Men's mental health is a particularly salient issue in these troubled times. Worldwide, more than one million people kill themselves each year. In the UK, men are four times more likely than women to kill themselves and there have been over 6,500 male suicides in the past six years.
Incidence data from the last century show suicide rates have peaked during past economic recessions. Gay men are two to three times more likely to have a mental health problem and 4.3 times more likely to attempt suicide than straight men, and have around double the rate of depression and anxiety. 94% of young offenders are male and 80-90% have mental health problems.
Furthermore, while the rate of deliberate self-harm is higher in females (associated with problems in interpersonal relationships), it is four times more likely to lead to suicide in males, and is associated with alcohol, employment, financial and housing difficulties. One question is, will we see an escalation of distress and suicide in males during the current economic downturn?
Men's mental health is a dramatically understudied and poorly understood area of human wellbeing. Men are half as likely as women to be diagnosed with depression, yet twice as likely to abuse alcohol and drugs.
What's going on here? One compelling possibility is that what society teaches men about what it means to be a man leads us to express our pain in ways that differ from women. Among the more striking differences is that men are more likely to keep their problems to themselves. We frequently suffer in silence, and sometimes with dire consequences. Our research at Clark University in the US has shown that men who are more likely to value self-reliance and stoicism are more likely to have significant symptoms of depression; they are also more likely to report feeling ashamed of being depressed, and more likely to keep the problem to themselves.
Factors that may lead to mental wellbeing or ill-health are multiple and have complex interrelationships. Comparatively little is understood about how these manifest in men differently to women. There is lack of public knowledge about mental health problems generally. During their lifetime, 25% of the population will experience a mental health difficulty. However, when asked, half of company bosses estimated levels at 0% in their workforce.
Stigma is associated with mental health problems and their perceived effect on employment. In western cultures, boys are taught that it is better to express emotions such as anger than fear or pain and there are cultural sanctions for those who deviate from this. Depression and anxiety may get expressed as anger. Men are socialised to fix problems. As one service user put it "men deal with it – I'm not dealing with it, therefore I'm not a man". No wonder men may have a tendency to play down their problems, overestimate their ability to deal with them and have a reluctance to seek help. Nor is it surprising that it is commonly hard for those around them to spot the symptoms.
So, what can be done? Men and women need educating in what symptoms to look out for in themselves and others. Signs may include inability to concentrate; being unable to engage with people; a change in appetite; feelings of worthlessness or hopelessness; change in sleeping patterns; and increase in use of alcohol or drugs.
Some men have faulty perceptions about, and place low value on, therapy. As a society, we need to associate help-seeking with strength and courage. Media campaigns in the UK, such as Time to Change, aim to start addressing this. The effects of redundancy on men and women need consideration and employers need educating. At Clark University there are plans to establish the first centre devoted to the study of men's mental health.
Half of people experiencing depression, after a relatively short course of therapy, go on to make a full and lasting recovery. However, sitting and talking about problems is not what many men are comfortable doing. Therapists need to develop more effective methods of engaging them.
The national strategy, Increasing Access to Psychological Therapies (IAPT), is aimed at identifying and treating anxiety and depression more effectively in the general population. Early statistics show lower take-up of this service among men. While research indicates that higher numbers of women experience mental health difficulties than men, it is unclear whether this is because it is a hidden problem and self-referral to the new IAPT services might help. Linking commissioning of educatio n, social care and health care services may lead to men's needs being more comprehensively addressed in future.
http://www.guardian.co.uk/society/joepublic/2009/apr/07/men-mental-health
PDF version 24 June 2009 - UNODC today released the World Drug Report 2009.
The Report was launched in Washington, D.C., by UNODC Executive Director Antonio Maria Costa and the newly appointed Director of the United States Office of National Drug Control Policy, Gil Kerlikowske. The Report shows that global markets for cocaine, opiates and cannabis are steady or in decline, while the production and use of synthetic drugs is feared to be increasing in the developing world.
The Report shows a downward trend in major drug markets. Opium cultivation in Afghanistan, where 93 per cent of the world's opium is produced, decreased by 19 per cent in 2008. Colombia, which produces half of the world's cocaine, saw a fall of 18 per cent in cultivation and a staggering 28 per cent decline in production compared to 2007. Global coca production, at 845 tons, is at a five-year low, despite some increases in cultivation in Peru and the Bolivia.
Cannabis remains the drug that is most widely cultivated and used around the world, although estimates are less precise. Data also show that it is more harmful than commonly believed. The average tetrahydrocannabinol (THC) content - the harmful component - of hydroponic marijuana in North America has almost doubled in the past decade. This has major implications for health, as evidenced by a significant rise in the number of people seeking treatment.
While the use of synthetic drugs - amphetamines, methamphetamine and Ecstasy - has levelled off in developed countries, new data, though limited, suggest an increase in their use in the developing world.
The Report documents a shift in the routes used for drug trafficking. In West Africa, for instance, there has been a decrease in seizures, which appears to reflect lesser cocaine flows, following five years of rapid growth. While 41 per cent of the world's cocaine is being seized (mostly in Colombia), only one fifth (19 per cent) of all opiates are being intercepted.
The Report pays special attention to the impact of drug-related crime, and calls for stronger measures to fight such crime and for more resources for drug prevention and treatment.
It also offers several recommendations on how to improve drug control. These include universal access to drug treatment, international agreements against organized crime and greater efficiency in law enforcement.
In an effort to improve transparency and the quality of drug data, this year UNODC has introduced ranges into country-level estimates used in the World Drug Report. For many regions, and for some drugs (such as ATS and cannabis) the ranges are relatively wide since information is more limited.
Related information
World Drug Report 2009 (interactive Presentation)
Executive Summary (Interactive Presentation)
Webcast of launch of World Drug Report 2009
http://www.unodc.org/unodc/en/frontpage/2009/June/world-drug-report-2009...
Divorcees, widowers and middle-aged people who live alone are much more likely to develop dementia than those who are married or who live together, researchers say.
The findings, from a Swedish team and published online by the British Medical Journal, suggest that being in a steady relationship helps insulate people against mental decline, while singletons and those who lack regular social contact are at greater risk of developing a brain-wasting condition such as Alzheimer's.
People who either do not have a partner in their middle years, or whose partner dies, are three times more likely to end up with dementia than those who are married or cohabiting, the researchers find.
People of the same age who live alone have twice the risk of developing dementia, claim researchers.
The team, led by Miia Kivipelto, from the Karolinska Institutet medical university, Sweden, says the results add to evidence suggesting that social interaction plays a key role in sustaining heathy brain function into later life. "Living in a relationship with a partner might imply cognitive and social challenges that have a protective effect against cognitive impairment in later life."
Previous research has identified physical activity, education, mentally demanding work, working in higher managerial positions and certain hobbies, as factors that help ward off dementia. Some studies have found that friendships and a busy social life also reduce the risk.
About 700,000 people in the UK have some form of dementia, and that figure is expected to rise to 1.7 million by 2051. There is a trend towards one-person households, with 7.25 million people now living alone, says the Office for National Statistics. The researchers studied 2,000 men and women from eastern Finland, who took part in a study of cardiovascular risk factors, ageing and dementia, when they were about 50 and then again about 21 years later. While both single men and women had a "significant" extra risk of dementia, men had a "slightly higher odds ratio", the researchers said.
http://www.guardian.co.uk/lifeandstyle/2009/jul/02/single-people-risk-de...
The existing codes on the National Drug Treatment Monitoring System (NDTMS), and their definitions, reflect the description of the types of treatment that were published in Models of Care for Treatment of Adult Drug Misusers: Update 2006 (NTA, 2006a). However, since then, there have been a number of new publications that impact on the terminology,
understanding and definition of structured drug treatment interventions.
We are asking stakeholders to review the proposals presented here and comment back to us. The consultation will last for 12 weeks and will close on 23 October 2009. However, we are keen to give providers of NDTMS software as much notice as possible of any changes and so early responses would be appreciated.
So here we go again. Ten years ago I heralded the government's 1999 strategy for mental health (the national service framework) as a new dawn for the sector. Great things were promised but where was the money going to come from, I asked. A decade on and here I am proclaiming New Horizons, the government's latest vision for mental health, as an inspiring strategy that's full of hope for people with severe mental illness. Yet once again, I'm at a loss as to where the cash is going to spring from to finance the grandiose expectations.
As a vision for mental health, New Horizons is forward thinking and comprehensive. Its optimistic aim that by 2020 mental health services will be available to all who need them will be sweet news to the one in four people who experience difficulties; the focus on prevention and recovery a welcome shift in approach.
Few people choose to have a mental illness, but fewer still never recover and it's reassuring to see the government show recognition of this.
For the people stuck in between prevention and recovery who are coping with symptoms, the government promises personalised services to put individuals in the driving seat of their care. Once in control of the gear stick, people with mental health problems, including those with a severe mental illness such as schizophrenia, can set the pace of recovery at whatever tempo suits them best.
For us at mental health charity Rethink, the strategy's pledge to cut mental health stigma is a hugely welcome – if ambitious – component. However, the suggestion that by 2020 people will know and accept that mental health problems can affect anyone at any time will only be achieved if significant resources are dedicated to the cause.
As one of the partners delivering Time to Change, a campaign to transform attitudes and behaviour towards people with mental health problems, we at Rethink know just how tough a challenge tackling stigma can be. One of our recent surveys found that nine out of 10 people with mental health problems have been affected by prejudice and discrimination and that this has stopped them from doing certain things, such as applying for jobs and going to the pub.
Almost a third of people do not want to live next door to someone with mental health problems. That's a lot of discrimination to cancel out if we're to achieve the government's aim of a society where people with mental health problems are deemed the same as those with physical conditions. We and our colleagues are ready to aim high – we want to see stigma eradicated – but we need long-term political and financial backing to do so.
At the very least, New Horizons sets a benchmark for standards and offers an opportunity for debate about the shape of mental health services. If implemented to the letter, New Horizons could revolutionise the sector and dramatically enhance the lives of people with severe mental illness and their carers. The difference between the two is several billion pounds.
• Paul Corry is director of public affairs at mental health charity Rethink
http://www.guardian.co.uk/society/joepublic/2009/aug/04/mental-health-ne...
Men with angina are much more likely than women to develop further serious heart problems, a study suggests.
Researchers found male patients were twice as likely to have a heart attack and almost three times as likely to suffer a heart disease-related death.
Angina, a type of chest pain, is common and can be the first sign of heart disease - but the risks are unclear.
The study of UK patients, led by the National University of Ireland, Galway, appears in the British Medical Journal.
Angina is caused by insufficient supply of blood to the heart muscle.
Recent estimates suggest that 4.8% of men and 3.4% of women aged over 16 in England have angina.
In Scotland, the figures are higher: 6.6% of men and 5.6% of women.
The Irish team identified 1,785 patients in Scotland who were diagnosed with angina between January 1998 and December 2001, and tracked their progress for five years.
They found being male, older and a smoker was associated with an increased risk of having a heart attack.
The same factors - along with obesity - were also associated with a higher risk of dying from heart disease.
Men were also more likely than women to undergo angioplasty to open up blocked arteries, or to have coronary artery bypass surgery.
Lead researcher Dr Brian Buckley said the reasons why men appeared more at risk were unclear.
Some believe the problem could be that men are less likely to follow medical advice following diagnosis.
Others suspect that men do not go to their doctor until their condition is more advanced.
Women are also thought to receive some protection from the sex hormone oestrogen.
Dr Buckley said: "We need to look at what the hell is happening here rather more closely than we have in the past.
"Hopefully, our study has demonstrated that men are at more risk -so indisputably, that more research will take place looking at why."
He said the main message from the study was that people with angina should take steps to improve their lifestyle to minimise risk of more serious disease.
He said: "If you are diagnosed with angina, you should not panic - it won't necessarily end up in a heart attack - but you ought to take what the doctor says to you seriously, both in terms of taking medication and adopting a healthier lifestyle."
Dr Mike Knapton, associate medical director of the British Heart Foundation, said the study was important because it was based on large numbers of people living in the community, rather than in a hospital setting.
He said: "It confirms that smoking and being obese greatly up your risk of dying from heart disease.
"This is good news for people living with angina, as it shows that it's never too late for them to change their lifestyles, or to stop smoking."
The research was carried out in collaboration with the University of Aberdeen.
The UK's ageing population is set to cause a huge rise in the number of older people living with long-term illnesses, campaigners have said.
Help the Aged says that by 2025 there will be a big increase in the number of over-65s with heart disease, osteoporosis and dementia.
It warned this could stretch the NHS to breaking point and called for more research into these conditions.
But the Department of Health said measures were being taken to cope.
Having analysed current disease patterns and predictions about the ageing population, Help the Aged made a number of estimates about the future levels of ill health in the elderly population.
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 Unless we find ways to prevent or treat these conditions, the strain on society and its infrastructure will reach breaking point  Dr Lorna Layward
Help the Aged |
The charity said there was likely to be a 46% rise in the number of people living with the effects of stroke, from 601,000 now to 878,000 by the mid 2020s.
And the researchers said those living with late-onset dementia would go up 50% to one million while the number of elderly people with heart disease would rise by 42% to 2.6 million.
Levels of incontinence and osteoporosis were also likely to rise by a third, while sight problems could go up by over half, the charity has claimed.
In total, more than six million elderly people could be living with a life-limiting condition by 2025 - a 45% rise, Help the Aged concluded.
These rises mostly mirror the expected increase in the over-65 population which stands at just under 10 million in the UK currently, but will reach about 14 million in 16 years' time.
And the researchers warned such a scenario could see the cost of caring for older people rise from £40bn a year to over £50bn.
'Breaking point'
Dr Lorna Layward, from Help the Aged, said: "Unless we find ways to prevent or treat these conditions, the strain on society and its infrastructure will reach breaking point.
"More attention and funding must be directed to researching the causes, prevention and treatment of the diseases and disabilities that become increasingly common with age."
But the government said it was taking the consequences of the ageing population seriously.
The Department of Health said it would soon be publishing plans for an overhaul of social care, while more money than ever was being put into research for these conditions.
A spokesman said the vascular screening programme which was being phased in from this year would save lives by preventing heart attacks and strokes.
He added: "The government is already preparing for the pressures of an ageing population."
Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, said: "An even more pressing problem among the growing number of over-65s is the widening health gap between the haves and have-nots.
"Poorer people suffer more chronic disease - and this disparity is getting worse.
"We must focus our efforts where the need is greatest."
James Purnell, the former cabinet minister whose resignation almost toppled the prime minister, tells the Guardian today that he is unlikely to ever return to frontline politics and calls on the Labour party to stop the "nostalgic" hankering for the heyday of New Labour in the late 1990s.
In his first major interview since he quit as work and pensions secretary last month, Purnell likens that period in politics to the dynamism and excitement of the music scene generated around Oasis and Blur. "All those Blairite, New Labour labels … for me it's a bit like Britpop – I feel nostalgic for it, it was absolutely right for its time, but that time was 1994."
Purnell was one of the most senior ministers of the 11 who walked out of Brown's government last month and the only one to directly call on the prime minister to stand down. In his resignation letter, Purnell told the prime minister: "I now believe your continued leadership makes a Conservative victory more, not less likely."
In his exclusive interview with the Guardian, which will run in full in tomorrow's paper, the former Downing Street adviser to Tony Blair talks about his career spanning nearly 20 years in politics.
On Monday, Purnell will launch a three-year project at the thinktank Demos on the future of the Labour party, called Open Left. It will include contributions from the respected leftwing backbenchers Jon Cruddas and Alan Simpson.
Rasing doubts about the government track record over 12 years on schools, immigration policy and electoral reform, Purnell says he wants to "try and be as radical on the left as on the right".
He showers praise on the foreign secretary, David Miliband, and explains the circumstances surrounding his decision to resign from Brown's government on 6 June as polls closed in council and European elections.
"The moment when it became a really simple decision to take was when I stopped worrying about what exactly would be the consequences of different things and when I realised I just had to be true to myself. I couldn't go on the telly the following morning and say something I couldn't believe."
Describing life after government, he says: "The thing I worked out is that I really loved policy and I love leading an organisation like DWP. Politics, I don't miss as much. Journalists, I don't miss as much.
"I love having a weekend. I love not having a red box hanging over me all weekend."
http://www.guardian.co.uk/politics/2009/jul/17/james-purnell-first-inter...
Scotland's drug death toll has risen by more than a quarter in the last year, new figures have suggested.
Figures from the General Register Office revealed drugs killed 574 people in 2008, up from 455 the year before.
The report found the number of deaths more than doubled in a decade and said the long-term trend "appears to be steadily upwards".
It revealed deaths were rising most sharply among older people and falling among the under-25s.
The Scottish Government published its drugs action strategy in May last year.
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Older drugs users not in treatment services can lose hope about their chances of overcoming their drug problem Scottish Drugs Forum spokesman
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Community Safety Minister Fergus Ewing said: "As a legacy of long-term drug misuse over recent decades, drug-related deaths may continue to rise over the next few years, especially among older men, which is exactly why we have put in place a strategy to turn the situation around.
"It's a long-term problem with no single solution.
"That is why we must continue to take action to tackle this issue now and for the long-term."
A spokesman for the Scottish Drugs Forum said more must be done at the prevention and treatment stages of tackling drugs problems.
'Socially isolated'
He said: "It is difficult to tell exactly why older drug users are increasingly featuring among the drug death statistics. However, many will have been using drugs - primarily heroin - for a long time.
"Their physical health will have deteriorated and many will have become increasingly socially isolated over the years, which could make them more vulnerable to accidental or deliberate overdose.
"In addition, older drugs users not in treatment services can lose hope about their chances of overcoming their drug problem and living a normal life."
The number of drug-related deaths have increased in eight of the past 10 years.
The majority of deaths were among men, at 80%. The 35-44 age bracket made up 30% or drug-related fatalities and 37% were aged between 25-34 years old.
The Greater Glasgow and Clyde NHS Board area accounted for 34% of the deaths, Lothian 16% and Tayside 9%.
Heroin and morphine were present in the body in 59% of the deaths.
Gay men's health charity GMFA has launched a campaign to warn gay men they cannot guess whether their partner will be HIV-positive.
According to the charity, studies have shown that around 40 per cent of HIV-negative men who claim to know their sexual partner’s HIV status are actually guessing. Research suggests that only 20 per cent of HIV-positive men say they always disclose their status, while it is estimated that a third of men with HIV do not know they have the virus.
GMFA has launched a campaign which features a video of a man using a fantasy 'HIV detector' to tell whether the man he is trying to pick up is positive or negative.
Another part of the campaign will be postcards in London gay bars with messages such as ‘How do you know his HIV status?’ and encouragement to use condoms.
Matthew Hodson, head of programmes at GMFA, said: “Lots of gay men believe that they can always tell the HIV status of their partners just by looking at them, or by where they meet or the sex that they’re into.
"The truth is that there are HIV-positive and HIV-negative men, of all shapes and sizes, in every city and in every gay venue across the country.
"Guesswork won’t keep you and your partners safe. Using a condom remains the best way to prevent the spread of HIV.
"The video is based on our previous ad campaign and we hope that it gets the message across in a way that’s a bit fun and a bit quirky.”
To see the video, click here. Postcards can be downloaded here.
Sexually transmitted infections are on the increase.
New data released today by the Health Protection Agency (HPA) shows the total number of STIs in the UK rose to 399,738 last year. That was just 0.5% up on the 397,909 recorded in 2007. Health officials hailed a fall in cases of both gonorrhoea - down 11% from 18,649 to 16,629 - and syphilis, for which the number of people infected fell 4% from 2,633 to 2,524. However, the overall total continued the upward trend seen in recent years mainly because cases of genital herpes went up from 26,270 to 28,957 - a rise of 10% - and those of genital warts by 3% from 89,515 to 92,525. Perhaps predictably, while 16 to 24-year-olds make up just 12% of the population, they accounted for 65% of all cases of Chlamydia, 55% of those with genital warts and 47% of gonorrhoea infections.
The HPA's Dr Gwenda Hughes said that the figures underestimate the true scale of infection through sexual contact because "there is still a substantial pool of people who are infected with STIs who remain undiagnosed".
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Region
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Chlamydia
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Gonorrhoea
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Syphilis
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Herpes
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Warts
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|---|---|---|---|---|---|
| EAST OF ENGLAND | 178.0 | 14.6 | 1.3 | 36.7 | 129.5 |
| EAST MIDLANDS | 201.6 | 24.1 | 3.2 | 40.4 | 130.9 |
| LONDON | 294.5 | 77.5 | 10.6 | 82.3 | 187.8 |
| NORTH EAST | 224.9 | 18.5 | 3.7 | 39.3 | 183.6 |
| NORTH WEST | 234.6 | 31.5 | 4.9 | 56.2 | 178.5 |
| SOUTH CENTRAL | 182.4 | 15.6 | 2.2 | 51.3 | 142.7 |
| SOUTH EAST COAST | 160.9 | 13.2 | 2.6 | 45.9 | 143.0 |
| SOUTH WEST | 171.9 | 14.8 | 3.0 | 43.9 | 145.6 |
| WEST MIDS | 172.3 | 29.0 | 4.8 | 42.0 | 126.0 |
| YORKS & HUMBS | 239.2 | 24.7 | 3.2 | 52.8 | 168.9 |
| ENGLAND | 211.1 | 29.7 | 4.3 | 51.4 | 155.0 |
| UK | 201.8 | 27.3 | 4.1 | 47.5 | 151.7 |
http://www.guardian.co.uk/news/datablog/2009/jul/24/health-sexeducation
I've been seeing dementia everywhere recently. Terry Pratchett has it. Half of my friends' parents have it. Every time someone forgets a name they put it down to creeping dementia. It sometimes seems that half of the medical research community is working on it. They are not, of course (far from it), but we are forever reading about what might cause, hinder or cure dementia. In fact, the prospect of prevention or cure is still a very long way off, and in the meantime half a million people in the UK are acting as informal carers to the 700,000 people who have the illness, most of them living in their own homes. Those numbers will more than double in the next 40 years.
So what? Well, those people, 1.2 million and rising, are struggling with really tough decisions every day – struggling to help people with dementia lead better, fulfilling lives. And they can lead better lives. It is surprising how much people with even quite advanced dementia can do, and can understand – if they are treated as valued individuals; if they are approached at the right time and in the right way; and if they and their carers are given sympathetic support. People can often make their own decisions, or at least share in decision-making. The idea of people as autonomous individuals has become something of a mantra in recent years, but in fact most of us make decisions within a social or family context. We do this when we have all our faculties, and there is no reason why we shouldn't continue to do so as our capacity diminishes.
This links with another important theme when looking at the ethics of dementia – that of solidarity. The half a million people caring for those with dementia do so for many reasons, including love, loyalty or a sense of duty. They demonstrate a real sense of solidarity within the family, and as a society we have a corresponding responsibility towards them. This means giving support and recognising the needs and interests of both the person with dementia and their carers, whose lives are often bound together, albeit in difficult and stressful conditions. They deal daily with agonising ethical problems, such as whether to keep their husband/wife/mother/father safe, or to allow them freedom – can Dad still go fishing? Does he have to be accompanied to the bathroom? Can Mum still be allowed in the kitchen? Should she be made to give up work? There are structured ways of approaching these ethical questions, even if they don't have clear cut answers, but people currently feel totally isolated, and are afraid that they are getting it wrong. Training for professionals and support for carers through formal and informal means are achievable, and could improve lives immeasurably.
We have, over the last couple of decades, taken great strides. Wheelchair access means that more people with disabilities get to use public spaces and buildings. Hearing loops are available at public counters. We have normalised many areas of illness, disability and difference. But how are we treating people with dementia? How often do we see people taking their relatives with dementia to the cinema or theatre? Or even to shops, cafes or restaurants. Football matches? Religious services? Parties, gigs, festivals? Why not? Actually the law requires providers of services to enable people with dementia to use their services. The Equality and Human Rights Commission should publicise and enforce this. That would potentially change the lives of people with dementia, and their carers, very much for the better.
Many such changes can be made, and at relatively little cost, in fulfilling our social responsibilities towards the growing number of people who are, frankly, carrying an unbearable burden. Health departments, social services departments and professional societies all need urgently to look at what they can do to bring about these changes. In our report, Dementia: ethical issues, the Nuffield Council on Bioethics sets out an ethical framework to underpin a number of recommendations that will hopefully move us in this direction, driving changes in the way we approach decision-making, health and social care and research in relation to dementia. But real change will come only when we start to see people with dementia for what they really are – just people.
http://www.guardian.co.uk/commentisfree/2009/oct/02/dementia-carers
Antidepressants get to work immediately to lift mood, contrary to current belief, UK researchers say.
Although patients may not notice the effects until months into the therapy, the team say they work subconsciously.
The action is rapid, beginning within hours of taking the drugs, and changes negative thoughts, according to the Oxford University researchers.
These subtle, positive cues may add up over time to lift the depression, the American Journal of Psychiatry reports.
It may also explain why talking therapies designed to break negative thought cycles can also help.
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We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively Lead researcher Dr Harmer
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Psychiatrist Dr Catherine Harmer and her team at Oxford University closely studied the reactions of 33 depressed patients and 31 healthy controls given either an antidepressant or a dummy drug.
The depressed patients who took the active drug showed positive improvements in three specific measures within three hours of taking them.
These patients were more likely to think about themselves in a positive light, rather than dwelling on their bad points, the researchers said.
They were also more likely to see the positive in others.
For example, if they saw a grumpy person they no longer internalised this to think that they must have done something wrong to upset the person.
New drugs
This was despite feeling no improvement in mood or anxiety.
Dr Harmer said: "We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively.
"Over time, this will affect our mood and how we feel because we are receiving more positive information."
She said the findings could help scientists looking for new drugs to treat depression.
Dr Michael Thase, a psychiatrist from the University of Pennsylvania, said the findings challenged conventional wisdoms and were potentially "paradigm-changing".
But he said much more research was needed.
"The highest research priority is to confirm that the rapid effects observed in this study are predictive of eventual clinical benefit."
He said it was possible that switching off the negative thoughts was a crucial part of the therapy.
Alternatively, it might merely be a sign that the drug was beginning to work at the cell level in the brain.
Paul Farmer, chief executive of Mind, said: "This research may contribute to our understanding of how our bodies respond to antidepressants, but the changes recorded can't always be felt by patients and it can be some weeks before they begin to feel the symptoms of depression easing.
"We must also remember that the side-effects of medication can often be felt straight away long before the benefits really kick in, and this will always affect people's experiences in the initial stages of treatment."
Antidepressants should not be used routinely to treat depression in adults with chronic health problems, according to the treatment regulator, NICE.
Depression is two to three times more common in patients with problems such as cancer, heart disease and diabetes.
NICE recommends structural physical activities and talking therapies, known as CBT, for mild to moderate problems.
But charities said the guidance could be interpreted as an excuse to cut counselling services.
'Serious impact'
The National Institute for Health and Clinical Excellence says chronic physical health problems can have a serious impact on an individual's psychological wellbeing.
It says doctors should be alert to possible depression, particularly in patients with a past history of depression or where the health problem causes serious functional impairment.
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Depression can be a complex issue and while CBT can bring huge benefits to many people, for others it isn't always the right approach Paul Farmer, Mind
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The new guidance sets out two key questions patients should be asked if a doctor suspects they may be at risk of depression.
They are: "During the last month, have you often been bothered by feeling down depressed or hopeless?
"Or have you had little interest or pleasure in doing things?"
If the patient says yes, the doctor should refer a patient on to a specialist or, if they are trained in mental health assessment, ask a further three questions.
These will check if the patient has, in the last month, been bothered by feelings of worthlessness, poor concentration or thoughts of death.
The doctor should also consider if the patient is receiving the best kind of treatment for their physical health problem, ask about history of depression and whether relationships or living conditions are having an impact.
Treatment choices
NICE says structured group physical activities, peer support or self-help based on the principles of cognitive behaviour therapy (CBT) and computerised CBT should be used for mild to moderate depression.
It also recommends couples therapy for people who have a regular partner and where the relationship may contribute to the depression, or where involving the partner can be a therapeutic benefit.
Nice says antidepressants should only be considered for patients with a past history of moderate or severe depression, those who have mild depression that complicates the care of the physical health problem, or those whose depression has lasted for at least two years or persists after other treatments.
Professor Steve Pilling, director of the National Collaborating Centre for Mental Health, said: "This is the first time that NICE has published guidance looking at depression in people with chronic physical health problems.
"It will help clinicians to provide the most effective treatments and bring real benefits for patients."
But Paul Farmer, of the mental health charity Mind, said: "We are concerned that the stronger focus on CBT over counselling will be interpreted by health services as an excuse to cut counselling services.
"Depression can be a complex issue and while CBT can bring huge benefits to many people, for others it isn't always the right approach and there is no substitute for talking through long-term issues with a counsellor."
"The supply of talking therapies is still below the demand and providers need to increase the availability of all talking treatments across the board."
http://news.bbc.co.uk/1/hi/health/8328263.stm
The suicide of German footballer Robert Enke has raised fresh questions about the particular pressures of sport on the psyche.
Every case is unique, and Enke had suffered intense personal tragedy with the death of his baby daughter from a congenital heart problem three years ago.
His widow Teresa said he had battled depression for years, and that he lived in fear the daughter they had subsequently adopted would be removed from them if his condition became public knowledge.
His career was also dominated by the extreme highs and lows that characterise sporting life.
A goalkeeper who was sidelined before finding favour again, he said openly that the threat of being usurped by a younger, better player made him falter, not flourish - and that it was faith in his talents that he needed to perform, not the challenge of competition.
After a stomach illness ruled him out of recent friendly internationals, a headline referred to his promised appearance in next year's World Cup as the "comeback of the man thought dead".
Researchers have sought to unpick the various threads that may tie sport with suicidal tendencies. But the picture is a complex one, with each sport throwing up very different issues.
"We also have to keep this tragedy in perspective. There are particular pressures associated with sport but people do commit suicide - it is the most common form of death among young men," says sports psychologist Victor Thompson.
'All consuming'
"We pay attention to this young man because he's famous, but arguably many sports stars have access to the kind of support - from their team members, their club - that others could only dream of."
Mind Games - Inside Sport (UK users only)
Former cricket player turned writer David Frith does however believe there is something inherent to his sport which means English cricketers are apparently twice as likely to commit suicide as the average male.
"It is the all consuming nature of the sport, the number of hours you spend not necessarily playing but sitting around waiting to play - quite different to football say. You live and breathe it in a very intense, nerve-shattering way, and then very suddenly you're spat out, it's over," he says.
"But we're also starting to see problems at the other end of the spectrum, when players are just beginning their career. In India in particular, where there is glamour and fervour akin to the English football premiership, we're seeing youngsters take their lives as they realise they're not going to go all the way."
The England career of cricketer Marcus Trescothick was ended by a stress-related illness, although he dates the onset of anxiety attacks back to when he was just ten years old.
Taking to the stand
The most high profile footballer to commit suicide in England was Justin Fashanu - the first professional footballer to admit he was gay.
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You live and breathe it in a very intense, nerve-shattering way, and then very suddenly you're spat out, it's over David Frith
Cricket writer |
He was found hanging from the rafters of a London garage in 1998, at the age of 37. He was at the time facing a court charge in the US of sexually assaulting a teenage boy, and wrote in a suicide note that while innocent he felt he would be treated unfairly because of his homosexuality.
His career had already nosedived by the time he spoke about his sexuality, but to his own mind it was a deep-seated prejudice within the English game which led to his demise.
The consensus remains that the sporting arena remains a difficult place to be gay, but regardless of sexuality all athletes live under the constant threat of injury, pressure to perform, and early retirement in which the commentators' box is not always an option.
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I had clinical depression and I've probably had it all my life. It's just that, for most of my life, I couldn't admit to having something wrong Wendy Williams
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Injuries clearly take their psychological as well as their physical toll, but there is also growing evidence that head injuries may have a role to play in suicidal behaviour.
Chronic Traumatic Encephalopathy (CTE), associated with repeated blows to the head, is a risk for boxers and wrestlers - and has also been diagnosed in American football players - including two who had recently committed suicide.
Mind over matter
Chicken and egg theories also abound - and the question has been raised as to whether sport attracts a very particular type of personality.
There are athletes who have attained a high level of success in spite of psychiatric disorders such as manic depression, but also those who have perhaps chosen sport as a way of dealing with a problem like Attention deficit hyperactivity disorder, or ADHD, Antonia Baum, a psychiatrist at the George Washington University Medical Center, has argued.
Eating disorders, which are associated with suicide, may also have started as result of involvement in sports which require the leanest body possible.
The American Olympic diver Wendy Williams said she became preoccupied with finding a way to commit suicide before finally getting the help she needed.
"I had clinical depression and I've probably had it all my life. It's just that, for most of my life, I couldn't admit to having something wrong.
"I was an athlete. I was supposed to be able to get over it. Mind over matter."
http://news.bbc.co.uk/1/hi/health/8354979.stm
Last week's suicide of the German goalkeeper Robert Enke revealed more than the terrible news of one man's death, the cruelty of depression and the pressures on sportsmen to protect the public's idealised view of them; it also exposed the ongoing shame and stigma of mental illness. For years he had been struggling with depression, kept secret from the public and his colleagues for fear of a vicious backlash that could, he apparently feared, raise questions about his capacity to care for his adopted baby girl and play for his nation.
Rather than risk this, and perhaps further despairing under the force of these private terrors, he chose the solution of death. That this seemed preferable to risking public awareness of his depression and the imagined consequences of personal shame, family destruction and exclusion from his nation's crucial sporting event, demonstrates something of the huge level of hatred that mental illness still evokes in the public imagination. The stigma only worsens the burden on those with mental health problems, typically reported as one in four of the adult population in the UK.
When people die by their own hand, a response of shocked disbelief, of the sense of an awful secret that has been starkly exposed, occurs all too often. How is it in this advanced age of emotional literacy, psychological self-help and media shrinks that the shame of depression and other mental illness causes people to desperately try to hide their problems rather than challenge society to accept that they, like so many others, are vulnerable?
In my experience as a mental health professional I have suffered the loss of two highly regarded male colleagues, by suicide, whose depression had never been spoken about or known by those best placed to help them – their workmates and friends. Their terror of public exposure drove them to the point of deception and absolute isolation. Only after their deaths were their colleagues able to understand.
One could argue that this reflects only individual psychic defences, that those who work as healers of mental illness project their own disturbance into others as a way of disowning it in themselves, but I believe that the forces that drive these people are not just internal fears about facing the depression within themselves, but reflected realistic assessments of the professional and personal damage that disclosing mental health difficulties can cause in a society that still only pays lip service to real tolerance of difference.
While soul-searching can not bring back the lost lives of Enke or my two talented and troubled colleagues, an enlightened view on the commonplace nature of depression, the ordinary treatments of psychological therapies and psychotropic medication that can help it so profoundly, and a degree of restraint in our own temptation to vilify those whom we admire but who show some vulnerability, could go some way to helping prevent other young suicides.
The courage of celebrities like Paul Merton and Stephen Fry, who make public their struggles with depression, should be celebrated as valuable antidotes to the destructive power of stigma.
http://www.guardian.co.uk/commentisfree/2009/nov/15/mental-health-stigma...
A damning report into the levels of stigma being faced by people with HIV in Britain has led to calls for the government to produce a strategy to tackle discrimination.
Researchers found that one in five people with an HIV diagnosis had been harassed, threatened or verbally assaulted in the past 12 months. Many reported ignorance and prejudice from within the medical profession, particularly from GPs and dentists. One in five reported being denied medical treatment because they had HIV.
In findings to be unveiled in parliament tomorrow, The People Living With HIV Stigma Index, a two-year research project funded by the Department for International Development and the International Planned Parenthood Federation, found that only 39% of people felt confident that their medical records were being kept confidential, with 18% saying their HIV status had been revealed without their consent.
Lisa Power, head of policy at the Terrence Higgins Trust, said that the public was more ignorant about HIV than a decade ago. "This research is really important because it's about people's perception of the prejudice they face.
"We did have a good education programme in this country, but that's all gone to pot. The UK has slipped from being a shining beacon of HIV prevention programming and education, to being behind everyone else in Europe. While the General Dental Council gives its members quite clear advice on HIV, we still have dentists refusing to see patients or, which is quite common, asking them to wait until the end of the day for an appointment, apparently so the instruments can be sterilised twice.
"With far more contagious things around, like hepatitis C, it's an insult to anyone using a dentist's surgery if everything is not completely sterilised between each patient. People with HIV can lead long lives, have healthy children, but still they suffer higher levels of unemployment and relationship breakdown, more poverty, more depression and a lot of that is down to stigma, not to the actual virus."
Figures released on Friday by the Health Protection Agency showed the numbers of people living with HIV in the UK had reached an all-time high of 83,000, an 8% rise on the previous year. Of that number, 27% will not know they have the virus because the figure was reached by scientists anonymously testing random blood samples.
It is a long way from the forecasts made in 1984 of millions of people infected and dying, at a time when Britain had only 108 cases of Aids and 46 deaths. The country was gripped by fear, leading to incidents that included the fire brigade union telling members to stop mouth-to-mouth resuscitations of gay men, to patients facing isolation wards.
Even today, one London participant in the Stigma Index research said: "When the nurse put on two sets of gloves I was so humiliated – who taught her to do that?"
Another woman, who lives in a small town in Wales, told the Observer that she used health services miles away from home to protect her child from gossip at school.
"It would be round the town in a flash and yes, living with secrecy can be tough, but I think the stigma and ignorance would be far worse. Once you tell people, you can't take it back and it's too big a risk for me."
Alastair Hudson, 41, a researcher on the project, was taken aback by the stories. "People feel battered by their experiences. It was a diversity of people, from all sorts of ages and backgrounds, up and down the country, but a lot of the stories were similar, people they were coming into contact with didn't understand even the basics of HIV.
"The advertising campaigns of the 80s had a profound effect and people were scared, but the epidemic has changed so much and people's knowledge hasn't. One guy said, 'HIV is a diagnosis, not a lifestyle choice'. We don't want to normalise the virus, but we do want to make sure it's not forgotten."
However, the findings were not all negative. More than 60% of respondents said they felt they could change attitudes if they challenged discrimination. "The vast majority of people living with HIV, 84%, are also working to support each other. It was interesting that although 80-odd% of people knew where to go to access HIV support, only 23% did, which I think means people are empowered enough to look for their own support. There's far less of this victim thing than there was," said Hudson.
On the basis of the research, the all-party parliamentary group on HIV and Aids is calling for a cross-departmental government strategy to tackle discrimination. Its chair, David Borrow MP, said: "Stigma is rife in Britain and the NHS has an opportunity to lead the way in tackling it. Discrimination on the grounds of a health condition is totally unacceptable anywhere, but the public sector has a special responsibility to treat everyone it serves with respect."
Andy Burnham, the health secretary, welcomed the report, which he will launch in the Commons tomorrow.
"Effective treatments have transformed the lives of people with HIV and many more people with HIV can plan for their future with more certainty. But even in the UK, individuals and families affected by HIV can experience stigma and discrimination."
Gay men are still most likely to acquire HIV in the UK, but heterosexual infections are rising, with 58% of new diagnoses in 2008 being among heterosexuals, two-thirds of whom were black Africans. The majority of infections were probably acquired abroad, with 27% having caught the virus in the UK.
http://www.guardian.co.uk/lifeandstyle/2009/nov/29/hiv-study-stigma-atti...
The government is preparing to announce a major shift in mental health policy in England with a new emphasis on tackling and preventing depression.
The 10-year strategy is expected to call for better identification of those most at risk and wider access to psychological therapies for patients.
Depression or anxiety affect one in six people at some point in their lives, yet only one in four is in treatment.
It is not clear what, if any, funding will be available to back the plans.
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We need to be better at preventing depression, better at treating it and better at reducing the impact of depression Professor Louis Appleby
National Director for Mental Health in England |
Professor Louis Appleby, the government's mental health tsar, said at any one time one in six people were struggling with depression, but only a quarter of those people were in treatment.
He said: "We need to be better at preventing depression, better at treating it and better at reducing the impact of depression."
Professor Appleby said depression affected physical health, raising the risk of conditions such as stroke, and the likelihood that people would not seek treatment if they became ill.
He said it was important to tackle the issue as early as possible, for instance, by providing the right atmosphere for children to thrive and build self esteem at school.
The World Health Organization warned in September that in 20 years' time more people will be affected by depression than any other health problem.
The strategy, to be published on Monday, is expected to say that depression is as big a problem as heart disease.
Sources say the ambition of the plans to prevent and treat depression are unprecedented in Europe.
Huge savings?
Since 2007, there has been a £170m programme to increase access to a type of treatment called cognitive behaviour therapy, which is designed to help patients to pinpoint - and then change - thoughts and actions that cause emotional problems.
It came after the National Institute of Health and Clinical Excellence said anti-depressants should be reserved for the more severe cases.
But the programme has been criticised by some as placing too much emphasis on one type of treatment.
It is thought the plans to be outlined later will broaden the range of psychological therapies available for GPs to recommend for their patients.
Much of the focus is expected to be on prevention - identifying those most at risk, particularly in schools.
There will also be more help in the workplace, and support in finding a job.
The hope is that a co-ordinated strategy, working across several government departments, could yield huge savings.
It is likely that critics will be watching closely to make sure the commitment is backed by resources.
Mental health is already the single biggest part of the NHS budget with 13% of all funds going on community, hospital, and drug and alcohol addiction services.
Dr Lynne Friedli, an expert on mental health who has written on the subject for the World Health Organization, said depression was most likely to hit the poorest in society.
She said the government needed to tackle poverty and reduce inequality.
"If we don't grasp the psychological impact of the big gap between rich and poor we will not have any impact on depression and anxiety."
Two thirds of doctors and dentists who attended a pioneering scheme run by the National Health Service to rehabilitate sick medics were suffering mental health disorders while the rest were addicted to alcohol and "every drug under the sun", the GP leading the programme said today.
In its first year more than 180 medics used the Practioneer Health Programme (PHP), set up to help medics grappling with the stress of long hours as well as the stigma of illness and addiction in the profession. The vast majority of cases were doctors who were clinically depressed or suffering from alcoholism.
Of those with addiction problems about one in four were hooked on drugs, the rest were dependent on alcohol. Clare Gerada, the programme's medical director highlighted cases of addiction to "ketamine, methadrone, amphetamine, heroin... every drug under the sun." Unlike normal addicts, it appeared doctors would not imbibe while at work such was their concern for their patients but would binge when off-duty.
Almost one in three of those reporting mental health issues had depression, about a fifth suffered from anxiety attacks and a third had a condition such as an eating disorder. Alarmingly Dr Gerada said in six cases there had been an "undiagnosed psychosis... bipolar disorders where doctors were working but nobody had picked up the illness... obviously with (this programme) we were able to pick it up much earlier before they were able to damage patients".
The programme, the brainchild of the outgoing chief medical officer Sir Liam Donaldson, was set up in London in September 2008 as a belated recognition that doctors do not always have the same access to healthcare as their patients. The problem was often doctors would try to "manage their own condition rather than seek help".
The programme offers a confidential service to get doctors back into work and the figures released yesterday showed it had managed a 77% success rate. It is likely to be replicated in other parts of the country starting with Newcastle and Avon.
In a sense the breakthrough is a wider acceptance that doctors get ill and need help as patients, said Dr Gerada. "The problems are complex but there's a feeling that is wrong that doctors do not get sick... they also don't seek help or treat themselves. Patients could be harmed if doctors go untreated."
Thanks to a campaign to promote the programme, run from a south London GP clinic, officials said PHP had become the largest of its kind in the world. "In Canada a similiar service had 11 patients, in Poland they had 9... the service destigmatizes (the process)," said Professor Alastair Scotland, medical director of the National Clinical Assessment Authority.
http://www.guardian.co.uk/society/2010/jan/29/sick-medics-rehabilitation
The middle-aged are to be urged to downsize their plates and dance to the radio as part of the government-backed Change4Life advertising campaign.
It is the latest stage of a multi-million pound drive to curb England's obesity rates, launched a year ago.
The campaign has come in for criticism, but the government says one million mothers have sought to change their families' lifestyles in the past year.
The 45-65 age bracket is the new target of "Swap It, Don't Stop It".
The adverts feature a plasticine-type figure with a "friendly geezer" voice and a tyre around his waist. His tyre gradually deflates as he watches what he eats and takes more exercise.
The ads, warning that extra weight increases the chances of a host of diseases, will run on the TV and in print.
An accompanying leaflet offers a series of "simple ways to swap some of the things you eat, drink and do for healthier choices".
"Room swap", for instance, urges this age group to go out in the garden rather than lounge in the living room, while "dance swap" encourages people to get up and dance to the radio rather than sitting back and enjoying celebrities waltzing on the TV.
To curb the amount of food consumed, the adverts also advise that the size of plates are reduced, while other tips include putting your crisps in a bowl instead of dipping your hand into a jumbo size bag.
Skimmed milk success
The Department of Health is claiming significant successes from the first year of its campaign, which targeted young families. It extrapolates from surveys that more than 1m mothers have made changes to their children's diet or activity levels as a result of Change4Life.
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SWAP RECOMMENDATIONS INCLUDE:
Food swap: Fill up on healthier food like fruit and veg instead of food that is high in fat or added sugar
Toast swap: white bread has very little fibre, so swap your white toast for wholemeal or wholegrain toast
Spritzer swap: A good way to cut down on alcohol calories is to have a smaller glass of wine topped up with soda water
TV swap: think about the sports you enjoy watching on TV and get out and give them a try
Source: Change4Life leaflet
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It also suggests that data gathered from supermarkets suggests changes in the types of food purchased, with more low-fat milk and low-sugar drinks passing through the checkouts.
The three-year Change4Life initiative followed a major report which warned the government must act to stop Britain "sleepwalking" into an obesity crisis, although some of the predictions have subsequently been modified.
Latest figures show that childhood obesity rates are in fact levelling off, with significantly downgraded predictions of rates for both boys and girls by 2020.
The reasons for the slow-down are unclear - and may include government intervention - but they are in line with trends now being recorded in other developed countries.
No such slow-down has however been seen among UK adults, with 44% of men and 38% of women predicted to be classified as obese during middle-age by 2020.
There are doubts as to whether this next stage of the £75m campaign will alter these predictions.
While some brand the drive patronising, others suggest the government is doing too little, too late.
"It is an inoffensive campaign, but falls far short of being a world changing one. People being encouraged to get up and dance to the radio is not the answer to this problem," says Dr David Haslam, the clinical director of the National Obesity Forum.
"Yes, mothers buying lower fat milk and people changing their plate sizes - if they indeed do - is to be applauded, but really the government would be better spending money and time on interventions which have more evidence behind them."
But the UK Faculty of Public Health is impressed by what it has seen to date.
"Change4Life does seem to have sparked off a whole national movement for healthier family living," says faculty president Dr Alan Maryon-Davis.
"Shifting the focus to adults may get more people involved - but I hope it won't mean cutting back on the family-based approaches which have proved so popular. We need sustained investment in promoting family health."
One in 25 deaths across the world are linked to alcohol consumption, Canadian experts have suggested.
Writing in the Lancet, the team from the University of Toronto added that the level of disease linked to drinking affects poorest people the most.
Worldwide, average alcohol consumption is around 12 units a week - but in Europe that soars to 21.5.
The report authors warn the effect of alcohol disease is similar to that of smoking a decade ago.
We face a large and increasing alcohol-attributable burden
Dr Jurgen Rehm
The analysis also found that 5% of years lived with disability are attributable to alcohol consumption.
The paper says that, although there have been some benefits of moderate drinking in relation to cardiovascular disease, these are far outweighed by the detrimental effects of alcohol on disease and injury.
In addition to diseases directly caused by drinking, such as liver disorders, a wide range of other conditions such as mouth and throat cancer, colorectal cancer, breast cancer, depression and stroke are linked to drinking.
Drinking patterns do vary around the world, and the researchers point out that most of the adult population - 45% of men and 66% of women - abstain from drinking alcohol for most of them for their life.
Across the Americas, average consumption is 17 units per week, while the Middle East was the lowest at 1.3 units per week.
Death rates
For 2004, the latest year for which comparable data are available on a global level, 3.8% of all global deaths (around 1 in 25) were attributable to alcohol.
Overall, alcohol-attributable deaths have increased since 2000 mainly because of increases in the number of women drinking.
Europe had the highest proportion of deaths related to alcohol, with 1 in 10 deaths directly attributable.
Within Europe, the former Soviet Union countries had the highest proportion at 15%, or around one in seven deaths.
This study is a global wake-up call
Professor Ian Gilmore, Royal College of Physicians president
Globally, men are five times more likely to die from alcohol-related illness than women.
And young people are more likely to have a disease linked to alcohol than older people.
Of all years lived with disability attributable to alcohol, 34% were experienced by people aged 15-29, 31% in the 30-44 age group, and 22% by those aged 45-59.
Writing in The Lancet, the researchers led by Dr Jurgen Rehm said: "Globally, the effect of alcohol on burden of disease is about the same size as that of smoking in 2000, but it is greatest in developing countries."
But they added: "This finding is not surprising since global consumption is increasing, especially in the most populous countries of India and China.
"We face a large and increasing alcohol-attributable burden at a time when we know more than ever about which strategies can effectively and cost-effectively control alcohol-related harms."
'Irresponsible sale'
Professor Ian Gilmore, president of the Royal College of Physicians and chair of the Alcohol Health Alliance UK, said: "This study is a global wake-up call.
"We need an international framework convention for alcohol control, similar to that on tobacco, as soon as possible, to put into practice the evidence-based measures needed to reduce alcohol-related harm.
"These include increasing the price of alcohol, reducing its availability and banning advertising, and the action needs to start now."
Alcohol Concern chief executive Don Shenker added: "These statistics are unfortunately reflected in England, where we have seen deaths caused by alcohol increase almost a fifth since the beginning of the decade.
"On both a national and global scale we're facing a disease burden of huge proportions.
"There is no longer any doubt that if a society drinks large amounts of alcohol, we'll see high levels of harm as a result."
He added: "Many countries are investigating new ways to cut deaths and disease and reduce the burden on health services by using the price of alcohol to lower consumption.
"As the chief medical officer has identified, putting a stop to the irresponsible sale of low cost alcohol would be an effective step in the right direction.
http://news.bbc.co.uk/1/hi/health/8118475.stm