Back to School

Recent newspaper articles and electronic media stories have drawn attention to the relationship between going to university or college and mental health problems and mental disorders. In both the USA and Canada this has been headline news.

It is really difficult to tell if the rates of mental health problems are going up or not but it is true that between the early 1990’s and early 2000’s, suicide rates have fallen. This has been closely associated with better identification and treatment of young people with mental disorders.

Certainly there is a clear need for universities, colleges and other institutions of higher learning to actively promote mental health literacy and provide contextualized information known to enhance knowledge and help seeking behavior for their students. Across Canada, over 30 institutions of higher learning have done so – using the “Transitions” program developed by our group. 

What is confusing to me is why so many have chosen not to do so, or have tried to reinvent the wheel by developing one-offs of undemonstrated value but with local small “p” political appeal. In my opinion this once again illustrates why it would be a good idea to have a single point national clearing house for mental health programs. But not just any kind of clearing house – one that only includes programs for which there is substantive evidence of effectiveness and cost effectiveness. Both are needed. And, this is not a “best practice” list of programs. I for one would like to see the whole idea of “best practice” scrapped and replaced by the framework of “best evidence”. I have seen to many “best practices” unable to demonstrate substantive value while at the same time costing us dearly in both implementation and opportunity lost.

This could surely be a role of the Public Health Agency of Canada. But it will take a bit of reforming to ensure it is responsibly carried out.

--Stan

Human rights, gender issues and suicide

The tragic story of Tyler Clementi’s suicide is well known to many by now . It was an event, not improved by the media circus that has erupted after it. And it raises a number of fundamental issues. Here are three that come to mind, I am sure that there are more.

First: human rights. The secret video and its subsequent broadcast of Mr. Clementi’s intimate activities violated his human rights – period. That is clear, regardless of whom his intimate partner (or partners) was. The electronic age has made it easier to both address and infringe on human rights. The digital world is a global world. We as a global society will have to deal with this, and quickly. 

Second: gender issues. My family, my community, my country and my world are places in which diversity is celebrated, where gender inequalities are not tolerated and where gender differences are embraced. It seems that we still have a lot of work to do on these issues. We cannot stop until they have been long relegated to the dustbin of history.

Third: suicide. Mr. Clementi’s suicide was certainly a tragic event. Yet we do not know all the details of his story and it is too easy to jump to certainty about what emotional turmoil and what other factors lead him to choose the tack that he did. We do not need to argue that we must respect and support human rights and gender differences by raising the specter of suicide. We need to address suicide on its own terms, in all its complexities and in all its layers. We need to do the right thing not just something.

 I for one, look forward to a time when I do not ever read a media story such as the one about Mr. Clementi. Not because the media has not made a circus about it, but because there are no more similar stories to tell. But in order to do that, we must work hard to make sure our friends and our neighbors are on a similar page. And who is my neighbor? Everyone is my neighbor, and everyone is your neighbor.

--Stan

The Healing Touch

The idea of the healing touch has a very long history. The New Testament recounts stories of miracles of healing resulting from touch. Pop psychology trumpets the necessity for “group hugs”. Mother infant bonding is enhanced by skin to skin “touch”. Different cultures have different approaches to “touch”, some celebrate it and some fear it. Metaphorically we are told to “reach out and touch somebody” and about a decade ago, a pseudo-science initiative called “therapeutic touch” caused all sorts of enthusiasm until controlled research studies showed that not touching someone was not the same as actually touching someone. And who has not felt the complex meaning of touch from a loved one? Few types of human interaction have been so well understood or so much misunderstood as “touch”.

As a recent news article has noted:http://www.npr.org/templates/story/story.php?storyId=128795325&ps=cprs, human touch is an essential component of the human condition. This is because we touch with our brains. Every touch is a perception that has meaning – and that meaning is created and applied in our brain. We no more touch with our fingers or skin than we see with our eyes or hear with our ears. And the meaning of touch results in the activation of specific brain areas, areas that can lead to a host of positive or negative emotions and cognitions. Basically put, touch is a key component of human connection. And, as I have often said: human connection is the key to improving the human condition.

As human beings we live in complex family and community settings. How we navigate those settings depends on many things. Hope and connection are fundamental to health. Touch is fundamental to healing. So why are we so afraid to give someone a hug?

So what is the allure of the drugs and alcohol and creativity connection?

So, there is recent report of research that shows that creativity in the arts and literature is not improved by drugs or alcohol. On the contrary, drugs and alcohol use have a negative impact on the quality and quantity of what writers and artists and musicians produce when under the influence: http://www.independent.co.uk/news/science/drunk-writers-were-better-sober-says-psychiatrist-2010053.html. 

Shucks. Ever since I was a teenager (and that was some time ago), I was always intrigued by the hard-living experiences of famous writers and musicians. It was hard to believe that all those amazing adventures and the impact of drugs and alcohol somehow did not make them better artists or give them deeper insights into the human condition. I can still remember reading (many years ago now) a study that compared musician’s playing on and off drugs and demonstrating that off drugs was so much better in quality.

So what is the allure of the drugs and alcohol and creativity connection? Hard to say. Some very talented artists live with significant mental health problems including mental disorders. There may be a fine line between creativity and bipolar disorder for example. Substance abuse can be part of this mix. 

However, I think that this myth of the substance fueled writer or painter or musician producing wonderful work when stoned or drunk is the result of simple logical mis-reasoning. Its confusing co-relation with causality! Because a writer uses drugs does not mean that the drugs make him or her a good writer. Actually, as we know, it’s the opposite.

Now, we need to stop thinking its “cool” and start learning to think in a way that does not depend on our subjective biases and does not support creating “causal” linkages where they are not present. If there are one million possible reasons for a person writing a good story and we focus on just one – drugs, we are likely completely wrong; on the basis of statistics alone.

So, there we go. Stop the drugs and write the great Canadian novel!

Suicide Prevention Programs, Do They Work?

A few weeks ago, the Ottawa Citizen Newspaper carried another sad story about youth suicide. This is a story that is still unfortunately all too common. It is a story that we would all like to never see again. We all would like to be able to prevent youth suicide.

Unfortunately we are not very good at that yet. Hopefully we are getting better at it. A recent guest editorial by Dr. Alan Apter in the Canadian Journal of Psychiatry ( Suicidal Behavior in Adolescence: 55: 271-273; 2010) pointed out that despite the plethora of so called suicide prevention programs we really have very little good evidence that any of them work. Or even that they may do no harm.

And these programs are very popular. Not only are they offered to individuals and organizations that think they are learning how to prevent suicide, but I understand that some health organizations and governments have mandated their application. And they are not inexpensive. I recently looked on the website of one of these so called “suicide prevention” programs and it was being offered for one hundred and sixty dollars per person! 

Recently our research group conducted an exhaustive and intensive assessment of the evidence that one of the most commonly used community suicide prevention programs actually prevents suicide. And, in contrast to the advertising, we were not able to find any substantive evidence that this was the case! We are in the process of writing up this research and will publish our findings in the next little while.

So what are we to do? Well, we should at least do what there some evidence of effectiveness for. We need to educate teachers and health care providers to better identify, refer and provide effective treatments for young people who develop a mental disorder. Will doing this prevent all youth suicides? Unfortunately not, but it would be a good start. And we need to do some good solid scientifically sound research to see if programs that say they prevent suicide actually do prevent suicide, before we spend a ton of public money on them.

--Stan

You Can Make a Difference

What comes to mind when you see the word health? For many, it might just mean one’s physical condition. While physical health is part of it, health is not only of the body, but also of the mind. A number of people of people are uninformed, or pay no attention to this equally important side of health. Physical health and mental health go hand-in-hand and it is extremely important to raise awareness for people to take care of their body and their mind.

Statistics and fast facts are often used as eye openers about health and different diseases. How much do you know about mental health? You can check numerous reputable websites with statistics on just how much we are all affected by mental health. Quick fact from the Canadian Mental Health Association website: 20% of Canadians will personally experience a mental illness in their lifetime. That’s more than 6 million Canadians – and mental illness is not just some cold that will bother you for just a few days. For some, it could last years and years of their life. People who are unaware and have an undiagnosed mental illness could go on for years without treatment and have their lives adversely affected.

I’d like to talk to you about To Write Love On Her Arms, an organization started by Jamie Tworkowski. Don’t recognize the name? He’s not exactly a celebrity. Jamie is an ordinary guy who turned a passion into something big. Another example is that of the group of 12-year-olds who started what is now known as Free The Children. Ordinary people do extraordinary things everyday. You don’t have to be famous to make a difference, and you don’t have to look far to see ordinary people doing remarkable things. Even in your own community, you can find people who are making a difference.

So what can YOU do? There is still much research to be done to improve the mental health system in our country – and your ideas are important. There aren’t always easy answers to problems, but combining our personal experiences and knowledge can help improve mental health for everyone.

There are endless ways for everyone to help. If we want to change something, we have to start with ourselves. You can take the time to learn more about the issues and share your thoughts. You can help and support projects or events that would also help raise awareness and stigma.

Stigma is a major issue experienced by those suffering from mental illness. People are stigmatized because of the lack of knowledge on mental health. In 2008, the national report card from the Canadian Medical Association stated that 46% of Canadians, almost half, believe that people use mental illness to excuse bad behaviour. It also states that one in four Canadians are afraid to be around people suffering from mental illness. What does this mean for people legitimately suffering from a mental illness?

It may be difficult to change the minds of adults but we must still try. It starts with education. As with abolishing problems such as racism and other kinds of prejudice, educating people at an early age about mental health is one of the most effective ways to reduce stigma.

Youth are also profoundly affected by mental health. It is a time when we’re fragile and undergoing changes and maturity. In a survey for youth with a diagnosed mental disorder, nearly 70% had their onset of symptoms at early ages.

These points all bring me to the most important question: Why should we care? We need to be concerned about the well-being of those affected by mental illness. We mustn’t stray away from this issue and start thinking of these figures and statistics as just numbers. We need to put a face to this problem and think of the people we care about. It could be your parent, sibling or perhaps a friend, who is suffering from mental illness. So, what will you do?

--Karl Yu

Check This Out

Her name is Laura Burke, and if you do not know her or what she does already, you will by the time you finish reading this blog. But before you go any further, check out this link: http://www.youtube.com/watch?v=23a18HKYLW4. Ok, so here we go.

Recently it was my privilege to present Laura with the first ever youth award in the Champions of Mental Health Awards history. And she is a worthy recipient. She has worked hard to get well and to stay well. She takes her challenges head on and addresses them. She does not look for pity or solace she looks for recognition of her strengths. In short, she fell down, she got up, she dusted herself off and she began all over again. Kudos!

I am not sure if this is what the legion of resilience researchers are talking about or not. It seems that not a day goes by that I do not read about a new program or a new direction that will transform the lives of young people by enhancing their resilience. Usually this is achieved (or more properly said to have been achieved without the solid evidence we need to critically determine the outcomes) by some kind of learning of how to be resilient, taught no doubt by a well meaning and well paid human services provider.

And what about people like Laura. How did she become so resilient? Maybe she had it in her all along. Maybe everyone does. Maybe we need to work at ensuring environments support the development of that. Maybe we need allow young people to fall down gently, so that they can learn to stand up, dust themselves off and start all over again.

--Stan