Just was reading an interesting article on police and mental health.  Not the mental health of police, although that would be a very important issue to know more about.  Can you imagine the stresses of that occupation?  But about how police respond to individuals who are exhibiting mental health problems, or individuals with mental disorders who are in distress or acting in such as way as to be causing distress to others.  So here is the piece: http://www.guardian.co.uk/commentisfree/cifamerica/2010/jul/14/police-mental-health-training. As you can see the title is: US Police need proper training in mental health.  And the sub-title is: “People suffering mental health crises are too often subjected to brutality by poorly trained and frightened police officers”  According to the writer (in a UK paper by the way): “Every day in various American communities, people enter mental health crises and their friends and family members pick up the phone to call for help. Often, the first responders on the scene are police officers, and the resulting interaction does not go well. Poorly trained and frightened police officers may resort to excessive force, and sometimes this ends in death for a person who is guilty only of being in urgent need of psychiatric care.”

Although the piece is long on hyperbole and heart wrenching descriptions of police attacking individuals suffering from mental disorders, and short on any substantive data and overall balanced reporting regarding what police forces are actually doing, the writer does bring attention to an important issue.  Certainly police officers should have more training in dealing with the unique needs of people who have mental illnesses and who are behaving in a way that may put them or others at risk of harm.  Certainly we need more and better community based mental health care services.  These needs are real and we have to get working on doing more.

But it is also important to recognize that much has been done in the last decade or so.  Here in Halifax, there is a mobile crisis service that I am proud to have been part of its launch.  It pairs police officers with mental health professionals.  It goes to where people need them and it works – not perfectly mind you, but it works.  One of my colleagues, Dr. Bianca Horner and members of the Department of Psychiatry and the Mental Health Program have developed a national training program for the RCMP, called “Recognition of Emotionally Disturbed Persons” regarding this matter.  Other police forces in Canada are now beginning to address this issue.  I have had the opportunity to be part of the Minister’s task force on TASER in Nova Scotia and the privilege to chair the sub-task force on excited delirium.  As a result of these reports there have been substantive movements towards improving all aspects of first responder approaches to individuals with mental disorders.

While these are a good beginning we certainly have to do more.  It is not appropriate nor is it fair nor is it right that our prisons have become holding bins for people who require mental health care.  The federal government has decided to build more prisons.  I for one would like to see them invest more in mental health care instead.  Don’t you think it’s preferable to treat someone who has a mental disorder in such as way as to assist and support their recovery instead of throwing them in jail?  I do.

–Stan

Interesting story in the Toronto Star. Seems that some bright inventor decided to apply restaurant technology to hospital clinics and ER waiting rooms. So, (wait for it) here is the amazing way forward! Yes, you guessed it – beepers. http://www.thestar.com/news/sciencetech/article/828089–the-wait-is-over-laval-inventor-tackles-waiting-room-frustration. Mrs. Jones, your table, er… guernsey is waiting. Please slip on this johnny gown with the gap at your backside and wait behind this curtain. Your health provider will be here sometime before H-ll freezes over. Actually, if you happen to be a patient with a mental health crisis it could take much longer than that.

If I had a dollar for every hour that a patient with a mental health crisis had to wait to be seen by the emergency physician in many of the hospitals that I have known, I could have retired a wealthy man. Why is it that people who have a mental disorder end up at the back of the line? Surely it can not be because of stigma in health providers? Surely it can not be because of inefficient care pathways? Surely it can not be because of inadequate numbers of mental health providers?

Maybe it is all of the above. In that case, you can hand out as many beepers as you want and nothing will happen. Mrs. Jones, your bed is ready for you. Sorry it took seventeen hours to get you there. If only you had a broken leg instead of a depressive psychosis accompanied by severe suicidal ideation we could have done a bit better. And your beeper? Please put it in that box over there. Mr. Watson will be needing it next. We only have one available for psychiatric patients and he has already been here six hours.

–Stan

The G(irls) 20 Summit delegates, Globe and Mail article, resonates with me. There is no doubt that the equality of women should be a joyous and wonderful thing celebrated by all women everywhere! But what is this meeting of delegates missing? Focusing entirely on women fails to address women’s equality and health. What? That’s crazy! Women and girls are facing inequality resulting in health disparities—shouldn’t we then focus on women? No, actually we shouldn’t.

Focusing exclusively on women is bad for the health of men and women. It fails to provide the necessary variety of perspectives about how gender interactions are contributing to inequality and how this could be addressed in a comprehensive manner.

There are negative consequences of societal gender expectations on all members of society. This includes the people, too often forgotten (at least in North America) who don’t fall into this fabricated gender binary. What about people who are not male or female? What does that mean? You know, people who identify as something other than male or female, including (but not limited to) gender queer people, transmales, transfemales, and intersex people. These groups of people are often ignored completely and face oppression to an exponential degree in comparison to women.

Imagine this. You’re suffering with mental illness and searching for your identity in a society that doesn’t represent you on the washroom label. You’re unsure of your gender identity because examples of others like you are lacking and your existence is denied in innumerable ways. How do you then go about treating your mental health issues (in a society poorly structured to deal with mental illness in the first place) or for that matter any of your other health issues that largely fly under the radar of most mainstream doctors?

Many trans people face a complex web of health issues (mental, sexual and physical health). This is further complicated by the lack of research pertaining to trans people and plausible solutions to the issues they face. A potential starting point for society to tackle this challenge is by backing trans-supportive organizations to take the lead on an international initiative with money and resources. Taking trans initiatives international has potential to provide insights about how other cultures treat trans people and how to improve our society.

But most importantly, we should be tackling the problematic gender expectations and we should be doing it in an all-encompassing/collaborative manner. That is, if we want to address inequalities and related health disparities successfully. Or we could continue attempting to separate inseparable social issues (gender inequality vis à vis males) and members of society (female, male, or gender queer) to create an illusionary solution for the illusionary “separate” issue.

–Holly Huntley

When I read the piece in the Globe and Mail about the G(irls) 20 Summit delegates, I was impressed. Kudos to Belinda Stronach and her Foundation for this innovative and necessary initiative.

Unlike the ongoing boondoggle involving fake lakes and public toilets well out of the reach of the public and denial of reproductive rights enjoyed by Canadian women to women in other countries, the Stronach initiative strikes the right notes.

Domestic violence, rape, the need for gender equality, the need for high quality easily accessible education, maternal health and well-being (including family planning) where all issues identified by the young delegates profiled in the Globe article.  Of course these are all issues that are too familiar with here in Canada as well – not to the same degree as in low and middle income countries but certainly in kind.  Guess what.  These are mental health issues as well.

Empowering girls and women and ensuring gender equality in all social, civil and economic undertakings are interventions that will spill over into mental health promotion and prevention of negative social and health outcomes.  This is an excellent way to address the social determinants of mental health – everywhere.

We have to do a much better job in this area globally and at home!  The mental health of nations must be built in part on national policies that promote and ensure the well-being of girls and women.  This is a task that we all must participate in.  I for one would like to see very piece of federal, provincial and territorial legislation reviewed to ensure that it promotes this agenda.  Sure we need mental health policies, programs and plans.  But we need a pro-gender equality framework that informs everything we do.

–Stan

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)