School Mental Health: The Road Ahead

Posted on 30/01/2014 | 0 Comments

Canada’s largest school board (Toronto District School Board, TDSB), recently made a major announcement that the entire workforce is to receive mental health training, as far down the line as the lunch lady. The four-year strategy will provide roughly 40,000 staff members with mental health training, focusing on promoting positive mental heath and wellness in schools, enhance the communication between school staff and parents and increase the number of anti-stigma programs by 50 percent. Click here to read the rest of this entry.

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Young People and Concussions

Posted on 17/05/2013 | 0 Comments

Recently, Hockey Nova Scotia moved to decrease the probability of significant head injury in young people playing Canada’s game.  This type of regulatory progress is to be applauded and needs to be paired with increased educational activities designed to inform youth, parents, coaches, educators and health providers about concussions. Click here to read this entry and many more on our new blog!

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Mental Health Week Live Tweet Chat Recap: Engaging and Educating Through Social Media

Posted on 15/05/2013 | 0 Comments

TeenMentalHealth.org and Dr. Kutcher took to social media to educate and create awareness around mental health. Engaging in a live Twitter tweet chat, the public were able to ask and elaborate on questions in relation to mental health. Click here to read this entry and many more on our new blog!

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Even, if that means letting go of our opinions.

Posted on 24/09/2011 | 0 Comments

It has been fascinating reading to follow the discussion after Andre Picard of the Globe and Mail wrote a piece about the as yet unreleased Mental Health Commission of Canada strategic framework, particularly as that discussion has addressed the issue of the role of science in mental health.

javascript:void(0)For me, the conversation has been both uplifting and disappointing. Uplifting, because of the many good insights and ideas that have been discussed and the hope for a better future that resonates in many comments. Disappointing because so many comments still refer to “models” and to ideological camps instead of addressing how we can together work to solve the mystery of what the causes of mental illnesses are and what the best interventions to prevent and treat mental illnesses may be. 
 
In particular I am struck with the difficulty some commentators seem to have with recognizing how it is that we find out the best answers to those very important questions. That is, how science works.
 
We do not find out these answers by staking out battlegrounds based on our opinion and belief and defending them against all comers. On the contrary, we accept that all of us come to every consideration with built in biases and perspectives that may or may not be valid – or that may or may be more or less valid. We need to be able to accept that: in ourselves as well as in others. We must also then seek how we can best wade through conflicting perspectives, not to “win” for our own viewpoint and to be right, but to “win” on the side of being likely to be less wrong. Even, if that means letting go of our opinions.
 
The tool that we use to help us do that is one that to date has provided us with the best method to be less wrong most of the time. Not to find the truth, but to save us from everlasting error (to paraphrase Brecht). And that tool is the scientific method. This does not mean that opinion or perspective or experience is not important. All these are important, and all these can be tossed fairly and properly into the crucible of the methodology that is the foundation of scientific study. This does not mean that science can get us the best answer immediately. Science is conducted by people and is subject to the same social and cultural influences that all aspects of our lives are subject to. Science however does have a self-correcting capacity based on repeated experiment and an unrelenting challenge of accepted “truths”. In the long run, this will give us a better way forward than opinion or belief or any other framework that we want to champion.
 

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A Global Opportunity to Advance Mental Health: Can we grasp it?

Posted on 13/07/2011 | 1 Comments

September 2011 will be an important month for many different reasons. One reason will be especially important for improving mental health across the globe. The United Nations will be holding a special session on Non-Communicable Diseases in New York that month. The purpose of that meeting is to encourage a global response to these diseases, and mental disorders are at the top of the list of diseases causing the greatest burden of illness worldwide. Unfortunately, mental disorders are not at the top of the list of the conveners of this special session. As we are all too familiar, mental disorders are too often not on the list when it comes to health care investment – not only here in Canada but around the world.
 
We know how important mental health is – in wealthy and in poor countries. It is well documented that mental disorders can lead to poverty, decreased educational attainment, job difficulties, incarceration and a poorer quality of life. They increase the risk for substance abuse (including alcohol and tobacco), a variety of physical illnesses and poor adherence to treatment for a number of different illnesses – including HIV-Aids. Mental disorders are very costly, in both direct (for example, hospital beds) and indirect (for example, decreased work productivity) ways. Effective and cost efficient treatments are available and have recently been catalogued and widely distributed to health providers across the globe by the World Health Organization (if you are interested, google mhGAP). What is now needed is to get mental health on the global health agenda.
 
And we need your help to do this.
 
Write your Provincial Minister of Health and the Federal Minister of Health and your local member of Provincial and Federal Parliament. Tell them that you would like them to bring this issue forward at this very important meeting. Ask your friends and neighbors to do the same. Not only may this have an impact at the global level, but it may help in your Province and in Canada as well!
 
--Stan

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Helping Early May Help in Unexpected Ways

Posted on 11/07/2011 | 4 Comments

Our team has been doing some interesting work in school mental health for a few years now. Much of it has been focused on enhancing mental health literacy for teens (through a secondary school curriculum) and teachers (through a variety of different mental health for educators training programs) as well as facilitating early identification and effective treatment for young people who have a mental disorder – such as depression, panic disorder; etc. While the potential mental health benefits of early identification and effective treatment are relatively easy to understand, there are other benefits that may be less evident but also very important. One area of such benefit is found in relation to a number of physical illnesses: diabetes; heart disease and maybe even some forms of cancer!

We have known for some time now that mental disorders are risk factors for a number of other illnesses. That means that the presence of a mental disorder (such as depression) can increase the probability that a person will develop another illness (such as diabetes). There is also some evidence that suggests that having a mental disorder following the onset of another illness, such as heart disease, increases risk for early death from that disease. Although there are many hypotheses about why this may happen, we do not yet really know how this happens and research into understanding how this may happen is currently underway. Did you know that the same brain chemical that is involved in controlling mood (serotonin) may also be involved in controlling how platelets clump together in the blood? Could it be that problems with serotonin function in the brain can result in depression and at the same time may make blood clotting (which could lead to strokes or heart attacks) more of a problem? Ongoing research may help us better understand this issue.

So, it may also be that if we can better identify, diagnose and effectively treat young people when they first develop a mental disorder, we may also be able to decrease the risk of them developing another illness – such as heart disease, diabetes and perhaps even some forms of cancer. Or, if not that, maybe early and effective treatment of mental disorders might delay the onset of another illness or maybe improve treatment outcomes. Right now we do not really know the answers to these questions but being aware of this possibility is really important for us – both personally and for public health reasons.

Secondary prevention, meaning the prevention of another illness by effective treatment of a pre-existing disorder, of some physical illnesses might be achieved by early effective treatment of a mental disorder during the teenage years. This is an exciting possibility! Will this pan out? We don’t know yet. But, to my way of thinking, there is enough evidence on this possibility already available to further underscore the need to better identify, diagnose and treat mental disorders in young people. We know what needs to be done – now we only have got to get our act together and do it!

--Stan

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The Academy in Mental Health for Educators: A new opportunity

Posted on 07/07/2011 | 1 Comments

We have been working in the area of school mental health for some years now and have created a variety of programs and educational resources for educators, health providers, youth and parents. Over and over again we have heard from teachers, social workers, psychologists, nurses, principals, school superintendents and others about the need to provide more training for educators in the area of youth mental health and a better understanding of youth mental disorders. Over and over again we have heard that a summer program would be a good venue in which this could be done. So guess what – we listened and decided to do exactly that. Our first Academy in Mental Health for Educators will start next week – in Halifax, Nova Scotia. As far as we know, this is the first event of its kind ever in the Atlantic Provinces.

So what will happen at this Academy. First, it will take place over a two day period – actually two such two day periods. The first will be on a Monday/Tuesday and the second, on a Thursday/Friday will be a repeat of the first session.   There are a variety of different topics to be covered. These range from detailed information about common mental disorders in youth to advice on how to talk to teens and parents to understanding medications and their role in treatment to specific “classroom pearls” for helping young people who are living with a mental disorder be more successful in the school setting. Participants will also be exposed to a variety of useful and effective educational materials and programs.

We are really excited about the program and our presenters. In addition to key members of our Sun Life Financial Chair in Adolescent Mental Health Team, presenters will include psychiatrists; psychologists; teachers and others who work with youth, families and educators. We hope that the program will be fun and informative for all who attend. One of the fun components will be a “Halifax dine around” evening where participants can sign up to join one of the presenters for dinner at one of the many excellent restaurants in the city. Not only may people discover a great new place to eat, but they will have the chance to chat to an expert in the field – and hopefully that will be both fun and informative!

As always, we will be evaluating how the Academy turns out. Not only in terms of participant satisfaction and improvement suggestions but also in terms of learning that has happened during the sessions. And, as always, we will be posting the results of this learning on our website. Frankly, I am both a bit excited and a bit nervous about this. What if our learning evaluation does not show a significant positive impact of the session on participants’ mental health knowledge? Or horrors of horrors, what if it shows a negative impact on participants’ mental health knowledge? At best that would be so embarrassing.

--Stan

*Photo Credit: Surian Soosay

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Stigma’s Role in Perpetuating the Cycle

Posted on 30/05/2011 | 1 Comments

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Helping Students with ADHD Achieve Success: Tips for Teachers

Posted on 26/05/2011 | 0 Comments

ADHD impacts approximately 5-10% of children, which means as a teacher, 1 in 10 students may present with ADHD symptoms. It can seem like a handful with students squirming, drifting off in space, and disturbing others around them. But it doesn’t have to be.
 
As a teacher you are in a unique position to help the student learn habits at school that will help them be successful in their home and with them as they move through the education system.  Assisting young people with ADHD to learn how to feel and think better about themselves, and to identify and build on their strengths can be an important step in helping them control their symptoms of ADHD. Students with ADHD need to learn how to cope with daily problems and control their attention as well as their impulsivity, teachers and parents need to work together to help students achieve this success.
 
Tips for teachers:
 
·         Encourage youth to ‘stop and think’. This could take the form of counting to 3 before asking a question, or writing the question down and asking it at the proper time.
 
·         Create a token reward system – where emphasis is placed on the positive outcomes of behaving appropriately.
 
·         Help your students have a regular routine. Posting the routine, reminding them of homework at the end of the day, use organizers to help them keep their days straight.
 
·         Post rules in the classroom where they are easy to see and adhere to. Out of sight, is out of mind.
 
·         Helping kids who distract easily involves physical placement, increased movement, and breaking long work into shorter chunks.
 
·         Post the day’s schedule each day at the front of the room, and cross of items as they are done. Young people with impulse problems may gain a sense of control and feel calmer when they know what to expect.
 
·         Be brief when giving instructions. Breaking them into bite sized chunks by asking the student to do one step, and then tell them the next step once the first is completed, will help all students, but especially those with ADHD
 
·         Incorporate physicality into learning by giving students opportunities to act out stories, or sing songs. Providing them with outlets for their physical energy.
 
Students with ADHD are often easily distracted and can become that way even in mid-sentence. If you do not know what they are talking about, ask them to help you understand. When speaking with a student, it’s best to not assume you know what a young person is going through (unless you yourself have struggled with ADHD) and instead ask them to tell you what it’s like, and what they need from you to help them be successful.
 
Meet with parents and talk about their son/daughter’s treatment as well as tactics and techniques they use at home. If you can reinforce successful tactics at home and school, you create an increasingly familiar routine for the student. Rewards programs can extend beyond the classroom and into the home life if a parent and teacher can work closely.
 
Each student will be different, so developing a toolkit of strategies that you can use with each child will help you find the best fit for them. Make sure to talk to other teachers and parents, to share great ideas and success stories.
 
--Stan Kutcher, MD, FRCPC and Christina Carew, ABC

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How do I talk to my teenager about suicide?

Posted on 25/05/2011 | 0 Comments

One of the issues that arise in discussions with parents about youth mental health is: “how do I talk to my teenager about suicide?" This is most often in the context of a media report about a youth suicide or a community or school experience of youth suicide. There is no “right” way to discuss this issue but there are some useful guideposts.
 
Be prepared to chat if your teen brings it up but do not be surprised if that does not happen. If you have concerns that your teen may want to discuss this you can address the issue in a gentle and “just putting it out there” manner. Saying something such as: “I was reading in the paper about the young person who recently died. Sounds like a tragic situation” can be an ice-breaker. Then if your teen is interested, they have an opportunity to discuss it with you. Sometimes they will be interested and sometimes they will not be interested. Or, they may bring it up at a later time, when they are ready.
 
If, however, you or your teen knows the person who had died, then this discussion should be explicit. This is now not an issue of “talking” to your teen, but an issue of grieving while at the same time acknowledging that death was by suicide. There can be a tendency to both avoid the issue of suicide or to over-focus on the issue of suicide. Try not to do either. 
 
Sometimes both you and your teen may need more support than usual (such as family and friends or religious communities). If this is the case, you can seek out services that are available through your local community health center or mental health care providers. A useful resource is the booklet “Have you lost someone to suicide?” which is available on this website here.
 
If you are concerned that your teen is having a mental health problem or may be depressed, it is a good idea when you are discussing this to bring the issue closer to home. There is nothing wrong with acknowledging that depression or a mental health problem increases risk for suicide and making that knowledge part of what you monitor when your teen is not feeling well. If you have diabetes you monitor your blood sugar and your diet. If you have depression you monitor your mood and thoughts about suicide.
 
There is a recent article that can be helpful when thinking about this issue. You can find it at: http://www.micheleborba.com/blog/2011/04/26/talking-to-teens-about-suicide-and-depression/.
 
-Stan

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Parents Can Make A Difference

Posted on 23/05/2011 | 0 Comments

As a psychiatrist (and a parent of a child with ADHD), I want to reassure parents of children with (or exhibiting signs of) ADHD, it gets better when they receive the right intervention.

The best thing a parent can do is to be informed. The more you know about ADHD, the better you will be able to help your son or daughter with the challenges they face. There is no biological test that can confirm a diagnosis, so it is often a discussion between parents, teachers and health care professionals that determines the diagnosis of the child involved.

It’s important to remember that all children are not the same, and therefore can’t be treated the same. If you have a child that has ADHD, and one that doesn’t, it’s challenging to remember that you can’t expect the same behaviors from both. When your child is fidgety, when it seems like they aren’t listening, or they’ve forgotten something again -- if you know are aware these are their struggles, your response will be different to the situation. It’s often difficult to remember that this child isn’t bad (in relation to their brother or sister or other children), but that their ADHD causes them to be impulsive, inattentive or both.

As a parent, it’s important to help your child to be successful and to reach their maximum potential. Young people with ADHD responds better in well structure environments, you can help them with homework and chores, by creating a routine. As many children with ADHD have trouble sustaining attention, breaking items into small tasks with an immediate reward at the end has proved to be quite effective. Instead of suggesting your son clean his room, ask him to fold his clothes. The way to reward your child varies with age.  Charts have a better impact in smaller children, for older children or teens you can offer them pick out what’s for dinner, let them watch their favorite television show or spend extra time with favorite video game.

Increase your child’s self-esteem, this point is very important as many young person with ADHD has a low self-esteem. Focus on their strengths and things they do well.  For instance, individual sports and activities such as track and field, or swimming, are generally more fulfilling and successful then groups sports.

Help make the things they find most challenging easier. One of the best ways to do this is to help your child be organized. It can be helpful to tape lists to mirrors, doors and lunches. Calendars, timelines, agendas, alarm clocks can all be tools that can be helpful. And helping your teen get on a regular schedule can do wonders for their organization.

Make sure you spend quality time with your teen. Going for a walk with them is a great way to be able to connect with them and get some exercise. Sharing feelings, connecting with someone they trust, and getting regular exercise are great ways for your youth to have positive interactions and shed some pent up energy.

As a parent you can also help to make sure your youth is good to their body. Eating a healthy breakfast can decrease stress and improve performance at school and work. Caffeine and sugar rich drinks can increase anxiety and agitation. Ensuring your teen has a balance diet, and stays away from alcohol and drugs can help improve life balance.

Depending on the severity of your child’s ADHD, treatments will include therapy and sometimes medication. In combination with the above, you can get your child on the road to recovery and a successful life ahead.

-- Stan Kutcher, MD, FRCPC; Iliana Ortega-Garcia, MD, and Chrisina Carew, ABC

This blog can also be read on: http://www.ourkids.net/blog/for-children-with-adhd-it-gets-better-with-help-10095/

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Youth have a Say in Mental Health Research

Posted on 20/05/2011 | 0 Comments

A recent Australian media report describes an “innovative approach to mental health research”: http://melbourne-leader.whereilive.com.au/your-news/story/what-works-4-ur-new-website-investigating-treatments-for-mental-health-problems-in-youth/
 
This is a website where young people who have received mental health care can rate what they think was helpful to them. Good idea, but hardly new.
 
Our group in Toronto published an academic study on this question in the 1990’s in the Canadian Journal of Psychiatry. And, last year, the Institute for Families published its report of a national consultation involving youth, parents and researchers from across Canada in which the issue of what should be mental health research priorities in our country. This report was the outcome of shared consultations that may help identify national child and youth mental health research priorities for our national and provincial health granting councils.
 
Regardless of pride of place with the idea – it’s essential that young people and their families be involved in the identification of what should be researched. Those who provide clinical care and those who do research can only do what they do best when they are informed by those they work with – patients. I can still remember when one of my patients, a young girl with a manic episode told me that the mood rating scale I had given her to fill out made no sense – because it did not have a place to mark down depressed or low mood. When I changed the scale with her help we made the discovery that manic episodes in young people fluctuated widely in their mood levels. And when we applied this new measurement technique to scores of other young people we were able to describe for the first time, the now understood to be “classic” description of mania in teenagers: mixed rapid cyclic manic episodes. And that is only one example.
 
So what does this tell us? What good health providers have known for centuries. Listen to your patients. Involve them respectfully as full partners in their care. Learn from them.
 
--Stan

Photo Credit: Kipp Jones

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Substance Use and Mental Health Care, Can They Co-Exist?

Posted on 18/05/2011 | 0 Comments

I remember once seeing one of my patients who had a psychotic illness. He was doing very well and was very engaged in his recovery process. Unfortunately, a “friend” of his was providing him with free and easy access to illegal drugs – mostly marijuana. This was having a negative impact on his well-being and about a week before our visit his employer had let him know that if he appeared to be “stoned” once more at work, that he would be let go. In our discussion, I raised the opportunity for him to attend a drug discontinuation group that we had been working with. It provided young people with a support system and framework to help them get off and stay off illicit drugs. Mike (not his real name) became annoyed when I suggested that. “I have a psychotic illness” he said, “I am not a drug addict”.
 
What Mike was voicing was in some way a stigmatizing perspective about people who struggle with drug misuse and abuse. This is the topic that another friend of mine just recently wrote about. It’s worth a read and you can find it here: http://www.huffingtonpost.com/dr-harold-koplewicz/is-drug-addiction-mental-illness_b_858815.html. His point is well taken. There is a lot of stigma about drug use in young people and this stigma can get in the way of getting help. I agree.
 
This is why it is so important to make sure that we have both substance abuse and mental health care easily available in the primary health care system. A young person with either one or both of these problems should be able to get help without going into a stigmatizing separate program. We will know we have finally broken the stigma about substance abuse and mental disorders when anyone can go to their primary health care provider (general practitioner, nurse practitioner, psychologist, nurse, etc.), and get the help and the care that they need. Much as they now go for a sore throat, high blood pressure or diabetes treatment. 
 
That is our goal. It will take lots of work to get there, but it will be worth it.

-Stan

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Reaching Out Can Make the Difference

Posted on 16/05/2011 | 0 Comments

Youth that are suffering from mental illness more often than not find it difficult to get through school. For some people, all they can think about is how they’re going to get through the day and keep it together. Sometimes things such as anxiety and depression can get in the way of success. The gravity of the anxiety and the depression can take a toll and negatively affect academic performance or social interactions.
 
For most of my life, I was an overachiever and always excelled in school. However, in years past, I dealt with anxiety and depression and found myself going in a downward spiral. It started in junior high and at first, it wasn’t a big deal. A few missed assignments and my grades fell a bit. I knew I could do better but then I stopped caring. My grades dropped from excellent to mediocre. For a time period due to a loophole in the school system, I got away with skipping class without my parents finding out. I never thought I would ever skip class, but things happened and I started doing it more and more. I felt terrible whenever I was at school, so I thought “why should I have to go?” I had a minor intervention and things were fixed, at least for the time being.
 
So then high school rolls around and I moved to a different area, with a new school and a new start. At first, I was doing really well. However, I started heading downhill again. I had difficulty with school and my grades began to gradually fall. Due to my anxiety, I was afraid of approaching anyone, not even my teachers. I felt like I had nobody to talk to. My grades declined from the 90s to failing badly and barely even making the 50s. I was lost in a sea of students and I hardly spoke to any of my teachers if at all.
 
It was hard to spot a teacher who might have cared but one of my teachers who knew me and knew what I was capable of saw what was happening and started talking to me. Confronted by this particular teacher, I couldn’t keep it together and she brought me to the guidance counsellor. It was difficult at first to get me talking but eventually I did… and it felt like a huge weight off my shoulders to let all the thoughts and emotions out. It took a while to figure out how to make things better but it was a great leap forward for me. When I couldn’t bring myself to speak, a teacher reached out to me.
 
So what I want to tell teachers is this: sometimes, all it takes is the simple act of reaching out, and you could make a really big difference for that person. When you look at the sea of students, please reach out and make a difference for those who might be lost in the system.
 
--Karl Yu

Karl Yu is a grade 12 student in Halifax, Nova Scotia and will be attending University this Fall. He has been an active member of the Youth Advisory Council for the Sun  Life Financial Chair in Adolescent Mental Health.  The Chair works directly with youth to provide easy-to-understand materials about mental health and the brain.  The materials are offered free to parents, families, physicians and anyone who wants them. Visit teenmentalhealh.org for more information.

Karl's blog has also been published on: http://www.ourkids.net/blog/the-simple-act-of-reaching-out-makes-a-difference-10108/

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Moving the Mental Health Agenda Forward in Canada

Posted on 13/05/2011 | 0 Comments

There was some large scale news reported in the Globe and Mail recently: http://www.theglobeandmail.com/life/health/new-health/health-news/bells-10-million-donation-hailed-as-mental-health-game-changer/article2018049/. Kudos to Bell Canada for stepping up and making a huge (yes, 10 million dollars is a lot of money) donation to CAMH in Toronto. This is also yet another public statement from corporate Canada as to its awareness of and support for mental health. And this is very much appreciated.
 
Now comes the next very important part. How to ensure that this interest is not merely a reflection of the “flavor of the moment” and how can this translate into substantive and sustainable improvements in mental health and mental health care for all Canadians?
 
Some of this responsibility will of course need to be undertaken by CAMH, as they are the recipient of this largess. Some of this responsibility however will need to be undertaken by those who work in other parts of Canada, parts not as fortunate as Toronto, but where innovative and life-altering work is being done and new directions are being forged. 
 
Perhaps the generosity of Bell will rub off on other corporations. Perhaps the innovation and improvements that this generosity will help develop at CAMH can be used to encourage and support other parts of Canada as well – so that research conducted and lessons learned there can swiftly and effectively be used to improve the lives of all Canadians. Perhaps all provincial/territorial governments will realize that more and more effective investment in mental health is needed. Perhaps mental health will make it to the table in the discussions in the upcoming national Health Accord (I hope that we will have another Health Accord).
 
Who know? What is clear however is that the generosity of Bell and the innovative changes un
 
--Stan

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Teachers Can Make A Difference—My Experience with Mental Illness

Posted on 12/05/2011 | 0 Comments

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Nova Scotia and its mental health plan: how is it going?

Posted on 05/05/2011 | 0 Comments

Nova Scotia is once again developing a mental health plan. I have been active in mental health in the Province since 1995 and have seen at least half a dozen or more Provincial and Regional planning processes addressing mental health over that time. Some “wag” once said that if the number of mental health plans sitting in the Department of Health where laid end to end then we would have a pathway of good intentions leading from Province House to the Elephant and Castle.
 
While I can not vouch for the accuracy of that comment I can certainly resonate with the emotions behind it. And in a recent story on this issue the Chronicle Herald newspaper reported a similar concern by a participant about the current process: “"These are the same issues that have being going on for 25, 30 or 40 years now," one person said. "What’s going to be different?" - http://thechronicleherald.ca/Metro/1241478.html
 
That is an excellent question. 
 
The issue frankly is not that we do not know what to do. The previous Bland Report had a number of excellent recommendations that have not yet seen the light of day in Nova Scotia. The newly available document from the MHCC provides a useful call to action. The Evergreen Framework provides a set of values and strategic directions that could be easily incorporated by the Province in addressing child and youth mental health now. The World Health Organization has produced realms of useful documents/materials ranging from the MHPP monographs to the mhGAP. Recently released mental health documents from British Columbia and Ontario have excellent components that could easily be modified for use in NS.
 
And the list goes on.
 
The issue is doing, and making sure that what is done is based on what we know and supported by strong and independent evaluation of what we are doing so that we can change things that are ineffective or inefficient and replace them with actions that are effective and efficient. 
 
We also need to ensure that the appropriate funds are in place to permit necessary action to happen. The mental health budget for Nova Scotia is woefully inadequate. No plan will be useful if it is not properly resourced. 
 
So what will happen? Follow the money!

-Stan

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New Brunswick and its new mental health plan: how will it go forward?

Posted on 04/05/2011 | 0 Comments

Now that the federal election is over I can turn my attention fully (or as fully as I can get it) back to our very important mental health in youth work. And my attention has been caught by the following article: “NB Unveils Mental Health Plan” which you can find at:
http://timestranscript.canadaeast.com/news/article/1403340
 
The Minister of Health announced the new plan which is supposed to put people at the center of interventions (I assume these include prevention, early identification, treatment and ongoing system improvements) and identified an additional 12.6 million dollars to help do that. 
 
Now that sounds like a lot of money but apparently it is to be spread out over 7 years. So lets see what that translates into: about 1.8 million per year. If all of that money is put into human resources that can meet mental health needs of people then that will result in a good improvement in service availability. If however, much is put into administration there will be little to show for that investment. Some also must go into training as we know that substantive concerns about diagnostic and treatment capacity, especially in the primary health care system exist: not only in New Brunswick but across Canada. Some must also be spent on evaluation and quality assurance. How else are we going to know if the investment results in improvement at the personal, family and the system level?
 
So what will happen in New Brunswick to improve mental health care in that province? Follow the money!
 
-- Stan

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Charlie Sheen, the Media Circus and Mental Disorder

Posted on 11/03/2011 | 4 Comments

 
 
I for one am getting sick of the media circus that revolves around Charlie Sheen. It reminds me of a group of sharks circling around a bloodied and dying mammal, waiting for an opportunity to move in for the kill.
 
It may well be that Charlie Sheen has a mental health problem. He may also have a mental disorder: bipolar illness has been suggested by some. He may be suffering from the emotional, cognitive and behavioral effects of substances. Or it may be all of the above. Or it may be something else.
 
Armchair diagnostician’s aside, it is simply not possible to come to a substantive conclusion about the presence or absence of a mental illness such as bipolar disorder without careful, comprehensive and detailed analysis of presenting problems and a life history. The same goes for any other psychiatric diagnosis, including substance abuse and personality disorders. Nobody can speak with any authority about Mr. Sheen based on media reports!
 
Personally, I find it sad that so many do. I also find it sad that we as a society seem to revel in the difficulties and life problems of those who we have made celebrities. This is not fair to them and certainly does not say much about us.
 
Recently, Dr. Paul Keedwell wrote a thoughtful piece on this issue. Actually, it has been the first thoughtful piece I have read in the media about this: http://www.bbc.co.uk/news/health-12701154. As for me, I think the media circus should stop. Let us leave Mr. Sheen alone so that he can start to address his concerns in private. Send the sharks away.
 
--Stan

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Can Facebook Prevent Suicides?

Posted on 08/03/2011 | 17 Comments

Today I read about yet another suicide intervention strategy, launched with media fanfare in the UK. According to the BBC News, an NGO in the UK called the Samaritans has now launched a Facebook scan for people who discuss ideas about suicide http://www.bbc.co.uk/news/technology-12667343. If they identify someone at risk they will contact police and ask them to go and intervene.
 
Apparently this idea was in response to a suicide tragedy in which a young person died by suicide after posting their intent on Facebook. Is this a good idea? I do not know. Will it work? I have no idea. Will it have the opposite effect of maybe encouraging suicide in vulnerable youth? I do not know. Will this become the focus of hoaxes and “crying wolf”? I have no idea.
 
On the one hand, it could be argued that addressing youth suicide through social media makes sense because that is where youth “live”.  On the other hand, it could be argued that such Facebook vigilance will lead to more harm than good – either through “copy-cat” activities or to hoaxes that lead to police “interventions”. 
 
Suicide is an emotional issue. Not every good idea turns out to be a good idea. Sometimes good ideas have negative unintended consequences. However, it seems that the cat is out of the bag on this activity. I hope that someone is doing a careful and appropriate evaluation of what is happening. That alone will give us an idea if this idea is worth pursuing or not.
 
In the meantime, I would really like to see us all put into place those things that we know actually do work. This includes: limiting access to lethal means (such as controlling access to guns); training all health care providers to better identify and treat those people at risk; providing “gatekeeper” training for teachers and others who spend a good amount of time with young people – so that they can identify those at risk for mental disorder (still the single largest risk factor for suicide) and seamlessly refer them for the care that they need.
 
It seems pretty simple to me. Let us do what we know works. Not do what we know does not work. And, if we do not know, let us study it properly so that we can find out.

--Stan

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Mental Health in Schools Act

Posted on 18/02/2011 | 4 Comments

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 followup. 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.
 
For more about the Act check out:
http://www.napolitano.house.gov/mhsa.shtml.
 
--Stan

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Mental Health and Universities: the SFU innovation

Posted on 11/02/2011 | 1 Comments

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 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

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Check This Out

Posted on 08/12/2010 | 6 Comments

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

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

Posted on 24/11/2010 | 0 Comments

I don’t know how may young people today are familiar with the story of Chicken Little, but for sure they will google it (or click here) 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

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When is behavior an illness?

Posted on 14/10/2010 | 1 Comments

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/family-and-relationships/cheaters-do-prosper-but-are-they-psychologically-ill/article1704646/.   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?

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Back to School

Posted on 12/10/2010 | 0 Comments

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 http://www.latimes.com/health/boostershots/la-heb-college-20100812,0,3226328. and Canada http://www.cbc.ca/health/story/2010/08/12/mental-illness-college.html 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

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If we don’t build it, it can’t work…

Posted on 07/10/2010 | 0 Comments

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Human rights, gender issues and suicide

Posted on 05/10/2010 | 2 Comments

The tragic story of Tyler Clementi’s suicide is well known to many by now (http://news.yahoo.com/s/ap/20101001/ap_on_re_us/us_student_taped_sex).    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

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The Healing Touch

Posted on 04/10/2010 | 0 Comments

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?

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

Posted on 30/09/2010 | 0 Comments

Another nail in the coffin
 
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!

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Suicide Prevention Programs, Do They Work?

Posted on 27/09/2010 | 2 Comments

A few weeks ago, the Ottawa Citizen Newspaper carried another sad story about youth suicide: http://www.ottawacitizen.com/news/young+life+senseless/3317331/story.html. 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 where 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

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You Can Make a Difference

Posted on 23/09/2010 | 0 Comments

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

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Who’s the Professional?

Posted on 21/09/2010 | 0 Comments

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The police and mental health

Posted on 16/07/2010 | 6 Comments

Just was reading an interesting article on police and mental health.  Not the mental health of police, although that would be a very important issue to know more about.  Can you imagine the stresses of that occupation?  But about how police respond to individuals who are exhibiting mental health problems, or individuals with mental disorders who are in distress or acting in such as way as to be causing distress to others.  So here is the piece: http://www.guardian.co.uk/commentisfree/cifamerica/2010/jul/14/police-mental-health-training. As you can see the title is: US Police need proper training in mental health.  And the sub-title is: “People suffering mental health crises are too often subjected to brutality by poorly trained and frightened police officers”  According to the writer (in a UK paper by the way): “Every day in various American communities, people enter mental health crises and their friends and family members pick up the phone to call for help. Often, the first responders on the scene are police officers, and the resulting interaction does not go well. Poorly trained and frightened police officers may resort to excessive force, and sometimes this ends in death for a person who is guilty only of being in urgent need of psychiatric care.”

Although the piece is long on hyperbole and heart wrenching descriptions of police attacking individuals suffering from mental disorders, and short on any substantive data and overall balanced reporting regarding what police forces are actually doing, the writer does bring attention to an important issue.  Certainly police officers should have more training in dealing with the unique needs of people who have mental illnesses and who are behaving in a way that may put them or others at risk of harm.  Certainly we need more and better community based mental health care services.  These needs are real and we have to get working on doing more.

But it is also important to recognize that much has been done in the last decade or so.  Here in Halifax, there is a mobile crisis service that I am proud to have been part of its launch.  It pairs police officers with mental health professionals.  It goes to where people need them and it works – not perfectly mind you, but it works.  One of my colleagues, Dr. Bianca Horner and members of the Department of Psychiatry and the Mental Health Program have developed a national training program for the RCMP, called “Recognition of Emotionally Disturbed Persons” regarding this matter.  Other police forces in Canada are now beginning to address this issue.  I have had the opportunity to be part of the Minister’s task force on TASER in Nova Scotia and the privilege to chair the sub-task force on excited delirium.  As a result of these reports there have been substantive movements towards improving all aspects of first responder approaches to individuals with mental disorders.

While these are a good beginning we certainly have to do more.  It is not appropriate nor is it fair nor is it right that our prisons have become holding bins for people who require mental health care.  The federal government has decided to build more prisons.  I for one would like to see them invest more in mental health care instead.  Don’t you think it’s preferable to treat someone who has a mental disorder in such as way as to assist and support their recovery instead of throwing them in jail?  I do.

--Stan

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Who Makes the Decisions?

Posted on 13/07/2010 | 1 Comments

Recently there was a report of an extraordinary example of political interference in mental health treatment. A political interference based not on knowledge but as far as I can tell, based on stigma or perhaps with a bit of so called “law and order” pandering to the uninformed.

The story unfolds in this way. A person who is in secure treatment for a murder committed when he was psychotic applied to have supervised outdoor walks. The mental health treatment team supported that application and it was permitted by the Criminal Code Review Board who are charged with the responsibility for such decisions. Without these walks (remember that they would be supervised – that is, the person who as far as I know has improved with treatment would be accompanied by two trained mental health staff during short outings) the person would have to languish indoors all summer.

Upon hearing about this decision, the Minister of Justice in Manitoba – Andrew Swan, overturned the board’s decision, ordering that no supervised walks could be allowed! Why? According to Swan it was “contrary to the interests of public safety”.

What hogwash. Since when did Minister Swan get his credentials in mental health? And what possessed him to overturn a duly constituted and credible evaluative process? Could it be stigma against the mentally ill? Could it be the lowest form of political pandering to ignorance and fear? What kind of a message does this send to people living with mental illness? What message does this send to their families? What message does this send to society in general?

Shame on Minister Swan. This is something we could have expected in medieval times, not in 2010 in Canada.

--Stan

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What’s next?

Posted on 29/06/2010 | 2 Comments

What people are saying?

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Preventing Youth Suicide:  Doing the right thing or not?

Posted on 24/06/2010 | 0 Comments

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

Posted on 23/06/2010 | 0 Comments

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

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Advancing mental health through gender equality

Posted on 23/06/2010 | 1 Comments

When I read the piece in the Globe and Mail 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

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Digital Media and Mental Health—Another Opinion

Posted on 15/06/2010 | 1 Comments

What people are saying?

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Digital Media and Mental Health

Posted on 15/06/2010 | 1 Comments

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

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Preventing Tragic Outcomes Starts with Us

Posted on 03/06/2010 | 1 Comments

There was a tragic story in the Halifax newspaper, the Chronicle Herald this week: http://thechronicleherald.ca/Front/1185324.html. 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

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Early onset of mental disorder hurts – in your wallet

Posted on 21/05/2010 | 0 Comments

We have known for a long time that the majority of mental disorders begin before age 25. We have also known for a long time that early onset mental disorders are a risk for many poor short and long term outcomes – indeed that is why we recommend early identification and early effective treatment. So that we can try and prevent poor outcomes and enhance good outcomes.

So a recent study, just published has found that for each person (on average) who has an early onset mental disorder it costs her/him over ten thousand dollars per year when they are an adult – that is correct: PER YEAR. This is compared to what their siblings make. ! OUCH!

So, as you know, I am a strong advocate of early identification and early effective treatment for mental disorders. It is simply not right that we do not meet the mental health needs of children and youth at the time that they need the help most – right after they get sick! We know that not providing care early leads to a host of poor outcomes for the person and for our society. Now we have additional information – this is the personal cost – over ten thousand dollars per year! Think of the effect that has on life and wellbeing. Think of what negative spiral effect that could have – poverty, use of food banks, etc. Think of the loss of tax revenue and the impact of lower incomes on the lives of their families and the wellbeing of their children. Not only is this not economically unacceptable, it is simply not fair.

Hey governments. Hey society. Hey banks and wealthy corporations. Hey citizens. It is time we made the investments early on. We can not afford not to do that!

--Stan

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Show Me the Evidence

Posted on 08/04/2010 | 3 Comments

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

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Understanding Teens—Is it Possible?

Posted on 19/03/2010 | 0 Comments

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Should we fix child and youth mental health first?

Posted on 18/03/2010 | 0 Comments

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?

Well, I wrote about three ideas on this http://thechronicleherald.ca/Letters/1172666.html and the first was focusing on child and youth mental health.

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

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Lets make everyone feel good and ignore those who need help!

Posted on 16/02/2010 | 0 Comments

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 fascitious) 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 predicitive 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 successsful.

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, particulary 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, “labelling” 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

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Anxiety: Flight or Fight?

Posted on 12/02/2010 | 6 Comments

Today I was teaching in a primary health care workshop.  Helping a variety of health care providers become comfortable with mental health competencies that could be used by family doctors, nurse practitioners, nurses, social workers and other to provide mental health care to those that need it.

During the discussion about anxiety, we chatted about the way that anxiety makes us feel.  Many of the examples that people gave included the phenomenon of withdrawal, that is, avoidance of the situations in which we feel anxious.  That is surely true, and is one way that anxiety causes great difficulty for people.  This is one way in which anxiety leads to what we call functional impairment: the inability to do what you want or need to do because of the mental disorder.
But, there is another way that anxiety shows itself.  That is through aggression.  Yes, sometimes anxiety can lead to lashing out at others.  Have you ever been worried about someone who is late for dinner or late in meeting you at a movie?  What about the parent who is worried about where their child is late at night when it is an hour past the time that they were supposed to be home?  What often happens when your friend shows up or the child slinks into the house?

Right.  You got it.  Instead of being hugging and warm it is often the opposite that occurs.  You get angry and act annoyed.  The parent yells at their child.  Yelling is verbal aggression.  The anxiety has resulted not in avoidance but in attack!

That this happens should not be a surprise.  Remember that anxiety leads to the fight or flight response.  Avoidance is part of the flight and anger is part of the flight.  Yet another way that anxiety can make lives more difficult for people.

We often forget how much of a problem overwhelming anxiety can be.  Panic attacks, social anxiety, generalized anxiety and obsessive compulsive disorder all have the potential to be quite disabling.  They can also all be treated and both avoidant behavior and attacking behaviors can be controlled.  In the next couple of months we will be posting a lot of new information on this website, much of it about anxiety.  Stay tuned!

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Whatever Were They Thinking?

Posted on 04/02/2010 | 0 Comments

FINALLY, the Lancet (one of the world’s top medical journals) has retracted their publication of one of the most misleading articles in the history of modern medical science – the now totally discredited piece on the relationship between autism and the MMR vaccine http://www.cbc.ca/health/story/2010/02/02/autism-mmr-lancet-wakefield.htmlt.

What took them so long? It seems that the Lancet editors where the last in the world to know that the article was basic bunkum. And why did they even print it?

If you can find me another article that uses the same low level of scientific evidence and flawed thinking that the Lancet has published in the last decade as this one used I will buy you a chocolate cookie. (Only one cookie per customer, just in case). I for one have no idea about what the answer to either of those questions is. But the fallout has been substantial. It seems that large numbers of children died because they were not vaccinated. And to what end? Because a researcher (who it seems was in the employ of lawyers making lots of money suing vaccine manufacturers) published such poor science and because a learned journal did the publishing?

So what is a possible lesson here? Although there are many, one most certainly is that one swallow does not a summer make. That is, scientific knowledge is not built on one study, but on many, conducted by different and independent investigators, using best methods and techniques and scrutinized by peer review. Is there the possibility that some studies will show one thing and others will show another? For sure. Science is nasty, brutish and long. Remember the word attributed to Mark Twain: “be careful reading a medical text book. You may die of misprint”

--Stan

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How about a mental health day!

Posted on 01/02/2010 | 5 Comments

So it was late afternoon and I was chatting with some of my young, active and thoughtful research team members. And guess what came up? We need a mental health break during the “dog days” of winter. The more I thought about it, the more I liked it.

We know that the winter blues are very common at northern latitudes – such as all of Canada. We know that there is a mental disorder, called Seasonal Affective Disorder that is linked to the relative lack of sunlight during our winter months. We know how long that stretch of going to work when it is dark and going home when it is dark is – especially between Christmas and the first holidays in the spring. Apparently there is even some anecdotal evidence that work and school problems peak in February. And, we know how important a good down day – preferably one in which we can go exercise outside in the sunshine- is for our mental health.

So here is my proposal (actually it is the proposal of Jess Wishart and Christina Biluk), but I am putting forward as mine. Let’s have a national holiday in early February. Lets call it mental health day. Why not? We can just prorogue for a while. I bet that it will be good for all of us. And the researchers can study to see if the two weeks after the day show less work and school stress than the two weeks before the day. Or they could do a controlled trial – one part of the country with the day off and the other part without. Hah. Maybe we should just take the day off!

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How much longer before action?

Posted on 26/01/2010 | 1 Comments

Last week, there appears an article in the San Francisco Chronicle about suicide deaths due to jumping from the Golden Gate Bridge http://www.sfgate.com/cgi-bin/blogs/inmarin/detail?&entry_id=55733. According the Chronicle, last year there were 31 deaths, the year before that there were 34. Over 1,300 people have died by suicide from jumping from the bridge since it was built.

And what is the essence of the story? Apparently the Marin County Coroners Office wants to recommend suicide prevention barriers and this is controversial. And guess what – more studies are apparently recommended.

Now, readers of this blog know how committed I am to research. You also know that I am committed to action. Will putting up an appropriate barrier decrease the rate of successful suicides by jumping from the bridge? Highly likely. Is this a good thing. For sure. So why is it not being done. Who knows?

I remember the hard work that went into getting barriers erected on the Bloor St. Viaduct in Toronto. There the effort was lead by a young man with lived experience of mental illness. I know of the hard work that went into getting a barrier erected on the MacDonald Bridge in Halifax. There the effort was lead by a mother who had lost her son to suicide from the bridge.

It the courageous activity of people like those Toronto and Halifax citizens that seems to be necessary before authorities can act. I am so proud to know and support those leaders and I thank them for everything that they have done and continue to do in this regard. What I don’t get is this. Why is it so hard to do the right thing when it comes to mental health action?

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Doing the right thing in mental health programs

Posted on 22/01/2010 | 1 Comments

Arguably, the area of mental health is the newest domain of health in using independent, empirically valid and scientific approaches to determining what works, for whom, at what financial cost and with what potential harm.  Perhaps because of this “newness” we seem to spend a lot of unproductive time arguing or discussing what we should be doing and frequently confusing opinion with evidence and often not understanding that all evidence is not equal.

The Health Development Agency of the National Health Service (United Kingdom), in a 2004 critical review of youth suicide prevention programs provided the following four criteria to be used in the application of all mental health programs:

1 – Apply good and effective interventions
2 – Avoid ineffective interventions
3 – Eliminate harmful interventions
4 – Facilitate public accountability

These seem pretty reasonable to me.

The problem we seem to have is making sure we do each of these things.  This is especially a difficulty when our pet theories or personal perspectives do not stand up to independent, substantive and appropriate scrutiny.  Yet these are the things that we need to do.

So here is a suggestion.  Before implementing any mental health program can those people charged with doing that simply tic off each of these four criteria.  Have you clearly and with the proper and most substantive type of evidence demonstrated that the interventions are good and effective?  Are you using programs or other interventions that have none or inadequate evidence of effectiveness?  Are you sure that your programs or other interventions do not cause harm?  Have you been open with the public about the effectiveness, cost effectiveness and safety of all the programs and other interventions that you have in place?

If not, why not?

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Using What Works and NOT Using What Does Not Work

Posted on 20/01/2010 | 1 Comments

Recently, my research team published a scientific commentary in the Canadian Medical Association Journal dealing with an important mental health concern. We conducted an assessment of the information dealing with psychological debriefing in schools and found that there was no substantive evidence to support the use of that kind of intervention following traumatic events. We also found that the best available evidence in studies of adults showed that these type of interventions were not helpful, and indeed in some studies turned out to be harmful (see: Psychological debriefing in schools, www.cmaj.ca Online publication, January 4, 2010)...

Yet, these interventions have been very popular and used so frequently that they have become commonplace. Who has not heard the news on the radio that grief counselors have been dispatched to a school after a traumatic event?

This raises a very important issue. That is, before we start wide-scale mental health interventions we need to be pretty sure that they work and we need to be really sure that they do not cause harm. If we put programs into place that do not work we are creating a false sense of security and using scare resources; money and people, to no good end. Furthermore, because of our investment in such programs we may be less interested in considering other options – options that may actually work. In other words, what seems like a good idea may not be a good idea and if that gets codified or ingrained in an organization or institution it may have more negative than positive consequences.

So, what is to be done? First, when we do get solid substantive evidence that what we are doing does not really work, is not cost effective, could be done better in a different way or may cause harm – we should stop doing whatever that is that we are doing. Sounds simple but it is not so easy. Usually because there has been a big investment in the initial program and there may even be a big industry and local champions pushing for its continuation. Second, before putting in a program we should demand solid substantive evidence that the program really works and that it causes no harm. Third, if we decide to put programs in without the kind of evidence we need to have, we better make sure that we also provide the kind of independent and unbiased research that is needed to help us determine if the program works or not, if it is cost effective and it does not lead to harm!

We have to do the right thing, not just do something.

--Stan

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More on the word depression

Posted on 14/01/2010 | 0 Comments

Today I saw an article about the movie Avatar. This article tells all who read it that this movie is causing people to become depressed and suicidal. What a bunch of journalistic hokum. (http://www.news.com.au/entertainment/feature/avatar-perfection-causing-depression/story-e6frfnv0-1225819063598).

What this likely illustrates is what a topic of a previous blog has been: the inappropriate use of the word “depression”. People do not become clinically depressed after watching a movie; they may however experience a variety of negative feelings (or sometimes positive feelings). We do not call the feeling state that a movie such as Chariots of Fire engenders “mania”. No, on the contrary. We call it; uplifting, joyous, awesome, elevating, etc. Why do we call negative feelings “depression”?

There are so many other words to use. Our language is so rich in words that describe affect. So let’s use some of them: dispirited; demoralized; dysphoric; distressed; disgruntled; disaffected; pathic; etc. And while we are at it, lets give reporters who may not know how or can not be bothered to write clearly. (or who are using emotive words to sell copy), a clear message that these headlines are of no value in furthering our understanding of the human spirit. Can a movie stir our emotions? Totally! Does it cause mental disorder? No!

--Stan

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A mind at sleep is a mind at rest

Posted on 13/01/2010 | 1 Comments

A recently published study about the relationship between sleep time and depression in teens (http://behavioralhealthcentral.com/index.php/20100111172002/Special-Features/teens-who-dont-get-enough-sleep-risk-depression-and-suicide.html) has many people confused. It was a co-relational study and thus does not confirm causality. So it is not possible to conclude that going to bed late causes depression in adolescents. On the other hand, the study does bring the spotlight back on the well known scientifically but less well appreciated complex relationship between sleep and depression in teens.

We have known for a long time that sleep is disturbed in teen depression. We have also known for a long time that the usual sleep architecture (that is how the different stages of sleep happen during the night) is disturbed in teen depression. We also know that some teens who get depressed show subtle changes in their sleep architecture before they get depressed. Many years ago my research team reported those findings and we also showed that there were abnormalities in hormone secretion at night in depressed teens. And, we know that forced waking early in the morning may improve symptoms in depression. So there is clearly something happening in how the brain controls mood and how it controls sleep.

But, it is simplistic and wrong to assume that setting late bedtimes for teen’s causes depression. This is not the case and it would be foolish to try to tell parents and teens that going to sleep before midnight is protective against depression. However, there is much for us to learn about sleep and depression in teenagers. And there is a growing interest amongst researchers in this area. So stay tuned!

--Stan

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Presents for Christmas

Posted on 23/12/2009 | 1 Comments

Since it is Christmas and since gift giving is “top of mind” (regardless of your religion – this is a time of year that gift giving is celebrated – OK, not the retail kind, the REAL kind), I thought about what gift I as a mental health professional would like to receive. And guess what – a number came to mind.

First, I would like to see a Canada and the global society be a place in which people living with mental illness had exactly the same rights, equalities and access to care as people with illnesses that are not disorders of the brain have. When we can speak of diabetes and colitis and arthritis and schizophrenia all in the same breath and with the same considered and supportive perspective then we will have gone a long way to decreasing stigma and barriers to mental health care.

Second, I would like to see us beginning to talk about finding a cure for various mental illnesses, much as we speak about finding a cure for breast cancer or finding a cure for prostate cancer. We have finally developed and are rapidly developing our understanding of the brain and its functions – in health and in disease. And we are getting closer to understanding the social and enviromental impacts that effect brain function and how those may contribute to the development or perpetuation of mental disorders. So its time we set our sights on a cure for schizophrenia, a cure for major depressive disorder, a cure for bipolar disorder and so on. We may not find a cure in the next five or ten years, but by gosh the search will take us a long way forward.

Third, I would like to see our mental health community supported and enhanced by coming together of various components instead of those components pulling us apart. Sometimes I think that if we spent one half of the time and effort that we seem to put into supporting pet ideologies or convincing others of our “truths” in common purpose, we would be so much further ahead. One foundation that we really need to build our community on is scientific literacy. We need to use science to advance our cause. We need to use the best scientific methods and the knowledge that they bring to us to inform our directions. We need to embrace the science and not rail against it. Building on this foundation we can work together to ensure that all the interests and different voices of individuals and groups are expressed, heard and included. A house has many rooms, but if its foundation is not strong it will collapse, regardless of how pretty it may look.

So those are my three Christmas gift wishes. The best of this gift reminding season to you and yours. Regardless of your religious beliefs or other defining features. Be well.

-Stan

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Doing better with Depression

Posted on 18/12/2009 | 3 Comments

It's hardly a day goes by that we don’t read about depression and its impact on people and the economy and the toll it takes with suicide. We also read about how wonderful treatments are and how it is important to get help as soon as possible. All the above is true and for sure if I, or one of my loved ones, or one of my friends, was depressed I would certainly opt for immediate treatment with an antidepressant medication and an evidence based psychotherapy, delivered by competent health care providers.

But, and this is a big but – the evidence shows that good as our treatments are, they are not as good as they should be. The medications really help a lot but they do not help everyone. The psychotherapies help a lot but they do not help everyone. Combining the treatments helps more people but even this does not help everyone. So what do we need to do?

Well, it's all well and good to make our systems of care more accessible and to train more health care providers to be able to treat depression but wait a minute. Shouldn’t we be spending a whole lot of time and effort on making our treatments better? Shouldn’t we be making sure that when we offer a treatment to someone the chances of it working the first time are as close to 100 percent as we can get? What would you prefer – a one day wait time for a treatment that works 50 percent of the time or a one week wait time for treatment that works 90 percent of the time? And while we are at it – why not a one day wait time for a treatment that works 100 percent of the time.

So we need to invest in treatment research. We can have all the health care providers and all the clinics and all the nice posters on the walls of schools and neat anti-stigma ads on the television and radio and on and on and on – but, if we do not get better at treatment, how much further are we really ahead? Do you know how many high powered (meaning really good scientific studies) have been done in Canada in the last five years on the treatment of some of the most common mental disorders that begin in adolescence. One? Five? Nine? Maybe none? Do you have any idea how much money is being spent on finding out how to better treat young people that have psychosis or depression or obsessive compulsive disorder compared to treatments for other medical illnesses or even compared how much is spent on posters that tell youth about problems? Don’t you think you should have some idea?

We need to invest in a major way in learning better ways to treat mental disorders in this country. We are not doing that in Canada. It is time we started to. Improving access to care is a good idea. Improving access to care that actually works is an even better idea.

-Stan

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Suicide attempt or self-harm: does it matter?

Posted on 16/12/2009 | 1 Comments

Some of us think we have a problem in our suicide research and in our suicide prevention approaches. Actually there may be many problems with those (stay tuned for future blogs) but one of the concerns is the meaning of the statistics when it comes to the definition of “suicide attempt”.

A suicide attempt can be defined as a purposeful self-injury with the intent to die. A self-harm attempt on the other hand can be defined as a purposeful self-injury without the intent to die. Self-harm can be the result of many different factors, including but not limited to: difficulties with problem solving, difficulties with impulse control, copycat phenomenon, social or situational control, etc. Increasingly, research is showing that young people who self-injure may be substantially different from those who attempt suicide. So what does this mean?

Hospitals that use the ICD system (and that is all of them) tend to code self-injury as a suicide attempt. Even DSM at the time of this writing, does not allow for differentiation of self-injury from suicide attempt. Could it be that many of our statistics about suicide attempts are incorrect? Could it be that “truths” that we think we know – such as more females attempt suicide than males – may not be accurate but may be an artifact of not separating out self-harm attempts from suicide attempts?

And what about suicide prevention programs? Does a decrease in reported incidents of self-harm equal a decrease in real suicidal behaviour – that is suicide attempts? That does not mean that we should not try to bring down self-harm attempts, but it may mean that the methods useful for one outcome may not be useful at all for another outcome.

Actually, I think its time that we started to think more critically about what we mean when we use the words “suicide attempt”. Is it really a suicide attempt or is it a self-harm event? It is an important distinction. Both are important targets for interventions – public health type and clinical type. We need to separate them out in our statistics and we need to separate them out in our programs. Then we can get a better handle on what is actually happening and what we can do about it.

-Stan

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Sleep – A Teenagers Best Friend

Posted on 04/12/2009 | 1 Comments

So what is this with sleep anyway?

Given what we know at this time, sleep is necessary for brain growth and development. It is also fundamentally necessary for academic success. For example, when we sleep, we learn. Important memories from the previous days are consolidated and the capacity to learn for the next day is refreshed. And, during the teen years, with the accelerated brain growth and re-organization that occurs during those years – youth actually need more sleep than when they were children.

During the teenage years the child pattern of getting up early and going to bed early shifts to going to bed later and getting up later. And at the same time, the brain’s need for total sleep time increases – as much as an hour or more per night. When accentuated by the digital and light enhanced evening environment, staying up later and later becomes the norm for many teens. And, because the school day usually starts fairly early, students (as the research has shown us) are frequently sleep deprived, sleepy and not at their optimal learning capacity – especially in the first hour or two of classes. This pattern leads to not enough sleep during the week and this leads to sleep debt – time that needs to be repaid – you guessed it – on the weekend! This results in a pattern of about 2 hours difference between usual sleep/wake patterns between school days and weekend days for many teenagers. This is equivalent to a jet lag of 2 hours. And that happens mostly every week!

One obvious solution to this problem is starting the school day later for high school students. Indeed, some studies have reported that this results in improved academic performance and one study in Kentucky also found fewer automobile accidents during the later school start trial. However, this accomodation to the changing teen brain has not proved to be popular with education officials and across most of Canada and the USA, schools still start early and teenagers still come to class tired and not ready to learn. And guess what? In many places, exams (including those that take an enormous amount of concentration – such as mathematics) are frequently scheduled for early in the morning!

So what can be done about this? Well, changing the school day is not likely to happen, but that would be a really good idea. Just think, setting up a school protocol to meet the needs of the students – what a novel idea! For the individual student, trying to get to sleep a little earlier (even one hour earlier) would pay big dividends. And if that is just as hard as changing the school start time – at least get a good nights sleep before your exam. Staying up all night and cramming is not helpful. Getting your beauty rest is. Isn’t science grand? Did your grandmother tell you this at some time?

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Understanding Youth Suicide

Posted on 02/11/2009 | 0 Comments

Today’s Los Angeles Times carried a front page local story regarding youth suicide in Palo Alto: "Palo Alto campus searches for healing after suicides”. Although details are sketchy and of course incomplete, the story points out that there has been a cluster of suicides involving students from the same school campus over a short period of time, occurring in the same place and under similar circumstances. As expected, such tragic events have caused substantive community consternation.

Youth suicide is a very emotional issue. It cuts to the very core of our families and our communities. It leaves scars in parents, siblings, grandparents, other family members, friends and many others. It elicits strong responses from individuals or from communities. Some of those responses are of grief – private and shared with only a few. Some of those responses are very public – it is not clear what motivates them or how these differ from the private responses. Some of these responses may be helpful – such as support and counseling from family and friends. Some of these responses may be harmful – such as bringing in grief counselors and creating community emotional contagion in the wake of a suicide. Some of these responses may be neither helpful nor harmful – but may be costly. So, what can be done?

Here the evidence is not fully in yet and each situation begs careful assessment and considered planning before anything is started. What is not helpful is putting into place those things we know do not work. What is likely not helpful is grief contagion. This can be created by mass grief counseling and enthusiastic and well meaning initiatives to “do something”. What may be useful is identifying young people who know the victims and addressing their mental health needs and emotional concerns. What may be useful is for the newspapers and television and radio stations to stop running front page stories and prime time news about youth suicide. This does not mean that we do not talk about it. This does not mean that we avoid the topic. Not at all! This means that we address this tragic and emotionally issue rationally and responsibly.

-Stan

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Mental Illness can impact anyone

Posted on 22/09/2009 | 1 Comments

September 22, 2009

Recent events in the National Basketball Association (NBA) involving two high profile players, Delonte West and Michael Beasley have highlighted the issue of mental health in the NBA. And, this is an important step forward, not only for the NBA in specific but for professional sports in general.

Professional athletes are no less likely to suffer from mental disorders than the general population. We can expect that approximately 10 to 15 percent of professional athletes will have significant and substantial mental health problems, including mental disorders. The most common mental disorders will be: depression, anxiety disorders and substance abuse. A few may have bipolar illness or other psychotic conditions.

These disorders will affect them in both their personal and professional lives. Athletes living with mental disorders can expect to have the same challenges that people who are not athletes but who are living with mental disorders have. These include but are not limited to personal problems and decreased job performance. One important difference however is that professional athletes are very high profile. Their lives are often lived in a public arena. When they have problems these are difficulties are known to the many, not only to the few.

When mental disorders in professional athletes lead them to experience personal and professional difficulties these can be publicly addressed in positive or in negative ways. One positive way may be for their employers (professional sports teams) or their associations (players associations, professional leagues such as the NBA , the NHL and others) to publicly acknowledge these difficulties – much as they now do with physical illnesses or injuries. Another way may be for the players themselves to be open about their problems and to discuss them much as they discuss any physical injuries or other similar issues. Another way may be for the sports media to become more knowledgeable about mental health problems and mental illnesses and to write their stories from a position of understanding.

Mental disorders affect everyone – including professional athletes. How they, their employers and the media handle these issues may have an important impact on how society in general and youth in particular understand mental illness. Its time for professional sports to get “on side” – so to speak.

-Stan

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Suicide Prevention – Time to Get On With What We Know Works

Posted on 15/09/2009 | 0 Comments

Another World Suicide Prevention Day (September 10, 2009) has passed and in many locations a variety of activities were underway across Canada, for example, community suicide awareness walks such as the one that has been initiated in New Minas/Kentville Nova Scotia and one that will be occurring in Halifax on the weekend following. The Canadian Broadcasting Corporation has presented a number of stories on the topic and the London Free Press newspaper has announced that it will publish obituaries in which suicide can be identified as a cause of death. The president of the Canadian Association for the Prevention of Suicide is quoted as saying that a national suicide prevention strategy is needed. All in all, there is increasing awareness of the importance of this issue nationwide.

Unfortunately, in all the media reports I have seen or heard on this issue there has been not one mention of what I consider to be the most important item that needs to be addressed. That is, based on solid scientific evidence we already know what to do to decrease suicide rates, so why are we not doing those things? Marches are good for raising awareness but do we need to march to put effective programs into place?

So what do we know helps bring down suicide rates? First of all is the identification and effective treatment of people who are living with a mental illness – especially depression, bipolar disorder and schizophrenia. Second is the reduction of access to lethal means – be that through control of handguns or barriers on bridges. Third is the creation of “gatekeeper” programs in organizations such as schools or similar institutions. In this way those individuals at highest risk can be identified and interventions provided to them. None of these are difficult to do. None of these are costly to develop and implement. So why are they not universally in place?

Health care systems are notoriously inert – change comes very slowly and often inefficiently. Stigma against the mentally ill pervades the health care system and providers are not immune from its insidious effects. Could this be a reason why those relatively simple and proven effective approaches are not already in place everywhere? Where are our legislators - provincial/territorial and federal? Why are they not demanding that these approaches are in place and properly supported? Perhaps it is because they feel no pressure to do so. Perhaps the scientific evidence and moral imperatives are not enough. Perhaps they need a push from the people.

So, what do I have to say about this? Walk on. Speak out. Demand change. Demand that what we already know works be implemented. Demand that we learn more. Crush the stigma and let the science lead us to do what works best!

 

Dr. Stan Kutcher

Sun Life Chair in Adolescent Mental Health

IWK and Dalhousie University

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It’s Time To Focus On Triumphs

Posted on 03/09/2009 | 1 Comments

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Mental health in schools: How teachers have the power to make a difference

Posted on 17/08/2009 | 1 Comments

We've had a lot of great feedback from our post on schools as the next frontier for mental health education.

We all know the problem. Mental disorders represent the most common and disabling condition affecting young people and therefore have major implications for students and for schools. In short, mental health problems affect a student’s emotional well-being, their ability to learn, are a factor in why some students drop out of school.

But too often we focus on the problems instead of the solutions. In a recent article entitled "Mental health in schools: how teachers have the power to make a difference" for Health and Learning Magazine, Dr. Kutcher, Leigh Meldrum and I outlined a three-pronged approach to address mental health problems in schools. Here's an excerpt:

Schools can be an important location for mental health promotion, early identification and intervention, combating stigma associated with mental illness and possibly providing interventions and ongoing care. But as a teacher, what can you do to make a difference in the mental well being of your students? The answer is not always easy, and requires cooperation at all levels of the education system and a positive collaboration with health care providers.

Using the classroom for stigma reduction

One of the largest obstacles facing youth with mental illness is the associated social stigma against people living with a mental disorder. While the scientific understanding and treatment of mental disorders, as well as the awareness of the importance of mental health in all aspects of life, has advanced considerably in the past decade, the public’s perception about people with mental illness has been much slower to change.

In the classroom, stigma associated with mental illness can affect how teachers, classmates, and peers treat the student living with a mental disorder. School-based anti-stigma activities present an opportunity to enhance understanding of mental illness and improve attitudes towards people living with mental illness. Furthermore, school-based anti-stigma activities reach people on all social levels, from teachers, principals and administrators to parents and community members to most importantly, the students themselves.

Identify and intervene!

Early identification and effective intervention for youth with mental disorders is critical. If left untreated, the symptoms of a mental illness may increase in severity, and its effects may become more serious and potentially life threatening. Educators and school personnel are in an ideal position to recognize behavioural or emotional changes, which may be symptomatic of the onset of mental illness.

By providing training related to youth mental health and mental disorders in young people that is specific to educators we will be better equipped to protect and promote the mental health of our youth. Educator-specific programs, such as Understanding Adolescent Depression and Suicide Education Training Program, addresses the signs and symptoms of depression, as well as risk factors for suicide, methods of identification and appropriate referral of high-risk youth. The basis of this innovative Canadian program is supported by documented evidence of effectiveness and has been demonstrated to improve mental health literacy in educators and health professionals.

School curriculum meets mental health promotion

A potential starting point for the integration of mental health care into existing school health systems is through the implementation of a gatekeeper model. A gatekeeper model provides training to teachers and student services personnel (such as social workers, guidance counseling, school psychologists) in the identification and support of young people at risk for or living with a mental disorder. It also links education professionals with health providers to allow for more detailed assessment and intervention when needed.

Schools can also address students’ mental health through the implementation of mental health promotion strategies through innovative curriculum initiatives. Improving mental health literacy through curriculum development and application could enhance knowledge and change attitudes in students and teachers alike, and embedding mental health as a component of health promoting activities could enhance mental health while decreasing stigma associated with mental disorders. Two examples of recently developed Canadian mental health curriculum for schools are: Healthy Minds, Healthy Body (Province of Nova Scotia) and the Secondary School Mental Health Curriculum (Canadian Mental Health Association).

Read the full article online in the May 2009 issue of Health and Learning.

~ David Venn

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Stigma associated with mental illness runs deep

Posted on 11/08/2009 | 4 Comments

Try playing this little game with a friend, parent or co-worker. Ask them to list three adjectives that describe a person with mental illness. Then ask them to list three adjectives that describe a person with breast cancer. Finally, ask them to list three adjectives that describe a friend.

More than likely the person will use words like "crazy", "sad", "depressed", "lonely", "patient", "consumer or victim", "scared", "down", "violent", etc. to describe someone with a mental illness. In describing someone with breast cancer they will likely use words such as "strong", "confident", "undeserving", "survivor", "thriving", "family connection", etc.

And in describing a friend the person will likely use words like "fun", "caring", "happy", "smart", "loyal", "honest", "responsible", etc. See the difference?

Whether you play this game with youth, parents, educators or even health professionals you get the same result - positive words to describe a friend or a physical health problem like breast cancer and negative words to describe a mental illness like Depression.

And what if the your friend had Anxiety Disorder or Depression? Would that change your perception of them as a fun, smart, caring, loyal person? Would they suddenly be relegated to being a crazy, lonely, scared patient? The stigma surrounding mental illness runs deep. It is embedded in our actions, our culture and our language. Imagine a time when we describe and perceive people living with mental illnesses the same way we describe and perceive our friends or people living with physical health problems!

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Teens aware of marijuana harm and impact on mental health

Posted on 06/08/2009 | 3 Comments

According to a BBC article, a survey of of 27,000 teenagers found that "nearly one in two teenagers knows someone who has suffered from a mental health problem like paranoia after using cannabis."

The research, which was carried out on networking website Habbo Hotel, found 64% of young people were aware cannabis could cause panic attacks, 41% knew it could bring on paranoia and 38% thought it could result in memory loss.
Over 50% of teenagers associated cannabis use with losing motivation and doing badly at school or college.

While the survey is far from scientific - it does point to some interesting trends among teens and their perception of marijuana use and how it affects mental health. Recent research suggests that heavy use of cannabis may increase the risk of psychosis in some young people The website Psychosis Sucks maintains that:

Psychosis can be induced by drugs or can be "drug assisted". Some stimulating drugs, like amphetamines, can cause psychosis, while other drugs, including marijuana, can trigger the onset of psychosis in someone who is already at increased risk because they have "vulnerability". The risks associated with drug use for a person with psychosis include an increased risk of relapse, the development of more secondary problems (including depression, anxiety or memory problems), a slower recovery and more persistent psychotic symptoms.

The good news is that with early identification, treatment and support, people living with psychosis, substance abuse or a combination of these mental health problems can recover. Because people with psychosis may have interlinked problems with substance use problems, treatment that combines both mental health and addiction services into one program is best. ALSO - integrating treatment for psychosis and substance abuse into one program is an effective way to help both problems at the same time. Treatment programs include:

  • Improving quality of life including belief in the possibility of recovery.
  • Going beyond just eliminating symptoms of psychosis and substance use and emphasizing social and other supports.
  • Motivation support to help you set and accomplish your goals.
  • Taking medications as prescribed

For more info check out: Psychosis and Substance Abuse Brochure for Youth (pdf) Psychosis Sucks - Substance Abuse and Psychosis Schizophrenia: A Journey to Recovery - A Consumer and Family Guide to Assessment and Treatment (pdf) Rays of Hope - A reference manual for Families & Caregivers (pdf) Nova Scotia Early Psychosis Program Resources

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Kutcher Adolescent Depression Scale for the iPhone

Posted on 04/08/2009 | 8 Comments

Recently I wrote a post on mental health in the palm of your hand - exploring how technology and iPhone applications were being used to share medical and mental health information. Following that post I contacted Dr. Harvey Castro at Deep Pocket Series to ask him about Sad Scale - a self screening Depression test and iPhone application tool. Understanding the need for a Depression scale for children, Dr. Castro worked with our team to adapt the Kutcher Adolescent Depression Scale (KADS) for use on the Sad Scale application. The KADS, along with the Center for Epidemiological Studies Depression Scale for Children (CES-DC), are now available on the Sad Scale. These applications will give you a graph on your progress and will also allow you to email your health care provider the results of the test. The iPhone application is available now and can be downloaded for $0.99 from iTunes. We are now adapting the Kutcher Generalized Social Anxiety Disorder Scale for Adolescents (K-GSADS-A) ... stay tuned! (literally) ~ David Venn

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New mtvU & Associated Press Poll Examines College Students’ Mental Health

Posted on 30/07/2009 | 3 Comments

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School Mental Health: The Next Frontier

Posted on 27/07/2009 | 1 Comments

Promoting student health and well-being in school has long been a component of education. Traditionally, varsity athletics, school intramural sports programs and gym classes have stressed the importance of staying physically healthy through exercise. More recently, school-based sexual education programs have informed young people about the importance of sexual health, exposing students to issues of contraception use, gender identity, reproductive rights, and sexual behaviour. Nutrition has also made headway, with some schools banning high-caffeine/energy drinks and introducing healthier eating options into school cafeterias. But despite these advances, mental health – a fundamental part of student health and well-being – still remains largely absent from the education agenda.

According to the World Health Organization, mental disorders are the single largest health problem affecting young people. In Canada, approximately 15 to 20 percent of children and adolescents suffer from some form of mental disorder; which translates to one in five students in the “average” classroom. Furthermore, most major mental disorders onset prior to the age of twenty-five, making adolescence a critical time for the prevention and treatment of mental health problems.

Mental disorders can lead to serious consequences if untreated. They may impede a student’s emotional well-being and social development, leaving young people feeling socially isolated, stigmatized and unhappy. Mental disorders may also present significant barriers to learning. For example, students with mental disorders may have difficulty meeting academic standards or reaching their academic potential. These barriers can be so difficult to overcome that they may lead to chronic absenteeism or even school drop-out.

Early and effective treatment of mental health problems can substantially improve emotional and behavioural difficulties, thus reducing the number of days of school missed and reducing instances of contact with law enforcement. Treatment can also lead to improved social and behavioural adjustment, school performance, and enhanced learning outcomes. The earlier that mental health problems are addressed through appropriate effective interventions, the more likely that beneficial effects will be achieved in both the short and long term.

For all of these reasons, addressing the mental health of young people should be a priority for schools. (Excerpt from "Mental Health: The Next Frontier of Health Education", Education Canada, Spring 2009- by Dr. Stan Kutcher, David Venn, Magdalena Szumilas)

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YoungMinds launches youth mental health video and manifesto

Posted on 20/07/2009 | 0 Comments

Great video on youth mental health produced by YoungMinds in the UK. But good advice for any country and its leadership. "YoungMinds Very Important Kids (VIK), our national panel of young people with mental health problems, have launched a manifesto and accompanying film to highlight to politicians the changes that need to be made to improve young people’s mental health." You can download the YoungMinds children and young people's manifesto here "Written in their words and including their own stories it covers 11 areas where they believe things must change so that all young people with mental health problems get the support they often so desperately need." Manifesto main points

  1. Stigma still affects us; its about time we were able to talk about how we feel.
  2. Dealing with problems when we are young; train primary school staff
  3. Growing up is difficult; support us when changes happen in our lives
  4. Getting what we need at secondary school; train everyone to understand teenagers problems.
  5. Waiting lists and assessments just make it harder; make them shorter and provide us with one worker for all our care.
  6. Some doctors don’t listen to us; they need to understand and support us
  7. Going to Accident and Emergency can be traumatic; treat us with respect, see beyond our labels
  8. Some psychiatric units feel like prisons; learn from the best ones
  9. Someone to speak up for us; we all need advocates
  10. Lost in the system; don’t forget about us when we are 16 plus
  11. We’re the experts; start listening to us

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Nova Scotia Releases Report on Suicide, Attempted Suicide

Posted on 15/07/2009 | 2 Comments

Official press release

A new report will better position government and its partners to help Nova Scotians at risk of attempting suicide.

The report, Suicide and Attempted Suicide in Nova Scotia, was released today, July 15. Its purpose is to help those who work in the areas of suicide prevention, intervention and support.

"Suicide is a very complex and sensitive public health issue," said Dr. Robert Strang, Nova Scotia's chief public health officer. "We need to talk about it more and better understand it to ensure the right programs and supports are in place to help Nova Scotians."

The report describes the conditions surrounding suicide and attempted suicide in Nova Scotia. The data is based on hospital and vital statistics records of suicides and suicide attempts from 1995 to 2004. It examines demographic factors, how people attempt suicide and complete suicide, and the types of health-care services used by Nova Scotians at risk.

"This report is a baseline we can use to evaluate future efforts on this important issue, and we've made good progress since 2004," said Dr. Strang. "We've developed a suicide prevention framework to reduce suicides and attempted suicides, we're doing additional research with the medical examiner's office, and we fund our community partners who work with Nova Scotians."

Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health, a partnership with the IWK Health Centre and Dalhousie University, said that even though suicide and suicide attempt rates are decreasing, and Nova Scotia is experiencing lower suicide rates than most Canadian provinces, there is more to be done. "Improving care for people with mental disorders, enhancing the capability of health care and education professionals to identify people at risk, promoting overall good health and resiliency, and improving access to good mental health care, can all help further reduce Nova Scotia's suicide rates.

" Highlights of the report include:

  • The rate of hospitalizations for suicide attempts declined by 30 per cent over the 10-year period
  • 55 per cent of those hospitalized were female
  • Lower income was associated with higher rates of both hospitalizations for suicide attempts and suicide deaths
  • The rate of suicide death declined from 11 to nine individuals per 100,000
  • Nova Scotia's suicide rate was lower than the national average, nine out of 100,000 individuals compared to 11 out of 100,000
  • 84 per cent of suicide deaths were male
  • 55 per cent of suicide deaths were previously diagnosed with a mental disorder

The report is available online at www.gov.ns.ca/hpp.

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Mental illness ad campaings: sexy, edgy or emotional?

Posted on 09/07/2009 | 0 Comments

In the past few weeks I've come across several advertising campaigns aimed at raising awareness about mental health problems. Two in particular focusing on Autism and Eating Disorders caught my attention (you can see why below). Advertisers know what "sticks" when it comes to marketing: sex, shock and emotion. These approaches can be effective ways to sell products or promote a brand identity - but how well do they transfer into the world social awareness? Or for that matter mental health? SEXY The people at Sociological Images alerted me to this Rethinking Autism ad campaign. The RA site maintains that:

"All too often in the world of autism, celebrity and sex appeal are used to promote pseudo-science that exploits autistic people, their family members and the public. We decided to put those very same factors to work in service of the truth."

This is a clever ad. It's information is scientifically-based and it captures your attention. But is it effective? While I get the tongue-in-cheek reference that Autism has become a "sexy" topic of discussion, I question whether the core message gets buried beneath a sea of lingerie. The Rethinking Autism website claims to want to "change the conversation one video at a time", but are we changing the conversation towards Autism and debunking pseudo-science or does the ad instead meander towards a debate about the objectification of women as sex objects. If the latter then the message is lost. EDGY Next up is a series of ads from the Looking Glass Foundation for Eating Disorders based in Vancouver BC. The ads are edgy alright - but their message is misleading. The tagline in the ads is "Not every note is a suicide note" - which falsely implies that eating disorders are a method of suicide. We know this is not true. So while the ads are effective in shocking us, they do little to advance discourse because of their false message - in fact they may even perpetuate the myth that eating disorders are motivated by suicidal intent. EMOTIONAL Finally an anti-stigma ad campaign from the Mental Health Foundation of Nova Scotia (see video on their homepage). The ad uses personal narratives, emotional music and dream-like backgrounds to tell a story. In under a minute the video captures the pervasive stigma that accompanies mental illnesses, touches on the scientific basis of mental disorders as brain disorders, points to the need to improved resources to meet the needs of those living with mental illnesses and challenges the viewer to talk more openly about mental illness and mental health. Effective doesn't have to be flashy and this ad is a great example of the power of emotion and story to communicate an important message. ~ David Venn

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Evergreen Child and Youth Mental Health Survey

Posted on 01/07/2009 | 0 Comments

Happy Canada Day!! Canada has a proud history of valuing health care as part of the fabric of this country and as a basic right for all citizens. However, despite our commitment to overall health care, our attention to mental health care is overdue. In Canada, approximately 1 in 5 children and adolescents experience some form of mental disorder. Most major mental disorders begin prior to the age of 25, making this period a critical time for the promotion and treatment of mental health problems. One of the key initiatives of the Mental Health Commission of Canada is to develop a Mental Health Strategy for Canada. As part of the strategy the Child and Youth Advisory Committee of the Mental Health Commission of Canada will support the development of a framework specific to the needs of child and youth mental health. We need your help!! We invite all Canadians to share their thoughts and opinions in an online survey about values and principles relating to child and youth mental health. TAKE THE SURVEY NOW The survey will take about 30 minutes to complete (but you can save your answers and come back to it at any time). It is important that we get the thoughts and opinions from as many different people as possible. Please pass this information along to your network, family, friends, or anyone who you think should join this consultation.

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How to Spread your Cause: A Child and Youth Mental Health Case Study

Posted on 29/06/2009 | 0 Comments

How do you let people know about your cause? For big corporations and organizations this problem isn't so difficult. They throw money at national advertising campaigns, they hire creative PR firms, they design complex websites, etc. But as non-profits our capacity to engage in these expensive promotional techniques is often limited. Here are some useful, more cost-effective ways to share your message

Collaborate instead of communicate - when we work in a silo we don't accomplish as much as we could if we worked in partnership. Find other organizations either at home or around the world who have the same cause and vision as you and ask them to partner. Don't help yourself first. Bring something to the table that is of value to them, especially if you are the smaller organization. What do you have that they don't? Find a way to make the partnership mutually beneficial. (See our project with ViewFinders as an example)

Listen to what others are doing - yours is not the only voice in the room. Instead of trying to communicate your message, listen to how others are communicating theirs. Set up RSS feeds to track what other people are doing, read blogs (Beth Kanter's blog on how non-profits can use social media is excellent), follow people on Twitter and Facebook. Listening to others will give you great ideas about how to spread your cause.

Know your audience - a group of a few who care is often better than an army of many who don't. Communication is not always a numbers game. Find a core group of people who really care about what you are doing and ask them to help you spread your message. (Chris Guillibeau talks about this idea in his Brief Guide to World Domination). A few people in power positions and really connected to what you are doing may have a much greater impact on your cause than many people with minimal influence.

Use multiple mediums - diversify the mediums you use to communicate your message. The best approach encompases multiple streams of communication. Email and e-newsletters may be great for reaching some people, but blogs and social media may be useful for reaching others. Cross-link your communications for a comprehensive approach. To Write Love On Her Arms is doing this really well.

A Child and Youth Mental Health Case Study On July 1st we are opening up a survey as part of the Evergreen project to ask Canadians to share thier values and ideas about child and youth mental health. We have been implementing the principles above to spread the word about this initiative.

Here's how we are using these principles:

Collaboration - we don't have many connections with parent groups so we found a publication that did and partnered with them. Today's Parent has been supportive of our project from day one and have even helped us by asking their audience to take a survey about mental health and take part in this cool online flower garden for children's mental health.

Listen - we have been using google RSS feeds and a del.icio.us account to track news and blogs about mental health. It's been a great way to listen to what others are doing and to join the conversation.

Know your Audience - our key audiences, in addition to youth and parents, are health professionals and educators. By using promotional networks specific to these audiences (ie: HPClearinghouse) we can target our communications efforts.

Multiple Mediums - our blog and website are strong tools for reaching our audience. Recently we have expanded to Facebook and are using e-newsletters (sign up on left hand side) to engage people who are interested in what we are doing. Another great tool is interactive media like Slideshare. Have you found a particular technique helpful or useful? What other ways are you are promoting your cause and voicing your message? Share your ideas in the comments section!

 

~ David Venn (image credit: omacaco)

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Youth Mental Health on Facebook

Posted on 23/06/2009 | 0 Comments

So after months of team discussion we have finally made our first foray into Facebook! Yeah I know ... we are a little behind the trend - but better late than never. Our goal is to get over 1,000 people to become a fan of our "Help Canada Create a Youth Mental Health Strategy" page. The Facebook page is an offshoot of our Evergreen project - a collaborative initiative with the Mental Health Commission of Canada to produce a document to help improve policy and programming related to child and adolescent mental health across Canada. We created the Facebook page for 4 primary reasons:

  1. Engagement - we want people to share their opinions with us about what values and principles Canadians want to uphold in relation to mental illness and child and adolescent mental health services. On July 1st the public forum will be open for you to share your voice.
  2. Education - an informed public is a strong public. Our Facebook page will feature some of the guides and information uploaded on our teenmentalheatlh.org site. We want to give people the best available info to make good decisions about their mental health.
  3. Advocacy - the Mental Health Commission of Canada is committed to creating a comprehensive mental health strategy for Canada and are in support of a component specific to the needs of children and youth. Youth mental health will stay in the shadows unless we speak up and advocate for change - Facebook is just one of the ways you can speak up.
  4. Connection - facebook is a great way to connect with people who share similar causes to you. By creating this page we want to connect people who care about youth mental health and want to make a difference to Canada's mental health system.

Help make a difference for thousands of young people. Join "Help Canada Create a Youth Mental Health Strategy".

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Stigma associated with Mental Illness: A long road ahead

Posted on 18/06/2009 | 3 Comments

New government figures out this week in the UK claim that public attitudes towards people with mental illness have reached a tipping point. The Department of Health survey shows improvements including:

  • 77% agree mental illness is an illness like any other an improvement of 3% on last year and up 6% since 1994
  • 73% think that people with mental health problems have the same right to a job as everyone else, up 7% on last year
  • 78% judge the best therapy for people with mental illness is to be part of a normal community, up 8% on last year
  • 61% agree that people with mental illness are far less of a danger than most people suppose, an improvement of 4% on 2008

However, it also includes some more alarming figures:

  • 11% would not want to live next door to someone with a mental health problem, an increase from 8% since 1994
  • Almost a third of young people (16-34yrs) think there is something about people with mental illness that makes it easy to tell them from 'normal people'
  • 52% of young people agree people with mental illness are far less of a danger than most people suppose, 17% less than people over 55yrs
  • 22% feel anyone with a history of mental health problems should be excluded from taking public office
  • When the issue is brought closer to home - only 23% feel that women who were once patients in a mental hospital can be trusted as babysitters.
  • 65% underestimated the actual prevalence of mental illness and only 13% were aware that 1 in 4 people will experience at mental health problem.

Stigma is essentially the polite word for discrimination. It has no place in our caring society. While some public attitudes toward people with mental illness are improving, the numbers above suggest we still have a long way to go. It is all too easy to look at these numbers with rose-coloured glasses and proclaim that we have reached a tipping point. However I believe the Canadian Medical Association's assessment of a similar study conducted last year to be more accurate when they called Canadian stigma and attitudes a "national embarrassment". Findings from that report (pdf) indicate:

  • One in 10 thinks that people with mental illness could "just snap out of it if they wanted"
  • One in four Canadians is afraid of being around someone who suffers from serious mental illness.
  • Only half of those surveyed would tell friends or co-workers that a family member was suffering from mental illness.
  • Only 16 per cent said they would marry someone who suffered from mental illness, and 42 per cent said they would no longer socialize with a friend diagnosed with a mental illness. By contrast, 72 per cent would openly discuss cancer and 68 per cent would talk about diabetes in the family.
  • Half of Canadians think alcoholism and drug addiction are not mental illnesses.
  • One in nine people think depression is not a mental illness, and one in two think it is not a serious condition.
  • Almost half of Canadians (46%) think the term "mental illness" is used as an excuse for bad behaviour;
  • A solid majority of Canadians would not have a family doctor (61%) or hire a lawyer (58%) who has a mental illness;

Stigma against the mentally ill is recognized as one of the greatest barriers to social justice, appropriate health care and development of civic society. We are not at a tipping point yet, but hopefully sometime soon. ~ David Venn & Dr. Stan Kutcher (image credit: nite fate)

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Animated Minds: Part II

Posted on 16/06/2009 | 0 Comments

Last week I blogged about an animation film project we co-developed with ViewFinders. I posted some of the videos from the camps. Here are the rest of em. Enjoy!

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Teenmentalhealth.org wins Gemstone Award of Excellence in Web Communications

Posted on 15/06/2009 | 0 Comments

This has been a good few months for teenmentalhealth.org. First we won a Web Health Award - now a Gemstone Award! The Atlantic Gemstone Awards recognize public relations practitioners from the Atlantic region who have made outstanding contributions to the profession and who demonstrated innovation and creativity in communications programming in the past year. Only six Gemstones were awarded at the May event making this an extra special honour. Kudos to our great web partners at Impact Communications for another job well done!

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Animated Minds: Youth make movies about mental health

Posted on 11/06/2009 | 2 Comments

This past March Break the Sun Life Financial Chair in Adolescent Mental Health partnered with the ViewFinders International Film Festival for Youth to host a free animation film camp for budding filmmakers (ages 12-18).

The purpose of the camp was to allow youth to express their creativity and learn about the film-making process. Participants were asked to explore the topics of mental health and mental illness and create a short films about what mattered most to them.

The films were screened as part of the ViewFinders International Film Festival last April and are now being taken on the road and shown to schools and community groups across Atlantic Canada.

The documentary was filmed during the week of the camp and highlights the importance of talking about mental health problems. I've uploaded three films created as part of the camp. I'll upload the rest next week.

Thanks to all the youth, film instructors and ViewFinders organizers who made this possible! A special thanks also to the T. R. Meighen Family Foundation for their financial support.

DOCUMENTARY

ANIMATED MINDS FILMS

(Disclaimer: Youth participants were provided with information about youth mental health, however some of the statistics in the videos are inaccurate)

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Creating a mental health strategy for Canada

Posted on 08/06/2009 | 5 Comments

Currently, Canada is the only G8 country without a National Mental Health Strategy. Recently, the Mental Health Commission of Canada (MHCC) was established with one of its key priorities to develop a Mental Health Strategy for Canada. As part of the strategy the MHCC will support the development of a framework specific to the needs of child and youth mental health. The proposed framework, entitled Evergreen, will complement and provide child and youth context to the Mental Health Strategy for Canada.

What is Evergreen? Evergreen is a collaborative project that will produce a framework to help improve policy and programming related to child and adolescent mental health across Canada.

What is a mental health framework and why is it important? Think of a framework like a blueprint for a house. If we want to build the best house, we need to create the best plan to design it and hire the best people to build it. Canada’s mental health system is no different. Frameworks help keep everyone on the same page, working together towards a common goal – to develop a mental health system that effectively meets the needs of its consumers.

Who will Evergreen affect? Everyone. There is no health without mental health. A national child and youth mental health framework can be useful to assist provinces, territories and organizations to enhance their child and youth mental health strategies, policies and plans. Evergreen can also help to raise public awareness of the importance of addressing child and youth mental health needs, while helping to decrease stigma associated with mental disorders.

How is Evergreen being created? The Evergreen framework will be collaboratively constructed by professionals, youth, parents and members of the public from all regions across Canada who have expertise, interest or experience with mental health and mental illness. In the end we envision the framework to be among the most comprehensive and scientifically-based child and youth mental health frameworks in the world.

WE NEED YOUR HELP!! To make this framework truly unique and successful we need your input. We need you to tell us what values and principles Canadians want to uphold in relation to mental illness and child and adolescent mental health services. We also need you to help share this initiative with others who can contribute.

The public forum will be online July 1st. When it's ready our site and MHCC will link to it. Until then ... spread the word!

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Mental health in the palm of your hand

Posted on 04/06/2009 | 0 Comments

A while ago we wrote about Health 2.0 - 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 was only a matter of time before these technologies made the leap from the computer screen to the palm of your hand. The iPhone has been particularly successful at developing health 2.0 applications for users on the go. Here are a couple of cool examples of applications changing the way we receive health information: The Human Atlas The Human Atlas iPhone application provides point-of-care access to 3D animations of common medical treatments and conditions, (approximately one-two minutes in length) with accompanying narration.

Epocrates Rx The free Epocrates Rx software for iPhone OS puts continually updated peer-reviewed drug information at your fingertips.

Eponym Touch This application brings the eponym database to your iPhone or iPod touch. The database currently contains more than 1,600 medical eponyms and is updated from time to time. Mental health is hopefully the next frontier! The people over at Healthcare Administration Degree notified us about their 100 Best iPhone Apps for Your Mental Health.

Here some others I found related to mental illness: Sad Scale Sad Scale is an iPhone application which has three screening tests for general depression, postpartum depression and geriatric depression. Once completed the user can then email their primary doctor with the results. iConverse iConverse is an educational tool designed for young children and individuals with communicative disabilities, and also toddler-aged children who have yet to master language. Interestingly Scothoser’s Corner identified that this application may be helpful to children living with autism. But as always the best communications is face to face.

Don't rely on these tools in place of doctor-patient visits. ~ D. Venn

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If the world were a village of 100…

Posted on 02/06/2009 | 3 Comments

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Building Peace and Resilience in Uganda

Posted on 28/05/2009 | 1 Comments

The United Nations has called the situation in northern Uganda the most neglected humanitarian crisis in the world. The 20-year civil war between government forces and a rebel group known as the Lord’s Resistance Army has victimized tens of thousands of youth, destroyed families and fractured communities. The recent decrease in armed conflict has left the region with a difficult question: how do you teach peace to a generation who has known nothing but war? The future of this region is in its youth! Many young people have been traumatized as victims and as perpetrators of violence. They have grown up knowing fear, now they need to learn to adapt to a less frightening world and to help each other heal. Last year, the Dalhousie International Health Office (IHO) and Section of International Psychiatry: Youth Coalition for Peace participated in a joint project with the Canadian Physicians for Aid Relief (CPAR) and Gulu University. Their goal was to work with affected youth, communities and non-governmental organizations to help build a climate supporting sustainable peace in Northern Uganda. Using a youth peer counselling model, our team developed a training program to integrate mental health into local peace-building efforts and establish community activities to address these issues in a non-stigmatizing manner. Given the important role that sport plays in Ugandan communities, soccer was identified as tool to engage youth and teach peace-building skills such as teamwork and conflict resolution. My Daughter, Leah Kutcher - captain of the 2006 Dalhousie women’s soccer team - worked with Katie Orr at the Dalhousie International Health Office and coach Graham Chandler to send extra uniforms, equipment and soccer balls to Ugandan teams who lacked the materials needed to play. The Halifax City Soccer Club also contributed uniforms and equipment. A program update from CPAR earlier this year reported that the uniforms and equipment were successfully distributed to youth teams in Laiby and Bungaterra. The update also reported the establishment of many community-organized sports, music and drama programs and Peace Clubs, allowing Ugandan youth to finally start building a better, more peaceful future. Since then Stan Football Club (Stan FC) is thriving! Their latest blog entry is evidence of their success:

Stan football club players were honored by youth coalition for peace (YCFP), a community-based organization working (CBO) in northern Uganda to participate in a five-day children soccer camp for peace. Players are learning lots of new skills and rules for fair play that can foster harmony and sustainable youth participation in sport for development. The camp is being facilitated by professional coaches from Canada.

They have some great photos posted on their site too! ~ Dr. Stan Kutcher

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Youth Mental Health and the Internet

Posted on 25/05/2009 | 0 Comments

If you’ve ever felt that talking to someone about a problem you’re facing is difficult or you feel like you would be more comfortable asking a question anonymously you’re not alone. Many youth feel the same way! For a lot of young people the Internet is an important source of health information, and a place where they can ask questions about topics they may not feel at ease discussing with friends, family or doctors.

According to a 2001 report produced by Henry J. Kaiser Family Foundation entitled “Generation RX.com: How young people use the Internet for Health Information”, three out of four youth (ages 15-24) have used the Internet at least once to find health information. This statistic is more than the proportion who have ever gone online to check sports scores (46%), buy something (50%), or participate in a chat room (67%), and about the same proportion that have ever played games (72%) or downloaded music (72%) online. The report also highlighted that about one in four youth have researched depression or mental illness (23%) and problems with drugs or alcohol (23%). And with the growth of the Internet and the number of youth who have access to computers, the number of young people accessing health information online might be even higher today!

Because so many youth are looking for information online about their health, including their mental health, it is more important than ever to provide young people with the best information possible for them to make informed decisions about their health and well-being. This means providing information that is based on scientific evidence and coming from qualified health care professionals.

One online resource doing just that is YooMagazine, an interactive health literacy program designed for young people. YooMagazine’s goal is to provide youth with accurate health and mental health information in a variety of interactive formats (information sheets, how-to sheets, Q&A, quizzes, etc.) and to improve health literacy and decision-making skills among youth.

YooMagazine started in 2006 by Dr. Darcy Santor, at the Provincial Centre of Excellence for Child and Youth Mental Health in Ottawa, and by Dr. Alexa Bagnell, at the IWK Health Centre in Halifax. The program has partnered with experts and institutions across Canada giving the website a national scope and expertise. YooMagazine is also available to schools and community groups free of charge.

~ By Haley McInnis (excerpt from Moods Magazine - 2008 Fall Issue)

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Halifax-Dartmouth Bridge Commission to Install Barrier on the MacDonald Bridge

Posted on 19/05/2009 | 0 Comments

Thanks to Mr. Steve Snider the CEO of the Halifax-Dartmouth Bridge Commission for finally moving to install a barrier that will substantially increase the difficulty of completing suicide from the MacDonald Bridge.

Many large cities have a “favoured” location to which individuals contemplating suicide congregate. In Halifax-Dartmouth, the MacDonald Bridge is one of those places. The fact that it is conveniently close to a major mental health facility only serves to accentuate its importance in this problem.

Since the impetus to complete suicide often waxes and wanes, actions that can substantially delay the final act leading to suicide may deter the suicidal individual from acting and may increase the probability of choosing life instead. Indeed, many people who have decided not to complete suicide or who have survived a suicide attempt go on to live positive and productive lives and when reflecting on their suicide considerations are very pleased that they did not go through with their plans. Restriction of lethal means is one of the few public health measures that have been associated with decreasing suicide rates. Although method substitution is technically possible, research studies have not been able to demonstrate a clear pattern of this occurring when a bridge barrier is erected. So is it likely that putting up a barrier on the MacDonald Bridge will save lives? Probably. Will it send a clear message of concern for this important health issue? Totally! Is it about time this happened? Absolutely!

Actually, important as the role that Mr. Snider had in moving this agenda forward, the true heroes of the story are Carol Cashen and a concerned group of citizens and mental health advocates. As many residents of Halifax-Darthmouth Ms. Cashen is a public health nurse and the mother of a young man who took his life by jumping from the MacDonald Bridge. Together with other members of the community , with the input of the Canadian Mental Health Association and with responsible print and electronic media reporting Carol and the citizens of Halifax-Dartmouth were able to accomplish what the professionals and government were not able to do. They have made the difference. They are the people we all have to be thankful to.

Further Reading: AJA Award winner: Adam's Fall, by Matthieu Aikins Mother calls for screen to stop bridge jumpers ~

Dr. Stan Kutcher (photo credit)

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New resource helps make academic transitions easier for students

Posted on 12/05/2009 | 2 Comments

Excerpt from the latest issue of Canadian Psychiatry Aujourd'hui:

Mental health problems are the single most disabling health disorder affecting young people, according to the World Health Organization. In fact, about 15 to 20 per cent of children and adolescents in Canada are suffering from some form of mental disorder.

The adolescent years are thus a critical window in which mental health can be promoted and problems can be addressed in a manner that will improve mental health and de-stigmatize mental illness. Within the “average" classroom, three to four students will suffer from some form of mental disorder, making schools an ideal place to address mental health promotion, introduce targeted mental health interventions and stigma reduction, as well as address the linkage between mental disorders and learning. Many schools, particularly at the post-secondary level, are trying their best to help their students recognize and address problems. Early identification of mental health issues is an important first step. If left untreated, they can affect student success in three major ways. First, mental disorders affect the emotional well-being of students. If left untreated, they can hinder a young person’s social development, leaving them feeling isolated, stigmatized and unhappy. To deal with these problems, some may turn to socially or personally inappropriate methods of coping, such as violence, drugs or alchohol. Mental disorders may also impact a young person’s capacity to develop and keep a strong and supportive peer network, including positive relationships with adults. Second, mental disorders may present considerable barriers to learning since most mental illnesses are characterized by unique learning challenges. Studies have shown that poor social-emotional functioning and difficulty meeting academic standards are two common obstacles for students with mental disorders. Some illnesses, such as learning disabilities and attention deficit disorder, present distinct challenges to successful learning. These problems can then continue as young people transition to the workplace, thus decreasing the likelihood of vocational success. And third, mental disorders are a factor in why some students drop out of school. About 15 per cent of youth attending post-secondary school drop out before finishing their program (Statistics Canada, 2004). Students cite many reasons for dropping out of school, but near the top of the list are reasons relating to their mental health. Sadly, many of these dropouts could be prevented with early and effective interventions. When you combine these issues with all of the other social and academic pressures facing young people, it is no wonder that some students find the transition from secondary school to college or university to be difficult. The transition into a new educational and social environment can create stress that some students are ill-equipped to manage. Moreover, the period between the ages of 18 and 25 is the time when many mental disorders, such as depression, psychosis and anxiety disorders, first present. All of these factors (and others) can affect the transition to college or university for some students. So what can be done? Read the rest of the article on Canadian Psychiatry Aujourd'hui More info: Teenmentalhealth.org - Transitions: Student Reality Check University Affairs article Collegiate mental health gets a better exam

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Teens and Self-Harm

Posted on 08/05/2009 | 0 Comments

Great post on Teens Who Self-Harm by Marie Hartwell-Walker, Ed.D. over at Psych Central. In the blog Marie Hartwell-Walker encourages that "Self-harmers need to be understood, not scolded. They need to unlearn the idea that their feelings are “wrong” and learn that it’s okay to feel them. Most important, they need to learn new ways to manage stress and emotions that they find overwhelming." Also we just linked up with Dr. Mary Kay Nixon and her team of the Interdisciplinary National Self-Injury in Youth Network Canada (INSYNC). Lots of great info for youth, families and professionals. For some interesting and powerful reading on self-harm I recommend the books Cut by Patricia Mccormick and Skin Game: A Memoir by Caroline Kettlewell

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National Child and Youth Mental Health Day

Posted on 07/05/2009 | 0 Comments

Today is Child and Youth Mental Health Day - a national day of celebration dedicated to enhancing the awareness and understanding of the importance of youth mental health. The day of recognition is part of Mental Health Week (May 4-10). Mental health is the positive balance of the social, physical, spiritual, economic and mental aspects of one’s life and is as important as physical health. During adolescence youth travel through a period of major physical, emotional, social and vocational changes as they move from childhood into adulthood. Though the youth years are among the most physically healthy, they are also a time when mental illness most commonly develops. Therefore, it is important that youth engage in activities that help build self esteem, create positive family relationships, and stimulate their mental health as well as their physical health. According to the World Health Organization, almost one-third of the global burden of disease in young people is due to neuropsychiatric disorders. In Canada it is estimated that 15 – 20 percent of children and youth suffer from a treatable mental disorder, yet only the minority of those in need (an estimated 20 percent) receive mental health services. No other such pressing health problem in Canada is so neglected. It is also important that young people and their parents learn the warning signs that may signal when a problem is not just something that will go away or that can be overcome by health improvements. Sometimes problems are the first signs of a mental illness that can be effectively treated, particularly if it is caught early on. Mental health is everyone's business. We all need to be informed

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Teenmentalhealth.org Wins Web Health Award

Posted on 07/05/2009 | 0 Comments

Teenmentalhealth.org is now an award-winning website! The site, which focuses on sharing knowledge about youth mental health and mental illness, won silver at the 2008 Web Health Awards. “Teenmentalhealth.org is dedicated to providing information on youth mental health that is based on the best available scientific evidence, and this award recognizes our commitment to excellence,” say Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health. The Web Health Awards recognizes the best Web-based health-related content for consumers and professionals. The program is held twice a year — spring/summer and fall/winter — with the goal of providing a "seal of quality" for electronic health information. “I was thrilled to collaborate with Dr. Kutcher and his team,” says Jennifer Ayotte of Impact Communications. “They had the vision to take a complex subject like teen mental health and present it in a state-of-the-art website that uses social media to build global community of support.” Some of the website’s key mental health resources include: a guide to understanding teen depression, a guide to understanding evidence-based medicine, a booklet for siblings with a mental illness, various multimedia presentations, and free clinical tools for health professionals.

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Celebrating National Mental Health Week

Posted on 06/05/2009 | 0 Comments

Today marks the start of National Mental Health Week (May 4-10, 2009). Halifax and the IWK Health Centre are privileged to be the national host for Mental Health Week events, but others are doing their part across Canada to build awareness.

As part of Mental Health Week Canada will celebrate National Child and Youth Mental Health Day on May 7. The day's events will include an address by Dr. Stan Kutcher and the Honourable Senator Michael Kirby, a recipient of the Order of Canada for his lifetime of achievement on public policy issues and his commitment to confronting issues related to mental illness.

A quick snapshot of Mental Health Week news:

The Schizophrenia Society of Canada recently commissioned a Canada-wide survey to learn how it can support people living with schizophrenia and their families to recover the best quality of life possible. The extensive survey, the largest of its kind in North America, highlighs certain key areas in which quality of life can be improved for people living with a mental illness.

The Mental Health Foundation of Nova Scotia has launched a mental health awareness campaign that looks really sharp.

OurHealthyMinds.com, a Capital District Health mental health website, is launching officially on May 7.

The Canadian Mental Health Association and Desjardins Financial Security are encouraging Canadians to test their stress levels over the lunch hour. Volunteers and Staff from CMHA will be handing out stress cards as part of a public education campaign to promote mental health in the workplace.

Stand Up For Mental Health, a program that teaches stand-up comedy to people with mental illness, will perform their inaugural show on Friday, May 8 in Ottawa.

Canada Post is accepting applications for mental health projects. In October 2007, Canada Post adopted mental health as its cause of choice, becoming the first major Canadian corporation to do so. Now, Canada Post has created an independent organization, the Canada Post Foundation for Mental Health, to support this often-overlooked  cause and stigmatized illness.

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Sexual expressions and social expectations

Posted on 20/04/2009 | 1 Comments

Dr. Perri Klass writes eloquently about boys and girls and sex, and the importance of values, manners and gender equality.  As a child and youth psychiatrist I find much of what she recounts not only reasonable but reasoned.  There is however a developmental neurobiological reality that can help us put these sex and youth issues into a wider perspective.  Simply put, neurodevelopment prior to puberty has as its major goal the survival of the individual to the time of puberty so that species reproduction can take place.  As a result, the adolescent brain normatively develops its drive for sex and the associated dopamine driven nigro-striatal-cortical systems associated with craving (yes – the same system that allows for addictions to begin).  So there we have the phylogeny of the species.  So what now?

Every society develops social structures that serve to channel and direct sexual activities in youth.  And, because the brains of young people can be modified by the environment that they are in, by and large these social structures do modulate these behaviors, although sub-group and sub-cultural frameworks may not always conform to wider social norms and expectations.

So to be simple about it – young people will generally channel their sexual expressions within social expectations created by their environments.  Environment can be helpful or un-helpful in this regard.  However, while we may not be able to control the relentless process of pre-programmed neurodevelopment, we can provide behaviorally optimizing and socially enhancing environments for young people.  These begin within the family and include all aspects of values and behavioral expectations.  They extend outside the family and are taken up by our institutions and collective organizations.  They should extend to the media and the advertising industry.  The most interesting question for me is why they do not seem to.

~ Dr. Stan Kutcher

you can read the original New York Times article here.

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What we can learn from the tragedy of suicide

Posted on 07/04/2009 | 1 Comments

Carol Marquis has written a touching and highly personal story about her brother Donnie and his tragic suicide at age 27 years. While Carol’s personal journey led her to feel life more deeply, my professional journey is more focused on what we can do to prevent others, who like Donnie are living with a mental disorder (in his case bipolar illness), from death by suicide.

We know that unfortunately suicide is a mode of death for people who suffer from and live with mental illnesses, much like a heart attack is a mode of death for those who suffer from and live with heart disease. Thus, it is no surprise that in Canada, the highest rates of suicide are found in people who live with a major mental illness – in particular: major depression; bipolar disorder; schizophrenia. Study after study has demonstrated that these mental disorders are the greatest risk factors for suicide. Study after study has demonstrated that there are effective interventions for individuals living with mental illness that can decrease this risk for suicide.

Some of these interventions are: the continued application of effective treatments (medications and psychological interventions); easy access to emergency/crisis mental health care; unique programs that address a variety of factors that can lead to or trigger a suicide act. We know that the majority of individuals who die by suicide visit a health provider prior to the event.

The difficult questions we need to ask are as follows. Why is it that with so much knowledge about what can be helpful that so many people living with mental illness still die by suicide? Why is it that with so much knowledge about what we can do we still invest in programs and activities for which there is little or no evidence of effectiveness? Why is it that we do not widely distribute and ensure that evidence based standards of care for suicide prevention are available in every location where health care is provided? Why is it that we spend little or no time in educating the large legion of health providers to identify and intervene when their patients are or could be suicidal?

Are there many other areas in medicine where we know what to do to make things better and we still persist in doing things that we either know do not work or do not know if they work? If not, what is it about the field of mental health that encourages us to act this way?

~ Dr. Stan Kutcher

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A Neuroimaging Revolution

Posted on 02/04/2009 | 0 Comments

Neuroimaging has indeed revolutionized and continues to revolutionize our understanding of mental disorders, because it is based on learning about how the brain grows, develops and functions.

This is so far removed from earlier ideas about how “society” or “the environment” or “culture” or “religion” or “monsters” created mental illness, that some people whose beliefs or other investments are in these explanations will have problems accepting its value. When linked to other new tools of understanding such as genetics and molecular biochemistry, we are beginning to learn how the brain functions in health, when it is challenged by the environment and in disease.

The recent article in the Globe and Mail by Elizabeth Scott brings to life the importance of this technologically enabled explosion in understanding. She shows us how valuable this harnessing of new methodologies can be as we pull away the shrouds of uncertainty and begin to lift the veil of confusion caused by centuries of invalidated explanations of why mental illness occurs.

The real challenge however will be in changing our perspective based on new knowledge. Simply put, old ideas die hard and the new understanding will be strongly resisted by those who either do not or will not wish to be informed. On the other hand, this new information will need to stand the rigorous and unfriendly critical scrutiny of science, as different researchers conduct different studies and argue about what their results mean. This is a messy business and science is not about “the truth”. It is merely about being less wrong, most of the time.

All of which brings me to an exciting study recently published in the Proceedings of the National Academy of Sciences which demonstrated an almost 1/3 reduction in the right cerebral cortex (the outer cell layer on the right side of the brain) in the brains of people who have a family history of depression. These changes were associated with a number of difficulties in thinking and when the left side showed thinning, these difficulties became part of the syndrome of what we call major depression.

To me, these findings suggest that depression (at least the type that runs in families) may be a degenerative brain disorder. That’s right, a degenerative disorder – much like Parkinson’s disease or Alzheimer’s disease. And the thinking problems that we have noticed in people with depression may not be the result of the mood problem but may actually be part of the same disease process that gives rise to the depressed mood. That is, our theories that negative thoughts cause depression are likely wrong. Both the mood problem and the thinking problems are due to the same disease process in the brain.

This finding supports observations that many researchers and clinicians have been making for years. And, this finding suggests that we may have to change how we search for better treatments for depression. Maybe we should be looking at medications that can arrest brain degeneration or maybe we should be looking at medications that can improve cognition. Whatever the outcomes, these findings are exciting, offer new hope for future research and challenge what we “believe” to be true. Stay tuned – the story will unfold as it should!

~ Dr. Stan Kutcher

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The promise of real-time health care

Posted on 31/03/2009 | 0 Comments

The battle against chronic illness is long, expensive and can involve a lot of guesswork. But closer monitoring of our body in real time is improving chances for better long-term health – and, ultimately, quality of life.

Over the past decade, the evolution of medical technology has produced sophisticated, hi-tech and non-invasive tools. Devices like advanced brain scans and semi-invasive blood sugar sensors are opening exciting new doors to research – and in the face of new data, whole medical disciplines are shifting focus as science debunks theories of the past.

For a long time, brain researchers could only theorize about how the brain worked; there was no way watch it in living colour.

But thanks to neuroimaging, “what we know today compared to a decade ago blows your mind,” says Stan Kutcher an expert in adolescent mental health based at Dalhousie University in Halifax.

“Explanations for mental disorder [used to be] what I would call ‘brainless,' ” Dr. Kutcher says. They were “based on theories of mind or psychological models in which the brain did basically nothing.”

This was because, until recently, data gleaned from CAT scans and EEGs wasn't sufficiently sharp.

“The data was overwhelming, but it wasn't specific enough because both psychoneuroendocrinology and our special EEG analysis of function were still so far removed from what was actually going on inside the brain itself. They were very, very rough tools. So it was like trying to have sex wearing five condoms. You're sort of in the general area, but you haven't got a clue what should be going on.”

But where brain scans of the mid- to late eighties proved there were structural differences in the brains of people with mental disorders compared with healthy ones, today we can also actually watch the brain in action as it functions, both in health and in disease: “How does the brain control anger, listen to music, read, express love?” Dr. Kutcher asks.

Answers to those questions are being found, thanks to today's functional MRIs and PET scans – technology that has eclipsed former scanning methods. Dr. Kutcher believes that will soon lead to direct diagnosis. The hope is that brain illness – from injury to stroke to mental illness – will become precisely and accurately diagnosable, in turn making targeted, consistently successful treatments possible.

“I wouldn't be surprised if in the next 15 to 20 years two things happen,” Dr. Kutcher says. “We will have abandoned our current nomenclature, which is based on science and symptoms, for one based on a much better understanding of brain dysfunction and the symptoms that are a result of that … and at that time neuroimaging may well become diagnostic.”

Read the rest of the article on Globe and Mail.

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Mental Health: Care is Key

Posted on 20/03/2009 | 0 Comments

 

Recently, The Chronicle Herald published a story titled "Young people need more access to mental health services – volunteer." While I agree with this message, we must also begin to think about how we can better provide mental health care, and not just keep applying a model of mental health services that does not appropriately meet the needs of young people and their families.

Just doing more of the same will not result in substantial improvements in the mental health of our youth, nor will it ensure that those who develop and are living with mental illness receive the best possible scientifically validated care in the most timely and respectful manner. We have to begin to think differently and act innovatively.

First, we must use the best available scientific evidence to create, deliver and evaluate all programs and interventions that are provided to young people and their families. Fortunately, there is increasing recognition of this necessity among policy makers, care providers and the public.

Unfortunately, many programs in place or being promoted either have not been appropriately demonstrated to be effective, or their effectiveness is not known. Worse, some programs are known not to be effective, yet continue in place.

Second, we must think of how to provide mental health care, rather than mental health services. Currently, youth and families frequently must attend specialty mental health providers to receive care that could be more appropriately, more efficiently and perhaps even more cost-effectively provided in primary health care settings.

It is essential that effective and evidence-based mental health care be available throughout Nova Scotia in all primary health care settings. This can be achieved by modifying the way in which primary health care is delivered and by enhancing the mental health competencies of all primary care providers.

Third, we must meet young people where they are – that is, in their families and in their institutions.

Young children are profoundly influenced by their family environments and there is substantial scientific evidence that supports the use of specific early life interventions on improving outcomes for youth. These interventions should be widely available.

Concurrently, we know that our young people spend most of their lives in one of two institutions – schools or jails. It is imperative that we keep them in schools and enhance the capacity of schools to meet their mental health needs in conjunction with providing the best learning enabling environments possible.

In Nova Scotia, a number of initiatives, supported by various government departments are beginning to address this need. These innovations need to be further developed so that all our young people can benefit, and those of us who assist them in their growth and development can be better assured that our efforts will be likely to succeed.

~ Dr. Stan Kutcher

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

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Brain Awareness Week: How to Keep your Brain Healthy

Posted on 17/03/2009 | 0 Comments

This week is Brain Awareness Week (BAW). BAW is an international campaign dedicated to advancing public awareness about the progress and benefits of brain research.

According to the Dana Foundation:

Brain Awareness Week began in 1996 as a modest effort involving 160 organizations in the United States. BAW was created to bring together diverse groups from academia, government, professional, and advocacy groups and unite them with a common theme that brain research is the hope for treatments and preventions, and possibly cures, for brain diseases and disorders, and to ensure a better quality of life at all ages. In 1998, the campaign became international, first as a day and then as a week. Since that time, BAW has evolved into a powerful global initiative with more than 2,200 partners in 76 countries (as of the 2008 campaign).

What is the brain made of and how does it work?

The brain is made of millions and millions of special cells called neurons and other special cells called glial cells. Each of these cells is connected to many many many other cells by long “arms”. These long arms let different cells talk to each other. The places that the arms touch other cells are made specially to help cells talk to each other. Cells talk to each other by sending electrical and chemical messages to each other.

There are more connections in the brain then there are stars in the sky. The human brain is the most complex thing that we know about – and we are learning more about it every day. All things that we do and are as human beings comes from the human brain. It writes our greatest stories, builds our most complicated machines and buildings, creates music and art, plays games, builds social networks, lets us fall in love and directs us to do all the good and not so good things in life.

The brain remembers everything that happens to a person and stores little bits and pieces of those happenings in different parts – we call that memory. The brain takes information from the environment and checks that information against its memory. Then the brain decides what it will do. Every thought we have, every feeling we have, and everything that we do is decided by our brains. It is really important for us to keep our brains healthy.

Here are some ways to help your brain to be healthy.

  • Eat proper food. A healthy diet is important for a healthy brain.
  • Gets lots of sleep. Your brain needs sleep to grow properly and to remember things better.
  • Don’t use drugs. Drugs damage the brain.
  • Get lots of fresh air and physical exercise. Your brain needs oxygen to work properly and physical exercise is good for your brain because it reminds the brain to send “feel-good” messages to itself and to the body.
  • Spend time enjoying music, dance or art. Your brain uses these things to help it work better at all sorts of activities.
  • Take time to learn things. The more you practice skills or lessons the better your brain will be at doing what you want to do.
  • Learn how to decrease stress. Your brain can be hurt by too much stress. Learn what makes you relax – such as exercise, hanging out with your friends, playing music, etc. and when you are feeling stressed out try to do those things that decrease your stress.
  • Make good friends. Your brain develops best in a social network. Good friends are important.

 

More information about the brain:

Teenmentalhealth.org – The Teen Brain Brain Blogger PBS Documentary – “Inside the Teenage Brain” The Dana Foundation Brain Explorer

Previous Brain Posts:

Your Brain and the Internet: Use it or Lose it Studying the Brain from the Inside Out Enhancing Successful School Learning by Understanding How the Brain Works

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Science News: National Institute of Mental Health

Posted on 13/03/2009 | 0 Comments

Ever wonder where funding for mental health research goes? Or how research evidence informs medicine and practice?

 

The scientific evidence used in medicine comes from a pool of tens of thousands of published research studies. There are many types of studies, and the design of any given study usually depends on the question that the researchers want answered. Studies can differ considerably in the way they are designed and conducted, and can therefore differ considerably in quality.

 

Often the scientific community behind mental health research, studies and reports don't get a lot of attention or gratitude, but without them our knowledge of mental health and mental illness would develop pretty slowly.

 

Evidence-based medicine is extremely important in the treatment of mental illness in general, and is particularly important in the treatment of mental illness in children and adolescents.

Here are some recent examples of research related to adolescents conducted by the National Institute of Mental Health.

(Our group is not affiliated with any of these studies, their results or NIMH)

 

Anxious and Depressed Teens and Adults: Same Version of Mood Gene, Different Brain Reactions

An NIMH study using brain imaging shows that some anxious and depressed adolescents react differently from adult patients when looking at frightful faces. This difference occurs even though the adolescent and adult patients have the same version of a mood gene. Researchers in the NIMH Mood and Anxiety Disorders Program and colleagues reported these findings online October 31, 2008, in the journal Biological Psychiatry.

Depression Relapse Less Likely Among Teens Who Receive CBT After Medication Therapy

Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Suicidal Thinking May Be Predicted Among Certain Teens with Depression

Certain circumstances may predict suicidal thinking or behavior among teens with treatment-resistant major depression who are undergoing second-step treatment, according to an analysis of data from an NIMH-funded study. The study was published online ahead of print February 17, 2009, in the American Journal of Psychiatry.

Getting Closer to Personalized Treatment for Teens with Treatment-resistant Depression

Some teens with treatment-resistant depression are more likely than others to get well during a second treatment attempt of combination therapy, but various factors can hamper their recovery, according to an NIMH-funded study published online ahead of print February 4, 2009, in the Journal of the American Academy of Child and Adolescent Psychiatry.

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What does the doctor talk to your teenager about?

Posted on 11/03/2009 | 0 Comments

Beth J. Harpaz, The Associated Press

NEW YORK -- If you're the parent of a tween or teen, chances are you've been asked to leave the room during your child's visit to the doctor so they can have a private chat. Now of course I believe that teenagers should have a trusting relationship with their doctors. But while I'm sitting there alone in the waiting room, watching the younger mommies bounce babies on their knees, I can't help but wonder what my kids are telling the doctor behind that closed door. See, I'm a nosy mom, and if something's going on with my children's health, I want to hear about it. I mean, if your kid was suicidal, or a heroin addict, and somehow you didn't know it, would the doctor tell you? Turns out the answer is yes. "If we are concerned that someone is in danger, we are compelled to share that information," said Dr. Joseph Hagan, who is part of the American Academy of Pediatrics' Bright Futures initiative to improve children's health. But Hagan emphasized that giving kids a chance to speak privately with doctors "is not about secrecy. It's about autonomy. A 16-year-old should begin to ask his own questions about his health." In fact, if your pediatrician doesn't ask you to leave the room during teen visits, maybe he or she should."The pediatrician should spend most of the office visit alone with the adolescent," according to Dr. David Tayloe, president of the American Academy of Pediatrics. "It's very important for teenagers to have confidential conversations with their pediatricians." Tayloe said "the emphasis on confidential appointments for adolescents has become more the norm over the last 10 years." Tayloe added that 75 per cent of teenagers are sexually active by their senior year of high school, and Hagan said he starts talking to kids about sexuality around age 12, to let them know that sexual feelings are normal and to answer questions. But he also tries to get patients and parents communicating. "If a girl is concerned about pregnancy, I might say, 'What do you think your parents would say if you talked to them about this? Shall we tell them together?"' Some of the other things that keep me up at night - oh, the usual nightmares about teen smoking, car accidents and too much pepperoni and soda - are also on doctors' lists for teenage checkups. According to Tayloe, at least two-thirds of teen traffic fatalities involve teens who are not wearing seat restraints. Thirty per cent of teens are overweight and need to be enrolled in fitness and nutrition programs. And the vast majority of adult smokers began smoking by age 18. Tayloe added that most teenagers have experimented with alcohol by the time they are high-school seniors. "Pediatricians need to level with teens about alcohol," he said, including the fact that underage drinking contributes to car accidents and unplanned pregnancies. He also said that 20 per cent of children have mental health problems, but only 20 per cent of those kids are getting help. Pediatricians should screen adolescents for depression, anxiety, attention deficit disorder and suicidal thoughts. Kids who are teenagers now may also have missed some of the newer vaccines that became available after their early childhood inoculations against diseases like polio, mumps and measles. The AAP recommends that kids 11 to 12 and older be vaccinated against meningitis, a disease that can spread in settings like sleepaway camps and college dormitories, according to Dr. Meg Fisher, a member of the AAP committee on infectious diseases. Fisher says AAP also recommends that girls get the human papillomavirus vaccine, which protects against cervical cancer. And kids who were not inoculated against tetanus, diphtheria and pertussis when they were little need a one-dose combination vaccine against those diseases. By the way, some doctors are interested in parents' behaviour too. If you do meet the doctor with your teen, you might just get asked whether you smoke, or whether you wear your bike helmet. So while you're out there in the waiting room thumbing through a copy of Babies magazine that no longer holds any meaning for you, don't just worry about what's going on with your kids. Take a look at yourself as well.

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Teenage students deserve 11am sleep-in

Posted on 03/03/2009 | 0 Comments

Good piece today in on BBC about how sleep and teens:

Teenage pupils should be given an extra two hours in bed to boost their learning abilities, a Tyneside head teacher has urged.

Dr Paul Kelley, of Monkseaton High School in North Tyneside, said continuous early starts created "teenage zombies" in the classroom. He said research showed allowing teenagers to begin lessons at 11am had a "profound impact" on learning. Dr Kelley has already pioneered shorter lessons at the school. Research suggests teenagers' brains are wired differently to those of adults and work two hours behind adult time, he said. Memory tests performed on Monkseaton pupils by neuroscientist Russell Foster, chair of circadian neuroscience at Brasenose College, Oxford, showed the students' brains worked better in the afternoon. This suggested young people's body clocks may shift as they begin their teens - meaning teenagers got up later not because they were lazy, but because they were biologically programmed to do so. Dr Kelley said depriving teenagers of sleep could have an impact on their mental and physical health as well as their education. He said evidence had shown rousing teenagers from their beds early resulted in abrupt mood swings, increased irritability, depression, weight gain and reduced immunity to disease.

Read the rest of the article here. Also see:

Why Teens Need Their Sleep

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Two Steps Forward, One Step Back: The Case of Vince Li

Posted on 03/03/2009 | 0 Comments

The case of Vince Li, the man who beheaded a victim aboard a Greyhound bus last year, made international headlines yesterday as judge ruled Mr. Li was not criminally responsible due to mental illness. The ruling means that Vince Li will be treated in a mental institution instead of going to prison.

While the ruling is probably the right one, the resulting media frenzy is doing little to dispel the myth that people with mental disorders are violent. It also begs the question: what is the role and responsibility of media in reporting on cases that involve mental illness?

A selection of headlines from major news networks clearly seek to sensationalize the case of Vince Li and in the process make a link between violence and mental illness :"Canada judge: Vince Li not responsible for bus beheading due to mental illness" (Associated Press), "Canada bus killer found mentally ill" (The West Australian), "Judge rules bus beheading suspect mentally ill" (CNN.com), "Crazy bus cannibal sent to mental institution" (Healthcare Industry Today). Even accompanying photographs (like the one above) attempt to "demonize" Li again reinforcing the idea that people with mental disorders look frightening.

While some people who suffer from mental illness do commit antisocial acts, mental illness does not equal criminality or violence - despite the media's tendency to emphasize a suspected link (e.g. psychotic serial killers). In fact, people with mental illness are no more likely to commit violence than the general public, but they are 2.5 times more likely to be victimized and are more likely to inflict violent behaviours on themselves. Furthermore, the general public is more likely to be violently victimized by someone who does not have a mental illness rather than by someone who suffers from mental illness.

From Reuters:

According to Chris Summerville, the Chief Executive Officer of the Schizophrenia Society of Canada, the likelihood of violence by people with mental illness is exceptionally low. In fact, people living with mental illness are more often the victims of violence. "Fortunately, studies show that when people who were or would have been dangerous receive psychiatric treatment they are no more dangerous than people without a diagnosis. But they have to receive the treatment," says Dr. John Gray, a board member of the British Columbia Schizophrenia Society.

Some evidence suggests that certain medications might rarely be associated with aggression, but this doesn't mean there is a link between psychiatric medications and violent behaviour. In fact, the drug that is most often associated with aggressive behaviour is alcohol! Many medications used to treat mental disorders are also helpful in treating violent behaviour. It is important to remember that the best known predictor for future violent behaviour is past violent or criminal behaviour, not mental illness.

While a tragedy of this scale is awful, it can lead to constructive discussions about the need for improved care and a national mental health strategy.

This tragic event reinforces the urgent need for a national mental health strategy. Despite the significant health, economic and social costs of mental illness, Canada is the only G8 nation without a national strategy on mental illness. Summerville who is also a board member of the Mental Health Commission of Canada, says, "In many areas in Canada, there is a lack of psychiatric beds as well as lengthy wait times to access appropriate mental health care." He adds, "If there were not a comprehensive hospital or community services for people with cancer, heart problems or other medical conditions, we as a society would be outraged. Stigma and the lack of social and political will have resulted in Canada's failed mental health system."

Canada has recently made some important strides in addressing mental health and mental illness. The establishment of the Mental Health Commission of Canada is indeed a vital step. But unfortunately it may be some time before the national discourse and media coverage of people with mental illness catches up, and we stop stigmatizing and sensationalizing people living with mental illness. ~ D. Venn & Dr. Stan Kutcher

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