so hi everybody thank you so much for
coming here it’s really nice to be here
and to see so many of you with an
interest in these topics so did you know
that the NHS carbon footprint is 20 2.8
million tons of carbon dioxide
equivalents this is about 25% of Inglis
England’s public sector emissions so in
the pharmaceutical sector this could
apply to carbon embodied in a particular
drug to chemical waste that’s being
disposed by a supplier or to the release
of greenhouse gases from an inhaler used
my patients and this is important
because the NHS estimates that about 60%
of emissions is due to people using or
buying prescribed drugs the point I want
to make is this excessive
over-diagnosing of mental health
disorders may lead to an increase in
prescription of all sorts of medicines
thereby increasing the ecological
footprint of our NHS substantially so
I’m a psychologist and we use this book
called the DSM and in this book all the
mental health disorders are listed then
we use it for diagnosis so some time ago
Ellen the Francis and his task force
we’re working on a new version of this
book because it’s constantly being
updated so we’re now at its fifth
version but the example I want to talk
to you about is about ADHD and about the
move from the DSM 3 to the DSM 4 so this
taskforce was working on a new version
of the DSM and they wanted to make this
minor change to the criteria for ADHD
attention deficit hyperactivity disorder
and they estimated that this minor
change would lead to an increase of
about 15 percent of people being dike
with ADHD and they consider that to be
okay it would just mean that the system
would become a bit more sensitive to
detect people who were clearly suffering
in important life areas so DSM 4 was
published including this change but at
the same time in the u.s. the
pharmaceutical industry got approval
from the government for making adverts
for registered pills so from that moment
there were commercials on TV and adverts
everywhere and they might look something
like this so you might see a poster with
a bit of a theatrical child’s drawing
and it might have some slogans on there
saying ADHD affects more than your
grades or ADHD medication can improve
your academic performance and most of
these posters were aimed to sensitize
parents uncertainties regarding their
their children for instance being
worried that they were not finishing
their homework or were acting overly
playful and the message that all of
these commercials had was basically if
you think your child has ADHD please go
to see your GP
we have ADHD medication that can solve
the problem so what do you think
happened to that estimated 15 percent
increase of ADHD diagnosis does anybody
dare to give an estimate how much do you
think the percentage change really was
30 right
actually it was 300 percent and a reason
that this can happen is because we have
so few biomarkers and with biomarkers I
mean there’s no blood or urine tests we
can do or brain scan we can observe to
test whether we are suffering from a
mental health disorder which makes that
label in nearly all cases quite
subjective so my area of expertise is
about dissociation and
relation with sleep and I’ve been
studying this topic for over seven years
now both in the Netherlands and here in
Oxford dissociation is about feeling
detached from yourself or your
surroundings and it happens to most of
us from time to time in mild forms at
least so I think most of you will
recognize the feeling of driving home
from work the same route you drive every
day and then suddenly realizing that you
have no recollection for some parts of
your journey right
you didn’t miss any traffic lights
though you didn’t crash your car it’s
just kind of when to an automatic pilot
does anybody recognize this yeah so this
is a mild form of dissociation that we
call absorption people are suffering
from more severe forms of dissociation
might have trouble recognizing
themselves in the mirror okay again some
of you may recognize this after having a
late night out and coming across your
mirror image in the morning but that’s
more about maybe not wanting to
recognize yourself so the problem with
diagnosing these mental health disorders
whether we’re talking about ADHD or
dissociative disorders is that they’re a
dimensional problem so they arranged on
a continuum from mild to severe but
we’re using a categorical approach to do
this because you either have it or you
don’t and we use this book the DSM where
all these criteria are listed and if you
take enough symptoms of the list then
that means you’re suffering from the
disorder
take for example post-traumatic stress
disorder
the DSM states that you need to suffer
from at least 8 out of 19 symptoms in
order to be diagnosed with this disorder
if you then do this really complicated
mathematical formula it quickly shows
that there are six hundred and thirty
six thousand a hundred and twenty waist
have post-traumatic stress disorder can
you imagine the consequences for
prescribing anti-anxiety medication so
let’s consider this problem of the
carbon footprints again one we are over
prescribing drugs and too many drugs are
being sold and to our system for
classifying and labeling mental health
disorders might not be the best approach
and it might lead to over diagnosis of
disorders thereby increasing the
ecological footprint substantially so
mind you talking about these labels
we’re not just doing this in the mental
health sector it seems like we are using
all these psychopathological terms in
our everyday language so nowadays people
can come out with these these statements
such as oh you almost gave me a panic
attack or I’m feeling a bit bipolar
today yeah it seems like we’re labeling
everything so what can we do to improve
sustainability and mental health because
I think it’s time for a change now let’s
consider these dissociative disorders
again although it is really marvelous
that we have all these brilliant minds
working on improving medication all of
the time
unfortunately for dissociative disorders
Moniz most drugs don’t seem to have much
effect now my research has been about
connecting dissociation to sleep
disturbances because people who suffer
from these disorders tend to sleep quite
poorly and as it turns out by improving
their sleep were able to reduce
dissociation and I can hear what you’re
thinking we can improve sleep by
prescribing sleep medication right but
what I’m pleading for is that we as
mental health professionals could focus
more on social prescriptions
eco-friendly alternatives that have
proven useful rather than drug
prescriptions that leave a considerable
footprint there are ways of improving
sleep using sleep hygiene that have
proven just as effective as sleep
medication which by the way can be very
addictive as well so sleep hygiene is
all about employing these routines
that’ll help us
to sleep better so would you would
advise people to not drink coffee and
evening have plenty of exercise during
the day preferably outside go to bed at
the same time every night and perhaps
most difficult refraining from alcohol
and evening all of these combined will
improve your sleep thereby reducing
psychological symptoms or if we put it
in the very wise words of Ronald Reagan
who said I never drink coffee at lunch I
find it keeps me awake for the afternoon
so let’s also consider nature feeling
connected with nature is related to
mental wellness so going out for walk in
the woods or joining a running group not
only will benefit your sleep and your
physical health
but your mental well-being in general
one other example of where our natural
responses come in the mix is this
suppose you have to go to the emergency
department because you’ve been in an
accident you’re physically alright but
you you feel pretty shaken up that means
you’re feeling restless and agitated so
what do clinicians in a in A&E typically
do they will prescribe you some sleep
medication so that you can sleep and
feel better in the morning
however recent studies we conducted here
in Oxford actually show that if you are
awake for that first night after having
gone
through a trauma it actually helps you
in terms of having less intruding
memories directly after so maybe this is
our body’s way of telling us that we
need to be agitated and perhaps we need
to sleep poorly for a night in order for
us to cope naturally with what with what
has happened to us rather than trying to
treat these symptoms with sleep
medication so the point I want to make
is this we need to normalize the way we
view mental health we need to stop
trying to categorize a dimensional
problem we need to stop labeling mental
health complaints into little boxes and
we need to stop this trend of using all
the psychological symptoms in our
everyday language what we do need is
stepped care starting with normalization
of complaints than minor low-frequency
interventions and only if necessary
moving on to drug prescriptions try
sleep hygiene interventions first before
moving on to sleep medication in the
social of disorders this linked with
sleep has been well evidenced and it’s
an avenue worth pursuing so the idea is
that mental health should should be
connected more to being connected with
community and to be sustainable we could
use the resources around us and in
nature so for example having a dose of
nature and therapy by joining a
community garden group interventions
like these have proven successful to
reduce anxiety depression delusions and
schizophrenia and aggression in dementia
so in summary spending time in nature
participating in developments that
contribute to sustainable communities
and making simple changes in your life
such as employing a good sleep hygiene
can all contribute to a positive mental
health now I’ll be starting my own
experiment in a couple weeks from now
and I remember from when I had my first
child and that I will get pretty
sleep-deprived and there may be times
where I don’t recognize myself in the
mirror I guess people who say they sleep
like a baby usually don’t have one thank
you so much for your time good night
[Applause]
you
coming here it’s really nice to be here
and to see so many of you with an
interest in these topics so did you know
that the NHS carbon footprint is 20 2.8
million tons of carbon dioxide
equivalents this is about 25% of Inglis
England’s public sector emissions so in
the pharmaceutical sector this could
apply to carbon embodied in a particular
drug to chemical waste that’s being
disposed by a supplier or to the release
of greenhouse gases from an inhaler used
my patients and this is important
because the NHS estimates that about 60%
of emissions is due to people using or
buying prescribed drugs the point I want
to make is this excessive
over-diagnosing of mental health
disorders may lead to an increase in
prescription of all sorts of medicines
thereby increasing the ecological
footprint of our NHS substantially so
I’m a psychologist and we use this book
called the DSM and in this book all the
mental health disorders are listed then
we use it for diagnosis so some time ago
Ellen the Francis and his task force
we’re working on a new version of this
book because it’s constantly being
updated so we’re now at its fifth
version but the example I want to talk
to you about is about ADHD and about the
move from the DSM 3 to the DSM 4 so this
taskforce was working on a new version
of the DSM and they wanted to make this
minor change to the criteria for ADHD
attention deficit hyperactivity disorder
and they estimated that this minor
change would lead to an increase of
about 15 percent of people being dike
with ADHD and they consider that to be
okay it would just mean that the system
would become a bit more sensitive to
detect people who were clearly suffering
in important life areas so DSM 4 was
published including this change but at
the same time in the u.s. the
pharmaceutical industry got approval
from the government for making adverts
for registered pills so from that moment
there were commercials on TV and adverts
everywhere and they might look something
like this so you might see a poster with
a bit of a theatrical child’s drawing
and it might have some slogans on there
saying ADHD affects more than your
grades or ADHD medication can improve
your academic performance and most of
these posters were aimed to sensitize
parents uncertainties regarding their
their children for instance being
worried that they were not finishing
their homework or were acting overly
playful and the message that all of
these commercials had was basically if
you think your child has ADHD please go
to see your GP
we have ADHD medication that can solve
the problem so what do you think
happened to that estimated 15 percent
increase of ADHD diagnosis does anybody
dare to give an estimate how much do you
think the percentage change really was
30 right
actually it was 300 percent and a reason
that this can happen is because we have
so few biomarkers and with biomarkers I
mean there’s no blood or urine tests we
can do or brain scan we can observe to
test whether we are suffering from a
mental health disorder which makes that
label in nearly all cases quite
subjective so my area of expertise is
about dissociation and
relation with sleep and I’ve been
studying this topic for over seven years
now both in the Netherlands and here in
Oxford dissociation is about feeling
detached from yourself or your
surroundings and it happens to most of
us from time to time in mild forms at
least so I think most of you will
recognize the feeling of driving home
from work the same route you drive every
day and then suddenly realizing that you
have no recollection for some parts of
your journey right
you didn’t miss any traffic lights
though you didn’t crash your car it’s
just kind of when to an automatic pilot
does anybody recognize this yeah so this
is a mild form of dissociation that we
call absorption people are suffering
from more severe forms of dissociation
might have trouble recognizing
themselves in the mirror okay again some
of you may recognize this after having a
late night out and coming across your
mirror image in the morning but that’s
more about maybe not wanting to
recognize yourself so the problem with
diagnosing these mental health disorders
whether we’re talking about ADHD or
dissociative disorders is that they’re a
dimensional problem so they arranged on
a continuum from mild to severe but
we’re using a categorical approach to do
this because you either have it or you
don’t and we use this book the DSM where
all these criteria are listed and if you
take enough symptoms of the list then
that means you’re suffering from the
disorder
take for example post-traumatic stress
disorder
the DSM states that you need to suffer
from at least 8 out of 19 symptoms in
order to be diagnosed with this disorder
if you then do this really complicated
mathematical formula it quickly shows
that there are six hundred and thirty
six thousand a hundred and twenty waist
have post-traumatic stress disorder can
you imagine the consequences for
prescribing anti-anxiety medication so
let’s consider this problem of the
carbon footprints again one we are over
prescribing drugs and too many drugs are
being sold and to our system for
classifying and labeling mental health
disorders might not be the best approach
and it might lead to over diagnosis of
disorders thereby increasing the
ecological footprint substantially so
mind you talking about these labels
we’re not just doing this in the mental
health sector it seems like we are using
all these psychopathological terms in
our everyday language so nowadays people
can come out with these these statements
such as oh you almost gave me a panic
attack or I’m feeling a bit bipolar
today yeah it seems like we’re labeling
everything so what can we do to improve
sustainability and mental health because
I think it’s time for a change now let’s
consider these dissociative disorders
again although it is really marvelous
that we have all these brilliant minds
working on improving medication all of
the time
unfortunately for dissociative disorders
Moniz most drugs don’t seem to have much
effect now my research has been about
connecting dissociation to sleep
disturbances because people who suffer
from these disorders tend to sleep quite
poorly and as it turns out by improving
their sleep were able to reduce
dissociation and I can hear what you’re
thinking we can improve sleep by
prescribing sleep medication right but
what I’m pleading for is that we as
mental health professionals could focus
more on social prescriptions
eco-friendly alternatives that have
proven useful rather than drug
prescriptions that leave a considerable
footprint there are ways of improving
sleep using sleep hygiene that have
proven just as effective as sleep
medication which by the way can be very
addictive as well so sleep hygiene is
all about employing these routines
that’ll help us
to sleep better so would you would
advise people to not drink coffee and
evening have plenty of exercise during
the day preferably outside go to bed at
the same time every night and perhaps
most difficult refraining from alcohol
and evening all of these combined will
improve your sleep thereby reducing
psychological symptoms or if we put it
in the very wise words of Ronald Reagan
who said I never drink coffee at lunch I
find it keeps me awake for the afternoon
so let’s also consider nature feeling
connected with nature is related to
mental wellness so going out for walk in
the woods or joining a running group not
only will benefit your sleep and your
physical health
but your mental well-being in general
one other example of where our natural
responses come in the mix is this
suppose you have to go to the emergency
department because you’ve been in an
accident you’re physically alright but
you you feel pretty shaken up that means
you’re feeling restless and agitated so
what do clinicians in a in A&E typically
do they will prescribe you some sleep
medication so that you can sleep and
feel better in the morning
however recent studies we conducted here
in Oxford actually show that if you are
awake for that first night after having
gone
through a trauma it actually helps you
in terms of having less intruding
memories directly after so maybe this is
our body’s way of telling us that we
need to be agitated and perhaps we need
to sleep poorly for a night in order for
us to cope naturally with what with what
has happened to us rather than trying to
treat these symptoms with sleep
medication so the point I want to make
is this we need to normalize the way we
view mental health we need to stop
trying to categorize a dimensional
problem we need to stop labeling mental
health complaints into little boxes and
we need to stop this trend of using all
the psychological symptoms in our
everyday language what we do need is
stepped care starting with normalization
of complaints than minor low-frequency
interventions and only if necessary
moving on to drug prescriptions try
sleep hygiene interventions first before
moving on to sleep medication in the
social of disorders this linked with
sleep has been well evidenced and it’s
an avenue worth pursuing so the idea is
that mental health should should be
connected more to being connected with
community and to be sustainable we could
use the resources around us and in
nature so for example having a dose of
nature and therapy by joining a
community garden group interventions
like these have proven successful to
reduce anxiety depression delusions and
schizophrenia and aggression in dementia
so in summary spending time in nature
participating in developments that
contribute to sustainable communities
and making simple changes in your life
such as employing a good sleep hygiene
can all contribute to a positive mental
health now I’ll be starting my own
experiment in a couple weeks from now
and I remember from when I had my first
child and that I will get pretty
sleep-deprived and there may be times
where I don’t recognize myself in the
mirror I guess people who say they sleep
like a baby usually don’t have one thank
you so much for your time good night
[Applause]
you
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