On average a multiple will be in the mental health system for 7 years prior to diagnosis and during this time may receive several varying diagnosis’s. They often include:
Temporal lobe epilepsy’
Dissociation is more common in patients with temporal lobe epilepsy than in any other neurologic disorder. The clinician should refer patients with dissociative symptoms for a thorough neurologic workup to rule out the presence of temporal lobe epilepsy or other organic processes. The standard EEG is of little help in distinguishing MPD from temporal lobe epilepsy because a high rate of nonspecific abnormalities has been detected in patients with MPD, most commonly bilateral temporal lobe slowing.
The differentiation between dissociation identity disorder and schizophrenia can be made along several lines.
Patients with schizophrenia hear voices emanating from the external world, whereas patients with dissociation identity disorder hear voices originating from within the individual’s own head.
Patients with schizophrenia may experience visual hallucinations, although they are less well formed than those observed with certain other brain disorders. Patients with MPD occasionally experience hypnagogic phenomena.
Poor reality testing is observed with schizophrenia, whereas patients with MPD have essentially intact reality testing.
Tangential or loose associations accompanied by inappropriate affect are commonly observed with schizophrenia. Patients with dissociation identity disorder may have circumstantial association with appropriate affect.
Borderline personality disorder
Borderline personality disorder has been diagnosed in 70% of a sample of 33 patients with dissociative disorder and in 23% of 70 patients with dissociative disorder. Putnam acknowledged that a large number of his cases resembled Briquet syndrome or somatization disorder, but, like other investigators, he proposed that once the diagnostic criteria for MPD are satisfied, MPD should be considered the superordinate diagnosis because working with the alternates can provide a therapeutic device that cannot be used in the unified individual.
Malingering is said to be an important differential diagnosis in times when an obvious gain may result from mental health intervention. Malingering is the deliberate and fraudulent production of false and exaggerated symptoms to deceive observers for secondary gain that is recognizable with an understanding of the individual’s circumstances.
Dissociative amnesic disorder
MPD may prove difficult to distinguish from other dissociative amnesic disorders. With other dissociative amnesic disorders, behavior may be complex, but recovery is often complete, recurrences are less common, and the onset of amnesic spells may be intimately related to stressful events or to ingestion or intoxication.
Many people, politicians included, assume that mental ill health is a medical issue that affects a small number of people. By many political parties mental health is seen as a security treat and a drain on the ecconomy, but the people behind the disorders are forgotten about.
In fact, one in four people experience mental health problems, and it costs the economy £77 billion per year in England alone – so mental health is very much a public health issue. We need candidates to understand that social factors – such as crime, debt, unemployment and poor housing – all affect our mental health and wellbeing, so there are things they can do to improve mental health in their constituency.
The Conservative party are committed to repealing the Human Rights Act (HRA). In their manifesto they state: “To protect our freedoms from state encroachment and encourage greater social responsibility, we will replace the Human Rights Act with a UK Bill of Rights”. The Labour party and the Loiberal Democrats both oppose the repeal of the HRA.
There is widespread opposition to the repeal of the HRA among leading voluntary and community organisations. The HRA represents a clear statement of the fundamental rights of British citizens and is a vital tool for holding government to account and protecting our civil liberties. It defines the relationship between parliament, citizens and the courts. As the alliance of leading voluntary organisations co-ordinated by the British Institute of Human Rights has pointed out that the HRA can provide a lifeline to individuals from all walks of life, from elderly people in care homes to disabled children and those who struggle with mental illness. It is a protection for us all and in particular for the marginalised and vulnerable in our society. If the Conservatives did repeal the HRA then this suggests that a Conservative government intend to water down our rights and would be less accountable to the courts.
In their election manifestos, Labour has promised more than 8,000 new psychological therapists, the Conservatives have pledged to increase access to “talking therapies”, and the Liberal Democrats say they would improve access to counselling and protect mental health services. Yet despite such promises, Monitor, the independent regulator of NHS foundation trusts, sent out a letter to the organisations it oversees this month warning UK mental health providers to prepare this year for extra cuts, which mental health charity Rethink estimates could amount to £50m.
Mental illness could almost be called the invisible killer, which is why it is the first to be neglected when there are cuts to be made. However, the current downturn has created a greater demand for mental health services, as Roehampton University in south London found this month. Its study with children’s charity Elizabeth Finn Care showed that 71% of people who lost their jobs last year displayed symptoms of depression.
Upon closer inspection of the parties manifestos though some disturbing things can e seen. The Conservatives, for example, mainly only mention mental health in relation to “a threat to society” and in terms of “financial cost” even going as far as to insist that everyone with a mental health disorder should get back to work within 3 months and then implying that anyone who cannot should essentially be on an in-patient programme… Now this may just be me, but does that not sound a bit like “contribute to society or be instritusionalised”? The Conservatives seem to completely fail to relise two fundermental facts: 1) for some sufferers of mental illness employment is not a practical option, and 2) studies have shown that many people with mental illnesses do better and recover mre easily when they remain in the community with support rather than being put into hospital.
Other than Labours promice to add 8,000 new psychological therapists mental health isn’t really mentioned in their manifesto, and they also fail to explain where these 8,000 therapists are coming from, how they will be paid for, nor how this will help the mental health system.
Out of the main 3 paties the Liberal Democrats are the only ones who have pledged to protect the mental health services from cuts, which to me implies that the other 2 parties may be planning to make said cuts.
Out of all the parties the best policies on mental health and disability in general are defantly set down by the Green Party, but they were never really likely to win the election, though they did gt one seat which I was impressed by 🙂 .
So anyway… This election has been a complex affair and as yet we can’t predict much. But one thing I think we can say is that improvements in the mental health service are unlikely and unless we get a hung parliment which gives the Liberal Democrats some degree of infuance then we are likely to face cut in the near future.
Mental health has been dubbed the ‘Cinderella service’, traditionally neglected by health policy makers and receiving proportionally low funding when compared to its burden on society. The launch of the National Service Framework for Mental Health in 1999 by then Health Secretary Frank Dobson was intended to show the new Government’s commitment to this area.
There have been few specific commitments from the Conservative Party on how they would propose to improve mental health services. What we do know is that the Conservative Party wants to see an increase in the number of people with a mental illness returning to work, indicating that they recognise the full economic costs of this condition. So basically we cost too much by being ill?
Of cource the Conservatives seem to fail to recognise that for some mental health sufferers employment will not be a practical option, and that instead volunteering projects may help them to regain confidence and self-esteem. But meh, just worry about how much our illness costs you, that’s fine… until you become one of the 1 in 4 effected by mental illness that is…
Mental health would be a big winners in the event of a hung parliament. As the polls have narrowed speculation has begun about the issues on which the Liberal Democrats may exert pressure in a partnership with a minority Government. Mental health has been an issue on which Nick Clegg has sought to take a leadership position. He has explicitly stated, for example, that budget cuts should not hit mental health services and has proposed extra support to help those from whom the recession has caused mental health problems.
Specific proposals include training debt advisors to recognise mental health problems, allowing individuals to freeze their credit rating so that they won’t be given new loans or credit cards, and encouraging banks to offer people who have declared mental health problems supervision of their accounts.
These are the sort of detailed interventions in mental health policy which are often not heard from either Labour or the Conservatives. So it is just about possible that in a coalition government – or if we end up with a Lib Dem-supported minority administration – mental health services may end up being accorded greater priority.