Tuesday, April 28, 2009

Mental Health Foundation of Nova Scotia Awareness Campaign



I am very impressed with the two new videos produced by the Mental Health Foundation of Nova Scotia (MHFNS). They can by viewed by clicking here.

For those who don't know, the video featuring Mr. Robert Hunt (pictured), Chair, Board of Directors, MHFNS, was filmed in the tunnels connecting buildings at the Nova Scotia Hospital, through which patients, staff, and volunteers travel on a regular basis, particularly during the winter months.

Please click on the image to magnify it.

The Soloist: A Call to Action


A press release from the National Alliance on Mental Illness:
April 23, 2009

Arlington, VA— The National Alliance on Mental Illness (NAMI) has launched a new Web site, www.nami.org/soloist, as part of a social action campaign with Participant Media surrounding Friday’s release (April 24) of The Soloist, starring Jamie Foxx and Robert Downey, Jr.

"The movie will help humanize people who live with schizophrenia and are homeless," said NAMI executive director Mike Fitzpatrick. "It will help people look beyond stereotypes and create better understanding of the challenge for treatment and recovery."

"The mental health care system is in crisis. After people exit theaters and leave popcorn behind, we want to translate new awareness into action."

Schizophrenia is a mental illness that affects about 2 million Americans—twice the number living with HIV/AIDS.

The Soloist is based on the true story of the unlikely friendship between Nathaniel Ayers, a street musician living in Skid Row, and Steve Lopez, a columnist with the Los Angeles Times. In a series of columns, Lopez reports on Ayers’ journey as a gifted student from the Julliard School of Music to the streets of Los Angeles, living with schizophrenia.

On NAMI’s special Web site, visitors can:
  • Watch The Soloist trailer
  • Test their schizophrenia knowledge
  • Listen to Dr. Ken Duckworth, NAMI’s medical director, answer questions about schizophrenia, diagnosis and recovery
  • Learn more about NAMI’s education programs
  • Alert state and national representatives to NAMI advocacy goals
  • Register for a local NAMIWalk to support people living with mental illness

OTHER RESOURCES


Participant Media: Take Part

NAMIWalks

NAMI Schizophrenia Report

NAMI 2009 Grading the States Report

Photograph of Nathaniel Ayers and cellist Yo-Yo Ma (2007) courtesy of G.P. Putnam's Sons.

Monday, April 27, 2009

Teen tries to quiet the voices caused by schizophrenia


Posted April 24th on CNNhealth.com:
By Madison Park

(CNN) -- The intrusive voices popped into William "Bill" Garrett's head. "They're coming for you," the voices told the 18-year-old. "Find somewhere to hide; they're going to get you."

They told the Johns Hopkins University freshman that his father had poisoned the family dog, his sister had injected crystal methamphetamine into his pet lizard and his grandmother had put human body parts into his food.

As schizophrenia took hold, the Maryland teenager became lost within his own mind and had to leave college after winning a full, four-year scholarship.

Garrett's experience echoes the teenage years of Nathaniel Ayers, a promising string bass player whose musical training at the Juilliard School was cut short by schizophrenia, a brain disorder that blurs a person's ability to distinguish between reality and delusions.

Ayers became homeless and played Beethoven pieces on a broken violin in the streets of Los Angeles, California. His struggles with schizophrenia and his friendship with a Los Angeles Times columnist inspired the movie "The Soloist," which releases Friday.

His sister, Jennifer Ayers-Moore, hopes the movie will raise awareness about schizophrenia and has established the Nathaniel Anthony Ayers Foundation for the artistically gifted mentally ill.

To read the entire article, please click here.



Jennifer Ayers-Moore plays an air violin next to her older brother, Nathaniel Ayers, in San Diego, California.

Friday, April 24, 2009

The Soloist ...

... opens today, Friday, April 24!



Also see:


The Soloist actually gets it right - to a point (The Globe and Mail, May 7th)

Robert Downey Jr. and Jamie Foxx Deliver a Wake-Up Call in The Soloist about the Complexities of Living With Schizophrenia (A press release from the Schizophrenia Society of Ontario, April 24th)

Struggle and Rescue, a Duet in Sharps and Minors
(Film review, The New York Times, April 24th)

Review: 'The Soloist' (Film review, The Christian Science Monitor, April 24th)

The Soloist (Film review, Roger Ebert, The Chicago Sun-Times)

Good intentions, dubious decisions (Film review, The Globe and Mail, April 24th)

Wednesday, April 22, 2009

Hyde fatality inquiry to be webcast


An article posted today on CBCnews.ca:
The inquiry into the death of Howard Hyde [pictured], the Dartmouth man who died in a Nova Scotia jail 30 hours after he was shocked with a Taser, will be broadcast live on the internet.

It will be the first time a fatality inquiry in Nova Scotia will be visible to people outside the hearing room.

Lawyers agreed to the webcast on Tuesday.

Kevin MacDonald, who represents Hyde's sister, said it would give Hyde's father a chance to follow the proceedings from his home in the U.S., and also provide Nova Scotians with a front-row seat.

"The public are interested," said MacDonald. "The inquiry's going to be held in Halifax. But for the webcast it really would be closed off to many members of the public, even in rural Nova Scotia."

Halifax Regional Police used a Taser to subdue Hyde, 45, after responding to a domestic abuse complaint on Nov. 21, 2007. He was taken to the Central Nova Scotia Correctional Facility in Dartmouth, where he died 30 hours later after struggling twice with corrections officers.

Last fall, Nova Scotia's chief medical examiner ruled that Hyde died of excited delirium due to paranoid schizophrenia, and declared his death accidental.

MacDonald said Hyde's relatives have many questions.

"The family wants to know what those people did and why they did it, or why they didn't do what they didn't do?" said MacDonald.

There are also issues about mental-health crisis intervention, said Blair Mitchell, the lawyer acting for the Schizophrenia Society of Nova Scotia.

"Everyone's concerned about the Taser. Everyone is concerned about the use of force and the use of restraint, particularly in the case of a person in a situation of distress," said Mitchell.

Lawyers and court officials will meet again in June to discuss procedural issues, though Judge Anne Derrick won't hear from witnesses until early July.

Derrick can make recommendations relating to any matter that arises during the inquiry.

Also see:

From CBC News: Nova Scotia at Six:
In the fall of 2007, Howard Hyde died 30 hours after he was tasered by Halifax police. Now an inquiry into his death is about to begin. Jim Nunn speaks with Dan MacRury, the lawyer for the inquiry. (To view, please click here; runs 3:14, requires RealPlayer.)

Hyde inquiry online

Inquiry into death of man Tasered in police custody to be streamed on web

Friday, April 17, 2009

Schizophrenia: Take a walk on the Road to Recovery


A letter to the editor published in the April 16th edition of The Chronicle Herald:
By Sharon Murphy

Imagine that you are living with terrifying delusional thoughts that some unspeakable tragedy is about to devastate you or those you love. Or you are living with unsettling auditory or visual hallucinations that give you no peace. These are facts of life that many people who live with untreated schizophrenia, or some other untreated psychosis disorder, must deal with daily.

Schizophrenia and psychosis are highly treatable brain disorders. Psychosis, a common manifestation of schizophrenia, affects a person’s ability to distinguish what is real from what is not. Symptoms of psychosis include delusions (false beliefs that are not part of reality), hallucinations (sensing things that aren’t actually there), disturbances in thinking and communication, and withdrawal from normal social activities. These symptoms are thought to be caused by disturbances in the flow of information in the brain. Schizophrenia and other psychotic disorders often first develop among people between the ages of 15 and 25 – a critical period in a young person’s life.

While the exact causes of schizophrenia and other psychotic disorders are not yet known, many advances have been made in the past few years. Researchers are looking at a number of factors that may affect brain development, such as genetic factors and gene expression, maternal illness, and viruses. Environmental factors, such as stress or the use of marijuana, have also been implicated.

There remains much stigma and discrimination associated with schizophrenia, even when a person living with the illness is very well along in their recovery journey. Stigma can be defined as a negative attitude – characterized by a lack of compassion – towards someone living with schizophrenia. Schizophrenia and psychotic disorders continue to be stigmatized because having a mental illness somehow implies a distinction from being physically unwell, although, as neuroimaging studies have recently shown, the two are intimately entwined. To some, the term "mental" also suggests something besides a legitimate medical condition, something that results from the person’s own doing. That somehow the person should just get over it.

For someone with schizophrenia or some other psychotic disorder, the consequences of stigma can be devastating in many cases – almost as devastating as the illness itself. This results in people not seeking treatment because they fear being labelled and rejected by family, friends, co-workers and employers. And some people become socially isolated because of the shame engendered by the stigma.

Stigma also leads to discrimination in the workplace and inadequate health insurance coverage compared with coverage for other illnesses. The evidence indicates that the time has come to shift the focus of research and action from stigma to discrimination. So instead of asking an employer if they would hire a person with a mental illness, we should ask if they actually do so!

Language is also important – that is, the messages conveyed by everyday words that are tossed about without a care, and how this language contributes to negative stereotyping. We are all familiar with this language; it includes such words as "loony," "crazy" and "schizophrenic." Schizophrenia is not a religion (i.e., I am a Catholic), and it is not multiple personality disorder. It is interesting that such negative stereotyping language is rarely used now in reference to physical illness. It is difficult to fathom why it is still used in relation to the mentally ill.

Michael Kirby, in his report on mental illness called Out of the Shadows at Last, quotes from another report entitled More for the Mind: "In no other field, except perhaps leprosy, has there been as much confusion, misdirection and discrimination against the patient as in mental illness … Down through the ages, they have been estranged by society and cast out to wander in the wilderness. Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible."

Dr. Kirby notes these words were written in 1963, nearly half a century ago. He also notes, incredibly, that the 2,000 submissions to the standing Senate committee on social affairs, science and technology from 2004 to 2006 made it clear that these opinions still ring true today. Society still has a long way to go in combating stigmatization and discrimination of the mentally ill.

To help stamp out old prejudices and to raise awareness about schizophrenia and other psychotic disorders, the Schizophrenia Society of Nova Scotia invites you to lace up your sneakers and join us on our five-kilometre Road to Recovery Walkathon. The walkathon takes place on Saturday, May 9, from 12 noon to 6 p.m., and starts at St. Matthew’s Church Hall, 1479 Barrington St., Halifax. Registration is free. To register to participate, and to obtain an official pledge sheet, please contact Donna Methot at 902-462-8658 or email hrmchapterssns@accesswave.ca. For more information, visit www.ssns.ca.

The Schizophrenia Society of Nova Scotia is a community-based not-for-profit organization incorporated in April 1982. Its mission is to improve the quality of life for those affected by schizophrenia and psychosis – including families and friends. The society has over 25 years of solid history providing education and support services to individuals living with schizophrenia and other psychotic disorders, as well as their families and friends. The vast majority of its current work is focused on providing education and support, as well as influencing public policy relating to the timely provision of mental health services.

Sharon Murphy is director, Schizophrenia Society of Nova Scotia.

Also see:

Another Misconception of Schizophrenia

Laura Burke - This Much I Know

Laura Burke, an artist who read her original poetry at the 2008 SSNS Annual Conference, has released This Much I Know, a CD of spoken word poetry (including the poem she read at the Conference). The CD is available for purchase for $15.00 by contacting the Schizophrenia Society of Nova Scotia at (902) 465-2601 or by sending an email to ssns@ns.sympatico.ca. To view a YouTube videos of Laura performing, please click here and here.

Ms. Burke has been kind enough to donate a portion of the proceeds from the sale of each CD to the Schizophrenia Society of Nova Scotia.



Click on the image to magnify it.

Thursday, April 16, 2009

Gaining Insight Art Prints for Sale!



Amber Christian Osterhout now has her art prints and posters available to purchase. Seventy five percent of ALL print sales will be donated to various mental health charities.

From Ms Osterhout's website:
The following poster series examines the relationship between mental illness and stigma. These posters encourage others to help put an end to stigma.



Click on the image to enlarge it.


Please Don’t Judge Me

The left-hand poster emphasizes the various misperceptions and stereotypes that exist today. For those dealing with a mental disorder, stigma can decrease the possibility of recovery.

This is Reality

The middle poster reveals the truth about mental illness. Many will be surprised by the facts and may begin to view mental illness in a positive light.

Proud of Who I Am

The right-hand poster puts a face on recovery and shows that a person should not be defined by his or her illness.

I thank Roger Cann for bringing this information to my attention.

Friday, April 10, 2009

Rethinking Mental Disorders


A series edited by Thomas R. Insel published in The Journal of Clinical Investigation:
Mental disorders such as schizophrenia, bipolar illness, depression, and autism are the number one source of medical disability for people 15–44 years of age in the U.S. and Canada. In the past, these disorders have been considered psychological conflicts or chemical imbalances, but, as highlighted in this Review series, recent research indicates they are brain disorders, developmental disorders, and complex genetic disorders.
All papers in the series are free to download by clicking here.

Also see:

Translating scientific opportunity into public health impact: a strategic plan for research on mental illness.

Dalhousie University Department of Psychiatry Headlines

Click on the image to expand it.


Page 6 of the March 2009 issue features a profile of Dr. Zenovia Ursuliak (pictured, right), a regular guest educator on motivational interviewing at meetings of the HRM Chapter of the SSNS.


To view back issues of Psychiatry Headlines, please click here.

Is Recovery from Schizophrenia Possible? An Overview of Concepts, Evidence, and Clinical Implications


An abstract from the June 2008 edition of Primary Psychiatry:
By Paul H. Lysaker [pictured] and Kelly D. Buck

Contrary to long-standing pessimistic views regarding the prognosis for people with schizophrenia, emerging literature suggests that many with this condition can meaningfully recover over time.

Using increasingly complex models of recovery with clearly defined operationalized criteria, numerous longitudinal studies have provided data pointing out that progressive deterioration is more of an exception than a rule for people with this condition.

To address the issues of the definition and likelihood of recovery from schizophrenia, this article reviews evolving definitions which stress that recovery must involve the development of a sense of hope, self-reliance, and a personalized awareness of current strengths and challenges.

Empirical research indicates that while many with schizophrenia experience significant bouts of disability, more people experience long periods of relatively good functioning, including symptom remission, healthy levels of self-esteem, and meaningful community participation.

Implications for how clinical practice can reinforce and promote recovery are discussed.
To download the entire article, please click here (PDF).

Posting of this abstract is for the purposes of research into schizophrenia.


Self-Stigma in People With Mental Illness


An article published in the November 2007 issue of Schizophrenia Bulletin:
By Amy C. Watson (1), Patrick Corrigan (2), Jonathon E. Larson (2), and Molly Sells (3)
  1. Jane Addams College of Social Work, University of Illinois at Chicago
  2. Joint Research Programs in Psychiatric Rehabilitation, Illinois Institute of Technology
  3. University of Chicago

Persons with mental illnesses such as schizophrenia may internalize mental illness stigma and experience diminished self-esteem and self-efficacy. In this article, we describe a model of self-stigma and examine a hierarchy of mediational processes within the model.

Seventy-one individuals with serious mental illness were recruited from a community support program at an outpatient psychiatry department of a community hospital. All participants completed the Self-Stigma of Mental Illness Scale along with measures of group identification (GI), perceived legitimacy (PL), self-esteem, and self-efficacy. Models examining the steps involved in self-stigma process were tested. Specifically, after conducting preliminary bivariate analyses, we examine stereotype agreement as a mediator of GI and PL on stigma self-concurrence (SSC); SSC as a mediator of GI and PL on self-efficacy; and SSC as a mediator of GI and PL on self-esteem.

Findings provide partial support for the proposed mediational processes and point to GI, PL, and stereotype agreement as areas to be considered for intervention.
To download the full text of this article, please click here (PDF).

Posting of this abstract is for the purposes of research into schizophrenia and self-stigma.

Also see:

An Anti-Stigma Approach to Working with Persons with Severe Mental Disability: Seeking Real Change Through Narrative Change (Journal of Social Work Practice, March 1st, 2009)

A Google Scholar search for "self-stigma" & "mental illness"

Thursday, April 9, 2009

Altered Gene Can Increase Risk Of Schizophrenia


An article posted on April 7th by ScienceDaily:
Rutgers geneticist Linda Brzustowicz [pictured] and her colleagues have identified a specific DNA change that is likely to increase risk for developing schizophrenia in some people. It provides a potential mechanism that may be a point of entry for drug therapy, consistent with the growing trend of personalized medicine.

The research findings are reported in the April issue of the American Journal of Psychiatry (AJP). An accompanying editorial highlights the significance of this work.

Brzustowicz, a professor of genetics at Rutgers, The State University of New Jersey, and board-certified psychiatrist, said that the research has demonstrated a functional DNA change that increases gene expression. This conclusion is based on its presence in the genes of a Canadian study population of 24 families where multiple individuals had been diagnosed with schizophrenia. The gene in question, NOS1AP, previously known as CAPON, is one which Brzustowicz has been studying for six years.

The paper also presents an innovative statistical method, Posterior Probability of Linkage Disequilibrium (PPLD). This is the work of co-author Veronica Vieland of The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. The new analytical technique quantifies the statistical evidence for association, in this case between the altered gene and schizophrenia. The researchers evaluated 60 variants of the gene or single nucleotide polymorphisms (SNPs).

"Our use of the PPLD was really helpful in sorting the evidence. It showed that of the 60 SNPs we were evaluating, three had a much higher probability of association with the illness," Brzustowicz said. "This paved the way for our next step – doing a functional analysis using cells grown in culture – which is much more labor intensive. We had reduced our 60 candidates down to a short list of three, which greatly simplified this next step."

Each of the three candidate SNPs was introduced into separate cultures of identical cloned cells derived from human brain tissue. The cultures differed only in which of the SNP variants was introduced. The challenge was to measure the quantity of overexpression, that is, how much excess protein was being produced by each of the three variants.

To each culture the researchers also added DNA that contained the gene that produces the enzyme which makes a firefly glow, along with human regulatory DNA which would control the production of that enzyme. The three kinds of DNA (the SNP, the firefly and the human regulatory) were all joined together prior to insertion into the brain-derived cells. Thus, the amount of expression of each SNP would be reflected (via the regulatory DNA) in the intensity of the light produced. An instrument known as a luminometer measured the glow produced and showed a dramatic increase in gene expression in one variant over the others. These results echo the increased expression of NOS1AP that has been observed in postmortem brain samples from individuals with schizophrenia.

Bonnie Firestein, a professor in Rutgers' Department of Cell Biology and Neuroscience, though not an author on the AJP paper, is conducting complementary research. She is investigating the consequences of increased expression of the NOS1AP gene. Firestein is looking at this gene in cells in culture and examining how the overexpression of this protein alters the way neurons branch.

Identifying this specific functional genetic variant is an important step, but there are qualifiers. Schizophrenia is not a single-gene disorder, and there are environmental factors that are also important. "It is not as though, if you have this altered gene, you will get the disease," said Brzustowicz.

The frequency of this variant in the general population is more than 40 percent. Approximately 1 percent of the general population has schizophrenia but not all of those with the illness will have this altered gene. Brzustowicz estimates that the frequency of the altered gene in people with schizophrenia is going to be higher than the average in the general population. For example, the frequency of this variant in people with schizophrenia in the Canadian families is 55 percent.

To refine this estimate, Brzustowicz and her team will be looking at the altered gene's frequency in DNA samples from the National Institute of Mental Health collection of cell lines housed in the Rutgers University Cell and DNA Repository. The collection includes samples drawn from large populations of Asian, Caucasian, African American and Hispanic individuals with schizophrenia.

Adapted from materials provided by Rutgers University.

Request for Proposals: When People Living with Severe Mental Health Illnesses Interact with the Police


Submission Deadline: Thursday, April 30th

From the Mental Health Commission of Canada:
The Mental Health Commission of Canada Announces a Request for Proposals for a study of Types of Interactions, Attitudes, Experiences and Feedback: When People Living with Severe Mental Health Illnesses Interact with the Police


The Mental Health Commission of Canada (MHCC) is requesting proposals from qualified candidates to conduct a study of types of interactions and experiences with, attitudes towards, and feedback for the police from the perspective of persons living with severe mental health problems and illnesses.

Background

The MHCC is an arms-length, federally-funded, non-profit organization. It was created to focus national attention on mental health issues and to work to improve the health and social outcomes of people living with mental health problems and illnesses. The Government of Canada established the Commission in 2007 in response to the findings of a Senate-generated report Out of the Shadows at Last – Transforming Mental Health, Mental Illness and Addiction Services in Canada (Standing Committee on Social Affairs, 2006).

Purpose of the Study

Therefore, the purpose of the study will be (1) to examine the perceptions of persons living with severe mental illness1 of their interactions with the police, (2) to determine the attitudes of persons with a severe mental illness* toward police in general and (3) to solicit feedback that persons with a severe mental illness would like to convey to police. It is hoped that these data will contribute to the development of evidence-based best practice guidelines for police services.


* “Severe mental illness” in this study will refer to disorders such as schizophrenia, bipolar disorder (manic-depression), and Alzheimer's disease which significantly disrupt a person's ability to think, feel, and relate to others and to their environment [Cotton, D. & Zanibbi, K. (2003). Police officers’ knowledge about mental illness. Canadian Journal of Police and Security Services, 1: 136-143.].
For the complete document, please click here (PDF)

Tuesday, April 7, 2009

Watchdog questions RCMP’s Taser use


An article published in today's edition of The Chronicle Herald:
Caution urged when using stun guns on young people, mentally ill

By Jim Bronskill, The Canadian Press

OTTAWA — The RCMP complaints commissioner says the Mounties should be more careful about using stun guns on young people and the mentally ill.

In a final report on RCMP Taser use last year, Paul Kennedy also says the force’s tracking and analysis of incidents still needs improvement.

The findings come 10 months after Kennedy, chairman of the Commission for Public Complaints Against the RCMP, called on the police force to rein in Taser use and better monitor how officers use the potent device.

In his report Monday, the RCMP watchdog said there has been commendable progress on his 22 recommendations to the force, "however, more needs to be done in order to alleviate many of the concerns repeatedly expressed by the commission."

To that end, the commission is working with the RCMP on member training, reporting and policy development "with the view to providing a more in-depth analysis of the RCMP’s progress on all of the recommendations."

Some of the commission’s figures, released in a preliminary report last week, show the Mounties were far less likely to fire their Tasers last year. Use dropped 30 per cent from a peak of 1,583 incidents in 2007.

The statistics suggest police officers were more cautious about firing the stun guns following a public furor.

A B.C. inquiry is probing the case of Polish immigrant Robert Dziekanski, who died in October 2007 after he was stunned five times with an RCMP Taser at the Vancouver airport.

The RCMP says it has limited Taser use to situations involving a threat to officer or public safety.

The new Mountie policy warns officers that Taser use carries a risk of death, particularly for agitated people.

But Kennedy says it’s too early to tell whether the changes will address the issues he’s outlined. "While the revised policy is a positive step forward, the commission remains concerned."

The report flags two specific groups — young people and the mentally ill.

"It is not that (Tasers) should never be used with these groups, but rather, that there should be a higher threshold for usage where these subjects are concerned. This higher threshold is not always observed."

It says the RCMP still appears to define "at-risk populations" as acutely agitated and delirious people and, before using the Taser, the force needs to consider those experiencing mental health crises or people who’ve taken large quantities of drugs or alcohol.

"This is problematic as there is a higher statistical likelihood that these persons will die in police custody and therefore any effort made to mitigate this outcome should be adopted by the RCMP."

The report also notes that while members reported that use of the Taser avoided the use of lethal force — that is, a conventional gun — in over half of the reports, "there is reason to be suspicious of this figure."

In many cases, the summaries of these Taser incidents "did not support the members’ statement" that lethal force would have been used if not for the Taser.

Finally, Kennedy said the RCMP has not fully addressed how it will tackle the issue of under-reporting by members who use stun guns — a problem identified in his previous report. And while the force has begun to share Taser usage reports with more people inside the force, it is not clear how the information is being incorporated into training.

The RCMP had no immediate comment on the report.

Hilary Homes, a human rights campaigner with Amnesty International Canada, says there is a lack of clarity about RCMP policy on Taser use.

"Until there is clear policy, and a demonstration that that clear policy is followed, there simply won’t be the confidence that the police would like to see in their own work."

‘While the revised policy is a positive step forward, the commission remains concerned.’
Also see:

News Release – CPC Chair Releases In-Depth Analysis of 2008 Conducted Energy Weapon (Taser) use by the RCMP

RCMP Use of the Conducted Energy Weapon (CEW): January 1, 2008 to December 31, 2008 (March 31, 2009)

RCMP shocked 16 people five times or more last year

Sunday, April 5, 2009

Landmark Institute of Medicine Report Paves Road to Prevention


An article published in the April 3rd edition of Psychiatric News:
By Mark Moran

American Psychiatric Association (APA) leaders involved with the report say it points to a "paradigm shift" in the way medicine and psychiatry approach mental health and illness in the future.

Prevention of mental illness and promotion of mental health are scientifically feasible, and the time is ripe to transfer the science into practice.

That is the conclusion of a landmark report by the Institute of Medicine (IOM) titled "Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities."

Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations—such as children and youth in the child-welfare system—school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations, according to the report.

The report updates a 1994 IOM book, Reducing Risks for Mental Disorders, and focuses attention on the research base and program experience with younger populations that have emerged since that time.

The book-length report includes chapters on (among other subjects) using a developmental framework to guide prevention and promotion; perspectives from developmental neuroscience; preventive intervention research—including family, school, and community interventions; prevention of specific disorders; screening; benefits and costs of prevention; and implementation and dissemination of prevention and promotion practices.

APA leaders are hailing the report saying it points to a paradigm shift in the way psychiatry approaches mental illness in the future.

"Both prevention and psychiatry have always been the stepchildren of medicine," said APA President Nada Stotland, M.D. "It is not as glamorous as open-heart surgery or restoring a brilliant individual with bipolar disorder to her career and family. It is much easier to get credit for fixing something that is broken than for keeping it from breaking in the first place. However, most of the improvements in life span are the result of preventive, rather than treatment, measures—immunizations, pap smears, clean air and water, smoking cessation.

"Most health professionals are unaware of the crucial data in the IOM report," Stotland said. "Now that it has been published, and we know that there are effective ways to prevent psychiatric disorders in children, there is no excuse for our country's continued failure to implement the policies that would protect our children from lifetimes of suffering and disability."

Child psychiatrist William Beardslee, M.D., a member of the IOM committee and chair of APA's Corresponding Committee on Prevention of Mental Disorders and Promotion of Mental Health, echoed Stotland.

"This is a landmark report and deserves to be read with care by every psychiatrist," Beardslee told Psychiatric News. "Psychiatry has an opportunity to provide extraordinary leadership in the prevention of mental illness, and we strongly urge APA and individual psychiatrists to support the report's recommendations."

Those recommendations include a call for a coordinated national strategy originating in the White House for implementing prevention and promotion practices.

The IOM report stated, "The White House should create an ongoing mechanism involving federal agencies, stakeholders (including professional associations), and key researchers to develop and implement a strategic approach to the promotion of mental, emotional, and behavioral health and the prevention of mental, emotional, and behavior disorders and related problem behaviors in young people."

Psychiatrist Carl Bell, M.D., also a member of the IOM committee, said that recommendation was modeled on the success of a similar White House cabinet-level strategy during the Clinton administration concerning violence against women.

"What the IOM is saying is that it is possible to prevent psychiatric disorders, substance abuse, and problem behaviors," Bell told Psychiatric News. "The challenge for psychiatry is to shift its paradigm and stop thinking of itself as a field that only treats the sick, but begins to think in terms of a public-health model."

Beardslee and Bell both stressed that the IOM report underscores the importance—and scientific basis—not only of preventing or preempting the occurrence of major mental disorders among individuals who exhibit preclinical symptoms, but also broad population-based strategies aimed at promoting mental health.

Beardslee stressed as well that in the background of all behavioral disorders are the issues of poverty and health disparities.

"Prevention should be a part of regular psychiatric practice," Beardslee said. "I see three levels at which psychiatrists can be putting prevention into practice. As social scientists, we should be embracing the public-health perspective and broad reforms to address health disparities and poverty. A second level where psychiatrists can have a very large impact is in working with adults with mental illness who have children, doing preventive work using psychoeducational models.

"And the third level is the use of preventive strategies that have been designed for people at very high risk."