Thank you for Sheila Hale’s long read about her family experience of stroke (My husband and son suffered strokes, 30 years apart. Shockingly little had changed, 15 May). I remember reading her book as a junior doctor and despairing at the differences between the stroke and neurorehabilitation units that I worked on. This drove my career to stroke medicine, particularly rehabilitation.In 2021, without the technology to give thrombolysis beyond four and a half hours after a stroke, Sheila’s son was unfortunately one hour over time and the risks of severe brain bleeding outweighed the benefit. CT perfusion techniques mean that this time constraint is reducing, and mechanical thrombectomy is becoming more individually based and more available.Sheila is right to highlight that delivering the intensity of rehabilitation required in the NHS is a huge challenge – the inpatient and community teams I work with continually change what they do to use what resources they have, but we are constantly told there is no more money.The attitudes of doctors reflected in Sheila’s article sadden me, as prognostication in early stages is difficult and younger brains show greater capacity for recovery and adaptation. There is, however, that delicate balance of hope, uncertainty and reality. Perhaps this article will spark a campaign for post-discharge neurorehabilitation gyms in every locality. The evidence supports it. A stroke is often not the end, but it is a difficult journey to a new type of life.Dr Jessica BeavanConsultant stroke physician, Derby Sheila Hale highlights a tragic and unacceptable truth. For decades, rehabilitation has remained the poor cousin of surgery and medication in the NHS. Physiotherapy services are starved of the staff and equipment to deliver effective rehab. They are told to limit the number of times they can see a patient, and for how long. In effect, they are prevented from doing their jobs. The impact on patients is stark, as seen in this article. The impact is also harsh on physiotherapy staff themselves, who must explain this reality each day and go home every night feeling they have let their patients down.The NHS wouldn’t tell a surgeon to stop an operation halfway through. A pharmacist wouldn’t hand out 40% of a course of antibiotics. So why is it OK for patients to be denied a full course of rehabilitation?Sara HazzardAssistant director, the Chartered Society of Physiotherapy; co-chair, the Community Rehabilitation Alliance Sheila Hale mentions mechanical thrombectomy, a procedure to remove blood clots from the brain. This is available at 24 hospitals in the country, but can be done 24/7 at only six of them. So in York if you have a stroke that is suitable for this procedure, it is only available at the hospital in Hull Monday to Friday 8am to 4pm. I wrote to our local MP, Luke Charters, about this and he contacted the Department of Health, which said there were no plans to bring the service to the York and Scarborough Trust. Maybe when the NHS is sued for negligence in not providing this, things may change.Sally SimpsonYork It is true that many stroke patients feel abandoned by the NHS, as Sheila Hale states. But our work with patients at the Pulross Centre in Brixton, a rehabilitation unit that is part of St Thomas’ hospital in London, is reducing that. We deliver a weekly gardening session for patients, and when they are discharged, we gift them a plant to grow at home. If they don’t have a garden, we try to link them to a community garden or gardening group in a local healthcare setting.We introduced this during the pandemic when our gardens were closed and stroke patients were self-isolating; several felt alone and forgotten. We have used the gift of a plant or seeds as an expression of connectedness between all of us and to let our stroke patients know they are not abandoned by the NHS.Edward RosenLondon

It’s Saturday afternoon and my friend’s five-year-old daughter is lying next to me on her living room floor. She explains to me that she does this at school. She lies on her back with the rest of the class and they do something called the body scanner, where they all pay attention to various body parts in turn. I know she is describing a mindfulness exercise, because I’m a psychologist who researches mental-health lessons. I listen as she explains it all to me, but in my head I’m thinking something else: she shouldn’t be learning mindfulness at school.On the face of it, mental-health lessons in schools seemed like an excellent idea. Young people’s mental health is worse now than it was in the past, and one-to-one treatment is hard to access. If you teach young people about mental health at school – which often includes teaching techniques based on therapies such as cognitive behavioural therapy (CBT) or mindfulness – it’s more accessible. If you teach these concepts to everyone in a class – so-called universal interventions – you avoid missing the under-the-radar kids who aren’t seeking help, and avoid the potential stigma of singling anyone out. If you teach the information when pupils are young enough, even better: you might prevent mental-health problems from starting in the first place.At least, that was the idea. The reality is more sobering. Researchers have now run many studies testing the impact of universal school mental-health interventions and have found that they don’t really improve mental health. When improvements are found, they’re small – a tiny average shift on a symptom questionnaire – and the quality of the research is often poor, meaning it’s hard to trust the findings. The best-designed studies show that interventions don’t work at all: no improvement in mental health symptoms, either immediately after the course of lessons or later down the line.In fact, some studies have found that universal mental-health lessons actually make things worse. There are now high-quality studies showing that school lessons based on CBT, mindfulness, dialectical behavioural therapy (DBT) and general mental-health awareness lead to a small increase in symptoms of mental-health difficulties. There is evidence of other bad outcomes too, such as decreased prosocial behaviour or decreased relationship quality with parents.It is not every study, but it is enough that we should take this seriously – not least because all schools in England are now required to teach something about mental health. And these are the ones that have been tested: there are many, many interventions being sold to and taught in schools that haven’t been evaluated at all.I have now reached the conclusion that we should stop these all-class mental-health lessons. My view is that the only information we should teach en masse is where a young person should get help, both inside and outside school, if they’re struggling. That’s it. Then we should focus the time, energy and money on supporting the smaller group of young people who are actually unwell.I have not come to this conclusion lightly. Like so many others, I was once enthusiastic about the potential of the universal approach. It is a logical, intuitive idea that mental-health lessons in schools are a good idea, an obvious solution to an obvious need. But once you can accept the evidence, something surprising happens. It starts to become clear why all-class mental-health lessons don’t improve young people’s mental health, and why they were never going to.In any one classroom, young people vary enormously. For starters, the majority of them do not have mental-health problems. This means some pupils are being asked to engage in effortful practices at home – mindfulness meditation, CBT-based thinking exercises – when they are not struggling in the first place. When you ask them in qualitative studies, where they can convey openly what they think, some young people say such lessons are irrelevant to them, and they are right. Proponents of these lessons would say that the exercises are still worth learning, that positive effects may appear later down the line – but this is not supported by the evidence.At the other extreme, in every class there will be students who already have significant mental-health problems, and thus will need more than what is on offer in universal lessons. They will need focused one-to-one support: therapy tailored to their specific challenges, built on a meaningful, trusting relationship with a qualified adult. Others will need changes in their external circumstances, not guidance about how to cope better in their own minds. For these students, mental-health lessons will be far too light touch, like being given plasters and paracetamol when they have a broken leg.Other students say that these lessons make them focus on negative feelings and memories, which then upsets them. Others simply do not understand what they are being taught, and find the exercises confusing and stressful. We have very little understanding about how specific groups – such as neurodivergent children or those with language difficulties – experience these all-class lessons and whether they are able to correctly implement what they are being told to do.Another problem is that the classroom may not be the right setting to learn about mental health. Some young people feel socially secure at school and have good friends, but others are lonely or bullied. Many young people do not feel safe at school. In one study, several students said they didn’t want to do mindfulness meditation at school because they didn’t trust what their peers would do to them if they shut their eyes. Hearing this, it suddenly seemed obvious: without resolving these social challenges, the classroom is just not the right environment for a young person to do vulnerable work on their mental health.Importantly, this doesn’t mean there should be no mental-health support in schools. School is a logical, equitable place to provide help, and there is evidence that one-to-one and small-group support in schools, given to those who need or want it, can work well, at least in the short term. But when it comes to all-class lessons, we should listen to the evidence, and to young people themselves. We came up with a good idea, we spent a lot of time and money testing it, and we have our answer. Given the evidence, we should now stop doing those lessons.The people running this research, and those making decisions to teach these lessons in schools, really want a solution to this crisis. We all want to figure out what to tell young people about mental health, and how to best help them when they are struggling. Against a backdrop of ever rising mental-health problems, and lack of affordable alternatives, I completely understand why it feels wrong – unethical even – to call a halt to these lessons.Yet it is also unethical to ignore evidence, and to continue delivering something that doesn’t work. At best, the universal lessons we have are a waste of time; at worst, they are harmful. The numbers tell us these lessons don’t improve mental health. The qualitative data tells us that many young people don’t like or want them. We need to listen.

Dr Lucy Foulkes is an academic psychologist at the University of Oxford, where her group researches mental health and social development in adolescence. She is the author of What Mental Illness Really Is (and what it isn’t), and Coming of Age: How Adolescence Shapes Us

A pandemic agreement governing how the world should work together to tackle future disease outbreaks has been adopted by global leaders after three years of negotiation.Dr Tedros Adhanom Ghebreyesus, director general of the World Health Organization (WHO), said it was “a victory for public health, science and multilateral action”.“It will ensure we, collectively, can better protect the world from future pandemic threats. It is also a recognition by the international community that our citizens, societies and economies must not be left vulnerable to again suffer losses like those endured during Covid-19,” he said.The WHO Pandemic Agreement was passed with applause by delegates at the World Health Assembly (WHA) in Geneva. The US will not be part of the agreement, having withdrawn from the WHO and negotiations after Donald Trump took office.Plans for a pandemic treaty, governing how the world should respond to future global disease outbreaks, were first announced in March 2021. World leaders, including Boris Johnson, promised a “legacy that protects our children and grandchildren and minimises the impact of future pandemics on our economies and our societies”.However, the initial deadline of the WHA in 2024 was missed amid mistrust between the global north and south. There were high levels of disinformation surrounding negotiations, including false claims that the accord would cede sovereignty to the WHO or give it the power to impose lockdowns and vaccine mandates.In order to reach the agreement this week, some key points of contention have been pushed back for later talks. The issue of pathogen access and benefit sharing (Pabs) – or what countries can expect, in terms of access to vaccines and treatments, in return for sharing data on any novel bugs emerging in their territory – will be governed by an annexe to the treaty, to be negotiated over the next 12 months.The Independent Panel for Pandemic Preparedness and Response recommended an agreement of this kind four years ago after reviewing the international response to Covid-19. The panel co-chair, former prime minister of New Zealand Helen Clark, said the agreement should be considered “a foundation from which to build, starting today”.She warned: “Many gaps remain in finance, equitable access to medical countermeasures and in understanding evolving risks. Don’t wait to get started. Dangerous pathogens are looming, and they certainly will not wait.”The agreement will not open for signatures until the Pabs annexe is completed. It will then come into force after at least 60 countries have signed. However, it is already being seen as a key achievement for the WHO at a time of crisis, with lower funding after the US withdrew necessitating dramatic cuts.Dr Teodoro Herbosa, secretary of the Philippines Department of Health, and president of this year’s WHA, said: “Now that the agreement has been brought to life, we must all act with the same urgency to implement its critical elements, including systems to ensure equitable access to life-saving pandemic-related health products.“As Covid was a once-in-a-lifetime emergency, the WHO Pandemic Agreement offers a once-in-a-lifetime opportunity to build on lessons learned from that crisis and ensure people worldwide are better protected if a future pandemic emerges.”

I first took beta blockers two years ago, when I was asked to give a eulogy. Terrible at public speaking on a good day, let alone at a funeral, my first instinct was to refuse to do it. I had made a speech at a friend’s wedding 15 years before and my legs shook so violently throughout that I thought I would collapse. This isn’t a case of being overcritical or dramatic: I find it almost impossible to stand up in front of a crowd and talk. It is an ordeal, for all involved – or it was before I took beta blockers.Beta blockers are a prescription medication that blocks adrenaline and therefore temporarily reduces the body’s reaction to stress. Routinely given to patients with heart and circulatory conditions, including angina, atrial fibrillation and high blood pressure, as well as to prevent migraines, they are also prescribed for some kinds of anxiety. Some doctors will suggest taking them regularly, at certain times of the day. Others will suggest taking a specified dose when you feel you need it. “They work by reducing the effects of adrenaline on the heart, so you don’t get that heart-racing feeling, you may not get short of breath or sweaty, and they can reduce the symptoms of a full-blown panic attack,” says doctor and broadcaster Amir Khan, who has been a GP in Bradford for 16 years.Prescriptions for anti-anxiety medication have soared in recent years – driven mainly by increases among women and young people. According to a 2022 study by the University of Bristol’s medical school, which looked at prescriptions issued for anxiety between 2003 and 2018, for every man prescribed beta blockers, there were 2.33 women. The reasons for the uptick in prescriptions are complex – but GPs interviewed for the study suggested that women and young people tend to be more open about anxiety. Also, beta blockers are generally considered lower risk and quicker-acting than other anxiety medications such as benzodiazepines, which are known to be addictive, and antidepressants, which can come with side effects. Patients did not consider beta blockers as “mental health drugs”, the study found, and therefore perceived them as “less stigmatising”. There has also been a cultural shift – celebrities including the actor Kristen Bell, Khloé Kardashian and cook Prue Leith have all spoken about taking beta blockers. When Robert Downey Jr went to collect his Golden Globe for Oppenheimer, he told the audience: “I took a beta blocker so this will be a breeze.” The writer and actor Sharon Horgan told Louis Theroux on his podcast recently: “They do something very practical, physically, but I think the sort of mental stuff that goes with it … has had a real calming effect on me, and in situations that would normally kind of terrify me.”It was a friend who suggested I try beta blockers for the funeral. She had been taking them on and off for years, although this was the first I had heard about it. “I’m not ashamed that I take them, but I also don’t need to advertise it,” she says. “I suppose I’m worried people would think it meant I’m not coping with life. I don’t know. But most people largely keep their medications to themselves, don’t they? It’s private.”Well, yes, but once I told a few people that I was thinking of taking beta blockers, it was like a domino effect, with more and more of them revealing they had taken them, either for specific events or just now and then.“I never leave home without them,” another friend tells me. “I bet I’m far from the only frazzled mum at the school gates who has them.”Someone else I know takes them for perimenopausal anxiety, instead of upping her HRT, which could be another way to remedy the symptom. She says: “I’m also trying wild swimming, yoga and meditation. I’m really being proactive, not just leaping to drugs. But beta blockers work well for me.”Despite the anecdotal evidence, the University of Bristol study says there is “no conclusive evidence” for the effectiveness of beta blockers for anxiety. They do not feature in guidance from the National Institute for Health and Care Excellence (Nice) on treating anxiety. So why do doctors prescribe them?“Although beta blockers can help with some of the physical symptoms of anxiety, they don’t treat the biology behind it,” says Khan. Instead, he says, Nice recommends a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs), which work by boosting levels of serotonin – known as the “happy hormone” – in the brain, alongside talking therapy, especially for those with generalised anxiety disorder.“Saying this, many GPs and prescribers use beta blockers for situational anxiety – when you know you are going to be in a situation where you are likely to become anxious,” says Khan. “So, ‘if and when’ rather than long term.”When I spoke to my GP, she said she prescribed beta blockers relatively often, to people who had to do big presentations at work, or lawyers about to make their closing speech in a trial. She advised me to have a practice run rather than trying them for the first time on the day of the funeral. Within 10 minutes of taking them, I felt like me, but calm. When I gave the eulogy, I was as fine as anyone could be in those circumstances.Like most medications, beta blockers are not suitable for everyone. Dr Adrian Hayter, medical director for clinical policy at the Royal College of General Practitioners, says: “GPs take a holistic approach to assessing their patients and proposing treatment plans, in conversation with them. This will take into account a patient’s unique circumstances, the severity of their symptoms and their medical history, as well as possible side-effects and other medication they may be taking.”Side-effects of beta blockers include tiredness, dizziness and difficulties sleeping and they are not suitable for people with asthma. Taking more than your prescribed dose can be dangerous and you could end up in need of urgent treatment in A&E. Khan says: “Beta blockers are not addictive, but if you are taking them long term, you can’t suddenly stop them.” You need to be weaned off them. And he adds: “Interestingly, they have been linked to higher rates of depression, so I wouldn’t prescribe them for anyone who has depression alongside their anxiety.”Khan says that in the broader picture of more and more patients being in contact with mental health services, he is seeing a rise in the number of patients with anxiety, and in particular work-related anxiety. “I don’t think I am specifically prescribing more beta blockers, but I am certainly treating more people for anxiety overall … I think life is becoming harder and harder for so many people that this is manifesting as anxiety.”Last November, I lost the job I had been doing for 20 years, because of budget cuts. As I worked as a freelance, there was no redundancy pay out, just thank you, have a lovely Christmas. From the moment the bombshell was dropped, I felt constantly on the verge of a panic attack, as if sheer blind terror instead of blood was coursing through my veins. As an already anxious person, a phone call out of the blue that shattered my family’s financial security in an instant did not improve my mindset. After a discussion with my doctor, I now take beta blockers three times a day. They are helping to make my life manageable as I navigate my new normal.We did talk about antidepressants instead, which I have taken in the past, but they didn’t feel like the right way to go at this time. The anxiety I was feeling was a reaction to my situation, to circumstances beyond my control, rather than a longer term issue.And while they are working for me at the moment, I hope that I won’t need to take them indefinitely. Hayter says: “Wherever possible, GPs don’t want patients to have to rely on medication long term, and most patients don’t want that either. Best practice is for medication reviews to be held at regular intervals, where GPs and patients discuss whether there are opportunities to reduce the dosage or stop taking medication altogether.”At some point, I’m sure I will feel able to stop taking beta blockers as regularly. But if another stressful public speaking event came up again, I can see myself heading back to my doctor.

8 hours agoShareSaveNikki FoxBBC health correspondent, East of EnglandShareSavePAEight months into its 25-month timeline, the Lampard Inquiry is beginning to expose deep-rooted issues in NHS mental health services in Essex. With more than 2,000 deaths in inpatient units between 2000 and the end of 2023, the inquiry is examining not only local failings but also whether these reflect wider national problems. Here is what has emerged so far.A system under scrutinyThe inquiry is named after its chairwoman, Baroness Kate Lampard.She is a former barrister who oversaw the NHS investigations into abuse by former television presenter Jimmy Savile.It is primarily focused on Essex Partnership University NHS Foundation Trust (EPUT), formed in 2017 from the merger of North and South Essex Partnership Trusts. It is also looking at the deaths of patients from Essex at inpatient units run by private providers and 215 facilities run by other NHS organisations, such as North East London NHS Foundation Trust.The former health ombudsman Sir Rob Behrens said on average, 5% of all mental health cases received by his team between 2011 and 2023 were related to Essex.He called the failures in care “the National Health Service at its worst”.During testimony from the relatives and friends of those who died, it emerged that they were individuals from a range of backgrounds, including a chef, bus driver, heating engineer, former head teacher, and parish councillor.LAMPARD INQUIRYLack of staffThe inquiry has heard evidence of a long-term reduction in registered mental health nurses, with increased reliance on healthcare support workers across England. This shift has been linked to reduced patient engagement and increased risk.Former chief nurse Maria Nelligan told the inquiry this was because healthcare support workers were “cheaper” and said the shift compromised therapeutic care.Dr Paul Davidson, a consultant psychiatrist, described how staff across England were “rushed off their feet,” contributing to a workplace culture where professionals feared being blamed “whatever decision they took”. Paul Scott, chief executive of EPUT, stated the trust had reduced its use of agency staff by 30%. Poor data STUART WOODWARD/BBCThe inquiry has also highlighted issues with data collection and transparency. Deborah Cole, from the charity Inquest, described how there was no “complete set of statistics in relation to those who die in mental health detention”. Dr Davidson added: “There is good information in relation to deaths by suicide, [but] this is not a helpful tool by which to assess how mental services are being provided overall.”Baroness Lampard has warned that the inquiry may never uncover the full scale of deaths linked to failings in Essex mental health services.She stated that while a figure would be published, it was likely to be approximate, due to incomplete or inconsistent data over the 24-year period under reviewRegulating trustsThe inquiry has examined the complexity of the regulatory system overseeing NHS trusts. Mr Scott described being “overwhelmed” by the number of regulatory bodies -19 in total – each issuing recommendations. This, he said, made it difficult to implement consistent change.Away from the inquiry, in October 2024, the health secretary stated that the government intended to reform the regulatory system.This was in response to a review of the way the Care Quality Commission (CQC) inspected trusts, called the Penny Dash Review, which said the framework was too complicated.The Lampard Inquiry will consider the CQC’s role in relation to events in Essex.AnalysisThree systemic issues raised by the inquiry – staff shortages, poor data, and regulatory complexity – have been longstanding concerns. The Royal College of Nursing, the CQC and a 2023 Public Accounts Committee report all flagged staffing shortages and burnout. A 2023 review found Norfolk and Suffolk NHS Foundation Trust had lost track of patient death data, while a 2025 Health Services Safety Investigations Body (HSSIB) report called for a unified national dataset. Regulatory reform is also under way following multiple critical reviews. While Baroness Lampard is expected to reference these reports, the inquiry is also under pressure to uncover new evidence.Some families have expressed concern regarding its pace, and limited focus so far on cultural change.They have also noted that safeguarding issues, such as patients absconding from units, have received little attention – a relevant issue given a recent inquest into the death of an 18-year-old who died while on escorted leave from an EPUT unit.Transparency and whistleblowingOnly 11 out of 14,000 staff came forward during the earlier non-statutory phase of the inquiry. Baroness Lampard has said she will use statutory powers to compel evidence if necessary. Mr Scott acknowledged that “closed cultures” existed at EPUT but said the trust was encouraging openness. During a recent inquest into the death of a 16-year-old patient, a manager testified that staff were reluctant to raise safety concerns. Brian O’Donnell, clinical lead at the St Aubyn Centre in Colchester, said there was a “real concern about safety on the wards, and staff are too worried to say anything about it”.Families have also raised concerns about delays in evidence disclosure, including a postponed inquiry session on a Oxevision, an infrared monitoring system, due to late submission of information by EPUT.But Baroness Lampard said her decision to delay the hearing “should not be viewed in any way as enabling EPUT to avoid answering questions about its use of Oxevision”.ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUSTWhat comes next?PAIn July, the inquiry will focus on the two former trusts that merged to form EPUT. Mr Scott has said, when he arrived at the trust in 2000, the legacy of the merger was that “there was too much focus on governance and management and not enough on patient safety”.Families are calling for detailed scrutiny of individual deaths, but the inquiry is more likely to use selected cases to illustrate broader systemic issues such as governance, and culture.Mr Scott has apologised for deaths under the trust’s care and stated that he believes EPUT should remain the provider of mental health services in Essex. More on this storyRelated internet links

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