We take a two-fold approach to changing and saving lives: firstly providing support for men who are down or in crisis, and secondly campaigning for culture change to tackle outdated stereotypes of masculinity that prevent men seeking help.
We do this in the face of a problem that is deeply entrenched. Many men feel forced to stoically “man up” (whatever that means) and grind through bad times without societal permission to open up or seek help. Calm’s research shows that while 67% of women tell someone about going through depression, only 55% of men do the same.
The result? Men are three times more likely than women to take their own lives and suicide is the single biggest killer of men aged between 20 and 49 – something the Duke of Cambridge describes as “an appalling stain on our society”.
But the tide is turning. Since Calm was founded 10 years ago, awareness of male suicide has trebled. Definitively, men are talking more. Calm alone has taken 200,000 helpline calls to date, and prevented more than 1,000 suicides.
The work of organisations and campaigns such as Lift The Weight and the royals’ mental health campaign Heads Together (Calm is a partner charity of the latter) – is a massive step forward. Historically, the alpha-male archetype has had no time for conversations about emotions but, in recent weeks, this has been dismissed by men such as Stormzy, Rio Ferdinand, and Calm’s patron Professor Green – strong, famous, tough men explaining how communication has, in some way, saved their lives.
There is still much work to be done. The emphasis now is to move beyond the rallying cry to open up. We must better equip ourselves, our mates, our workplaces, schools and health services to support those who need it. And we start by building a generation who believe that society’s ideas of your gender should not be a death sentence.
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.
Dr BJ (Bruce) Miller is convinced that how we care for people towards the end of their lives needs an urgent, radical rethink. An American palliative care specialist, Miller is in the UK this week as the keynote speaker at a conference marking the 50th anniversary of modern hospice care in Britain. He will argue that much more needs to be done to ensure the best possible quality of life for people as they deal with illness and approach dying.
“The way in which we handle death and dying is enormous, fascinating and elemental, and yet it is something that continues to be seen as a taboo,” Miller says of how societies like Britain and America tend to confront the issue. Palliative care is not as high a priority as it should be, he says, and while there are encouraging signs of a growing understanding of the importance of end-of-life care, “at least here in the United States, and I presume [in Britain], a lot of people don’t understand what the heck palliative care is”.
A physician and faculty member at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, Miller has emerged in the US as a leading advocate for an approach to palliative care that focuses on promoting people’s quality of life, not merely managing pain. It also emphasises the involvement of others including healthcare workers and caregivers in making that happen.. The 46-year-old sprung to prominence with a 2015 TED Talk, What Matters Most at the End of Life, which ended up being among the 15 most viewed online that year. In it he laid out his vision and talked of how his own life experience (at 19 he almost died in an accident and lost both his lower legs and a forearm) informed his perspective on dying and end-of-life care.
Like his UK counterparts in the palliative care sector, including this month’s conference co-organisers Hospice UK and St Christopher’s Hospice, Miller promotes a focus on the individual and the quality of their life, not just on the disease, illness or disability. Palliative care, including hospices and home visits delivered by “interdisciplinary” teams that include doctors, social workers, volunteers, carers and family as well as fresh perspectives from areas like design and art, should contribute to a better life even as it nears the end, he says.
Delivering first-rate palliative care is not just a worthy ambition, it’s a necessity, Miller says. Wider health and social care systems need to respond to the fact that so many more people are living much longer with chronic or degenerative conditions. “People at the end of their lives often do not have access to the services they need, and with an ageing population demand continues to grow.” The availability of hospice services needs to meet the demand, he says.
Miller’s assessment appears to tally with public opinion, at least in Britain. A recent ComRes poll for Dying Matters, a coalition of voluntary and public sector organisations found that only 16% of people agreed there is enough support for people dealing with death, dying and bereavement.
It’s good news that people are living longer, Miller says, but “we’ve opened up these enormous ranges of lifespans too quickly, soour society has not kept up. And that’s a problem.”
We don’t need to demonise hospitals; we just need to use them more surgically
The “default” mode within healthcare systems of “a strictly medicalised approach” won’t suffice, he says. A situation where older or dying people end up in hospitals because there isn’t a better, more appropriate place for them to be is unacceptable. “Being sick, dying; these are hard things that we all go through, but they are much harder than they need to be. The seduction of acute care remains outrageously and disproportionately the receiver of funding and attention,” he adds. “Let’s not ask them to do everything. We don’t need to demonise hospitals; we just need to use them more surgically.”
To truly transform things, Miller says, the public needs to be properly informed about what palliative care is – where the quality of life for people with advanced or serious illnesses is the focus of teams with a range of skills. They need to be made aware of the benefits too, not least because once they do understand, they are likely to put pressure on politicians to make it a priority. This is why he “keeps banging the public education drum”, he says. And policy-makers need to realise that palliative care can be cost-effective.
“Part of the good news of palliative care is that if you are to take the total cost to the system point of view, time and again this approach saves the damn system money. Even if you’re the most narrow-minded bean counter, you’re still going to arrive at palliative care and the approach it provides as good for the system.”
The US and UK palliative care systems may be different, but both should concentrate spending on residential hospices, more homecare services, video conferences and teleconferencing to reach people in rural areas, says Miller. “These things exist. They just need to be developed and amplified.”
He accepts that the challenges are vast. At a time when social care and healthcare in the UK is under huge financial strain, and when Republicans in the US are attempting to dismantle Obama’s Affordable Care Act – which saw healthcare provision expanded to millions who were previously without insurance (including the very sick, disabled and older people) – the climate is far from conducive.
But he firmly believes the status quo can’t continue: “I believe there is a true urgency to this.”
Curriculum vitae
Age: 46.
Lives: Mill Valley, California.
Family: Dog named Maysie and two cats: The Muffin Man and Darkness.
Education: St George’s school; Princeton, undergraduate studies in art history; University of California, San Francisco, MD as a regents’ scholar; Cottage Hospital, Santa Barbara, California, internal medicine residency as chief resident; Harvard Medical School, fellowship in hospice and palliative medicine, with clinical duties split between Massachusetts General Hospital and Dana-Farber Cancer Institute.
Career: 2007 to present: assistant clinical professor of medicine, UCSF; 2011-16: executive director, Zen Hospice Project; 2008-11: associate director, Symptom Management Service, UCSF; 2008-10: associate programme director, UCSF; 2008-10: associate fellowship director, hospice & palliative medicine, UCSF.
Interests: Nature, the arts, the built environment.
Students living on campus at the University of Surrey are being offered the meningitis B vaccine after a student died and two others were taken to hospital with the bug.
John Igboanugo, a first-year physics undergraduate, died earlier this month following a sports trip to Rimini in Italy.
Two other Surrey students also fell ill with meningitis but have now been discharged from hospital.
Public Health England (PHE) said laboratory reports had confirmed two of the students had meningitis B while the third was thought to have contracted the B strain of the bug as well.
About 4,200 full-time students living in halls on the Guildford campus – around a third of the total student population – are now being offered the jab to protect against meningitis B.
The vaccine is normally only routinely given on the NHS to young babies.
Prof Max Lu, vice-chancellor of the University of Surrey, said: “We are greatly saddened by the death of our student, and our hearts go out to his family and friends during what continues to be a very difficult time.
“The health and wellbeing of everyone on campus is of the utmost importance.
“We are working closely with PHE on a targeted vaccination programme and are reassured that the risk to staff, students and visitors is still very low.”
Prof Kamila Hawthorne, associate dean for medicine at the University of Surrey, added: “We appreciate that when cases of meningitis B occur there is increased concern about the potential spread, but evidence shows that meningococcal infection is not highly contagious, comparatively rare and the risk to the wider community remains very low.
“Only people who have prolonged, close contact with an ill person are at a slightly increased risk of becoming unwell.
“If anyone is in any doubt or concerned about their health, or the health of others, please call NHS 111 urgently.”
The university said there was no direct link between the three cases.
The two students who were taken to hospital had not been on the sports trip to Italy.
PHE said passengers on the coach trip had been offered antibiotics as a precaution.
It said the wider population in the town and non-students who visited but did not live on the university campus were not considered to be within the at-risk group.
Dr Peter English, consultant in communicable disease control from PHE in the south-east of England, said: “Meningococcal infection is comparatively rare and the risk of transmission is relatively low.
“People who have prolonged, close contact with an ill person are at a slightly increased risk of becoming unwell in the following days.
“This is why immediate contacts of the cases have already been offered antibiotics as a precautionary measure.
“After considering the medical evidence, we have decided to offer vaccination to around 4,200 students living in halls of residence at the university to reduce risk of further cases next term.
“I would like to reassure other students, teachers, their families and the local community that the risk of catching this infection remains very low, and any higher risk is confined to those being offered the vaccine.”
Students are regularly offered a vaccine against other strains of meningitis, known as the Men ACWY jab.
Meningitis can develop rapidly and is sometimes mistaken for flu. Those who survive can be left with life-changing disabilities.
Symptoms include a high temperature, feeling or being sick, exhaustion and irritability, a headache and aching joints, stiff neck and dislike of bright lights, confusion and a rash.
When I was first diagnosed ( Karen’s Journey ) I couldn’t help myself but to feel afraid, somehow I felt shame for feeling this emotion because I thought as a believer of God I had to be strong in every area of my life despite the challenges I may face. After all the word of God says in His perfect love there is no fear. Could it be then that I really didn’t know of His love? Or perhaps, I’m a normal human being with normal emotions? God gave us emotions right? Let me tell you… Yes!! It is normal to feel afraid!! Now, the question is… what do we do in the midst of that emotion? Do we allow it to paralyze us or do we move from it? So many questions and yet, the bible, pastors, therapists, family, relatives, friends, colleagues, will have their own very unique answer to this complex question. Would they all coincide that Steadfast Courage is a must?
Emotions?
You may be wondering why is this woman talking about emotions on this site? Very simple! Emotions play such a significant role in our everyday life consequently these emotions have a great impact in our over all health. I have personally found a great void in the medical community addressing this very important area of life. Somehow doctors have been trained to separate this vital component of health and detached it from patients healing practices and protocols.
My healing journey has embarked me into a journey of self discovery and I believe this is true for most cancer patients regardless of their treatment preference. Somehow we focus a great deal on our physical being, which of course must be addressed but how about our emotional health? It is known that our emotions have perhaps a greater impact on our health than what we eat. One of the doctors on my team whom I greatly admire once said “A negative thought can kill you faster than a bad germ. One of the main things to detoxify is your mind” (Dr. Antonio Jimenez, 2014).
I am not a doctor nor do I claim to know what is right or wrong for any cancer patient needing medical advice. However, as a cancer thriver myself I can say that I prefer to believe and hope that things can change for me in my reality. Believe I can heal and hope I will live a long life as it was intended by God the creator of the universe.
Settling?
Why should I settle for what the doctors say or what the medical reports reflect. We ALL have an expiration date on our lives and what matters is how we choose to live daily now. I reject fear as it drains my immune system and it puts me in an unnecessary anxiety mode. Think about it… Does fear change the medical report or the doctor’s opinion on your life? Of course not. But what if your positive thoughts and words you intentionally choose to speak over yourself are filled with Steadfast Courage? This choice alone will have an immediate impact over your situation. What if you choose to be vigilant in your emotional awareness just as you are with your diet, exercise, therapies, supplements, relationships, etc. What if you choose to face death with Steadfast Courage? What if you choose to overwhelm your circumstances with hope and faith vs fear? And even if things don’t change for you, would you spend your remaining days alive as an slave of fear?
YOU CHOOSE
You choose what will fill your mind and heart and allow it to take over you… Thankfulness, Peace, Hope, Love … No cancer can ever take that away from you. I don’t claim to be fearless but it is a daily choice I must make to live in gratitude, peace, joy, love and in hope. I have been told that I am an idealist and I don’t live in reality. To be honest if reality means to live in fear, anxiety, hopelessness, faithlessness, unhappiness, pressured with time and allowing life to happen instead of living life, well than yes I am an idealist. I choose to create this other reality for me filled with joy peace hope and love, I choose to believe I can heal. I believe you and I are powerful people and we must choose Steadfast Courage in the Face of Death.
Blogger
After much thought I took the path less travelled, a path on which I strongly believe the Lord is walking right alongside of me.
I started my healing path in 2014 as a 41-year-old wife, mother of three and business owner. I’m still holding these titles as I travel on my new cancer journey. The C diagnoses has given me an invitation to live again, allowing me to learn so much about myself, health, relationships, lifestyle and of course this awful disease… cancer…
I decided to start a blog to share my experiences with you. Of course, many of you may ask why? Why would this woman make herself open and vulnerable to thousands of strangers on the internet? Simple! An amazing invitation was given to me, to embark myself into a healing journey, not only to bring back physical order but to heal my mind and soul, to develop and grow into a new season of change. Although I don’t have all the answers and I don’t have it all together, I want to share, ignite and declare the works of that healing light that dwells in all of us.
No, I cannot say that I am completely “cancer free.” But things are definitely moving in the right direction. Tumor has shrunk, and blood flow to it has been reduced. Looking at my blood work through the eyes of the (conventional) medical community, I can say that my immune system is stronger and my level of tumor markers is lower. I know in my heart that I’m on my way to discover, heal and fully live in thankfulness for every blessing I have, embracing the journey with joy and hope and intentionally loving people everyday of my life. I don’t know how it is all going to end but I know I can choose how I want to live today.
It is my hope and prayer that by sharing my journey, you and others can benefit from what I’ve learned and what I’m still going through. If you, too, are searching for answers, I want you to know that you are not alone, that I am right here with you. But most importantly I want you to know that the power to heal is within you.
Weight loss surgeries have witnessed huge popularity in recent times. The number of stomach-shrinking operations, a type of bariatric surgery meant for severely obese people has skyrocketed in recent years. Few celebrities of Hollywood have also opted for this form of surgery to curtail obesity.
But there are various risks associated with these surgeries especially for elderly people and those suffering from heart disease (1, 2, 3). At times, it can result in early death. Patients aged 65 or older face a nearly threefold increase in the risk of early mortality according to latest findings. It has been found that men are nearly twice as likely to die following such procedures as opposed to women. According to the Journal of the American Medical Association, more than 5% of men and nearly 3% of women aged 35 to 44 years were dead within a year of having the surgery and a slightly higher rate was found in patients aged between 45 to 54.
Bariatric surgery is a complicated procedure therefore a surgeon requires prior experience to perform it properly. Patients whose surgeons had performed fewer than 20 procedures were nearly five times as likely to die within 30 days after the operation as compared to others. Despite the greater risk associated with it, bariatric surgery can be a safe and effective tool for morbidly obese people, who face serious health problems if they don’t lose weight.
Things you need to know about bariatric surgery 1.Bariatric surgery is not an easy option for obesity sufferers as it carries the usual pain and risks of any major gastrointestinal surgical operation. 2.Bariatric surgery requires changes in eating habits therefore after having bariatric surgery; patients remain at a lifelong risk of nutritional deficiencies. 3.Bariatric Surgery is best suited for morbidly obese people. 4.High amount of motivation is required to make the surgery a success. 5.This procedure is costly as compared to other weight loss techniques. Therefore, be well informed about the surgery you want to opt for as it can make weight loss an easy and safe affair for you.
Dr. Serge is a clinical nutritionist. He owns a doctorate degree in nutrition from McGill University in Canada. In addition, he completed a 7-year postdoctoral training at Harvard Medical School in Massachusetts where he studied the impact of fat as it relates to heart disease.
He has authored a book on this topic that is awaiting publication with Edition Berger publishers in Canada. He holds an advance certification in Nutrition Response Testing (SM) from Ulan Nutritional Systems in Florida and he is a certified herbalist through the Australian College of Phytotherapy.
His personalized nutritional programs allow to help individuals with a wide variety of health concerns such as hormonal imbalance, digestive issues, heart-related conditions, detoxes/cleanses, weight loss, fatigue, migraines, allergies, among others.
The effect on wellbeing of exposure to nitrogen dioxide, a gas mostly produced in diesel fumes, is comparable to the toll from losing a job, ending a relationship or the death of a partner, research suggests.
The study found a “significant and negative association” between life satisfaction and levels of the pollutant, which causes lung problems. These effects were “substantive and comparable to that of many ‘big-hitting’ life events,” according to the researchers behind Can Clean Air Make You Happy?.
Sarah J Knight and Peter Howley of York University took life satisfaction data from the British Household Panel Survey and UK Household Longitudinal Survey and compared it with detailed air quality records from the Department for Environment, Food and Rural Affairs.
Given that far more people are exposed to to nitrogen dioxide than suffer unemployment or end a relationship, Knight and Howley suggest that the benefits to society from reducing such emissions would be substantive.
The highest levels of nitrogen dioxide occur in London, with the lowest levels in parts of south-west England. The capital has the dubious honour of being home to the worst NO2 hotspot in Europe: Marylebone Road, which recorded the highest annual mean levels of the pollutant, more than double the legal EU limit.
Pollution from nitrogen oxides is responsible for tens of thousands of premature deaths across Europe, with the UK suffering a particularly high toll. Much of the pollution is produced by diesel cars, which emit about six times more than allowed in the official lab-based tests.
The European Environment Agency said the UK had 11,940 premature deaths in 2013 from nitrogen dioxide. The number was down from 14,100 the previous year, but was still the second worst in Europe after Italy.
Modern diesel cars produce 10 times more toxic air pollution than heavy trucks and buses, according to European data released in January.
The European commission started legal action late last year against the UK and six other EU members for failing to act against car emissions cheating in the wake of the Volkswagen dieselgate scandal.
A charity that has been given £250,000 from the government’s so-called tampon tax fund has scrubbed language describing abortion after rape as a “death penalty” from its website after being challenged on it.
The Life charity has now said it will do a full review of its website to remove offensive language, after the Guardian pointed out that the same article referred to abortion in cases of disability as a “death sentence”.
Life, which campaigns against abortion, was among 70 organisations working with women and girls to receive funding from the £12m tampon tax fund set up by George Osborne.
The £250,000 funding will go into housing and counselling services run by Life for homeless pregnant women in west London, the government announced. But the decision to award Life funding provoked concern among some women’s groups.
On Monday, Life’s education director Anne Scanlan was challenged on the BBC Radio 4’s Today programme about a piece on the charity’s website in which abortion after rape was described as a “death penalty”.
Ann Furedi, of the British Pregnancy Advisory Service, brought up the phrasing and said: “You cannot be saying on one hand that you provide an unbiased, non-judgemental approach to dealing with women when this is the ideological motivation of your organisation.”
Scanlan responded: “I cannot believe we use that terminology at all, we would absolutely never use that kind of language face to face when dealing with women.”
The article was swiftly edited on Monday morning to remove the description. However, the same article still referred to abortion in cases of disability as a “death sentence”.
When the Guardian pointed this out, Scanlan said the language was inappropriate and offensive, and pledged to review all content on the website. “Where inappropriate language was used, we will amend it or remove it,” she said.
“We offer help and support to women. We certainly don’t want anything on the website that’s offensive,” Scanlan said. “We are not going to shy away from it: we are an anti-abortion organisation. But I was genuinely surprised to find out that language was being used on our website.”
Scanlan said she did not know how long the article had been online but believed it was written before she arrived at Life six years ago and had slipped through the net when the website was revamped last year. “Unfortunately a whole swathe of briefing papers have been moved from the old website without being adequately checked,” she said.
She denied that the group’s opposition to abortion made it unsuitable to receive the tampon tax funding. “We never, ever try to push our views onto anybody else,” she said, adding Life provides “non-directive counselling” that avoids recommending any particular course of action. “When it comes to providing support for women, we’re not debating the issue: we are just providing support,” she added.
Furedi told the Guardian she did not believe it was possible to separate Life’s opposition to abortion from the advice it provides to women. “Organisations are led by their values, and that runs through advocacy and campaigning, but it also runs through the way services are delivered,” she said, adding: “What they are saying is abortion has, as far as they are concerned, no place in the management of problem pregnancy.”
The government’s decision to provide funding to an anti-abortion organisation was a “slap in the face” to public opinion, which is increasingly supportive of choice, Furedi said, pointing out that the £250,000 was among the largest grants handed out: “Every woman who’s buying sanitary protection is being caused to effectively make a donation [to Life]”. The charity has a turnover of £3.6m a year.
A spokesperson for the Department for Culture, Media and Sport, which determines how the tampon tax fund is distributed, said the money is being spent to “help improve the lives of disadvantaged women and girls, including those who have been affected by violence,” adding: “Life has been awarded £250,000 to fund a specific project in west London that will help homeless and other at risk women who are pregnant by providing housing, counselling and life skills training.”
The government declined to comment on whether it had any concerns about providing significant funding to an avowedly pro-life organisation.
I am a NHS hospital consultant and work in a healthcare team that specialises in the care of adults with cystic fibrosis (CF). This is a genetic condition that affects various organs, but primarily the lungs. It results in recurrent and severe chest infections that ultimately cause the lungs to fail. There have been considerable advancements in new therapies that we are hopeful will change the natural history of the disease. Nevertheless, it remains a life-shortening illness and coping with the death of young adults brings many challenges to the team that I work in.
Patients move to our CF centre when they are 18 years old. The doctor-patient relationship is a dichotomous and delicate balance of professional distance and empathy. But it does not fully guard against emotion when we see those we look after approach death. Over the years we develop bonds with our patients and their families and witness many life events. We share in their laughter and tears. Occasionally I am the focus, a patient recently said to me: “You’ve lost weight … you need to look after yourself better.” That made me chuckle.
Clinical care satisfies the needs of today, but research brings the hope for tomorrow
Patients strive to lead normal lives and I am frequently in awe of their achievements. Some of their journeys are truly Homeric in stature. But years of infections and damage to the lungs take their toll. The hope of a better tomorrow is a powerful support but the reality of declining health can dismantle the scaffold. Broaching these end-of-life conversations is often difficult as the words uttered can confirm patients’ fears.
It is so important to choose those words carefully as they can linger in the family’s memory. I remember one young 22-year-old woman who was not responding to treatment in hospital; her death was imminent. It was important for her to have some sort of control. I asked her: “You are in the driving seat now, what would you like us to do with your treatment?” She wanted to stop it, and I did. Some months after her death her mum called into the hospital and said: “Thank you for putting my daughter in the driving seat”. I’ve cherished those words.
Many patients now have young families of their own and the death of a parent is a traumatic experience. We arrange for our patients to engage with a specially trained counsellor to express their thoughts in words and pictures. A personalised memory book is produced, which includes advice for the future without them.
I’ll always remember the young girl, after losing a parent, who put her thoughts down in a letter. It was a remarkable achievement for one so young. She said the book helped her and reminded her of the parent she had lost. The presence and tactility of a book is tangible. A father whose son died wrote to me: “It is impossible to balance the awfulness of our heartbreak with the comfort that this book provides, but what is paramount is that it provides amazing comfort to us all.” Their letters are the most powerful I have ever read.
In the liminal transition from life to death a peace descends in the half light. I reflect on what I could have done differently. Should I have changed the treatment plan? Could I have phrased things a little better? Some parents have lost all their children to this disease and they have been made to endure grief that is simply unendurable. So when I go home at night my family are hugged that little bit tighter, as nobody is immune to loss. Death casts light on my own mortality and the impermanence of life comes sharply into focus.
In the following days and weeks we redouble our efforts. Clinical care satisfies the needs of today, but research brings the hope for tomorrow. It is so important to be part of that hope. I walk into the hospital ward to hear new stories and guide as best I can. It is an enormous privilege to do what I do.
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Cancer death rates in the United States are continuing to fall and the five-year survival rates of those diagnosed with the disease have risen, research shows.
The Annual Report to the Nation on the Status of Cancer, published on Friday, also shows a decline in incidence of cancer among men in recent years, although it remained stable among women.
Death rates from 2010 to 2014 decreased for 11 of the 16 most common types of cancer in men and for 13 of the 18 most common types of cancer in women, including lung, colorectal, female breast, and prostate cancers.
The authors, from the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute and the North American Association of Central Cancer Registries (NAACCR) suggest a decline in smoking – down more than 50% over the last 50 years – as well as improved early detection and more effective treatment helped bring about the fall.
But they warn that smoking continues to pose a threat along with obesity, rates of which are at 20% or or more in every state.
NAACCR executive director Betsy Kohler said. “The continued drops in overall cancer death rates in the United States are welcome news, reflecting improvements in prevention, early detection, and treatment.
“But this report also shows us that progress has been limited for several cancers, which should compel us to renew our commitment to efforts to discover new strategies for prevention, early detection, and treatment, and to apply proven interventions broadly and equitably.”
The report, published in the Journal of the National Cancer Institute, showed that death rates increased for cancers of the liver, pancreas, and brain in men and for liver and uterine cancer in women.
Overall, cancer death rates decreased by 1.8% per year in men and 1.4% a year in women.
During the period 1999 to 2013, cancer incidence rates in men fell by 2.3%, according to the study.
Compared with cases diagnosed between 1975 and 1977, five-year survival for cancers diagnosed in 2006 to 2012 increased significantly for all manifestations of the disease bar cervical and uterine cancer.
The greatest absolute increases in survival (25% or greater) were seen in prostate and kidney cancers, non-Hodgkin lymphoma, myeloma (bone marrow cancer) and leukaemia.
Further improvements in survival prospects are expected in the wake of recent advances in precision medicine and immunotherapy for late stage cancers. But the authors warn that the high cost of new cancer drugs – up to $ 10,000 (£8,000) per month – may put them out of reach even to Medicare-insured patients, who would still be left with a bill for around 20% of the drug’s cost.
Never be scared to question a doctor, however senior they may be. We are our patients’ advocates and can protect them from potential mistakes. A good doctor will respect you for this. If you feel something isn’t right but are not confident enough to challenge a situation yourself, go to someone you know, trust and respect – watch how they deal with it and learn. Emma McLellan, staff nurse in the ICU, Manchester
Learn to trust your gut instinct
I believe good nurses are really tuned into their gut instinct and new nurses should learn to trust it. A nurse’s gut instinct is their deeply grounded knowledge base developed in practice, their critical awareness and what they have learned from previous situations plus an overall sense of knowing the patient well. You’ll just know something doesn’t add up, or you may convinced there’s something more going on, so make sure you go that extra mile to cover all bases. Maybe, for example, all of a patient’s baseline observations are normal, but you just sense that there is still that underlying thing you can’t put your finger on – monitor them really closely because you’ll often be right. Zoë Hartwright, community mental health nurse, Shropshire
Death is a part of nursing – talk about it with patients
Death is a regular part of nursing. Patients need someone to talk frankly about death. We plan births for nine months, but talking about death always seems awkward and hard. One of the best things you can do for a patient who is nearing the end of their life is to give them opportunities to talk about their death and how they would like it to be. Being able to give advice and support to help them get their affairs in order can relieve a lot of their pain and worry. It is possible to have a good death but the conversations have to be had.
When death is unexpected this is very hard to deal with. I worked in an accident and emergency department for 10 years and learned that life and death is unpredictable. I have seen many patients and nurses struggle with the last words that they said to that person, so I try to adopt the approach of being kind. Really think about what you say during emergency situations – it is likely that patient can hear you right to the end – even if the rest of their body is not responding. Use their name, talk calmly to them, explain everything you do as you are doing it. Speak to them as if they are awake. Christine Bushnell, advanced nurse practitioner, nurse partner in a GP surgery and trainer, Harrow
Don’t treat patients you don’t like differently
It’s OK not to like some patients. That’s bound to happen, and some patients really won’t be very likeable. Just be aware of yourself; notice that you don’t like the patient and make sure you’re not treating them any differently. Maybe confide in a trustworthy colleague and ask them to let you know if you are behaving differently towards that patient. And draw on other people, often you find that another colleague works well with a patient you just can’t seem to get along with; make the most of that by getting them to tell you the good qualities of the patient, or even letting them take the lead. Elizabeth Cook, clinical charge nurse, south London
Be kind to patients’ relatives
It’s very hard not to take it personally when relatives are difficult with you. As a nurse in paediatrics, I found it tough at first as a newly qualified nurse without any children of my own. Now that I am older and I have my own children, it is different. When dealing with emotional or difficult relatives, try to put yourself in their position and understand that they do not have anything against you – they are just desperately worried about their child, for example, and you may be the nearest person to them and so they might take it out on you. It is important to listen without judging and, if treated with hostility, try to respond with kindness. Speak to your manager if certain behaviour from a family member is bothering you, but ultimately try to be understanding.
Don’t say, “I know how you feel” when you have never been in that situation. Instead you can say something like: “I can’t begin to imagine how worried you must be, but we are doing everything we can, if you have any questions please ask and if I can’t answer them I will find someone who can, etc”. Sally al-Habshi, paediatric emergency nurse, Leicester
Be nice to healthcare assistants
Always be nice to healthcare assistants, they’re amazing. Make lists of jobs you need to do – a good list helps everything. And always remember that when you’re having a bad day, your shift will come to an end and you can go home and eat pizza. Laura Thompson, ward manager, London
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On Monday, disabled representatives from disability organisations across England, Scotland and Wales presented reports to the UN Committee on the Rights of Persons with Disabilities in Geneva. It is now eight years since the UK ratified the UNCRPD with cross-party support and this is the committee’s first full examination of the UK’s performance.
So how are we doing? The government is fond of claiming that the UK is a “world leader” on disability rights. Superficially, this claim remains fairly accurate. We have the most comprehensive and proactive equality law anywhere in the world; social care legislation and practice that embodies the principle of choice and control; a social security system that claims to recognise the extra costs of disability; and law and regulations to advance accessibility. It is important to remind ourselves of what disabled people have achieved over the past 30-40 years of disability rights activism, as we have charted our journey from objects of care and charity to becoming active, contributing citizens. But any assessment of progress cannot be confined solely to what we now have, or where we were in the past. And judging by the UK’s direction of travel, the government’s claim of world leadership quickly unravels: we are seeing big cuts to services and watering down of rights and opportunities of disabled people.
Last year, I served on the House of Lords select committee, reviewing the impact of the Equality Act on disabled people. We found that this government’s deregulatory zeal and spending cuts significantly undermined the intended effect of the act. Employment tribunal fees, legal aid cuts and loss of advice services have put the act’s protection beyond the reach of most disabled people. And colossal cuts to the Equality and Human Rights Commission’s budget have left the act under-promoted and unenforced.
The UK’s mental health and mental capacity laws fail to comply with the CRPD, which stipulates that disability cannot be grounds for denying people equal recognition before the law or for depriving people of their liberty. Yet in England, there has been a 10% rise in detention each year for the past two years. More than half of these cases related to people with dementia, and a significant minority to adults with learning disabilities. The sanctioned use of restraint, seclusion and anti-psychotic medication remains commonplaceon mental health and learning disabilty wards, violating people’s rights to physical and mental integrity and to live free from torture, inhuman or degrading treatment. NHS benchmarking data revealed that there were 9,600 uses of restraint during August 2015 in mental health wards in England, while the Learning Disability Census 2015 found that one-third of patients with a learning disability were subject to the use of restraint in 2015-16.
Unexpected deaths of mental health in-patients, or those cared for at home in England, are up by 21% yet, unlike deaths in police, prison or immigration detention, there is no system of independent investigation. Since 2011, hospitals in England have investigated just 222 out of 1,638 deaths of patients with learning disabilities. Among deaths they classed as unexpected, hospitals inquired into just over a third.
The Care Act fails to ensure disabled people’s right to independent living, and swingeing cuts in health, social care and benefits are eroding the availability of support and people’s right to exercise choice and control. Disabled people are confronting the spectre of re-institutionalisation as councils and clinical commissioning groups limit the amount they spend on individual packages of support.
The UN disability rights committee has already reported on the negative impact of the UK’s measures to cut social security spending. Yet further disability benefit cuts continue to be implemented and the extension of punitive sanctions to those hitherto assessed as unable to work is being proposed on the back of declining investment in employment support.
“Nothing about us without us” is the international motto of the disability rights movement, but there is little evidence of disabled people being involved in policy development. The last 10 years have seen the proportion of public appointees with a self-declared disability halve in number, while helpful measures to support more disabled people into politics, such as the Access to Elected Office Fund, have been suspended in England.
Advancing the rights of disabled people requires good leadership to establish coherence and coordination in Whitehall, and in devolved and local government. The Office for Disability Issues was set up for this very task, but has become a shadow of its former self. But in Wales and Scotland, things are more positive, with the convention firmly embedded in policy and strategy.
If the UK wants to maintain the mantle of world leader on disability rights, it must see the forthcoming examination as an opportunity to listen and take stock. If it fails to do so, current and future generations of disabled people face the slow, inexorable slide back towards social death once again.
Three Devon and Cornwall police staff have been cleared by a jury at Bristol crown court of the manslaughter of a man with mental health issues who collapsed while in custody after a heavy webbing belt was placed around his face.
Thomas Orchard suffered a cardiac arrest and brain damage after the belt was held across his face for more than five minutes.
The Independent Police Complaints Commission (IPCC) has been investigating Devon and Cornwall police and senior management for suspected corporate manslaughter.
The Health and Safety Executive has also been looking into whether the force breached health and safety legislation. The results of those investigations are due to be announced soon.
A number of officers also face disciplinary proceedings over Orchard’s death.
The jury’s decision is a huge relief to the three men on trial, who would have been the first British officers to have been convicted of killing a suspect while in custody.
A number of jurors wept as the verdicts of not guilty were delivered. The judge, Mrs Justice Cheema-Grubb, said: “The defendants can be discharged from the dock. Members of the jury, thank you very much for your attention in this case.”
Speaking outside court, Orchard’s parents, Ken and Alison, said: “Today we join a growing group of people who have lost loved ones in police custody and have found no sense of justice.
“Thomas cannot be brought back, but we want his needless death to bring about change. The change we want most is in the attitude of the police, particularly towards those with mental health vulnerabilities.
“The pain for the past four-and-a-half years has diminished us and today is a setback but, on behalf of those vulnerable people and in memory of our Tom, our fight for truth and transparency continues.”
Thomas Orchard trial: CCTV shows police restraining him
Sgt Jan Kingshott, 45, and civilian detention officers Simon Tansley, 39, and Michael Marsden, 56, had denied manslaughter. They argued the force used on Orchard, 32, was proportional and lawful.
Orchard, who had paranoid schizophrenia, was arrested in October 2012 following a disturbance in Exeter city centre and taken to the city’s Heavitree police station.
The officers insisted the US-made emergency response belt (ERB) had been used to stop Orchard from biting or spitting at them and said it was an approved piece of equipment supplied to them by Devon and Cornwall police for that purpose.
The prosecution said the ERB had been wrapped tightly around Orchard’s face when he was carried in a prone position and then placed face down in a cell and had restricted his ability to breathe.
The case raises important questions about how people with mental health problems are treated in custody. According to the IPCC, about half of all deaths in or following police custody involve detainees with some form of mental health problem.
Orchard family: ‘If police had treated this as a medical crisis, Thomas would be alive’
Orchard’s family expressed deep concern at how he was treated.
“I’m completely certain that, had it been picked up as a mental health crisis and taken to a place where that was understood, he would be alive,” Alison Orchardsaid. His sister, Jo, added: “Tom was really, really let down. It was clearly a medical crisis, not a criminal one.”
They are angry at Devon and Cornwall police. Alison Orchard said: “I think I have seen an arrogance and I think I’ve seen them not take this death seriously.”
Deborah Coles, the director of the campaign group Inquest, said: “Irrespective of the verdict, it has been a matter of significant wider public interest that this prosecution was brought.
“Thomas’s death is amongst the most horrific that Inquest has ever seen. Thomas was in crisis and should have been taken to hospital. Instead he found himself bound and gagged with a restraint belt across his face in what must have been a terrifying ordeal.
“At a time when police are calling for more restraint equipment, including spit hoods and Tasers, we need to question priorities. Surely the first and most urgent need must be to train officers to respond safely and humanly to those in mental health crisis.
“We hope that this trial and the immense courage Thomas’s family have shown will help lead to changes in police culture and practice so urgently needed.”
After the hearing the IPCC said it has submitted a report from an investigator who had included the opinion that the three officers acquitted – together with four other Devon and Cornwall police officers who were involved in the arrest and restraint of Orchard – have cases to answer for gross misconduct. The final decisions on whether whether disciplinary proceedings should be brought are under deliberation.
The IPCC continues to examine Devon and Cornwall police’s corporate decision-making about the ERB. Investigators are conducting detailed analyses to fully understand the force’s policies and processes governing its use. An independent expert with a background in health and safety has also been instructed in relation to this matter.
The watchdog identified a risk in the way the ERB was used on Orchard as a spit hood and wrote to all chief constables in England and Wales in November 2012. The letter expressed concern that such use of an ERB posed a risk to the individuals being restrained.
I hate it when people who didn’t know you ask me how you died. As soon as I tell them you were an alcoholic, I know exactly the kinds of thoughts running through their heads. That one word conjures a vivid, stereotypical picture. You were violent. You were neglectful. You weren’t a good mother. I had a horrible childhood. You damaged me.
But that’s not how it was. You were a wonderful mother and I had a golden childhood. You gave me everything a child needs and more. You loved me, supported me, invested your time and money in me and cultivated a deep mother-daughter bond between us. I miss waking up in the middle of the night to find you kneeling by my bed and stroking my hair. I miss the way you took care of me when I was ill. I miss your cuddles and kisses and the strong, heady scent of your expensive perfume.
You really did lead a charmed life. You were married to a good man who provided for you and took care of you. You were never short of money, attention or love. You were the life and soul of the party and people flocked around you. You were strikingly beautiful and unfailingly kind. From the outside, you had it all.
When you were drunk you became nasty and spat out horrible, unforgivable words. It wasn’t like you at all
Yet appearances can be deceptive. You weren’t happy and it’s taken a long time for me to understand why. You always said you loved me more than I could ever understand and you would die for me. But then you did die and it wasn’t for me.
When you started drinking, it was a bit funny. “Oh, Mum’s drunk again,” we would giggle at parties, as you stumbled around talking nonsense. As the years rolled on, it became increasingly less funny. You changed beyond recognition and when you were drunk you became nasty and spat out horrible, unforgivable words. It wasn’t like you at all. I became accustomed to compartmentalising my feelings – the love and respect I had for my mum and the fear and loathing I had of this drunken stranger.
Things progressed badly and the drunken stranger took the steering wheel. My beloved mum gave up the fight. Your marriage fell apart and you lost your home. You were irreparably broken. I was young and selfish and, more importantly, I understood nothing of life or loss.
I’ve spent many years feeling guilty because I didn’t do more to help you. If this happened today, things would be very different. I’m a mother now and used to putting others before myself. I know what I should have done to understand you and help you. If only I could turn back time and be the daughter I should have been, perhaps you would still be alive today. At the time, I did nothing except feel sorry for myself. I blamed you. I was at a loss to understand what you had to be so deeply unhappy about. You had a perfect life and you chucked it all away.
Today, I see you with the compassion of a fellow mother and wife. Life experience has provided me with valuable perspective as to how you really felt. I am able to piece together all the little clues you subconsciously gave me until I can see the whole picture. I have suffered some heart-breaking losses, the first of which was you.
I used to be angry with you for hurting me and then leaving me. I then spent many years feeling guilty and blaming myself for your demise. Finally, I am now able to disentangle myself from all these feelings and treat everyone involved in your story with compassion. If I could have just two minutes with you today, I would take both your hands in mine and say: “I love you and I understand.” Anonymous
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Five portions of fruit and veg a day is good for you, but 10 is much better and could prevent up to 7.8 million premature deaths worldwide every year, say scientists.
The findings of the study led by Imperial College London may dismay the two in three adults who struggle to manage three or four portions – perhaps some tomatoes in a sandwich at lunchtime, an apple and a few spoonfuls of peas at dinner.
All of that is good because a daily intake of even 200g, or two and a half standard 80g portions, is associated with a 16% reduced risk of heart disease, an 18% reduced risk of stroke, a 13% reduced risk of cardiovascular disease, 4% reduced risk of cancer and a 15% reduction in the risk of premature death.
But the study suggests we should be piling up platefuls of vegetables and raiding the fruit bowl every day if we want the best chance of avoiding chronic diseases or an early death.
“We wanted to investigate how much fruit and vegetables you need to eat to gain the maximum protection against disease, and premature death. Our results suggest that although five portions of fruit and vegetables is good, 10 a day is even better,” said Dr Dagfinn Aune, lead author of the research from the School of Public Health at Imperial.
Eating up to 800g of fruit and vegetables – equivalent to 10 portions and double the recommended amount in the UK – was associated with a 24% reduced risk of heart disease, a 33% reduced risk of stroke, a 28% reduced risk of cardiovascular disease, a 13% reduced risk of total cancer, and a 31% reduction in premature deaths.
And not all fruit and veg are created equal. Apples and pears, citrus fruits, salads and green leafy vegetables such as spinach, lettuce and chicory, and cruciferous vegetables such as broccoli, cabbage and cauliflower were found to be best at preventing heart disease and stroke.
To reduce the risk of cancer, however, the menu should include green vegetables, such as green beans; yellow and orange vegetables such as peppers and carrots; and cruciferous vegetables.
The researchers did not find any difference between the protective effects of cooked and raw fruit and vegetables.
“Fruit and vegetables have been shown to reduce cholesterol levels, blood pressure, and to boost the health of our blood vessels and immune system,” said Aune. “This may be due to the complex network of nutrients they hold. For instance they contain many antioxidants, which may reduce DNA damage, and lead to a reduction in cancer risk.”
Compounds called glucosinolates in cruciferous vegetables, such as broccoli, activate enzymes that may help prevent cancer. Fruit and vegetables may also have a beneficial effect on the naturally occurring bacteria in our gut, he said.
Most people struggle to eat three or four portions a day, the study shows. Photograph: Simon Masters/Getty Images/Vetta
And it will not be possible to bottle the effects of fruit and vegetables or put them in a pill, he said. Forget the supplements. “Most likely it is the whole package of beneficial nutrients you obtain by eating fruits and vegetables that is crucial to health,” he said. “This is why it is important to eat whole plant foods to get the benefit, instead of taking antioxidant or vitamin supplements (which have not been shown to reduce disease risk).”
The analysis in the International Journal of Epidemiology pooled the results from 95 different studies involving a total of approximately 2 million people. They assessed up to 43,000 cases of heart disease, 47,000 cases of stroke, 81,000 cases of cardiovascular disease, 112,000 cancer cases and 94,000 deaths.
Aune said more research was needed, but “it is clear from this work that a high intake of fruit and vegetables hold tremendous health benefits, and we should try to increase their intake in our diet”.
Sarah Toule, from the World Cancer Research Fund, said: “This interesting research shows just how incredibly important vegetables and fruit are as part of a healthy diet. In fact, they’re essential for maintaining a healthy weight, which our own evidence has shown reduces the risk of 11 common cancers.
“People should aim to eat at least five portions of vegetables and fruit a day but the more the better. If people find this hard, why not start by adding an extra portion of fruit or veg a day to your lunch or try swapping one of your naughty snacks for a piece of fruit?”
In 1998, Norma McCorvey, the “Jane Roe” in the Roe v Wade supreme court decision, testified before a group of senators about the case fought in her name 25 years earlier. “I am dedicated,” she said, “to spending the rest of my life undoing the law that bears my name.”
McCorvey did become an activist against abortion rights, although she wouldn’t live to see Roe, which in 1973 established a right to abortion, overturned. She died on Saturday in Katy, Texas, at the age of 69.
Knowing the end was near, McCorvey gave her friends and fellow activists a mission the day before she died, according to her friend Janet Morana. “She wanted to tell everyone to continue the fight,” said Janet Morana, executive director of Priests for Life.
But while McCorvey died in a country still shaped by the case that bears her pseudonym, the practical realities of abortion access may more closely resemble the country of her youth than she imagined.
Anti-abortion activists began to chip away at Roe v Wade almost as soon as the supreme court handed the decision down. In 1976, Congress began prohibiting poor women from using Medicaid to cover abortions. Conservative state lawmakers have unleashed a tidal wave of abortion restrictions, such as an Ohio law signed in December, that make the procedure more difficult to obtain. The most effective of these laws forced abortion clinics to close down. Since 2011, abortion clinics have closed at a record pace of more than 30 clinics per year.
McCorvey wasn’t a soldier in the early battles. In the 1980s, she revealed her identity publicly and spent time volunteering in a Dallas abortion clinic and taking part in abortion rights rallies. It wasn’t until 1995, when she converted to evangelical Christianity – later, to Catholicism – that she began to join activists who wanted abortion to be abolished.
For the most part, she was active with religious groups and ordinary people who wanted to see abortion outlawed as quickly as possible. Occasionally, she lent her name to legal efforts that challenged Roe head-on. In 1997, she wrote a friend-of-the-court brief in a long-shot case claiming Roe had led to untold numbers of coerced abortions, and must be overturned.
The most successful contingent of the anti-abortion movement had long since left those tactics behind. In 1984, at a conference sponsored by Americans United for Life, a participant proposed what would become the movement’s most powerful weapon against Roe: laws that allowed the courts to chisel away at its doctrine.
It is a strategy that has proved highly effective. Activists have sufficiently narrowed Roe so that states can require women seeking an abortion to attend anti-abortion counseling; require minors seeking an abortion to receive the permission of one or both parents; require women to wait 24 hours or more before receiving an abortion; extensively regulate abortion after 20 weeks; and block public funding for abortion.
All the while, fewer women have found they needed abortions. This year, US researchers announced that the proportion of pregnancies that ended in abortion had reached its lowest point since the supreme court decided Roe v Wade. The decline was largely due not to new abortion restrictions, they believed – with the exception of unconstitutional laws that forced clinics to close – but to more effective and widely available methods of contraception.
Anti-abortion activists have credited the low abortion rate to the triumph of their tactics and rhetoric, and have largely hailed the Republican takeover of Congress and the White House. The party has historically aided their fight against abortion rights, and its leaders have announced plans to gut widespread access to contraception and place new restrictions on abortion.
All of this, of course, is achieved with an eye toward overturning Roe v Wade. Donald Trump, in his election-season efforts to win the support of anti-abortion groups, promised to appoint judges to the supreme court who would be open to overturning the decision. Many legal experts are skeptical, however, given the amount of precedent that now exists to protect abortion rights, that overturning Roe v Wade is even possible.
With this in mind, anti-abortion campaigners have noted the difference between overturning Roe v Wade and making it as though Roe v Wade had never happened. Activist groups and conservative lawmakers have shown that they can achieve one without the other.
Twenty-one states have laws allowing a parent to all but prevent minors from having abortions. The ban on using Medicaid to cover abortion has foreclosed the option of abortion to at least 1 million women. The closure of half of Texas’ abortion clinics, under a law that was later ruled unconstitutional, caused a 50% drop in abortions in areas where the distance to the nearest clinics suddenly increased by more than 100 miles.
Owing to a record number of clinic closures, thousands of women each year travel great distances for abortions and even cross state lines. An unknown number of women have attempted to perform their own abortions, including some who have tried to do so with sharp objects. The difficulties begin to recall a time before abortion was legal in all 50 states.
Two years ago, one abortion provider reflected on the changes, saying: “Sometimes, I feel like I’ve gone back 40-some years.”
The maintenance worker found the woman just before 2pm. She had made her way inside the parking garage in downtown Portland, Oregon, and now stood in the corner of the second floor, mumbling something the worker could not understand. The temperature was about 18F (-7C) with a wind chill. The woman started to remove her pants, a common reaction to severe hypothermia.
He ran to get help from a parking attendant, but by the time they returned, Karen Batts was lying on her back, naked from the waist down and unconscious.
Outside in America
At 2.16pm, medics called Portland police to notify them that Batts, 52, was dead. Within days it would emerge that, months earlier, she had been evicted from her apartment, in part because she had been unable to pay $ 338 in rent.
The death of Batts on 7 January has shaken Portland like few other events in recent memory.
The city’s image of itself as a bastion of liberal values and affable quirkiness is increasingly undermined by the plight of its homeless residents. Amid unusually brutal weather, Batts was among four homeless Portlanders who died of exposure in the first 10 days of 2017.
In the same period, a homeless woman was found holding a dead infant at a bus shelter; the medical examiner ruled it a stillbirth.
The toll on the city streets is rising with each passing year, up from 47 in 2011 to 88 in 2015. Of the recent deaths, Batts’s appears to have resonated the most. And while her death made headlines, a deeper investigation of her story raises difficult questions about whether Portland is failing its neediest citizens.
The SmartPark garage in downtown Portland, where Karen Batts died. Photograph: Jason Wilson for the Guardian
About five miles from where Batts was found, there is a white craftsman cottage in the middle-class, rapidly gentrifying Hollywood neighborhood. The mantelpiece in the living room is laden with family photos, including one of Batts, a studio portrait taken almost a decade ago at JC Penney. Her smile is broad and unforced. Her hair, in long ringlets, is just beginning to gray at the temples.
The cottage is home to Batts’s mother, Elizabeth, 77, and her brother, Alan, 53. The family knew that Batts’s health was declining. The last time Alan saw her, “she had her fingers in her ears to keep out the voices in her head”, he said. “I asked her if she wanted me to hug her and she said she didn’t want me to touch her.”
But it seemed impossible to do anything. “I was trying to help her,” he said, “but I just kept getting resistance.”
I was trying to help her, but I just kept getting resistance
Batts was born in 1964 in the German town of Heidelberg, while their father was serving in the US army. They returned to Portland when she was six years old, a mixed-race child in a town where African Americans were just 6% of the population.
At Grant high school she was a vivacious, outgoing cheerleader. She loved to dance. Even then, there were signs of what lay ahead. Her mother would find “little jars of spit-up” around the house. Later the family realized that she had an eating disorder, but at the time “I didn’t know what that was,” Elizabeth recalled.
Batts graduated with honors in 1982 and enrolled at Fisk University, a historically black college in Nashville, for a pre-dentistry course. Although she received several small scholarships, it became unaffordable and she dropped out after her first year. She came back to Portland and took intermittent classes at Portland State but was unable to finish the degree.
From then on, Batts drifted between short-term jobs and unstable housing arrangements. The family found it hard to keep track. “She lived in maybe 20 places” from the early 1990s onwards, her brother said. A comment that Batts once made to her mother revealed her mental disarray: “Don’t say too much in the apartment, they can hear me over the sprinkler system.”
Elizabeth and Alan Batts at the family home. Photograph: Jason Wilson for the Guardian
In 1995, she went missing altogether, leaving her brother to put up flyers all over the city. When she returned after a few months, she telephoned and acted as though nothing had happened. The family suspects that she was homeless between 2000 and 2002.
Batts’s illness came to a head in December 2003, when she was found unconscious on a Portland street with alcohol poisoning. She was committed to Oregon State Hospital for a year.In 2004, having recovered sufficiently, she moved into a suburban halfway house.
She would never hold down another paying job and survived on disability benefits. At some point she was diagnosed with schizophrenia.Still, taking her medication and attending addiction meetings, it seemed like Batts had regained a measure of control over her life.
Batts spent most of her last decade in a downtown building for seniors and people with disabilities, owned by a nonprofit called Northwest Housing Alternatives, or NHA. For most of her time there she was stable – well enough, even, to join a family vacation to Hawaii in 2009.
Yet years later something tipped her off balance. Her brother theorizes it was when she stopped taking her medication.
Martha McLennan, the executive director of NHA, said that Batts started displaying serious behavioral problems in early 2016. She caused “damage, disruptions and hazards of different types”, such as entertaining rowdy guests, and was apparently consuming wood alcohol. Police records indicate that Batts was the victim of an assault.
As she racked up lease violations, on-site staff tried to connect her with mental health services, but Batts declined to engage with them. McLennan said there was nothing else they could do. “We’re a housing organization, not a mental-health organization,” she said.
Alan also pushed to get help for his sister, but she often refused visitors, including him. He called various county authorities and services, but each time found himself stymied. Police spoke to her through the door and did not consider her a danger to herself.
333 Southwest Oak, in downtown Portland, from which Karen Batts was evicted last year. Photograph: Jason Wilson for the Guardian
In September of last year, Batts received an eviction notice over her erratic behavior and failure on two consecutive months to pay rent.
Batts did not attend her eviction hearing, and on her last day, 27 October, the sheriff’s department was called to provide an escort off the property.
McLennan said that such evictions on NHA properties are rare and usually prevented. “She was evaluated for a mental health hold a number of times,” McLennan said, but “the standard required is a really high bar.”
Batts fell into an impossible middle ground, according to McLennan: healthy enough to refuse help, but perhaps too sick to recognize that she needed it.
“She didn’t really have the capacity to make positive choices, but the system says she has the right to make bad choices.”
It is not entirely clear how Batts spent her final months. But it appears she drifted into Portland’s homeless population, only occasionally attracting attention from law enforcement.
In early November, police found Batts in the middle of the street in a run-down part of downtown. She wasn’t wearing a jacket, shoes or pants.
As they got closer, they realized that she had been consuming hand sanitizer. “She was drinking it to keep her mouth clean,” according to a police report of the incident. “She had several bottles on her person.”
The police took Batts to the hospital, where she was placed on psychiatric hold. But soon, for reasons that are not fully clear, she was let back out onto the streets.
The following month, she received a ticket for sleeping on the train. The month after that, she would find her way to the parking garage where she died.
A Multnomah County investigation is under way into Batts’s death, involving what it calls a “full system analysis”.
McLennan said her organization has done some “soul-searching” since Batts’s death. “If things fall apart again, what systems are there to provide resilience? If someone doesn’t have strong systems, what is going to catch them?”
She also said she regrets the eviction. “But given the same set of circumstances, would it have the same result? You know, there’s a point at which we have to look after the interests of the neighbors and the property.”
Instead of laying individual blame, onlookers condemn a fragmented web of social services that prevents even the most well-intentioned from averting tragedy. “I am angry all the time, justifiably so,” said Benji Bao Vuong, a Portland activist. “There is no holistic, integrated treatment for the houseless person.”
A spokesperson for Portland’s new mayor, Ted Wheeler, defended his record, noting that the city opened 750 additional beds during the severe weather and that nobody who sought shelter was turned away.
Housing and homelessness were already hot-button topics in the city, but since the deaths there is a sense of greater urgency. Wheeler has co-sponsored an ordinance that will compel landlords to assist with relocation costs for tenants subject to no-cause evictions.
Back at the Batts family home in the Hollywood district, Alan, who spent 11 years in the air force and is a calm and steady man, struggled to control his emotions as he remembered his inability to help his sister. He recalled the last time he saw her alive, about a year before she died. They were walking together to a local train station.
“She asked me for a cup of hot water,” he said. “She didn’t drink tea or coffee, she just wanted to warm her hands.”
He watched as his sister walked into a bank where there was a counter offering drinks. She got what she needed. Then she walked away.
