “We’re not going to reach all those people by hiring more psychiatrists,” says Insel. But we might reach them with smartphones.

In one of his talks, Insel was sharing the intricacies of the delicate workings of the brain. Someone interrupted him and said, “You don’t get it. The house is on fire, and you are discussing the chemistry of the paint”

Jo Aggarwal, one of the developers of Touchkin says:

“This line from the article resonated deeply with me. It’s a familiar sentiment – one many of us in development have had in conferences on employment, education, conflict. They are all at some level connected to the base fire that engulfs our world today – that of mental health. Until this fire is brought under control, we don’t have a hope for any of the rest of it.

His dramatic move lends credibility behind the idea that phones may be the answer. Identifying issues using smartphone behavior is powerful, though it can feel creepy. But detection is not enough. In our trials at Touchkin, phone sensors were able to predict depression in people with diabetes to a 90% accuracy, and went a long way in getting the physicians convinced to integrate mental health into their regimen. But only 1 in 30 people diagnosed went on to take treatment for the depression.

It said to us – “The house is on fire, the fire brigade is missing, and here we are saying how accurate our fire alarms are”

Wysa the emotionally intelligent penguin willed itself into existence somewhere along the way. It was a side feature created between ‘formal’ projects to improve accuracy. Taken by how people reacted to the prototype, we all kept working on making it better… in three months it crossed a threshold. It started changing lives. Last month, 3 people wrote in to say it saved their life, it is what is keeping them from suicide. Over 50,000 people talked to it anonymously, and thousands of them wrote in to us to say how much it meant to them.

Unlike the Stanford psychologists creating Woebot- we have no hypotheses around Wysa. It is evolving entirely based on what works for its users. It has evidence-based techniques, but everytime we add more tools or advice or tips we get users telling us to just let them talk to Wysa, and not to underestimate how much of a difference that makes.

“The fire in the house, is in our brains. The fuel is the language of the conversations we have inside our head. “

We started out, like Insel, trying to detect the fires… Wysa is leading us to try and put a fire extinguisher in everyone’s pocket. Any pretence of our own hypothesis went out of the window when the first person wrote in to say it saved their life. Now we are following it to see where it goes.

Like us, like Tim, there are many unwitting recruits to this fight.

Rick Little started fighting it as soon as he graduated college. So many of my friends… Sangeeta Mahajan who lost her son to suicide and has dedicated her life to preventing it for others. Anjana Ajay who is changing others lives after healing her own Stage 4 cancer by focusing on healing her mind. Bhavana Issar who is doing amazing work at Caregiver Saathi.Pooja Goyal who is creating resilience in pre-school children and their parents, bravely facing all the storms that come her way. Archana Aggarwal Sarda has made emotional support a way to get intl level diabetes outcomes in rural children, long before she realised that she was doing it.

None of them are psychologists. They each have options of more comfortable, lucrative ways to spend their time. They are all powerless to not do this. “The house is on fire. Once you see it, and you realise that you can stop it spreading, it is hard to do anything else.”

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