Sunday, April 29, 2007
The new Involuntary Psychiatric Treatment Act will be proclaimed in effect in Nova Scotia on July 3, 2007. The regulations that accompany this Act can be found here (downloads a PDF file; note: parts of some pages are missing).
Results from the first International Caregiver Survey provide significant insight into the experiences and concerns of families caring for individuals with mental illness.
Key among the findings were the harsh physical, emotional and financial consequences that occur within families when an individual’s treatment is disrupted.
The survey was developed by the World Federation of Mental Health and Eli Lilly and Company, and conducted by Ipsos-Insight and All Global Ltd. It included 200 Canadian families, as well as families in Australia, France, Germany, Italy Spain, the United Kingdom and the United States.
Keeping Care Complete: International caregiver survey
View PDF File
Friday, April 27, 2007
For immediate release – Today the Canadian Psychiatric Association (CPA) joined the expanded Wait Time Alliance to step up its advocacy for wait time benchmarks in psychiatry.
“Benchmarks establish what is adequate care and this makes it easier to hold the system accountable to patients and their families,” says Dr. Manon Charbonneau, President of the Canadian Psychiatric Association. “We want the federal government and health ministers to include serious psychiatric illnesses on their priority lists.”
More people die by suicide than from motor vehicle accidents. Most people who die by suicide have some history of psychiatric illness—and those who die by suicide are disproportionately young. We also know untreated depression is the greatest cause of disability in women of working age. “The tragedy is that too often such illnesses do not get treatment in time to prevent these horrible consequences,” says Dr. Charbonneau.
CPA published wait time benchmarks for patients with serious psychiatric illnesses last March. Timely access to psychiatric health services is critical for the 20 per cent of Canadians who will need mental health services in their lifetime.
The Wait Time Alliance of Canada (WTA) is a partnership of specialty associations and the Canadian Medical Association.
The Canadian Psychiatric Association (CPA) is the national voice for Canada’s 4,100 psychiatrists and more than 600 psychiatric residents. Founded in 1951, the CPA is dedicated to promoting an environment that fosters excellence in the provision of clinical care, education and research.
View the CPA policy paper on wait time benchmarks by clicking here.
Information: Hélène Côté, Canadian Psychiatric Association
Cell: (613) 797-5488
Wednesday, April 25, 2007
Earlier this month, American society imploded. In a cultural environment teeming with intense violence and in a country rife with lethal firearms available to just about anyone, another young man has lashed out at a society he believed had destroyed and rejected him. There was a wide range of reactions to this tragedy. Some are calling for stricter gun laws, others are pointing to violent computer games. There are many people who are calling for armed guards in their schools, and a policy of zero tolerance against young people with emotional problems.
The problems with the later approach are many. The main ones are the implications of punishing people or restricting their freedoms because of something that they might do. There is also the danger that, seizing on the fact that the individual was being treated for a mental illness, many people will come to believe a that all people with a mental illness are capable of such an act, when in fact that they are generally less prone to violence than ordinary individuals, if they are being properly treated.
The stigma attached to mental illness is only going to be reinforced by these events, especially in our schools, and make young people even more reluctant to get help if they have a problem, for fear of being seen as a psycho and a killer. This sort of attitude will only serve to make things worse by making other such tragedies even more likely.
This is no time for the mental health community to shrink from the task of educating the public about mental illness; rather it is a wake up call. People need to know the facts about mental illness now more than ever. This tragedy needs to be placed within a larger context, so that people do not respond to it in a way that will increase stigma. This is a wake up call.
The opinions expressed here are those of the author and do not necessarily represent those of the Schizophrenia Society of Nova Scotia.
For another opinion click here.
'Poppy Shakespeare could never have been written had I not spent nigh on a third of my life as a patient in the psychiatric system...'Thanks go to John Devlin for bringing this book to my attention.
Saturday, April 14, 2007
Tuesday, April 10, 2007
The Schizophrenia Society of Canada and the Provincial Schizophrenia Societies across the country are proud to announce the launch of a new, joint mission statement that promotes improved quality of life for individuals and families affected by schizophrenia.
The new mission inspires the societies to improve the quality of life for those affected by schizophrenia and psychosis through education, support programs, public policy and research.
“This exciting new mission statement recognizes the significant changes in our understanding of and approaches to mental illness over the last 20 years,” said Chris Summerville, Interim Chief Executive Officer of the SSC.
“Today, the emphasis is rightly upon the possibility of recovery, not the mere reduction of suffering. Thus a shared mission statement more accurately reflects the purpose of the work of the schizophrenia societies across Canada,” Mr. Summerville said. “It represents our shared passion to advocate for mental health services that are recovery oriented and enhance quality of life, that advance the needs, rights and abilities of people living with and affected by schizophrenia and psychosis.”
The new statement expands beyond symptom reduction alone to promote the fact that there is hope for individuals and families to improve their quality of life. It integrates the importance of medical and psychiatric treatment to achieve maximum symptom relief and control with the myriad of other health, social and economic factors that can also add to a person’s quality of life, including but not limited to: community-based psychiatric rehabilitation with access to psychological support services; peer support; family education; safe and affordable housing; adequate income security; meaningful work; court diversion programs and mental health courts.
Quality of life and recovery are very individual, noted SSC President Michael Thomson. “The new mission statement incorporates that individuality and it promotes the idea of working towards a quality of life and recovery level that is possible and appropriate for each individual.”
The focus on the individuals and their quality of life is particularly meaningful for many impacted by the illness.
“I think the new mission statement is more proactive,” said 24-year-old Tammy Lambert of Winnipeg, Manitoba, who was diagnosed 10 years ago. “It doesn’t focus on symptoms alone; it focuses on the future and it gives people hope that they may be able to achieve a better quality of life.”
“As parents of a son who is living with schizophrenia, we welcome this new mission statement and its broader emphasis on the person rather than the illness,” said Dennis and Amy Butcher. “It conveys the hope and the opportunities that exist for many individuals – with the right supports and services – to return to a quality of life that is meaningful and fulfilling.”
The adoption of a shared mission also enhances the societies’ ability to speak with one united voice on behalf of those affected by the illness.
“As we promote the work of our societies, both individually and together, the shared mission statement enables us to promote the same message across the country and this will be a significant advantage in our ongoing efforts to educate, raise awareness and reduce the stigma and misperceptions that abound about schizophrenia,” said Mr. Summerville.
Schizophrenia is a serious biochemical brain disorder characterized by delusions, hallucinations, disturbances in thinking and emotional and social withdrawal. Statistics show that one person in
100, or about 300,000 Canadians, will experience an episode of schizophrenia in their lifetime.
The Schizophrenia Society of Canada and the 10 Schizophrenia Societies across the country work independently and together to improve the quality of life of those affected by the illness through education, public policy, support and research.
Friday, April 6, 2007
NIMH Perspective on Antipsychotic Reimbursement: Using Results from the CATIE Cost Effectiveness Study
The recent publication (December 1, 2006, American Journal of Psychiatry) of the cost-effectiveness results from the National Institute of Mental Health (NIMH)-funded Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) has raised questions among advocates, families, and clinicians about reimbursement policies for antipsychotic medications.
Antipsychotics have now become the fourth largest group of medications prescribed in the United States, with a collective cost expected to surge past $10 billion this year. About 80 percent of the prescriptions for antipsychotics are paid via the public sector. The new atypical medications, representing 90 percent of the current market, are approximately 10 times the cost of the older conventional antipsychotics.
In a report in the September 22, 2005, New England Journal of Medicine, the CATIE research team compared discontinuation rates with four atypical antipsychotics (olanzapine, quetiapine, risperidone, ziprasidone) and one older conventional antipsychotic (perphenazine). The results demonstrated few differences overall among the various medications. The older medication, perphenazine, was as well tolerated as the newer compounds and as effective as three of the four newer drugs. The fourth compound, olanzapine, was slightly better than all the others in terms of discontinuation and hospitalization rates but was also associated with higher rates of weight gain and metabolic side effects.
The December 1, 2006 study analyzed the economic implications of the CATIE results and found that, because perphenazine was as effective overall and less expensive, the older antipsychotic medications such as perphenazine still have a valuable role in treating schizophrenia. The results should encourage doctors to reconsider the use of these older medications as another choice for patients with schizophrenia. This study should help expand the current list of medications most commonly used for schizophrenia, rather than restrict or reduce access to any of the antipsychotic medications. NIMH believes that this is important for the following reasons:
- Although the CATIE results suggest little difference in the overall effectiveness for the entire cohort, individual patients respond differently to different medications. To say the medications are equivalent is not to say they are identical. There is substantial variability in the response of individuals to these treatments. Future studies will focus on predicting individual patterns of response.
- There are additional outcomes to consider. Upcoming reports will describe the effectiveness of these various medications on quality of life and cognitive deficits. Cognitive impairment is a central clinical feature of schizophrenia and is strongly associated with functional outcomes.
- CATIE was limited to people with chronic schizophrenia who were moderately treatment-resistant. People with acute, first onset schizophrenia and those with other psychotic disorders were not included in this study. These patients may respond differently to antipsychotic medications.
- CATIE was an 18-month study. While this is longer than most clinical trials it is not long enough to fully consider whether patients would develop serious long-term side effects such as tardive dyskinesia, diabetes, or other medical conditions that can develop even years after starting medication.
Taking all these points into consideration, NIMH holds that families and physicians need more, not fewer, choices for addressing schizophrenia. A one-size-fits-all approach for treating schizophrenia could be harmful, essentially turning the clock back 40 years to an era when conventional antipsychotics were the only medications available for patients with this chronic, disabling disorder affecting 3.2 million Americans.
Tuesday, April 3, 2007
By Amanda Crabtree
In this month’s column, I have two exciting and long awaited announcements. In May, the Abbie Lane Mental Health Outpatient Department will move some of its services to Bayers Road Centre (the former Bayers Road Shopping Centre) in Halifax. The result will be the opening of Community Mental Health Services, Bayers Road on Tuesday, May 8th, 2007. We have also just confirmed that Dartmouth Community Mental Health will relocate to Belmont House [pictured above] on Alderney Drive in Dartmouth. We do not yet have a move date.
Information about Community Mental Health Services, Bayers Road is being provided to clients of the Abbie Lane Mental Health Outpatient Department and their families, community organizations, family physicians and others. All clients who will need to go to Bayers Road Centre to receive services will be contacted. We have set up a phone line where people can leave messages with questions about the move. The phone number is 473-4847. Messages left at this number will be returned within two business days.
We are in the early planning stages of moving Dartmouth Community Mental Health to Belmont House. This is why a move date is not yet confirmed. Once the move date is confirmed, clients will be notified.
We are very excited about both of these moves because through mental health strategic planning, we heard that clients wanted services located in their communities as much as possible. This is a first but significant step toward building relationships with residents, leaders and service providers in those communities. It will be these relationships that give us the knowledge we need to tailor our services to meet the needs of clients and their communities.
For more information on the Initiative, please e-mail or call me: firstname.lastname@example.org or 460-7401.
Sunday, April 1, 2007
From the Partnership for Workplace Mental Health, A Program of the American Psychiatric Foundation:
Most employers know that a mentally healthy workforce is linked to lower medical costs, as well as less absenteeism and presenteeism. And most employers know that a mentally unhealthy workforce is associated with increased loss of productivity. What employers may not know, however, is how to get from A to B: How does a company change a mentally unhealthy workplace — or a marginally healthy one — to a healthy workplace? Where does it start?
The Partnership provides some insight into that question with its just-released publication, A Mentally Healthy Workforce—It’s Good for Business. The document is unique because it weaves together stories from the workplace world with research findings to build a coherent picture of workplace mental health.
Click here to download a PDF version of A Mentally Healthy Workforce— It’s Good for Business.
John Devlin writes in to the Schizophrenia Society of Nova Scotia:
A while ago I was asked by the editor of a Cambridge University publication - the NEWSLETTER - to do up a little blurb on my thoughts on King's College, Cambridge architecture. It appeared online yesterday in their April/May 2007 issue and is here [click the word here].Indeed we do, John. Congratulations!
You scroll down to the very bottom to the last page and it is there [near the top left hand side of page 16]. This newsletter is not an alumni office publication but is an in-house magazine "for the staff of the University of Cambridge" as it says on the front cover.
I thought you might find it a bit interesting.
According to a recent review article written by Peter Byrne (right), Early Intervention Team for Ealing, Southall, United Kingdom, and published in the British Medical Journal:
The one year prevalence of non-organic psychosis is 4.5 per 1000 community residents (Ref. 1). Most new cases arise in men under 30 and women under 35, but a second peak occurs in people over 60 years. Psychotic symptoms had a 10.1% prevalence in a non-demented community population over 85 years (Ref. 2). Schizophrenia has a one year prevalence of 3.3 per 1000 people, and a lifetime morbidity risk of 7.2 per 1000 people (Ref. w1). Independent of known associations with migration and ethnic origin, increased economic inequality in areas of high deprivation also predicts a higher incidence of schizophrenia (Ref. 3). Some people who become depressed (one in five of us over a lifetime) also develop hallucinations and delusions, related to and “congruent with” their low mood.
Bipolar affective disorder has a lifetime prevalence of 1.3-1.6% (Ref. 4), and it is characterised by episodes of psychosis during both high (“manic”) and low (depressive) relapses. The misuse of substances, notably cannabis (Ref. 5), raises the prevalence of psychotic symptoms further — substance misuse partly explains the 10 times higher prevalence of psychosis in prison populations (Ref. 1). Psychosis occurs frequently in all forms of dementia including Parkinson’s disease. Other causes of organic psychoses are neurological disorders (epilepsy, head injury, haemorrhage, infarction, infection, and tumours) and most causes of delirium.
Altogether, therefore, acute psychosis is one of the most common psychiatric emergencies. There are explanations of psychotic “symptoms” other than the biomedical model of this review; medicalising psychosis as “an illness like any other” increases both public pessimism about outcome and the stigma attached to people with psychosis (Ref. 6).
1. Brugha T, Singleton N, Meltzer H, Bebbington P, Farrell M, Jenkins R, et al. Psychosis in the community and in prisons: a report from the British national survey of psychiatric morbidity. Am J Psychiatry 2005;162:774-80. (Download a free PDF of this paper by clicking here.)
2. Ostling S, Skoog I. Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old. Arch Gen Psychiatry 2002;59:53-9. (Abstract available by clicking here.)
3. Boydell J, van Os J, McKenzie K, Murray RM. The association of inequality with the incidence of schizophrenia: an ecological study. Soc Psychiatry Psychiatr Epidemiol 2004;39:597-9. (Abstract available by clicking here.)
4. Müeller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. Lancet 2002;359:241-7. (Abstract available by clicking here.)
5. Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, et al. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ 2005;330:11. (Abstract available by clicking here.)
6. Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the “mental illness is an illness like any other” approach. Acta Psychiatr Scand 2006;114:303-18. (Abstract available by clicking here.)
w1. Saha S, Chant D, Welham J and McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med 2005; 2(5): e141. (Download a free PDF of this paper by clicking here.)