Mental Health in Schools Act

I read some really interesting news from the USA today. Mental Health in America reports that new legislation is being introduced by Rep. Grace Napolitano (D – Calif.) who is co-chair of the Congressional Mental Health Caucus: the Mental Health in Schools Act. 

As far as I can tell from the news reports, this Act will provide a means to address the mental health care needs of children and youth by providing funding for a variety of mental health related activities, including safe schools, early identification and referral to treatment. Kudos to Rep. Napolitano!

This is what I would like to see happen in Canada. First, wouldn't it be a neat idea if we had a mental health caucus in Parliament – non-partisan, committed to moving the mental health agenda forward.  When I become the federal MP for Halifax, I will work to establish this kind of structure. Second, this Act sounds like it may do some good. Although I do not know the details, it seems that it will provide funding to support evidence-based school mental health programs and improve case identification and linkages to mental health services. 

This almost sounds like the model that we developed a few years ago and have been piloting in Nova Scotia and elsewhere in Canada. This “Pathways to Care Model” has been described in various publications (including an upcoming entry in the McGill Education Journal) and an overview can be found on our website. If we can only improve the identification and referral to effective care pathway for young people, we would make great strides forward in improving youth mental health and advance economic, social, family, civic and personal success through secondary prevention following from effective treatment and follow-up. And our model adds even more – mental health literacy for students and teachers as well!

This to my mind is a good federal approach to mental health. It is focused on addressing a huge need, is grounded in best evidence and has the potential for amazing positive impact – both primary and secondary. What a difference to what is happening here in Canada!   In the area of mental health at least, we cannot keep having smug “we are so much better than the USA” self-congratulations.   Now that is a scary thought.

--Stan

Mental Health and Universities: the SFU innovation

Simon Frazer University (SFU) has taken an innovative first step in addressing mental health on campus. Launching their multifaceted program in concert with a national eating disorders awareness week SFU is putting into place a variety of mental health activities and infrastructures. These include programs that seem novel, some that we know may work and ofcourse some that may have little if any substantive impact. In one sense, this is an issue that has characterized many types of community-based mental health interventions as well as the development of mental health treatment facilities. Where numerous interventions are put into place together with the hoped for outcome of success but with little certainty in what components are necessary, which are useful and which are neither.

Regardless of this concern however, kudos to SFU for taking this initiative. Its about time. Our Transitions Program (of demonstrated effectiveness) and our staff (residence dons and faculty) mental health training programs can be used by post-secondary schools across Canada to effectively address mental health needs of students (see http://www.teenmentalhealth.org/). These however, need to be seamlessly linked to intervention and treatment programs for them to have the full range of positive effects needed. Improving mental health is an important goal but it must be linked to early identification and easily accessable effective treatments. Without that link, it is energy expanded for outcomes that are insufficent.

It is addressing this continuum that has been the focus of our work for the last three years. How do we go from mental health promotion (primarily through the enhancement of mental health literacy) all the way to support, intervention, treatment and continuity of holistic helping? 

What we have learned is that interventions must cross traditional silos of education and health providers. There are ways that we can do this and be successful. Part of the answer includes the enhancement of diagnostic and treatment competencies in primary care and reserving specialty mental health services for those students who require more intensive assistance. We are pleased that our first national program to address adolescent depression and suicide has now been made available through MD-CME at Memorial University. This web-based educational program provides both MainPro and MainCert credits. 

We are also working with groups in Nova Scotia, Ontario and British Columbia to pilot and evaluate a novel integrative model that spans the continuum from mental health promotion to care in high schools. Time and lots more work with many partners will help us better understand what needs to be there and how to make it available. Until then, many thanks to SFU for taking this important step. Look forward to seeing the results roll in.

--Stan

Modern Technology and the Brain – is it Chicken Little all over again?

I don’t know how may young people today are familiar with the story of Chicken Little, but for sure they will google it and then they will know.  Briefly it is the story of a chicken who thought the sky was falling and lost her/his head (metaphorically) about it.  It has given rise to the Chicken Little Awards and I would like to nominate Matt Richtel, writing in the New York Times for contributing to the hysteria around the impact of digital technology and the brains of young people.

Brought to you in the manner of most pseudoscientific writing, the story of Vishal is meant to be a modern take on a medieval morality play railing against the horrors of new digital technology that is supposed to create attention-deficit morally decrepit youth of today by destroying the brain’s ability to sustain attention and to make moral-emotive linkages.  Like the Luddites of the past, the story harkens back to some mythical imaginary Arcadia of the distant and never-existing past in which harmony between brain and nature thrived in pastoral villages supplied by streams flowing with milk and honey. Yesh!

So what is the real scientific story here?

Does the environment affect how the brains of young people grow and develop?  Totally.  Has it always been like that?  As far as we know.  Why?  Maybe because that is how we as a species adapt to our environments, including those we create ourselves and then need to adapt to.  This allows us to change with the times and contributes to our evolutionary success.

Will modern technology change our brains?  Yes it will, just like the discovery of fire, the discovery of the wheel, the creation of the printing press, and the invention of glasses (to name but a few of the trillions of historical impacts on brain function) have done.  And what is the moral message here?  There is none.

We are what we are because of where we have been and what we are doing.  What we will become is not known and how we will get there is unclear.  Can we make ourselves develop in a certain and pre-ordained way?

That has been tried for centuries by political and religious dictators alike without success.  So what do we do?  Let’s start by not writing such Chicken Little drivel and focus on better understanding how our brains work and how we can accomplish things that ensure we leave the world a better place for future generations.  Not in the manner of the Luddites nor with the fear mongering of the protagonist in the famous novel written by Mary Shelley (look it up!). But in honoring each other, respecting each other, celebrating who we are and understanding that we will change.  

--Stan

When is behavior an illness?

This sounds like a simple question, yet it is a fundamentally important one. It is a question that I for one have tried to answer to some degree of rational certainty over the many years of my work in the mental health field. It is a question that a recent news article I happened to read once again raised in my mind.

Briefly, the article: “Cheaters do prosper, but are they psychologically ill?” from the Globe and Mail: http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/cheaters-do-prosper---but-are-they-psychologically-ill/article4258538/. The study reported there found that university students who admitted to cheating scored high on personality traits of psychopathy. This suggests that psychopathy which in its most extreme forms can translate to Psychopath may be associated with self-reported cheating. The one obvious question that I would ask is why do we think that cheaters are honest about reporting if they cheat or not – but that is a question for the researchers.

Cheating clearly has adaptive value and in evolutionary terms probably has an evolutionary advantage. It happens in every society that I know of and I would not be surprised if it is common behavior in animals, particularly primates. So what does this say about how we think about “normal” behavior and “illness”?

Obviously this is very complex and one blog can not address this issue. But we can start. So here is one thought to help us think more. Most if not all behaviors that we exhibit, occur on a continuum or spectrum. The point at which a particular behavior “crosses” from “normal” to pathological depends on many things. Think of it as “carving nature at the joints”. How we decide where to carve is very complicated and lots of different perspectives come into play, including; statistics; probability theory; social and cultural frameworks; emotion; history; personal bias; etc.  One of the cutting points commonly considered, is: does it create harm to self or others, does it lead to impairment in functioning? Does stopping or diminishing the behavior lead to better outcomes for all concerned?

What do you think about this as a “cutting point”. What other “cutting points” do you think are useful?

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?