Monday, June 30, 2008

Report of Residential Services: June 2008



From the Nova Scotia Department of Community Services, Services for Persons with Disabilities:
Executive Summary

In November 2006, the Department of Community Services, Services for Persons with Disabilities Program commenced a review of all residential services for persons with disabilities in Nova Scotia. Helen Patriquin, a private consultant, conducted the review under the direction of Mildred Colbourne, Director, Services for Persons with Disabilities Program, and with the assistance of program and regional staff working with persons with disabilities.

The consultant conducted site visits at various residential options and also distributed a questionnaire to other service providers. All information was documented and analyzed in conjunction with departmental resources, especially the program area and the regional offices.

The Services for Persons with Disabilities program area provides residential and other supports to three broad population groups:
  1. Individuals with intellectual disabilities.
  2. Individuals with long-term mental illness.
  3. Individuals with physical disabilities.
Approximately 4,800 individuals with disabilities are provided services and support at this time. Another 400 individuals are currently awaiting services.

This report provides the findings, recommendations and a plan to address the action items, or areas of concern, that have been identified. Major themes were recognized throughout the review and are the focus of this report. These themes include:
  • Leadership and direction for the program.
  • Governance and leadership in the sector.
  • Integration and coordination of services and supports.
  • Programming and supports for individuals with disabilities.
  • Quality and best practices.
  • Eligibility criteria and assessment processes.
  • Waiting lists and residential options.
  • Human resource issues.
  • Infrastructure issues.
This report provides a comprehensive examination of current services and supports for individuals with disabilities. It is with great gratification that we can state that because of the tremendous commitment of staff of the Department of Community Services and the many service providers throughout the sector, the system has been able to serve the needs of individuals with disabilities despite the current limitations. These limitations, however, are at a critical point and must be addressed to ensure that persons with disabilities have access to a range of services and supports that will enable them to live to their fullest potential within their communities.

The plan outlined further in this document details a long-term strategy to address the gaps in residential services and supports for persons with disabilities. These recommendations have been developed following extensive consultation and review of best practices in other jurisdictions, along with current research, such as the Kirby Report (2006). While preliminary costing has been completed at this time, further work is required to specify the funding commitment required on a per year basis to move the strategy forward.

The Department of Community Services would like to thank all of those individuals and organizations that assisted in this review through participation in a site visit, completion of questionnaires, attendance at meetings, and other input. Certainly without this level of participation we would not have been able to move forward.
To read the entire report, click here (added to the Nova Scotia Department of Community Services website on Monday, June 30th, 2008).

Also see:
Investment to Improve Quality of Life for Persons with Disabilities (June 17, 2008)

Saturday, June 28, 2008

A 12-step program for Canada

From today's edition of The Globe and Mail:
Setting priorities and solutions to address the mental health crisis.
To read this excellent article by André Picard, click here.


From www.andrepicard.com:
André Picard is the public health reporter at The Globe and Mail and one of Canada's top public policy writers.

He is the author of the best-selling books CRITICAL CARE: Canadian Nurses Speak For Change and THE GIFT OF DEATH: Confronting Canada's Tainted Blood Tragedy. He is also the author of A CALL TO ALMS: The New Face of Charity in Canada.

André has received much acclaim for his writing, including the Michener Award for Meritorious Public Service Journalism, the Canadian Policy Research Award, and the Atkinson Fellowship for Public Policy Research.

In 2002, he received the Centennial Prize of the Pan-American Health Organization as the top public health reporter in the Americas. In 2005, he was named Canada's first Public Health Hero by the Canadian Public Health Association, and in 2007 he was honoured as a Champion of Mental Health.

André is also a four-time finalist for the National Newspaper Awards – Canada’s Pulitzer Prize.

He has been the recipient of the Canadian Nurses' Association Award of Excellence for Health Care Reporting, the Nursing in the Media Award of the Registered Nurses Association of Ontario, the International Media Prize of Sigma Theta Tau (Nursing Honor Society), and the Science and Society Book Prize.

His advocacy work has been honoured by a number of consumer health groups, including Safe Kids Canada, the Canadian Mental Health Association, the Canadian Alliance on Mental Illness and the Canadian Hearing Society.

He lives in Montréal.
Photo of André Picard courtesy of www.andrepicard.com.

More help for people with mental illness


From the June 27th edition of The Chronicle Herald:
People living with mental illness in Halifax will soon have more resources at their disposal, thanks to a $46,000 investment from the Mental Health Foundation of Nova Scotia.

The foundation said Thursday that it will provide new funding for three programs in metro through its provincial grants program.

Grants will be awarded to the YWCA of Halifax, the Schizophrenia Society of Nova Scotia and Laing House, a local youth support centre.

"Thanks to these organizations and the quality programs they offer to mental health patients and their families, we are changing the way people think about mental health," Myrtle Corkum, the foundation’s executive director, said in a release.

"Slowly, we are seeing a shift from stigmatizing, silence and isolation to acceptance, inclusion and understanding."

The grants will be used to fund educational initiatives, housing programs and support groups for family members and friends of people [living with] mental illness.


Friday, June 27, 2008

The Scottish solution: 'Look good but feel crap?'

From today's edition of The Globe and Mail:
Scotland has become a leader in tackling mental illness, thanks to innovative legislation and high-profile public-awareness campaigns. The suicide-prevention effort features everyone from football teams to the pop duo the Proclaimers.
To read the entire article, click here.

Eleanor Trebilcock of Arbroath, Scotland, with her dog Jake. After suffering with depression, Ms. Trebilcock became a product of the country’s old thinking about mental illness, but she’s also benefited from its new approach. 'The stigma,' she said, 'is slowly disappearing.' (Randy Quan for The Globe and Mail)


BY THE NUMBERS


25 to 33 - Percentage of Scottish people experiencing mild to moderate mental-health problems, out of a population of five million 3 Percentage of the population with severe and enduring mental illness

1 - Ranking of suicide as the cause of death for Scots under 35 years old

765 - Number of suicides in Scotland in 2006

13 - Percentage decline in the suicide rate since 2002

20 - Percentage drop that Scotland wants to see in the suicide rate by 2013 (from the base year 2002)

Also see: The branding that devalues.

Thursday, June 26, 2008

'The mad and the bad'

From today's edition of The Globe and Mail:
The mentally ill are often saddled with a double stigma, cycling through the justice system without getting treated for underlying disorders. As Dawn Walton reports, the prisons are full of people with mental problems, many of them so-called frequent fliers.
To read the entire article, click here.

Corry Grunsky, with granddaughter Cera Smith and mother Mary Lewis, in Edmonton. Drugs became Ms. Grunsky’s crutch – and livelihood – after she was diagnosed with depression and bipolar disorder. Convicted of drug dealing, she calls her time in federal prison 'a complete joke.' (John Ulan for The Globe and Mail)

Wednesday, June 25, 2008

Addiction Prevention and Treatment Services: Capital Health


Community Oriented Recovery Environment (CORE) schedules for July 2008:

Morning Schedule [Starting July 14th, 2008] (PDF)

Treatment/Discussion Groups (PDF)

The express route to mental illness

From today's edition of The Globe and Mail:
From the lab to the legislature, the push is on to recognize and treat addiction as a mental illness. A growing body of research finds addiction is not the result of bad behaviour or weak character, but the result of biochemical disruptions in the brain that genetically vulnerable people are, on their own, powerless to overcome. It distorts mood, clear thinking and compulsion control. People who suffer from it, scientists believe, can no more talk themselves out of their dependence any more than people can talk themselves out of depression.
To read the entire article, click here.

The push is on to recognize addiction as a mental illness (Tonia Cowan/The Globe and Mail)
Click on the image to enlarge it.

Tuesday, June 24, 2008

Podium TV broadcasts presentations made at the SSNS's 20th Annual Conference



Over the next three weeks, Eastlink Cable's Podium TV is broadcasting three presentations made during the Schizophrenia Society of Nova Scotia's 20th Annual Conference: Families as Partners in Mental Health Care.

The broadcast schedule for Halifax Regional Municipality is as follows:

Monday, June 23rd, through to Thursday, June 26th:

Topic: "Prejudiced, who me? Are the attitudes of health care professionals contributing to stigma about schizophrenia and other psychotic illnesses?"
Speaker: Dr. Pamela Forsythe
Organization: Schizophrenia Society of Canada


Monday, June 30th, through to Thursday, July 3th:

Topic: Developing Effective Partnerships with Families - Benefits and Challenges
Speaker: Dr. Gráinne Fadden
Organization: Meriden, the West Midlands Family Programme, United Kingdom


Monday, July 7th, through to Thursday, July 10th:

Topic: An Overview of the Nova Scotia Family Pharmacare Program
Speaker: Dr. Jane Gillis
Organization: Nova Scotia Department of Health


Broadcast times for Halifax Regional Municipality during each week are as follows:

Monday: 8:00 am and 5:05 pm

Tuesday: 8:00 am, 5:05 pm, and 9:00 pm (if the HRM Council Meeting does not go overtime)

Wednesday: 8:00 am and 5:05 pm

Thursday: 8:00 am, 5:05 pm, and 9:00 pm

To view broadcast times in other areas of Nova Scotia, click here.

The orphans of medicare

From today's edition of The Globe and Mail:
Jennifer Clark has been living for two years in a stark room in Victoria's Royal Jubilee Hospital. In fact, patients with mental illness — unwanted and forgotten — account for an astounding one-third of all hospital time.
To read the entire story, click here.

Jennifer and her husband Rhys Clark in her room at the Royal Jubilee Hospital May 17, 2008. (John Lehmann/The Globe and Mail)

By the numbers

9: percentage of visits to the emergency room that are related to mental health

24 to 72: the number of hours a patient with severe depression can wait for care at the ER

16: percentage of hospital stays in Canada related to treatment for mental illness

75: percentage of patients treated at Victoria’s Archie Courtnall Centre who have substance-abuse problems

38: percentage of patients [diagnosed with schizophrenia] discharged from hospital who are readmitted within a year

80 percentage of sufferers of mental illness treated primarily by a family doctor

34,418: the dollars required to support someone with serious mental illness to live in the community for one year

170,820: the dollars required to keep a mental-health patient in hospital for a year

Sources: Canadian Institute for Health Information; Centre for Addiction and Mental Health

Fear | Less: Opening Minds about Schizophrenia



From the Schizophrenia Society of Ontario:
Fear|Less: Opening Minds about Schizophrenia explores one young man’s journey of living with schizophrenia. It balances the perspectives of Jesse (the young man) and that of his mother, Susan, while touching on the broader sociological and clinical perspectives.

Fear|Less first premiered at the October Schizophrenia Awareness Month reception kick-off in 2007, at Hart House, University of Toronto. It was subsequently screened at the Rendezvous with Madness film festival, and then at the U of T Film Festival, where it won a Director’s Award.

We are very proud of Fear|Less, and acknowledge the courage it took for Jesse and others to speak out on camera about schizophrenia.

This documentary was a co-production between SpaceCapsule Films and the Schizophrenia Society of Ontario.
To view this documentary, click here.

Monday, June 23, 2008

The working wounded

From today's edition of The Globe and Mail:
Mental illness is costing the Canadian economy a staggering $51-billion a year, and each day 500,000 people miss work because of psychiatric problems. What are employers doing about it? Not much.
To read the entire story, click here.

Sylvie Giasson, a Health Canada worker in Ottawa, [lives with] severe depression/anxiety disorder. (Brigitte Bouvier for the Globe and Mail)

By the numbers:

1 Rank of depression among the leading causes of disability in the world.

8% Percentage of workers taking medication in Canada to treat depression and other mental-health conditions.

20.6% Percentage of workers who suffer a bout of mental illness, most in the prime of their working lives

40% Percentage of short- and long-term disability claims that involve a mental-health problem.

60% Percentage drop in family income when a breadwinner is diagnosed with mental illness.

500,000 Number of workers off sick each day in Canada with mental-health problems.

$8.5-billion Amount that employers and insurers spend each year on long-term disability claims related to Mental illness.

$9.3-billion Annual cost of short-term leave for mental-health problems.

$51-billion Amount that mental illness costs the Canadian economy each year.

Sources: World Health Organization, Centre for Addiction and Mental Health, Canadian Public Health Agency, Great-West Life Centre for Mental Health in the Workplace, Statistics Canada

Saturday, June 21, 2008

'We must never give up on the potential of people to recover'

An excellent video posted on globeandmail.com.

Psychiatrist David Goldbloom talks about the stigma surrounding mental illness in Canada and some essential first steps in changing things for the better

To view the video, click here.

Photograph of David Goldbloom courtesy of The Globe and Mail.

Breakdown: Canada's Mental Health Crisis



From today's edition of The Globe and Mail:
Follow me home

Four brave Canadians invite readers into their lives to shine a light on the human face of mental illness. The series Breakdown: Canada's Mental Health Crisis begins today.
To view the series Breakdown: Canada's Mental Health Crisis, click here.

Friday, June 20, 2008

Thursday, June 19, 2008

Study of the Conductive Energy Weapon - Taser®


Report of the Standing Committee on Public Safety and National Security

To view the Report, click here (downloads a PDF).

From the Introduction:

To prevent confidence in the RCMP from eroding further, the Committee considers that the RCMP must react immediately by revising its policy on CEWs to stipulate that use of such weapons can be justified only in situations where a subject is displaying assaultive behaviour or represents a threat of death or grievous bodily harm. This immediate restriction is necessary given the persisting uncertainty about the effects of CEW technology on the health and safety of persons subjected to it, and the scarcity of independent, peer-reviewed research in this regard. The Committee also urges the RCMP to implement preventive methods designed to diminish the use of Taser guns during police interventions, in particular by enhancing accountability at the RCMP and improving officer training on intervention involving persons suffering from various problems, including bipolar disorder, autism and autism spectrum disorders, schizophrenia and drug addiction.

Some selected recommendations from the Report:

Recommendation 5
The Committee recommends that the RCMP improve the training of its members on mental health and addiction issues. The RCMP should make sure that the training given to its members reflects the findings of independent research in these areas, particularly in regard to the relationship between mental health disorders, addiction and use of the Taser gun.

Recommendation 6
The Committee recommends that, wherever possible, the RCMP make use of psychiatric support staff to assist them in providing assistance when an intervention is expected to involve a person suffering from mental illness or drug addiction.

Recommendation 7
The Committee recommends that Health Canada, through the Health Human Resource Strategy and the Canadian Mental Health Commission [sic], look into the lack of psychiatric programs and drug addiction programs.

Recommendation 10
The Committee recommends that Statistics Canada’s Canadian Centre for Justice Statistics be given the mandate to create and manage a national database on in-custody deaths, including, at least, the method of restraint used, the authority involved and the context of incidents, such as mental illness or drug use.

Recommendation 11
The Committee recommends that Statistics Canada’s Canadian Centre for Justice Statistics also be given the mandate to create and manage a database on the use of the Taser gun and other restraint methods.

Mounties agree to cut frequency of Taser use

From the June 19th edition of The Chronicle Herald:
By Sue Bailey and Jim Bronskill, The Canadian Press

OTTAWA — The RCMP say they will restrict Taser firings in the face of mounting public pressure on the national force to rein in what critics call "usage creep."

Officers will have clearer direction on how and when the powerful weapons should be wielded "as quickly as possible," the Mounties said Wednesday following renewed calls for action by the RCMP complaints commission.

Chairman Paul Kennedy released a final report echoing his interim call to limit Tasers to clashes where suspects are combative or risk serious harm to themselves, the police or the public.

The RCMP agreed that the force must "properly instruct" its members "and account for our use of the weapon."

"We have already implemented or begun implementation of much of what Mr. Kennedy has recommended."

To read the entire story, click here.



Paul Kennedy, the RCMP complaints commission chairman, refers to the two prongs on a Taser as he discusses his final report on the RCMP's use of the Conductive Energy Weapon, commonly referred to as a Taser, at a news conference in Ottawa Wednesday June 18, 2008.

Photograph by Tom Hanson of The Canadian Press.

Wednesday, June 18, 2008

CPC Chair Submits Final Conducted Energy Weapon Report to Public Safety Minister



From the Commission for Public Complaints Against the RCMP:
June 12, 2008

NEWS RELEASE

Ottawa, June 18, 2008 - Paul E. Kennedy, Chair of the Commission for Public Complaints Against the RCMP (CPC), today made public his Final Report concerning the RCMP's use of the Conducted Energy Weapon (CEW), commonly known as the Taser, following a request made by the Minister of Public Safety Stockwell Day on November 20, 2007.

The Final Report includes 12 recommendations for immediate implementation. It follows an Interim Report that the Commission provided to Minister Day on December 11, 2007.

"Our recommendations are designed to hold the RCMP publicly accountable for its use of a weapon that has caused considerable apprehension among Canadians, and to control usage creep," said Mr. Kennedy. "The Commission is not calling for a moratorium."

The primary finding is that the quality of data in the RCMP national CEW database is so poor that RCMP policy shifts following the 2001 introduction of the weapon cannot be factually supported. Seemingly, these small policy changes have led to major operational consequences.

Due to the significant public policy debate occurring over CEW use by the police in Canada, the Report is premised on the notion that CEW use must be situated within the principle of proportionality: that the amount of force used should bear some reasonable relationship to the threat a police officer is facing and its impact upon public safety.

Key recommendations in the Final Report include:
  • That the conducted energy weapon be classified as an "impact weapon" and its use be allowed only in situations where an individual is "combative" or posing a risk of "death or grievous bodily harm", including individuals appearing to be experiencing the condition(s) of excited delirium;
  • That the RCMP immediately instruct its members who deploy a conducted energy weapon on a subject to seek immediate medical attention for the subject in all circumstances;
  • That the RCMP immediately restrict the use of the conducted energy weapon to the following members: Rank of Corporal or above in urban (1) settings, and Constables with at least five (5) years of operational experience who are posted to detachments in rural (2) settings;
  • That the RCMP publicly release the requested Quarterly and Annual Reports concerning the RCMP's use of the conducted energy weapon.
Mr. Kennedy's Final Report is complementary to his ongoing Chair-Initiated Complaint into RCMP actions surrounding the in-custody death of Robert Dziekanski at the Vancouver International Airport on October 14, 2007.

The Report's executive summary and 12 recommendations are available on the CPC website at www.cpc-cpp.gc.ca. The full document is available upon request via email at org@cpc-cpp.gc.ca or by contacting the Commission representatives listed below. It will also be available in the near future on the CPC website.

- 30 -

For more information, please contact:

Nelson Kalil
Manager, Communications
613-952-2452
nelson.kalil@cpc-cpp.gc.ca

Melanie Rushworth
Manager, Outreach
613-952-3738
melanie.rushworth@cpc-cpp.gc.ca



(1) Urban setting is defined as a population of 5000 residents or more.

(2) Rural setting is defined as a population less than 5000 residents.

To download the entire report, please click here (PDF).

Saturday, June 14, 2008

Wrong Prescription


How the emptying of state-run mental hospitals produced a social disaster

From the June 14th edition of The Wall Street Journal:
By Paul McHugh

The Insanity Offense
By E. Fuller Torrey
Norton, 265 pages, $24.95

There are times and situations that call for prophets. Not fortunetellers or soothsayers, but biblical prophets like Amos or Jeremiah who furiously proclaim the old truths, puncture our pretensions and predict from current tribulations worse to come if what lies deeper than sin -- idolatrous worship of false gods -- continues. E. Fuller Torrey, a psychiatrist who cares for patients with schizophrenia and manic-depression, is to my mind the doctor nearest in character to an ancient Hebrew prophet.

In "The Insanity Offense," he describes the grim consequences -- in death, violence and suffering -- of laws that, beginning in the late 1960s, released the seriously mentally ill from the oversight of state mental-health services and permitted them to wander away from the treatment and protection they desperately needed. Dr. Torrey identifies an unholy alliance of rash conservatives seeking to save public money by abandoning a traditional state obligation and self-righteous liberals defining the neglect of these patients as "defending their civil rights." We need prophets to confront such alliances -- anything less will fail -- and in this splendid book we hear one.
To read the entire article, click here.

For a book excerpt from the The Insanity Offense, click here.

Friday, June 13, 2008

Officials call for change in how mental illness is treated

From the June 12 edition of the Leader-Post:
By Anne Kyle, Leader-Post

REGINA -- Mental health needs a champion, someone with a public profile, to come forward to advocate on behalf of persons struggling with mental-health issues, say the people who work in the field.

"They need to have someone brave enough with a mental illness, who has maybe some celebrity status, who steps forward and says, 'I have schizophrenia and I am doing pretty good.' Being able to have a role model to look up to will give others hope and help to remove the stigma attached to mental illness,'' said Anita Hopfauf, executive director of the Schizophrenia Society of Saskatchewan.
To read the full story, click here.

Paying the Price: The Cost of Mental Health Care in England to 2026


From the Mental Health Specialist Library:
This report from the King's Fund, the results of a year-long study into the costs of meeting the mental health needs of the nation over the next two decades, reveals that mental illness in England cost £50 billion [$CDN 100 billion, $CDN 20 per capita] in 2007. Almost half, £22.5 billion [$CDN 45 billion] represents money spent on direct NHS and social care services to support people with mental disorders. The rest, £26.1 billion [$CDN 52.2 billion], represents the estimated cost to the economy of earnings lost because of the thousands of people unable to work due to their mental illness.

Although it finds that the prevalence of most mental disorders, including schizophrenia, is likely to remain stable over the next 20 years, it predicts a huge increase in dementia - up by almost two-thirds (61 per cent) from 582,827 to 937,636 due to an ageing population. As a result of this, and above inflation rises in health care costs, the bill for mental health services is expected to grow from £22.5 billion to £47 billion.

The report contains chapters on eight different specific disorders: depression, anxiety disorders, schizophrenic disorders, bipolar and related conditions, eating disorders, personality disorder, disorders affecting children and adolescents, and dementia.
For more information, including access to the report, click here.

Also see:
Mental Disorders Cost Society Billions in Unearned Income (United States)

Wednesday, June 11, 2008

News from the Lunenburg County Chapter of the SSNS

The winners of the Lunenburg County Chapter of the SSNS's raffle at the SSNS's 20th Annual Conference were:

First Prize - The Heron a.k.a. Big Bird handcrafted by Jim Smith of Bridgewater. Won by Lisa P.

Second Prize - a painting donated by Jane Whitfield Smith of Bridgewater. Won by Margaret Burton.


Click on the photographs below to enlarge them.

Assisted by Denton Conrad (left), past-president of the Lunenburg County Chapter of the Schizophrenia Society of Nova Scotia (LCC-SSNS), Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, draws the names of the winners of the raffle.


Denton Conrad (left) presents the painting donated by Jane Whitfield Smith to Second-Prize Winner Margaret Burton.


Gail Corkum, Richard Balser, and Jan House (left to right) volunteering at the LCC-SSNS's display booth during the SSNS's 20th Annual Conference held in Halifax on May 30th, 2008.


Gail Corkum (left) and Richard Balser volunteering at the LCC-SSNS's display booth (with Big Bird in the foreground!).

Tuesday, June 10, 2008

Schizophrenia: Twice as Common as HIV/AIDS, But Survey Shows Americans Misinformed


From the National Alliance on Mental Illness (NAMI), June 9, 2008:
Arlington, VA — Twice as many Americans live with schizophrenia than with HIV/AIDS, but a major report by the National Alliance on Mental Illness (NAMI) reveals most Americans are unfamiliar with the disease.

"Americans are not sure what to think about schizophrenia," said NAMI executive director Mike Fitzpatrick. "They know schizophrenia is a medical illness affecting the brain, but it is largely misunderstood. There are gaps in knowledge— and access to treatment. Misinformation, misperceptions, and misunderstanding represent a public health crisis."

The report is available at www.nami.org/schizophreniasurvey. It is based on an on-line survey conducted by Harris Interactive among the general public, caregivers and individuals living with schizophrenia.

Approximately two million Americans live with schizophrenia. Two-thirds do not receive treatment, even though the disease can be managed successfully.

The survey found the average age at onset was 21, but a nine-year gap exists between symptoms and treatment.
  • 85% of Americans recognize schizophrenia as an illness, 79% believe that with treatment, people with the diagnosis can lead independent lives, but only 24% are familiar with it. Many cannot recognize symptoms or mistakenly believe they include “split” or multiple personalities (64%).

  • 79% want friends to tell them if they have schizophrenia, but only 46% say they would themselves. Even with treatment, 49% are uncomfortable with the prospect of dating a person with schizophrenia.

  • Among people living with schizophrenia, 49% said doctors take their medical problems less seriously, even though the report notes that the death rate from causes like heart disease or diabetes is 2-3 times that of the general population.

  • A vast majority believe that better medications (96%) and health insurance (82%) would be most helpful to improving their condition.

  • Caregivers agree better medications are needed. Approximately 80% have difficulty getting services for loved ones, 63% have difficulty finding time for themselves, and 41% have provided care for more than 10 years.
"We know what to do to increase recovery, but it requires public support, which depends on public attitudes," Fitzpatrick said.

The report offers five recommendations:
  • Public education

  • Closing the gap between symptoms and treatment

  • A welcoming healthcare system

  • Education and support for caregivers and individuals living with the illness

  • Greater investment in medical research
# # #

Monday, June 9, 2008

MPs ready to clamp limits on Taser use

Recommendations not expected to include stun-gun moratorium

From today's edition of The Chronicle Herald:
By Sue Bailey and Jim Bronskill, The Canadian Press

OTTAWA — MPs studying Taser use are expected to urge the RCMP to restrict the powerful weapons to high-risk confrontations — especially when suspects are highly agitated.
To read the full story, click here.

Photo from AP Photo by Khampha Bouaphana:

A TASER X26, the newest model equiped with a TASER Cam, is photographed in Scottsdale, Ariz. in this April 26, 2006 file photo.

Sunday, June 8, 2008

Schizophrenia therapy: beyond atypical antipsychotics

From Nature Reviews Drug Discovery 7, 471-472 (June 2008) | doi:10.1038/nrd2571:
By Eric M. Snyder & Melanie R. Murphy

Antipsychotics remain the current standard of care for mental disorders including schizophrenia (1% prevalence) and bipolar mania (3% prevalence), and generate over US$16 billion worldwide in annual sales (Fig. 1; Table 1). However, a large trial known as CATIE, sponsored by the US National Institutes of Health, found that 74% of patients discontinue use within 18 months of therapy due to either poor tolerability or incomplete efficacy (1), indicating a need for novel therapies.


Figure 1. The schizophrenia drug market has grown from less than $1 billion annually in 1993 to more than $10 billion. This rapid growth has followed the introduction of Risperdal in 1993, followed by Zyprexa, Seroquel, Geodon [Zeldox in Canada] (ziprasidone; Pfizer) and Abilify (aripiprazole; Bristol–Myers Squibb). Annual prescriptions have increased from approximately 20 million to more than 40 million in this time. Source: IMS. (Click on the figure to magnify it.)


Table 1. Currently marketed antipsychotics. (Click on the table to magnify it.)


The first generation of antipsychotics — termed conventional or 'typical' antipsychotics — such as haloperidol, inhibit dopamine D2 receptors and are moderately effective in treating positive symptoms of schizophrenia (for example, hallucinations), but may cause extrapyramidal movement disorders. Second-generation 'atypical' antipsychotics — such as Lilly's Zyprexa (olanzapine), Johnson & Johnson's Risperdal (risperidone) and AstraZeneca's Seroquel (quetiapine) — inhibit D2 receptors in conjunction with other receptors (notably 5-hydroxytryptamine 2A (5-HT2A) receptors) (Table 1). Atypical antipsychotics have proved less likely to cause movement disorders, but are associated with weight gain, prolactin and glucose elevation, and sedation.

Zyprexa is widely regarded as being the most effective atypical antipsychotic on the market, but in the past 3 years, issues related to side effects have led to the drug losing nearly half its market share, as well as over 28,000 lawsuits, again indicating the need for drugs with better side-effect profiles. Furthermore, with all of the currently marketed atypicals facing generic competition within 5 years, there is a considerable market opportunity for new branded antipsychotics.

A new approach: mGluRs

In September 2007, Eli Lilly announced results of a 4-week Phase II trial of their metabotropic glutamate receptor 2/3 (mGluR2/3) agonist LY2140023 for schizophrenia. Although LY2140023 exhibited slightly less efficacy than Zyprexa in reducing positive symptoms, it nonetheless delivered significant improvement (2). Importantly, while treatment with Zyprexa was associated with weight gain, patients who received LY2140023 actually lost an average of 0.5 kg. These data indicate that mGluR agonists could represent a breakthrough in the search for a better-tolerated antipsychotic.

Indeed, this mechanism appears so promising that Eli Lilly, Merck, Johnson & Johnson and Pfizer (as well as partners Addex and Taisho) are all racing to develop mGluR-targeted drugs for schizophrenia. For example, early this year, Merck expanded their commitment to develop a new antipsychotic by entering into an exclusive worldwide license agreement with Addex for their preclinical, positive allosteric mGluR5 modulator ADX63365. This is Merck's second deal for an mGluR modulator for schizophrenia, having previously partnered with Taisho for another preclinical compound.

Eli Lilly clearly holds the lead in the mGluR race, with proof-of-concept data in hand and Phase III trials anticipated to begin later this year, whereas other competitors are not yet in the clinic. However, it remains to be seen whether Eli Lilly's LY2140023 will prove superior in the long run. This compound is a traditional, orthosteric agonist that provides continual activity as long as it is bound to the receptor. Conversely, allosteric modulators such as those being developed by Addex provide activity only when the endogenous agonist is present. This might provide a more normal pattern of signalling and be more attractive for long-term use.

The precise mechanism by which LY2140023 and other mGluR-targeted agents have efficacy in schizophrenia is not understood, although there may be some overlap with previously established mechanisms. Glutamate and dopamine axons converge on the medium spiny neurons of the striatum (3), 4 (Fig. 2). In addition, mGluR2/3 agonists have been shown to inhibit dopamine release, demonstrating functional interconnectivity of these two neurotransmitter pathways. It remains possible that mGluR2/3 agonists may in fact target the conventional pathway of dopamine D2 antagonism. Alternatively, mGluR2/3 may form a complex with 5-HT2A receptors, suggesting that mGluR activation can regulate 5-HT signalling5.


Figure 2. Metabotropic glutamate receptors (mGluRs) in the synapse. (Click on the figure to magnify it.)


Addex and Merck's ADX63365 targets mGluR5, which has no known effect on dopamine signalling, but which can modulate the signalling of the ionotropic NMDA (N-methyl-D-aspartate) glutamate receptor, another receptor that has long been thought to be associated with schizophrenia. This pathway may have additional benefits: while Merck and Addex still await human clinical data for ADX63365, animal studies suggest that this compound can improve cognition as well as positive symptoms. Thus, in addition to being safer than atypicals, mGluR agonists might offer improved efficacy in the cognitive domains of schizophrenia.

Outstanding issues


Long-term studies of mGluR-targeted agents have yet to be conducted and it remains to be seen whether the efficacy seen in Eli Lilly's 4-week study can be maintained. Further-more, although mGluRs appear to offer good tolerability, longer-term trials are needed to gauge safety. If mGluR-targeted drugs can mimic the profile seen so far with Eli Lilly's LY2140023, it will be interesting to see how physicians would use mGluR agonists. Would they be prescribed independently, even though they may not have the efficacy of their atypical predecessors? Would they be used as adjunctive therapies, in combination with lower doses of atypicals? This cocktail therapy model is being pursued by Acadia with their 5-HT2 inverse agonist primavanserin, which improves the efficacy of low doses of risperidone without causing weight gain. A third possibility is that mGluR-targeted agents could be used in conjunction with primavanserin, creating a selective, targeted therapy with few side effects.

Overall, the development of mGluR-targeted drugs for schizophrenia represents an opportunity for a new class of drugs that might represent a superior treatment option to that of currently available antipsychotics, as well as an advance in the understanding of the molecular basis for therapies for psychiatric disorders.

Beyond atypicals

The market for drugs for schizophrenia has grown tenfold in the past decade (Fig. 1, Table 1). In 2007, Risperdal and Zyprexa led the worldwide market with $4.7 billion in sales each. Zyprexa sales have grown, despite continuing concerns with side effects. In addition to the need for novel antipsychotics with improved safety and efficacy profiles, the approaching patent expirations of leading products is creating a challenge for the pharmaceutical industry. Recent data indicate that agents that target mGluRs could represent a promising new class of antipsychotics, and such agents are now being developed by several companies (Table 2).

Table 2. Next-generation antipsychotics. (Click on the table to magnify it.)


References


1. Lieberman, J. A. et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N. Engl. J. Med. 353, 1209–1223 (2005).

2. Patil, S. et al. Activation of mGluR2/3 receptors as a new approach to treat schizophrenia: a randomized Phase 2 clinical trial. Nature Med. 13, 1102–1107 (2007).

3. Sesasck, S. et al. Anatomical substrates for glutamate–dopamine interactions: evidence for specificity of connections and extrasynaptic actions. Ann. NY Acad. Sci. 1003, 36–52 (2003).

4. Moghaddam, B. Bringing order to the glutamate chaos in schizophrenia. Neuron 40, 881–884 (2003).

5. Gonzalez-Maeso, J. et al. Identification of a serotonin/glutamate receptor complex implicated in psychosis. Nature 452, 93–97 (2008).

Author affiliations

Eric M. Snyder and Melanie R. Murphy are at Mehta Partners Global BioPharmaceutical Investments, 276 Fifth Avenue Suite 1100, New York 10001, USA. Email: snyder@mpglobal.com

Competing interests statement

The authors declare competing financial interests.

To download a PDF of this article, click here.

Friday, June 6, 2008

We're all to blame for staying mum on mental illness



Rarely do I offer my opinion on this blog, however, I highly recommend reading an article by Andre Picard published in the June 5th edition of The Globe and Mail. To read the article, click here.

A very big thank you goes to John Devlin for bringing this article to my attention.

Wednesday, June 4, 2008

Schizophrenia — Dealing with a Crisis


From the the World Fellowship for Schizophrenia and Allied Disorders (WFSAD):

Sooner or later, when a family member has schizophrenia or a major affective disorder, a serious crisis [may] occur. When this happens there are some actions you can take to reduce or avoid the potential for disaster. Ideally, you need to reverse any worsening of the psychotic symptoms (psychotic means out of touch with reality) and provide immediate protection and support to the ill person.

Seldom, if ever, will a person suddenly lose total control of thoughts, feelings and behaviour. Family members or close friends will generally become aware of a variety of behaviour which gives rise to mounting concern: sleeplessness, ritualistic preoccupation with certain activities, being suspicious, unpredictable outbursts, etc.

During these early stages a full blown crisis can sometimes be averted. Often the person has ceased taking medication. If you suspect this, try to encourage a visit to the physician. If this is not successful (and the more psychotic the person the less likely it is to be so) you should contact the physician by telephone or by a note dropped off at his office [or by email] in order to get advice. [And call the Mental Health Mobile Crisis Team at (902) 429-8167 or 1-888-429-8167 (toll free in Nova Scotia.]

You must also learn to trust your intuitive feelings. If you are truly frightened, the situation calls for immediate action. Remember, your primary task is to help the patient regain control. Do nothing to further agitate the scene.

It may help you to know that the person is probably terrified by his/her own feelings of loss of control over thoughts and feelings. Further, the "voices" may be giving life-threatening commands. In the person's mind messages may be coming from light fixtures; the room may be filled with poisonous fumes; snakes may be crawling on the window.

Accept the fact that the person is in an "altered reality state". In extreme situations the person may "act out" the hallucinations, e.g. shatter the window to destroy the snakes. It is imperative that you remain calm. It is also imperative that your relative get medical treatment. While waiting for medical help to arrive (or before attempting to take your relative to the hospital) the following suggestions may prove helpful:

  • Remember that you cannot reason with acute psychosis.
  • Do not express irritation or anger.
  • Don't threaten. This may be interpreted as a power play and increase assaultive behaviour by the person.
  • Don't shout. If the psychotic person seems not to be listening, it isn't because he or she is hard of hearing. "Voices" or deluded thoughts are interfering.
  • Don't criticize. It will only make matters worse; it cannot possibly make things better.
  • Don't squabble with other family members over "best strategies" or allocations of blame. This is no time to prove a point.
  • Don't bait the person into acting out wild threats; the consequences could be tragic.
  • Don't stand over the person if he/she is seated. Instead, seat yourself.
  • Avoid direct, continuous eye contact or touching the person.
  • Comply with requests that are neither endangering nor beyond reason. This provides the person with an opportunity to feel somewhat "in control".
  • Don't block the doorway. However, do try to keep yourself between your relative and an exit.
  • Decrease other distractions immediately — turn off the TV, radio.
  • Express understanding for what your relative is experiencing.
  • Speak quietly, firmly and simply.

Should the psychotic episode involve violence, there may be no time for all the above strategies. Do not be hesitant to call the police [dial 911]. Tell them that your relative has schizophrenia. Explain what you are experiencing and that you need the help of the police to obtain medical treatment and to control the violent behaviour. Instruct the police not to brandish any weapon. If you are alone, be sure to contact someone to come and stay with you until the police arrive. The doctor who has been involved with the care of your relative should be advised of the situation as soon as possible.

Because a crisis often comes without warning, a plan should be made before it happens. Call you local police station and advise them that your relative has schizophrenia and can act in bizarre ways at times. Let close friends or neighbours know that you may call upon them for help if things get difficult. Then keep a list of the names, addresses and telephone numbers of these special people handy. If a crisis arises, you will be prepared. (You will not have to worry about your pets, the other children, etc.)

When you have weathered one crisis, your family may try to find the reasons it happened. It is normal for people to want explanations. It is important that the family does not blame itself or anyone else for the ill person's behaviour. Very little is understood about why crises occur and why violence can be so unpredictable. One factor is important: continuous taking of medication considerably reduces the risk of relapse and possible crisis.