Happy Holidays – to taking it slow with good cheer.

Happy Holidays – to taking it slow with good cheer. Wishing you a wonderful 2021.

MHB IP is ten years old at the end of next year, so if all goes well, we hope to have a #tango and #salsa #event on 31 December 2021 in #Cambridge, UK, in honour of Latin America.  Email us at admin@mentalhealthbus.co.uk if you want us to add you to the list.

To see what we’ve been up to or to join us ….




Warmest regards

Food for thought

Food for thought:

The immune system can be strengthened and maintained by simple measures such as:

1. Maintain a calm and positive mental state and environment (many would agree that management of anxiety to reduce anxiety is the most important factor)

2. Positive in person engagement with loved ones and peers (consider current local guidelines re social distancing)

3. Regular engagement in normative activities (please see earlier comments on normative activities)

4. Regular relaxation in fresh air with nature and / or animals (many report noticeable positive changes in blood pressure and general health when spending time with animals; animals are a life long (or sometimes 15 year long) responsibility, so opt for volunteering, animal rescue or pet sitting if you cannot make a longterm commitment to animals)

5. Regular exercise

6. Sufficient sleep

7. Adequate hydration

8. Healthy food options such as fresh fruit and vegetables

We have received many questions regarding which foods are ideal to support a healthy immune system and general health. We have asked our medical and para-medical colleagues, patients and their families what their favourite foods are to remain healthy.

We have only included thoughts from people who have reported that they have not presented with any symptoms of respiratory illness or any other infections in the last 12 months.

Favourites choices for:

Vit A: Eggs, oily fish such as salmon, tuna, sardines, anchovies and mackerel (once a week), fruit such as cantaloupe melon and mangoes, and vegetables such as carrots, spinach, butternut squash, broccoli, chilli peppers and tomatoes

Vit B1: Milk, some fortified breakfast cereals, yeast products (marmite is a favourite for many) and nuts such as peanuts (peanut butter is a favourite for many)

Vit B2: Milk, milk products, eggs, yeast extracts and some fortified breakfast cereals

Vit B3: Milk, eggs and meats such as chicken, pork or beef

Vit B6: Fortified cereals, bananas, nuts such as walnuts and hazelnuts (Nutella is a favourite for many), and meats such as turkey, chicken or beef

Vit B7: Yeast products, eggs, nuts such as peanuts, and green vegetables

Vit B12: Milk, dairy, fortified breakfast cereals, eggs, fish such as tuna, salmon, sardines and anchovies, and yeast products

Vit C: Kiwi, guava, citrus (oranges, lemons, satsumas, clementines, grapefruit), mangoes, papaya, black currants, strawberries, nectarines and vegetables such as sweet potatoes and broccoli

Vit D: Oily fish such as salmon, tuna, sardines, anchovies and mackerel, and eggs and milk

Vit E: Almonds, hazelnuts, peanuts, peanut butter, pine nuts (pesto is a favourite with pasta) and vegetables such as sweet potatoes

Vit K: Leafy vegetables such as spinach and broccoli (good with lemon, garlic and anchovies), eggs and dairy

Folate: Some breakfast cereals, milk, yoghurt, eggs, spinach (good on pizza or with fish), broccoli, green beans, peas and chickpeas

Calcium: Milk, cheddar cheese, yoghurt and sardines

Magnesium: Cocoa, pine nuts, cashew, hazelnuts and walnuts

Phosphorus: Milk, dairy (except butter), fish and nuts

Selenium: One or two brazil nuts per week (we usually recommend no more than one brazil nut per day), eggs and fish such as tuna or sardines

Iron: Fortified cereals, cocoa, nuts such as cashews, meat such as beef, and vegetables such as broccoli (a favourite for many is pasta with salmon, pine nuts and broccoli)

Zinc: Milk, milk products, eggs, oysters, cocoa and nuts such as pine nuts and cashews, as well as leafy vegetables such as spinach

Copper: Nuts such as cashews

Manganese: Fruit such as pineapple and vegetables such as spinach

Additional thoughts: Honey, bananas and yoghurt drinks with live cultures (such as Actimel) are healthy favourites and make excellent milkshakes for children and adults.

Olive oil with garlic and onions make a good and healthy start to any dish, as most reported.

Mushrooms are also a healthy favourite for many in pastas or on pizza.

Salads with rocket, leeks, fennel and fish are a favourite for many French families.

Chillies and avocado are also healthy options and Mexican food is a favourite for many.

Desserts: Greek yoghurts with berries such as raspberries, blueberries, blackberries, cherries, and honey. Dark hot chocolate drinks or sauces with spices such as ginger, turmeric and cinnamon over fruit including berries, figs, apples, apricots and pears, or in pancakes.

General information:

Please know that this list only includes ‘favourite items’ of people who we have liaised with in the last few months, there are many more food choices available in every category.

Remember some vitamins or minerals are best absorbed when taken with certain food types such as with fats or orange juice, and some foods or drinks such as tea or wine reduce absorption such as tannins or caffeine, so avoid combinations where absorption is reduced if you can.

Some food choices such as grapefruit cannot be taken with certain medications, your pharmacist will be able to advise you. We always recommend that care is taken when new medications or food choices are introduced, please speak to your GP if you have concerns. We usually recommended ‘go low and slow’ with anything new, and have access to emergency facilities, in our work with children and families. Many doctors, nurses and pharmacists recommend for instance that you remain within 3 minutes of the office with emergency facilities after you have received vaccines or started a new medication for at least 20 minutes, and for some a bit longer.

Balance is key. Healthy fats such as olive oil, proteins and carbohydrates are essential for most bodily functions. Many food choices including herbs and spices are good for health, however, if you consume high amounts, health benefits change to health risks. Moderation is key.

Enjoy your favourite food such as chocolate, but in moderation, and ideally choose healthy options such as dark chocolate possibly with nuts and berries. Enjoy your favourite drinks such as coffee and tea, but try to limit intake to two cups per day.

Drink 1-2 litres of water or decaffeinated and unsweetened tea per day (camomile or thyme and peppermint ice teas are a favourite for some). Hydration is essential for nearly all physiological functions in the body.

We usually recommend that vitamins and minerals are received through food choices, rather than tablets or capsules, unless specific medical indications exist and medical recommendations from your doctor include medication or supplements.

We recommend that you always follow medical advice given to you by professionals including medical doctors, nurses, pharmacists and dieticians. No two people are the same and medical conditions such as Diabetes Mellitus or Ischaemic Heart Disease will likely mean that you likely have to alter your diet significantly to ensure reduced risk and improved health, which often means avoiding some food types in total. Discuss options with your treating doctor or medical team.

If you have medical problems or symptoms or if you are worried about your health, we would recommend that you book an appointment to speak to your GP without delay. The pandemic is not a good reason to postpone contacting your health service if you have concerns, even if your concerns appear ‘not serious’. Health professionals will advise you on next steps specifically detailed for your unique circumstances.

Please know that some doctors who offer services to the NHS report that they have not been less busy in decades, please therefore do not assume that your concerns are not important during this time. Health and mental health is important and prevention is key, therefore please liaise with your medical professional without delay if you have concerns for you or your family.

The content of our websites and social media accounts is intended for general information purposes only. These pages do not constitute any form of consultative or diagnostic tool or process, and is no substitute for assessment and recommendations by a medical doctor. The assessment, diagnosis and treatment of mental health or general health difficulties, particularly in children, but also in many adults, is a complex and specialised process and should only be undertaken by qualified mental health or medical professionals with appropriate training and sufficient experience.

#food #nutrition #fats #carbohydrates #proteins #fruit #vegetables #children #immunesystem #health #vitamins #minerals #COVID19 #calm #anxiety #dessert #animals #nature #bloodpressure #exercise #sleep #hydration #GP #HealthServices #balance #moderation

Deprivation of liberty

Deprivation of liberty

Deprivation of liberty significantly increases bio-psycho-social risk for many adults and young people; negatively affecting behaviour, thoughts, beliefs, emotions, physical health and social risk with negative consequences for the immune system, general health and mental health, increasing morbidity and mortality. 

Lockdown, stay at home and shelter in place are associated with significantly increased social risks for many such as relating to domestic violence (80% increase), child abuse (30-65% increase), economic challenges, poverty and unemployment (the World Bank estimates that an additional 88-115 million people will fall into extreme poverty in 2020, 150 million in 2021), along with an inability to access clean water or food (89% increase, resulting in 12 000 deaths per day, exceeding 10 000 deaths a day recorded from COVID-19 in April 2020) and social isolation (87% of Young Minds respondents) in most countries (see reports from Childline, NSPCC, Young Minds, United Nations, UNICEF, NCMEC, Oxfam, The Trussell Trust, Stop UK Hunger, England’s Children’s Commissioner and the WHO, recently published).  These increased social risks, frequently associated with a high mortality rate, also significantly and negatively affect the immune system, general health and mental health, which affect clinical health outcomes in every culture. 

Deprivation of liberty affects behaviour for many which contributes to social risk, general health and mental health in most cultures.  Consider statistics illustrating significantly increased figures reported by organisations such as the UN, UNICEF, WHO, NSPCC, Alcohol Change UK, England’s Children’s Commissioner and RCPCH in the UK in recent months relating to aggression, violence (300% increase in one study in February 2020), alcohol abuse (400% increase), along with child abuse, suspected child sexual exploitation (90% increase reported by NCMEC, US) and non-engagement in hospital activities required to maintain or protect health (93% increase).  Public Health England identified a drop in Emergency Department visits, particularly by children.  UNICEF and the WHO reported that children in many countries were not receiving necessary childhood vaccinations before the pandemic, and the pandemic and restrictive initiatives have increased these concerns markedly; this has a worldwide impact relating to serious infectious diseases.  These are significant risk factors that negatively impact on the immune system, general and mental health for every nation.

Deprivation of liberty has direct effects on thoughts and beliefs for many that negatively impact on the immune system, general health and mental health.  Statements starting with “I can’t” and ending with “so there is no point” are frequent and relevant.  One young person recently reported “I can’t leave home, because we are weak and this flu is scary, we will get sick if we leave home, what is the point of caring” and “the world is not safe for us”.  Thoughts affect immediate and long term clinical outcome directly and significantly.  What the mind believes often transpires; many evidence-based therapies are based on this principle.  

Deprivation of liberty in any context causes high levels of stress and chronic anxiety within many or most individuals.  Emotions such as anger, hostility, panic, low mood, hopelessness and depression are also frequently observed.  Negative experiences and emotions such as chronic anxiety are risk factors that significantly and negatively impact on the immune system, which cause increased susceptibility to infections and a poorer general health prognosis through increased morbidity and mortality.  Chronic anxiety also affects mental health morbidity and mortality in children and adults.  We have observed a significant increase in referrals relating to tic, anxiety and mood disorders of children of all ages during the last few months and the profile of referral has changed; children with no previous concern or family history are presenting for the first time.  

We have also observed an increase in referrals relating to possible ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autism Spectrum Disorder); however, in our experience, 30-60% of all ADHD and ASD referrals or caseloads typically do not present with ADHD or ASD, but rather with mood or anxiety disorders or histories of trauma or abuse.  Children with ADHD and ASD often present similar to children with anxiety disorders, such as PTSD, or depression, along with child abuse or trauma (differential diagnoses), and preliminary diagnoses or diagnoses are often made by professionals with limited training in Child Psychiatry.  Children with mental health problems often present differently compared to adults.  Paediatricians often report that they have had no training in child psychiatry to differentiate between eg anxiety disorders, ADHD or ASD.  Misdiagnosed children often wait 6-8 years before receiving appropriate treatment.  This is of particular concern to us in the context of the pandemic. 

Mental health morbidity is markedly increased for many in the context of deprivation of liberty.  Consider statistics illustrating increased figures reported by organisations such as Young Minds, Samaritans and MIND in recent months relating to increased mental health problems in adults (80% increase) and young people (75% increase) with relevant mental health histories and an increase in mental health presentations in young people with no previous mental health problems (55% increase).  10% of adults presented with suicidal ideation within the first week of lockdown and 2% attempted suicide or self-harmed.  Research indicates that living or feeling alone along with feelings of hopelessness are significant risk factors for suicide.  MIND reports that 33% of young people with mental health difficulties self-harmed to cope during lockdown, which is a significant risk factor associated with suicide.  These numbers are likely to be underestimated.  The NCMD reports 25 child suicides in the first 56 days of lockdown.  In 48% of the 25 post-lockdown deaths, factors related to COVID-19 or lockdown were thought to have contributed to the deaths.  Mental health problems, associated with its own morbidity and mortality, also significantly affects the immune system and clinical outcome relating to general health. 

Many children and adults who presented with neurodevelopmental or mental health problems before the pandemic now present with decreased impairment and distress, due to recommendations to remain at home and subsequent non-engagement in challenging, social and normative activities within the public and community; this does not encourage recovery or maintenance of positive progress. 

An indirect effect on the immune system via multiple pathways has been illustrated in this section, however, a direct effect is also relevant and important for many; most systems in the human body including the endocrine, haematological, cardiovascular, respiratory, gastrointestinal and neurological system can be directly affected by deprivation of liberty.  This is emphasised and repeated because it affects susceptibility or resistance to infections and subsequent prognosis in terms of morbidity and mortality; degree of illness, associated complications, recovery times and outcomes during the pandemic.  

General health morbidity is also affected by direct effects on general health, not relating to indirect pathways such as via chronic anxiety and the immune system, for many, although these are major factors.  Confinement or the impression of confinement or ‘being trapped’ often leads to agitation.  Agitation is not necessarily associated with anxiety, particularly as a medical or psychiatric term.  Agitation is often associated with irritability and restlessness, and is often seen in psychiatry units, emergency departments and care facilities secondary to eg head injuries.  Concerns in this context can extend to, but are not limited to, increased blood pressure, heart rate and respiratory rate, poor attention, concentration and memory, as well as chronic headaches, digestive problems, fatigue, lethargy, loss of appetite, weight loss, insomnia, muscle and joint pain.  General health and mental health morbidity and mortality can be affected directly and indirectly by these presentations, which contribute to clinical outcome during this pandemic. 

As illustrated, deprivation of liberty in any context therefore increases social risk, mental health risk and general health risk for many, and can be associated with very strong messages to the mind and body for every individual, high and low risk groups, which can significantly and negatively affect prognosis.  Doctors in every medical discipline will be aware of these risks.  There are important evidence-based clinical, ethical and legal reasons why liberty should be considered and safeguarded where possible for every individual. 

Initiatives that prevent chronic anxiety, support the immune system and prevent harm are essential if health is to be protected for the general public in the context of this pandemic.  Initiatives should protect, not harm, and this needs to be evaluated and weighed on a regular basis. The outcomes of deprivation of liberty for vulnerable and at risk children and individuals, along with the general public, relating to serious mental health, physical health and social risks, are of significant concern, not only in the UK, but worldwide, as per recent statistics published.

A systemic approach is important; relevant evidence-based bio-psycho-social risk and protective factors should considered.  A systemic approach implies that all things are connected and that every factor must be considered.  Deprivation of liberty is one of the risk factors that can cause the most stress and chronic anxiety for many, and clinical outcome can be significantly affected for most in this context. 

#COVID19 #liberty #confinement #trapped #risk #behaviour #thoughts #beliefs #feelings #emotions #ImmuneSystem #ImmuneResponse #health #outcomes #prognosis #susceptibility #complications #recovery #morbidity #mortality #culture #ADHD #ASD #mentalhealth #anxiety #PTSD #calm #agitation #depression #anger #hopelessness #violence #endocrine #haematological #cardiovascular #respiratory #gastrointestinal #neurological #irritability #restlessness #bloodpressure #heartrate #respiratoryrate #attention #concentration #memory, as well as chronic #headaches #digestive #fatigue #lethargy #appetite #weight #insomnia #musclepain #jointpain #protect #FirstDoNoHarm #Childline #NSPCC #YoungMinds #UN #UNICEF #Oxfam #WHO #Samaritans #MIND