Advancing mental health through gender equality

When I read the piece in the Globe andMail about the G(irls) 20 Summit delegates, I was impressed. Kudos to Belinda Stronach and her Foundation for this innovative and necessary initiative.

Unlike the ongoing boondoggle involving fake lakes and public toilets well out of the reach of the public and denial of reproductive rights enjoyed by Canadian women to women in other countries, the Stronach initiative strikes the right notes.

Domestic violence, rape, the need for gender equality, the need for high quality easily accessible education, maternal health and well-being (including family planning) where all issues identified by the young delegates profiled in the Globe article. Of course these are all issues that are too familiar with here in Canada as well – not to the same degree as in low and middle income countries but certainly in kind. Guess what. These are mental health issues as well.

Empowering girls and women and ensuring gender equality in all social, civil and economic undertakings are interventions that will spill over into mental health promotion and prevention of negative social and health outcomes. This is an excellent way to address the social determinants of mental health – everywhere.

We have to do a much better job in this area globally and at home! The mental health of nations must be built in part on national policies that promote and ensure the well-being of girls and women. This is a task that we all must participate in. I for one would like to see very piece of federal, provincial and territorial legislation reviewed to ensure that it promotes this agenda. Sure we need mental health policies, programs and plans. But we need a pro-gender equality framework that informs everything we do.

--Stan

Girls not boys and definitely not in between or beyond (another opinion)

The G(irls) 20 Summit delegates, Globe and Mail article, resonates with me. There is no doubt that the equality of women should be a joyous and wonderful thing celebrated by all women everywhere! But what is this meeting of delegates missing? Focusing entirely on women fails to address women’s equality and health. What? That’s crazy! Women and girls are facing inequality resulting in health disparities—shouldn’t we then focus on women? No, actually we shouldn’t.

Focusing exclusively on women is bad for the health of men and women. It fails to provide the necessary variety of perspectives about how gender interactions are contributing to inequality and how this could be addressed in a comprehensive manner.

There are negative consequences of societal gender expectations on all members of society. This includes the people, too often forgotten (at least in North America) who don’t fall into this fabricated gender binary. What about people who are not male or female? What does that mean? You know, people who identify as something other than male or female, including (but not limited to) gender queer people, transmales, transfemales, and intersex people. These groups of people are often ignored completely and face oppression to an exponential degree in comparison to women.

Imagine this. You’re suffering with mental illness and searching for your identity in a society that doesn’t represent you on the washroom label. You’re unsure of your gender identity because examples of others like you are lacking and your existence is denied in innumerable ways. How do you then go about treating your mental health issues (in a society poorly structured to deal with mental illness in the first place) or for that matter any of your other health issues that largely fly under the radar of most mainstream doctors?

Many trans people face a complex web of health issues (mental, sexual and physical health). This is further complicated by the lack of research pertaining to trans people and plausible solutions to the issues they face. A potential starting point for society to tackle this challenge is by backing trans-supportive organizations to take the lead on an international initiative with money and resources. Taking trans initiatives international has potential to provide insights about how other cultures treat trans people and how to improve our society.

But most importantly, we should be tackling the problematic gender expectations and we should be doing it in an all-encompassing/collaborative manner. That is, if we want to address inequalities and related health disparities successfully. Or we could continue attempting to separate inseparable social issues (gender inequality vis à vis males) and members of society (female, male, or gender queer) to create an illusionary solution for the illusionary “separate” issue.

--Holly Huntley

Digital Media and Mental Health

Recently the Globe and Mail published a story about a study that purported to show that college students in the USA were 40 percent less emphatic than those of a few decades ago. Whether this is indeed correct cannot really be determined by the methodology used in the study quoted but that does not seem to stop enthusiastic speculation about what has “caused” this so called drop in empathy. As expected, the usual boogy-men have been trotted out. None of these have been demonstrated to be causal in this change but that does not seem to stop pontification, particularly if it leads to sales of programs or newspapers.

So what are the suggested causes? Of course, the digital media – facebook and myspace. The argument here is that they are “physically distant online environments” [that allow] people to “lionize their own lives” and “functionally create a buffer between individuals, which makes it easier to ignore others’ pain, or even at times, inflict pain upon others.” This hyperbole makes good theatre but is not very good social science.

Of course the usual cause for every generational “issue” is then also brought to the table. It’s the fault of the parents: “These kids were born around 1980. It could be a change in parenting style. … Kids are getting the implicit message from parents that success is what really matters. It’s hard to spend your life pursuing success and at the same time pursue empathy, because empathy takes work.” So here we are treated to more unproven hyperbole. It sounds plausible so therefore it must be true (that at least is the reasoning). And guess what – there is a program that can be purchased to fix this supposed deficit.

So what is the back story? First, is there really a significant change in empathy (even in the face of the research limitations of this study)? Well the first question is: what does a drop in 40 percent mean? Is this a relative drop or an absolute drop? A drop from 0.1 percent to 0.06 percent of the population is a 40 percent drop – but likely means very little. A drop from 100 percent of the population to 60 percent of the population is also a 40 percent drop but likely means a lot! Beware any news story that uses percentages! Stop confusing co-relations with causality. Sure facebook and myspace are new social realities. So are globalization and climate change. Parenting styles are blamed for every social ill. Darn parents, if only they could learn to do things right!

Well there are some very interesting things on the horizon in terms of understanding empathy and how it develops and how it may change over time. Research into children with the rare genetic condition called Williams syndrome (one of the features is extreme sociability) is peeling away the complexity of interactions associated with racial stereotyping.

Other research has identified mirror neurons in the human brain that are associated with abstract thinking, planning and ability to empathize. This type of research, linking our understanding of how brains develop in response to their environments will help us sort out these important issues. The rest provides lots of impetus for speculation and opportunities to spend our money on programs that work about 40 percent of the time.

--Stan

Preventing Tragic Outcomes Starts with Us

There was a tragic story in the Halifax newspaper, the Chronicle Herald this week. The story was both new and unfortunately very old at the same time. The gist of the story was that a young man who had killed a woman a number of months ago was found not criminally responsible because, as the story states: “the teen was psychotic when he killed a woman in February”.

Although there are few details of what happened in the paper, it seems as if the young man had been experiencing psychotic symptoms for some time prior to the event. Apparently, “his family had been trying to get him psychiatric help”.

What a shame. How tragic. How sad. How ironic, that Nova Scotia has one of the nation’s best first onset psychosis programs. What happened? What is the back story?

The Province of Nova Scotia spends about 3.5% of its annually recurring health care budget on mental health, and a fraction of that on child and youth mental health services. This is in spite of the knowledge that about 3/4th of all mental disorders arise prior to the age of 25 years and increasing realization that early intervention and effective treatment may prevent substantial long and short term negative outcomes and yes, maybe in this case would have prevented such a tragic outcome.

I for one am getting sick and tired of reading these stories and writing these blogs. I have decided to run for federal office in Halifax in part to make mental health a national health agenda item. This tragic case should not have happened. Why is it taking so long to do so little that can help so many so much?

--Stan

Show Me the Evidence

So I was just reading an interesting piece called “Protecting Teens in Crisis: Constructive Oversight of Programs”, in which a number of significant concerns were raised about what is called the “struggling teen industry”. Put bluntly, it seems that there are a number of institutions (mostly in the USA as far as I can tell) that may be or may have been involved in a number of non-therapeutic or perhaps even abusive practices, all in the name of “therapy” or “treatment”. Indeed one of the phrases used in the piece was “stories of mistreatment, abuse and even death…”

Wow. Shocking.

An American professor is quoted as saying that these concerns need to be addressed using state regulations and licensing. This makes sense for sure. I am personally astonished that such a regulatory framework is not apparently in place. How could “treatment” settings operate without oversight and standards of care?

However, this is not enough. Not by a long shot. Reading about some of what passed as “treatment” makes me shudder. It sounds brutal and harmful, not therapeutic and helpful. So, where do people who offer these “treatments” (whatever they are) dream them up? Who has studied these so called “treatments” and what have they found? Are these interventions helpful? Are they useful? Do they work? Are they safe?

In short, what is the scientific evidence for the so called treatments being used? And here, let me be very clear. We need strong, hard scientific evidence. This not the same thing as “best” evidence. “Best” evidence can be what someone thinks is a good idea shared with some other people who think it’s a good idea. It may even be a well-intentioned idea. But, the road to hell is paved with good intentions (as the saying goes).

So – bottom line. Show me the evidence.

--Stan

Should we fix child and youth mental health first?

The Province of Nova Scotia spends about 3.8 percent of its health care budget on mental health services. Well below the minimum recommended by the World Health Organization. A small proportion of this goes to child and youth mental health. As the week long series in the Chronicle Herald (March 8 to March 12) pointed out – the entire provincial mental health system is very broken. In my opinion, we have to tear it down and start again. If we had a blank slate there is no way that we would build a mental health system in the way we currently have it.

So, where do we start. Tearing and building will take a bit of creative thought and a bit of time, not to mention some very difficult slogging to move out of current rigidities and the control of vested interests. 

What should we do now?

Most mental disorders begin before age 25 years. Most of these are life-long. Most of these respond quite well to the evidence based treatments that we have. Early intervention with effective care has the potential to decrease short term morbidity and improve long term outcomes. The most effective way to decrease suicide rates is to identify and treat mental disorders. And the list goes on and on.

Yet we persist in back end investment. Lets stop this foolishness now. Of course we need to provide better care and services for post-youth and vulnerable populations (such as refugees, first nations, the economically and socially disadvantaged, etc), but we need to really ramp up our investment at the front end. So while we work on transforming the entire system we should immediately increase our investment in providing the best evidence based care with the best human resources we can allocate to children, youth and their families. And we should do it now!

--Stan

Let’s make everyone feel good and ignore those who need help!

I am sitting in the comfort of a rustling train as it bumpingly floats its way through the winter-white Nova Scotia countryside, heading back home after four days of work in a rural part of a neighbouring province.

I am reading yesterday's Globe and Mail. The lead editorial headlines: “Those who read well at 15 succeed”. And, the story is about a Canadian study reported by the OECD that young people who can read well at age 15 tend to do well in life and that young people who can not, do not. It also reports the truly amazing finding (here I am being facetious) that those youth who study do better than those who do not!

What insights! What revelations! What a surprise! Teenagers who read well and study hard do well? This is news?

Well, the news here is that reading ability is a good proxy measure for many problems. We have known for a long time that the inability to read at grade level in grade three is predictive of poor educational, social and vocational outcomes. Seems that is also the case at age 15. Reading is a complex skill. Reading difficulties can be the result of psychosocial adversity, mental disorder, learning disability, or combinations of many factors. Whatever the reason, reading ability is a “marker” that can be used to identify young people who may need help in sorting out what the problem is and then they can be given personal assistance in addressing the problem so that they can become successful.

So why are we not doing this? Why are we not assessing reading levels in grade three and at age 15 in every single school in this country and using that assessment to identify young people and develop personal interventions that can help them be as good as they can be? Why are we wasting large amounts of money on building self-esteem and other similar programs when the issue is not self-esteem? Why are so hesitant to put our money and our efforts into those areas that are likely to bring the best results, particularly for those who need it?

From what I have seen, one reason may be that it is difficult and costly to provide the assessment and intervention services that young people who are having difficulty need. So it is easier and perhaps cheaper to provide programs for the many that do very little, than interventions for the minority that may do a lot.

There is also a highly discriminatory ideology at play – not manifest but latent. We do not want to “label” those who need help so we do not identify them and we do not provide them with what they need for success. You see, “labeling” would hurt their self-esteem and would thus be unfair. Instead we shunt them aside in favour of “helping” everyone (including mostly those who do not need any extra help). This of course is more “fair” to those who need help as it denies them what they really need and sets them solidly on the road to poor outcomes. “Oh well, at least they were not labeled and their self-esteem did not suffer as a result”.

Is this fair? Is this the right thing to do? Not in my book.

--Stan