The Chy Sawel Project
The Chy-Sawel project has been spearheaded by Sandra Breakspeare whose son has been under long-term mental health care for schizophrenia. Sandra has spent many years researching the issues and became interested in different approaches to the standard psychiatric treatments. She has attended conferences in the UK and in Canada and has formed a group of professionals in Cornwall to work on showing that there are other options for treating mental illness.
Conferences in Cornwall have been organised to explore and inform about nutritional, dietary, and talking therapies approaches to acute mental illness and the project has been very grateful for the support it has received from many eminent UK and international speakers. Attendance has been from mental health and general medical practitioners, psychologists, therapists, carers and sufferers and the conferences have helped not only to inform and challenge but also to demonstrate that feasible and tested alternative approaches are available.
Chy-Sawel has recently achieved registered charitable status which has been one of its aims and this has led to a review of the development of the project and this document.
Vision, Mission and Purpose
Chy-Sawel looks forward to when ‘mental illnesses’ are treated effectively and humanely, without recourse to harmful treatments.
Its mission is to promote awareness among the public and professionals of different ways of perceiving and treating mental health problems. To encourage through education, research and project support methods to foster natural mental health treatments that are effective, compassionate and based on understanding.
The overriding purpose of Chy-Sawel is to support and promote treatments of chronic mental illness by methods less traumatic and dangerous than through long term drug use, surgery and electroshocks. It supports the development of alternatives to these treatments such as the use of natural nutrients, exercise, social engagement and coping skills, and talking therapies. Chy-Sawel is concerned that current medical-pharmaceutical treatments of ‘mental illness’ are not very effective and can be dangerous, have various severe side effects, contribute to relapse, and detract significantly from the quality of life of patients and their families. It is with the vision and purpose of helping to create better treatments for chronic mental health problems that Chy-Sawel was established as a registered charity.
The overall aims of Chy-Sawel are contained in the organisation’s charitable objects which are:
· To assist in the treatment and care of persons suffering from chronic mental illness, or in need of rehabilitation as a result of such illness, by providing and assisting in the provision of facilities, support services and equipment not normally provided by the statutory authorities.
· To advance the education and training of individuals, families, the public and health care professionals on the causes and effects of mental health difficulties and the benefits of an holistic approach for the relief and rehabilitation of persons suffering from psychiatric disorder or at risk of suffering from such disorders.
· To promote research into matters related to the holistic treatment of mental illness and the publication of the results of such research.
Why the need to look again at psychiatric treatment
The scale of mental health disorders should make this a priority area for health treatment and research. The Office for National Statistics Psychiatric Morbidity report, 2001 says that 1 in 4 British adults experience at least one diagnosable mental health problem in any one year and 1 in 6 experiences this at any given time. MIND breaks this down as out of 1000 people every year in Britain, 102 will be diagnosed as having a mental health problem, 24 of these will be referred to a specialist psychiatric service and 6 of these will become inpatients in a psychiatric hospital.
The 2011 European Neuropsychopharmacology Report, ‘The Size and Burden of Mental Disorders and other Disorders of the Brain in Europe 2010’ stated that, ‘well over one third of the EU population during any given 12 month period suffers from mental disorders alone, most of which are not receiving any treatment’. The report concludes that the true size and burden of disorders of the brain in the EU has been significantly underestimated in the past. ‘Concerted priority action is needed at all levels, including in particular substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the care health challenge of the 21st Century’.
The 2008 WHO World Mental Health Surveys: ‘Global Perspectives on the Epidemiology of Mental Disorders’, point out that even in countries with the best health care systems only a minority of people with mental disorders are receiving treatment and although more chronic cases eventually obtain treatment, it is often substantially delayed and there is questionable quality of most treatments.
The cost of mental illness in England according to the Centre for Mental Health, taking into account economic and social costs, is estimated at £105.2 billion in 2009/10, an increase by 36% between 2002/03 and 2009/10. They put this into context by pointing out ‘Our 2003 policy paper showed that mental health problems carried a bigger cost to society than crime, and falling crime rates since then imply that the difference is now even bigger’.
The Mental Health Bulletin on NHS adult specialist mental health services 2010 states that over 1.25 million people used NHS specialist mental health services in the year 2009/10 which was the highest number since data collection began in 2003/04 and a 4% increase from 2008/09. The number of people who spent time in a mental hospital rose by 5.1% - the first increase in five years. This rise was due to a 30.1% (estimated at 17.5% allowing for improved recording) in the number of people being compulsorily detained in hospital under the Mental Health Act from 32,649 in 2008/09 to 42,479 in 2009/10.
Meanwhile, the Royal College of Psychiatrists point out on their website that for chronic mental health disorders such as bipolar disorder and schizophrenia, they don’t understand what the causes are. The reality is that it has not been possible to identify a specific causal factor and it is recognised that mental disorders come about through a number of causal factors including behavioural and biological changes. Also there is recognition that often mental illnesses are not illnesses as such but the result of the way we live our lives, the nature of society and environment in which we live or were brought up in, and the food we eat or don’t eat.
Given the pervasiveness of mental health problems and their financial and human costs it seems absurd that limited resources are being provided for mental health research. Treatments need to be brought into the 21st Century and become more advanced than just drug, electroshock, lobotomy and crude interventions. More emphasis needs to be placed on psychosocial methods of treatment, healthy lifestyles and care and support within families and communities.
This has been recognised by psychiatry and the Royal College of Psychiatrists in their June 2011 report ‘Do the Right Thing: How to Judge a Good Ward’ which says that adult inpatient mental healthcare hospital wards should provide patients with access to a range of psychological therapies and follows NICE (National Institute for Health and Clinical Excellence) updated guidelines that recommends the use of psychological interventions, such as cognitive behaviour therapy, family interventions and arts therapies for the treatment of people with schizophrenia. However, it is concerning that the report finds that only 38% of patients have been offered supportive counselling and only 29% of patients receive access to talking therapies, with almost a quarter of patients that request therapy not actually receiving it.
Drugs remain dominant in the treatment of mental illness and this seems to have created its own blinkered approach. Drugs fit the medical paradigm of biological cause and cure, and suit a financially lucrative pharmaceutical industry. However, drugs produce problems of withdrawal and with longer term use in chronic mental illness often produce tardive dyskinesia (movement disorder); tardive dementia (deterioration of mental faculties); tardive akathisia (anxiety and uncontrollable drive to move the body) and brain damage and dysfunction. These effects have been so common that they have been taken as symptoms of the illnesses rather than recognised as the results of drug treatment.
Studies indicate an integrative treatment approach is best with use of motivational interviewing; antipsychotic medications used with close monitoring; community based rehabilitation and social skills training; family psychotherapy; cognitive-behavioural therapy to reduce delusions and hallucinations; developing a healthy physical and social lifestyle.
Chy-Sawel recognises the need for an holistic treatment approach to mental illness and regards much of the current heavily drug based treatment approach as inappropriate and believes that other models of treatment need to be researched and, if successful, used to improve mental health problem treatment even if it means re-examining the position of psychiatry and that of the pharmaceutical industry.
Chy-Sawel has developed a particular interest in the nutritional connection with chronic mental illness and this has been supported by a growing professional interest in this field of enquiry and by the results that have emerged from research.
Sustain, the alliance for better food and farming, together with the Mental Health Foundation produced a report in 2006 ‘Changing Diets, Changing Minds: How Food affects Mental Well-being and Behaviour’, in which the authors have collected and analysed around 500 research studies and as a result comment: ‘People eating diets that lack one or more of the combination of polyunsaturated fats, minerals and vitamins, and/ or contain too much saturated fat (or other elements, including sugar and a range of food and agricultural chemicals) seem to be at higher risk of becoming ADHD (attention deficit/ hyperactivity disorder); a range of depressive conditions; schizophrenia; dementia, including Alzheimer’s disease’.
The report does not claim that diet alone can prevent or cure these conditions but that research is suggesting ‘that the combination of polyunsaturated fats, minerals and vitamins may help to relieve the symptoms of some mental illnesses; improve the effectiveness of medications for some conditions; and reduce the unpleasant side effects of some medication’.
It is no longer tenable to believe that the mind and body are separate and that poor nutrition and chemical imbalances do not underlie the majority of mental illnesses. The brain, although only around 2% of the body weight, nevertheless uses up about 20% of the body’s energy. Essential nutrients are therefore more important for brain function than for other tissues and are important to good mental health.
There is a growing awareness, supported by research, of the connection between food and mental health. Poor foods, junk foods and levels of pollution in the environment are connected to mental disorders. For example, research by Southampton University published in the Lancet (September 2007) connected food additives with hyperactivity and ADHD.
Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation (the leading charity working in mental health and learning difficulties) in their publication, ‘Feeding Minds: The impact of food on mental health’ points to ‘a growing body of evidence, and a number of significant voices are championing the role of diet in the care and treatment of people with mental health problems. The potential of dietary interventions in treating depression and ADHD, for example, are being increasingly recognised. An integrated approach, recognising the interplay of biological, psychological, social and environmental factors is key to challenging the growing burden of mental health in western nations. Diet is a cornerstone of this integrated approach’.
Professor Malcolm Peet (Consultant Psychiatrist in the NHS and former Head of the University Department of Psychiatry, Sheffield) writing in Nutrition and Schizophrenia in 2004 (Vol95 pp17-28) points out current treatments by antipsychotic medication are palliative but not curative so that most people suffering from schizophrenia experience lasting disability. However, he notes that although the incidence of schizophrenia is similar across modern cultures, the two year outcome of schizophrenia is substantially better in developing countries than in the developed countries of Europe and North America. He believes that nutrition may be the explanation and points out that ‘this has been largely neglected until recently’. Besides putting this down to concepts of mind/ body duality which ‘appears to be an alien concept to most mental health researchers’, he refers to epidemiological evidence of ‘an association between nutrition and schizophrenia and biological mechanisms exist by which nutrition could affect the onset and outcome of the schizophrenic process’ and ‘there is evidence that nutritional approaches may be beneficial even after the onset of schizophrenic illness’.(In a further article in the British Journal of Psychiatry (Vol184 pp404-408) he points out that the dietary predictors of schizophrenia and depression are similar to those that predict illnesses such as coronary heart disease and diabetes, which happen to be more common in people with mental health problems).
Malcolm Peet concludes by referring to several studies which have shown the beneficial effects of dietary control on schizophrenia but points out that, so far, there have been no formal studies of a low saturated fat, low sugar diet on the management of schizophrenia. He notes that some clinicians have adopted this approach and have anecdotally reported success. For example, clinicians have adopted approaches of fasting often followed by vegetarian diets; reduced consumption of saturated fat and sugar (cutting out processed food) and recorded improvements. He goes on to say that such dietary interventions ‘follows the principles of orthomolecular’ psychiatry that were first put forward by Linus Pauling. This was based on the philosophy that the body, and in this case specifically the brain, functions at its best when it is in the biological environment provided by the nutrition on which it evolved’.
Chy-Sawel has been interested for some time in orthomolecular medicine which is about preventing and treating disease by providing the body with optimal amounts of substances that are natural to the body such as vitamins, minerals, amino acids and essential fatty acids, and controlling diet. The term orthomolecular was first used by the Nobel Prize winner Linus Pauling in the 1950s and subsequently much pioneering work was done by Dr Abram Hoffer and Dr Carl Pfeiffer in Canada and North America respectively. Orthomolecular medicine is now used by some clinicians and is promoted by the International Society for Orthomolecular Medicine. In diagnosis and formulating treatment, a nutritional history is central in looking for evidence of cerebral allergies, vitamin deficiencies and imbalances of minerals. This has led to biochemical investigations and connections with lifestyle factors influencing mental illness.
The ‘Parliamentary report on the links between diet, mental health and behaviour – January 2008’ after looking at the scientific evidence on whether mental health and performance can be affected by what we eat agreed there were benefits but a need also for further well conducted research. However, they did make nineteen wide ranging recommendations including nutritional training for GPs and other medical professionals, and that the number of dieticians should be increased.
Research is finding links between mental disorders such as schizophrenia and cell membrane chemistry and that nutritional interventions are important to improving lives of people with chronic mental illness.
Chy-Sawel has recently been in contact with Dr William Walsh who was the Chief Scientist at the Pfeiffer Treatment Centre in Illinois and who now runs the Walsh Research Institute. He holds the results of a considerable number of chemical tests on the blood, urine and tissues of patients diagnosed with mental disorders including schizophrenia, bipolar, and depression which have been compared with the general population. This has found correlation between symptoms, traits and physical characteristics recorded for each patient and specific chemical imbalances. There were high incidence chemical imbalances in mental disorders of zinc deficiency, copper overload, methylation disorder, folate imbalances, pyrrole disorder, toxic metal overload and severe oxidative stress. It is clear that these biochemical abnormalities are associated with either the symptoms or regulation of major neurotransmitters. Because of genetics and epigenetics (inherited changes in appearance or gene expression caused by mechanisms other than changes in the underlying DNA sequence, for example by an environmental cue), most people are deficit in several nutrients and overloaded with others. Nutrient deficiency or overloads can be naturally eliminated by biochemical therapy in a large number of cases. Dr Walsh reports 85% of patients report ‘life is better’ success rate after nutrient therapy, 75% are able to reduce or eliminate medication and many cases show complete recovery.
Chy-Sawel recognises that helping those suffering from chronic mental problems back to normal mental function involves a multiple approach and although nutrition is seen as very important, it needs to be supplemented. For example, the benefits of daily physical exercise for both healthy and depressed people have been demonstrated in both clinical and experimental studies. Exercise improves levels of energy; reduces anxiety, tension and depressive symptoms; and improves sleep. Also, work needs to be included in the treatment to bring people back to normal social functioning by using appropriate therapies, as well as occupational and social supportive work.
Developing the Chy-Sawel Project
Supporting Training and Research
Chy-Sawel has organised two very successful and well attended conferences in Cornwall that have brought a number of expert speakers on new research and approaches to psychiatric care. These have included Prof Michael Crawford (Director, Institute of Brain Chemistry and Human Nutrition at London Metropolitan University and consultant for WHO); Dr Alex Richardson (Senior Research Scientist at the University of Oxford); Dr Damien Downing (President of the British Society for Ecological Medicine); and speakers including consultant psychiatrists and a senior nutritionist working within the NHS.
The conferences have been open to clinicians, psychologists, nutritionists and complimentary therapists interested in new approaches to psychiatric treatments, and sufferers and carers wishing to understand more.
A further conference is to be held in October 2011 which will be run jointly with Cornwall College and at this conference the key speakers will be Robert Whitaker (Author of ‘Mad in America’ and ‘Anatomy of an Epidemic’ about psychiatric research and medications) and Prof John Stein (Professor of Neurophysiology at University of Oxford).
Chy-Sawel sees its training work as a key element in achieving its mission of making information available regarding new psychiatric treatments and accessible to a wide audience.
Of considerable importance to the project is to have a closer involvement in supporting research. The conferences contribute to this by allowing the presentation and discussion of the work by leading figures in psychiatric care and academia but Chy-Sawel is aware of the need for robust studies and Case reports to be made available to support progressive changes to help people with chronic mental health problems.
Over the past year Chy-Sawel has achieved:
· A strong and committed team of project management which meets monthly in Truro and includes a former consultant psychiatrist; nutritional, complementary therapy, and community development expertise, as well as having an accountant and parents of sufferers of acute mental illness. The diverse backgrounds of members contribute to a range of perspectives and fit well the holistic approach of the project.
· Registration as a company limited by guarantee with Companies House and registration as a charity with the Charity Commission
· Continued development and support for Chy-Sawel’s work by networking with other organisations in the UK and internationally.
· Remaining a source of support for many sufferers of mental illness and their carers
Looking forward it will now be:
· Strengthening the financial position of the charity by seeking grant and donations support towards developing its work programme and influence
· Seeking funding to employ a project co-ordinator who will help in obtaining further project funding, developing networks, helping in disseminating information to support the mission of Chy-Sawel and assisting in the development of specific projects.
· Developing the website and producing a Chy-Sawel newsletter to go to professionals and supporters with information about the project’s work and flagging up research, conferences and initiatives that are relevant to treatment of chronic mental illness treatment.
· Setting up a research sub group of Chy-Sawel to review the increasing amount of relevant material that is now becoming available to keep the project abreast of new thinking and to ensure the soundest case is put forward to support its work and initiatives.
· Working on producing a model for a residential holistic treatment centre for chronic mental illness treatment in Cornwall.
A Residential Holistic Treatment Centre.
It has always been an aspiration of Chy-Sawel to be able to support the establishment of a residential holistic treatment centre in Cornwall which acts as a model of good practice in treating chronic mental health disorders (here we differentiate between ‘mental disorders’, such as depression and schizophrenia and ‘neurological disorders’, such as dementia, epilepsy and multiple sclerosis) and moving away from the harmful effects of drug use and promotes preventative and effective long-term restorative outcomes.
What is envisaged is a Centre that can provide residential facilities for up to 18 people in a rural setting, such as a farm, which will not only provide a peaceful, safe and relaxing environment but be a source of therapeutic work such as organic horticulture and taking part in daily tasks of running the Centre. Participants would be expected to stay at the Centre for between six months and two years. Each person will be treated on an individual basis which will include a programme of nutritional therapy, psychological therapy and counselling, psychotherapy, exercise, occupational and recreational therapies, social re-education, and work with family relationships. The Centre would be staffed and have available appropriately qualified personnel.
The aim of the Centre will be to help participants to meaningfully re-enter society.
In the UK there are already a number of therapeutic communities for those experiencing mental health and emotional difficulties and a particular differentiating feature of Chy-Sawel will be its pioneering approach through nutrition and diet. The project is aware and has contact with other projects internationally, such as the ‘Earth House’ project in the US which has been running for the past 30 years, caring for young adults suffering from major mental disorders including schizophrenia and bipolar disorder.
Earth House is located in a rural community and accommodates about 14 adult residents; most of these have had multiple diagnoses and have been previously hospitalised, some for ten years or more. Earth house provides good overall nutrition and supplements are given as needed, together with exercise and therapy support. Appropriate doses of psychotropic medications are continued to treat immediate symptoms but as brain chemistry becomes more normal through proper nutrition small doses of drugs are required.
Chy-Sawel will be looking in depth at projects such as Earth House and other therapeutic communities in developing its model. It believes that such a model may prove to be an optimal environment for recovery and an important centre for education, training, research, and service evaluation.
Chy-Sawel is still in its formative stage but has made considerable progress in defining its work and committing to progress towards improving the treatment of people suffering from chronic mental disorders.
Research has begun finding key links between chronic mental disorders and an underlying genetic and biochemical base which hold exciting prospects for new treatments and in the prevention of such conditions. Yet research is still sadly limited and this appears absurd given the social and financial costs. Brain disorders affect young and old and cannot be left to current inadequate treatments.
Chy-Sawel aims to challenge the existing paradigms of mental health treatment, to make information more publicly available and accessible, and to help develop treatment centres that will be 21st Century beacons of care and cure.
Cures not pills!