It’s hardly a day goes by that we don’t read about depression and its impact on people and the economy and the toll it takes with suicide. We also read about how wonderful treatments are and how it is important to get help as soon as possible. All the above is true and for sure if I, or one of my loved ones, or one of my friends, was depressed I would certainly opt for immediate treatment with an antidepressant medication and an evidence based psychotherapy, delivered by competent health care providers.

But, and this is a big but – the evidence shows that good as our treatments are, they are not as good as they should be. The medications really help a lot but they do not help everyone. The psychotherapies help a lot but they do not help everyone. Combining the treatments helps more people but even this does not help everyone. So what do we need to do?

Well, it’s all well and good to make our systems of care more accessible and to train more health care providers to be able to treat depression but wait a minute. Shouldn’t we be spending a whole lot of time and effort on making our treatments better? Shouldn’t we be making sure that when we offer a treatment to someone the chances of it working the first time are as close to 100 percent as we can get? What would you prefer – a one day wait time for a treatment that works 50 percent of the time or a one week wait time for treatment that works 90 percent of the time? And while we are at it – why not a one day wait time for a treatment that works 100 percent of the time.

So we need to invest in treatment research. We can have all the health care providers and all the clinics and all the nice posters on the walls of schools and neat anti-stigma ads on the television and radio and on and on and on – but, if we do not get better at treatment, how much further are we really ahead? Do you know how many high powered (meaning really good scientific studies) have been done in Canada in the last five years on the treatment of some of the most common mental disorders that begin in adolescence. One? Five? Nine? Maybe none? Do you have any idea how much money is being spent on finding out how to better treat young people that have psychosis or depression or obsessive compulsive disorder compared to treatments for other medical illnesses or even compared how much is spent on posters that tell youth about problems? Don’t you think you should have some idea?

We need to invest in a major way in learning better ways to treat mental disorders in this country. We are not doing that in Canada. It is time we started to. Improving access to care is a good idea. Improving access to care that actually works is an even better idea.

-Stan

September 22, 2009

Recent events in the National Basketball Association (NBA) involving two high profile players, Delonte West and Michael Beasley have highlighted the issue of mental health in the NBA.  And, this is an important step forward, not only for the NBA in specific but for professional sports in general.

Professional athletes are no less likely to suffer from mental disorders than the general population.  We can expect that approximately 10 to 15 percent of professional athletes will have significant and substantial mental health problems, including mental disorders.  The most common mental disorders will be: depression, anxiety disorders and substance abuse.  A few may have bipolar illness or other psychotic conditions.

These disorders will affect them in both their personal and professional lives.  Athletes living with mental disorders can expect to have the same challenges that people who are not athletes but who are living with mental disorders have.  These include but are not limited to personal problems and decreased job performance.  One important difference however is that professional athletes are very high profile.  Their lives are often lived in a public arena.  When they have problems these are difficulties are known to the many, not only to the few. 

When mental disorders in professional athletes lead them to experience personal and professional difficulties these can be publicly addressed in positive or in negative ways.  One positive way may be for their employers (professional sports teams) or their associations (players associations, professional leagues such as the NBA , the NHL and others) to publicly acknowledge these difficulties – much as they now do with physical illnesses or injuries.  Another way may be for the players themselves to be open about their problems and to discuss them much as they discuss any physical injuries or other similar issues.  Another way may be for the sports media to become more knowledgeable about mental health problems and mental illnesses and to write their stories from a position of understanding.

Mental disorders affect everyone – including professional athletes. How they, their employers and the media handle these issues may have an important impact on how society in general and youth in particular understand mental illness.  Its time for professional sports to get “on side” – so to speak.

-Stan

We’ve had a lot of great feedback from our post on schools as the next frontier for mental health education.

We all know the problem. Mental disorders represent the most common and disabling condition affecting young people and therefore have major implications for students and for schools. In short, mental health problems affect a student’s emotional well-being, their ability to learn, are a factor in why some students drop out of school.

But too often we focus on the problems instead of the solutions. In a recent article entitled “Mental health in schools: how teachers have the power to make a difference” for Health and Learning Magazine, Dr. Kutcher, Leigh Meldrum and I outlined a three-pronged approach to address mental health problems in schools. Here’s an excerpt:

Schools can be an important location for mental health promotion, early identification and intervention, combating stigma associated with mental illness and possibly providing interventions and ongoing care. But as a teacher, what can you do to make a difference in the mental well being of your students? The answer is not always easy, and requires cooperation at all levels of the education system and a positive collaboration with health care providers.

Using the classroom for stigma reduction

One of the largest obstacles facing youth with mental illness is the associated social stigma against people living with a mental disorder. While the scientific understanding and treatment of mental disorders, as well as the awareness of the importance of mental health in all aspects of life, has advanced considerably in the past decade, the public’s perception about people with mental illness has been much slower to change.

In the classroom, stigma associated with mental illness can affect how teachers, classmates, and peers treat the student living with a mental disorder. School-based anti-stigma activities present an opportunity to enhance understanding of mental illness and improve attitudes towards people living with mental illness. Furthermore, school-based anti-stigma activities reach people on all social levels, from teachers, principals and administrators to parents and community members to most importantly, the students themselves.

Identify and intervene!

Early identification and effective intervention for youth with mental disorders is critical. If left untreated, the symptoms of a mental illness may increase in severity, and its effects may become more serious and potentially life threatening. Educators and school personnel are in an ideal position to recognize behavioural or emotional changes, which may be symptomatic of the onset of mental illness.

By providing training related to youth mental health and mental disorders in young people that is specific to educators we will be better equipped to protect and promote the mental health of our youth. Educator-specific programs, such as Understanding Adolescent Depression and Suicide Education Training Program, addresses the signs and symptoms of depression, as well as risk factors for suicide, methods of identification and appropriate referral of high-risk youth. The basis of this innovative Canadian program is supported by documented evidence of effectiveness and has been demonstrated to improve mental health literacy in educators and health professionals.

School curriculum meets mental health promotion

A potential starting point for the integration of mental health care into existing school health systems is through the implementation of a gatekeeper model. A gatekeeper model provides training to teachers and student services personnel (such as social workers, guidance counseling, school psychologists) in the identification and support of young people at risk for or living with a mental disorder. It also links education professionals with health providers to allow for more detailed assessment and intervention when needed.

Schools can also address students’ mental health through the implementation of mental health promotion strategies through innovative curriculum initiatives. Improving mental health literacy through curriculum development and application could enhance knowledge and change attitudes in students and teachers alike, and embedding mental health as a component of health promoting activities could enhance mental health while decreasing stigma associated with mental disorders. Two examples of recently developed Canadian mental health curriculum for schools are: Healthy Minds, Healthy Body (Province of Nova Scotia) and the Secondary School Mental Health Curriculum (Canadian Mental Health Association).

Read the full article online in the May 2009 issue of Health and Learning.

~ David Venn

Try playing this little game with a friend, parent or co-worker.

Ask them to list three adjectives that describe a person with mental illness. Then ask them to list three adjectives that describe a person with breast cancer. Finally, ask them to list three adjectives that describe a friend.

More than likely the person will use words like “crazy”, “sad”, “depressed”, “lonely”, “patient”, “consumer or victim”, “scared”, “down”, “violent”, etc. to describe someone with a mental illness.

In describing someone with breast cancer they will likely use words such as “strong”, “confident”, “undeserving”, “survivor”, “thriving”, “family connection”, etc.

And in describing a friend the person will likely use words like “fun”, “caring”, “happy”, “smart”, “loyal”, “honest”, “responsible”, etc.

See the difference?

Whether you play this game with youth, parents, educators or even health professionals you get the same result - positive words to describe a friend or a  physical health problem like breast cancer and negative words to describe a mental illness like Depression.

And what if the your friend had Anxiety Disorder or Depression? Would that change your perception of them as a fun, smart, caring, loyal person? Would they suddenly be relegated to being a crazy, lonely, scared patient?

The stigma surrounding mental illness runs deep. It is embedded in our actions, our culture and our language.

Imagine a time when we describe and perceive people living with mental illnesses the same way we describe and perceive our friends or people living with physical health problems!

In the past few weeks I’ve come across several advertising campaigns aimed at raising awareness about mental health problems. Two in particular focusing on Autism and Eating Disorders caught my attention (you can see why below).

Advertisers know what “sticks” when it comes to marketing: sex, shock and emotion. These approaches can be effective ways to sell products or promote a brand identity - but how well do they transfer into the world social awareness? Or for that matter mental health?

SEXY

The people at Sociological Images alerted me to this Rethinking Autism ad campaign. The RA site maintains that:

“All too often in the world of autism, celebrity and sex appeal are used to promote pseudo-science that exploits autistic people, their family members and the public.  We decided to put those very same factors to work in service of the truth.”

This is a clever ad. It’s information is scientifically-based and it captures your attention.

But is it effective?

While I get the tongue-in-cheek reference that Autism has become a “sexy” topic of discussion, I question whether the core message gets buried beneath a sea of lingerie.

The Rethinking Autism website claims to want to “change the conversation one video at a time”, but are we changing the conversation towards Autism and debunking pseudo-science or does the ad instead meander towards a debate about the objectification of women as sex objects. If the latter then the message is lost.

EDGY

Next up is a series of ads from the Looking Glass Foundation for Eating Disorders based in Vancouver BC.

The ads are edgy alright - but their message is misleading. The tagline in the ads is “Not every note is a suicide note” - which falsely implies that eating disorders are a method of suicide. We know this is not true.

So while the ads are effective in shocking us, they do little to advance discourse because of their false message - in fact they may even perpetuate the myth that eating disorders are motivated by suicidal intent.

EMOTIONAL

Finally an anti-stigma ad campaign from the Mental Health Foundation of Nova Scotia (see video on their homepage).

The ad uses personal narratives, emotional music and dream-like backgrounds to tell a story. In under a minute the video captures the pervasive stigma that accompanies mental illnesses, touches on the scientific basis of mental disorders as brain disorders, points to the need to improved resources to meet the needs of those living with mental illnesses and challenges the viewer to talk more openly about mental illness and mental health.

Effective doesn’t have to be flashy and this ad is a great example of the power of emotion and story to communicate an important message.

~ David Venn

New government figures out this week in the UK claim that public attitudes towards people with mental illness have reached a tipping point.

The Department of Health survey shows improvements including:

• 77% agree mental illness is an illness like any other an improvement of 3% on last year and up 6% since 1994
• 73% think that people with mental health problems have the same right to a job as everyone else, up 7% on last year
• 78% judge the best therapy for people with mental illness is to be part of a normal community, up 8% on last year
• 61% agree that people with mental illness are far less of a danger than most people suppose, an improvement of 4% on 2008

However, it also includes some more alarming figures:

• 11% would not want to live next door to someone with a mental health problem, an increase from 8% since 1994
• Almost a third of young people (16-34yrs) think there is something about people with mental illness that makes it easy to tell them from ‘normal people’
• 52% of young people agree people with mental illness are far less of a danger than most people suppose, 17% less than people over 55yrs
• 22% feel anyone with a history of mental health problems should be excluded from taking public office
• When the issue is brought closer to home - only 23% feel that women who were once patients in a mental hospital can be trusted as babysitters.
• 65% underestimated the actual prevalence of mental illness and only 13% were aware that 1 in 4 people will experience at mental health problem.

Stigma is essentially the polite word for discrimination. It has no place in our caring society. While some public attitudes toward people with mental illness are improving, the numbers above suggest we still have a long way to go.

It is all too easy to look at these numbers with rose-coloured glasses and proclaim that we have reached a tipping point. However I believe the Canadian Medical Association’s assessment of a similar study conducted last year to be more accurate when they called Canadian stigma and attitudes a “national embarrassment“.

Findings from that report (pdf) indicate:

• One in 10 thinks that people with mental illness could “just snap out of it if they wanted”
• One in four Canadians is afraid of being around someone who suffers from serious mental illness.
• Only half of those surveyed would tell friends or co-workers that a family member was suffering from mental illness.
• Only 16 per cent said they would marry someone who suffered from mental illness, and 42 per cent said they would no longer socialize with a friend diagnosed with a mental illness. By contrast, 72 per cent would openly discuss cancer and 68 per cent would talk about diabetes in the family.
• Half of Canadians think alcoholism and drug addiction are not mental illnesses.
• One in nine people think depression is not a mental illness, and one in two think it is not a serious condition.
• Almost half of Canadians (46%) think the term “mental illness” is used as an excuse for bad behaviour;
• A solid majority of Canadians would not have a family doctor (61%) or hire a lawyer (58%) who has a mental illness;

Stigma against the mentally ill is recognized as one of the greatest barriers to social justice, appropriate health care and development of civic society. We are not at a tipping point yet, but hopefully sometime soon.

~ David Venn & Dr. Stan Kutcher

(image credit: nite fate)