Brazil announces end to Zika public health emergency

Brazil has declared an end to its public health emergency over the Zika virus, 18 months after a surge in cases drew headlines around the world.

The mosquito-borne virus was not considered a major health threat until the 2015 outbreak revealed that Zika can lead to severe birth defects. One of those defects, microcephaly, causes babies to be born with skulls much smaller than expected.

Photos of babies with the defect spread panic around the globe as the virus was reported in dozens of countries. Many would-be travellers cancelled their trips to Zika-infected places. The concern spread even more widely when health officials said it could also be transmitted through sexual contact with an infected person.

The health scare came just as Brazil, the epicentre of the outbreak, was preparing to host the 2016 Olympics, fuelling concerns the Games could help spread the virus. One athlete, a Spanish wind surfer, said she got Zika while training in Brazil ahead of the Games.

In response to the outbreak, Brazil launched a mosquito-eradication campaign. The health ministry said those efforts have helped to dramatically reduce cases of Zika. Between January and mid-April, 95% fewer cases were recorded than during the same period last year. The incidence of microcephaly has fallen as well.

The World Health Organization (WHO) lifted its own international emergency in November, even while saying the virus remained a threat.

“The end of the emergency doesn’t mean the end of surveillance or assistance” to affected families, said Adeilson Cavalcante, the secretary for health surveillance at Brazil’s health ministry. “The health ministry and other organisations involved in this area will maintain a policy of fighting Zika, dengue and chikungunya.”

All three diseases are carried by the Aedes aegypti mosquito.

But the WHO has warned that Zika is “here to stay,” even when cases of it fall off, and that fighting the disease will be an ongoing battle.

Brazil announces end to Zika public health emergency

I know how alcohol can ruin our mental health. So why is it so rarely discussed? | Matthew Todd

It’s amazing to see the British finally begin to talk about our feelings. But even as we mark this year’s Mental Health Awareness week, there’s still an elephant in the therapist’s waiting room: alcohol.

The physical health risks of drinking are well known. Less discussed are the mental health consequences. These are real and significant, and seem to be getting worse. For instance, the number of people admitted to hospital with alcohol-related behavioural disorders has risen in the last 10 years by 94% for people aged between 15 and 59, and by 150% for people over 60.

Alcohol played a key part in my own problems but it took me years to come out of denial about it.

I never drank in the morning or in parks, just in a British way, bingeing along with, well, everybody else. I didn’t question it because no one else seemed concerned.

Presenting to therapists over the years with anxiety, patterns of self-destructive compulsive behaviour, swinging between thinking I was the most important and the most worthless person on the planet, they barely asked how much I was tipping down my neck. And it was a lot.

The more I drank to medicate my low self-esteem, the worse my anxiety got and the more I drank to dull it. Years passed and I couldn’t see I was stuck right in the classic “cycle of addiction”.

Eventually a friend of mine who had gone into Overeaters Anonymous sheepishly suggested I might have a problem. I resented it hugely. I was successful with a good job. There was no problem.

Eventually, it was a work incident that woke me up. As editor of Attitude magazine, I believed it would be culturally significant to have Harry Potter on the cover of a gay magazine. When Daniel Radcliffe, who played Harry in the film franchise, agreed, the only gap in his schedule for a shoot was early on a Sunday morning, which was annoying. Saturday night was my favourite time to go out. But fine. I could do this.

‘The next thing I remember was waking up, empty cans everywhere, with a bunch of messages on my phone asking where I was.’ Photograph: David Jones/PA

I decided not to drink the day before. No wine at lunch, nor during the play I went to see, and then straight home. All went well. Just as I was about to go to bed, ready for the shoot the next day, curiosity got the better of me and I logged on to a dating site, just to check my messages.

The next thing I remember was waking up, empty cans everywhere, with a bunch of messages on my phone asking where I was. Daniel and his publicist couldn’t have been nicer when I arrived with my lame excuse, insisting I go home to bed and that the shoot would be OK, and he found time later in the week to do our interview. Disaster was averted but it was the wake-up call I needed.

Since finally giving up alcohol, I’ve learned many things. First, that addiction is everywhere. That it is not about the drinking (or whatever the substance is), but the feelings underneath. Usually there is some kind of childhood trauma that needs to be addressed. I’ve learned that it isn’t about when or where you drink but about whether you can easily stop once you’ve started. I’ve also learned that there is an astonishing lack of understanding about addiction in general, not just from the public but sometimes by professionals who, being human too, often have their own issues to deal with.

The positive news is that despite alcohol being a socially acceptable carnage-causing drug that is pushed on us from an early age, it too is beginning to be talked about less furtively. Brad Pitt spoke in an interview last week about his struggles, Colin Farrell recently spoke on Ellen about being 10 years sober. Daniel Radcliffe himself has spoken about his problem drinking.

Last year I did another interview, with Robbie Williams and singer John Grant talking about their life-saving experiences of recovery from alcohol, drugs and sex addiction – and this time, I wasn’t late for it. Studies continually show a link between alcohol abuse and violence, domestic abuse and suicide, so talking about it is not a luxury, it is a necessity.

The British drink too much. Alcohol must be next on the mental health agenda.

I know how alcohol can ruin our mental health. So why is it so rarely discussed? | Matthew Todd

We need to open up about mental health in the workplace | Sue Baker

Looking after the wellbeing of employees benefits everyone – no matter your role, seniority, and whether you have a mental health problem, or not.

Working with employers over the past six years means we have a good indication of what works to ensure a mentally healthy workplace. Those elements are incorporated into the Time to Change employer pledge, which gives organisations the opportunity to demonstrate their commitment to opening up the conversation about mental health. More than 500 organisations have made that commitment.

There are multiple things employers can do to create a more open working environment. Senior leaders have a pivotal role to play in leading by example – being open about their own mental health experiences sends the strong message that this isn’t a sign of weakness and doesn’t limit your ambition or aspiration. Employees at all levels talking honestly and openly about their experiences has contributed hugely to a cultural shift in how we think about the topic.

When employees feel their work is meaningful and they are valued and supported, they tend to have higher wellbeing levels. We often talk about a three-pronged approach that employers can adopt: promoting wellbeing for all staff; tackling the causes of work-related mental health problems; and supporting staff who are experiencing mental health problems.

We’ve made a conscious effort in recent years to target male-dominated workplaces, such as construction. Our research shows that men still don’t consider mental health relevant to them. Men try to be self-sufficient, keeping problems to themselves. But mental health problems don’t discriminate – they can affect anyone.

Many of the biggest UK construction firms have signed our pledge, and they tell us that for them it has been crucial to have people “on the ground” in the form of employee champions who challenge workplace stigma, normalise conversations about mental health and encourage those who need help to feel comfortable asking for it.

With the right support from those around them, people with mental health problems can recover and have equal opportunities in all areas of life – including work.

Sue Baker is director of Time to Change, the anti-stigma Movement run by charities Mind and Rethink Mental Illness.

We need to open up about mental health in the workplace | Sue Baker

To improve mental health, start with benefits system | Sarah Chapman

Two-thirds of British adults have experienced mental health problems at some point in their lives, according to the Mental Health Foundation. For people forced to use a food bank like ours, the figures are even higher.

It’s no wonder. The NHS says depression can be caused by “an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy and job or money worries”. People who use food banks face many of these – often at the same time.

A blister from new work boots leads to an ulcer; you’re struggling to walk round the building site and the foreman lays you off with no warning and no sick pay. It takes weeks to access sickness benefits. Your marriage breaks down and you’re suddenly homeless. This is just one story, of a man in his 60s facing an onslaught most of us would struggle to withstand.

Our research highlights that poor mental health is both a cause and a consequence of poverty. Of 20 food bank users we interviewed during one week, 18 said they had experienced poor mental health – stress, anxiety and depression – in the last 12 months. Six said they had considered or attempted suicide in the past year.

Philip*, for instance, had just left hospital when he came to us, after being sectioned six weeks earlier when he attempted to take his own life. Sue*, a grandmother in her 50s, told us, “I’ve had suicidal thoughts. Sometimes I do feel it is the answer. I constantly think of different ways, you know – that can take up a whole evening”.

This is the reality of food banks across the country. Research with referrers to our food bank (such as GPs, mental health services, schools and children’s centres) highlights the same issue; nine out of 10 cite seeing poorer mental health as a direct consequence of poverty.

Time and time again, research [pdf] shows that poverty exacerbates mental health issues by increasing feelings of humiliation, fear, distrust, isolation, insecurity and powerlessness.

Insecurity when you lose your low-paid temporary job or you don’t get the hours you need in a zero-hours contract; when your benefits are due to change as a child turns five, or your Disability Living Allowance needs replacing with Personal Independence Payment; when your private landlord calls time and you join the queue at the council, desperate to be accepted on to the housing list.

Humiliation when your benefits are sanctioned for missing one appointment and “you can’t complain because they’ve got control of you by the money”, as one lady told us after being referred to our food bank by the job centre that sanctioned her. “They can do what they want with you, unless you say please and thank you, and beg.”

Policies that create appalling situations that damage people’s health make me more angry than I can say

Isolation when your “one offer” of temporary accommodation is miles away in another borough, where you don’t know anyone but you’ll still need to get your children back to primary school every day (and you’ll receive no financial help for the extra travel costs).

Fear and distrust when you are called for a medical assessment and the report bears little relation to the interview you had, and even less relation to the expert testimony of your GP, hospital consultant or support worker. Your benefit stops.

We listen to these stories every day at the food bank, keeping how we feel to ourselves as we nod, hand out tissues and make more tea. The short-sightedness of policies that worsen – sometimes even create – appalling situations that damage people’s health makes me more angry than I can say.

You try it. “The job centre told him he needed to do his job in a wheelchair,” says Asha*, mum of three, about her husband, a supermarket delivery driver whose back problems mean he can’t walk properly. “His job? It doesn’t make sense. But to even get to work, he needs to get out of his depression first. Last week he took an overdose.”

“It’s like a nightmare,” she continues. “The system makes it worse and in the end they just leave you with your problems. Any small change and you can lose everything. When it will stop?”

If politicians are serious about tackling poor mental health, our social security system needs to be strong – and for those lining up at our door every day to put food on the table for their kids, it just isn’t.

We should be a country in which people are treated with humanity, fairness, respect and compassion. We need a safety net that is more responsive to unexpected changes in circumstances and health, and less quick to penalise people for whom, at one particular moment in time, life has become an unbearable struggle. That would mean a benefits system which actually boosts people’s chances of improving their life prospects. Until then, we’ll have to keep training our volunteers in mental health issues, because we’re not just handing out food – we’re a source of solace.

* Some names have been changed

Sarah Chapman is a trustee at Wandsworth food bank

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To improve mental health, start with benefits system | Sarah Chapman

How schools are dealing with the crisis in children’s mental health

It could easily be a child’s bedroom. In the centre is a large mat, while a selection of dolls and soft toys line the walls. It is hard to believe that this nurture point in Plaistow, east London, aimed at helping children deal with their emotional problems, was once a school staff room.

Youngsters aged five to 11 can drop in three days a week and speak to a trained counsellor from the charity Place2Be. But as well as worries over friendships, bullying or problems at home, headteacher Paul Harris reveals that a growing number of children are suffering from anxiety as a result of Brexit and the election of Donald Trump.

Fortunately, pupils at Curwen primary and its sister school, Kensington primary in Manor Park, can speak to a counsellor before their problems become overwhelming.

The lunchtime drop-in – known as Place2Talk – is part of a package of support services offered by the charity, which includes one-to-one counselling and play therapy for children suffering from more serious mental health issues.

Working with 282 primaries and 50 secondaries, the charity provides early intervention support in schools to children who are troubled and unhappy.

The charity is not the only one working with schools. The Art Room charity supports five- to 16-year-olds who are experiencing emotional and behavioural difficulties.

There are eight Art Rooms in schools in Oxfordshire, London and Edinburgh, supporting 500 children a week by offering art as therapy to increase their self-esteem, self-confidence and independence.

It is this kind of partnership that Theresa May, the prime minister, said in January that she wanted to see more of. She said then that one of her priorities was children’s mental health, which has long been recognised as in crisis.

Statistics show that one in 10 children – or an average three children in every classroom – has a diagnosable mental health problem, and that 75% of mental illness in adults has its roots in childhood.

The prime minister said, before the election was announced, that she wanted every secondary school to be offered mental health first aid training, as well as new ways introduced to strengthen links between schools and NHS staff alongside more online support services for children and young people. May’s recognition of the crisis in children and adolescent mental health has been welcomed. But headteachers say that cuts of £3bn to school budgets threaten existing in-school care and want mental health funding ringfenced.

Harris, who is also executive head of three other primaries in the London borough of Newham, says the proposed school funding cuts mean losing the service of 17 teaching staff: “I believe support needs to start young in primary schools to build resilience before children go on to secondary.

“Cash needs to be earmarked for this from health budgets, otherwise we will lose this vital service.”

Celine Bickerdike: ‘Teachers had to believe you had a problem before you could access the school’s services’

Celine Bickerdike is a young champion for the mental health charity Time to Change

Celine Bickerdike, 19, is an apprentice in Leeds and has secured a university place to study history. She has had anxiety and depression since aged 12. But it was five years before she sought professional help.

“My first experience of being judged because of having a mental health problem was when some girls took my antidepressants from my bag and started reading out the side-effects in front of everyone. They humiliated me. How can people be so cruel?

“There was some school mental health support, but teachers had to believe you had a problem before you could access it. Most of my teachers thought I was OK – one even said that I was stressed because I wasn’t working hard enough. I broke down during my mocks, which was when my history teachers, who I was really close to, told me to go and see a doctor.

“I put an enormous amount of pressure on myself to get the grades I needed for university. I was anxious about the future – and failure.

“I didn’t get into the university I wanted and this really took its toll. I felt completely lost. All my friends were at university. I had gone from having a promising future to being on job seeker’s allowance.

“I think initially, my parents didn’t take my mental health problems seriously; they thought it was just ‘hormones’. I’d always been a bit of a worrier so they assumed that my problems were small because of that.

“Nowadays I find it easier to talk to people about my mental health because I’m more confident and don’t doubt my condition as much. People’s conditions should be believed as soon as they develop so that it’s easier to prevent them worsening like mine did.”

How schools are dealing with the crisis in children’s mental health

Poverty blighting health of many UK children, paediatricians warn

Poverty is seriously affecting the health of many British children, who are paying a heavy price as a result of housing, food and financial insecurity, paediatricians have warned.

A report from the Royal College of Paediatrics and Child Health (RCPCH) and Child Poverty Action Group (CPAG) paints a bleak picture of the wellbeing of children in low-income households.

Among the problems cited by paediatricians are poor growth in children, whose parents cannot afford healthy food or to take them to medical appointments, respiratory illnesses being caused or exacerbated by cold, damp housing, and mental health problems resulting from financial stress.

Two in five of surveyed doctors said they had experienced difficulty discharging a child in the past six months because of concerns about housing or food insecurity.

Prof Russell Viner, RCPCH officer for health promotion, said its members were seeing problems that seemed to belong to a bygone era.

“Paediatricians around the country are telling us that poverty is affecting the health of children in a way we haven’t seen before,” he said.

“It’s an absolute wake-up call for our political parties that they really need to deliver on promises to make Britain a more equal society.

“The prime minister talked on her first day about the burning injustices in society and how she wants to change that and this chimes with that kind of focus.”

Latest figures show that 4 million children in the UK live in poverty and projections suggest that could rise to 5 million by 2020. In 2015, the Conservative government scrapped the target requiring the eradication of child poverty by the end of the decade. The decision was much-criticised at the time and the restoration of the target is one of the recommendations of the RCPCH and CPAG in their report, published on Thursday.

Only one respondent out of 266 paediatricians from 90 NHS trusts who completed the survey said poverty and low income did not contribute to the ill health of the children they work with, while more than two-thirds said it contributed “very much”. Almost half of doctors who responded said things were getting worse and only three believed they were improving.

Housing problems or homelessness were a concern for just under nine out of 10 respondents, with one London doctor commenting that “overcrowded, damp or unsuitable housing amongst our patients is the rule rather than the exception”.

Another paediatrician said that they had seen a number of babies unable to be discharged from the special care babies unit due to the parents being homeless. Four out of five doctors said an inability to keep warm at home contributed to ill health among children they treat.

More than three in five said food insecurity contributed very much to the ill health of children, with more than nine in 10 saying it had some impact. The inability to afford enough healthy food is associated both with poor growth of deprived babies and children on the one hand, and rising child obesity on the other.

One doctor who responded to the survey said the biggest impact of poverty on their patients was “insecurity, inferiority and stress. Through the biological and psychological factors these undoubtedly lead to poor health”.

More than nine in 10 paediatricians said financial stress and worry contributed to the ill health of children they work with.

The CPAG chief executive, Alison Garnham, said the results “should sound alarms for the next government. Low family incomes, inadequate housing and cuts to support services are jeopardising the health of our most vulnerable children.”

As well as restoring child poverty targets the report recommends that the next government reverses cuts to public health and universal credit, and examines the impact on child health of all prospective policies.

Viner stressed that the report did not aim to lay the blame for the problem at the door of one political party. “We need our children to be healthy, for the economy to be competitive, post-Brexit,” he said.

The shadow health secretary, Jonathan Ashworth, said child health inequality was a “national scandal”. He added: “Labour will bring down childhood obesity rates, improve early years’ services, enhance mental health provision and improve the state of all our children’s teeth.

“Our children deserve the best possible start in life and no child will be left behind under the next Labour government.”

Poverty blighting health of many UK children, paediatricians warn

"Shattering stigma starts with simple conversations": tackling the child mental health crisis

Public concern around child and adolescent mental health is at an all-time high. The prime minister, Theresa May announced in January her intention to better identify and help the growing number of young people in schools who are at risk of developing mental health issues. Prince Harry and the Duke and Duchess of Cambridge, meanwhile, are using their profiles to convince the public that “shattering stigma on mental health starts with simple conversations”.

And yet, despite growing awareness of the issue, child and adolescent mental health services (Camhs) are under an increasing amount of pressure. Healthcare professionals bemoan a lack of resources and staff while the health secretary, Jeremy Hunt, has described Camhs as the “biggest single area of weakness of NHS provision”.

What are some of the issues facing children and young people today? What problems are services confronted with? What examples of best practice are there and how can the health, education and social care sectors provide better mental healthcare for children and young people? These were some of the questions addressed by experts in mental health at a roundtable discussion, chaired by the Guardian’s health policy editor Denis Campbell and supported by online counselling service XenZone.

“For children, there are so many messages about what to be, what to look like, how you should present yourself to the world. It’s 24/7 and social media judges most things,” said Anne Longfield OBE, children’s commissioner for England. “There’s anxiety around exams, schools and increasingly linear expectations. That all builds up.”

Sarah Hulyer, an activist from YoungMinds, the young people’s mental health charity, agreed that exams and stress are part of the problem. She also talked about the considerable effect of social media on young people’s mental health. “I think social media is negative in several ways in that your public life never ends. You’re always being watched,” she said.

Hulyer pointed out that social media can glamorise mental health problems and emphasised how important it is to start a conversation about mental health at a young age. “A lot of young people learn about mental health in the media, but often the only things talked about are anxiety and depression,” she said. “Young people don’t know [the range of] problems there are until they’ve had them explained to them.”

Attendees also discussed the problems facing services. Norman Lamb, Liberal Democrat MP and former mental health minister, said: “We’re faced with a dysfunctional system with awful access, which leads to people taking their own lives. We’re not going to solve the whole problem if we focus on the system giving treatment. It has to be about prevention and a fundamental shift of emphasis.”

Most agreed that there were significant problems facing the Camhs workforce. “We do not have an available workforce with sufficient morale to deal with the problem,” said Dr Bernadka Dubicka, consultant child and adolescent psychiatrist and chair-elect of the child and adolescent faculty, Royal College of Psychiatrists. She believes there are vast numbers of children and adolescents who could have been helped before they were referred to Camhs.

Sean Duggan, chief executive of the Mental Health Network at the NHS Confederation, claimed that the importance of child and adolescent mental health has not been properly recognised in the sustainability and transformation plans (STPs) that have been drafted to improve health and care in England. “STPs are here to stay and are a vehicle for setting priorities,” he said, adding that child and adolescent mental health is an urgent priority that needs to be addressed.

Although many around the table underlined the role that schools can play in reducing mental health problems among pupils, Malcolm Trobe CBE, general secretary for the Association of School and College Leaders, pointed out that there is a gap between what schools can deal with and their access to external support.

“Teachers have workload pressures – they just don’t have the time [to offer additional support],” he said. But he also asked where children with mental health problems were going to get that extra support: “We’ve got to move from talking about it to actually doing something. Health and education departments have got to work together so we have a strategic view of this.”

While the majority of those in attendance bemoaned the state of child and adolescent mental health services in the UK, Dr Matt Muijen, adviser in international mental health, painted a different picture. “There’s an unusual publicity about poor mental health in England. That creates demand,” he said.

“When you look at the supply side, you have remarkably good standards. There is no separate budget for child mental health but you’re the second highest funder of mental health services after the Netherlands. As a proportion of the health budget, you are by far the highest.” He went on to criticise local authorities for their inability to commission services, adding: “I always feel like health services in England are constantly changing, with a total lack of stability with no one quite knowing what they’re expected to do.”

Given the huge demand on services, attendees agreed that action was needed and floated possible solutions and examples of best practice. Elaine Bousfield, founder and chair of XenZone, suggested a digital approach could help, as long as it is tied into the wider health and social care system.

Bousfield spoke about XenZone’s online counselling and emotional wellbeing platform for children and young people. It’s used by them to talk to someone – generally for one to three sessions. “The beauty is they’re not then ruminating and adding to their anxiety,” she said. “Quite often young people don’t know what’s going on. They just feel terrible and they might not know why. They need a space where they can talk about that.”

Hulyer said a large part of the solution lies in the digital world, as that is how young people communicate. She said young people have a despondent view of Camhs and don’t believe that services will ever be there for them. She stressed the importance of learning about mental health at school and how it should be part of the curriculum. “You learn about physical health, so you should learn about resilience; how to deal with stress.” Hulyer also said that parents need support and talked about a helpline set up by YoungMinds that they can call for information and advice.

Dr Emma Blake, paediatric mental health consultant and chair of the Child Mental Health Committee at the Royal College of Paediatrics and Child Health, also highlighted MindEd, an online service for adults designed to provide help with, and information on, child and adolescent mental health.

Lamb and Duggan, meanwhile, cited some areas of the country where services are working well to tackle child and adolescent mental health. In Oxfordshire, mental health professionals go into schools every week and work with teachers to increase their understanding. Lamb said they had seen a drop in referrals to Camhs because they are intervening much earlier.

In Northamptonshire, a referral management centre was developed in 2015, which includes a consultation line open to young people and families, a texting service offered by school nurses, online chat for young people to talk to a mental health professional, self-referral, a children’s crisis home treatment team and two adolescent in-patient wards. Duggan also highlighted a new programme at Sussex Partnership NHS foundation trust – the Discovery College.

The concept is based on the existing recovery college, which involves free courses developed and delivered by health professionals. The discovery college applies the same principles for children and young people. It involves free courses for 13- to 20-year-olds, providing knowledge and skills to maintain and manage mental health.

Despite these positive schemes, there is still frustration over the lack of action relative to the tone of the conversation around child mental health.

During his time in government, Lamb produced a blueprint for mental health services, Future in Mind, which brought together a number of key proposals. Two years on, the government is now producing a green paper on the same subject. “This is an excuse to carry on talking rather than doing,” he said. “I’ve said to the health secretary to create incentives around the country to make urgent progress. The green paper can provide some value, but we need to do what we said we were going to do.”

At the table

Denis Campbell (Chair)
Health policy editor, the Guardian

Anne Longfield OBE
Children’s commissioner for England

Noman Lamb MP
Liberal Democrat health spokesman

Prof Miranda Wolpert MBE
Director, Evidence Based Practice Unit, UCL and Anna Freud Centre

Dr Emma Blake
Chair, Child Mental Health Committee, Royal College of Paediatrics and Child Health

Dr Bernadka Dubicka
Chair-elect, Child and Adolescent Faculty, Royal College of Psychiatrists

Sean Duggan
Chief executive, Mental Health Network, NHS Confederation

Elaine Bousfield
Founder and chair, XenZone

Sarah Hulyer
Activist, YoungMinds

Tony Hunter
Chief executive, Social Care Institute for Excellence

Dr Matt Muijen
Adviser in international mental health

Charlotte Ramsden
Chair, Health, Care and Additional Needs Policy Committee, ADCS

Prof Helen Stokes-Lampard
Chair, Royal College of General Practitioners

Malcolm Trobe CBE
General secretary (interim), Association of School and College Leaders

"Shattering stigma starts with simple conversations": tackling the child mental health crisis

"A little bit OCD": the downside of mental health awareness | Dean Burnett

It’s mental health awareness week. So that’s good. Well, mostly. There are downsides to increased awareness of mental health, it turns out.

You ever met someone who is needlessly cold or even outright rude to those who deign to engage with them? I used to work with someone like that, and eventually one of his superiors had to call him out on it. I was within earshot, and happened to hear his defence, which was something like “It’s just the way I am. I think I’m on the spectrum.”

He didn’t specify which spectrum. Maybe he meant the visible spectrum? He was correct if so, as everyone could “see” that he was a massive A-hole, as our American cousins may put it. However, given the context, he was clearly claiming to be on the autism spectrum. Maybe he was? However, having observed him in various contexts, I’d argue that if he was it was on a more expansive spectrum than usual, one that encompassed “not autistic, just a bit of a dickhead”.

A similar phenomenon is those people who insist on things being neat or precisely arranged, who will straighten your pens or cutlery right in front of you, or go to other socially-awkward lengths to satisfy their desire for right angles, and explain it away with a wry shrug and an admission that they are “a little bit OCD”.

As a lifelong glasses-wearing person, it can be teeth-grindingly annoying when people wear spectacles as an affectation. But to genuine medical conditions as an affectation? That’s actually quite sinister, for several reasons.

You can’t just don a mental health problem like you would some novelty glasses or a silly hat – well, you can, but you probably shouldn’t. Photograph: Robert Kneschke/Getty Images/EyeEm

Mental health problems aren’t minor tics or affectations

Being diagnosed with a mental health issue is a big deal. Despite countless pundits claiming that people with depression are just “attention seeking”, or selfish, that isn’t the case at all. Depression is often a debilitating condition, as are many other mental health problems.

Autism is a lifelong developmental disorder that impacts on pretty much every facet of your existence. Many argue this isn’t always a bad thing, but then there are an alarming number of parents out there who would seemingly rather risk their child dying from preventable diseases than risk them being autistic. In any case, most would agree that autism is a serious thing, not something on a par with a minor head cold, a poor memory for names.

Same with OCD, obsessive compulsive disorder. True OCD has many, often-debilitating features that put a serious dent in the individuals ability to live a normal life, and these usually have to all be present before someone is diagnosed with the condition. Again, it’s not something that comes and goes, like mild hay fever. Hence my usual response to someone claiming to be “a little bit OCD” is: “That’s nice. I’m a little bit five foot ten.” That’s not how things work.

This is why it’s incredibly irksome to hear people claim such afflictions, but only as and when it’s useful for them to do so. You’re not too selfish to observe social niceties like “manners” but simultaneously too cowardly to admit your flaws and work towards addressing them; no, you’re “on the spectrum”, so can carry on as you are, guilt free. I’m not the first person to point this out, but it’s still valid. If someone claimed to have motor neurone disease that only affected them in their home so they’re entitled to a free stairlift, you’d conclude that they were a disgraceful human being, and rightly so. But claiming serious mental issues to avoid having to obey social norms is fine, apparently?

If your only experience with a condition is the people citing it as an excuse for objectionable behaviour, your impression of people with that condition is obviously going to be somewhat affected. Photograph: Alamy

Emphasising the negatives

In truth, people who say things like “I’m a little bit OCD” clearly often do so with no ill intentions. At this point, citing certain mental health conditions has just become part of everyday language, like “I’m crazy I am” or “It’s bedlam in there”. People say things like this all the time. But just because something is common it doesn’t mean it’s consequence free. Language is important, and changes can and should occur. For instance, people still say “committed” suicide, when it’s not been a crime for nearly 60 years, and the media especially is urged not to use that term.

When you casually invoke a mental health problem to excuse a personality flaw or irritating trait, the only person who really benefits is you. Anyone who hears this excuse just makes unflattering associations, rudeness = autism, fussiness and annoyance = OCD. Should they then later meet someone who does genuinely have these conditions, that person will have to work to overcome this pre-existing negative preconception. Considering that they’re already dealing with their mental health issues which, as has been mentioned, are pretty demanding, that’s an extra burden they don’t really need.

Great strides have been made in broadening the awareness and understanding of mental health, but as the old saying goes, “a little knowledge is a dangerous thing”. An awareness of mental disorders isn’t really much good if it only concerns the aspects that can be used as a cop-out for unpleasant behaviours.

Sometimes, there seem to be medications that are solutions in search of a problem. Photograph: Toby Talbot/AP

Unhelpful exploitation

It’s all well and good to say people shouldn’t invoke mental health problems to explain their own quirks and behaviours, but surely the average person doesn’t spontaneously think: “I will blame my flaws on a mental illness”?

In truth, exploiting mental health issues happens all around us, so it’s no wonder people are OK with it. From the media, citing mental illness as the cause for any violent attack where the perpetrator has inconvenient political views/is white, to drug companies and affiliated professionals labelling an ever-expanding range of psychological phenomena, like grief and tantrums, as disorders that need medicating. Lovely, profitable medication.

However it occurs and is perpetuated, invoking mental health to explain unpleasant behaviours is clearly a widespread habit, and even if it is sometimes understandable, it’s not really helpful.

The human brain has plenty of weird traits and properties even when it’s functioning 100% normally. It wants a sense of control, it dislikes uncertainty, it’s warps memories, it shuts out rational arguments, and so much more. Many of these can explain bizarre or unreasonable behaviour in people, so there’s plenty of options that should be considered before you start claiming a clinical diagnosis.

Of course, we may end up with someone arguing that “claiming to have mental health problems in order to excuse irritating behaviour” is a type of clinical disorder. And then the whole thing will just be significantly more confusing.

More of the baffling properties of our brain can be found in Dean Burnett’s book The Idiot Brain.Available in theUK,USand many other countries

"A little bit OCD": the downside of mental health awareness | Dean Burnett

Signs of hope in the prison mental health crisis

Mental health problems in the prison population have long been a matter of concern. Suicide rates in prisons in England and Wales are at an all-time high; a record 119 people killed themselves in 2016 – an increase of 29 on the previous year, according to figures from the Ministry of Justice. The rise in prison suicides has been accompanied by a 23% increase in incidents of self-harm, to a total of 37,784.

“It’s a huge issue because lots of people in prison have mental health problems,” says Dr Steffan Davies, consultant forensic psychiatrist and co-chair of the Community Diversion and Prison Psychiatry Network at the Royal College of Psychiatrists. A study by the Prison Reform Trust found that 72% of male and 70% of female prisoners experience two or more diagnosable mental health disorders. Research by the National Institute for Health and Care Excellence found that 7% of male and 14% of female prisoners have a psychotic disorder – 14 and 23 times the level in the general population respectively.

The situation looks set to get worse. In recent years, staff numbers have dropped significantly, budgets and staff training have been cut, the prison population has more than doubled, and the introduction and rising use of new psychoactive substances has contributed to increasing violence.

Jacob Tas, chief executive of the social justice charity Nacro, says: “The overcrowded prison environment is likely to worsen existing mental health problems that are often the key drivers for offenders to commit further crimes or become violent while in prison.”

Davies adds: “It does feel like things are getting worse and I’m hearing it’s hard to recruit people to prison mental health services. People are leaving, and quite a few find it an extremely stressful environment to work in.”

While the general outlook is bleak, projects such as the self-management training programme at HMP & YOI Parc, Bridgend, south Wales, hold out some hope. Developed as a partnership between the Mental Health Foundation and G4S, and funded by Big Lottery Fund Cymru, the aim was to improve prisoners’ mental health through self-management and peer support.

The programme was delivered between September 2013 and December 2016, and involved two to three hours’ training one day a week for four weeks. Up to 10 participants could attend. Training included positive thinking, goal setting and problem-solving.

Fifty prisoners filled in the Warwick-Edinburgh mental wellbeing scale at the start of the course and a month after its completion: the mean score showed a significant increase in the prisoners’ wellbeing.

Lauren Chakkalackal, senior research officer at the Mental Health Foundation, says: “A number of positive stories came from the project. It was an opportunity for people to feel listened to and express how they were feeling.

“A group of prisoners produced resources to better support the mental health needs of new prisoners. The prisoners themselves took ownership of that group.”

Plans are afoot to develop similar models in other prisons and the project is being redesigned to support older prisoners and young offenders.

Signs of hope in the prison mental health crisis

Designed by patients: the mental health centre saving the NHS £300,000 a year

Soft, neatly folded blankets hang invitingly over the backs of the modern but comfy armchairs in the Gellinudd Recovery Centre’s communal living room. In the en suite bedrooms, there are white waffle slippers and dressing gowns embroidered with the centre’s tree symbol.

Staff and guests – those who stay are not termed patients – join forces to cook, clean and tend the fruit and veg they then sit down to eat together at Gellinudd, which is the UK’s first inpatient mental health centre to be designed by service users and their carers. “If you’re a psychiatrist you’ll still be expected to be in the kitchen chopping vegetables alongside everyone else,” says the centre’s director, Alison Guyatt.

Over three years, via consultation meetings attended by up to 50 people and annual general meetings attracting as many as 300, service users and carers who are also members of the Welsh charity Hafal, which runs the centre, have influenced everything from the policies and procedures to the decor, facilities and recovery-focused activities on offer.

“They’re the experts,” says Guyatt. “They can say how it feels to be on the receiving end of care, how anxious you would be, what your concerns would be. They have such powerful stories to tell.” The lack of privacy and dignity in hospital settings, together with old and decrepit buildings that provide little access to fresh air, were common themes among those who gave input. “A lot of them feel very clinical, rather than homely and welcoming,” Guyatt says.

Ensuring a different atmosphere at Gellinudd, which opened in April 2017, was therefore critical. Members met the architects in the earliest stages, and Guyatt arranged for furniture makers to bring chairs, tables and beds to consultation events to be tested.

Hafal believes co-produced, recovery-focused services improve outcomes for patients and reduce costs. It has estimated that Gellinudd, which was developed with Big Lottery funding of £1m and £500,000 from the Welsh government’s Invest to Save scheme, will generate year-on-year NHS savings of £300,000 in Wales.

Could the model be copied elsewhere in the UK? Commissioners are increasingly interested in co-production, according to Grazina Berry, director of performance, quality and innovation at the Richmond Fellowship, a voluntary sector mental health support provider that involves its users in shaping services. But the resources to make it happen are not necessarily available.

“We’re seeing many more opportunities coming up which directly ask for co-produced innovations,” Berry says. “But the money to match that isn’t always there because funding is reducing. We as a provider can say we’ll implement a whole range of innovative services. But to prove they work we want to evaluate them, and evaluation costs money.” Berry has no doubt that services designed with users bring better outcomes: “They give power to the people who understand recovery the most.”

At the National Survivor User Network (NSUN), a charity which helps mental health service users shape policy and services, managing director Sarah Yiannoullou believes the extent to which service users are listened to remains patchy. “There are some really good examples where the rhetoric is starting to become the reality, but it’s not consistent,” she says.

“I think we’re still in a system where the medical model is dominant and there’s this culture that the professional still knows best. The problem for the voluntary sector is that quite often what you say works and helps is regarded as anecdotal or dismissed as not credible.”

But it is crucial service users are listened to: “Meaningful, effective involvement can transform people’s lives, improve the quality and efficiency of services and develop the resilience of communities,” says Yiannoullou. “If commissioners and clinicians really listen to us, respect us and treat us as equals then our experience of services will improve.”

Designed by patients: the mental health centre saving the NHS £300,000 a year

Mental health nurses in short supply as NHS struggles to fill vacancies

Community-based teams care for 97% of mental health patients. And nurses play a pivotal role, building up trust between patients and their families.

However, since 2010 the total number of NHS mental health nurses in England has dropped by 15% – in parts of London, about 20% of job vacancies are unfilled. Helen Gilburt, a fellow in health policy at thinktank the King’s Fund, says: “Community mental health teams are supporting people to stay well, so if you haven’t got sufficient workforce to deliver that care, people are more likely to relapse.”

The nursing shortage is caused partly by an ageing workforce that is not being replaced quickly enough. In 2013, more than 32% of mental health nurses were aged over 50, and the abolition of bursaries for student nurses may also have had an adverse effect on the number of new recruits.

As a result, individual nurses are taking on a higher caseload. Research last year found that some community mental healthcare coordinators – not all of whom are nurses – have caseloads as high as 50 patients.

Ben Hannigan, reader in mental health, learning disabilities and psychosocial care at Cardiff University, who co-authored the study, says: “You will firefight with that number of people – it’s very difficult to do all the things you would aspire to.” Therapeutic care, aimed at helping people to recover, will be harder to provide, he says.

The shortage is affecting the whole service; a 2015 report by the Care Quality Commission revealed that only 14% of mental health patients said they received appropriate care in a crisis. And a review of psychiatric care by the Commission on Acute Adult Psychiatric Care found that 16% of patients per ward could have been treated in an alternate setting, including crisis houses and rehab services, if they had been available.

Trusts are struggling to deal with the shortages. Many, says Neil Brimblecombe, director of nursing at South London and Maudsley NHS foundation trust, are employing agency nurses, meaning that patients “have less opportunity to develop long-term relationships with individual nursing staff”.

Instead of “chasing an increasingly diminishing pool of nurses”, Brimblecombe believes trusts should take a different approach to workforce design. His own trust has joined two neighbouring trusts to develop a new assistant practitioner role to take on some of the work traditionally carried out by registered nurses.

In the long term, Brimblecombe believes the community mental health workforce should include more peer workers with “lived experiences of mental health problems” and more occupational therapists: “There will be an increasing range of new roles. The days when we have doctors, nurses and social workers, and that’s it, have gone.”

Mental health nurses in short supply as NHS struggles to fill vacancies

Gardening, art, sport – "prescriptions" for mental health that don"t involve pills

Group therapeutic work had never appealed to Kerina, who was diagnosed with borderline personality disorder and obsessive compulsive disorder in her 30s after suffering from mental health issues all her life. “You sit there reading paperwork and it feels like you’re in a classroom,” she says.

Then two years ago the community mental health team in Mid Ross in the Scottish Highlands gave her a “social prescription” – referring her to Branching Out, a Forestry Commission Scotland programme designed to help people recover from long-term mental health problems. For 12 weeks she spent five hours a week in the woods doing conservation work, bushcraft and environmental art.

“I enjoyed it straightaway,” says Kerina, who now volunteers as a mentor with the Abriachan Forest Trust, where she completed the course. “It’s so different from your normal life. You go out there and all your worries leave you. We built shelters, tables, workbenches, a kitchen. We chopped wood, we cooked, we sat around the campfire.

“It just seemed to really work for me. I remember saying: ‘I feel like I’ve been here for ages.’ I’d only been there a day.” Though she still has good and bad days, she says she now finds her problems easier to deal with, and is working towards a formal award in volunteering.

The use of social prescribing – where GPs and other primary care professionals refer patients to non-medical activities, such as gardening, arts and sports, normally delivered by the voluntary sector – is growing, with many schemes tackling mild to moderate mental health problems. Studies have suggested a range of positive mental health and wellbeing outcomes.

But in January a report commissioned by Natural England warned that the lack of a standardised referral mechanism, or funding for the activities offered in the majority of services, posed “fundamental barriers” to the NHS’s ambition to increase the scale of social prescribing.

It identified Rotherham’s service for people with long-term health conditions, which started in 2012, as having many of the ingredients for good practice – including a simple and effective referral system, well-informed link workers to help patients choose an intervention, and, crucially, funding for those interventions.

The report also highlighted the service Rotherham has since started for people with mental health issues, which began as a one-year pilot in 2015 and has just been extended for a third year. In an evaluation of its first year, 93% of service users reported progress against at least one of eight wellbeing outcome measures, and 64% reported progress on four or more.

While the service initially focused on those who had been using services for five to 20 years and needed a support network and meaningful activities to help with a successful discharge, it is now expanding to work with people earlier on.

But Janet Wheatley, chief executive of Voluntary Action Rotherham, which coordinates the programme, backs up the warning in the Natural England report: “You can’t direct more and more people to use resources in the community without providing funding to support that.”

Gardening, art, sport – "prescriptions" for mental health that don"t involve pills

Radio DJs are suppliers of banal chatter, not health advice on partying | David Mitchell

Sometimes it’s the little things that get to you. Viruses, obviously. Bacteria. Tiny, tiny flakes of asbestos. Or, to be less literal, the inconsequential things. An inconsequential thing that got to me last week was a report of some Northumbria University research saying that Radio 2 DJs’ repeated references to alcohol were making their listeners hit the bottle.

That’s how it was spun by the tabloid reporting it. But I suppose that was just its way of dragging the story closer to one of the small collection of things it likes to always say: “Women who aspire to do anything deserve the misery they inevitably suffer”; “Decent people are no longer safe in their own homes”; “The BBC is evil”; “Everything gives you cancer”. “This one’s a three!” someone must’ve shouted across the newsroom.

I’m sure the details of the study are more nuanced. The researchers analysed four radio stations aimed at listeners who were middle-aged or older – three commercial ones and Radio 2 – to find out the frequency and nature of the booze-mentioning. And what do you think they found out? You’re right, it’s that.

They are blaming Simon Mayo for ‘normalising’ drunkenness. I’m pretty sure it’s been normal since Dionysus

Yes, obviously the DJs mentioned booze loads and repeatedly implied that it was fine and nice. As Northumbria’s associate professor of public health and wellbeing put it: “Alcohol consumption is often portrayed as the norm without negative consequences, and just 5% of references on all stations were about sensible drinking.” That’s a lot more discussion of sensible drinking than I would’ve expected.

This is a bit of a soft target, you might think. Leave the guys at Northumbria University alone. If they can get funding for counting the number of times Steve Wright mentions Lambrusco, maybe I should wish them luck. But I don’t. Because it’s another case of people scrutinising how other people talk and vetting them for inadvertent divergences from an approved value system. A mild case, perhaps – these guys aren’t no-platforming Peter Tatchell – but they are blaming Simon Mayo for “normalising” drunkenness. I’m pretty sure it’s been normal since Dionysus. The study will probably be ignored but, in these inane times, you just can’t be completely sure.

So it might be worth saying something obvious: DJs on the radio have to talk like human beings – the specific human beings they happen to be. That’s the premise of this form of entertainment: natural chat interspersed with music. It’s not high culture but it passes the time in heavy traffic.

But it won’t work if the people at the microphone, desperately trying to keep the energy up, also have to reflect some externally imposed consensus of how life should be lived. That’s Thought for the Day, which is scripted in advance and lasts under three minutes. Any longer than that and it really would drive listeners to drink…

DJ 1: And Chris from Reading has tweeted to say he’s “just kicking back and chilling with a couple of beers”. Nice one, Chris, but do remember that’s at least four of your recommended maximum of 14 weekly units right there. So do maybe stick at two.

DJ 2: Depending on how much you’ve been drinking the rest of the week, Chris. Are these really your first? Or has it been two every night? Maybe it’s time for a break. I’d hate to think you can’t kick back and chill without the soporific effect of beer. I wouldn’t want to normalise that.

DJ 1: But it’s good that you’re talking about it. Perhaps this is the first step towards a better understanding of your problem.

DJ 2: Yes indeed. And keep those tweets, texts and emails coming in. The weekend starts here…

JINGLE: It’s Friiiiidaaaaaaaaaaaaay! The weekend starts here!

DJ 1: Julie from Norwich has asked for a shout-out to everyone who works with her…

DJ 2: Hi guys!

DJ 1: And says they’re partying already.

DJ 2: Nice one!

DJ 1: She says they’re “already popping the prosecco around the photocopier”.

DJ 2: Ooh. Now, erm, should we be normalising that? I assumed she meant dancing, games, cake…

DJ 1: Not to underplay the obesity crisis.

DJ 2: Of course not – we’re sitting on a diabetes timebomb. Nevertheless, cake is OK occasionally, at a party.

DJ 1: Mary Berry is stick thin.

DJ 2: Exactly. And it certainly doesn’t lead to the sort of partying that results in poor life choices. You know, money problems, problems in the home…

Illustration by David Foldvari.

DJ 1: Neil, I was really hoping we could get through one drivetime without you mentioning domestic violence.

DJ 2: It happens, Tim!

DJ 1: I know.

DJ 2: Do you want me to say it doesn’t happen?!

DJ 1: No, because that would involve mentioning it again.

DJ 2: It’s a terrible world out there.

DJ 1: Yeah, but… you know… Friday!!

DJ 2: Yeah.

DJ 1: Good. So, take it easy on the prosecco, girls. It’s got a higher ABV than you’d think, but nevertheless have a great one.

DJ 2: Just not the sort of great one you look back on with bitterness in a couple of decades when you get cirrhosis of the liver!

DJ 1: We should get that turned into a jingle. Here’s one from Andy in Luton: “At the end of a long week working for a faceless corporation, I intend to make myself feel briefly better by consuming more alcohol than is medically wise, something as ingrained in western European culture as that weird thing that makes the women’s necks all long is with whoever does that…”

DJ 2: That should have gone through Compliance.

DJ 1: “…but I really miss the days when your show used to make that feel normal and positive and like it was how I’d want to live my life. I’m not fulfilled and I like a drink. It’s essential that society has a way to make people like me continue to acquiesce in our existences, and media references to ‘having it large’, ‘chilling’ and ‘having a massive one’ may be a crucial part of what makes that happen. After all, I’ve long since realised I’m never going to stop drinking and follow my dream of becoming a sculptor and it would only harm the economy if I tried. Cheers.”

DJ 2: I’m quite surprised you read all of that out.

DJ 1: It’s for balance. And here’s one from the regulars at the Crown in North… actually let’s go to a song.

DJ 2: I expect the lyrics somehow reinforce the patriarchy.

DJ 1: Here’s hoping.

Radio DJs are suppliers of banal chatter, not health advice on partying | David Mitchell

Theresa May pledges mental health revolution will reduce detentions

Theresa May will pledge to scrap the “flawed” Mental Health Act, warning that it has allowed the unnecessary detention of thousands of people and failed to deal with discrimination against ethnic minority patients.

In an attempt to meet her pledge to prioritise mental illness during her premiership, she will commit to ripping up the 30-year-old legislation and replace it with new laws designed to halt a steep rise in the number of people being detained. Increased thresholds for detention would be drawn up in a new mental health treatment bill to be unveiled soon after a Conservative victory. Mental health charities, clinicians and patients would be consulted on the new legislation.

While the announcement is likely to be welcomed by mental health campaigners, there will be warnings that a lack of resources, rather than badly drafted laws, has been the real driver of the increase in detention.

The overhaul is being described by the Conservatives as the biggest change to the law on mental health treatment in more than three decades.

“On my first day in Downing Street last July, I described shortfalls in mental health services as one of the burning injustices in our country,” May said. “It is abundantly clear to me that the discriminatory use of a law passed more than three decades ago is a key part of the reason for this.

“So today I am pledging to rip up the 1983 act and introduce in its place a new law which finally confronts the discrimination and unnecessary detention that takes place too often. We are going to roll out mental health support to every school in the country, ensure that mental health is taken far more seriously in the workplace, and raise standards of care.”

More than 63,000 people were detained under the Mental Health Act in 2014-15, an increase of 43% compared with 2005-06. Black people are also disproportionately affected – with a detention rate of 56.9 per 100 patients who spent time in hospital for mental illness. It compares with a rate of 37.5 per 100 among white patients.

In its last report on the act, the Care Quality Commission, the independent regulator of healthcare services, said it had “failings that may disempower patients, prevent people from exercising legal rights, and ultimately impede recovery or even amount to unlawful and unethical practice”.

The new legislation would include a code of practice aimed at reducing the disproportionate use of mental health detention for minority groups and countering “unconscious bias”. Safeguards would be introduced to end rules that mean those who are detained can be treated against their will. Those with the capacity to give or refuse consent would be able to do so.

The new bill would form part of a series of measures designed to improve mental health in schools and the workplace. However, ministers would face immediate questions over whether they were providing sufficient funding for their plans.

The Tories would commit to hiring 10,000 staff in the NHS by 2020. An insider said the plan would be funded from existing budgets, because mental health service funding will be up by £1.4bn in real terms by 2020.

The Equalities Act would also be altered to prevent workplace discrimination. Currently patients who have conditions such as depression, anxiety and bipolar disorder are only protected from discrimination if their condition is continuous for 12 months. That would be altered to take account of the fact that the conditions are often intermittent.

Every primary and secondary school in England and Wales would have staff trained in mental health first aid and be given a single point of contact with local mental health services. Children would be taught more about mental health, including keeping safe online and cyber-bullying.

Large companies would be required to train mental health first responders alongside traditional first aiders.

Theresa May pledges mental health revolution will reduce detentions

Air pollution plan: sacrificing the nation"s health to save an election campaign

For seven years, people in Britain have been forced to hold their breath and wait for a comprehensive plan to tackle the nation’s toxic air crisis. After a series of humiliating defeats in the courts, Friday’s government plan was meant to finally deliver.

But instead ministers hit the brakes and slammed the policy into reverse – the farcical new strategy has even less detail than the one already ruled illegal. What was the impassable roadblock in the way of finally starting to cut the 23,000 early deaths diesel pollution causes every year? Nothing but pure political expediency.

The only sure way to bring the toxic nitrogen dioxide spewed out by dirty diesel vehicles down to legal levels is to keep them out of cities and towns. The law demands the fastest possible action, which means deterring polluting drivers with charges – as will happen in London. But backing new taxes on drivers in the heat of an election campaign promises a political car crash, so ministers have simply swerved and crashed into the nation’s health instead.

The most shocking aspect is that buried in the documents are candid admissions that the crisis is the “largest environmental threat to public health in the UK” and that it is a “direct result” of car makers gaming emissions tests for years, so that their vehicles pump out far more pollution on the road than in the official lab tests.

Ministers even say: “We will continue to press car manufacturers to develop options for recalling existing vehicles to improve their real world emissions performance.” But unlike in Germany and France, the government’s pressing of car makers has driven precisely zero action.

Rather than tackle air pollution head on, the government has passed the buck to local authorities, daring them to impose the needed charges instead and face the electoral consequences. Ministers suggest councils should penalise any diesel cars more than two years old – most of them – but lack the courage of their convictions.

In place of meaningful action, the government’s plan suggests gimmicks such as removing speed bumps and re-phasing traffic lights, measures as likely to increase traffic and emissions as to cut them.

One of the few good parts of the new plan is funds to clean up older buses, lorries and taxis but even this is old money, already announced in the budget. The much vaunted scrappage scheme is mentioned only as a possibility and even then would only cover 0.1% of all diesel cars.

The new plan will leave the nation gasping for years to come and it seems likely that ClientEarth, the lawyers who have twice had the government’s plans declared illegal, will return to the courts for a third time.

The government is likely to view its manoeuvring as a political success, having buried its feeble plan under the local election results. The government’s cynical calculus is that diesel drivers are more of a political force to be feared than people angry about the health damage being caused to them and their children.

Air pollution plan: sacrificing the nation"s health to save an election campaign