Monday, June 27, 2011

Police chiefs urge province to tackle mental health

An article published in the June 26th edition of The Toronto Star:
By Sandro Contenta, Staff Reporter

The provincial government should boost mental health services because a growing number of people with those problems are getting into trouble with the law, Ontario’s police chiefs say.

“There’s simply not enough support for people with mental health problems,” said Joe Couto, director of government relations with the Ontario Association of Chiefs of Police.

The result is that people who need the help of health care workers are instead “coming into contact more and more with the justice system,” Couto added in a phone interview Sunday.

“We are spending a lot of time and resources dealing with mental health issues,” he said, referring to police officers across the province. “This goes way back to the Mike Harris (Conservative) government, which started making cuts in social support. And guess who got to take a lot of those responsibilities?”

The association’s board of directors, which includes Couto, approved a resolution Sunday calling on the provincial government to implement a policy that makes social services — rather than police — the cornerstone of helping mental health sufferers. The resolution will be voted on by about 150 police chiefs and inspectors Wednesday, the final day of the association’s annual conference in Huntsville.

“It’s more a crime prevention strategy than a law enforcement strategy,” Couto said. “We don’t believe that dealing with mental health should be about law enforcement. It should be about addressing people’s needs at the front end so they don’t get into the justice system.”

Twelve per cent of men and 26 per cent of women in federal prisons suffer from mental health problems, according to a federally-commissioned report. And four out of every five offenders enter penitentiaries with serious drug or alcohol abuse problems.

Couto said Premier Dalton McGuinty’s government has acknowledged that more mental health support is needed, and has talked about plans for a comprehensive policy. With a provincial election in October, and McGuinty’s Liberals trailing in the polls, the police chiefs want the premier to move faster. But they won’t get a chance to make their case face-to-face. McGuinty has declined the association’s invitation to address its annual meeting.

“He won’t be here, which I think has raised a few eyebrows,” Couto said. “We don’t know why he’s not here. We assume he has other commitments.”

Couto said McGuinty attended the annual meeting during the two previous election years. In his place will be community safety minister, Jim Bradley. Progressive Conservative Leader Tim Hudak will address the chiefs Tuesday, and New Democrat Leader Andrea Horwath will do so Wednesday.

The association’s board of directors also approved a resolution calling on the federal government to continue funding a program that saw 2,500 police officers hired across the country during the past five years — 325 of them in Ontario. The federal government has yet to say if it will.

But the board rejected a resolution calling on the Ontario government to make it mandatory for gas stations to have pay-first gas pumps. Police chiefs believe it’s more appropriate for the industry to make that appeal to the government, if that’s what it chooses to do, Couto said. The board’s rejection means the resolution won’t be debated at the conference’s full session Wednesday, unless there’s a motion for that to happen.

The resolution was proposed by the Hamilton police service after a Mississauga gas station attendant was killed last May trying to stop someone who filled his gas tank and drove off.
Also see:

Mental health services for everyone

Saturday, June 25, 2011

Serious Mental Illness, Care-Giver Stress and the Mental Health Commission of Canada

An article posted on June 24th by Huffpost Canada:
By Marvin Ross

Caring for a family member with a serious mental illness (mainly schizophrenia and bipolar disorder) is often extremely stressful for families; it impacts them financially, emotionally, socially and physically.

Hoping to improve the situations for the tens of thousands of families in this situation, a group of 45 B.C. families sent suggestions to the Mental Health Commission of Canada with the hope that the Commission would adopt them and help support families. Their suggestions were sent via e-mail and were widely distributed.

The Commission had previously stated they wanted to hear from stakeholders. But, Susan Inman [pictured], a Vancouver teacher, writer and parent said in an e-mail to me, "We didn't feel very reassured" that they are listening. "We are still hoping that Ms. Bradley will respond to our suggestions."

Ms. Inman is the unofficial group spokesperson and Louise Bradley is chair and CEO of the commission.

The commission defines itself as "a catalyst for transformative change" with the goal to, among other things, "improve services and support." The organization arose from the report Out of the Shadows at Last -- Transforming Mental Health, Mental Illness and Addiction Services in Canada in 2006. It received federal funding in 2007.

Ms. Inman further stated in her e-mail:
"I don't think that family caregivers for people with psychotic disorders are feeling hopeful when we see the limited agenda promoted by the Family Caregivers Advisory Committee (FCAC) on the Mental Health Commission of Canada's website. The group pointed out that the only research project the FCAC listed, a family mutual assistance strategy, has already been well researched in BC.

The group also pointed out that, by selecting this as their one project, the FCAC is communicating that "the message that what is most important is for caregivers to just learn how to take better care of each other. Meeting the needs of family caregivers involves much more careful examination of many systemic issues."
One suggestion is to research the quantity and nature of family care-giving for people with serious mental illnesses and to estimate the value of the unpaid family labour in terms of decreasing health care costs. The group also believes that the Commission should advocate to raise the standards of programs training mental health professionals to include science based approaches to understanding severe mental illnesses. Many professionals are not knowledgeable about advances in brain research and often still believe that families cause these mental illnesses. Inadequately trained mental health professionals aren't equipped to refer to early intervention programs -- a new best practice being implemented across the country. The group would like to see more collaboration between families and professionals.

One area of growing scientific understanding is of anosognosia -- the neurologically based inability of someone who is ill to understand that they are ill. Research shows that 40 to 50 per cent of people in the grip of a psychosis suffer this and it often results in treatment refusal.

Family caregivers wish to see the Commission recognize this problem and to recognize the need, at times, for involuntary treatment. Many have ill relatives who look to their families to ensure that they are not left untreated and allowed to deteriorate in case of a relapse. Families need help to gain access to legal means to be able to fulfil this responsibility.

Parents often still continue to experience the destructive impact of unjustified blame for these disorders -- a holdover from the non-research based and unscientific theories that dominated psychiatry and psychology in the past. These parents would like to see the Commission openly acknowledge and address this.

Finally, the language in Commission documents suggests that severe and persistent mental illnesses, like other mental health concerns, may be caused by adverse social circumstances. The Commission should openly support a science based understanding of these neurobiological disorders. As well, it should actively promote the brain based research that can lead to better treatments and, ultimately, cures. Currently, on the Commission's Science Advisory Committee site, there are no proposals for encouraging ongoing scientific investigation of any kind of mental illness.

The group has yet to hear from Ms. Bradley. They did receive a response from Ella Amir, Chair, Family Caregivers Advisory Committee (FCAC). She stated in her e-mail reply to the group, "One of the projects the FCAC has proposed focuses on the same concerns you describe... if approved, this proposed project will address yours (and our) concerns," Since Ms. Amir didn't describe any of the proposed projects, Ms. Inman didn't feel reassured that the FCAC is moving in the right direction.

Ms Amir did add that she was sure that Ms Bradley would also reply. When contacted, Kyle Marr, a spokesperson for the Commission, said he understood their concerns about not having any reply yet but "due to the depth of the email and the issues that it addressed, careful consideration is required".


Follow Marvin Ross on Twitter: www.twitter.com/dysdads

Photo credit

How Budget Cuts Affect the Mentally Ill

A letter to the editor published in the June 24th edition of The New York Times:
To the Editor:

A Schizophrenic, a Slain Worker, Troubling Questions” (front page, June 17):

The story of Deshawn James Chappell, a man with schizophrenia accused of killing one of his caregivers, is a tragedy that could have been prevented if Mr. Chappell had been receiving the proper treatment. However, only a very small percentage of people who live with schizophrenia ever become violent, and then it is usually when the treatment system fails them and they discontinue their medications.

Our mental health care system, which is reeling from repeated state, county and federal budget cuts, is simply too overwhelmed to provide all of the compassionate and quality treatment that patients need. It is imperative that we as a society prioritize the treatment of psychiatric disorders to align with the high prevalence of these disabling conditions.

Doing so would ultimately cost less than warehousing and treating people in jails and prisons, where those with mental illnesses all too often end up.

JOHN OLDHAM [pictured]
President
American Psychiatric Association
Arlington, Va., June 20, 2011

The importance of measuring psychosocial functioning in schizophrenia




The abstract of an article posted on June 24th by Annals of General Psychiatry:
By Sofia Brissos, Andrew Molodynski, Vasco Videira Dias, and Maria Luisa Figueira

Abstract (provisional)

Background

Schizophrenia is among the most disabling of mental illnesses and frequently causes impaired functioning. We explore issues of definition and terminology, and the relationship between social functioning, cognition, and psychopathology considering relevant research findings.

Methods

The present article describes measures of social functioning and outlines their psychometric properties. It considers their usefulness in research and clinical settings. Treatment aims and objectives are explored in the context of cognitive and social functioning. Finally, we identify areas for developing research and refining the measurement of social functioning.

Results

The definition and measurement of social functioning in schizophrenia remains a complex and disputed area. The relationships between symptoms, cognitive functioning and social functioning are complex but we are beginning to understand them better. Scales for measuring functioning in clinical practice must be brief and sensitive to change and the Personal and Social Performance (PSP) scale may offer several advantages in these regards. Brief cognitive assessments focusing upon the domains most commonly affected in schizophrenia, such as verbal memory and executive functions, should be coadministered with measures of functioning.

Conclusions

The use of validated scales for schizophrenia that are sensitive to change over the course of the illness and its treatment, should allow for a better understanding of patients' functional disabilities, enabling better and more comprehensive monitoring and evaluation of both pharmacological and non-pharmacological treatment strategies.
To download the entire article, please click here (PDF).

Also see:

Symptomatic remission in schizophrenia patients: Relationship with social functioning, quality of life, and neurocognitive performance

Friday, June 24, 2011

Dr. A.J.: Mental health-care needs fix




An article published in today's edition of The Chronicle Herald:
Physician urges collaboration over fee-for-service model

By John McPhee, Health Reporter

Big changes are needed to fix our ailing mental health-care system, a Halifax family doctor says.

For example, the way doctors are paid doesn’t allow them to take time with people, said Ajantha Jayabarathan [pictured], better known as Dr. A.J.

She and other general practitioners are paid for every patient they see, a system called fee-for-service. That may work for simple problems, but the complexity of treating mental illness is another matter.

The collaboration of many practitioners, from social workers to psychiatrists, is needed, Jayabarathan said in an interview Wednesday.

"Already they (the province and Doctors Nova Scotia) are looking at a different way to pay people," she said.

"For instance . . . I meet with a social worker, psychologist or a psychiatrist for an hour to discuss patients, or let’s say they came to my clinic once a month and we all work together. The whole system has been turned around."

Collaborative care is at the heart of a national conference that starts today in Halifax.

Jayabarathan, who will co-chair the 12th Canadian Collaborative Mental Health Care Conference, is passionate about the concept.

"I think what it will take is willingness, interest and people stepping forward to say, ‘I think we’re ready to do something like this.’ "

A lack of health-care providers or resources isn’t the problem. It’s a matter of using those resources more effectively.

"We’re drowning in a sea of plenty," said Jayabarathan, who has practised in Halifax for 25 years.

"Family doctors don’t work enough with psychologists and vice versa to really understand each other’s expertise. You are unlikely to use a resource that you don’t know much or anything about, even if they work down the hall from you."

The collaborative effort must go beyond the people providing the care, said Dr. Ian Slayter, director of psychiatric services for the Capital district health authority.

For the patient’s privacy and other reasons, the family or other people close to the patient are often shut out, Slayter said Wednesday. Patient confidentiality is important, but addressing that issue can be as simple as asking for consent.

"The patient benefits because they will get better support from their family or whoever supports them," said Slayter, who will co-chair the conference with Jayabarathan.

"Their practitioners and clinicians will be better informed about what’s actually going on with the patient. Because what I see in the office and what the family sees at home can be different."

And family members benefit because they’re included in the process.

"They not only feel more effective but they get help in dealing with their own anxieties and the difficulties they have dealing with a person with a serious illness," Slayter said.

Next week, Capital Health is expected to approve treatment guidelines that include a duty of care to the family, Slayter said. These guidelines will be distributed to practitioners and health centres.

A group from the Meriden Family Programme in Birmingham, England, has been training a Capital Health team in its collaborative family approach, Slayter said.

The Collaborative Mental Health Care Conference runs from today to Saturday at the World Trade and Convention Centre in Halifax. Speakers and workshops will include officials from the Mental Health Commission of Canada, local practitioners and people who have used the mental health system.

The conference is open to the public, but registration and fees apply, although efforts will be made to make the event as accessible as possible. About 350 people were registered by Wednesday, Jayabarathan said. For more information, go to www.shared-care.ca.

(jmcphee@herald.ca)

Photo credit

Friday, June 17, 2011

Clozapine Rarely Prescribed for Refractory Schizophrenia

An article posted yesterday by Medscape Medical News:
June 16, 2011 (Boca Raton, Florida) — Clozapine, an effective antipsychotic medication for treatment-resistant schizophrenia, is not being prescribed as often as it should be, researchers reported here at the New Clinical Drug Evaluation Unit (NCDEU) 51st Annual Meeting, sponsored by the American Society of Clinical Psychopharmacology.

"Study after study shows clozapine, which is the first of the second-generation antipsychotics, to be the most effective antipsychotic out there, but it’s hardly being used," Susan M. Essock, PhD [pictured], from the New York State Psychiatric Institute and Columbia University, New York, New York, told Medscape Medical News at a poster session.

Up to 30% of people with schizophrenia are potential candidates for clozapine because they have refractory psychotic symptoms that do not respond well to first-line antipsychotics.

Yet only 2% to 3% of people with schizophrenia in the United States, and fewer than 6% in New York State, take the drug, Dr. Essock said.

She and her colleagues used New York State Medicaid data to identify factors associated with the initiation of clozapine compared with other antipsychotic medications.

Their study sample included 7035 Medicaid recipients who had a primary diagnosis of schizophrenia or schizoaffective disorder and who filled a prescription for an antipsychotic medication in 2009 without a fill of that same medication in the prior 90 days.

The researchers found that just 144 patients (2%) started clozapine and that 6891 (98%) started another antipsychotic medication.

The most frequently prescribed agent was aripiprazole, with 1175 prescriptions; closely followed by quetiapine, with 1161 prescriptions; risperidone, with 1127 prescriptions; and long-acting injectables, with 1078 prescriptions.

There were 663 prescriptions for olanzapine, 559 for haloperidol, 333 for ziprasidone, 253 for paliperidone, and 199 for fluphenazine.

The study also found that individuals who started clozapine were more likely to be younger (mean age, 36 ± 12 years vs 44 ± 13 years), male, and white. Patients in state-operated facilities were also more likely to get clozapine than patients in other types of facilities. Patients started on clozapine also had higher Medicaid costs (mean, $58,861 ± $65,367) than those not receiving clozapine ($16,687 ± $27,767).

Clozapine is well known to be the most effective antipsychotic for refractory schizophrenia, so why is its use so low?" Dr. Essock asked. "It is true that you need a blood test to make sure that the patient’s white blood cell count is adequate, but the data show that it is worth it to do this extra test."

Commenting on this study for Medscape Medical News, American Society of Clinical Psychopharmacology president John Kane, from the Albert Einstein College of Medicine and the Zucker Hillside Hospital, Glen Oaks, New York, said, "These are important data in highlighting the underutilization of clozapine. Many more patients could potentially benefit from a trial of the medication that has the best chance of succeeding when others fail. We need to work towards reducing the existing obstacles to wider use of clozapine."

Dr. Essock has disclosed no relevant financial relationships. Dr. Kane reported that he has financial relationships with Astra Zeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Cephalon, Dainippon Sumitomo, Eli Lilly, Esai Inc., H. Lundbeck A/S, Intracellular Therapeutics, Janssen Pharmaceuticals, MedAvante, Merck, Novartis, Otsuka, Pfizer, and Rules Based Medicine.


New Clinical Drug Evaluation Unit (NCDEU) 51st Annual Meeting, sponsored by the American Society of Clinical Psychopharmacology (ASCP). Abstract #63. Presented June 14, 2011.

Thursday, June 16, 2011

The Beacon Program's new website




The Beacon Program is a provincial psychosocial rehabilitation (PSR) program for adults who live with serious mental illness. As a voluntary, community-based program, it empowers people to make choices, gain skills, and meet goals for achieving the greatest amount of independence in life. It is ideally suited to young adults who have the potential to live independently, return to work or school, and expand their social network. Residents learn a wide array of skills related to activities of daily living (meal planning, grocery shopping, cooking, home maintenance, budgeting, etc.), medication and illness education, and social and recreational activities.

While attending the Beacon program, clients stay at the Beacon House. Located in Kentville, Nova Scota, this beautiful new residence, built in 2009, provides a “home away from home” while attending the program in the Annapolis Valley. Beacon staff feels it is important for residents of Beacon House to feel safe, secure and respected. In return, residents are asked to respect the house as their own during their stay.

In February of this year (2011), the Beacon Program launched a new website, www.beaconprogram.ca, designed by Nick Langford.

“I believe this new website offers an excellent overview of what the Beacon Program is all about and what one might expect from the program. I hope it helps to encourage all who are interested – potential participants, family, healthcare providers – from anywhere in Nova Scotia to learn more about the program and ultimately to benefit from this valuable resource.” says Valerie Davis, Manager, Community Support and Rehabilitation Mental Health Program.

The new website includes a “virtual tour” of Beacon House. “The ‘take a tour’ feature allows you to see what the Beacon House is really like, something we were not able to provide before,” says Davis.

For further information on the Beacon Program or for a referral package, please visit www.beaconprogram.ca.

Wednesday, June 15, 2011

Media Interviews for "Living with Schizophrenia" Documentary

From Ashley Smith's blog, Overcoming Schizophrenia:

May 2011, Ashley Smith and Dr. Xavier Amador shared their experience with being a part of the [Living with Schizophrenia: A Call for Hope and Recovery] documentary on radio and television interviews across the United States.
Also see:

Living with Schizophrenia: A Call for Hope and Recovery

The Tavis Smiley Show (Radio interview with Ashley Smith)

Schizophrenia Society of Nova Scotia's 22nd Annual Conference

Trailblazing on Tasers

An editorial published in today's edition of The Chronicle Herald:
THREE years ago, a mentally ill man died in custody 30 hours after being Tasered at an HRM police station. Howard Hyde’s heart stopped and he [pictured] had to be revived. The subsequent inquiry determined that it was a restraint hold — properly applied a day later by correctional officers — which caused his heart to stop forever.

Mr. Hyde’s death could have been avoided if he had been handled differently at every turn. Many Nova Scotians still suspect the Tasering was a contributing factor.

Ironically, they might be surprised to hear that many Quebecers were left wondering last week why Montreal police didn’t Taser a mentally ill man who allegedly charged them with a knife. Tragically, the suspect was shot dead instead, and an innocent bystander was killed in the crossfire.

We do not yet know the answers to these questions. If the officers believed they were in immediate, mortal danger, they would not have reached for a (generally) non-lethal weapon. Most likely, they were not armed with Tasers anyway — the Montreal force only has 42 stun guns on hand, compared to Toronto’s 700.

The use of Tasers, especially on emotionally disturbed people, is an emotional issue. But last week, Nova Scotia contributed something useful to the debate: the voice of reason.

In becoming the first province to clarify the rules of engagement in such circumstances, Justice Minister Ross Landry has found the right balance and created a model for other jurisdictions to follow.

We agree with Nova Scotia’s new guidelines that law enforcement officers should consider whether an agitated person is mentally ill and do everything in their power to de-escalate a confrontation, before deploying a stun gun.

We further agree with the precaution — although it’s not always practical — of calling paramedics to the scene before making the call to Taser a medically precarious or disturbed individual.

Most important, police as well as correctional and sheriff’s officers in Nova Scotia will be better trained to recognize signs of a mental illness.

The Hyde inquiry made the salient point that the jail guards didn’t know how to de-escalate confrontations. Better training is certainly the key to enforcing this province’s policy of minimizing harm to the mentally ill.

(edits@herald.ca)

Also see:

Nova Scotia Guidelines on Conducted Energy Weapons (CEWs)

New guidelines a positive step

Tuesday, June 14, 2011

World Report on Disability

An article published in the June 11th edition of The Lancet:
Disability is a common, though uniquely personal experience that will affect increasing numbers of people as populations age. Common, because 1 billion people (15% of the world's population) are thought to have a disability. Unique, because how that disability affects an individual is mediated by environment and resources. For these reasons, the World Report on Disability, published on June 9, makes compelling reading for any citizen, and compulsory reading for health professionals, whose actions can moderate the effect of disabilities on people's lives.

Produced by WHO and the World Bank, the report is the first attempt to assemble best evidence about disability. The topics presented are not exhaustive, but illustrate barriers that can prevent people from realising their full potential, and provide examples that promote inclusiveness. The aim is to ease implementation of the 2006 UN Convention on the Rights of Persons with Disabilities, which established disability as a human rights issue. In presenting their findings, the authors mirror the philosophy of the International Classification of Functioning, Disability, and Health (ICF) by using a multidimensional approach that describes different domains of function, participation, and wellbeing. As the foreword by Stephen Hawking states: “disability need not be an obstacle to success”, but it is essential to provide the right environment if people with disabilities are to live productive and fulfilled lives in comfort and dignity.

Disability is shared unequally. 80% of people with disabilities live in developing countries, where the rising burden of non-communicable diseases accounts for two-thirds of disabilities. Within societies, women with disabilities are more disadvantaged than men, and those who are less economically successful have poorer outcomes than those with more income. The extent to which a person's full participation in society is limited by disability is the product of various inter-related factors. At the core is a combination of attitudes, access (physical and intellectual), education, and employment. Whereas consultation, funding, progressive policies, and decentralised services (particularly rehabilitation) could promote independence and improve outcomes for people with a disability, such actions require infrastructure and political will — in circumstances where, too often, both are lacking. The report emphasises physical, social, and attitudinal environments that enable rather than disable people with impairments. One practical example is a pavement ramp to aid people who use wheelchairs to cross a street. By embracing universal design, a concept that creates a shared solution for many users, regardless of ability, these ramps also improve access for people with children in pushchairs. The same principle of an enabling universal design should apply to the internet, which is often criticised as difficult to navigate for many people with disabilities.

Schools and workplaces are other potentially disabling environments. Not only do people with disabilities have lower participation rates in both than do their non-disabled peers; children with disabilities have lower educational attainment. Lack of agreement about what constitutes inclusion and which governmental department is responsible for children with disabilities perpetuates an unsatisfactory situation. As primary education for all is a Millennium Development Goal, surely the right of children with disabilities to receive good education (including physical education) in an inclusive setting should be a priority — and a foundation for future participation and employment within their communities.

This report reminds health professionals that people with disabilities are entitled to the highest standard of health without discrimination. Responsibilities go beyond primary prevention of disability, for instance by antenatal care, or secondary prevention after a cardiovascular event. To provide best care across the spectrum of comorbid physical and mental disabilities, health professionals need a sound understanding of access and communication needs, which should be central to all curricula.

The report makes care and policy recommendations for practitioners at all levels, as well as calling for better public understanding. However, progress on the global burden of disability will not be possible without country-specific strategies based on good research. Currently, data are fragmented and too many studies are of low quality. To provide meaningful findings that inform care and guide policy, a common framework for disability is necessary (such as the ICF), as are reliable metrics and validated instruments. This approach will require leadership from a well-supported, innovative cadre of researchers trained in many methodologies, who can focus on practical questions of direct importance to people with disabilities and other stakeholders.

For The Lancet themed issue on disability see www.thelancet.com/themed-disability.
Also see:

Disability: beyond the medical model

Monday, June 13, 2011

Do Not Cease from Exploration: A Report at the Nexus of Mental Health and the Criminal Justice System



Please click on the image to magnify it.


An article posted on June 13th by Jotwell.com:
Anne Derrick, In the Matter of a Fatality Inquiry Regarding the Death of Howard Hyde, Report pursuant to the Fatality Investigations Act (2010).

By Kim Brooks (pictured)

Long overdue, in 2010 Canada ratified the United Nations Convention on the Rights of Persons with Disabilities. (The United States has yet to ratify the Convention.) While countries can ratify conventions at the international level, it is often the case that only in translation to our domestic, sometimes even local, contexts do we see the real effects of our commitments.

Judge Anne Derrick’s piece, a report on the death of Howard Hyde ordered by Nova Scotia’s Minister of Justice, pushes at the boundaries of what most of us would consider scholarship; yet, it is the most interesting piece of scholarly work motivated by equality considerations that has crossed my desk in the last several months. It provides a marvellous illustration of the values reflected in the Convention played out against one very specific set of facts.

Howard Hyde, who was experiencing a recurrence of his chronic schizophrenia, was arrested by the Halifax Regional Police on November 21, 2007, after assaulting his common law partner. Mr. Hyde tried to escape from the police when he was being booked. A conducted energy weapon was twice used to shock Mr. Hyde. After additional struggles, Mr. Hyde collapsed and stopped breathing. He was revived and taken to the hospital. After recovering at the hospital, Mr. Hyde was discharged once again to the police. Later in the day, he appeared in court and was remanded to a correctional facility for the evening. Mr. Hyde did not sleep that night.

On November 22, while being transported to court, Mr. Hyde attempted to escape from correctional officers. He was restrained in a cell by correctional officers and stopped breathing. He was pronounced dead at 8:43 a.m.

This is the story that gave rise to the inquiry and the subsequent inquiry report. Even in its simple telling, drawn from the Preface of the report, the terror that a man living with a mental illness must have felt through the whole ordeal, and the inadequacy of the institutional response to his needs, is apparent.

The report deserves to be read in its entirety – all 7 parts, 57 chapters, 462 pages. Rooted in the experience of one man, in one small corner of the world, the inquiry report demands broad readership.

Following a moving introduction and preface, the report reviews the factual narrative (Part II), outlines the cause and manner of death (Part III), addresses a range of issues that arise from the inquiry (Part IV), delineates the major findings (Part V), reviews changes since the time that Mr. Hyde died (Part VI), and provides for recommendations (Part VII) and a conclusion (Part VIII).

Let me highlight two aspects of the report, simply as a teaser. First, the report’s 80 recommendations are essential ground for equality scholars with an interest in policy-relevant scholarship. It might be noted that the recommendations appropriately do not focus on the assault of Mr. Hyde’s common law partner (although the need for appropriate accommodation for accused persons living with mental illnesses is underscored); rather, they are focused on the interaction between mental health and the criminal justice system. The recommendations cover everything from the importance of developing a provincial mental health strategy that ensures coordination of care, integration of services and supports, and monitors quality and outcomes (Recommendation 1) to implementing a diversion program, including pre-charge diversion, for accused persons with mental illness (Recommendation 10) to training police with an eye to the overarching purpose of the development of a culture of respect and empathy for persons with mental illness in the justice system (Recommendation 49).

Second, the report is beautifully written. Let me draw from the conclusion, which demonstrates more than ably the skill of the author and her ability to cut to the core of the issues before her:

"At an immediate, fundamental level, what Mr. Hyde needed was human contact, reassurance and kindness. The evidence discloses how well he responded, even when somewhat agitated, to simple but effective interactions that incorporated these elements. Certain police officers, sheriffs and correctional officers were all successful in their interactions with Mr. Hyde utilizing approaches that were empathetic, respectful and caring. Even though he was acutely ill, Mr. Hyde was reassured and comforted “by talking to him.”3 Understanding this is to understand Mr. Hyde’s humanity and recognize in him, ourselves." (P. 388, footnotes removed)

I might conclude just by saying, briefly, something about the value of understanding this report as a form of scholarship. If the highest calling of scholarship is to reveal the truth of the world, and perhaps further to reason about what that truth should be, then this report fits within the core of that ambition. The report contributes to our knowledge about mental illness, the interaction between human beings experiencing a form of mental illness and the criminal justice system, and the potential to recognize and appreciate the fullness of the human experience. It is, in that regard, scholarship of discovery. In addition, Judge Derrick draws together diverse strands of evidence and weaves those together analytically, in a way that demonstrates the scholarship of integration. Finally, the report’s provision of thoughtful and detailed recommendations is exemplary of scholarship of application.

The report’s conclusion section opens with a quote from T.S. Eliot. It might be used to reveal the connection between the work of Judge Derrick in this report and the explorations we all take as scholars:

We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
– T.S. Eliot

Mental Health Commission of Canada Peer Project

An email received on June 8th from the Mental Health Commission of Canada's Peer Project Team Leader (pictured):
Subject: Communiqué about the Peer Project – Mental Health Commission of Canada (MHCC)

Following the April 2011 Peer Project update, many of you expressed interest in participating in a Webinar session to discuss how to preserve the natural, organic way in which grass-roots peer support has functioned, as we develop a certification process for peer support.

We decided to consult members of the Peer community to help plan for this event. During our discussions, we talked about the format of the Webinar, possible panelists were identified and the most beneficial means for participants to have an open discussion was determined.

It was important for us to organize this Webinar in a way where the issue was treated in a responsible and respectful manner. It was clear from the two groups we engaged with that panelists should rapidly present varying views on the issue but that the majority of the time allocated for this Webinar be at the disposal of participants, allowing a healthy dialog to take place.

We invite you to participate in one of the following events:
The Webinar will be structured with two panelists each presenting views on the issue for 10 minutes followed by a 40 minute moderated discussion where all participants will be invited to the dialogue. Both sessions will be organised in the same fashion and host the same panelists and the presentations during each session will be the same. Following the sessions, participants will have access to the content of both Webinars and have the opportunity to provide further input.

Our panelists:

Joan Edwards-Karmazyn, Executive Director with the National Network for Mental Health;

Diana Capponi, Employment Works Coordinator for Center for Addictions and Mental Health; and

John Massam, Peer Support Program Coordinator, Coast Mental Health.

Our moderator:

Karen Liberman, Executive Director, Mood Disorders Association of Ontario

* Biographies of the panelists will follow shortly

At this time, we request that you sign-up for one of the webinar sessions by Friday, June 24th. In order to ensure maximum participation and entertain a good dialogue, we will host 20 people per Webinar and we are prepared to hold additional Webinars if required, to accommodate all participants. Please indicate clearly which session you would like to attend.

Joining instructions, panelist and moderator biographies will follow shortly.

Thank you very much for your interest in participating in this very important part of the process.
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Friday, June 10, 2011

New Nova Scotia guidelines for stun gun use

An article posted yesterday by CBC News:
Nova Scotia has issued new guidelines for the use of stun guns and they go into effect immediately.

The guidelines call on police officers, court security and jails guards to consider whether a person is mentally ill before they use a shock to try to subdue them.

When confronting someone who is known to suffer from a mental illness, the officer or guard should only use a conductive energy weapon — more commonly known as a stun gun or Taser — as a last resort.

If there's a danger that shock could seriously hurt that individual, paramedics should be called to the scene before deploying a stun gun.

"We're educating not only the officers that are involved, but the health care services when an incidence occurs what the response should be," said Justice Minister Ross Landry [pictured].

Landry said Nova Scotia is the first province in the country to spell out when a Taser should be used on someone who may be mentally ill.

Officials with the Schizophrenia Society of Nova Scotia are pleased.

"These guidelines direct the officer to make the best possible decision as to whether or not this individual... actually is affected by a mental illness and in crisis," said Stephen Ayer, the executive director of the society.

Ayer said the key to the new rules is proper training and awareness.
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Also see:

Stronger Guidelines for Conducted Energy Weapons

Nova Scotia Guidelines on Conducted Energy Weapons (CEWs)

Conducted Energy Weapons (CEW) Fact Sheet (PDF)

Thursday, June 9, 2011

Attitudes improving towards mental illness, survey shows

Quoting Marjorie Wallace (pictured), chief executive of the U.K. mental health charity Sane:


"If we aspire to end the stigma surrounding mental illness, we must not rely simply on educational campaigns, but must also provide the care and treatment people need at times of crisis, in order to prevent the tragedies that so often colour the public's view."
To read the entire article, please click here.

Tuesday, June 7, 2011

Mental illness leading cause of disability in youth




An article posted on June 6th by CNN.com:
Mental health problems such as depression account for nearly half of all disability among young people between the ages of 10 and 24, according to a new study from the World Health Organization (WHO).

Researchers looked at data from 191 countries and estimated the number of years of good health lost to disability resulting from disease and injury (known as disability-adjusted life years). Among adolescents and young adults, 45 percent of disability was related to depression, bipolar illness, schizophrenia, and other mental disorders, including alcohol abuse.

Health.com: 10 subtle signs of bipolar disorder

Dr. John S. Santelli, M.D., a professor of population and family health at Columbia University's Mailman School of Public Health, in New York City, says that, fortunately, mental health issues at the root of a young person’s disability generally respond to prevention, early detection, and treatment.

"There’s much better behavioral treatments, there’s much better pharmacological treatments as well," says Santelli, who wrote an editorial accompanying the study, which was published in the journal The Lancet. "We know what to do. We just need to do it."

Health.com: 9 ways you can help someone who's depressed

The study was the first ever to look at the international burden of disability in young people. Worldwide, the researchers estimated, disability claimed about 236 million healthy years from this group, which includes both estimated and actual years of life lost to illness and premature death.

After mental disorders, accidental injuries were the second largest cause of disability, accounting for 12 percent, followed by communicable diseases (including HIV, malaria, and tuberculosis) at 10 percent.

The top risk factors for disability were drug and alcohol use, unsafe sex, failure to use birth control, and iron deficiency, a common sign of malnutrition.

Health.com: Myths about safe sex and sexual health

"Youth is considered to be a time of good health," says one of the study's authors, Fiona M. Gore, a WHO researcher in Geneva, Switzerland. However, she says, "important health factors and risk factors for disease in later life emerge in these years "

The study revealed some regional and socioeconomic differences. Compared to the world as a whole, for instance, mental disorders account for a greater proportion of disability in the U.S., in Europe, and in nations with high per-capita income. On the other hand, disability due to injuries and communicable diseases was lower in those countries than worldwide.

"There is a need to focus on prevention strategies and on health promotion of noncommunicable and nonfatal causes of disease in young people," Gore says.

Also see:

Global burden of disease in young people aged 10—24 years: a systematic analysis

Mental Disorders Leading Cause of Disability in World's Youth

Monday, June 6, 2011

Empirical Support for the Family-to-Family Program

From the This Month's Highlights section of the June 2011 edition of Psychiatric Services:
Family- and consumer-driven care is at the center of a transformed system. Family members play important roles in the lives of most adults with serious mental illness. They need information and skills to help their loved one, as well as the support of others to fulfill their caregiver role without being overwhelmed by distress and burden. The Family-to-Family Education Program (FTF), introduced in the early 1990s by the National Alliance on Mental Illness, is the most widely disseminated mutual-support program for family members of people with mental illness.

Although an estimated 250,000 family members have participated in FTF, little research has focused on family selfhelp. In the lead article this month, Lisa B. Dixon, M.D., M.P.H. [pictured], and colleagues report the results of the first randomized controlled trial of the effectiveness of FTF, which involved assignment of 318 family members from five Maryland counties to FTF or a waiting list. At three months (course termination), FTF participants had significantly greater improvements in problem-focused coping, as measured by empowerment and illness knowledge. Their emotion-focused coping was also significantly enhanced, and they had less distress and better problem- solving skills. These empirical findings confirm the word-of-mouth popularity of FTF among participants, the authors note, and provide support for consideration of brief family-driven educational programs as an evidence-based practice (page 591).
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Also see:

Strengthening Families Together

Friday, June 3, 2011

Taser rules coming

An article published in today's edition of The Chronicle Herald:
By The Canadian Press

New provincial guidelines on the use of Tasers by police in Nova Scotia have been approved and will be released soon, Justice Minister Ross Landry [pictured] said Thursday.

Three weeks ago, in response to an inquiry report into the death of a mentally ill Halifax man, Landry said the guidelines would be released within two weeks.

He now says he has reviewed and signed off on the guidelines and expects they will be made public within the next week or so.

Landry declined to say whether the rules would restrict Taser use against mentally ill people, but added that they would not be a major departure from national standards.

"We’re in line with the overall federal position," said Landry. "I think there are a couple of areas that we’ve probably tightened up ... and I believe it will meet our needs at this time."

The issue is a contentious one because the inquiry into the death of Howard Hyde recommended that Tasers not be used on emotionally disturbed people unless all attempts at de-escalation have failed.

Hyde died in November 2007 at a Halifax jail, 30 hours after police had Tasered him multiple times during a psychotic episode. But the inquiry concluded the Tasering did not cause his death.

Federal guidelines say the use of stun guns should be avoided where possible on women known to be pregnant, the elderly, young children and visibly frail people. The rules also say that the weapons should not be used on a restrained subject or on a person in control of a moving vehicle.

There are no references to mental illness in the national rules, but Landry said it would be addressed in Nova Scotia’s guidelines. He didn’t elaborate.
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Thursday, June 2, 2011

One Man’s Journey Through Crime, Drugs, Schizophrenia and Rehabilitation

An article and video posted yesterday by the Juvenile Justice Information Exchange:
By Leonard Witt

When Andrew Peterman of Idaho first came into the juvenile justice system at age 15, he did not know that schizophrenia was driving his anger, which in turn was resulting in arrests and illicit drug and alcohol usage. In time, thanks to juvenile detention and treatment for his schizophrenia he has been able to straighten out his life.

In fact, he has come so far on his journey that the Coalition for Juvenile Justice awarded him the 2011 National CJJ Spirit of Youth Award to “recognize and celebrate a young adult…who has made great strides through involvement with the juvenile justice system, overcome personal obstacles and is today making significant contributions to society.” In the video below by Leonard Witt, Peterman tells of his journey through crime, drugs, schizophrenia and rehabilitation.





Also see:

The Schizophrenia Society of Nova Scotia's YouTube Channel