Sunday, 11 September 2011

A Duty of Candour, Depressive Women, and Friends in Finland

The first two days of last week were spent at the University Strategic Conference. Unfortunately due to still having treatment at the clinic each morning, staying over was impossible. Experience tells me that it's the informal getting together in this way that are the most valuable and  enjoyable aspects of such events. However, the two days were very good and I came away with a sense that the University had somehow changed gear in working towards achieving its strategic aims. In the last session we were encouraged to raise ‘taboo’ topics. Ironically, the rules of confidentiality don’t allow me to say whether anyone did or not.

But arguably such sessions are important for any organisations health. How many of us have been party to a meeting where the 'Elephant in the Room' is completely ignored as people feel for whatever reason unable to voice their concerns. It’s sometimes easier to simply convince oneself to be a team player and not rock the organisational boat. It can be hard to stand up and be counted for what you believe to be right. I believe that it is important for organisations and the managers who lead within them to learn how to listen carefully to what is being said.

Last year the UK Department of Health signalled its intent to introduce a ‘duty of candour’ for all health care providers, making them contractually obliged to publicly reveal mistakes made. This month the Health Select Committee recommended that the ‘duty of candour’ will need to be a condition for licensing (by the Care Quality Commission) for any qualified provider wishing to contract for the provision of health care services. Even without the moral obligation to enact a duty of candour there are important economic drivers to consider. The cost of settling legal claims against the NHS for clinical negligence was £807m in 2010, a rise of £146m on the previous year. Each of these claims represents something going wrong, a patient harmed or killed. Being a current user of health care services and the fact there were just under 6000 claims last year is enough to make me feel quite depressed.

And I am not alone. The journal, European Neuropsychopharmacology last week published an updated report on work originally undertaken in 2005 which looked at the size and burden of mental illness in Europe. The report showed that almost 165 million people or 38% of the population suffer each year from a mental health problem such as depression, anxiety, insomnia or dementia. Professor Hans-Ulrich Wittchen, who led the systematic review of empirical based studies, noted that the rate of depression in women was 2.6 times higher than for men, particularly for those women aged between the ages of 16 to 42. These researchers attribute this higher rate of depression in women to the burden of balancing the demands of marriage, family and a job – although I am not convinced this link is clearly demonstrated in their paper.

The mental health organisation SANE note that perhaps one reason we believe that women are twice as likely to suffer from depression than men is more to do women being more prepared to talk about it, whereas many men can find it more difficult to describe their feelings of anxiety, depression or loneliness and may even lack the language to express their inner feelings.

However, maybe the depressive woman doesn’t need to be, well completely depressed. Dr Sabura Allen, a clinical psychologist at Monash University published, in 2007, her now famous piece of research which looked at the recent sexual experiences of depressed and non-depressed married and single women who were both in relationships or not. Her study found that depressed women had more sex than their non-depressed counterparts. The study concluded that depressed women were likely to be seeking out sexual intimacy more often to help make them feel more secure. I am not so sure her research really proved this is the case. But it is known that sexual activity provokes a release of endorphins which elevate our mood and can make us feel ‘happier’ and increase our sense of wellbeing.

And finally, it is likely that this weekend will be a difficult one for many people. Each anniversary of 9/11 provokes in me a sense of deep contemplation of the human condition. I was in Finland when 9/11 happened and with friends of many years. We sat and watched the dreadful events unfold together. And Mikko, Leena, and Heikki remain good friends all these years later. They have, and continue to bring much happiness to my life!