Thursday 18 December 2008

Holiday Suicide Myth Debunked

One of the goals of this blog is to provide evidence-based information about adolescent mental health. Scientific evidence helps us confirm truths and debunk myths. A recent BBC article looked at some Christmas myths debunked by the British Medical Journal. One of the myths the BMJ busted is the belief that suicides are more common during the holiday season and winter months.

"The combined stresses of family dysfunction, exacerbations in loneliness, and more depression over the cold dark winter months are commonly thought to increase the number of suicides," said Dr Vreeman. But, although the holidays may be difficult for some, there is no good evidence to suggest a peak in suicides. Also people are not more likely to commit suicide in the dark winter months - around the world suicides peak in warmer months, the researchers said.


Some of the other myths debunked in the article were: there's no cure for a hangover, eating late does not make you gain weight, and sugar doesn't make you hyperactive.

 ~ D. Venn

Monday 15 December 2008

Child and Adolescent Mental Health Services Review: Why Understanding First Onset is Important

Medical News Today, in mid-November carried a short story on the recently released Child and Adolescent Mental Health Services (UK)review.

The report, which contains 20 recommendations for Government, sets out a clear vision for how we can all take responsibility for promoting children’s psychological well-being and mental health and how we can best achieve a step change in the quality and consistency of services at all levels.
While there is much in this review to discuss – some excellent and some less so, I want to focus on one of the recommendations that addresses, (in part at least), the needs of youth – ages 18 to 25. Congratulations – and it’s about time!

I remember sitting as a member of what was called the Transitional Age Task Force in Toronto in the mid 1980’s (so the UK report is only 20 years later – but at least they got to it which is more than I can say for much of Canada) and working with various stakeholders to consider how to address the mental health care needs of youth in this age group.

At that time the research was just coming in, and it was showing that the majority of what had traditionally been considered to be “adult” mental disorders actually onset during the late teens and early twenties. Furthermore, nascent brain development research was identifying substantial neurodevelopmental processes underway during those years – problems or perturbations in which (such as defective pruning of dopamine receptors) was being linked to major illnesses such as schizophrenia and bipolar disorder. Indeed, we re-designed our “adolescent psychiatry unit” at Sunnybrook Hospital to address this age group and did not know that we were in the vanguard of the “first onset” movement.

So if such a high proportion of major mental disorders (for example: depression; panic disorder, social anxiety disorder; bipolar disorder; schizophrenia) onset during these years, why have we not designed services to meet these needs. On the contrary, traditional mental health services have hacked a gap between child and adult systems just when the need for continuity and integrative care was most necessary. Why do child mental health systems across Canada cut off around 17 – 18 years of age? What reason is there to send a young person with unique developmental needs who is struggling from the impact of a recent onset major mental illness to an “adult” program that is not designed to meet her or his needs? It simply makes no sense!

And, just before we get too complacent about this and say something silly such as “the research is only just coming in” let's remind ourselves that the ancient Greeks had already noted this. So did the father of modern psychiatry Emil Kraepelin and the father of the study of adolescence – George Stanley Hall (the later two over 100 years ago – the Greeks of course were on to this centuries ago).
Whatever the reasons, and they would be speculations, it's time now to throw out a system that does not meet the mental health needs of young people and replace it with one that does. The CAMHS review is a good start at the policy level. There are good pilot programs in Canada and in Australia under the leadership of Dr. Patrick Mcgrory there is a national initiative well underway.

I propose that we have a national forum on this topic – and invite some international leaders and some of the young people that we had the privilege to serve in Toronto some 20 years ago and some of the young people that we are not serving well now. Perhaps now is the time.


~ Dr. Stan Kutcher

Sunday 14 December 2008

The Complexity of Youth Suicide and Prevention

There's a lot of misinformation out there about youth suicide. Suicide rates in young people nationally have decreased by about 20% from the mid 1990’s to 2004. Nova Scotia is a good case study. It is difficult to determine trends in youth suicide in Nova Scotia because of the small numbers involved, but total suicide rates as well as total suicide attempts in this province have decreased substantially between 1995 and 2004.

Why this has occurred is not clear. One explanation is that effective treatment of depression in young people may be an important factor. Studies have demonstrated a strong relationship between increased use of antidepressant medications and decreased suicide rates in youth. Evidence shows that both medications and psychological therapies decrease rates of suicide attempts in depressed youth. Recent research reports in both Canada and the USA indicate that when anti- depressant medication treatment in young people has decreased, suicide rates have increased. Treatment of depression in young people may effectively reduce suicide rates. 

Suicide behaviour is complex. Not all self-harm behaviours are suicide attempts. Self-harm behaviour in young people may not be related to suicide, but rather to deficient problem solving strategies, difficulties with emotional control or impulsivity. It is only recently that we have understood the need to differentiate the two in how we collect data. Treatment for young people who demonstrate self-harm behaviours may be different than treatments for youth who attempt suicide.

Self-harm behaviours reflect many mental disturbances and may be an important vehicle by which young people can access emergency care. Thus, increases in self-harm emergency visits may not reflect an increase in suicide as has been erroneously suggested, but may reflect other phenomenon such as: greater parental awareness of the importance of immediately addressing these behaviors; difficulty in access to specialty mental health services; inadequate delivery of child and adolescent mental health care in primary care; inadequacies in the capability to provide early identification and interventions for youth at risk for mental disorders; or others.

Suicide in young people is a complex problem that requires thoughtful, evidence-driven approaches to appropriately address. It is also an emotional issue raising substantial concern amongst parents, youth, care providers, policy makers and the public alike. There are some interventions that we know work to decrease suicide rates in young people.

One of the most important is improving the early identification and effective treatment of depression in youth. This includes enhancing the competencies of primary health care providers (doctors, nurses, social workers, psychologists, etc) in the diagnosis and treatment of adolescent depression. Training programs for school personnel including “gatekeeper” programs for teachers and linkages between schools and health providers to facilitate identification, rapid assessment and effective treatment may also decrease youth suicide. Restriction of access to lethal means (such as bridge barriers) is helpful as is reasonable and informed media reporting.

Youth suicide is an important public health problem. We must work together to better understand it and to apply what we know works. We need to avoid inciting public anxiety through media reports that are not based on a solid understanding of the issue and we need to support the further development of easily accessible and effective mental health care – not just in hospitals but in schools and community settings. We need to do the right thing – not just do something!


~ Dr. Stan Kutcher

Wednesday 10 December 2008

Myths about Mental Illness

In the past decade we've come a long way in understanding mental illness, but we still have far to go. Dispelling myths about mental illness is one important step. Stigma about mental illness is still largely present in our social structures and institutions – including our health, social services, education and justice sectors. An October article in Canadian Living explored ten common myths about mental illness

One of the myths focused on children and adolescents:

Myth: Children don't get depression or other mental illnesses; their emotional problems are just part of growing up. Parents naturally want their children to do well, so some may brush off or explain away behavioural problems or other childhood difficulties as being mere growing pains. However, numerous psychiatric conditions, including depression, eating disorders, obsessive compulsive disorder and anxiety disorders, can and do occur in childhood, according to Kutcher. The U.S. Center for Mental Health Service reports that one in every 33 kids and one in every eight teens suffers from depression – and that's just one disorder.


Enhancing our knowledge and understanding about mental illness is one of the best ways to dispel these myths. ~ D. Venn

Monday 1 December 2008

Evidence-Based Medicine and You

Evidence-based medicine (EBM) is a term that has become widely used in health care settings. But, what exactly is EBM and what does it mean for you?

EBM is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. The “best evidence” comes from the more than 20,000 scientific research studies that are published every year, and “patient care” involves everything from diagnosis to treatment.

EBM is not just a recipe for treatment (e.g. every 15 year-old male with depression is not automatically prescribed the same medication). It is a methodical approach to patient care that is comprised of three components: the scientific evidence, the expertise of your health provider(s), and you.

EBM “integrates the best external evidence with individual clinical expertise and patients’ choice”  to ensure that patients receive the treatment that best meets their needs. Evidence-based medicine goes beyond treatments. It also applies to how patients are assessed, diagnosed, monitored, and followed over time.

When we are unwell, it is often difficult to tell what has caused the problem and what can best help. Imagine that you are ill for a few days with a sore throat and cough. When your condition improves, you might wonder what made you feel better. Was it the bedrest, the cold medication, the chicken soup, or was it simply giving your body enough time to fight off the illness? And what if your friend gave you a “secret remedy” made from milk, cognac and grass? Is that why you feel better?

Before you spend time and money on a treatment, you might have a lot of questions. You might want the best information about whether the treatment works, how well it works compared to other treatments and what possible problems can result from the treatment. You should be aware of possible problems (such as the types of side effects that might
happen, the cost of the treatment and the difficulties in taking the treatment) that may occur when you and your health care provider are deciding which treatment you should have.

The ultimate goal of EBM is to help patients receive the treatment that is most appropriate for them. This means finding a balance between the scientific evidence, the patient’s values and the experience of their health provider(s).

Remember, people can respond differently to any given treatment, so it is impossible to know exactly how you may respond. However, at least you can know what the chances are that you might be helped or harmed by a given treatment. This can help you, your doctor and other health providers come to a better decision about what treatment is right for you.

To help understand evidence-based medicine the Chair has developed a guide for patients. Feel free to download it from our website and use it to help you make the best decisions about your health care.

A teen version of this guide will be available sometime soon!

~ Dr. Stan Kutcher

Thursday 27 November 2008

Medications and Mental Disorders in Young People

The recent Globe and Mail piece on mental health concerns pertaining to children and youth strikes many correct notes, but unfortunately also incorrectly hits a few important “major chords”, particularly pertaining to the use of medications to treat mental disorders in young people.

Contrary to much popular opinion, there is a rich and scientifically sound data set pertaining to the effective use of medications to treat specific mental disorders and also specific symptoms that are found in some mental disorders. Indeed, there has arguably been much more rigorous first order clinical trials research conducted in medications use than in any other treatment modality in this population.
For many mental disorders, the use of medications is an essential (albeit not sufficient intervention) that helps control symptoms and promotes recovery. Unfortunately, public understanding of the medication use issue in the treatment of mental disorders in young people falls far short of the scientific evidence that supports this intervention. It is not uncommon to read reports about the increase in medication prescriptions to treat mental disorders over the last few years, and usually this data is negatively portrayed. Frequently the media issue focuses on the presumed “over-use” of medications.
Now, we know that diagnosis and treatment of mental disorders in young people has been a concern for decades. Fundamental to this concern has been the finding that these disorders have been under-recognized and under treated. This sorry state of affairs has been slowly changing. Today more young people are being appropriately diagnosed and treated for their mental disorder. However, now when we find the statistics increasing for both diagnosis and effective treatment, there is criticism that this increase is somehow alarming and to be feared.

Did you know that the use of medications in young people to treat asthma and diabetes has increased more than the use of medications to treat depression over the last few years? Do we read sensationalized reports of “over-medication” for diabetes? No we do not – quite the opposite. Publicly we are concerned about the increasing rates of diabetes and we want to address this problem effectively and comprehensively. So we advocate for better diet, more exercise and earlier diagnosis and treatment with medicines that help control blood sugar.This is different than what happens when we publicly address the issue of treatment for mental illnesses. In their case we seem to criticize the use of treatments known to be effective. This is quite the difference in approach, so we need to begin to wonder why.

I am not saying that medications are always properly prescribed and properly used in the treatment of children and youths living with mental illnesses. That is clearly not the case.And the proper use of these medicines needs to be improved. There is a great need to provide better education to doctors and all other health providers about how to best and most properly use medications to treat mental disorders in young people. We also need more research to help address some of the issues that we have not yet fully understood and we need to develop more sophisticated research studies that compare and contrast the use of medications with other forms of treatment so that we can get the complexity of care needs better understood.

So, I wonder why. Could it be that we as a society still somehow hold the fantasy that mental disorders really do not affect young people and thus they do not need medical treatments?Could it be that we hold invalidated beliefs about what works in the treatment of mental disorders in young people – a sort of herbs and spices model that we abandoned for such childhood diseases as cancer and diabetes long ago? Could it be that we do not really know the correct information about appropriate or inappropriate medication use and instead of trying to find out are just happy being intellectually lazy? Could it be that our understanding of brain function and brain development is so uninformed that we assume that any kind of medication that affects brain function will have more negative than positive effects but that for some unknown reasons other interventions, which also affect brain function, are somehow uniquely spared such concerns? Or could it be that we still hold a very very very strong stigma against children and young people that are mentally ill – and as a result would deny them access to properly researched and properly provided treatments?

These are serious issues. I will address a number of the important issues around medication use in young people in the next few blogs – starting with this: what does it mean for a medication to be used “off label”? Keep your eye on this space! If you want more info check out our evidence-based medicine guide for patients.


~ Dr. Stan Kutcher

Monday 24 November 2008

Broadening the Spectrum of Stories about Mental Illness

This week the Globe and Mail is revisiting the issue of Canada's mental health crisis in a week long expose. Saturday's article addressed child and youth mental health. Kudos to Anderssen and Picard for bringing attention to an issue that is often underreported and often misunderstood by mainstream media outlets. The piece has some important points to make - most notably about the absurd double-standard we have about mental health care in this country:

"If only one in six adults who needed a hip got one, there would be a revolt," says Simon Davidson, a psychiatrist at the Children's Hospital of Eastern Ontario. "So how can we tolerate a situation where one in six sick children get care?"

The article also successfully highlights the many ways that mental illness affects all aspects of a child's life, especially relationships with parents and teachers. The complexity of understanding mental disorders in children and youth, as well as the complex health systems in place for youth to get help are indeed barriers that need to be addressed.

"Most young people with mental illness suffer in silence ... Sometimes their parents are oblivious, or put it all down to a phase. But often their families suffer with them, unsure of where to turn in a system bogged down by turf wars, waiting lists and funding shortages."

The need to address mental health problems early in is also clear. Dr. Waddell's metaphor is apt: "If we wait until adulthood to treat these problems, it's like using a teacup to bail out the boat". However, for all the positive points addressed in the article, the authors somewhat undermine their own message by using language that only seeks to enhance the stigma associated with mental illness. By telling the stories of youth who have "violent rages", and by using phrases like "locked in their rooms, cutting themselves, crying and plotting suicide", and suffering from some kind of "Dr. Jekyll and Mr. Hyde" syndrome, the authors are not providing a very balanced viewpoint about youth with mental disorders. The challenge is to give mental illness a "face", without giving it a face that paints a very extreme picture of what people with mental disorders experience. So much of the public understanding of mental illness is informed by these extreme pictures - people who are violent, out of control, hallucinating, etc. - when in reality people who experience those episodes comprise a very small percentage of the population. if we are truly going to normalize and destigmatize the issue of mental illness we need to start telling stories from different perspectives that reflect the wide spectrum of experiences that youth and families dealing with mental illness have.

 ~ D. Venn

Monday 17 November 2008

Depression is not just being Blue


Everyone feels low or sad sometimes. Often those feelings are in response to a negative event or life problem. Those feelings are perfectly normal. Indeed the ability to experience these emotions may be an essential part of what it means to be human.

These feelings will frequently lead to changes in our behaviour. That is, they help us adapt to our environment – often by enhancing our use of social supports. That is why we feel better when a friend, parent or family member gives us a hug or spends quality time with us. These feelings can also be helped by us seeking out and participating in activities that we usually enjoy.

Sometimes we feel low or sad for no reason. This is also normal. Our moods fluctuate over the course of a day, monthly and yearly. Spontaneous mood changes may be more pronounced over the teen years but everyone has them. These changes are short-lived, do not lead to pronounced social, interpersonal or job problems and usually go away as mysteriously as they came. When these feelings are there you can help them leave by hanging around with people you care about, exercising, listening to music or doing things you like to do.

Unfortunately, we often refer to these normal feelings as depression. This is a shorthand for a whole host of different emotions, including the following: despondent, distressed, despairing, demoralized, disturbed, frustrated, blue, sad, low, etc. Not only does the use of the shorthand “depression” to mean all of the above detract from our ability to communicate the rich nuances of our feelings, but the word depression used as a substitute for these normal feelings can be confused with the concept of clinical depression – which the word depression could be reserved for.

A clinical depression represents a failure of brain adaptation. Unlike feelings of sadness, distress, despondency, etc. which signal brain adaptation, a clinical depression describes a state of being in which a person’s functioning is impaired – that is, they cannot do what they usually do because of how they are feeling. Fundamental to understanding a clinical depression is the decline in functioning that it causes; such as, poor performance at school or at work, problems in interpersonal interactions, social withdrawal, etc.

Unlike the usual and common feelings of sadness, despondency, distress, etc. which are often alleviated by increased positive social interaction or usual enjoyable activities, a clinical depression will usually require a more specific and sustained intervention – usually a psychological or biological treatment. That does not mean that doing things that usually make you feel better (for example: talking with friends, exercising, etc) are not helpful – on the contrary, they may well be. What this means is that for clinical depression these interventions are unlikely to be helpful by themselves. If someone is living with a clinical depression they usually require professional help – from a therapist or physician. These professional helpers will provide additional specific treatments that have undergone rigorous empirical scientific evaluation and have been generally shown to be effective in promoting recovery from the clinical depression.

In addition to the functional impairment, a clinical depression differs from usual low moods in many ways. The low feelings must be persistent and sustained; there is a marked loss of interest or pleasure; there are substantive and persistent feelings of worthlessness or hopelessness; there is often fatigue, lack of appetite and sleep difficulty and there frequently are persistent ideas about suicide or even suicide attempts. Clearly, this state is not a brief response to environmental adversity or a temporary blip in mood.

So, depression is not the blues. Personally, I would really like to see us get away from using the word depression as a shorthand term. So instead of saying “I feel depressed because my boyfriend broke up with me” say instead “I feel distressed (or unhappy, or pissed off, or hurt, or despondent, or whatever) that my boyfriend broke up with me”.

Let's start using the rich lexicon of our language to identify the varied and nuanced expressions of our moods.


~ Dr. Stan Kutcher

Wednesday 12 November 2008

Studying the Brain from the Inside Out

Ever find one of those websites you just can't stop going to? A few months ago a friend sent me a link to TED - an annual conference devoted to technology, education and design. Now I'm hooked. Their site contains hundreds of archived talks from some of the world's premiere thinkers and doers. One of the most inspiring talks on the site is by Jill Bolte Taylor, a brain scientist who had a massive stroke and was able to watch and experience as her brain functions shut down one by one. It's a pretty amazing story and gives insight into just how complicated the brain is. Often it's not until something goes wrong that we think about brain health, and how it's just as important to keep our brains healthy as it is to keep our bodies healthy.

When the brain is not working properly or is working in the wrong way, a person may experience difficulty thinking or focusing attention, extreme emotional highs and lows, or sleep problems. When these symptoms significantly disrupt a person’s life, we say that the person has a mental disorder or a mental illness.

While we know that mental disorders are brain disorders, Jill Bolte Taylor's story is an example that brain problems do not always indicate mental illness.


~ D. Venn

Friday 7 November 2008

Enhancing Successful School Learning by Understanding How the Brain Works

There is no health without brain health. A healthy functioning brain is the foundation for all successful learning, social, civic and economic development. The school environment is an important component of healthy brain development. Just as schools are locations in which physical health can be encouraged and improved, so are they locations in which brain health can be encouraged and improved.
How and when a young person's brain develops affects how they learn. An understanding of how a young person’s brain functions may help us better create brain-healthy environments and educational approaches that can enhance learning outcomes.

The human brain is the most complex entity in the universe. It has more connections than there are stars in the Milky Way. It is the organ of adaptation and of civilization. What we are, what we think and what we do, as individuals and as a human species are the outcomes of how our brains work. That in turn is influenced by a variety of other factors including our genetic endowment, the way our brains naturally develop over time, and the impact of the environment on the way our brains develop and on how they work.

The adolescent years (puberty to about age 25) are characterized by a second major period of brain development (the first is during the early years of development). New brain connections are developed, old connections are pruned, and complex systems that guide emotional integration, motivation, craving-induced behaviors and the capacity for good executive functioning (impulse control; problem solving; empathic/cognitive integration; etc.) come online.

These neurodevelopmental changes continue to be guided by both genetically-determined neurodevelopment and by environmental influences. As this development occurs a number of challenges are presented to the school setting. Some of these include the following: how to structure the school environment to improve learning potential; how to best motivate for learning; how to present materials to enhance uptake and retention; how to address brain dysfunction or brain disorder to best support the students with those disabilities.

The adolescent years are also characterized by the onset of the severe and persistent mental disorders, such as major depression; schizophrenia; bipolar disorder; panic disorder; social phobia and others.

Schools can provide curriculum on brain health and brain disorder to help decrease the stigma associated with these conditions and to help students identify these problems early when interventions can make the greatest positive impact. Teachers should be well versed in knowledge about and understanding of these issues and training institutions and ongoing continuing educational programs should be in place to enable teachers to acquire the knowledge and competencies needed.
The recently developed Secondary School Mental Health Curriculum and its accompanying teacher training module is a good example of this application. Schools could provide linkages to appropriate health care services and can become community resource centers that provide information on a variety of health related matters – including brain health and mental disorders.

In summary, neurodevelopment is directed by a genetic blueprint and modified by the environment. Schools are uniquely placed in a situation in which they can shape the developing brain by applying brain-healthy environments. Additionally, neurodevelopmental factors can be better understood and this better understanding could result in the creation and application of various educational strategies that can be applied in such a manner as to enhance learning outcomes.
Further information: Dana Foundation, Brain ExplorerBrainBlogger


~ Dr. Stan Kutcher

Monday 3 November 2008

What is Health 2.0?

Web 2.0 has been exploding over the past few years. Simply put Web 2.0 is a an innovative, creative and collaborative way to share information on the web using tools such as social-networking sites, video sharing sites, wikis, and blogs.

Because of the constant changing nature of the internet, Web 2.0 is also constantly changing to meet user demand. It's application is expanding to sectors beyond marketing and business. One of these expansions it into the health care sector.

Health 2.0 is an emerging concept of health care that uses web 2.0 technologies to promote collaboration between patients, physicians, health care professionals, and other members of the health community. It's application is ever-changing, and the evidence for its effectiveness is still raw, but there's a lot of potential for this type of new technology to improve mental health education and mental health care.

For more info check out Chris Paton's blog, Health 2.0 Conference and Medicine 2.0 Conference.

~ D. Venn


Thursday 30 October 2008

What is Knowledge Translation?

Knowledge translation (also known as KT) is one of those important things that has been going on since the dawn of time, but has now been given a name and a scientific grounding. Many things that we have learned have been from knowledge translation - someone who “knows” has taken that knowledge and put it into a format that helped us learn. This is great as long as the knowledge is correct.

But what happens if it is not?

We could learn something that will not be of maximal value to us and may even be unhelpful or harmful. So here is where the science of KT comes in. Over the last few years a methodology for doing KT has been developed and extensively tested. It consists of systematic and reproducible techniques of finding and evaluating all the available knowledge on any particular topic or issue. These techniques are necessary because all information out there is not of equal quality - some is better and some is much better than others. Some may be more likely to be correct and some more likely to be wrong. The techniques used to evaluate the information are very stringent and have been developed to try and ensure that when the information is synthesized the syntheses is more likely to be correct than not correct. So knowledge will have been translated from scientific studies into a common and more certain bundle of information.

Then the next step comes in — taking that bundle of information and putting it into a format that meets the needs of various users. Because what good is KT if it is not used by people to improve what they are doing and to better understand the world around them?

The Sun Life Chair group does both kinds of KT. We conduct systematic literature evaluations and critical analysis to provide the best available evidence on a variety of topics. For example, one recent topic was that of school-based programs designed to prevent suicide. Guess what we found — although there are many such programs (and I think that some people are making quite a bit of money by selling them) there is very shaky evidence that any are effective.

Indeed, we could not find one that clearly demonstrated it decreased suicide rates in young people! So this is very important information for people making health and education policy and for people who want to buy some of these programs. We think that it’s better to use those things that work instead of those things that do not work or that we do not know if they work or those things that may be harmful.

I recently filmed a video with Insider Medicine talking about knowledge translation. Check it out for more info.

Cheers - Dr. Stan Kutcher

Wednesday 22 October 2008

Teen Mental Health Blog - Our Mission

Teen Mental Health Blog is alive!

Our mission is to become the world’s premiere blog for child and youth mental health. Most of the entries will be written by me - Dr. Stan Kutcher. The blog be a place where people can come to get the latest news on youth mental health issues (policy, mental disorders, medications, school mental health, etc.)

This blog is part of teenmentalhealth.org a website dedicated to helping improve the mental health of youth by the effective translation and transfer of scientific knowledge. The website is a place where youth, parents, patients, educators, and health professionals can go to download resources and get information on youth mental health based on the best scientific evidence available.

 

Wednesday 8 October 2008

Facing mental illness: a 10-step plan for Nova Scotia

What does the face of a person with mental illness look like?

That question is at the heart of this year’s national anti-stigma campaign "Face Mental Illness," which is the theme of Mental Illness Awareness Week (Oct. 5-11). In Canada, one in five people is living with a mental illness. Mental disorders are some of the most disabling medical conditions, with about 70 per cent of them onsetting prior to age 25. They exact a huge negative impact on health, society and our economy. Yet a strong and persistent stigma prevents thousands of adults and youth from accessing and receiving the help they need to get well and say well.

While the scientific understanding and treatment of mental disorders and the awareness of the importance of mental health in all aspects of life have advanced considerably in the past decade, the public perception of people with mental illness has been much slower to change. A recent national survey conducted by the Canadian Medical Association found extremely high rates of stigma against those who suffer from mental disorders, permeating all aspects of Canadian society. This stigma is largely present in our social structures and institutions – including our health, social services, education and justice sectors.

Stigma is essentially the polite word for discrimination. There is no room in our caring society for discrimination against those living with mental illness. There is no reason for those living with mental illnesses to be denied adequate housing or equitable health care or to spend their lives in the shadows.

The recently established Mental Health Commission of Canada has announced that it will be addressing stigma against the mentally ill through a national strategy. However, Nova Scotians should not need to wait until a national strategy is unveiled to begin to address the complex issues that need our attention. We could start with these 10 steps to immediately begin to improve mental health and the care for those who suffer from mental disorders in this province:

1. Establish a consensus that promotion of mental health and recovery from mental disorders should be the framework for the development and delivery of mental health care across the province.

2. Establish a child and youth policy and plan that commit to providing equity in health access to all young people suffering from mental disorders.

3. Enhance funding for treatment of those with mental disorders, basing all interventions on best available scientific evidence.

4. Address youth needs as the cornerstone of mental health promotion and prevention activities. Focus these activities in schools and community organizations and link these to enhanced community based mental health care capacity for young people.

5. Support the creation and distribution of mental health literacy programs to enhance knowledge for the public, professionals and policy-makers alike.

6. Allocate a specific portion of the Nova Scotia Health Research Foundation funding for mental health research – especially in areas traditionally receiving little research support.

7. Establish innovative community-based and supported housing that meets the needs of the mentally ill – and link this to the development and delivery of peer support training for those who wish to obtain it.

8. Establish novel competency training programs to upgrade the mental health treatment skills of all health providers – so people with mental disorders can get their care from the same people who look after their diabetes, cancers and heart disease.

9. Establish youth engagement and intervention programs that will prevent young people from ending up in jails, and establish mental health courts for all offenders who are currently rotating through the legal system.

10. Accelerate the process of de-institutionalization of those who have mental disorders and ensure that sufficient acute and long-term care resources are available in usual health care locations instead of stand-alone mental health facilities – thus decreasing the stigma of receiving mental health care.

Societies are judged by how they treat their most vulnerable citizens. Nova Scotians are too good a people to continue ignoring the needs of our brothers and sisters, husbands and wives, friends and neighbours because they live with mental illness. It’s time we faced the issue and did ourselves proud.