Friday, August 31, 2007

Prime Minister launches national Mental Health Commission



New body to improve quality of life for Canadians suffering with mental illness

August 31, 2007
Ottawa, Ontario

Prime Minister Stephen Harper today announced the final selection of the Board of Directors for the newly created Mental Health Commission of Canada. Speaking at a gathering of international leaders in the mental health field, the Prime Minister said the selection of the new board members, as well as the chairs of the cross-country network of advisory committees, means the Commission is now formally set to launch its activities.

“The board and advisory committee members represent the best people in the mental health field in Canada today,” said the Prime Minister. “Their work will improve quality of life for Canadians and their families dealing with mental illness.”

In Budget 2007, Canada’s New Government committed $55 million over five years towards a mental health commission. The creation of the Mental Health Commission of Canada was a key recommendation of a Standing Senate Committee report on mental health, mental illness and addiction in Canada. It is the cornerstone of the Government’s strategy to address mental health issues in Canada.

“I can tell you that there is already widespread enthusiasm for the creation of the Commission,” said co-author of the report and Commission Chair Michael Kirby. “I cannot count the number of offers of help and proposals for collaboration that have already flooded in.”

The announcement came during the 2007 International Initiative on Mental Health Leadership Exchange and Conference. This conference brings together leaders in the mental health sector from around the world for collaboration, networking and the sharing of best practices. More information on the Conference can be found at: www.iimhl.com.

For the complete list of appointees, click here.

For the Prime Minister's speech, click here.

The SSNS congratulates Andy Cox, the Nova Scotia representative, on his appointment to the Board of Directors of the Mental Health Commission of Canada. We are very proud that one of our own, Chris Summerville (pictured, right), Interim Chief Executive Officer of the Schizophrenia Society of Canada, was also appointed to the Board of Directors.

Thursday, August 30, 2007

Mental disorders lead to homeless hospital visits

Anne-Marie Tobin writes in the Globe and Mail that "more than half of hospital stays by homeless Canadians are a direct result of mental disorders, suggests a study of mental health and homelessness released Thursday."

To read the entire story, click here.

Click here to read a similar story from CBC News.

From the Canadian Institute for Health Information:
The Improving the Health of Canadians: Mental Health and Homelessness report provides an overview of the latest research, surveys and policy initiatives related to mental health and homelessness and, for the first time, presents data on hospital use by homeless Canadians.

Thanks go to John Devlin for bringing the Globe and Mail article to my attention.


Mom: Give my daughter help


From the August 30th edition of the Halifax Chronicle Herald:
Official admits mental health facility may need more staff

By JOHN GILLIS Health Reporter

Sheila Morrison’s daughter has been confined in a psychiatric hospital room with only a mattress since Sunday.

She says her 33-year-old daughter would not be there now and may not have had the outburst that led to her isolation if there were enough staff members to deliver the kind of care she needs.

Her daughter attacked a nurse on Saturday after days of mounting agitation.

Ms. Morrison, who didn’t want to give her daughter’s name, hasn’t been able to speak to her daughter at the Abbie J. Lane Memorial Building of the Queen Elizabeth II Health Sciences Centre since then.

She said nurses have told her her daughter could rejoin other patients if there were more staff.

"The only reason she’s in there right now is that they don’t have enough staff to deal with her," she said.

But Ms. Morrison said the violent outburst might have been avoided altogether if nurses weren’t so overburdened.

Her daughter was first admitted from the emergency department to an acute-care unit on the seventh floor on May 11.

After about a month she was well enough to move to the sixth-floor community-focused living unit with a rehabilitation and recreation therapy program geared to getting people ready to move back into the community.

But recently, acutely ill patients are being admitted to the sixth floor, leaving the staff unable to focus on rehab, she said.

"They’re spending their days doing Band-Aid treatment, trying to get people stable," Ms. Morrison said.

The result is that staff may not notice when a patient like her daughter is growing agitated over a period of days.

"What is noticed is when she finally blows up and has an outburst and sometimes becomes aggressive and injures nurses," Ms. Morrison said.

At least five nurses have been injured by patients in distress since July, prompting the Nova Scotia Government and General Employees Union to call for solutions to the overcrowding and lack of security.

Prior to her recent outburst, her daughter had been growing more paranoid for two or three days.

There are clear signs, from her language to her breathing, that show she’s agitated and most often it can be managed before it progresses, Ms. Morrison said.

Instead, nurses are forced to call security codes when they feel they’re in danger, she said.

And although staff and security are specially trained to restrain agitated patients without injuring them, her daughter has been left with bruises all over her body when she’s been brought to the floor with her arms behind her back.

"The nurses would rather the patients be properly assessed and monitored and treated, but to do that they have to have more resources and more staffing," Ms. Morrison said.

Ms. Morrison learned Wednesday afternoon her daughter would be transferred to an acute-care room in the Nova Scotia Hospital when one becomes available.

Peter Croxall, director of Capital district health authority’s mental health program, praised Ms. Morrison’s advocacy for her daughter and other people with mental illness and agreed the facilities at the Abbie J. Lane are inadequate for modern mental health care.

He said there are regularly 26 or 27 patients on the 25-bed seventh floor and most tend to be very sick at admission.

"If somebody’s thinking is disordered and they come on that unit, it’s almost bound to make it worse," Mr. Croxall said.

"It’s not nicely designed; it doesn’t have nice colours; it doesn’t have a calm, home-like environment."

During the day, there are usually five registered nurses and three licensed practical nurses on that unit, plus occupational and recreational therapists and a social worker.

At night, there may be as few as three nursing staff, though the charge nurse is able to call on extra staff as needed.

Mr. Croxall said the small night staff wouldn’t be problematic if seriously ill and stable patients weren’t mixed together.

He said a proper psychiatric in-patient unit should have an intensive-care unit where the most critically ill could be cared for in private rooms away from other patients until they stabilize.

At present, the therapeutic quiet rooms are serving that purpose.

Mental health managers have met with staff several times in recent weeks.

They’ve instituted new criteria for admission, though Mr. Croxall noted patients needing emergency care must be admitted somewhere.

He said they’re also looking at changing staffing levels in the units.

"It’s often very difficult to get an extra staff person on short notice," he said. "We just don’t have a big enough pool of part-time or casual staff."

A longer-term solution being discussed is to expand the role of licensed practical nurses so they could shoulder more of the case load.
Photograph of Sheila Morrison in front of the Abbie J. Lane Memorial Building is by Darren Pittman.

For a related story published in the August 30th edition of the Halifax Daily News, click here.

Wednesday, August 29, 2007

A revised and updated edition of I Am Not Sick, I Don't Need Help


From the NAMI website:
For seven years, many families have found renewed hope and practical guidance in Xavier Amador’s defining book, I Am Not Sick, I Don’t Need Help: How to Help Someone with Mental Illness Accept Treatment. The revised and updated edition has been long awaited. Now it is here.

In the foreword to the new edition, Pete Earley, author of Crazy: A Father’s Search Through America’s Mental Health Madness, recounts how one man stood in line at a book-signing simply to thank and shake hands with Amador for having “given me my son back.” Earley echoes the sentiment, describing how the book also helped him to overcome a wedge that bipolar disorder had driven between him and his own son.

Individuals with mental illnesses sometimes have difficulty coming to terms with the nature of their conditions, and their need for medication or other treatment. Amador explains the root of the problem: agnosognosia, a clinical condition in which a person’s lack of awareness, insight, and acceptance of their illness is caused by the illness itself.

The condition is intimately tied to a person’s “sense of self,” including a state of being “stranded” in a past self-concept, unable to address the needs of altered personal circumstances.

For family members who want to help loved ones stricken by mental illness, agnosognosia is a source of endless frustration and distress, not to mention conflict.

Amador prescribes an approach that helps to overcome conflict and recognizes the individual dignity of the family member with the illness, without paternalism.

Based on four principles, it’s called the LEAP method—learn, empathize, agree, and partner. He calls it a “communication style” rather than a “complicated therapeutic intervention.”

In other words, LEAP is family-friendly. “You don’t need an M.D., M.S.W., or Ph.D. to use the main elements of this therapy effectively,” Amador writes.

The point of the therapy is not to force individuals to admit that they are sick. Instead, the goal is to get them to find other reasons to accept help and treatment. Once that happens, and a relationship of respect and trust is maintained, insight into the illness will begin to develop.

Amador is a professor of clinical psychology at Teachers College of Columbia University in New York City and a former NAMI research director and member of NAMI’s national board. He also writes from the heart. The book provides numerous references to individuals with whom he has worked with in clinical practice, but even more, his perspective is influenced by his loving relationship with his brother, who lived with schizophrenia.

Tragically, Enrique Amador died in an accident this spring. In a sense, the book is a memorial to him. It will also help the save lives of many people like him, who are equally loved by their own families.

Joyce Cooling speaks out on mental illness



Joyce Cooling performs at the third Jarasum International Jazz Festival in September 2006 (below).

Sunday, August 26, 2007

Look deeper

A letter to the editor published in today's Halifax Chronicle Herald:
The article, "Psychiatric nurses under assault," fails to address a number of possible causes of increased patient aggression. With the headline it used, and by neglecting to interview patients or ex-patients for balanced reporting, this newspaper is contributing to the stigma of living with a mental illness.

Individuals involuntarily admitted to a psychiatric facility may feel fearful and confused due to their loss of freedom. Additionally, the nature of some acute psychotic illnesses means that a few patients, while still deserving of dignity and respect, are at times incapable of distinguishing between appropriate and inappropriate behaviour.

For example, involuntary patients who smoke are no longer allowed to do so and alternative methods of nicotine delivery may not be satisfying to some people who are experiencing psychosis. As a result, these individuals may become aggressive. While smoking has significant negative heath effects, and the Schizophrenia Society of Nova Scotia encourages smoking cessation, the fact remains that the majority of individuals living with schizophrenia smoke.

Investigating the root causes of increased patient aggression at the Abbie Lane will contribute to public understanding of mental illness instead of reinforcing public prejudice.

Stephen W. Ayer, PhD, executive director, Schizophrenia Society of Nova Scotia

Tuesday, August 21, 2007

Focus Group: Mental Health Mobile Crisis Team (MHMCT) Services


Over the past year, have you used any of the crisis services of the Mental Health Mobile Crisis Team (MHMCT) for yourself or someone you know? If so, you may be interested in taking part in a focus group!

The MHMCT would like to know whether or not their new integrated service is meeting the needs of individuals living with mental illness and their family members. They will be bringing together groups of 8-10 people to talk about experiences with the Mental Health Mobile Crisis Team. If you participate, you will be given $25 as compensation for your time.

If you have any questions, or if you wish to participate, please contact the Dalhousie University Research Coordinator at (902) 473-7458. Space is limited.

Sunday, August 19, 2007

YWCA HERizons supports single moms at University


Posted August 13th on the Eastern Views blog:
HALIFAX - Are you or do you know a single mom who is attending University full time?

YWCA HERizons has a goal is to support women to achieve economic independence and long term housing security. the program provides a limited number of affordable, 2 bedroom supported apartments to mothers whose current housing is unstable or unaffordable. All applicants must meet entry criteria.

YWCA HERizons is currently accepting applications for fall occupancy. For more information or to obtain an application please contact Wanda Hill, HERizons Program Manager - by telephone 423-6162 ext 222 or by email at w.hill@ywcahalifax.com

Saturday, August 18, 2007

“Canvas” to hit theatres on October 12, 2007


From the British Columbia Schizophrenia Society (BCSS) website:
In his debut feature film, writer/director Joseph Greco explores mental illness through the eyes of a child (Devon Gearhart) as he learns to cope with his mother (Academy Award winner Marcia Gay Harden) and the fact that she has schizophrenia.

The subject matter is addressed with an uplifting and sometimes even humourous tone that illustrates how from tragedy springs hope, growth, and understanding.

BCSS has been in touch with the production company to find out the Canadian release dates for this movie.

Keep your eyes on www.bcss.org for further updates!

For more information on this film, please visit www.canvasthefilm.com.
Image courtesy of Schizophrenia Digest.

Novel targets for drugs in schizophrenia


The abstract of a paper by J.M. Stone and L.S. Pilowsky published in the August 1st issue of CNS & Neurological Disorders - Drug Targets:
Since the discovery of the first antipsychotic drug, chlorpromazine, in the early 1950s, all effective antipsychotic drugs have been found to share the common property of dopamine D2 receptor antagonism. There has been some suggestion that simple D2 receptor antagonism may not confer optimal antipsychotic efficacy. Currently available antipsychotic drugs leave many symptoms of the illness untreated and cause unacceptable side effects. Recent research in schizophrenia suggests a number of potential new non-D2 targets for pharmacotherapy including glutamate, acetylcholine and serotonin neurotransmitter systems. This review summarises the main neurochemical theories of schizophrenia, and, in the light of these, examines possible therapeutic targets for new antipsychotic drugs.

D2 receptor binding of typical and atypical antipsychotic drugs. (Source: ABPI via drugdevelopment-technology.com.) Click on the figure to magnify it.

Thursday, August 16, 2007

Two new books in the SSNS Library





Thanks go to the Schizophrenia Society of Canada for donating these two books to the SSNS.

To view the entire SSNS Library Catalogue, click here.

Wednesday, August 15, 2007

The [U.K.] Mental Health Act 2007: the final report


Produced by the Mental Health Alliance. Click here to read (downloads a PDF).

To view The Mental Health Act 2007, which was given Royal Assent on July 19th, 2007, click here (also downloads a PDF).

Sunday, August 12, 2007

Insight into a Schizophrenia-related Mutation


A paper of the week in The Journal of Biological Chemistry. Click here to read the editorial (downloads a PDF).

Schizophrenia Daily News Blog also has a summary of this research. To view, click here.

Factors affecting outcome in schizophrenia and their relevance for psychopharmacological treatment


In line with the Schizophrenia Society of Nova Scotia's mission to improve the quality of life for those affected by pschizophrenia and psychosis, below is the abstract of a paper written by A. Carlo Altamura, William V. Bobo, and Herbert Y Meltzer which was published in the September 2007 issue of International Clinical Psychopharmacology, pages 249-267:
A major focus of current treatment research in schizophrenia is the determinants of long-term outcome, including functional outcome and general medical well being, rather than just specific domains of psychopathology such as positive and negative symptoms, mood symptoms, and cognitive impairment. This focus does not negate the importance of the latter issues but sees them as factors contributing to long-term outcome to variable extents. A long-term treatment focus facilitates a more clinically relevant assessment of benefits versus risks of available treatments. For instance, atypical antipsychotic drugs as a group have clear advantages for several important domains of efficacy that may influence long-term outcome, but are also more expensive over the long term. Use of some agents may also result in deleterious physical health consequences as well as large additional costs over the long term owing to metabolic adverse effects.

The present paper focuses on several key issues in schizophrenia which are important determinants of long-term outcome in schizophrenia, or influence choice of antipsychotic drugs, or both, including: (i) duration of untreated psychosis; (ii) impact of relapse on long-term outcome; (iii) limited efficacy for specific domains of psychopathology of current treatments; (iv) mortality owing to suicide; and (v) mortality owing to other causes (e.g. cardiovascular disease).

Thursday, August 9, 2007

Elyn Saks: A Scholar's Memoir of Schizophrenia

Fresh Air from WHYY, August 7, 2007

From National Public Radio:
Click here to listen to this story.

In The Center Cannot Hold, lawyer and psychiatry professor Elyn R. Saks chronicles her own struggle with schizophrenia. The battle began with early symptoms at age 8 and has continued throughout her life; she had her first full-blown episodes during her terms at Oxford and Yale.

Saks, who has for years controlled her condition with daily medication and therapy, is an expert in the field of mental-health law, and teaches at the University of Southern California.
For information on the book, click here and here.

For an October 6th newspaper article, click here.

Trends in U.S. Mental Health Spending, 1986–2003


From the August 2007 issue of Psychiatric Services:
According to data in this month's lead article, total spending on mental health treatment in the United States grew from $33 billion in 1986 to $100 billion in 2003. Per capita spending increased from $205 to $345. However, as a percentage of total health care, spending on mental health treatment fell from 8% in 1986 to 6% in 2003. The research team, which was led by Tami L. Mark, Ph.D., found a large shift away from spending on inpatient mental health care—41% of total mental health expenditures in 1986 and 24% in 2003—to spending on psychoactive prescription drugs—7% in 1986 and 23% in 2003. Medicaid has assumed a more prominent payer role, accounting for 26% of mental health expenditures in 2003, up from 16% in 1986. One conclusion from these findings is that more people are receiving treatment for mental illness—an increase partly driven by the growing use of pharmacotherapy. In addition, the authors call for greater monitoring of the quality of care to ensure that Americans are getting an adequate return on their investment.
To read the abstract for the lead article referred to above, click here.

Wednesday, August 8, 2007

Professor develops snapshot of mental health economic burden

From the University of Alberta website:
By Donna Richardson - (January 30, 2007)

We don’t like to talk much about mental illness, but that doesn't mean it doesn't exist. In fact, it is estimated that one in three Canadians will experience it during their life. The effect of mental illness on an individual's well being and the associated social and economic burden in Canada are significant.

One person who understands this burden is Dr. Philip Jacobs (left), a professor in the Department of Public Health Sciences (School of Public Health) who directed the development of a booklet called Mental Health Economic Statistics.

The booklet, jointly published by the Alberta Mental Health Board (AMHB) and the Institute of Health Economics (IHE), is small enough to fit into your pocket, yet it is chock full of information about the social and economic burden of mental health, the resources that have been committed to addressing the burden, and an assessment of how well the Canadian system performs – relative to some other countries – in effectively allocating these resources.

Egon Jonsson, Executive Director and CEO of IHE, says, "In order to improve the overall mental health system and address its needs, we must understand the prevalence of mental health problems and where mental health resources are currently being utilized."

This is the first time that comprehensive economic statistics about mental health in Canada have been compiled. According to Jacobs, "No one has presented a bird's eye view of the economic aspects of the system." Along with his team, he used numerous sources to create a snapshot of information that was scattered and some times difficult to locate.

When asked about the status of the Canadian mental health system from an economic viewpoint, Jacobs points out that, "There is no single bottom-line indicator of mental health. We can't easily summarize the state of the system as it is very complex with multiple indicators." He does note, however, that prior to compiling the Mental Health Economic Statistics, we had very little idea how much money was spent in Canada on treatment of mental illness.

"The statistics also show that our system is not very generous towards people with mental illness in terms of social supports such as the Canada Pension Plan and Workers' Compensation," states Jacobs. He also draws attention to the gaps in information on private insurance.

Copies of the booklet, available through AMHB and IHE, have been provided to policy makers across Canada, including some in the Canadian Mental Health Association, the Canadian Psychiatric Association, and relevant provincial and federal departments.

Reflecting on the value of the publication, Ray Block, President and CEO of AMHB says, "With an estimated one in three Canadians experiencing a mental health problem at some point in their life, understanding its impact on families, communities, health systems, and the economy is critical."

Jacobs hopes the information contained in the booklet will assist policy makers and planners by providing a clear picture of the current mental health system. "I'm optimistic that this tool will be helpful for developing policies and allocating resources that will reduce the impact of mental illness on Canadians," he says.

Please refer to the links below to upload an electronic copy of Mental Health Economic Statistics. For hard copies, please contact the Alberta Mental Health Board or the Institute of Health Economics.

Links:

* Alberta Mental Health Board
* Institute of Health Economics
* Mental Health Economic Statistics: In Your Pocket (PDF 973 KB)

Friday, August 3, 2007

Cannabis Use Linked With Risk for Psychosis in Later Life


From Medscape Medical News
News Author: Marlene Busko
CME Author: Désirée Lie, MD, MSEd
August 1, 2007 — A systematic review of longitudinal studies suggests there is sufficient new evidence that the use of cannabis (marijuana) increases the risk for later psychotic illness by roughly 40%. The study showed a trend towards an increased risk for depression in people who had used cannabis, but the evidence was not as strong.

The article by Theresa H.M. Moore, MSc, from the University of Bristol in the United Kingdom, and colleagues is published in the July 28 issue of The Lancet.

Study author Stanley Zammit, PhD, from Cardiff University in Wales, told Medscape that individuals who used cannabis on a weekly or daily basis had about a 2- to 3-fold increase in risk for psychotic outcomes, independent of transient intoxication or other confounding factors. He added, "We looked at the quality of the studies quite rigorously and feel the evidence is strong enough to warrant advising everyone, particularly young people, that the use of cannabis does potentially have some health risks, especially if they are using it on a regular basis."

Cannabis is the most commonly used illegal substance in most countries, the authors write, adding that in the United Kingdom and New Zealand, about 1 in 5 young people report using cannabis weekly or having used it more than 100 times. Previous studies have suggested that cannabis use can produce transient, usually mild, psychotic and affective experiences, but whether it increases the incidence of mental health outcomes such as schizophrenia or depression is unclear.

The group searched for population-based longitudinal studies that looked at the relationship between cannabis use and subsequent psychotic and affective outcomes. They found 11 studies from 7 cohorts that looked at psychotic outcomes and 24 studies from 15 cohorts that looked at affective outcomes.

Increased Risk, Dose-Response Effect
The researchers found a consistent increased risk for psychotic outcomes in the people who had ever used cannabis (adjusted odds ratio [OR], 1.41; 95% confidence interval [CI], 1.20 - 1.65), with a greater risk in individuals who had used it most frequently (OR, 2.09; 95% CI, 1.54 - 2.84).

Most studies excluded people with psychosis at baseline, so this association between cannabis use and psychosis is unlikely to result from reverse causation, the group writes. The studies also adjusted for about 60 confounding factors. "People who use cannabis might be different from other people in a number of factors and some of those might increase their risk of mental health disease, but even once we had adjusted for these factors, there was still an association," Dr. Zammit said.

The evidence that cannabis use leads to depression, suicidal thoughts, and anxiety outcomes was less consistent. "Overall, the quality of the studies wasn't as robust as the studies for psychosis," said Dr. Zammit, adding that for example, many of the studies did not try to adjust for confounding factors.

Although an individual's lifetime risk of developing a serious psychotic illness is only about 2% or 3%, he added, cannabis can be expected to have a large impact at a population level because exposure to this drug is so common.

"The overall message is that people who use cannabis on a regular basis need to be aware of this risk, so they can make an informed judgement about whether they want to continue using it, or perhaps try to cut down their use," or seek treatment of dependency, he concluded.

Editorial: "Need to Warn the Public... Establish Treatment"
In an accompanying editorial, Merete Nordentoft, MD, and Carsten Hjorthøj, from Copenhagen University Hospital in Denmark, write that the study is the most comprehensive meta-analysis to date of this possible causal relationship and the adjustment for confounding factors and transient effects "is done more thoroughly than in previous reviews." They report, "We therefore agree with the authors' conclusion that there is sufficient evidence to warn young people that cannabis use will increase the risk of psychosis later in life."

The general public has considered cannabis to be relatively harmless in comparison with alcohol and opioids, they note, cautioning that, "however, the potential long-term hazardous effects of cannabis with regard to psychosis seem to have been overlooked, and there is a need to warn the public of these dangers, as well as to establish treatment to help young frequent cannabis users."
To view the entire article, click here.

References
Anonymous, Rehashing the evidence on psychosis and cannabis. The Lancet - Vol. 370, Issue 9584, 28 July 2007, Page 292.

Merete Nordentoft and Carsten Hjorthøj, Cannabis use and risk of psychosis in later life. The Lancet - Vol. 370, Issue 9584, 28 July 2007, Pages 293-294.

Theresa H.M. Moore, Stanley Zammit, Anne Lingford-Hughes, Thomas R.E. Barnes, Peter B. Jones, Margaret Burke, and Glyn Lewis, Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet - Vol. 370, Issue 9584, 28 July 2007, Pages 319-328.

Photograph courtesy of the United States Fish and Wildlife Service.

For another interpretation of the results of this study, click here.

Time to End Mind-Brain Split

To read an interesting viewpoint on the above subject click here. The article was written by Ronald Pies, M.D., and published in the August 3rd edition of Psychiatric News.