American Medical Association (AMA) Calls for Remedies for Psychiatric-Bed Shortage

From the July 18th edition of Psychiatric News:

By Mark Moran

Physicians from all specialties emphasized the scope of the problem and that it is embedded in other, larger problems in American health care, such as the rising number of the uninsured and the closing of psychiatric units.

Diminishing access to psychiatric beds and the resulting overcrowding of emergency departments is an urgent crisis and a national disgrace, said psychiatrists, emergency department specialists, and other physicians at the AMA's House of Delegates meeting last month in Chicago (see Psychiatry-Related Issues Prominent on AMA Agenda).

With virtually unanimous support, the AMA house called for efforts to facilitate access to both inpatient and outpatient psychiatric services and the continuum of care for mental illness and substance abuse as a means of relieving pressure on emergency departments (EDs) across the country that have been forced to board patients in crowded hallways—sometimes for days—before available beds can be found.

The recommendations were part of a report titled "Access to Psychiatric Beds and Impact on Emergency Medicine," prepared by the AMA's Council on Medical Service.

Experimental Schizophrenia Drug Shows Encouraging Results

From the July 18th edition of Psychiatric News:

By Joan Arehart-Treichel

A small study of patients with schizophrenia taking an alpha-7 receptor agonist (DMXB-A) found a lessening of negative symptoms in those taking the experimental compound. Subjects also reported better organized thinking and behavior.

For a few years now, Robert Freedman, M.D., chair of psychiatry at the University of Colorado Health Sciences Center, and colleagues have been undertaking a valiant quest to find a drug that improves cognition and eradicates negative symptoms in individuals with schizophrenia—something that available medications for schizophrenia generally fail to do.

Specifically Freedman and his team have been trying to determine whether drugs that soup up the action of the alpha 7 nicotinic acetylcholine receptors in the brain—the so-called alpha 7 receptor agonists—might be the answer.

Two years ago, they reported very preliminary, but heartening results for an alpha 7 receptor agonist called DMXB-A. Eleven subjects with schizophrenia were found to experience significantly better cognition a day after receiving DMXB-A than a day after getting a placebo. Improvement in attention was especially notable. Results were published in the June 2006 Archives of General Psychiatry [AJP] (Psychiatric News, July 21, 2006).

Now Freedman and his group report more encouraging results regarding DMXB-A. The results, which first appeared online in AJP in Advance on April 1, will be published in the August print edition of the American Journal of Psychiatry. Freedman is editor in chief of the journal.

To read the entire article, click here:

Also see:
Initial Phase 2 Trial of a Nicotinic Agonist in Schizophrenia

Molecular model of the alpha-7 nicotinic receptor courtesy of Dr. Jerrel L. Yakel.

Public engagement in setting priorities in health care

From the July 1st edition of the Canadian Medical Association Journal:

By Rebecca A. Bruni, BA, BScN, Andreas Laupacis, MD, MSc, and Douglas K. Martin, PhD, for the University of Toronto Priority Setting in Health Care Research Group.

Setting priorities in health care means allocating limited resources so that some programs are supported and others are not (Box 1, below). For more than a decade, patients, scholars and government reports have asserted that the public should have greater involvement in setting health care priorities (1), but progress on this front in Canada has been slow. We believe the merits of public involvement are compelling and in keeping with a democratic society's desire for an informed, fully engaged citizenry. In this commentary, we review the value of public engagement, address the perceived barriers and suggest ways forward.


Reference:
1. New B, editor. Rationing: talk and action in healthcare. London (UK): Blackwell BMJ Books; 1997.

To read the entire article, click here (PDF).

Moratorium still needed

To read this editorial from today's The Chronicle Herald, click here.

On the road to reduce poverty

From the July 7th edition of The Toronto Star:

By Carol Goar

The experts and activists have spoken. Now the Senate committee examining urban poverty wants to hear from the people.

This summer, Senator Art Eggleton and his five colleagues (three Liberals, two Conservatives) head out to ask Canadians what they want to see in a national poverty reduction plan, how it should be designed and who should pay for it.

They'll visit eastern Canada in August, Toronto and Montreal in September and the four western provinces in October.

The committee will provide witnesses with a 90-page report that distills the testimony it has heard over the past 18 months and sets out a list of options – 103 in fact – ranging from the complete replacement of the current income support with a guaranteed annual income to a few low-cost adjustments.

Even those who don't plan to attend the hearings will find Poverty, Housing and Homelessness: Issues and Options (available at by clicking here) an excellent primer.

To read the entire article, click here.

Photograph of Senator Art Eggleton courtesy of the Senate of Canada.

North Carolina Teen Shocked By Taser Died From Change In Heart Rhythm

Posted July 3rd on WSOCTV.com:

CHARLOTTE, N.C. -- Autopsy results released this week reveal why a 17-year-old who police shot with a Taser died in March.

Darryl Turner was in an altercation with his boss at the Food Lion on Prosperity Church Road in north Charlotte when someone called police. Police said he was highly agitated when an officer shot him with a Taser. Turner was pronounced dead at the hospital a short time later.

Turner's autopsy says the stress of the situation and the shock from the Taser was too much for his body to handle. It says he died of acute ventricular dysrhythmia and ventricular fibrillation. In other words, his heart was pumping so fast and irregularly that he died.

The report states Turner did not have heart problems and he didn't have drugs in his system except for the medicines emergency workers used trying to save his life.

Turner's grandfather, Donald Fontenot, saw the report and said he's angry.

"Very much so. Why wouldn't I be? You know, you take a 17-year-old child away," he said.

Turner's family has not said whether they plan to sue police. They hired an attorney in March after a witness said Turner was obeying the officer’s commands when he was shocked. Police said Turner had been threatening the officer.

Police are doing their own internal investigation to see if the officer who used the Taser followed the rules. That officer is back on active duty after being put on administrative leave following the incident.

Critics say N.S. restrictions on stun guns do nothing to clarify use of weapon

From The Canadian Press - July 10th:

HALIFAX — The Nova Scotia government issued new restrictions on the use of Tasers on Thursday, claiming the measure will help clarify when the powerful devices are deployed.

Justice Minister Cecil Clarke said he would immediately limit the use of stun guns to instances where police officers face "violent or aggressive resistance or active threat to the law enforcement officer, the subject or the public."

Clarke said the interim guideline is aimed at ensuring the controversial weapons are used appropriately by police forces in the province. An earlier study done for the province found police officers have become increasingly reliant on the so-called Conducted Energy Devices.

But Clarke refused to impose a ban on them despite lingering questions over the death of Howard Hyde, a Dartmouth, N.S., man who died after being Tasered by police last year.

"There is no moratorium," he told reporters at the legislature after the release of a 36-page report, which was prompted by Hyde's death.

"In the vast number of occasions the Taser has been effective and safe when deployed."

But critics panned the announcement, saying it will do nothing to create clear standards for Taser use and doesn't differ greatly from existing guidelines on when the devices should be used.

According to the old language, the device should only be discharged where there is "risk from aggression, violence or other reasonable conditions exist ... in the interests of public or officer safety."

NDP justice critic Bill Estabrooks said the measure is merely a stalling tactic and fails to provide any clear guidance on when the weapons are used.

"I'm disappointed in the delay, I'm disappointed in the lack of clarity," he said.

"I was expecting that they were going to make some clear decisions, particularly when it came to restrictions, use and accountability. I mean, the buck stops at the minister's desk."

Clarke called for the two-phase review by a panel of health, police and justice officials eight months ago, following the death of Hyde. The 45-year-old man died about 30 hours after he was Tasered by Halifax police.

Hyde, who suffered from paranoid schizophrenia, was arrested at his home for spousal abuse and was taken to police headquarters where he was shot with a Taser more than once.

He died after struggling with guards in a Dartmouth jail, leading to calls for an examination of the devices.

Stephen Ayer of the Schizophrenia Society of Nova Scotia said he was also disappointed with the review because it didn't include a ban or adequately study the issue of mental illness and how people with disorders are affected by stun guns.

He said the review should have included a recommendation that paramedics be on scene when someone with a psychiatric disorder or who suffers from acute agitation is hit with a stun gun.

"In my mind, there should be a moratorium," he said, noting that it's not known what caused Hyde's death since the autopsy results have yet to be released.

"The minister talks about violent or aggressive resistance. I'm concerned about that because someone who's acutely agitated would probably be putting up aggressive resistance."

The 50,000-volt weapons can be shot from a distance or in up-close stun mode - a pain likened to leaning on a hot stove, sometimes blistering the skin.

Nova Scotia's review is one of several across Canada ordered in the wake of the death of Robert Dziekanski, the Polish man who died after he was Tasered by RCMP officers at Vancouver International Airport on Oct. 14.

Reviews have also been ordered in British Columbia, New Brunswick, Newfoundland and Labrador, and nationally by the Canadian Association of Chiefs of Police and the Canadian Police Research Centre.

RCMP Supt. Blair McKnight of the Halifax division said the province's new restriction doesn't differ greatly from the Mounties policy on usage and that they're trying to align several different policies on when the devices should be used.

The RCMP announced last month that it will restrict Taser firings in the face of mounting public pressure on the national force to rein in what critics call "usage creep."

The Mounties said officers will have clearer direction on how and when the weapons should be wielded following renewed calls for action by the RCMP complaints commission.

Commission chairman Paul Kennedy released a final report echoing his interim call to limit Tasers to clashes where suspects are combative or risk serious harm to themselves, the police or the public.

Nova Scotia also announced it will appoint a co-ordinator who will establish new standards for the use of stun guns by law enforcement officers and conduct a full policy review.

Also see:
Nova Scotia restricts Taser use until review completed

Clarke tightens Taser use

Limits applied to Taser use

Image

Nova Scotia Justice Minister Cecil Clarke announces restrictions on the use of stun guns. The Canadian Press/Andrew Vaughan

Death Of Psychiatric Patient At New York Hospital Underscores Mental Health Care Crisis

A July 4th posting by Medical News Today:

The reported death of a woman at King's County Hospital in Brooklyn, N.Y., illustrates the dire need for more public services for individuals with mental illness, according to the American Psychiatric Association.

According to news reports, a woman who was suffering from agitation and psychosis, was kept waiting in the emergency room for almost 24 hours because the hospital reportedly did not have a bed available for psychiatric patients. She collapsed onto the floor and then lay there for approximately one hour before emergency room personnel tried to revive her. Tragically, the woman died of causes that have yet to be determined.

"The question is how and why hospital personnel could ignore a person who fell to the floor in an emergency room and stood by or walked around her while she died," said APA president Nada Stotland, M.D. "Still, the lack of emergency services for psychiatric patients is only one part of an overall health care crisis, which extends to and includes mental health services."

To read the entire article, click here.

Worsening of Symptoms Prevented by Early Detection

From the July 4th edition of Psychiatric News:

By Mark Moran

Negative symptoms such as cognitive deficits and lack of affect and volition have long been considered unmodifiable and appear to represent core neurobiological deficits of schizophrenia.

Reducing the duration of untreated acute psychosis in first-episode patients appears to prevent the worsening of negative symptoms—such as cognitive deficits and lack of volition, among others—at two-year follow-up.

That finding, from analysis of a public health intervention in Norway, suggests that early identification and treatment of acute psychotic symptoms may affect the core neurobiological deficit process of schizophrenia, and through this alter the course and prognosis for the better.

To read the entire article, click here.

Also see:
Prevention of Negative Symptom Psychopathologies in First-Episode Schizophrenia: Two-Year Effects of Reducing the Duration of Untreated Psychosis.

Insel: 'Different Kind of Science' Poised to Transform Psychiatry

From the July 4th edition of Psychiatric News:

By Mark Moran

Understanding genomic variation and how it affects normal or abnormal development of brain circuits in different ways at different points in time will help push psychiatric diagnosis and treatment into the 21st century.

Psychiatry is still awaiting the "disruptive innovations" in scientific research that have helped to reconceptualize disease in other areas of medicine, said Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), at APA's 2008 annual meeting in Washington, D.C., in May.

The study of genomic variation and its role in leading to changes in complex brain circuitry, recognition of the longitudinal and developmental nature of disorders, and the discovery of biomarkers linked to a more precise understanding of the pathophysiology of disease are the tools of a 21st-century science promising to transform the treatment of mental illness.

Insel said those same tools have been applied in other areas of medicine to reconceptualize the nature of disease and to reduce mortality dramatically for people with such disorders as cardiovascular disease and cancer.

In contrast, the diagnosis and treatment of mental illness, he said, have been stuck in a 20th-century model.

To read the entire article, click here.

NIMH Director Thomas Insel, M.D.: "Genes code for proteins that play out in particular brain areas at particular times to change the way brain circuitry develops. It's all about variation and how it plays out at each of these levels."

Photo credit: Mark Moran

150 Years of Hope: A Collection of Artifacts from The Nova Scotia Hospital

From the June 27th edition of Capital Health Update:

The Capital [District] Mental Health Program and the Dartmouth Heritage Museum have collaborated to recreate a piece of our history. 150 Years of Hope: a Collection of Artifacts from The Nova Scotia Hospital opens June 27 at 10 a.m. and runs until September 13 at Evergreen House. This was once the stately Victorian home of Helen Creighton, well-known folklorist. Evergreen House sits at 26 Newcastle Street, Dartmouth. Museum hours are 10 a.m. to 5 p.m. Tuesday through Sunday. For more information, please call the Dartmouth Heritage Museum at 464-2300.

Thanks go to Dachia Joudrey for bringing this article to my attention.

Milestone for this Weblog

Today this weblog had its 25,000th visit since November 25th, 2006. That works out to an average of 1,320 visits per month!

The first post to this weblog can be viewed by clicking here.

Thank you for visiting!

Painting by Louis Wain.

A new vision for mental health

From the Future Vision Coalition (United Kingdom):

Cabinet champion needed for better mental health for all, says new coalition

20 June 2008

The Prime Minister should appoint a Cabinet-level champion for mental wellbeing, according to a report produced by a coalition of seven leading health organisations.

'A New Vision for Mental Health' from the Future Vision Coalition, calls for action to build on the successes of the National Service Framework (NSF) for Mental Health, to put mental wellbeing at the centre of public policy and to improve the quality of life of all people with mental health problems.

It argues that action is needed to promote better mental health for all and to identify children at risk of mental distress for targeted support. It calls on mental health services to focus on helping people to get their lives back, not just to manage their illness, and to give those who use services more control over how money is spent on them.

A New Vision for Mental Health says that mental wellbeing is the business of the whole of government, not just the Department of Health. It needs a champion in the Cabinet to ensure all departments are working together to promote good mental health and to bring the voices of those who have mental health problems to the centre of government.

To read the entire press release, click here.

Recovery from Schizophrenia: An International Perspective

To read Rachel Jenkins' review of this book, published in the July 2008 edition of The British Journal of Psychiatry, click here.

To purchase Recovery from Schizophrenia: An International Perspective, click here.

Report of Residential Services: June 2008

From the Nova Scotia Department of Community Services, Services for Persons with Disabilities:

Executive Summary

In November 2006, the Department of Community Services, Services for Persons with Disabilities Program commenced a review of all residential services for persons with disabilities in Nova Scotia. Helen Patriquin, a private consultant, conducted the review under the direction of Mildred Colbourne, Director, Services for Persons with Disabilities Program, and with the assistance of program and regional staff working with persons with disabilities.

The consultant conducted site visits at various residential options and also distributed a questionnaire to other service providers. All information was documented and analyzed in conjunction with departmental resources, especially the program area and the regional offices.

The Services for Persons with Disabilities program area provides residential and other supports to three broad population groups:

1. Individuals with intellectual disabilities.
2. Individuals with long-term mental illness.
3. Individuals with physical disabilities.
   

Approximately 4,800 individuals with disabilities are provided services and support at this time. Another 400 individuals are currently awaiting services.

This report provides the findings, recommendations and a plan to address the action items, or areas of concern, that have been identified. Major themes were recognized throughout the review and are the focus of this report. These themes include:

• Leadership and direction for the program.
• Governance and leadership in the sector.
• Integration and coordination of services and supports.
• Programming and supports for individuals with disabilities.
• Quality and best practices.
• Eligibility criteria and assessment processes.
• Waiting lists and residential options.
• Human resource issues.
• Infrastructure issues.
  

This report provides a comprehensive examination of current services and supports for individuals with disabilities. It is with great gratification that we can state that because of the tremendous commitment of staff of the Department of Community Services and the many service providers throughout the sector, the system has been able to serve the needs of individuals with disabilities despite the current limitations. These limitations, however, are at a critical point and must be addressed to ensure that persons with disabilities have access to a range of services and supports that will enable them to live to their fullest potential within their communities.

The plan outlined further in this document details a long-term strategy to address the gaps in residential services and supports for persons with disabilities. These recommendations have been developed following extensive consultation and review of best practices in other jurisdictions, along with current research, such as the Kirby Report (2006). While preliminary costing has been completed at this time, further work is required to specify the funding commitment required on a per year basis to move the strategy forward.

The Department of Community Services would like to thank all of those individuals and organizations that assisted in this review through participation in a site visit, completion of questionnaires, attendance at meetings, and other input. Certainly without this level of participation we would not have been able to move forward.

To read the entire report, click here (added to the Nova Scotia Department of Community Services website on Monday, June 30th, 2008).

Also see:
Investment to Improve Quality of Life for Persons with Disabilities (June 17, 2008)

A 12-step program for Canada

From today's edition of The Globe and Mail:

Setting priorities and solutions to address the mental health crisis.

To read this excellent article by André Picard, click here.


From www.andrepicard.com:

André Picard is the public health reporter at The Globe and Mail and one of Canada's top public policy writers.

He is the author of the best-selling books CRITICAL CARE: Canadian Nurses Speak For Change and THE GIFT OF DEATH: Confronting Canada's Tainted Blood Tragedy. He is also the author of A CALL TO ALMS: The New Face of Charity in Canada.

André has received much acclaim for his writing, including the Michener Award for Meritorious Public Service Journalism, the Canadian Policy Research Award, and the Atkinson Fellowship for Public Policy Research.

In 2002, he received the Centennial Prize of the Pan-American Health Organization as the top public health reporter in the Americas. In 2005, he was named Canada's first Public Health Hero by the Canadian Public Health Association, and in 2007 he was honoured as a Champion of Mental Health.

André is also a four-time finalist for the National Newspaper Awards – Canada’s Pulitzer Prize.

He has been the recipient of the Canadian Nurses' Association Award of Excellence for Health Care Reporting, the Nursing in the Media Award of the Registered Nurses Association of Ontario, the International Media Prize of Sigma Theta Tau (Nursing Honor Society), and the Science and Society Book Prize.

His advocacy work has been honoured by a number of consumer health groups, including Safe Kids Canada, the Canadian Mental Health Association, the Canadian Alliance on Mental Illness and the Canadian Hearing Society.

He lives in Montréal.

Photo of André Picard courtesy of www.andrepicard.com.

More help for people with mental illness

From the June 27th edition of The Chronicle Herald:

People living with mental illness in Halifax will soon have more resources at their disposal, thanks to a $46,000 investment from the Mental Health Foundation of Nova Scotia.

The foundation said Thursday that it will provide new funding for three programs in metro through its provincial grants program.

Grants will be awarded to the YWCA of Halifax, the Schizophrenia Society of Nova Scotia and Laing House, a local youth support centre.

"Thanks to these organizations and the quality programs they offer to mental health patients and their families, we are changing the way people think about mental health," Myrtle Corkum, the foundation’s executive director, said in a release.

"Slowly, we are seeing a shift from stigmatizing, silence and isolation to acceptance, inclusion and understanding."

The grants will be used to fund educational initiatives, housing programs and support groups for family members and friends of people [living with] mental illness.

The Scottish solution: 'Look good but feel crap?'

From today's edition of The Globe and Mail:

Scotland has become a leader in tackling mental illness, thanks to innovative legislation and high-profile public-awareness campaigns. The suicide-prevention effort features everyone from football teams to the pop duo the Proclaimers.

To read the entire article, click here.

Eleanor Trebilcock of Arbroath, Scotland, with her dog Jake. After suffering with depression, Ms. Trebilcock became a product of the country’s old thinking about mental illness, but she’s also benefited from its new approach. 'The stigma,' she said, 'is slowly disappearing.' (Randy Quan for The Globe and Mail)

BY THE NUMBERS

25 to 33 - Percentage of Scottish people experiencing mild to moderate mental-health problems, out of a population of five million 3 Percentage of the population with severe and enduring mental illness

1 - Ranking of suicide as the cause of death for Scots under 35 years old

765 - Number of suicides in Scotland in 2006

13 - Percentage decline in the suicide rate since 2002

20 - Percentage drop that Scotland wants to see in the suicide rate by 2013 (from the base year 2002)

Also see: The branding that devalues.

'The mad and the bad'

From today's edition of The Globe and Mail:

The mentally ill are often saddled with a double stigma, cycling through the justice system without getting treated for underlying disorders. As Dawn Walton reports, the prisons are full of people with mental problems, many of them so-called frequent fliers.

To read the entire article, click here.

Corry Grunsky, with granddaughter Cera Smith and mother Mary Lewis, in Edmonton. Drugs became Ms. Grunsky’s crutch – and livelihood – after she was diagnosed with depression and bipolar disorder. Convicted of drug dealing, she calls her time in federal prison 'a complete joke.' (John Ulan for The Globe and Mail)

Addiction Prevention and Treatment Services: Capital Health

Community Oriented Recovery Environment (CORE) schedules for July 2008:

Morning Schedule [Starting July 14th, 2008] (PDF)

Treatment/Discussion Groups (PDF)

The express route to mental illness

From today's edition of The Globe and Mail:

From the lab to the legislature, the push is on to recognize and treat addiction as a mental illness. A growing body of research finds addiction is not the result of bad behaviour or weak character, but the result of biochemical disruptions in the brain that genetically vulnerable people are, on their own, powerless to overcome. It distorts mood, clear thinking and compulsion control. People who suffer from it, scientists believe, can no more talk themselves out of their dependence any more than people can talk themselves out of depression.

To read the entire article, click here.

The push is on to recognize addiction as a mental illness (Tonia Cowan/The Globe and Mail)

Click on the image to enlarge it.