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For those wondering who Ian Drury was....

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Ian Dury - Reasons To Be Cheerful Part 3

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Found this website Nomis- which is a service provided by the Office for National Statistics, gives lots of info on population, etc in different areas

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Found this website Nomis- which is a service provided by the Office for National Statistics, gives lots of info on population, etc in different areas

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Nomis - Official Census and Labour Market Statistics

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nomis - official labour market statistics

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Loneliness should be recognised as a problem for all age groups, says Tracey Crouch, the minister about to reveal England's first loneliness strategy.

She says there needs to be a "national conversation" to end the stigma about admitting to feeling lonely.

"The government can't make friends for us," she told a conference in London.

But Ms Crouch said the strategy will help to improve "social connections" and to get better evidence about what really works in reducing loneliness.

The loneliness minister says attitudes to taking loneliness seriously are "where we were with mental health a decade ago".

The loneliness strategy, commissioned by the prime minister and expected next week, will not be focused on the elderly, but would recognise how feelings of loneliness could deeply affect people at many times in their lives.

Ending the stigma

"It's a common misconception that it only happens in later life," the minister told a conference organised by the Campaign to End Loneliness, supported by a coalition of charities.

Ms Crouch said she had been shocked by the negative impact of isolation, which can affect young people, new parents, the bereaved, those who had lost touch with their family, as well as those in old age.

The minister for loneliness said it was a major health problem that needed to be tackled as much as smoking or obesity.

The strategy will work across departments, including transport, education and health.

Rising up agenda

The minister recognised that some local services which could reduce loneliness have been affected by austerity.

"Decisions taken at central government level and local government level may well have impacted some people's connectivity in their communities.

"There's no point pretending that has not happened," said Ms Crouch.

The strategy will also try to create a clearer picture of the extent of the problem.

The minister said the Office for National Statistics would produce a more "consistent" definition for measuring loneliness, which would provide better evidence on what works in reducing it.

But Ms Crouch told the conference that loneliness was rising up the political agenda.

"The government now recognises loneliness as one of the biggest health challenges we face."

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Loneliness threatens young as well as old

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Loneliness should be recognised as a problem for all age groups, says Tracey Crouch, the minister about to reveal England's first loneliness strategy. She says there needs to be a "national conversation" to end the stigma about admitting to feeling lonely. "The government can't make friends for us," she told a conference in London.

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Next week sees the seventh International Society for Physical Activity and Health Congress (ISPAH) come to England on 15-17 October 2018. As we approach the ISPAH congress, we take stock of how far we've come in the journey towards increasing physical activity in every level of society.

How physical activity can improve health

This year's congress coincides with the 65th anniversary of Jerry Morris' seminal London transport workers study which first highlighted the connection between physical activity and health. Jerry Morris found that bus conductors had a lower incidence of coronary heart-disease than bus drivers because they were physically active while the drivers were sedentary.

Despite our increased understanding of the importance of being active, recent World Health Organisation (WHO) data shows that inactivity stubbornly remains a global issue for today's society and England is no exception.

The UK Chief Medical Officers' guidance highlights the potential for active individuals to have lower risks of over 20 common health conditions, including cardiovascular disease, depression and type 2 diabetes.

Inactivity also costs the UK around £7.4bn each year, including up to £9.4m to each NHS CCG in England for five preventable diseases - ischaemic heart disease, cerebrovascular disease, breast cancer, colon cancer and Type 2 diabetes.

With people living longer, early intervention is needed to make sure physical activity is accessible and efforts go a long way to prevent ill health for everyone. This will not only lead to a healthier, fitter society, but it will have an economic impact, reducing the amount the NHS spends on treating preventable diseases.

The ISPAH Congress, co-hosted by PHE and Sport England and sponsored by the WHO, brings together over 1,000 leaders from research, policy and practice to discuss to discuss key challenges for increasing population physical activity. It presents a timely opportunity to lead the discussion around physical activity and health.

The WHO's recent publication of the Global Action Plan on Physical Activity (GAPPA), designed to help countries improve policy actions to promote increase physical activity globally, sets the direction globally. Here in England, PHE is taking this challenge seriously and is already working within the framework of this plan to improve the health of the nation.

In 2014, PHE co-produced the national physical activity framework for England, Everybody Active Every Day, based on international evidence of what works to increase population level physical activity with over 1,000 local and national leaders. Its four domains align closely with the four GAPPA objectives and will aid our commitment to support and delivering against the WHO plan across England.

Societal attitudes shape our view of health and how to stay healthy. Physical inactivity has increased since the 1960s due to societal changes and more sedentary lifestyles.

This is why we continue to provide leadership to change social norms and attitudes towards physical activity and make being active the easy choice.

By using insight-led social marketing, such as the Change4Life 'Train like a Jedi partnership with Disney UK, we incentivise children and families to follow in the footsteps of their favourite characters and be more active whilst having fun. We have also harnessed society's need for technology to integrate physical activity into people's everyday lives with the One You Active 10 and Couch to 5k apps.

The environment we live in has a crucial role to play in our attitude towards physical activity. Recognising the power that environments have in shaping our behaviours, we have partnered with the built environment and transport sectors through our Healthy Places programme. Work includes a Memorandum of Understanding with some of the country's leading housing developers committing to embedding health and wellbeing initiatives in new housing developments and working with NHS England on its Healthy New Towns programme.

We are also bringing place making agendas together to better facilitate sustainable changes, including providing evidence on creating Healthy High Streets that are inclusive and contribute to health and economic gains of local communities.

This work will ensure that physical activity and broader health and wellbeing strategies are factored into planning for housing, towns and communities.

There are a range of different sectors within which professionals and volunteers have a unique opportunity to encourage and support people to become more physically active.

We have developed a national Moving Healthcare Professionals programme with Sport England and other system leaders to support healthcare professionals develop the knowledge, skills and confidence to embed physical activity within clinical care.

This includes the PHE Physical Activity Clinical Champions programme, which has a national network of more than 40 healthcare professionals who have already delivered practical, peer-to-peer training to over 20,000 practicing healthcare professionals.

Schools are central to embedding healthy behaviours early on in life. We have worked with the education sector to develop ' What Works in Schools and Colleges to Increase Physical Activity? '. Aimed at head teachers, this resource helps them increase levels of physical activity among children and young people, links to Ofsted inspection criteria and signposts useful sources of support to bring policy into practice.

In addition, we have also produced an evidence review of strength and balance activities for general health benefits, commissioned with the Centre for Ageing Better, to reinforce forgotten guidelines that professionals can use to inform their advice to individuals and help keep people healthier for longer.

Getting the nation moving more relies on a range of initiatives implemented across the system, not just focused on health. As the statutory leader of the public health systems, we have worked to strengthen leadership, governance, advocacy and information across sectors to increase physical activity and reduce sedentary behaviour.

Following Everybody Active Every Day we have supported national government to embed its principles across a matrix of policies and commitments to get the nation more active, including: the Sport Strategy; Cycling and Walking Investment Strategy; and Childhood Obesity Action Plan. We have also supported action at local level, with the breadth and depth of action by local government and other stakeholders exhibited in the latest national implementation review.

It's important that positive change is measurable, permanent and consistent in order to improve its impact. We are enabling this through a data tool of the latest local physical activity datasets.

Building on our success

Getting the population more active requires long-term persistence and collaboration and no single intervention or organisation can respond to or solve the challenge alone.

We need to take a whole systems approach to physical activity like we are doing with our obesity pilots and supporting partners like Sport England on their Local Delivery Pilots to make this happen.

We also need to make sure physical activity is inclusive of everyone in our society. At ISPAH we will also be launching the world's first evidence review of its kind looking specifically at physical activity for general health benefits for disabled people - some of whom have the lowest levels of physical activity within the population.

Next week's congress provides an opportunity to share and learn from international counterparts, which we hope will help increase the pace and scale of change at local and national levels and help to encourage a more active and healthier nation.

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Increasing physical activity in every level of society

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Next week sees the seventh International Society for Physical Activity and Health Congress (ISPAH) come to England on 15-17 October 2018. As we approach the ISPAH congress, we take stock of how far we've come in the journey towards increasing physical activity in every level of society.

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Looks like an interesting foray into the history of Council Housing

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Foundry Sheffield is a 3 room live music and club night venue at Sheffield Students' Union. Click here for tickets.

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I mentioned this in a workshop

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Researcher: Claire Craig

Dementia has been identified by the World Health Organisation as one of the major causes of disability worldwide, impacting both on the person and their caregivers and families.

The 'Power of Sheffield Journeys' explores the potential of film and digital technology in helping individuals living with dementia to re-connect with meaningful journeys and to build community connectedness. The research seeks to understand how the arts (most notably film and photography) can promote social inclusion of marginalized groups by placing people with dementia as experts in the filming.

Public bus and tram routes have been filmed across the city and researchers have worked in partnership with people with dementia to narrate, edit and craft these into a series of short films to bring meaningful journeys to life again.

To date the research has shown that people with dementia have been able to fully engage in the process. It also demonstrates that visual methods of video and photo-elicitation are useful methods to gain understanding of the experiences of older people living in the city.
In collaboration with:
Jayne Wallace and Tommy Dykes, Northumbria University

Participating organisations: Sheffield Community Transport, Stagecoach bus/Tram, First Group South Yorkshire, Alzheimer Society, Dementia Action Alliance.

Funded through: Sheffield Hallam University, Catalyst grant

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Researcher: Claire Craig Dementia has been identified by the World Health Organisation as one of the major causes of disability worldwide, impacting both on the person and their caregivers and families. The 'Power of Sheffield Journeys' explores the potential of film and digital technology in helping individuals living with dementia to re-connect with meaningful journeys and to build community connectedness.

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Libraries and books impact on wellbeing- a community resource 

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Libraries and books impact on wellbeing- a community resource 

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When staff volunteered to open Plymouth's central library for two-and-a-half hours last Christmas Day, they thought it might give a few homeless residents somewhere warm and welcoming to go.

Instead, explains librarian Mandy McDonald, they were taken by surprise. People of all ages came to the library to enjoy free mince pies, biscuits and hot drinks, as well as a festive film showing. One family even brought some of their Christmas presents to open. "We had a massive response," says McDonald. "There were people who just wanted to come and have some company, or use our computers to contact family." That included one man living in temporary accommodation who used the library systems to get in touch with his son, to whom he hadn't spoken for some time.

"It's about health and wellbeing," says McDonald. "We helped to combat loneliness on Christmas Day." The event cost nothing "apart from a little bit of electricity": it was run by volunteers, including McDonald's own teenage son, and local residents and businesses donated food, clothing and toiletries. "A lot of volunteers, me included, felt it was in the spirit of Christmas," she says. "It was humbling." The library will open again this year, for slightly longer - and with more party games.

Libraries change lives. They should be protected at all costs | Nikesh Shukla

Libraries up and down the UK may have been financially squeezed, closed or forced to rely on volunteers, but they are fighting back and asserting their vital role in local communities. National Libraries Week, from 8-13 October, focuses on how libraries benefit wellbeing. That's fitting, given that World Mental Health Day this year falls in the middle of the week, on 10 October.

In Rhoose, near Barry, the community-run library is offering a free mindfulness taster session on Friday 12 October. In Blackpool, residents can sample salsa, Pilates and story time for adults, while libraries in, among other places, Wolverhampton and Northumbria are providing wellbeing and health checks. And on Monday, Leeds central library hosted a performance by the Giving Voice choir for adults with neurological conditions and their carers.

Meanwhile, Oldham Library, which last year became the first public library to offer a free Comic Con event, has been able to use interest in comics to get young people talking about their mental health. The Comics and Cosplay: Caring for Young Minds project was funded by Carnegie UK and the Wellcome Trust. "We invited young people in Oldham to watch a performance and take part in a workshop in which they explored the issues affecting their mental health," explains senior library officer Victoria Varley.

These discussions, in which more than 100 young people took part, were then documented by writer Rachael Smith and illustrator Jacob Phillips, who produced a graphic novel called Jack & Lucy. "The young people told us that sharing their stories had a really positive effect on their wellbeing, and the graphic novel also provides a unique resource for young people struggling with the same issues and the people supporting them," says Varley. The novel was launched at the second Oldham Comic Con, held in the library in May, and organised in partnership with Dennis Whittle, who runs a comic shop in the town.

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Young people at Oldham Library's Comic Con event, May 2018 Photograph: Oldham Library

Until recently, there hasn't been a lot of evidence to back up the feeling that libraries support health and wellbeing, but that is starting to change. Nearly every library in the country runs regular rhyme time sessions for parents and under-fives. The sessions are fun for children, and help with language development, socialisation and empathy.

New research has also highlighted the positive effect rhyme times have on the mental health and wellbeing of mothers. A recent research project run by consultants from Shared Intelligence and Essex Libraries, funded by Arts Council England, has demonstrated that sharing rhymes in a group in a library gives mums an instant mood boost.

Synchronising movements produces higher levels of the maternal dopamine associated with mood and pleasure and stronger parent-child bonding. Row Row Row Your Boat is a particularly good song for this, with parents and children holding hands and rocking back and forth.

"The research saw a very noticeable improvement in mothers' moods immediately after rhyme time - with the percentage describing themselves as 'very happy' more than doubling from 25% to 59% in the space of 30 minutes," says Sarah Mears, programmes manager at Libraries Connected, the membership organisation for public libraries in England, Wales and Northern Ireland. It's about more than just singing: the researchers found mothers' moods improved by the interaction with other like-minded parents, which reduced loneliness, boredom and stress, while adding structure to the day helped with self-motivation and promoted feelings of achievement through the simple act of getting to the session.

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Libraries are good for our health. One research project from 2015 showed that not only were library users more satisfied with their lives than non-library users, being a regular library user was also estimated to save the NHS just under £30m a year. Those are big claims. But if they help prove the value of libraries, and prevent the closure of any more, that will be a huge benefit for all our wellbeing.
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Books are the best medicine: how libraries boost our wellbeing

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When staff volunteered to open Plymouth's central library for two-and-a-half hours last Christmas Day, they thought it might give a few homeless residents somewhere warm and welcoming to go. Instead, explains librarian Mandy McDonald, they were taken by surprise.

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Public faces 'care injustice' as NHS struggles

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Public faces 'care injustice' as NHS struggles

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The public is facing a growing "care injustice" as people are finding it more difficult to get help in England, the regulator is warning.

The Care Quality Commission highlighted growing hospital waiting lists, delays at A&E and record dissatisfaction levels with GPs in its annual report.

Mental health and old-age care were also becoming harder to access.

And the report said even where there was care available many people only had the choice of failing services.

In its 130-page review, the regulator pointed to

the lack of out-of-hours GP care

rising rates of preventable admissions to hospitals

overcrowding on wards and worsening A&E waiting times

the growing waiting list for routine operations

mental health patients being made to travel long distances for treatment

older people going without the help they need for daily tasks such as washing and dressing

Don Redding, of the patient group, National Voices, said it was clear the system was "malfunctioning" and the report should act as a "loud alarm bell".

He urged the government and NHS leaders to take notice as they prepare to publish their 10-year NHS plan later in the autumn, setting out how the extra funding for the health service will be spent in the coming years.

The report is being published as the BBC relaunches its NHS Tracker project, which enables users to find out how their local areas are performing on cancer, A&E, hospital care and mental health services.

Which places are struggling the most?

The CQC is particularly worried about four areas of the country where access to good hospital and social care is problematic.

These have been named as the Isle of Wight, Kent, Wirral and Portsmouth.

People in these areas are hit by both struggling hospitals and poorer-than-average care services, with inspectors worried things are not going to get better in the future.

In Kent there are seven local hospitals that are all judged to be not good enough, while one in three nursing homes is failing.

The Isle of Wight's only hospital has an inadequate rating and a third of care homes are failing.

In Wirral, half the nursing homes are judged not good enough along with the two local hospitals, while nearly half of home care services in Portsmouth and its main hospital are not up to scratch.

Does this mean services are getting worse?

No. Overall, the CQC said the majority of services were rated as good or outstanding and the quality of care was being maintained.

In fact, on each measure, there has been a small increase in the number of good and outstanding performers on the year before.

However, that should not be interpreted as a definitive sign of improvement.

The CQC prioritises the worst-performing services for reinspection which means the overall picture is more likely to improve than deteriorate, because the poorest performers cannot get a lower rating.

Instead, the problem being highlighted is more a matter of it getting harder to access services.

People are waiting longer for treatment, going without or - in the case of mental health care - sometimes having to travel long distances for treatment.

What has gone wrong?

It is a simple matter of supply and demand. The ageing population and rise in illnesses such as diabetes means more and more people need care.

While the NHS budget has been rising, it has not been enough to keep up with the growing numbers of people needing treatment.

There are shortages of staff in key areas - 12% of nurse posts and 9% of doctor posts are vacant.

But the CQC is also clear there is a structural problem.

The nature of illness, which means people rely on ongoing care for incurable conditions like dementia, is placing a greater reliance on the way the NHS works with care services, such as nursing homes and help in the home for tasks such as washing and dressing.

Care services are organised by councils or rely on people paying for it privately.

It has created a situation where growing numbers are simply going without help in their later years.

The CQC pointed to figures showing the numbers not receiving the care they need has increased nearly a fifth in two years to 1.4 million - that is nearly one in seven older people.

Caroline Abrahams, of Age UK, said it has got so bad that it has become "pot luck" whether you can get help.

What is being done about this?

The Department of Health and Social Care said action is being taken.

It pointed to the increased funding for the NHS that was announced by the prime minister in the summer.

That will mean by 2023 the budget will have risen by more than £20bn a year in real terms.

There is also a big emphasis being placed on the NHS to work closely with care services.

On top of this, ministers have promised to reform the funding system for social care, with a Green Paper expected to be published later this year.

A spokesman added: "We want the NHS to be the safest healthcare system in the world - and this starts by ensuring every single patient in this country receives the highest quality of care, no matter where they live."
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Public faces 'care injustice' as NHS struggles

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The public is facing a growing "care injustice" as people are finding it more difficult to get help in England, the regulator is warning. The Care Quality Commission highlighted growing hospital waiting lists, delays at A&E and record dissatisfaction levels with GPs in its annual report.

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More than a million people in the UK live in "food deserts" - neighbourhoods where poverty, poor public transport and a dearth of big supermarkets severely limit access to affordable fresh fruit and vegetables, a study has claimed.

Nearly one in 10 of the country's most economically deprived areas are food deserts, it says - typically large out-of-town housing estates and deprived inner-city wards served by a handful of small, relatively expensive corner shops.

Public health experts are concerned that these neighbourhoods - which are often also "food swamps" with high densities of fast-food outlets - are helping to fuel a rise in diet-related conditions such as obesity and diabetes, as well as driving food insecurity.

The most deprived areas include Marfleet in Hull, Hartcliffe in Bristol, Hattersley in Greater Manchester, Everton in Liverpool and Sparkbrook in Birmingham. Eight of Scotland's 10 most deprived food deserts are in Glasgow, and three of Wales's nine worst are in Cardiff.

The study, by the Social Market Foundation thinktank and food company Kellogg's, says poor, elderly and disabled people are disproportionately affected, as they cannot afford or are physically unable to travel to large supermarkets.

Food deserts are defined by the report as neighbourhoods of between 5,000-15,000 people served by two or fewer big supermarkets. In "normal" areas of this size there are typically between three and seven large food stores, it says. Small shops are less likely to sell fresh or healthy food.

The report cites Lisa Cauchi, a mother of eight in Salford, in the north-west of England, who said the nearest reliable source of affordable fresh fruit and vegetables was a big supermarket half an hour's walk away. She occasionally gets a taxi but finds that depletes her food budget. "A taxi is a meal," she said.

A survey carried out as part of the study found that nearly a third of respondents reported that lack of money was the biggest barrier to eating healthily (29%), followed by lack of time to cook (22%). Some 18% said they did not know how to cook healthy meals.

"Everyday food insecurity is on the rise in neighbourhoods across the UK. For those living in a food desert this can mean having to dedicate a portion of an already stretched budget toward transportation costs in order to secure food," said Megan Blake, a food security expert at the University of Sheffield.

Almost 4 million children in the UK are estimated to live in households that would struggle to afford to buy enough fruit, vegetables and other healthy foods to meet official nutrition guidelines, according to the Food Foundation. Food prices rose by 7.7% between 2002 and 2016, while incomes for the poorest families fell by 7.1%.

A Cambridge University study published last year found that people on low-incomes who live furthest from their supermarket were more likely to be obese that those who lived close by. It concluded that improving access to supermarkets for the least well-off - as well as raising their incomes - would help cut obesity.

Some states in the US have experimented with so-called "supermarket solutions" - offering loans and grants to big food stores to attract them into deprived areas as a way of increasing the availability of cheap, healthy foods.

Anna Taylor, chief executive of the Food Foundation, called for urgent action by local authorities and central government to tackle the problem. "If you're in the poorest 20% of households you need to spend 42% of your disposable income after housing costs to afford the government's recommended diet. Compound this with transport costs to get to a food shop and a healthy meal is even further out of reach."

A government spokesperson said: "We are determined to support households to eat healthily ... We support 1.1 million children with free school meals and 300,000 pregnant women, families and children under four with Healthy Start vouchers for free fruit, vegetables and milk.

"We are also investing £15m to increase the amount of surplus food from retailers and manufacturers redistributed to charities and community groups every year."

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More than a million UK residents live in 'food deserts', says study

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Experts say areas with limited access to cheap fresh food are fuelling health problems

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Toxic Mix Of Fast-Food Outlets In Inner City Neighbourhoods Fuelling Diabetes And Obesity Epidemic. How close you are to fast-food outlets may be linked to your risk of Type-2 diabetes and obesity.

A new study led by the University of Leicester and Leicester's Hospitals has found that there was a higher number of fast-food outlets within 500 metres of inner-city neighbourhoods described as non-white as well as in socially deprived areas.

The research was carried out by a team from the Leicester Diabetes Centre based at Leicester General Hospital in collaboration with the University of Leicester's Diabetes Research Centre, Department of Health Sciences and Department of Geography.

Professor Melanie Davies and Professor Kamlesh Khunti, Co-Directors of the Department have been conducting one of the largest screening studies with south Asian patients. The data from this study has also helped with recommendations for the NHS Health Checks Programme.

The researchers warn that their findings, based on a study of over 10,000 people, have important implications for diabetes prevention and for those granting planning permission for fast-food outlets.

"Our study suggests that for every additional two outlets per neighbourhood, we would expect one additional diabetes case, assuming a causal relationship between the fast-food outlet and diabetes," the study authors (Dr Patrice Carter with Dr Danielle Bodicoat) write in the study published in Public Health Nutrition.

Professor Khunti, Professor of Primary Care Diabetes & Vascular Medicine at the University of Leicester, said:

"In a multi-ethnic region of the UK, individuals had on average two fast-food outlets within 500m of their home.

"This number differed substantially by key demographics, including ethnicity; people of non-white ethnicity had more than twice the number of fast-food outlets in their neighbourhood compared with White Europeans. We found that the number of fast-food outlets in a person's neighbourhood was associated with an increased risk of screen-detected type 2 diabetes and obesity.

"We found a much higher number of fast food outlets in more deprived areas where a higher number of black and minority ethnic populations resided. This in turn was associated with higher prevalence of obesity and diabetes. The results are quite alarming and have major implications for public health interventions to limit the number of fast food outlets in more deprived areas.

Dr Patrice Carter, the lead author with Dr Danielle Bodicoat stated

"This work has several notable strengths; namely, it is the first study, to our knowledge, to look at the association between the number of neighbourhood fast-food outlets and type 2 diabetes in a multi-ethnic population. Although it is not possible to infer causal effect, our study found that plausible causal mechanisms exist.

"The observed association between the number of fast-food outlets with obesity and type 2 diabetes does not come as a surprise; fast-food is high in total fat, trans-fatty acids and sodium, portion sizes have increased two to fivefold over the last 50 years and a single fast-food meal provides approximately 5860 kJ (1400 kcal). Furthermore, fast-food outlets often provide sugar-rich drinks."

The study team add:

"Our research is cross sectional by design, so results should be interpreted with caution and further research is required."

The research was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM), the Leicester Clinical Trials Unit and the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University and the University of Leicester.

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A new study led by the University of Leicester and Leicester's Hospitals has found that there was a higher number of fast-food outlets within 500 metres of inner-city neighbourhoods described as non-white as well as in socially deprived areas.

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If only there was a profession that had occupation at its heart !!  Not news for us... there are some great opportunities to critique this ....

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And a network of businesses - including Sainsbury's, Transport for London, the Co-op, British Red Cross, National Grid and Civil Service - have pledged to take further action to support their employees' health and social wellbeing.

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Dance lessons for the lonely - on the NHS

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And a network of businesses - including Sainsbury's, Transport for London, the Co-op, British Red Cross, National Grid and Civil Service - have pledged to take further action to support their employees' health and social wellbeing.

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The mighty Redcar - a gorgeous example of not telling a single story ! 

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The mighty Redcar - a gorgeous example of not telling a single story ! 

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https://www.bbc.co.uk/programmes/b0bjj734

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Awesome podcast set in a prison again challenging the single story 

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Awesome podcast set in a prison again challenging the single story 

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https://www.earhustlesq.com

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Useful links here x

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The Equality Hub Network brings communities and decision makers together to work for positive change.

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We have one in Sheffield now !

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How a wooden bench in Zimbabwe is starting a revolution in mental health

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Dixon Chibanda spent more time with Erica than most of his other patients. It wasn't that her problems were more serious than others' - she was just one of thousands of women in their mid-20s with depression in Zimbabwe. It was because she had travelled over 160 miles to meet him.

Erica lived in a remote village nestled in the highlands of eastern Zimbabwe, next to the border with Mozambique. Her family's thatch-roofed hut was surrounded by mountains. They tended to staples such as maize and kept chickens, goats and cattle, selling surplus milk and eggs at the local market.

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Erica had passed her exams at school but was unable to find a job. Her family, she thought, wanted her only to find a husband. To them, the role of a woman was to be a wife and a mother. She wondered what her bride price might be. A cow? A few goats? As it turned out, the man she hoped to marry chose another woman. Erica felt totally worthless.

She started thinking too much about her problems. Over and over, thoughts swirled through her head and began to cloud the world around her. She couldn't see any positivity in the future.

Given the importance that Erica would hold in Chibanda's future, it could be said that their meeting was fated. In truth, it was just the product of extremely high odds. At the time, in 2004, there were only two psychiatrists working in public healthcare in the whole of Zimbabwe, a country of over 12.5 million people. Both were based in Harare, the capital city.

Unlike his besuited colleagues at Harare Central Hospital, Chibanda dressed casually in a T-shirt, jeans and running trainers. After completing his psychiatric training at the University of Zimbabwe, he had found work as a travelling consultant for the World Health Organization. As he introduced new mental health legislation across sub-Saharan Africa, he dreamt about settling down in Harare and opening a private practice - the goal, he says, for most Zimbabwean doctors when they specialise.

Erica and Chibanda met every month for a year or so, sitting opposite one another in a small office in the one-storey hospital building. He prescribed Erica an old-fashioned antidepressant called amitriptyline. Although it came with a suite of side-effects - dry mouth, constipation, dizziness - they would probably fade over time. After a month or so, Chibanda hoped, Erica might be better able to cope with the difficulties back home in the highlands.

You can overcome some life events, no matter how serious, when they come one at a time or in a small number. But when combined, they can snowball and become something altogether more dangerous.

For Erica, it was lethal. She took her own life in 2005.

Today, an estimated 322 million people around the world live with depression, the majority in non-Western nations. It's the leading cause of disability, judged by how many years are 'lost' to a disease, yet only a small percentage of people with the illness receive treatment that has been proven to help.

In low-income countries such as Zimbabwe, over 90 per cent of people don't have access to evidence-based talking therapies or modern antidepressants. Estimates vary, but even in high-income countries such as the UK, some research shows that around two-thirds of people with depression are not treated.

As Shekhar Saxena, the Director of the Department of Mental Health and Substance Abuse at the World Health Organization, once put it: "When it comes to mental health, we are all developing countries."

Over a decade later, Erica's life and death sits at the front of Chibanda's mind. "I've lost quite a number of patients through suicide - it's normal," he says. "But with Erica, I felt like I didn't do everything that I could."

Soon after her death, Chibanda's plans were flipped on their head. Instead of opening his own private practice - a role that would, to an extent, limit his services to the wealthy - he founded a project that aimed to provide mental health care to the most disadvantaged communities in Harare.

"There are millions of people like Erica," Chibanda says.

During her psychiatric training at the Maudsley Hospital in London in the late 1980s, Melanie Abas was faced with some of the most severe forms of depression known. "They were hardly eating, hardly moving, hardly speaking," Abas, now a senior lecturer in international mental health at King's College London, says of her patients. "[They] could see no point in life," she says. "Absolutely, completely flat and hopeless."

Any treatment that might lift this form of the disease would be lifesaving. By visiting their homes and their general practitioners, Abas made sure that such patients were taking their prescription of antidepressants for long enough for them to take effect.

Working with Raymond Levy, a specialist in late-life depression at the Maudsley Hospital, Abas found that even the most resistant cases could respond if people were given the right medication, at the correct dose, for a longer duration. When this tack failed, she had one last option: electroconvulsive therapy (ECT). Although much maligned, ECT is an incredibly effective option for a small number of critically ill patients.

"That gave me a lot of early confidence," says Abas. "Depression was something that could be treated as long as you persisted."

In 1990, Abas accepted a research position at the University of Zimbabwe's medical school and moved to Harare. Unlike today, the country had its own currency, the Zimbabwean dollar. The economy was stable. Hyperinflation, and the suitcases of cash that it necessitated, was over a decade away. Harare was nicknamed the Sunshine City.

Positivity seemed to be reflected in the minds of the people who lived there. A survey from the City of Harare reported that fewer than 1 in every 4,000 patients (0.001 per cent) that visited the Outpatients department had depression. "In rural clinics, the numbers diagnosed as depressed are smaller still," Abas wrote in 1994.

In comparison, around 9 per cent of women in Camberwell in London were depressed. Essentially, Abas had moved from a city where depression was prevalent to one in which - apparently - it was so rare it was barely even noticed.

This data fit snugly within the theoretical environment of the 20th century. Depression, it was said, was a Westernised disease, a product of civilisation. It wasn't found in, say, the highlands of Zimbabwe or by the shores of Lake Victoria.

In 1953, John Carothers, a colonial psychiatrist who had previously worked at Mathari Mental Hospital in Nairobi, Kenya, published a report for the World Health Organization claiming just this. He quoted several authors that compared African psychology to that of children, to immaturity. And in an earlier paper he compared the "African mind" to a European brain that had undergone a lobotomy.

Biologically, he thought, his patients were as undeveloped as the countries they inhabited. They were caricatures of primitive people at peace with nature, dwelling in a fascinating world of hallucinations and witchdoctors.

Thomas Adeoye Lambo, a leading psychiatrist and member of the Yoruba people of southern Nigeria, wrote that Carothers's studies were nothing but "glorified pseudo-scientific novels or anecdotes with a subtle racial bias". They contained so many gaps and inconsistencies, he added, "that they can no longer be seriously presented as valuable observations of scientific merit".

Even so, views like Carothers's had been echoed over decades of colonialism, becoming so commonplace that they were considered to be somewhat of a truism.

"The very notion that people in a developing black African nation could either be in need of, or would benefit from, Western-style psychiatry seriously unsettled most of my English colleagues," wrote one psychiatrist based in Botswana. "They kept saying, or implying, 'But surely they are not like us? It is the rush of modern life, the noise, the bustle, the chaos, the tension, the speed, the stress that drives us all crazy: without them life would be wonderful.'"

Even if depression was present in such populations, it was thought to be expressed through physical complaints, a phenomenon known as somatising. Just like crying is a physical expression of sadness, headaches and heart pain can arise from an underlying - 'masked' - depression.

A handy metaphor of modernity, depression became just another division between the colonisers and the colonised.

Abas, with her background in robust clinical trials, kept such anthropological viewpoints at arm's length. In Harare, she says, her open-mindedness allowed her to go about her work unclouded by the opinions of the past.

In 1991 and 1992, Abas, her husband and colleague Jeremy Broadhead, and a team of local nurses and social workers visited 200 households in Glen Norah, a low-income, high-density district in southern Harare. They contacted church leaders, housing officials, traditional healers and other local organisations, gaining their trust and their permission to interview a large number of residents.

Although there was no equivalent word for depression in Shona, the most common language in Zimbabwe, Abas found that there were local idioms that seemed to describe the same symptoms.

Through discussions with traditional healers and local health workers, her team found that kufungisisa, or 'thinking too much', was the most common descriptor for emotional distress. This is very similar to the English word 'rumination' that describes the negative thought patterns that often lie at the core of depression and anxiety. (Sometimes diagnosed together under the umbrella term 'common mental disorders', or CMDs, depression and anxiety are often experienced together.)

"Although all of the [socioeconomic] conditions were different," Abas says, "I was seeing what I recognised as pretty classical depression."

Using terms such as kufungisisa as screening tools, Abas and her team found that depression was nearly twice as common as in a similar community in Camberwell.

It wasn't just a case of headaches or pains, either - there was the lack of sleep and loss of appetite. A loss of interest in once enjoyable activities. And, a deep sadness ( kusuwisisa) that is somehow separate from normal sadness ( suwa).

In 1978, the sociologist George Brown published The Social Origins of Depression, a seminal book that showed that unemployment, chronic disease in loved ones, abusive relationships and other examples of long-term social stress were often associated with depression in women.

Abas wondered whether the same was true half a world away in Harare, and adopted Brown's methods. Published in a study in 1998, a strong pattern emerged from her surveys. "[We found] that, actually, events of the same severity will produce the same rate of depression, whether you live in London or whether you live in Zimbabwe," Abas says. "It was just that, in Zimbabwe, there were a lot more of these events."

In the early 1990s, for example, nearly a quarter of adults in Zimbabwe were infected with HIV. Without medication, thousands of households lost caregivers, breadwinners or both.

For every 1,000 live births in Zimbabwe in 1994, around 87 children died before the age of five, a mortality rate 11 times higher than that of the UK. The death of a child left behind grief, trauma and, as Abas and her team found, a husband who might abuse his wife for her 'failure' as a mother. To exacerbate matters, what was described as the worst drought in living memory struck the country in 1992, drying up river beds, killing over a million cattle and leaving cupboards empty. All took their toll.

Adding to earlier reports from Ghana, Uganda and Nigeria, Abas's work was a classic study that helped demonstrate that depression wasn't a Westernised disease, as psychiatrists like Carothers had once thought.

It was a universal human experience.

Dixon Chibanda's roots are in Mbare, a low-income district of Harare that's a stone's throw - just across Simon Mazorodze Road - from Glen Norah. His grandmother lived here for many years.

Even though it is half an hour from the city centre by road, Mbare is widely considered the heart of Harare. (As a waiter I met one evening put it: "If you come to Harare and don't visit Mbare, then you haven't been to Harare.")

At its centre is a market that people come to from all over the country to buy or sell groceries, electricals, and retro, often counterfeit, clothing. The line of wooden shacks is a lifeline for thousands, an opportunity in the face of inescapable adversity.

In May 2005, the ruling ZANU-PF party, led by Robert Mugabe, initiated Operation Murambatsvina, or 'Clear out the Rubbish'. It was a nationwide, military-enforced removal of those livelihoods deemed to be either illegal or informal. An estimated 700,000 people across the country, the majority already in disadvantaged situations, lost their jobs, their homes or both. Over 83,000 children under the age of four were directly affected.

Those places where resistance might have emerged, such as Mbare, were hit the hardest.

The destruction also took its toll on people's mental health. With unemployment, homelessness and hunger taking hold, depression found a place to germinate, like weeds among the rubble. And with fewer resources to deal with the consequences of the destruction, people were wrapped up in a vicious cycle of poverty and mental illness.

Chibanda was the among the first people to measure the psychological toll of Operation Murambatsvina. After surveying 12 health clinics in Harare, he found that over 40 per cent of people scored highly on psychological health questionnaires, a large majority of whom met the clinical threshold for depression.

Chibanda presented these findings at a meeting with people from the Ministry of Health and Child Care and the University of Zimbabwe. "It was then decided that something needed to be done," Chibanda says. "And everyone sort of agreed. But no one knew what we could do."

There was no money for mental health services in Mbare. There was no option to bring therapists in from abroad. And the nurses already there were far too busy with dealing with infectious diseases, including cholera, TB and HIV. Whatever the solution - if one actually existed - it had to be founded on the scant resources the country already had.

Chibanda returned to the Mbare clinic. This time, it was to shake hands with his new colleagues: a group of 14 elderly women.

In their role as community health workers, grandmothers have been working for health clinics across Zimbabwe since the 1980s. Their work is as diverse as the thousands of families they visit, and includes supporting people with HIV and TB and offering community health education.

"They are the custodians of health," says Nigel James, the health promotion officer at the Mbare clinic. "These women are highly respected. So much so that if we try to do anything without them, it is bound to fail."

In 2006, they were asked to add depression to their list of responsibilities. Could they provide basic psychological therapies for the people of Mbare?

Chibanda was sceptical. "Initially, I thought: how could this possibly work, with these grandmothers?" he says. "They are not educated. I was thinking, in a very Western, biomedical kind of sense: you need psychologists, you need psychiatrists."

This view was, and still is, common. But Chibanda soon discovered what a resource the grandmothers were. Not only were they trusted members of the community, people who rarely left their townships, they could also translate medical terms into words that would resonate culturally.

With the buildings of the clinic already full of patients with infectious diseases, Chibanda and the grandmothers decided that a wooden bench placed under the shade of a tree would provide a suitable platform for their project.

At first, Chibanda called it the Mental Health Bench. The grandmothers thought that this sounded overly medical and were worried that no one would want to sit on such a bench. And they were right - no one did. Through their discussions, Chibanda and the grandmothers came up with another name: Chigaro Chekupanamazano, or, as it became known, the Friendship Bench.

Chibanda had read how Abas and her team had used a brief form of psychological therapy called problem-solving therapy in the early 1990s. Chibanda thought that it would be most pertinent to Mbare, a place where everyday issues are found in abundance. Problem-solving therapy aims to go straight to the potential triggers of distress: the social issues and stressors in life. Patients are guided towards their own solutions.

The same year that Abas published her work from Glen Norah, another piece of what would become the Friendship Bench was put in place. Vikram Patel, Pershing Square Professor of Global Health at Harvard Medical School and co-founder of the community-led Sangath project in Goa, India, had adopted Abas's research into the local idioms of distress to create a screening tool for depression and other common mental disorders. He called it the Shona Symptom Questionnaire, or SSQ-14.

It was a mixture of the local and the universal, of kufungisisa and depression. And it was incredibly simple. With just a pen and paper, patients answer 14 questions and their health worker could determine if they were in need of psychological treatment.

In the last week, had they been thinking too much? Had they thought of killing themselves? If someone answered 'yes' to eight or more of the questions, they were considered to be in need of psychiatric help. Fewer than eight and they weren't.

Patel acknowledges that this is an arbitrary cut-off point. It makes the best of a bad situation. In a country with few health services, the SSQ-14 is a quick and cost-effective way to allocate scant treatments.

Although Chibanda had found studies showing that training community members or nurses in mental health interventions could reduce the burden of depression in rural Uganda and in Chile, he knew that success wasn't guaranteed.

Patel, for instance, after moving back to his home in India in the late 1990s, had found that psychological treatment was no better than giving patients a placebo. In fact, giving patients fluoxetine (Prozac) was the most cost-effective option.

Chibanda, thinking back to his days in Outpatients with Erica, knew that this wasn't an option. "There was no fluoxetine," he says. "Forget about that."

Late in 2009, Melanie Abas was working at King's College London when she received a call. "You don't know me," she remembers a man saying. He told her he'd been using her work in Mbare and how it seemed to be working. Chibanda told her about the Friendship Bench, the grandmothers, and their training in a 'seven-step' treatment for depression, the form of problem-solving therapy that Abas had used in one of her first papers in 1994.

Notices about kufungisisa had been pinned up in health clinic waiting rooms and entrance halls in Mbare. In churches, police stations and inside the homes of their clients, grandmothers were discussing their work and explaining how 'thinking too much' can lead to ill health.

In 2007, Chibanda had trialled the Friendship Bench in three clinics in Mbare. Although the results were promising - in 320 patients, there was a significant reduction in depressive symptoms after three or more sessions on the bench - he was still apprehensive about telling Abas.

He thought his data wasn't good enough for publication. Each patient had only received six sessions on the bench and there was no follow-up. What if they just relapsed a month after the trial? And there was no control group, essential to rule out that a patient wasn't just benefitting from meeting with trusted health workers and spending time away from their problems.

Abas hadn't been in Zimbabwe since 1999, but still felt a deep connection to the country where she had lived and worked for two and a half years. She was thrilled to hear that her work had continued after she left Zimbabwe. Straight away, she decided to help.

Chibanda travelled to London to meet Abas in 2010. She introduced him to people working on the IAPT (Improving Access to Psychological Therapies) programme at the Maudsley Hospital, a nationwide project that had started a couple of years earlier. Abas, meanwhile, pored over the data he had sent her. Together with Ricardo Araya, a coauthor on a trial into using these types of psychological treatment in Santiago, Chile, she found it to be worthy of publication.

In October 2011, the first study from the Friendship Bench was published. The next step was to fill in the gaps - adding a control and including a follow-up. Together with his colleagues from the University of Zimbabwe, Chibanda applied for funding to conduct a randomised controlled trial, one that would split patients across Harare into two groups. One would meet with the grandmothers and receive problem-solving therapy. The other would receive the usual form of care (regular check-ups but no psychological therapy).

At 24 health clinics in Harare, over 300 grandmothers were trained in an updated form of problem-solving therapy.

Since poverty or unemployment were often at the root of peoples' problems, the grandmothers helped their clients to start their own forms of income generation. Some asked relatives for a small kickstarter to buy and sell their chosen wares, while others crocheted handbags, known as Zee Bags, from colourful strips of recycled plastic (originally an idea of Chibanda's actual grandmother).

"They didn't have an intervention for depression before, so this was completely new in primary healthcare," says Tarisai Bere, a clinical psychologist who trained 150 grandmothers across ten clinics. "I didn't think they would understand it the way they did. They surprised me in so many ways... They are superstars."

In 2016, a decade after Operation Murambatsvina, Chibanda and his colleagues published the results from the clinics, incorporating 521 people from across Harare. Although starting at the same score on the SSQ-14, only the group from the Friendship Bench showed a significant decrease in depressive symptoms, falling well below the threshold of eight affirmative answers.

Of course, not everyone found the therapy helpful. Chibanda or another trained psychologist would visit the health clinics to treat those patients with more severe forms of depression. And in the trial, 6 per cent of clients with mild to moderate depression were still above the threshold for a common mental disorder and were referred for further treatment and fluoxetine.

Although only based on what the clients were saying, domestic violence also seemed to decrease. Although there could be a number of reasons for this, Juliet Kusikwenyu, one of the original grandmothers, says that it is most likely a by-product of the income-generation schemes. As she says through an interpreter: "Clients normally come back and say, 'Ah! I actually have some capital now. I've even been able to pay school fees for my child. No longer are we fighting about money.'"

Although the Friendship Bench is more expensive than usual care, it still has the potential to save money. In 2017, for instance, Patel and his colleagues in Goa demonstrated that a similar intervention - called the Healthy Activity Program, or HAP - actually led to a net reduction in costs after 12 months.

This makes a lot of sense. Not only are people with depression less likely to keep returning to the health clinic if they receive adequate treatment, but there's also a growing pile of studies showing that people with depression are far more likely to die from other serious diseases, such as HIV, diabetes, cardiovascular disease and cancer. On average, long-term depression reduces your lifespan by around 7-11 years, similar to the effects of heavy smoking.

Treating mental health is also a matter of economic growth. The World Health Organization makes it very clear: for every US dollar invested in treating depression and anxiety there is a return of four dollars, a 300 per cent net profit.

This is because people receiving adequate treatment are likely to spend more time at work and be more productive when they're there. Mental health interventions can also help people earn more money, equipping them to develop emotional and cognitive skills that further improve their economic circumstances.

The true test is whether projects like the Friendship Bench in Harare and HAP in Goa are sustainable at scale.

Getting there is a huge task. A few small projects dotted throughout a city need to become a national, government-led initiative that encompasses sprawling cities, isolated villages and cultures that are as diverse as different nationalities.

Then there's the very real issue of maintaining the quality of the therapy over time. Michelle Craske, a professor of clinical psychology at the University of California, Los Angeles, knows all too well that non-specialist workers often construct their own methods of therapy rather than sticking to the tried-and-tested interventions that they have been trained to provide.

After training nurses and social workers to deliver cognitive behavioural therapy (CBT) across 17 primary care clinics in four US cities, Craske found that even when the sessions were audiotaped they still intentionally went off track. She remembers one therapy session in which the lay health worker told her client, "I know they want me to do this with you, but I'm not going to do that."

To add some consistency to community-led therapies, Craske argues that the use of digital platforms - such as laptops, tablets and smartphones - is crucial. Not only do they encourage lay health workers to follow the same methods as a trained professional, they automatically keep track of what has taken place in each session.

"If we add in accountability through digital platforms, I think it's a brilliant way to go," she says. Without this, even a successful controlled trial can start to falter, or fail, in the future.

Even with accountability, there is only one route to sustainability, I have been told: merging mental health with primary care. At the moment, most community-led initiatives in low-income countries are supported by NGOs or the investigators' university grants. But they are short-term contracts. If such projects were a part of the public health system, receiving a regular slice of the budget, they could continue year on year.

"That's the only way to go," Patel said in June 2018 at a global mental health workshop held in Dubai. "Otherwise you're dead in the water."

One clear spring morning in East Harlem, I sat on an orange bench that looks like a giant Lego brick with Helen Skipper, a 52-year-old woman with short tan-coloured dreadlocks, half-rim glasses and a voice that seems to quaver with the ups and downs of her past.

"I've been involved in every system New York City has to offer," she says. "I have been incarcerated. I am in recovery from substance abuse. I'm in recovery from a mental illness. I've been in homeless shelters. I've slept on park benches, rooftops."

Since 2017, Skipper has been working as a peer supervisor for Friendship Benches, a project that has adapted Chibanda's work in Zimbabwe to fit within New York City's Department of Health and Mental Hygiene.

Although at the heart of a high-income country, the same life events that are seen in Harare are also found here: poverty, homelessness, and families that have been affected by substance abuse and HIV. In one study, some 10 per cent of women and 8 per cent of men in New York City were found to have experienced symptoms of depression in the two weeks before being asked.

And even though there is an abundance of psychiatrists in the city, many people still don't - or can't - access their services. Have they been taught to keep their problems within the home? Are they insured? Do they own or rent a property and have a social security number? And can they afford their treatment?

"That cuts out a large portion of this city," says Skipper. "We're basically out here for them."

Since starting her role in 2017, Skipper and her peers have met with some 40,000 people across New York, from Manhattan to the Bronx, Brooklyn to East Harlem. They are currently planning to extend their reach into Queens and Staten Island.

In January 2018, Chibanda travelled from the summer of Harare into a freezing East Coast winter. He met with his new colleagues and the First Lady of New York City, Chirlane McCray. He was blown away by the support from New York's mayor, Bill de Blasio, the number of people the project had reached, and by Skipper and her team.

Chibanda seems to be in constant motion. As well as his work with the Friendship Bench, he teaches t'ai chi, helps children with learning disabilities acquire new skills, and works with adolescents who are HIV positive. When I met him in Harare, he often didn't even remove his satchel from his shoulder when he sat down.

Since the controlled trial in 2016, he has established benches on the island of Zanzibar off the eastern coast of Tanzania, in Malawi and in the Caribbean. He's introducing the messaging service WhatsApp to his teams. With a few clicks, community health workers can send Chibanda and his colleague Ruth Verhey a text message when in doubt or if they are dealing with a particularly worrisome client. This 'red flag' system, they hope, can reduce suicides even further.

For Chibanda, the greatest challenge still lies within his own country. In 2017, he received a grant to pilot Friendship Benches in rural areas surrounding Masvingo, a town in south-eastern Zimbabwe. As is the case for Mbare, this region of rolling hills and wine-red msasa trees has a claim to be the true heart of Zimbabwe.

Between the 11th and 15th centuries, the ancestral Shona people built a huge city encircled by stone walls that are over 11 metres high in places. It became known as Great Zimbabwe. When the country gained independence from the UK in 1980, the name Zimbabwe - meaning 'large houses of stone' - was chosen in honour of this wonder of the world.

But it is precisely this history that makes it so hard for Chibanda's work to take hold here. As far as the people of Masvingo are concerned, he is an outsider, a Westernised resident of the capital city that is closer in its customs to the former colonies than to Great Zimbabwe.

Although Chibanda speaks Shona, it is a very different dialect.

As one of Chibanda's colleagues who is collaborating on the rural Friendship Bench project tells me, "It's easier to introduce this to New York than to Masvingo."

"This is the real test," Chibanda tells his colleagues as they sit around an oval-shaped table, each with their laptop open in front of them. "Can a rural programme be sustainable in this part of the world?"

It's too early to know. What's clear is that, as with his previous projects and Abas's original work in the 1990s, the local community and its stakeholders are involved in every step. As of June 2018, the community health workers in Masvingo are being trained.

Although the process is becoming routine, this rural Friendship Bench project holds a special place for Chibanda. His patient Erica lived and died in the highlands just east of Masvingo, a place where such services may have saved her life. What if she didn't need to pay the bus fare to Harare? Did she have to rely solely on old-fashioned antidepressants? What if she could walk to a wooden bench under the shade of a tree and take a seat next to a trusted member of her community?

Such questions still plague Chibanda's mind, even as we speak over a decade after her death. He can't change the past. But with his growing team of grandmothers and peers, he is beginning to transform the futures of thousands of people living with depression around the world.
In the UK and Republic of Ireland, the Samaritans can be contacted on 116 123. In the USA, the National Suicide Prevention Lifeline is 1-800-273-TALK. Dixon Chibanda, Vikram Patel and Melanie Abas have received funding from Wellcome, the publisher of Mosaic.

References

The UN report on Operation Murambatsvina and its impact on livelihoods, by Anna Tibaijuka. [PDF]

'A long, hard slog in Zimbabwe', a Washington Post article from 2008.

Melanie Abas and Jeremy Broadhead's first study from Harare, highlighting the local idioms of distress, such as kufungisisa.

Results and discussion of Abas and colleagues' work in Harare.

Using similar methods to George Brown in Camberwell, in this 1998 study Abas and colleagues compared life events and their relation to mental health in women.

Dixon Chibanda and colleagues' study investigating whether psychological interventions delivered by lay health workers can improve symptoms of depression and anxiety in Zimbabwe.

A 2016 study that argues the economic case for scaling up responses to depression and anxiety.

World Health Organization global statistics on depression.

Photos, history and news from the Friendship Bench programme.

A 2017 paper by Vikram Patel that argues for a "staged model" for treating depression.

An evaluation of the Health Activity Program in India.

A 2016 paper from Abas and colleagues on the need for mental health advocacy in Zimbabwe.

An overview and analysis of the Friendship Bench Project by Abas and colleagues, published in 2016.

Although not mentioned by name, the following were crucial to this article: Alison Schafer, Anne Becker, Abhijit Nadkarni, Bethsaida George-Rodriguez, Cecilia Mushambi, Charles Reynolds, Crick Lund, Epiphania Munetsi, Giuseppe Raviola, Helen Hermann, Helen Verdeli, Juliet Kusikwenyu, Lloyd Zapasi, Margaret Cement, Rabih El Chammay, Ricardo Araya, Rudo Chinhoyi, Siham Sikander, Sister Mukanana, Sheena Wood, Takeesha White, Tsitsi Muza.

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How a wooden bench in Zimbabwe is starting a revolution in mental health

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Dixon Chibanda spent more time with Erica than most of his other patients. It wasn't that her problems were more serious than others' - she was just one of thousands of women in their mid-20s with depression in Zimbabwe. It was because she had travelled over 160 miles to meet him.

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voices from the margins ....

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What happens when you start truly listening to people who have all too often been overlooked?
What happens when, instead of presenting people with a list of questions or a form to fill in, you offer a blank canvas? What do people choose to talk about? What issues have been neglected? What is it that has swept them to the margins, and what could protect them from the swirling currents and rising tides of poverty, injustice and isolation? And what could society do differently, to people escape those tides?

It's just over a year since we launched Voices From The Margins. Our recent sets of stories from York and from Orkney means more than 100 people have now contributed to the project. We've heard, published and shared some remarkable stories - some galling, some inspiring, some deeply moving. Thousands of you have read the articles or watched the videos on this blog, on facebook, or through media organisations we have liaised with.

The collage above shows only a quarter of those who have contributed to this project, and if you're new to this site, here are some pieces you may have missed. Please pause for a moment to take a look at one or more of these articles:

In Sheffield, eight near-neighbours explored the issue of food poverty, drawing powerfully on their own experiences to say what could unlock hunger in their community.

Several people, including Clare in Salford, told how benefits delays, problems or errors swept them into debt, poverty and hunger. One of our contributors, David in York, lost his house and his relationship after being wrongly refused help when he had a double-stroke.

One of our most-read articles was by Lianne, a mum with first-hand experience of food poverty and holiday hunger, and who could see the solutions.

Contributors, like this man in Manchester who ended up £810 in debt, have told of being swept into poverty and debt amid the turmoil of Universal Credit. Others, like Anne, have told of the chaotic uncertainty of zero-hours contracts and have called for the economy to be redesigned.

We helped tell the story of Salford Poverty Truth Commission, through the eyes of one of its participants. Patrick said: "This is something that works and it can bring tremendous hope."

Beyond this website, the stories from contributors have reached readers of the Manchester Evening News, which ran John's story; The Daily Mirror, which reported on poverty in Salford; The Press in York, which reported on our work here; and on Channel 4 News, which broadcast this report last June:

Voices From The Margins began as a project around the General Election in 2017, supported by The Poverty Alliance and The Joseph Rowntree Foundation. Some of the earliest posts on this site (such as in Hull, Stockton and Cornwall) include references to the election, but they also address bigger issues, and the first-hand stories, insights and ideas from contributors were so powerful that we have kept the project going. In doing so, we have sought to amplify the views of people who have often been overlooked and ensuring people with first-hand expertise of poverty are given a chance to speak up.

Word has spread well, thanks to like-minded organisations and thanks to many of you, readers and supporters, sharing the links. There are many more stories to tell, and many challenges for all of us who hear and read the first-hand accounts of people who have been trapped in poverty.

Contributors have talked about all manner of issues, but there remain four broad themes Most of the contributors have touched on one or more of:

Voice - politicians and the media should actively listen to people with lived experience of poverty

Hunger - we need a more concerted, structural effort to support people caught in the rising tide of hunger and food insecurity

In-work poverty and zero-hours contracts - we can redesign our economy to provide secure, sustainable livelihoods for people

Benefits delays, changes, errors and sanctions - sudden cuts to people's income can act like rip currents, sweeping people into difficulties they hadn't seen coming. It needn't be like this. We can design a better system.

When we launched this project, Niall Cooper, director of Church Action on Poverty, said: "In a real democracy, everybody's views and everybody's voice count... Voices From The Margins is an opportunity for you to have you say about the things that matter to you, your family and your community, and also an opportunity to hear what matters to other people on the margins, or who feel excluded from the current political debate."

That is as true now as it was then. If you or your community are too often overlooked, please get in touch.

What values should be at the forefront of our society? What would make life better in your community? Why can't we redesign our economy, to create a society that really is just and compassionate? How can we unlock the poverty trap and, once we do, what will society look like?

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100 stories: Here's what happens when you really listen to people in poverty

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What happens when you start truly listening to people who have all too often been overlooked? What happens when, instead of presenting people with a list of questions or a form to fill in, you offer a blank canvas? What do people choose to talk about? What issues have been neglected?

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http://makingsheffieldfairer.co.u

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Thumbnails of different local communities. An easy overview.
https://www.sheffield.gov.uk/content/sheffield/home/your-city-council/community-knowledge-profiles.html

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Think about impact on community and on occupation in the areas...

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Network Rail has sold thousands of railway arches to a pair of investors as part of a £1.5bn property deal but vowed that businesses working from the spaces, which have raised fears about rent rises, would be protected by a "tenants' charter".

Telereal Trillium and Blackstone Property Partners won the bidding for 5,200 properties, the majority of which are arches, the operator of Britain's rail network said on Monday.

The £1.46bn sale proceeds will help fund railway upgrades, Network Rail said, bringing "major improvements for passengers and reducing the need for taxpayers to fund the railway".

But the deal has sparked anxiety among tenants, which include independent shops, garages and craft breweries, amid concern that the new owners may impose unaffordable rents.

Guardians of the Arches, a campaign group of more than 300 tenants, has already complained of rent rises imposed by Network Rail in the run-up to the sale.

A spokesperson for the group said: "We continue to dispute whether selling off the whole estate in one job lot is the best way of supporting small businesses and the local economies which rely on them."

The group had proposed alternatives such as local authorities buying smaller groups of arches. It is now calling for an independent body to carry out an audit of leases included in the sale and publish information about rents and how they are set.

The shadow rail minister, Rachael Maskell, called on the transport secretary, Chris Grayling, to block the sale, which she said would "undermine the financial sustainability of the railway and damage small and medium-sized enterprises across the country".

The Society of Independent Brewers also voiced concern about the potential impact on brewers producing craft beer underneath the arches. A spokesperson said: "We would hope that commercial landlords taking over these sites will support their new tenants and not hike prices overnight - something which could easily make viable, popular breweries face closure."

Telereal and Blackstone, which will hold equal ownership stakes, have agreed to sign a charter governing their relationships with tenants. The charter includes promises to listen to their worries about rent reviews and engage with them in a timely fashion, but does not make any promises to curb rents.

It promises the owners will consider "new structures to provide financial or other support" to tenants struggling to pay their bills.

But George Grant, owner of Clapham North Motors, said Network Rail had tried to impose a 350% rent increase on the garage - opened under a London railway arch by his 93-year-old father in 1960.

He said he believed the new owners would follow suit. "The way in which Network Rail have gone about this has been appalling," said Grant. "I don't believe for one moment that the people taking over are in it for us."

The business was facing the 350% rise in the run-up to the sale until Network Rail relented and agreed to an increase of nearly double instead.

A further 1,800 properties were not included in the sale because Network Rail either needs to keep them to operate the railways or because they are part of the northern gateway redevelopment plan, under the auspices of Manchester city council.

Network Rail's property estate, most of which is changing hands in the sale, brought in revenues of £304m last year, turning a profit of £81m.

But the company that oversees Britain's rail infrastructure has been looking to offload the majority of the estate to raise funds. The sites are being sold on a 150-year lease, with Network Rail retaining the freehold to ensure it still has right of access for the future operation of the railway.

The Network Rail chairman, Sir Peter Hendy, said: "This deal is great news - for tenants it will mean significant commitment and investment, and for passengers and taxpayers it will mean massive, essential improvements without an extra burden on the public purse."

David Biggs, the managing director of Network Rail Property, said: "We are proud to have fostered so many small, independent, diverse businesses and communities across the country, and we are confident that these will continue to thrive under the new owners.

"Ultimately our role is to run, improve and grow the railway, and managing these properties isn't essential to that."

The Department for Transport said: "Tenants' rights have been safeguarded in this sale and all current agreements between Network Rail and tenants will be fully honoured."
Topics

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Network Rail sells railway arches to investors for £1.5bn

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Network Rail has sold thousands of railway arches to a pair of investors as part of a £1.5bn property deal but vowed that businesses working from the spaces, which have raised fears about rent rises, would be protected by a "tenants' charter".

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By Emma Young

Listening to a story is known to be cognitively demanding, in part because the listener has to pay close attention to, and remember, plot and character detail in order to understand what's going on. Attention and memory are both diminished in people living with dementia. Might regularly reading aloud to such patients help, then, to train their attention and memory, and function as a treatment? A new study of people with various kinds of dementia, published in Psychology and Neuroscience, suggests that it could.

A total of 43 patients with Alzheimer's, vascular dementia or general cognitive decline, who were living in a nursing home in Perugia, Italy, took part. All these patients had mild to moderate dementia, according to scores on the Clinical Dementia Rating Scale. At the start of the study, they were each assessed by a psychologist using a standard test of attention, language, visuospatial abilities and both immediate and delayed memory. They were then divided into two groups, matched for scores on this test.

The training took place at a time when the residents would normally be in the common room watching TV. The control group watched TV, as normal. The other group went into another room for the listening activity. Over 40 sessions, run five days a week, Monday through Friday, this group listened to student volunteers from the University of Perugia reading material that became gradually more demanding over time.

At first, the residents listened for 20 minutes a day to Favole al telefono by Gianni Rodari - a book of short, individual, humorous stories with a simple narrative structure. After a few weeks, the reading shifted up a gear, to 30 minutes a day of traditional fairy tales written by Italo Calvino. This material had a slightly more complex narrative structure and characters, and recurrent motifs. A few weeks after that, the patients started to listen for 40 minutes a day (later upped to 45 minutes a day) to Un Trenzo per la Luna by Cinzia Giuntoli, a novel set in Tuscany during World War 1. To follow this novel, they had to retain memories from earlier instalments. At the beginning and end of each session, the residents were asked to share - if they wanted to - their thoughts on the reading material, and any relevant personal memories.

At the end of the study period, both groups' attention, language, visuospatial and immediate and delayed abilities were re-tested. For the listening group, there was an upward trend in their scores on all of these measures, while the control group showed no improvements (and even some decrements). Compared with the control group, those in the listening group now had statistically significant higher scores on immediate memory, attention and delayed memory (though not visuospatial memory).

A more detailed analysis revealed that people with vascular dementia and Alzheimer's disease showed improvements in immediate and delayed memory, but only people with vascular dementia got better at tests of language and attention.

This was a small study. And the people in the listening group didn't just listen to stories. Unlike members of the control group, who were watching TV, they also interacted with the student reader and with each other - and social interaction is cognitively demanding. How much this might have accounted for the attention and memory benefits is unknown because this wasn't something the researchers looked at.

Still, the intervention -listening to a story, plus the social interaction and the recall of autobiographical memories - did have significant effects. Given that there's no cure for Alzheimer's, anything that can help with memory is surely to be welcomed.

"The data from this study confirm the effectiveness of the daily narrative training in delaying cognitive decline and maybe in improving the overall quality of life and self-perception of individuals who suffer from mild to moderate cognitive decline," the researchers write.

Perhaps, they go on, this kind of training should then be implemented as a non-drug treatment for people with dementia, and explored as a possible prevention tool in healthy older people, or for the millions around the world diagnosed with mild cognitive impairment, which can - but does not always - progress to dementia.

- The effect of a narrative intervention program for people living with dementia
Emma Young (@EmmaELYoung) is Staff Writer at BPS Research Digest

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Story-listening shows promise as an intervention for people living with dementia

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By Emma Young Listening to a story is known to be cognitively demanding, in part because the listener has to pay close attention to, and remember, plot and character detail in order to understand what's going on. Attention and memory are both diminished in people living with dementia.

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PRESS RELEASE - #RealMe: Young People's Feelings Towards Self-worth

FOR IMMEDIATE RELEASE

Young Healthwatch launches new report: #RealMe: Young People's Feelings Towards Self-worth

#RealMe is the latest report from Healthwatch Sheffield.

Volunteers between 14-25 decided to investigate how Sheffield's young people feel about their own sense of self worth, and how that impacts on their mental health and wellbeing.

The volunteers are part of Young Healthwatch, a group of volunteers who work with Healthwatch Sheffield to make sure children and young people's views are listened to.

Their investigation involved an arts competition, a survey that 151 young people completed and a series of workshops at local colleges and schools.

Young Healthwatch found that:
* 51% of young people asked said they think about their self-worth often,
* Many young people are struggling because of a low sense of self worth - when asked to self-score their sense of self-worth, the average score was 4 out of a possible 9,
* Young people understand which activities help them to feel better and worse about themselves.

Young Healthwatch are convinced that there is a clear relationship between self-worth and mental wellbeing.

They are asking the city's key decision makers and all adults working with young people to consider the findings of this investigation, and to work with young people to understand the stresses and pressures that they experience.

The #RealMe report includes five principles Young Healthwatch have developed to help the city improve self worth amongst young people.

Margaret Kilner, Chief Officer of Healthwatch Sheffield said: "I am extremely proud of the work our young volunteers have put into the #RealMe investigation. They chose this topic because of very real concerns that young people with low self worth can find it hard to cope with the pressures that expectations from school, family, their peer group, and the media can bring.

Our volunteers were supported by a member of the Healthwatch staff team, but all of the key decisions were their own. They showed great energy and maturity and I am keen to encourage other young people with an interest in social action to join Young Healthwatch and make sure that their voices are heard".
Read the report in full here.
ENDS
Notes to Editors:
For more information please contact:

Grace Edwards
Operations Officer (Communications)
Healthwatch Sheffield
T: 0114 2536687
E: g.edwards@healthwatchsheffield.co.uk
About us
Healthwatch Sheffield is your local consumer champion for health and social care.
We're here to help adults, children and young people influence and improve how services are designed and run. We're completely independent and not part of the NHS or Sheffield City Council.
Our vision is health and social care services designed, commissioned and delivered using the views of Sheffield's people.
Young Healthwatch is a group of volunteers who work with Healthwatch Sheffield to make sure children and young people's views are listened to.
Any young person aged 14-25 living in the Sheffield area who is interested in volunteering for Healthwatch Sheffield can be part of Young Healthwatch.
The #RealMe report was created by Young Healthwatch volunteers, with support from Healthwatch Sheffield staff.

Principles to improve self worth:
1. Commissioners and providers should consider ways to raise awareness of the care and support available to help young people with a low sense of self-worth in Sheffield.
They should look at options for making this information readily accessible for all young people, parents/carers and professionals.
2. Commissioners and providers should explore their role in improving access to the wellbeing activities that young people have identified as having a positive effect on their sense of self-worth.
This could be through simple signposting of what's already available to increasing access through funding projects and groups.
3. Commissioners and providers should engage frequently and meaningfully with young people when designing services aimed at young people, to recognise the stresses and pressures that they are experiencing.
4. Schools, in particular, have a key role to play in raising awareness and encouraging attention to self-worth and wellbeing to counteract the negative impact of some of the pressures young people face.
5. On an ongoing basis, young people's views need to be heard, to help ensure that services respond in a way that meets young people's needs, particularly if they are not feeling supported at school or college

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PRESS RELEASE - #RealMe: Young People's Feelings Towards Self-worth - Healthwatch Sheffield

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FOR IMMEDIATE RELEASE #RealMe is the latest report from Healthwatch Sheffield. Volunteers between 14-25 decided to investigate how Sheffield's young people feel about their own sense of self worth, and how that impacts on their mental health and wellbeing.

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A perennial favourite of researchers in the archival collections of the Wellcome Library is the archive of the Pioneer Health Centre, Peckham, including the papers of its founders, George Scott Williamson and Innes Hope Pearse. Now thanks to a couple of recently digitised films, including some amateur footage, a much wider audience can discover more about the Centre for themselves.

The aim of its founders was to uncover the factors that made for positive health, rather than simply an absence of illness, and to this end they set up a family social centre in 1926 in the South London suburb of Peckham, which also offered periodical and thorough health checks and discussions with the doctors as to what the family should do. A blue plaque was unveiled in 2009 on the house in which the experiment took place.

Because of the enthusiasm for the project generated in the local population, it soon outran the capacity of this location and the Centre closed for several years while money was raised for a purpose-built centre, which was eventually opened in 1935.

Although this was a small and very local experiment - Scott Williamson and Pearse believed that the Centre, and others that they hoped would be established on the same lines, should be embedded in the local community and readily accessible to members - the Centre aroused an enormous amount of interest both nationally and internationally. It received many distinguished visitors, from doctors and scientists to health and welfare reformers. Queen Mary visited in 1939, though this was just before the Centre was obliged to close because of the outbreak of World War II and the particular danger to a largely glass building of bombing.

Thanks to the initiative of the membership, the Centre reopened in 1946, and the extent to which it was back to running at full capacity is demonstrated in the film called ' The Centre' made by the noted documentarist Paul Rotha.

Besides this professionally shot and carefully structured film of the Centre in action, the Library also holds some home movies of the Centre made by its members. These include footage of babies in the Centre nursery playing on the specially designed equipment and members of the Centre at Oakley Farm, Bromley Common. The farm had been leased by Pearse in 1935 in order to provide organic produce for Centre families, and a number of families were evacuated there on the outbreak of war until it was requisitioned by the RAF.

The Centre did not long outlast the foundation of the National Health Service. Scott Williamson had been unable to get his ideas accepted within policy-making circles in spite of the support that the Centre had accrued. As an institution it did not fit comfortably within the NHS top-down bureaucracy. In spite of receiving funding from the Rockefeller Foundation, it finally closed in 1950.

However, its ideals continued to be propagated and a number of projects inspired by its examples are documented within the archive. The Pioneer Health Foundation continues to promote the legacy of the Centre and its vision of positive health.
Author: Dr Lesley Hall is an historian and Senior Archivist at the Wellcome Library.

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The Pioneer Health Centre and positive health

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A perennial favourite of researchers in the archival collections of the Wellcome Library is the archive of the Pioneer Health Centre, Peckham, including the papers of its founders, George Scott Williamson and Innes Hope Pearse. Now thanks to a couple of recently digitised films, including some amateur footage, a much wider audience can discover more about the Centre for themselves.

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Prime Minister’s Office, 10 Downing Street

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PM launches Government’s first loneliness strategy

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Prime Minister Theresa May launches Government’s first loneliness strategy.

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Theo had just turned 17 when he became homeless. He turned to the council for help - but was given only a one-man tent, writes the BBC's Emma Forde.

It was August 2016 when Theo's mum, Rose, received a phone call from Cornwall Council that made her feel physically ill. Her son had moved down south to spend time with his dad, but things hadn't been going well. Theo had been kicked out of school. He'd been arrested for dealing drugs and assaulting his dad. Now he'd been evicted from supported accommodation - again because of drugs.

But still, Rose was taken aback by what the council had to say.

"The manager of the team phoned me up. She said, 'Oh we've got an alternative for Theo, we're going to be putting him in a tent.' I was at work at the time and there was lots of going on around me and I just remember the moment. I felt sick. And I said, 'Well how is that even possible? How is it legal? Even you know he's so vulnerable in a tent. He's not well. I do not give you my permission for my child to be placed here.'"

The council ignored Rose's objection and one of its staff went round to pick up Theo in a car.

"They were like, 'Load the car up with your bags, we're going to a campsite,'" remembers Theo.

"I was like, 'What? Why are we going there?' I was saying, 'How long am I going to be there? What's it going to be like?'

"And they were like, 'Oh, only for a few days until the council finds you somewhere to live.'

"And they were like, 'We've got you a tent!'

"I didn't really know what to say, I couldn't say no. They gave me the tent and drove off.

"I was pretty depressed at that point. I tried putting it up on my own. Luckily, this random guy started helping me put up the tent because he saw I couldn't."

Months earlier, the council had been expressing concern about Theo's mental health and drug use. Officials produced an assessment which found he was at risk of "overdose, addiction and potentially death".

Being homeless wasn't likely to improve things.

The day before it gave him the tent, the council had offered Theo the option of another place in supported accommodation, but it was more than 30 miles away, so he'd turned it down, not wanting to leave the area he knew and where he was attending college.

Faced with the prospect of living in a one-man tent, though, he appealed again to be housed. This time he was told his behaviour made the likelihood "remote".

Theo was given food vouchers, credit for a mobile phone and a torch. He had a sleeping bag but no chair to sit on and no cooking equipment.

Find out more

Listen to My Homeless Son on Radio 4's File on 4 at 20:00 on Tuesday 30th October

Or catch up later online

Trying to make the best of it, he bedded down for the night.

"It was a campsite in the middle of the woods. Very spooky. I remember hearing rustling in the bushes and I thought, 'Someone's there. I'm not going out of the tent,'" he says. "I didn't get much sleep."

Theo was determined to keep going to college but it wasn't easy. In the morning he would go to the shower block for a cold shower, and then walk for an hour to college. At night he would suspend a torch from a strap in the tent to do his college work.

He was only at that campsite for a short time before he was moved to another - it wasn't clear to him why. But at the new campsite people were kind to him, he says. One man used to make him a bacon sandwich in the morning.

Theo's mum, Rose, was desperate. She lived hundreds of miles away and was fostering some young children. But when she got the call she travelled to Cornwall, staying in a caravan near her son and imploring the council to provide him with proper accommodation.

She was rebuffed. On one occasion the council told her that Theo needed to take "some responsibility for his behaviour" - a reference to his drug abuse, perhaps, or to his refusal to accept accommodation in a distant town.

It wasn't long before that council officials had expressed concern that Theo might become addicted, overdose or die. Now children's services sent a referral to the council's housing department, which still described him as "extremely vulnerable", but went on to say that his "options with the local authority are limited due to his behaviour". These options would only increase, the referral said, "if he can evidence he wants to make some changes".

Around this time, Theo was found in an abandoned building, where he had set fire to a mattress to keep warm. The fire brigade came out and he was returned to the campsite by police.

Theo remembers one night in the tent when there was a violent storm.

"It was real bad. I thought my tent was going to go over so I was constantly in my tent," he says. "Loads of wind, torrential rain and all my stuff got wet. Everything was wet. Even I was wet when I woke up."

People on the campsite helped Theo patch up his tent and he told council staff it was leaking. The council's response? To buy him another tent.

"It's pretty mind blowing. I thought it would be for a day or two and then I'd get housed," says Theo. "But it ended up months. It was a pretty traumatic experience for me because I've always lived in a house somewhere. They should have done so much more. They should have put me somewhere with a roof over my head."

Towards the end of August, the council did make an attempt to find Theo a place in supported accommodation, but without success. It also said it could take him into care, but that idea didn't appeal to him.

Rose had been forced to return home with her husband and foster children, but she continued to travel down to Cornwall at regular intervals, desperate to help her son.

"I was back and forward every weekend where I could. I felt ill all the time, tired, exhausted emotionally drained, just barely able to function really," she says.

At one point, Theo started sleeping in the entrance of some specialist housing for 16- and 17-year-olds, hoping for a place there.

And then, after he'd spent five weeks living in a tent, social workers suddenly decided it was no longer safe - the risk of him being sexually exploited, or coming to harm from alcohol and drugs, was too great.

So he was moved from a tent... to a caravan.

"Then I got accommodation in this caravan. I felt like people were watching me through the windows. There was a lock on the door, but I made sure like all the windows were closed when I went to sleep," Theo remembers.

He was walking home one night when a man stopped and offered him a lift. He then took the teenager to a dark car park where he sexually assaulted him. Afterwards he dropped him off at the caravan.

Theo spent a further month in the caravan, petrified that the man might return.

"I always had to be out at night time. I was worried because he knew where I lived," he says.

Theo reported the assault but social care records show no evidence that the council even considered whether to take any action to protect him in the light of it.

By October, Theo's condition was rapidly deteriorating - his drug use was out of control and he was threatening to kill himself.

On 7 October he was finally found a place in some supported accommodation, run by a housing association that helps homeless young people.

But he was only there for a few weeks. By then it was clear he was very unwell. He was experiencing psychosis, hearing voices and needed specialist help. He was detained under the Mental Health Act and went on to spend 11 months in a psychiatric hospital.

Eventually, Rose's complaints about the treatment her son received were investigated by the Local Government and Social Care Ombudsman for England, Michael King.

He says the council failed to properly consider the risks Theo faced.

"This is one of the most extreme cases I've seen in 14 years in the Ombudsman's service," he told the BBC.

"It's deeply shocking both in terms of the impact it's had on that young man but also in terms of the depth of the failure. What we found was that the council offered him accommodation once. When he refused it, they didn't question whether that was a legitimate decision. He asked for help and asked for accommodation. The council didn't offer it to him. When they did offer him accommodation, they accommodated him in a tent for five weeks, they accommodated him in a static caravan for four weeks and he ended up sleeping rough for a period of time. None of that is acceptable."

He added: "What we saw in the council's records was them taking a moral judgement and blaming [Theo] for some of the choices he'd made... And it's incumbent on the local authority to actually step in and help in that situation and take the bigger view.

"He was homeless and he had a history of mental health problems and he was very vulnerable. He reported sexual assault, reported loneliness, he reported suicidal feelings. I mean, there was warning sign after warning sign, which the council should have acted on."

Jack Cordery, Service Director for Children and Family Services for Cornwall Council acknowledges that the care provided to Theo fell short.

"We're completely accepting that the services that this young man received and his mother actually were well below what we would expect. There's nobody, certainly not me who thinks that a tent on the best campsite in the world is suitable accommodation for a young person in that situation," he told the BBC.

"What they hoped is that that would be for a very short period and that they would be able to get him into suitable accommodation. If a young person is refusing the offer of accommodation, it closes down those options really, really quickly," he says.

"What I would say to Theo is that I will do everything in my power and in my authority to make sure this never happens again."

The council has since apologised to Theo and his mother.

Now 19 years old, Theo is taking things one day at a time. He's looking forward to getting settled somewhere permanent and resuming his college course. But he wants to make sure that no-one else goes through what he did.

"Young people's homelessness, it's always gonna happen, but I want it to be sorted out quickly. I'm not just here to do my sob story. I just don't want it to happen to anyone else to be honest."
Theo and Rose are pseudonyms
You may also be interested in:

At the age of 17, Sherry Denness tried to kill herself nine times in 10 days, and only then got the help she needed.
Read: I tried to kill myself nine times before the NHS helped me

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Why did the council 'house' me in a tent?

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Theo had just turned 17 when he became homeless. He turned to the council for help - but was given only a one-man tent, writes the BBC's Emma Forde. It was August 2016 when Theo's mum, Rose, received a phone call from Cornwall Council that made her feel physically ill.