Thursday, September 22, 2016

Media stories on BC's Mental Health System and Legal Challenges to BC's Mental Health Act

Sarah Leamon: It's time to change B.C.'s Mental Health Act


British Columbia’s Mental Health Act is under fire. On September 12, a legal action was filed in B.C. Supreme Court. It is challenging the constitutional validity of the legislation and argues that the forced treatment of patients, who are suffering from mental illness, is done in breach of their charter rights.

By way of background, under the Mental Health Act, any person who is involuntarily detained at a facility for mental-health reasons lacks the ability to consent, or deny consent, to any medical treatment. In other words, they are deemed to consent to all psychiatric treatment so long as it is authorized by a director appointed by the health authority. It also denies them the ability to designate and appoint a substitute decision maker on their behalf, such as a spouse or a parent. 

 This means that patients who have been involuntarily detained may be subjected to medical treatments against their will. Treatments can include medication, including injections, and invasive therapies, such as electroconvulsive therapy.

 The Mental Health Act is in stark contrast to the law governing general health care in this province. This law states that service providers cannot treat a patient without their express consent. The only exception to this is if there is an emergency or otherwise extraordinary and urgent circumstance. It also allows individuals who are not afflicted with mental-health issues to select substitute decision makers or make directive plans for their future care in the event that they would be unable to make such decisions or provide such consent on their own. In this way, it puts patient autonomy and dignity at its forefront.

British Columbia is actually the only province in this country to retain such a seemingly outdated legislative model. In all other provinces, all adult patients—afflicted with mental illness or not—are presumed to be capable of making decisions related to their own treatment until they are evaluated and proven incapable. Our province is therefore the only jurisdiction in which patients with mental illness are considered to be legally incompetent solely on the basis of their medical condition.

 Read the full article here: http://www.straight.com/news/790696/sarah-leamon-its-time-change-bcs-mental-health-act

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B.C. patients launch court challenge over forced psychiatric treatments



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Other articles and advocacy on mental health issues:
Young, T.A. (2010). Editorial: Mental health services need an overhaul. The Province.
Location: http://advocacybc.blogspot.com/2010_07_01_archive.html.

Young, T. (December, 2012). Tragedy results from mental health system, safety net that fall. Vancouver Sun. Retrieved from: http://advocacybc.blogspot.ca/2012/12/tragedy-results-from-mental-health.html.

Tracey Young: How Many Must Suffer, Die, Before Action? (February 8, 2013). Retrieved from:http://blogs.theprovince.com/2013/02/08/tracey-young-how-many-must-suffer-die-before-action/.

VPD apprehensions under the Mental Health Act level off but remain high

Lupick, T. (August 24th, 2016). Georgia Straight. Retrieved from: http://www.straight.com/news/763086/vpd-apprehensions-under-mental-health-act-level-remain-high



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Thursday, August 25, 2016

Understanding Schizophrenia, BC Information and Resources

Mystery of schizophrenia

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Schizophrenia is one of the most frightening psychiatric diagnoses.

It is a chronic condition affecting about one per cent of the population and is associated with some of the most notorious symptoms of mental illness – hallucinations and delusions.

Schizophrenia is troubling because it often begins when a person is in the prime of his or her life and can distort one’s ability to tell what is real and what is not.

Schizophrenia can be difficult to treat and its causes and triggers are still a mystery.

A large-scale study published in 2014 in Nature has brought us a little bit closer to understanding this complex disease.

A collaborative group of researchers examined the genetic codes of more than 150,000 people. Roughly 37,000 were diagnosed with schizophrenia and results found 108 genetic markers for the risk of getting the disease.

This is a big finding because the majority of these markers had not previously been reported.

Most people will have some of these genetic markers and still not develop schizophrenia, but this study did find that those with the most markers were 15 times more likely to develop the disease than those with fewer of them.

This is very interesting and provides some insight into genetic vs. environmental triggers for the condition.
We have long known there seems to be a link between the immune system and schizophrenia.

Families with autoimmune disorders appear to be at increased risk and there is a link between viral infections during pregnancy and higher rates of schizophrenia in offspring.

The markers identified in this study confirm this immune system link. Researchers associated with the study say it is now very clear the immune system is involved with the condition.

Although it will still be many years before this information can lead to new treatments for schizophrenia, it is a piece in the ongoing puzzle.

There is still much to learn, but when scientists from around the world work together and pool data from many thousands of people, it certainly allows our understanding to move forward much more quickly than when we work in isolation.

I look forward to seeing more results from this group and others as we continue to unlock the mystery of schizophrenia.

In the meantime, there are treatments available that help many with this frightening condition. If you are concerned for yourself or a loved one, contact your doctor now for help.

Resources


About EPI & About Us - About Us - earlypsychosis.ca



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What Psychiatrists Do

The psychiatric mystique

Dr. Paul Latimber (2012). Castanet: Kelowna page. Retrieved from: http://www.castanet.net/news/States-of-Mind/79436/the-psychiatric-mystique

For many people unfamiliar with the experience, the thought of seeing a psychiatrist seems a very mysterious business – akin to visiting a fortune teller or psychic.
Many people seem to have little idea of what a psychiatrist actually does, what training is involved and what might be uncovered during a session. As a result, most visit a psychiatrist with a certain degree of trepidation.
Unfortunately, Hollywood characterizations don’t help much. Most often, these movie portrayals are unrealistic and not very flattering of the profession.
I’d like to help dispel some of the mystery.
Psychiatrists are medical specialists just like cardiologists, surgeons, obstetricians, dermatologists or others. This means the educational training usually involves an undergraduate university degree of three or four years, a medical degree of three or four years, an internship of one or two years, a residency of an additional four to six years and sometimes a postgraduate degree like a PhD for a further three to five years.
In psychiatry, the special interest and training is in mental illness, which can include everything from attention deficit disorder to schizophrenia. Some specialize in one illness or group of illnesses like depression and other mood disorders while others specialize in certain age groups such as children or the elderly.
Psychiatry and psychology are also often confused. Although there is a big overlap between the two disciplines, the essential difference is that psychiatrists are medically trained while psychologists are not.
Many people have the mistaken idea that psychiatrists are only interested in prescribing medication and are not interested in psychotherapy. This is not true.
Psychiatrists are unique in the ability to prescribe medication for mental illness, but are also trained in various types of psychotherapy and are still interested in other aspects of a patient’s life and problems. In most cases, education and therapy are necessary in addition to medication.
A lot has changed in the field since the days of Freud - and we shouldn’t expect psychiatry to look the same as it did a century or more ago. Today we are very fortunate to have a variety of effective, evidence-based treatments both pharmaceutical and not.
Confusion also arises because patients sometimes have unrealistic expectations about what therapy involves and how much time it takes. This confusion is fostered by media portrayals and fringe therapists with little training who may offer strange therapies based on little evidence and flimsy theories.
If a psychiatrist doesn’t offer a particular therapy it often isn’t due to unwillingness or inability to conduct that treatment, but is because of a belief the therapy isn’t necessary in the specific situation.
Generally a psychiatrist will tailor treatment to meet the specific needs of the individual based on the presenting problems and what the patient wants. We are not usually trying to address every problem a person has and we don’t try to completely re-shape a personality.
Unfortunately, there are still many problems for which we don’t have very good solutions and many others that do not require psychotherapy. Sometimes people in the depths of depression become troubled about things from their past that do not normally concern them. In many cases, treatment of the depression is the first step rather than focusing on the particulars of a temporary preoccupation.
If you are seeing a psychiatrist and are uncertain of an approach or treatment focus, the best thing to do is ask about it. Your psychiatrist may explain his or her reasons or take your lead and pursue another avenue with you.
Remember, the average psychiatrist will have seen your problem hundreds if not thousands of times.
Something that seems strange, inexplicable and frightening to you may be very familiar to your doctor and it is likely the psychiatrist has a well practiced approach to the problem. This is one reason why simply talking with a psychiatrist for the first time is often very comforting and leads to substantial improvement even before any specific treatment is prescribed.
Your psychiatrist is not interested in judging you and will not think less of you because of the problems you bring. We deal with difficult situations all the time and are here for one reason – to hear your problem and work with you to find a solution.
When you are motivated, your psychiatrist will usually be quite interested in working with you and will not usually give up unless you do. However, if you give up, stop taking your medication or attending appointments, the psychiatrist will not be able to help you.
If you want to see a psychiatrist, speak with your family doctor and ask for a referral. 
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Tuesday, August 23, 2016

Older Adult Mental Health: Symptoms, Risks, Treatments for Depression

Geriatric Depression: Symptoms, Risk Factors and Treatments

Around 7 million of the nation’s 39 million adults ages 65 years and older are affected by depression, according to the Centers for Disease Control and Prevention (CDC). Although a majority of older adults are not depressed, they have an increased risk of developing depression, which is a persistent sad, anxious or empty feeling, or a feeling of hopelessness and pessimism.
Unfortunately, depression in older adults is often not recognized or treated. Symptoms may be mistaken for natural reactions to illness or life changes that occur during aging. Geriatric depression is associated with an increased risk of suicide, decreased physical, cognitive and social functioning, and greater self-neglect, reports the Annual Review of Clinical Psychology.
Due to its consequences, geriatric depression is regarded as a major public health problem. On a more positive note, the CDC says that it is “fairly easy to detect” and “highly treatable.”
Symptoms
Depression can cause feelings of sadness or anxiety that last for weeks at a time. Additionally, a wide range of other symptoms may be present.
  • Feelings of hopelessness, pessimism, guilt, worthlessness and helplessness
  • Irritability and restlessness
  • Loss of interest in activities once pleasurable
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Sleeping difficulties or irregular sleeping patterns
  • Overeating or appetite loss
  • Thoughts of suicide
  • Persistent aches or pains that do not get better, despite treatment
Depressed individuals over the age of 65 are less likely than younger individuals to exhibit dysphoria, which is a state of unease or general dissatisfaction with life, a study in the Journal of Gerontology found. Older individuals with depression are more likely than younger individuals to experience sleep disturbance, fatigue, psychomotor retardation, loss of interest in living and hopelessness, according to Psychological Medicine.
Additionally, older depressed individuals commonly complain of poor memory and concentration. The Archives of General Psychiatry found that patients with late-life depression had slower cognitive processing speed and performed poorer in all cognitive domains.

Risk Factors

“Non-genetic biological risk factors for depression are particularly important in old age,” says the Annual Review of Clinical Psychology. Several factors have been associated with late-age depression.
  • Endocrine dysregulation, bone loss and certain medications (beta blockers, central nervous system medications, hormones, anti-Parkinson agents, certain cancer medications and others) may cause late-life depression.
  • Around 20 to 25 percent of heart disease patients experience major depression, and another 20 to 25 percent experience symptoms of depression not meeting criteria for major depressive disorder, according to Biological Psychiatry.
  • Dementia may be a risk factor for depression, but diabetes is not. Rather, the evidence suggests that depression is a risk factor for diabetes.
  • Stroke patients have the highest rates of major depression (20 to 25 percent) among other neurological disorders. Rates are intermediate (15 to 20 percent) for Parkinson’s disease compared to Alzheimer’s disease (10 to 15 percent).
  • Anxiety disorder and sleep disturbance are also risk factors for depression among older adults.
Social risk factors for depression, though less important in old age, can become more significant in very old age when individuals face greater losses and fewer resources. As with other ages,Psychology and Aging found that late-life depression is linked to the number of stressful life events experienced. Also, troubled relationships can explain depressed older individuals, including spousal depression, marital conflict and perceived family criticism. In The Journals of Gerontology, financial trouble is one of the most common stressful life events experienced by older adults.

Treatment and Prevention

In a review of evidence-based therapies for depression in older adults, Clinical Psychology: Science and Practice named the following as beneficial: behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and reminiscence therapy. A behavioral treatment plan for depression in nursing homes was successful in Clinical Case Studies. It found a strong increase in positive affect and activity level after a 10-session program for increasing pleasant activities was administered. In the Journal of Mental Health and Aging, a meta-analysis found that psychotherapeutic interventions changed self-rated depression and other measures of psychological well-being in older adults by about one half standard deviation and clinician-rated depression by more than one standard deviation.
In 2007, an expert panel recommended home- or clinic-based depression care management (DCM) along with cognitive behavioral therapy for older adults with depression, the American Journal of Preventive Medicine reports. DCM uses a team approach with a trained social worker, nurse or other practitioner alongside a primary care provider who prescribes treatments in consultation with a psychiatrist. Clinical trials link DCM to a reduction in depression symptoms, higher remission rates and improvements in health-related quality of life, reports the CDC.
Prevention efforts are often directed to those who are at an increased risk of disorder. The American Journal of Psychiatry found that treating all patients with subsyndromal depressive symptoms could prevent 24.6 percent of new depression onsets in that period. In Aging & Mental Health, cognitive behavioral therapy demonstrated significant benefits in the prevention of depression in nursing home residents. Treatment of insomnia and other sleep disturbance is a valuable opportunity to prevent depression in older adults, given the highly effective nature of cognitive behavioral treatments for insomnia in this age group. The American Journal of Geriatric Psychiatry identified that individual educational interventions for subjects with chronic illness, individual therapy for at-risk bereaved older adults, cognitive-behavioral interventions to reduce negative thinking and life review were interventions with the most empirical support. Programs to reduce social isolation may also help prevent depression in older adults.
Helping Seniors in the Community
Human services professionals can join healthcare professionals and families to provide support for older adults who have or are at risk for depression. From clinics and nursing homes to homeless shelters, a variety of environments exist where individuals are particularly at risk for developing depression. Professionals trained to work with older adults and lead initiatives in the community can make a difference.
Southeastern University offers an online B.S. in Human Services and an online M.A. in Human Services to positively impact seniors. Both programs equip graduates with the knowledge and skills needed to work in and lead human service environments. The master’s program offers a gerontology specialization, and both degree options take place in a convenient online format.
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Thursday, June 16, 2016

Domestic Violence Exposure in Childhood Leads to Increased Suicide Risk in Adulthood

The Childhood Incidents That Increase Later Suicide Risk

Exposure to domestic violence, abuse cast a long shadow, study finds
Retrieved from: https://consumer.healthday.com/public-health-information-30/domestic-violence-news-207/what-incidents-in-childhood-increase-suicide-odds-711825.html

 MONDAY, June 13, 2016 (HealthDay News) — Adults who witnessed parental domestic violence in childhood are at increased risk for suicide attempts, a new study finds.

“When domestic violence is chronic in a home, there is a risk of long-term negative outcomes for the children, even when the children themselves are not abused,” said study lead author Esme Fuller-Thomson. She is a professor with the University of Toronto’s Faculty of Social Work.

The researchers examined data from more than 22,500 Canadian adults. They found that about 17 percent of those exposed to chronic parental domestic violence (more than 10 times before age 16) had attempted suicide, compared with roughly 2 percent of those not exposed to parental domestic violence.

“We had expected that the association between chronic parental domestic violence and later suicide attempts would be explained by childhood sexual or physical abuse, or by mental illness and substance abuse,” Fuller-Thomson said in a university news release. “However, even when we took these factors into account, those exposed to chronic parental domestic violence still had more than twice the odds of having attempted suicide.”

These chaotic home environments cast a long shadow, she added.

“Social workers and health professionals must continue to work vigilantly to prevent domestic violence and to support survivors of this abuse and their children,” Fuller-Thomson said.

The study also found that adults who were maltreated during their childhood were more likely to have attempted suicide. Almost 17 percent of those who’d been sexually abused and more than 12 percent of physically abused children were later found to have made at least one suicide attempt, said study co-author Reshma Dhrodia, a recent Master of Social Work graduate.

The researchers also found that a history of major depressive disorder, anxiety disorders, substance abuse and/or chronic pain was associated with significantly higher odds of a suicide attempt.

The study was published online June 9 in the journal Child: Care, Health and Development.
More information
The American Academy of Child and Adolescent Psychiatry outlines how to help children exposed to domestic violence.
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Trauma-informed care and practice resources for adults

Trauma-Informed Care and Practice 

To provide trauma-informed care to children, youth, and families involved with child welfare, professionals must understand the impact of trauma on child development and learn how to effectively minimize its effects without causing additional trauma (Child Welfare Information Gateway).

Below are resources that are helpful to support the development of trauma-informed practices and provide helpers with opportunities to develop enhanced knowledge and skills in supporting adults coping with trauma. I will be providing a separate post for trauma-related resources for children and youth.

Canada

Trauma-informed Practice Guide (2013). Retrieved from: http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf
  • The Trauma-Informed Practice (TIP) Guide and TIP Organizational Checklist are intended to support the translation of trauma-informed principles into practice. Included are concrete strategies to guide the professional work of practitioners assisting clients with mental health and substance use (MHSU) concerns in British Columbia. 
Authors: Emily Arthur, Amanda Seymour, Michelle Dartnall, Paula Beltgens, Nancy Poole, Diane Smylie, Naomi North, and Rose Schmidt
Initial draft authors: Cristine Urquhart and Fran Jasiura of Change Talk Associates
British Columbia Centre of Excellence for Women’s Health; BC Ministry of Health, Mental Health and Substance Use Branch; and Vancouver Island Health Authority, Youth and Family Substance Use Services, 2013.

Trauma-informed: The Trauma Toolkit Second Edition (2013). Klinic Community Health Centre (Manitoba). Retrieved from: http://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf
  • A resource for service organizations and providers to deliver services that are trauma-informed
Trauma-informed Approaches in Addictions Treatment (2010). Retrieved from: http://bccewh.bc.ca/wp-content/uploads/2014/02/2010_GenderingNatFrameworkTraumaInformed.pdf

  • A discussion guide to gendering the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada. Identifies Canadian examples of promising practices in action. Lists discussion questions on providing integrated approaches.

Authors: British Columbia Centre of Excellence for Women’s Health (BCCEWH) in partnership with the Canadian Centre on Substance Abuse (CCSA) and the Universities of Saskatchewan and South Australia, 2010.

United States
National Center for Trauma-Informed Care

Seeking Safety: A Treatment Manual for PTSD and Substance Abuse 

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Monday, May 30, 2016

Student Loan Debt & Mental Health Impacts

Schools look to address mental health impact of rising student debt

By Aleksandra Sagan (May 30, 2016). The Canadian Press/The Globe and Mail. Retrieved from: http://www.theglobeandmail.com/globe-investor/personal-finance/genymoney/post-secondary-schools-look-to-address-mental-health-impact-of-rising-student-debt/article30200722/

Many of this year’s new post-secondary graduates have left the academic world carrying tens of thousands of dollars in debt. Meantime, those heading to college and university this fall will soon contend with steep tuition rates that often result in a similar burden.

While schools attempt to lessen the load by offering financial aid, average student debt appears to be climbing. So some institutions are also responding by beefing up their mental health services to help students cope with life in the red.

“We’re worried about one type of debt — student debt — and we want to know how to pay it off as quickly as possible,” said Dillon Collet, who is about to enter his final year at the University of Toronto’s faculty of law and sat on the dean’s advisory committee on financial aid.

The committee organized a financial aid workshop that discussed the psychology of debt. It was well-attended, Collet said, with about 60 students in the room and a lineup outside.

The committee’s student representatives also pushed to have tuition fees — and their connection to student stress — to be discussed at the faculty council’s meeting each year, Collet said.

“A lot of students suffer silently.”

Estimates suggest average student debt in Canada is past the $25,000 mark.

In 2013-14, graduates finished school with an average of $12,480 in federal loan debt, according to numbers from the Canada Student Loans Program.

However, that figure doesn’t include provincial or private loans. An Ontario student graduating from a four-year university program, for example, shouldered an average of $22,207 in provincial debt in 2012-2013. That makes for a total debtload of more than $34,000 if they also borrowed the average sum from the federal government.

The Canadian University Survey Consortium surveyed more than 18,000 graduating university students from 36 Canadian universities for its 2015 annual report. The average debt-ridden student owed $26,819.
Such a debt load can have an impact on a student or graduate’s mental health, though only a small amount of published research exists on the apparent link.

A 2015 journal paper analyzed data from a U.S. Bureau of Labour Statistics survey of more than 8,000 youth in the United States — where tuition fees are significantly higher than in Canada — to determine if debtload and psychological well-being were connected.

“Students who took out more student loans were more likely to report poor mental health in early adulthood,” said one of the paper’s authors, Katrina M. Walsemann, an associate professor at the University of South Carolina.

Canadian experts have also noticed a link, even though Canadian students don’t generally go into as much debt as their American cohorts.

Jillian Yeung Do, York University’s director of student financial services, witnessed it while working with a student. While she couldn’t provide much detail for privacy reasons, she said she became really concerned about a student.

“After that encounter, I decided that it would be a good idea to — for myself, personally, and as well for the entire team — to be trained in having these conversations with students,” she said.

The university’s health educator taught the financial services staff how to identify students in distress, listen to them and provide proper referrals. York University also plans to launch a new financial literacy campaign soon, she said.

The University of Toronto’s faculty of law staff, including its financial aid workers, will also have training on mental health issues next month, said Alexis Archbold, the assistant dean of the JD (juris doctor) program. She’s also the chair of the dean’s advisory committee on mental health and wellness, formed this past academic year.

Archbold and the committee spent the year listening to students’ primary concerns. Unsurprisingly for a professional program, she said, high tuition and the anxiety of the corresponding debtload emerged as one of the common themes.

The school’s new academic, personal and wellness co-ordinator will work with Archbold this summer to develop a wellness strategy, she said.

The committee will continue to hear from students on how to improve the strategy, which seems to fall in line with at least some of what the students want.

“We want a platform in which we can engage with the faculty and the administration,” said Collett, “and we can really talk about the nuts and bolts.”


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