Recently, The Chronicle Herald published a story titled “Young people need more access to mental health services – volunteer.” While I agree with this message, we must also begin to think about how we can better provide mental health care, and not just keep applying a model of mental health services that does not appropriately meet the needs of young people and their families.

Just doing more of the same will not result in substantial improvements in the mental health of our youth, nor will it ensure that those who develop and are living with mental illness receive the best possible scientifically validated care in the most timely and respectful manner. We have to begin to think differently and act innovatively.

First, we must use the best available scientific evidence to create, deliver and evaluate all programs and interventions that are provided to young people and their families. Fortunately, there is increasing recognition of this necessity among policy makers, care providers and the public.

Unfortunately, many programs in place or being promoted either have not been appropriately demonstrated to be effective, or their effectiveness is not known. Worse, some programs are known not to be effective, yet continue in place.

Second, we must think of how to provide mental health care, rather than mental health services. Currently, youth and families frequently must attend specialty mental health providers to receive care that could be more appropriately, more efficiently and perhaps even more cost-effectively provided in primary health care settings.

It is essential that effective and evidence-based mental health care be available throughout Nova Scotia in all primary health care settings. This can be achieved by modifying the way in which primary health care is delivered and by enhancing the mental health competencies of all primary care providers.

Third, we must meet young people where they are – that is, in their families and in their institutions.

Young children are profoundly influenced by their family environments and there is substantial scientific evidence that supports the use of specific early life interventions on improving outcomes for youth. These interventions should be widely available.

Concurrently, we know that our young people spend most of their lives in one of two institutions – schools or jails. It is imperative that we keep them in schools and enhance the capacity of schools to meet their mental health needs in conjunction with providing the best learning enabling environments possible.

In Nova Scotia, a number of initiatives, supported by various government departments are beginning to address this need. These innovations need to be further developed so that all our young people can benefit, and those of us who assist them in their growth and development can be better assured that our efforts will be likely to succeed.

~ Dr. Stan Kutcher

Realted:
Facing mental illness: a 10-step plan for Nova Scotia

Mental disorders collectively constitute the largest burden of disease in young people. They have substantial negative short- and long-term outcomes across many domains, yet early identification and effective intervention can improve outcomes and can often lead to recovery.

Unfortunately, many young people do not receive the mental health care they require and may consequently enter the justice system. Studies of incarcerated youths show that up to 70% of them have mental disorders. Many of these youth receive primarily custodial care.

A variety of social, legal and medical interventions can and should be implemented to ensure that young people suffering from mental disorders do not inappropriately enter the justice system due to lack of access to health care and other services.

While the exact number is unknown, it has been estimated that as many as half of the incarcerated population suffers from mental illness(es), a substance abuse problem, and/or a learning disability. Because of a shortage of services and a lack of understanding by society, the mentally ill are not receiving the care they require and instead are being criminalized by being sent to prisons. Supreme Court Justice Beverly McLaughlin in a statement in on March 8^th, 2007 stated that “Such people are not true criminals, not real wrong-doers in the traditional sense of those words. They become involved with the law because they are mentally ill, addicted or both.”

Similarly, many police officers believe that mentally ill perpetrators represent a disproportionate number of individuals incarcerated for minor crimes. Some family members have noted that crimes may be committed or encouraged to be committed in order for the mentally ill person to be arrested. This may represent a “faint hope” that arrest will lead to treatment which for a variety of different reasons is not otherwise available.

Last week Hon. Judge Michael McKee produced a report calling for 80 recommendations to patch up the cracks in New Brunswick’s mental health system.

“The stigmatization of the mentally ill, the criminalization of the mentally ill in our court system and the silos of government not working together, that’s something that’s gone on for essentially decades and it has to be fixed,” Murphy said.

We need to move away from the common misconception that locking someone up and throwing away the key is an appropriate manner by which to address mental health problems in our society. Mental illness and addiction are health issues and are not effectively dealt with by the criminal justice system.

Download: Together into the Future: A transformed mental health system for New Brunswick

~ Dr. Stan Kutcher & Ainslie McDougall

From the Mental Health Commission of Canada:

Canada is the only G8 country without a mental health strategy. The Mental Health Commission of Canada has been given the responsibility to work with Canadians to address this gap.

The first step is to work out shared goals to guide the development of a mental health strategy. The Commission is seeking public and stakeholder input on the eight goals that are set out in the document “Toward Recovery and Well-being- A Framework for the Mental Health Strategy for Canada”.

This draft framework document proposes a vision of WHAT a transformed mental health system should look like. Your input will help to finalize the draft document, and to set the stage for developing a detailed roadmap for HOW to achieve the eight goals it contains.

To participate online, go to http://mentalhealthcommission.ca and follow the links for stakeholder consultation or public consultation.

Your contribution to this exercise is important: it is only by working together that we will keep mental health issues out of the shadows – forever.

This online consultation is being hosted by the Mental Health Commission of Canada – an independent, not-for-profit organization dedicated to improving the health and social outcomes of people living with mental health problems and illnesses as well as to promoting the mental health and well-being of all Canadians.

Medical News Today, in mid-November carried a short story on the recently released Child and Adolescent Mental Health Services (UK) review.

The report, which contains 20 recommendations for Government, sets out a clear vision for how we can all take responsibility for promoting children’s psychological well-being and mental health and how we can best achieve a step change in the quality and consistency of services at all levels.

While there is much in this review to discuss – some excellent and some less so, I want to focus on one of the recommendations that addresses, (in part at least), the needs of youth – ages 18 to 25. Congratulations – and it’s about time!

I remember sitting as a member of what was called the Transitional Age Task Force in Toronto in the mid 1980’s (so the UK report is only 20 years later – but at least they got to it which is more than I can say for much of Canada) and working with various stakeholders to consider how to address the mental health care needs of youth in this age group.

At that time the research was just coming in, and it was showing that the majority of what had traditionally been considered to be “adult” mental disorders actually onset during the late teens and early twenties. Furthermore, nascent brain development research was identifying substantial neurodevelopmental processes underway during those years – problems or perturbations in which (such as defective pruning of dopamine receptors) was being linked to major illnesses such as schizophrenia and bipolar disorder. Indeed, we re-designed our “adolescent psychiatry unit” at Sunnybrook Hospital to address this age group and did not know that we were in the vanguard of the “first onset” movement.

So if such a high proportion of major mental disorders (for example: depression; panic disorder, social anxiety disorder; bipolar disorder; schizophrenia) onset during these years, why have we not designed services to meet these needs. On the contrary, traditional mental health services have hacked a gap between child and adult systems just when the need for continuity and integrative care was most necessary. Why do child mental health systems across Canada cut off around 17 – 18 years of age? What reason is there to send a young person with unique developmental needs who is struggling from the impact of a recent onset major mental illness to an “adult” program that is not designed to meet her or his needs? It simply makes no sense!

And, just before we get too complacent about this and say something silly such as “the research is only just coming in” let’s remind ourselves that the ancient Greeks had already noted this. So did the father of modern psychiatry Emil Kraepelin and the father of the study of adolescence – George Stanley Hall (the later two over 100 years ago – the Greeks of course were on to this centuries ago).

Whatever the reasons, and they would be speculations, it’s time now to throw out a system that does not meet the mental health needs of young people and replace it with one that does. The CAMHS review is a good start at the policy level. There are good pilot programs in Canada and in Australia under the leadership of Dr. Patrick Mcgrory there is a national initiative well underway.

I propose that we have a national forum on this topic – and invite some international leaders and some of the young people that we had the privilege to serve in Toronto some 20 years ago and some of the young people that we are not serving well now. Perhaps now is the time.

~ Dr. Stan Kutcher

Ever find one of those websites you just can’t stop going to? A few months ago a friend sent me a link to TED - an annual conference devoted to technology, education and design. Now I’m hooked. Their site contains hundreds of archived talks from some of the world’s premiere thinkers and doers.

One of the most inspiring talks on the site is by Jill Bolte Taylor, a brain scientist who had a massive stroke and was able to watch and experience as her brain functions shut down one by one. It’s a pretty amazing story and gives insight into just how complicated the brain is.

Often it’s not until something goes wrong that we think about brain health, and how it’s just as important to keep our brains healthy as it is to keep our bodies healthy.

When the brain is not working properly or is working in the wrong way, a person may experience difficulty thinking or focusing attention, extreme emotional highs and lows, or sleep problems. When these symptoms significantly disrupt a person’s life, we say that the person has a mental disorder or a mental illness.

While we know that mental disorders are brain disorders, Jill Bolte Taylor’s story is an example that brain problems do not always indicate mental illness.

~ D. Venn

Teen Mental Health Blog is alive!

Our mission is to become the world’s premiere blog for child and youth mental health. Most of the entries will be written by me - Dr. Stan Kutcher. The blog be a place where people can come to get the latest news on youth mental health issues (policy, mental disorders, medications, school mental health, etc.)

This blog is part of teenmentalhealth.org a website dedicated to helping improve the mental health of youth by the effective translation and transfer of scientific knowledge. The website is a place where youth, parents, patients, educators, and health professionals can go to download resources and get information on youth mental health based on the best scientific evidence available.

What does the face of a person with mental illness look like?

That question is at the heart of this year’s national anti-stigma campaign “Face Mental Illness,” which is the theme of Mental Illness Awareness Week (Oct. 5-11). In Canada, one in five people is living with a mental illness. Mental disorders are some of the most disabling medical conditions, with about 70 per cent of them onsetting prior to age 25. They exact a huge negative impact on health, society and our economy. Yet a strong and persistent stigma prevents thousands of adults and youth from accessing and receiving the help they need to get well and say well.

While the scientific understanding and treatment of mental disorders and the awareness of the importance of mental health in all aspects of life have advanced considerably in the past decade, the public perception of people with mental illness has been much slower to change. A recent national survey conducted by the Canadian Medical Association found extremely high rates of stigma against those who suffer from mental disorders, permeating all aspects of Canadian society. This stigma is largely present in our social structures and institutions – including our health, social services, education and justice sectors.

Stigma is essentially the polite word for discrimination. There is no room in our caring society for discrimination against those living with mental illness. There is no reason for those living with mental illnesses to be denied adequate housing or equitable health care or to spend their lives in the shadows.

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