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!

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

Ever wonder where funding for mental health research goes? Or how research evidence informs medicine and practice?

The scientific evidence used in medicine comes from a pool of tens of thousands of published research studies. There are many types of studies, and the design of any given study usually depends on the question that the researchers want answered. Studies can differ considerably in the way they are designed and conducted, and can therefore differ considerably in quality.

Often the scientific community behind mental health research, studies and reports don’t get a lot of attention or gratitude, but without them our knowledge of mental health and mental illness would develop pretty slowly.

Evidence-based medicine is extremely important in the treatment of mental illness in general, and is particularly important in the treatment of mental illness in children and adolescents.

Here are some recent examples of research related to adolescents conducted by the National Institute of Mental Health.

(Our group is not affiliated with any of these studies, their results or NIMH)

Anxious and Depressed Teens and Adults: Same Version of Mood Gene, Different Brain Reactions

An NIMH study using brain imaging shows that some anxious and depressed adolescents react differently from adult patients when looking at frightful faces. This difference occurs even though the adolescent and adult patients have the same version of a mood gene. Researchers in the NIMH Mood and Anxiety Disorders Program and colleagues reported these findings online October 31, 2008, in the journal Biological Psychiatry.

Depression Relapse Less Likely Among Teens Who Receive CBT After Medication Therapy

Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Suicidal Thinking May Be Predicted Among Certain Teens with Depression

Certain circumstances may predict suicidal thinking or behavior among teens with treatment-resistant major depression who are undergoing second-step treatment, according to an analysis of data from an NIMH-funded study. The study was published online ahead of print February 17, 2009, in the American Journal of Psychiatry.

Getting Closer to Personalized Treatment for Teens with Treatment-resistant Depression

Some teens with treatment-resistant depression are more likely than others to get well during a second treatment attempt of combination therapy, but various factors can hamper their recovery, according to an NIMH-funded study published online ahead of print February 4, 2009, in the Journal of the American Academy of Child and Adolescent Psychiatry.

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

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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