Recently there was a report of an extraordinary example of political interference in mental health treatment. A political interference based not on knowledge but as far as I can tell, based on stigma or perhaps with a bit of so called “law and order” pandering to the uninformed.

The story unfolds in this way. A person who is in secure treatment for a murder committed when he was psychotic applied to have supervised outdoor walks. The mental health treatment team supported that application and it was permitted by the Criminal Code Review Board who are charged with the responsibility for such decisions. Without these walks (remember that they would be supervised – that is, the person who as far as I know has improved with treatment would be accompanied by two trained mental health staff during short outings) the person would have to languish indoors all summer.

Upon hearing about this decision, the Minister of Justice in Manitoba – Andrew Swan, overturned the board’s decision, ordering that no supervised walks could be allowed! Why? According to Swan it was “contrary to the interests of public safety”.

What hogwash. Since when did Minister Swan get his credentials in mental health? And what possessed him to overturn a duly constituted and credible evaluative process? Could it be stigma against the mentally ill? Could it be the lowest form of political pandering to ignorance and fear? What kind of a message does this send to people living with mental illness? What message does this send to their families? What message does this send to society in general?

Shame on Minister Swan. This is something we could have expected in medieval times, not in 2010 in Canada.

–Stan

So I was just reading an interesting piece called “Protecting Teens in Crisis: Constructive Oversight of Programs”, in which a number of significant concerns were raised about what is called the “struggling teen industry”.  Put bluntly, it seems that there are a number of institutions (mostly in the USA as far as I can tell) that may be or may have been involved in a number of non-therapeutic or perhaps even abusive practices,  all in the name of “therapy” or “treatment”.  Indeed one of the phrases used in the piece was “stories of mistreatment, abuse and even death…”

Wow.  Shocking.

An American professor is quoted as saying that these concerns need to be addressed using state regulations and licensing.  This makes sense for sure.  I am personally astonished that such a regulatory framework is not apparently in place. How could “treatment” settings operate without oversight and standards of care?

However, this is not enough.  Not by a long shot.  Reading about some of what passed as “treatment” makes me shudder.  It sounds brutal and harmful, not therapeutic and helpful.  So, where do people who offer these “treatments” (whatever they are) dream them up?  Who has studied these so called “treatments” and what have they found?  Are these interventions helpful?  Are they useful?  Do they work? Are they safe?

In short, what is the scientific evidence for the so called treatments being used?  And here, let me be very clear.  We need strong, hard scientific evidence.  This not the same thing as “best” evidence.  “Best” evidence can be what someone thinks is a good idea shared with some other people who think it’s a good idea.  It may even be a well-intentioned idea.  But, the road to hell is paved with good intentions (as the saying goes).

So – bottom line.  Show me the evidence.

–Stan

FINALLY, the Lancet (one of the world’s top medical journals) has retracted their publication of one of the most misleading articles in the history of modern medical  science – the now totally discredited piece on the relationship between autism and the MMR vaccine http://www.cbc.ca/health/story/2010/02/02/autism-mmr-lancet-wakefield.htmlt.

What took them so long?  It seems that the Lancet editors where the last in the world to know that the article was basic bunkum.  And why did they even print it?

If you can find me another article that uses the same low level of scientific evidence and flawed thinking that the Lancet has published in the last decade as this one used I will buy you a chocolate cookie. (Only one cookie per customer, just in case).  I for one have no idea about what the answer to either of those questions is.  But the fallout has been substantial.  It seems that large numbers of children died because they were not vaccinated.  And to what end?  Because a researcher (who it seems was in the employ of lawyers making lots of money suing vaccine manufacturers) published such poor science and because a learned journal did the publishing?

So what is a possible lesson here?   Although there are many, one most certainly is that one swallow does not a summer make.  That is, scientific knowledge is not built on one study, but on many, conducted by different and independent investigators, using best methods and techniques and scrutinized by peer review.  Is there the possibility that some studies will show one thing and others will show another?  For sure. Science is nasty, brutish and long.  Remember the word attributed to Mark Twain: “be careful reading a medical text book.  You may die of misprint”.

–Stan

Happy Canada Day!!

Canada has a proud history of valuing health care as part of the fabric of this country and as a basic right for all citizens. However, despite our commitment to overall health care, our attention to mental health care is overdue.

In Canada, approximately 1 in 5 children and adolescents experience some form of mental disorder. Most major mental disorders begin prior to the age of 25, making this period a critical time for the promotion and treatment of mental health problems.

One of the key initiatives of the Mental Health Commission of Canada is to develop a Mental Health Strategy for Canada. As part of the strategy the Child and Youth Advisory Committee of the Mental Health Commission of Canada will support the development of a framework specific to the needs of child and youth mental health.

We need your help!!

We invite all Canadians to share their thoughts and opinions in an online survey about values and principles relating to child and youth mental health.

TAKE THE SURVEY NOW

The survey will take about 30 minutes to complete (but you can save your answers and come back to it at any time).

It is important that we get the thoughts and opinions from as many different people as possible. Please pass this information along to your network, family, friends, or anyone who you think should join this consultation.

Currently, Canada is the only G8 country without a National Mental Health Strategy. Recently, the Mental Health Commission of Canada (MHCC) was established with one of its key priorities to develop a Mental Health Strategy for Canada.

As part of the strategy the MHCC will support the development of a framework specific to the needs of child and youth mental health. The proposed framework, entitled Evergreen, will complement and provide child and youth context to the Mental Health Strategy for Canada.

What is Evergreen?

Evergreen is a collaborative project that will produce a framework to help improve policy and programming related to child and adolescent mental health across Canada.

What is a mental health framework and why is it important?

Think of a framework like a blueprint for a house. If we want to build the best house, we need to create the best plan to design it and hire the best people to build it. Canada’s mental health system is no different. Frameworks help keep everyone on the same page, working together towards a common goal – to develop a mental health system that effectively meets the needs of its consumers.

Who will Evergreen affect?

Everyone. There is no health without mental health. A national child and youth mental health framework can be useful to assist provinces, territories and organizations to enhance their child and youth mental health strategies, policies and plans. Evergreen can also help to raise public awareness of the importance of addressing child and youth mental health needs, while helping to decrease stigma associated with mental disorders.

How is Evergreen being created?

The Evergreen framework will be collaboratively constructed by professionals, youth, parents and members of the public from all regions across Canada who have expertise, interest or experience with mental health and mental illness. In the end we envision the framework to be among the most comprehensive and scientifically-based child and youth mental health frameworks in the world

WE NEED YOUR HELP!!

To make this framework truly unique and successful we need your input. We need you to tell us what values and principles Canadians want to uphold in relation to mental illness and child and adolescent mental health services. We also need you to help share this initiative with others who can contribute.

The public forum will be online July 1st. When it’s ready our site and MHCC will link to it. Until then … spread the word!

How do we make sense of numbers?

Last year when when the economic crisis loomed the Federal Reserve and Treasury Secretary urged Congress to approve a $700 billion bailout of struggling financial institutions.

I remember politicians and media going to great lengths to try and put this amount of money in context. What does $700 billion mean to me? How do I relate that to my standard of living? Every technique was used…

Shock - Its over twice the amount of all money given to all charitable organizations in the United States in any given year.
Comparison - There are about 300 million men, women, and children currently living in the United States, so the bailout is equal to roughly $2,300 per person
Arbitrary - an average public school classroom filled up about 70% (between 2/3 and 3/4) of the way with salt!

But perhaps the best technique to explain figures like $700 billion is not to go big, but to go small.

I recently came across the work of artist Toby Ng. One of his latest projects tries to make sense of global numbers by simplifying them - what would gloabl statistics mean if the world were a village of 100.

In the field of mental health we have the same problem of making sense of numbers. Often when numbers are too large they become intangible, inhernetly meaningless and are no longer able to appeal to a person’s emotions. How do we put into context that “only a small minority of the 450 million people suffering from a mental or behavioural disorders are receiving treatment”? (World Health Organization).

Mental illness can affect anyone regardless of sex, age, race, religion, ethnicity or socio-economic class. In any given year one in five people are estimated to suffer from a mental illness and the economic and social costs of these disorders is staggering.

Mental health and mental illness are complex issues. They are complex to understand and require complex solutions. But perhaps the best way to start the conversation about them is to present them simply.

(Note: The image below is my own creation - an homage to Tony’s art project)

~ D. Venn

The United Nations has called the situation in northern Uganda the most neglected humanitarian crisis in the world. The 20-year civil war between government forces and a rebel group known as the Lord’s Resistance Army has victimized tens of thousands of youth, destroyed families and fractured communities. The recent decrease in armed conflict has left the region with a difficult question: how do you teach peace to a generation who has known nothing but war?

The future of this region is in its youth! Many young people have been traumatized as victims and as perpetrators of violence. They have grown up knowing fear, now they need to learn to adapt to a less frightening world and to help each other heal.

Last year, the Dalhousie International Health Office (IHO) and Section of International Psychiatry: Youth Coalition for Peace participated in a joint project with the Canadian Physicians for Aid Relief (CPAR) and Gulu University. Their goal was to work with affected youth, communities and non-governmental organizations to help build a climate supporting sustainable peace in Northern Uganda.

Using a youth peer counselling model, our team developed a training program to integrate mental health into local peace-building efforts and establish community activities to address these issues in a non-stigmatizing manner. Given the important role that sport plays in Ugandan communities, soccer was identified as tool to engage youth and teach peace-building skills such as teamwork and conflict resolution.

My Daughter, Leah Kutcher - captain of the 2006 Dalhousie women’s soccer team - worked with Katie Orr at the Dalhousie International Health Office and coach Graham Chandler to send extra uniforms, equipment and soccer balls to Ugandan teams who lacked the materials needed to play. The Halifax City Soccer Club also contributed uniforms and equipment.

A program update from CPAR earlier this year reported that the uniforms and equipment were successfully distributed to youth teams in Laiby and Bungaterra. The update also reported the establishment of many community-organized sports, music and drama programs and Peace Clubs, allowing Ugandan youth to finally start building a better, more peaceful future.

Since then Stan Football Club (Stan FC) is thriving! Their latest blog entry is evidence of their success:

Stan football club players were honored by youth coalition for peace (YCFP), a community-based organization working (CBO) in northern Uganda to participate in a five-day children soccer camp for peace. Players are learning lots of new skills and rules for fair play that can foster harmony and sustainable youth participation in sport for development. The camp is being facilitated by professional coaches from Canada.

They have some great photos posted on their site too!

~ Dr. Stan Kutcher

Today marks the start of National Mental Health Week (May 4-10, 2009). Halifax and the IWK Health Centre are privileged to be the national host for Mental Health Week events, but others are doing their part across Canada to build awareness.

As part of Mental Health Week Canada will celebrate National Child and Youth Mental Health Day on May 7. The day’s events will include an address by Dr. Stan Kutcher and the Honourable Senator Michael Kirby, a recipient of the Order of Canada for his lifetime of achievement on public policy issues and his commitment to confronting issues related to mental illness.

A quick snapshot of Mental Health Week news:

The Schizophrenia Society of Canada recently commissioned a Canada-wide survey to learn how it can support people living with schizophrenia and their families to recover the best quality of life possible. The extensive survey, the largest of its kind in North America, highlighs certain key areas in which quality of life can be improved for people living with a mental illness.

The Mental Health Foundation of Nova Scotia has launched a mental health awareness campaign that looks really sharp.

OurHealthyMinds.com, a Capital District Health mental health website, is launching officially on May 7.

The Canadian Mental Health Association and Desjardins Financial Security are encouraging Canadians to test their stress levels over the lunch hour. Volunteers and Staff from CMHA will be handing out stress cards as part of a public education campaign to promote mental health in the workplace.

Stand Up For Mental Health, a program that teaches stand-up comedy to people with mental illness, will perform their inaugural show on Friday, May 8 in Ottawa.

Canada Post is accepting applications for mental health projects. In October 2007, Canada Post adopted mental health as its cause of choice, becoming the first major Canadian corporation to do so. Now, Canada Post has created an independent organization, the Canada Post Foundation for Mental Health, to support this often-overlooked  cause and stigmatized illness.

Sometimes you have to travel far and wide to meet the leaders in your field. Other times they come to you. Dr. Leslie Ramsammy is in Halifax this week speaking about health for all in resource-poor countries and meeting with local health providers.

Dr. Ramsammy is the Minister of Health of Guyana and the President of the Sixty-first World Health Assembly. In May of 2008 his address to the WHA highlighted the importance of mental health. Here’s an excerpt from his speech:

“There is no health without mental health” is a global recognition. I believe Mental health is not properly integrated into our primary health care system. What has happened since The world health report 2001?

The world health report 2001 – Mental health: new understanding, new hope brought mental health to centre stage and called upon nations to prioritize mental health as an integral component of health. The world health report 2001 recommended the following actions:

• to provide treatment in primary care and the community;
• to make psychotropic drugs available;
• to educate and involve the public, communities, families and consumers;
• to establish national policies, programs, and legislation;
• to develop human resources and link with other sectors;
• to monitor community mental health; and
• to support continued relevant research.

Historically due to stigma and discrimination those with mental illness have not received the care they needed to support their recovery to become valuable contributors to civil society. We have the knowledge we need today to provide cost-effective, evidence-informed mental health care to all those who require it without discrimination and to ensure equal access to all health care for those with mental illness. Although we have made significant strides forward we have a long way to go.

Vertical mental health services have perpetuated the segregation and stigmatization of those suffering from mental illness. Mental health can no longer be the orphan of the health care system: it must be integrated into general health services and available in the communities in which people live and receive other services. New models based on population mental health needs can be achieved through enhancing competency of health care providers.

If only every Minister of Health around the world were so committed to advancing the understanding of mental health and mental illness.