The Iris

History of the Iris, our Floral Emblem

The Schizophrenia Society of Nova Scotia and the Schizophrenia Society of Canada adopted the Iris as an emblem for its crusade against mental illness in 1994. The Iris' three petals represent courage, wisdom and hope.

The National Alliance for the Mentally Ill (NAMI) and the National Alliance for Research on Schizophrenia and Depression (NARSAD) chose the flower following the historic sale of Les Irises, a painting by Vincent van Gogh, for more than $50 million in 1987. The English mental health organization, Schizophrenia - A National Emergency (SANE) also adopted the flower for its emblem in 1993.

Les Irises was painted in the garden of the asylum at St. Remy, in the south of France, in May 1889 when van Gogh was having his most desperate battle with a mental illness, now believed to have been schizophrenia. From the asylum he wrote numerous letters to his brother, Theo. In one of these letters, Vincent wrote a haunting account of his illness:

"As for me, you must know I shouldn't precisely have chosen madness if there had been any choice? What consoles me is that I am beginning to consider madness as an illness like any other, and that I accept as such."

During this period of his life, van Gogh reportedly painted at a frantic pace. He was discharged from the asylum, but the illness recurred and the following year he died by suicide. His paintings from this period are regarded by experts as his greatest works.

Throughout folklore, the iris has been regarded as the symbol of faith, hope and courage, one for each of its three sets of petals, and was given as encouragement to anyone who was suffering. With time, it became symbolized with warriors and soldier kings.

Legends tell of the victorious soldiers of King Clovis of the Franks crowning themselves with irises following the battle of Tolbiac in 496 AD. The flower became the symbol of Gaul in the first century and it was later proudly displayed by King Louis VII of France as his emblem during the second crusade. The flowers soon became known as the "fleurs de Louis", which eventually was altered to "fleurs de lys", now associated with the flag of Quebec. Artisans by this time had stylized the emblem so much that people forgot the original flower and assumed it was based on the lily.

The flower is also found in ancient mythology, where Iris was known as the "goddess of the rainbow", the swift-footed iridescent messenger of Zeus and his wife Hera. One of her duties was to lead the souls of dead women to the Elysian Fields. To encourage her, the Greeks planted irises on women's graves, a practice still in place.

Adapted from the Schizophrenia Society of Ontario website.

News from the 2007 International Conference

Families as Partners in Care: “How to Formally Include Families/Caregivers In your Mental Health Service” — a course for mental health providers, administrators, family advocates, policy-makers or those wishing to work with families in formal mental health systems.

I attended this course today. It was very well presented, interactive, and a great learning experience. The instructors were Dr Gráinne Fadden and Dr. Margaret Leggatt. Course participants were promised electronic versions of the presenter's the PowerPoint slides by email within the next week.

The main themes were:

1. Developing a respectful relationship with families in services ('low key interventions').
2. Evidence-based approaches to working with families ('more formal approaches').
3. Overcoming obstacles to the implementation of services for families (obstacles include, for example: confidentiality, family services not supported by management, lack of funding & resources for family services, and improperly planned discharge of a family member).
4. Carers as consultants - How carers can influence service planning and delivery ('taking on a partnership role').
   

Topics covered included:

1. Impact of mental health problems on families.
2. Role of family members on the treatment team.
3. Literature update on working with families.
4. Overcoming barriers to implementing family work.
5. Effectiveness of different therapeutic approaches.
6. Involving family members in services.

One interesting thing that I learned is that the United Kingdom has legislation requiring services to be offered to individuals who provide support to people living with a mental illness (i.e., services to carers).

Dr Gráinne Fadden
Dr. Fadden is a Consultant Clinical Psychologist (Birmingham and Solihull Mental Health Trust), Honorary Senior Research Fellow at the University of Birmingham and Director of Meriden, the West Midlands Family Programme. The Meriden Programme has trained over 2300 people to work with families and been awarded joint-winner of the National Institute for Mental Health in England (NIMHE) 2003 Positive Practice Award for ‘Modernising Mental Health Services' and winner of the ‘Social Care Award' (Midlands and East Region) in the Health and Social Care Awards by the Department of Health.

Dr Fadden has worked in the area of family work throughout her career; in clinical practice, research, training and more recently in relation to influencing organisational change to incorporate family work routinely into mental health services. She has also written extensively on the effects of mental health problems on families, the ways in which families can be supported, and on the training of mental health professionals to work with families, including books, book chapters and research articles.

Dr Fadden is a member of the CSIP National Psychosocial Interventions Implementation Group. She advises the Department of Health on issues relating to families and carers and also works closely with a range of national bodies, including the Royal College of Psychiatrists, regarding these issues.

Dr. Margaret Leggatt
Dr. Leggatt received a Ph.D from Monash University in Melbourne for a study that looked at the effects on families when a son or daughter was diagnosed as suffering from schizophrenia.

This led her to become part of a small group of family members and professionals who started the Schizophrenia Fellowship of Victoria in 1978. She was the Founding Director of this organization for 14 years and involved with the development of education and support programmes for families, as well as accommocation and rehabilitation programmes for people with mental illnesses.

She was responsible for the commencement of SANE – Australia, an organization designed to tackle nationally, the ignorance and discriminatory attitudes towards mental illness. She is the immediate past president of the World Fellowship for Schizophrenia and Allied Disorders.

She is presently working at ORYGEN Youth Health in Parkville, Victoria, as Coodinator of the Family Participation Project. This project is designed to facilitate ‘Families-Helping-Families' during the first episode of psychosis.

More photos from the SSNS Golf Tournament ...

... held September 24th, 2007.
















All photographs by Bill G.

SSNS Golf Tournament

The Schizophrenia Society of Nova Scotia held its Seventh Annual Golf Tournament at the Hartlen Point Forces Golf Club on September 24th, 2007. The Hartlen Point Forces Golf Club, “The Club by the Sea”, is located on the northern mouth of Halifax Harbour in Eastern Passage.

Click on any image to enlarge it.






























All photographs by Steve A.

Deconstructing Schizophrenia Offers Hope for Better Treatment

Click here for the entire story.

For an easier to read PDF of the above poster, click here.

Mental Health Courts: A Strategy That Works

From the September 21st issue of Psychiatric News:

By Aaron Levin

Criminal defendants with mental illness stay out of jail longer when they are enrolled in programs that divert them from the prison system to the mental health system.

Mental health courts offer an alternative to sending still more people with mental illness to jail. Judges, public defenders, district attorneys, case managers, therapists, probation officers, and psychiatrists together closely supervise defendants selected for these diversion programs, helping with housing, medical care, psychotherapy, education, and job training or coaching.

The goal is to prevent these defendants from committing more crimes and to help them find a place in the community. Offenders who complete the program can have charges dropped or expunged (Psychiatric News, April 21, 2006).

About 90 mental health courts operate around the country, yet little is known about the extent to which they reduce the chances of a defendant's committing another crime.

Now a study of the mental health court in San Francisco documents reduced levels of recidivism, as measured by the time to re-offending, although questions remain about what accounts for outcomes and who gets to participate in the programs.

Dale McNeil, Ph.D., a professor of clinical psychology in the Department of Psychiatry, and Renée Binder, M.D., a professor in residence in the Psychiatry and the Law Program at the University of California, San Francisco, compared 170 criminal defendants who entered the mental health court with 8,067 other offenders who received treatment as usual, consisting of passage through the criminal justice system. All subjects had been diagnosed with some mental illness, and two-thirds were charged with felonies. Defendants selected for diversion included a higher proportion of persons with developmental disabilities or severe mental illness—like schizophrenia, delusional disorder, or bipolar disorder—than the control group.

The researchers used a propensity weighting system to overcome nonrandom assignment and intention-to-treat analysis to include all offenders enrolled in the program, not just those who completed its requirements.

Participation in the mental health court program predicted a longer time before offenders faced any new charge or a new violent charge, wrote McNeil and Binder in the September American Journal of Psychiatry.

After at least six months of follow-up, 81 (48 percent) of the enrollees had completed the program, 45 (26 percent) were still in it, and 44 (26 percent) had left, whether voluntarily, for noncompliance, or other reasons. The mental health court graduates remained at a lower risk of recidivism even after they left the court's supervision, according to follow-up analysis.

At 18 months, mental health court participants were 26 percent less likely to be charged with any new crime and 54 percent less likely to be charged with a violent crime, they said (see chart).


Their findings, said McNeil and Binder, "provide evidence of the potential for mental health courts to achieve their goal of reducing recidivism among people with mental disorders who are in the criminal justice system."

Furthermore, since many defendants in the San Francisco program were charged with violent crimes or felonies, results with this more-difficult population argued for expanding the use of mental health courts beyond individuals who have committed minor offenses, as is the case in some other areas, they said.

Other studies have shown that outcomes vary little between violent and nonviolent offenders or for those diagnosed with more severe illness, said mental health court expert Henry Steadman, Ph.D., of Policy Research Associates in Delmar, N.Y., in an interview with Psychiatric News. "No research shows that a particular type of person does more poorly."

Steadman directed a study of 21 mental health court programs sponsored by the Substance Abuse and Mental Health Services Administration. He found that 42,518 screenings, assessments, and evaluations resulted in 32,917 decisions about whether to divert them to a treatment program. Only 2,001 of those decisions recommended diversion to mental health courts, and 1,237 of those were accepted by judges.

Although many decisions were needed to divert a few individuals, ultimately, disproportionate groupings by age, race, and gender predicted those chosen to take part.

Enrollees were more likely to be older, white, and female, wrote Steadman in the study published in the August Psychiatric Services. "That could represent bias, or it could result from the mechanism of assessment."

An array of people feed information into the system, he said—prosecutors, judges, mental health experts, public health nurses in the jails—making it hard to tease out the source of any overrepresentation of a particular demographic.

"I speculate that the people selected are seen as less threatening to the community, but the community needs to take a chance on a wider group," he said.

The study did not look at clinical data or outcomes.

These mental health courts may have benefits for society that go beyond just reducing crime. A recent study, described as the first of its kind, of 352 defendants by the RAND Corporation in courts in Pennsylvania, "Justice, Treatment, and Cost," found that participation in the jail-diversion program resulted in an increased use of mental health services and a decrease in jail time during the first year after entry into the program. Higher mental health care costs were almost balanced by the reduced costs for keeping the individual locked up. A two-year follow-up found a "dramatic" reduction in jail costs, although most of that came at the end of the second year, as mental health care costs leveled off.

Steadman agreed with McNeil and Binder that more intensive research is needed to support the case for mental health courts.

"All case studies show promising results," he said. "Now we need to use the same research methods in many different courts and look at for whom mental health courts work. What are their demographics, their social history, and their clinical history?"

"Effectiveness of a Mental Health Court in Reducing Criminal Recidivism and Violence" is posted here.

"Factors in Disproportionate Representation Among Persons Recommended by Programs and Accepted by Courts for Jail Diversion" is posted here.

The RAND report, "Justice, Treatment, and Cost," is posted here.

The photograph at the top of this posting, while not directly related to the above story, is of the Mental Health Court Team located in Saint John, New Brunswick. Click on the photograph to magnify it.

"A Cruel Confusion"

All this past week, Sounds Like Canada on CBC Radio One ran a series on mental illness.

"A Cruel Confusion" - our series on mental illness begins, Monday, September 17th, with the personal portrait on one family's 30 year struggle with schizophrenia. Our producer Phillip Ditchburn tells Shelagh Rogers about trying to find his way through the often frustrating mental health system - and how he finds where he finds support to keep going.

To hear the audio from the September 17th show, click here (starts RealPlayer streaming audio).

Tuesday, September 18th:
Our understanding of mental illness can be shaped by many things - including our cultural roots. In part two of our series "A Cruel Confusion" - we'll meet two people who are trying to bring a new understanding about mental health in Canada's Chinese and Korean communities.

To hear the audio from the September 18th show, click here (starts RealPlayer streaming audio).

Wednesday, September 19th:
Toronto's main mental health treatment centre is completely rebuilding to get the public onto the grounds, mingling with patients. It's supposed to break down the stigma of mental illness and make it easier for those getting treated to get back to a normal life. Will it work?

To hear the audio from the September 19th show, click here (starts RealPlayer streaming audio).

Thursday, September 20th:
Following a diagnosis of bipolar disorder and psychosis in the early 1990's, Victoria Maxwell took steps to control her condition, and eventually turned her medical problems into a career. Today, she is one of the most well-known educators and consultants in North America on the 'lived' experience of mental illness and recovery, and earlier this month she performed one of her solo shows for the new Mental Health Commission of Canada.

To hear the audio from the September 20th show, click here (starts RealPlayer streaming audio).

Victoria Maxwell's website.

Friday, September 21st:
We conclude our mental health series "A Cruel Confusion" with a feature interview with Senator Michael Kirby, the Chair of the Mental Health Commission of Canada.

To hear the audio from the September 21st show, click here (starts RealPlayer streaming audio).

We hear from the people who moved Senator Kirby so much - those who are coping with mental illness and those who are helping someone they love cope.

To listen, click here.

Shelagh reads your letters about our series "A Cruel Confusion". To listen, click here and here.

Thanks go to Jan H. of the Lunenburg County Chapter of the SSNS for informing me of this radio series.

Photograph of Shelagh Rogers courtesy of cbc.ca.

Sixth International Conference on Early Psychosis

Professor Patrick McGorry, IEPA2008 Conference Chair, writes:

Melbourne, Australia is the host city for the 6th International Conference on Early Psychosis. The meeting will bring together the world’s leading experts in early psychosis studies, research and treatments, acting as a forum for ideas to be exchanged, experiences shared, education developed and innovation inspired.

Visitors will find Melbourne an exciting city to explore. It has a reputation for friendly people, a cosmopolitan lifestyle, wonderful shopping and world-class entertainment.

An educational and stimulating program is being developed under the three stages of psychosis and will consist of plenary lectures, break out industry sessions, abstract presentations, a consumer festival and satellite meetings, including the 2008 Australian Schizophrenia Conference. We hope you can participate in the exciting program and look forward to welcoming you to Melbourne, Australia in October 2008.

To visit the IEPA2008 Conference Website, click here.

Thanks go to Dr. David Whitehorn of the Nova Scotia Early Psychosis Program for bringing this conference to my attention.

Carer Couples: when a partner has a mental illness

All In The Mind, a program of ABC Radio National (Australia) and hosted by Natasha Mitchell (photograph, right) aired the following story on September 15th:

Lover or carer? Partner or dependant? This week, when a partner is afflicted with a severe mental illness, how is the relationship redefined? Do they feel like the body and soul you first fell in love with? Two couples -- Lana and Paul, Gerard and Brendon -- share the trials and triumphs of confronting illness and prejudice together.

To listen to the story, click here (streaming audio).

To download the audio (best quality), click here (downloads a QuickTime mp3 file).

To visit the website for the story, which contains a large number of useful links, click here.

Many thanks to Marjorie W. for bringing this story to my attention.

Violence and Mental Illness — How Strong Is the Link?

Dr. Richard A. Friedman concluded the following in a recent article published by the New England Journal of Medicine:

"The challenge for medical practitioners is to remain aware that some of their psychiatric patients do in fact pose a small risk of violence, while not losing sight of the larger perspective — that most people who are violent are not mentally ill, and most people who are mentally ill are not violent."

He also noted:

"A study that compared the prevalence of violence in a group of psychiatric patients during the year after hospital discharge with the rate in the community in which the patients lived showed no difference in the risk of violence between treated patients and people without a psychiatric disorder. Thus, symptoms of psychiatric illness, rather than the diagnosis itself, appear to confer the risk of violent behavior."

An interview with Dr. Friedman can be heard by clicking here.

Schizophrenia and Violence

Click here to read this posting from Tony's Schizophrenia Corner.

Photograph of Tony taken from Tony's Schizophrenia Corner.

Mental Health Commission of Canada Appoints Four Executives to Its Team

CALGARY, ALBERTA--(Marketwire - Sept. 7, 2007) -

The Honourable Tony Clement, federal Minister of Health and the Honourable Michael Kirby, Chair of the Mental Health Commission of Canada, today announced the appointment of four senior executives to Canada's new Mental Health Commission.

- Glenn Thompson, Interim President;

- Dr. John Service, Executive Director;

- Phil Upshall, Advisor, Stakeholder Relations, and

- Dr. Howard Chodos, Director of the Office of the Chair.

The senior executives will be responsible for working closely with the Board of Directors and Advisory Committees to fulfill the Commission's mandate.

Establishing the Mental Health Commission was a commitment of Canada's New Government, and on Friday, August 31, 2007 Prime Minister Stephen Harper formally launched the body by announcing its Board of Directors and Advisory Committee Chairs.

"Mental Health is a significant public health issue that is affecting individuals and families across the country, and as Canada's Minister of Health I am proud that we now have a new national agency to bring about positive change," said Minister Tony Clement. "With today's announcement of four senior executives, we truly have an impressive national and qualified team who are passionate and committed to the Commission's mandate."

"I am very pleased to welcome these four outstanding individuals to our team," Mr. Kirby said. "The knowledge and expertise they bring from the mental health arena will further enhance the Commission's focus on mental health issues on a national level."

The new appointees will be responsible for working closely with the Commission's Board of Directors and Advisory Committees to work toward:

- Facilitating development of the national mental health strategy;

- Conducting a 10-year anti-stigma campaign; and

- Building a knowledge exchange centre.

In addition, the appointees will be responsible for continuing to foster an open dialogue on mental illness issues with stakeholders and members of the public from across Canada.

The search for a permanent president for the Commission is continuing.

About the Mental Health Commission of Canada

The Mental Health Commission of Canada is a non-profit national organization created to focus attention on mental health issues and to work to improve the health and social outcomes of people living with mental illness. The Commission is governed by a Board of Directors, consisting of 11 non-governmental directors, and seven who are appointed by the Federal, Provincial and Territorial governments, as well as the Chair - The Honourable Michael Kirby - who was appointed by the Government of Canada. The Board is assisted in its work by eight Advisory Committees.

BACKGROUNDER - Biographies

Glenn Thompson, Interim President

- Glenn recently served nine months as Interim President of the Canadian Mental Health Association (CMHA)

- Prior to filling the Interim President role, Glenn was CEO at the CMHA Ontario Division for nine years

- Prior to his leadership in the CMHA, Glenn was a Deputy Minister in the Government of Ontario for 16 years.

- Glenn has also served with the Nunavut government as the Executive Director and Director of Mental Health Services for the Baffin Region of the Department of Health and Social Services.

- Currently, Glenn is chairing a committee on the administration of psychotropic drugs for the Ontario Ministry of Children and Youth Services in Ontario and has just completed serving as co-chair of the Depression Strategy Advisory Committee for the Ministry of Health and Long-Term Care in Ontario

Dr. John Service, Executive Director

- Executive Director for the Canadian Psychological Association (CPA), for the past 14 years

- Prior to becoming Executive Director of the CPA, John was a clinical psychologist with the Aberdeen Hospital in New Glasgow, Nova Scotia

- John was Chair of the following organizations: Canadian Alliance on Mental Illness and Mental Health, the Canadian Consortium for Research, the Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative and the Health Action Lobby

- John brings extensive contacts from the Federal, Provincial and Territorial government's to the Commission

Phil Upshall, Advisor Stakeholder Relations (part-time)

- Phil is currently the National Executive Director and Founder of the Mood Disorders Society of Canada

- Phil is also a member of the Canadian Institutes of Health Research (CIHR) Advisory Board for the Institute of Neurosciences, Mental Health and Addiction

- Phil has also served as Chair and CEO of the Canadian Association for Mental Health and Mental Illness (CAMHMI)

Dr. Howard Chodos, Director of the Office of the Chair

- Prior to joining the Commission, Dr. Chodos was Director of Research for the Senate Committee on Social Affairs, Science and Technology, during the writing of its report on mental health in Canada - Out of the Shadows at Last

- Howard also brings to the Commission an outstanding knowledge of mental health policies and issues as well as extensive networks among mental health researchers and the broader stakeholder community.

Mouse model for schizophrenia has genetic on-off switch

A September 10th news release from Johns Hopkins Medicine:

Scientists at Johns Hopkins have developed a mouse model for schizophrenia in which a mutated gene linked to schizophrenia can be turned on or off at will.

The researchers developed the transgenic mouse by inserting the gene for mutant Disrupted-In-Schizophrenia-1 (DISC-1) into a normal mouse, along with a promoter that enables the gene to be switched on or off. Mutant DISC-1 was previously identified in a Scottish family with a strong history of schizophrenia and related mental disorders.

The study was performed in the laboratory of Mikhail Pletnikov, M.D., Ph.D., in the Department of Psychiatry and Behavioral Sciences.

Last month, another Hopkins researcher in the Department of Psychiatry and Behavioral Sciences, Akira Sawa, M.D., Ph.D., and his team, developed a comparable mutant DISC-1 mouse model for schizophrenia. Pletnikov’s is the first model in which researchers can control the expression of this mutated gene, and the model illuminates additional aspects of the biology of the disorder.

Researchers turn off the mutant DISC-1 gene by feeding the mice a nontoxic chemical that controls a genetically engineered switch mechanism to turn on production of the DISC-1 protein.

The study, which appears in the September issue of Molecular Psychiatry, showed that male mice with the mutant DISC-1 gene were significantly more active than control mice without the mutated gene. The investigators also observed that the male mutant DISC-1 mice had altered social interactions with other mice and were more aggressive. Females with the mutated gene had a more difficult time remembering how to navigate a maze.

“Schizophrenia is a human disorder, so we cannot say the symptoms displayed by the mouse model are schizophrenic. But they are in line with the kinds of behavioral changes we see in humans with schizophrenia,” says Pletnikov.

The research showed other strong similarities between the mouse model and humans with schizophrenia.

Examination of the brains of the mutated mice using MRI scans showed significant enlargement of the lateral ventricles (fluid-filled areas in the front of the brain), very similar to MRI findings in humans with schizophrenia.

Tissue culture studies showed that there was an abnormality in the development of brain cells in the part of the brain generally associated with schizophrenia. Also, the transgenic mice had abnormal levels of the proteins 25 kDa synaptosome-associated protein (SNAP-25) and lissencephaly-1 (LIS-1).

It’s known from previous research that SNAP 25 and LIS-1 are key players in brain cell development and maturation, and several prior studies of brain tissue from humans with schizophrenia showed abnormal levels of SNAP-25.

“This model supports the idea that schizophrenia is a disease associated with abnormal brain development,” says senior co-author of the study Christopher Ross, M.D., Ph.D., of the Department of Psychiatry and Behavioral Sciences. “And being able to regulate the timing of expression of the mutant protein provides an opportunity to study the timing and mechanism of specific abnormalities -- a tool that could eventually lead to the discovery of drugs that could potentially control or even prevent the disease.”

Additional authors of the study from Johns Hopkins include Yavuz Ayhan, M.D., Olga Nikolskaia, M.D., Yanqun Xu, M.S., and Timothy H. Moran, Ph.D., of the Department of Psychiatry and Behavioral Sciences; and Hao Huang, Ph.D., and Susumu Mori, Ph.D., of the Department of Radiology-Magnetic Resonance Research.

This study was supported by the Stanley Medical Research Institute, a NARSAD Distinguished Investigator Award, the National Institute of Mental Health and the National Institute of Neurological Disorders and Stroke.

What's needed to improve mental health services in your community?

On Wednesday, September 5th, Costas Halavrezos (pictured, right), host of CBC Radio's Maritime Noon, was joined by Michael Kirby, head of the new federal Mental Health Commission of Canada, and Andy Cox, a patient advocate with the IWK Health Centre in Halifax who lives with bipolar disorder. The phone-in question was: "What's needed to improve mental health services in your community?"

To listen to the entire program, click here (streaming mp3).

The Lancet Series on Global Mental Health: Article Collection

Well worth checking out - click here and here.

Launching a new movement for mental health

Despite the great attention western countries pay to the mind and human consciousness in philosophy and the arts, disturbances of mental health remain not only neglected but also deeply stigmatised across our societies. Viewed through a global lens, this marginalisation is only amplified still further. Yet the fragile—and utterly fragmented for the most disadvantaged—state of mental health services in many countries is not for the want of trying.

In 2001, for example, WHO devoted its World Health Report to mental health, with the optimistic message “new understanding, new hope”. Gro Harlem Brundtland wrote: “As the world’s leading public health agency, WHO has one, and only one option—to ensure that ours will be the last generation that allows shame and stigma to rule over science and reason (1).” As Director-General, she set a deservedly high standard for WHO and others to follow and be judged by.

Since then, WHO has continued to publish reports on mental health (2). But somehow the agency, through its leadership and partnerships, has been unable to convert fine words into tangible actions at country level. Partly this is because WHO has not backed its words with resources. And partly it is because WHO’s leadership has failed to build a sustainable mechanism across global and country institutions to hold itself and others accountable for its recommendations. This paralysis is surprising. Many low-income countries and civil society groups are crying out for help.

WHO is not the only institution with a responsibility to strengthen mental health services. The World Bank, country donors (such as the USA, UK, and European Union), foundations (such as the Gates and Rockefeller Foundations), research funding bodies (eg, the US National Institutes of Health), and professional associations all share a duty to make mental health a central theme of their strategies and financial flows. For the most part, these organisations have done far too little, if anything at all. In the past, The Lancet has tried to draw attention to mental health services in particular countries (3,4). With a Series of papers launched today from an internationally diverse Lancet Global Mental Health Group, to whom we owe a deep debt of thanks, together with a call to action and a commitment to track and monitor progress across a range of mental health indicators in the run up to a global summit on mental health in 2009, we aim to change this culture of lost opportunity.

The key messages from our Series are clear. First, mental health is a neglected aspect of human well-being, which is intimately connected with many other conditions of global health importance. Second, resources for mental health are inadequate, insufficient, and inequitably distributed. Third, there is already a strong evidence base on which to scale up mental health services. Fourth, most low-income and middle-income countries currently devote far too few resources to mental health. Fifth, there are critical lessons to learn from past successes and failures—for political leadership and priority setting, for increasing financial support, for decentralising mental health services, for integrating mental health into primary care, for increasing health workers trained in mental health, and for strengthening public health perspectives in mental health. Finally, any call to action demands a clear set of indicators to measure progress at country level.

During the next 2 years, The Lancet will make mental health one of its campaign focal points. We urge partners to join the broad new social movement we are launching to strengthen mental health.

Richard Horton
The Lancet, London NW1 7BY, UK

References

1. WHO. World health report. Mental health: new understanding, new hope. 2001. http://www.who.int/whr/2001/en (accessed Aug 20, 2007).

2. Herrman H, Saxena S, Moodie R, eds. Promoting mental health: concepts, emerging evidence, practice. 2005. http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf (accessed Aug 20, 2007).

3. The Lancet. Mental health: neglected in the UK. Lancet 2007; 370: 104.

4. Butcher J, Samarasekera U, Wilkinson E, Shetty P. Special report. Lancet 2007; 370: 117–24.

Normal Role for Schizophrenia Risk Gene Identified

A September 7th press release from Johns Hopkins Medicine:

--disc1 makes protein that helps new neurons integrate into our neural network

How the gene that has been pegged as a major risk factor for schizophrenia and other mood disorders that affect millions of Americans contributes to these diseases remains unclear. However, the results of a new study by Hopkins researchers and their colleagues, appearing in Cell this week, provide a big clue by showing what this gene does in normal adult brains.

It turns out that this gene, called disc1, makes a protein that serves as a sort of musical conductor for newly made nerve cells in the adult brain, guiding them to their proper locations at the appropriate tempo so they can seamlessly integrate into our complex and intertwined nervous system. If the DISC1 protein doesn’t operate properly, the new nerves go hyper.

"DISC1 plays a broader role in the development of adult nerves than we anticipated," says Hongjun Song, Ph.D., an associate professor at Hopkins’ Institute for Cell Engineering. "Some previous studies hinted that DISC1 is important for nerve migration and extension, but our study in mice suggests it is critical for more than that and may highlight why DISC1 is associated with multiple psychiatric disorders."

"Almost every part of the nerve integration process speeds up," adds fellow author Guo-li Ming, M.D., Ph.D., also an associate professor at ICE. "The new nerves migrate and branch out faster than normal, form connections with neighbors more rapidly, and are even more sensitive to electrical stimulation."

While it may not be obvious why high-speed integration would be detrimental, Song notes that because of the complexity of the brain, timing is critical to ensure that new nerves are prepared to plug into the neural network.

Ming, Song and their collaborators at the National Institutes of Health and UC Davis tracked the abnormal movements of the hyperactive nerve cells by injecting a specially designed virus into a part of a mouse brain known as the hippocampus -a region important for learning and memory and therefore quite relevant to psychiatric disorders. The virus would only infect newly born cells and would both knock down the expression of the disc1 gene and make the nerves glow under a microscope.

Combined with other recent Hopkins research that successfully engineered mouse models that have abnormal DISC1 and can effectively reproduce schizophrenia symptoms such as anxiety, hyperactivity, apathy and altered senses, these current findings teasing out the normal role of this protein may help unravel the causes for this complex disease

Song and Ming add that their studies in the hippocampus - one of the few places where new nerves are made in the adult brain - might answer why symptoms typically first appear in adults despite the genetic basis of many psychiatric illnesses. They plan on continuing their mouse work to try and find those answers.

The research was funded by the National Institutes of Health, McKnight Scholar Award, Whitehall Foundation and a Klingenstein Fellowship Award in the Neurosciences

Authors on the paper are Jay Chang, Sundar Ganesan & Bai Lu of the National Institutes of Mental Health; Regina Faulkner, Xiao-bo Liu & Hwai-Jong Cheng of the University of California, Davis; and Xin Duan, Shaoyu Ge, Ju Young Kim, Yasuji Kitabatake, Chih-Hao Yang, J. Dedrick Jordan, Dengke Ma, Cindy Liu, Guo-li Ming and Hongjun Song of Hopkins.

On the Web:

www.hopkins-ice.org/neuro/int/song.html

www.cell.org

Click here for more information from the Schizophrenia Research Forum.

Calgary home to new mental health commission

To read the full story from CBC News, click here.

Champion of a life-long crusade

From the September 1st edition of the Globe and Mail:

Michael Kirby long campaigned for a national mental health commission. That's now a reality: His late sister would be proud

By Gloria Galloway

OTTAWA -- For many of her adult years, Elizabeth Kirby battled the demons inside her own brain.

Prolonged bouts of depression had her in and out of psychiatric wards, and anorexia left her fighting the urge to starve herself. At one point, she tried to end her suffering through suicide.

But Ms. Kirby also had several things working for her - a supportive family and a strong advocate in her brother, Michael, who has made mental illness one of his life's causes.

Before Mr. Kirby retired as a Liberal senator last year, he co-authored a report called Out of the Shadows at Last that provided a blueprint for transforming mental-health services in Canada. It recommended, among other things, the creation of a Mental Health Commission of Canada that would reduce the stigma of mental illness, exchange knowledge about the disease and develop a national mental-health strategy.
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That commission is now a reality with the promise of $55-million in federal funds over five years. And Mr. Kirby, its first chair, stood with Prime Minister Stephen Harper in an Ottawa conference room yesterday to announce the names of the first 11 non-governmental members of the board of directors.

Selected from among 500 applicants, most have had some experience - either professional or personal - with the disease. Four have mental illnesses of their own. And several, like Mr. Kirby, have watched as close family members struggled with the problem.

In the end, Elizabeth Kirby's story is one of hope.

While she suffered from depression from the time she was in her mid-20s until her mid-40s, she did recover. "With the right combination of medicine and psychiatric care she was able to lead a normal life," Mr. Kirby said.

She has since died of cancer. But her final years were productive and fulfilling - a dramatic change from the decades when depression dominated her life.

As it usually does, the disease started slowly. But eventually it became apparent that Elizabeth's problems were not ordinary mood swings or just the normal bouts of feeling down that hit everyone from time to time.

"You got periods of frustration when you wanted to say to her because of her depression, 'Just get over it,' " Mr. Kirby said.

But he understood that it was not Elizabeth's fault, that it was a chemical problem that would take the right combination of chemicals to set right.

"So often when you say to people, 'I am depressed,' the reaction you get from family members is 'Oh buck up, get over it, how can you have that bad a life?' " Mr. Kirby said. "The lack of sympathy, and the notion that you should just get stronger and get it done, is a very prevalent feeling."

Then there was the time she tried to kill herself.

"When someone in your family attempts suicide which, thank God, failed, it's a life-altering moment, particularly when it's someone you are that close to," he said.

Elizabeth gradually grew well enough that she could live normally.

"Her mood disorder never went away, but it got terrifically controlled so that she graduated with an undergraduate degree at age 45 and a masters degree two years later," Mr. Kirby said. And, for the last 15 years before her death, she devoted herself to helping others who shared her affliction by running group homes for the mentally ill.

"During the period when she was ill, I was effectively her mental-health advocate. We were virtually like twins. We were less than a year apart and we were so close that I got very interested in the system," Mr. Kirby said.

"I thought she was continually falling through the cracks - until I actually got into the mental-health system in detail and discovered that, what I thought was falling through the cracks was just the way the system was, that there were cracks everywhere. The service that I thought was so abysmal was routine."

So he became, through his Senate position, an advocate for mental-health policy along with his colleague Senator Wilbert Keon. Together they wrote what became the first extensive report into mental illness in Canada.

In introducing the men yesterday, Mr. Harper credited them with laying the groundwork for the commission.

"They made the case for a comprehensive national strategy," he said. "They showed how we can improve the ways we develop and share our knowledge of mental-health issues. They argued, eloquently and passionately, that we must reject once and for all the stigma attached to mental illness, and they proposed that a national mental-health commission be created to pursue all these goals."

As for Mr. Harper's own decision to support their recommendations, Mr. Kirby said he didn't think the Prime Minister needed anyone to tell him that the issue of mental health is important.

"When I talked to him, there was no need to convince him of the need for something to be done," Mr. Kirby said. "There was discussion about was the commission the right mechanism and how would you do it. But the objective of obviously caring about the mental-health issue - you could see from this morning that was a personal comment."

There are many things to do over the coming months and years, Mr. Kirby said. But the first job is to tackle stigmas.

"If somebody has diabetes, they don't have any difficulty saying to someone, 'I am taking insulin for my diabetes.' If someone is depressed, they have huge difficulty saying, 'I am taking medicine to regulate the serotonin in my brain.' "

ON BOARD

The board of the Mental Health Commission, chaired by Michael Kirby, has 11 non-government directors and six government-appointed directors. Several live with a mental illness, or have family members who have been diagnosed. They include:

Joan Edwards Karmazyn: A resident of Grand Bank, Nfld., who lives with a mental illness, Ms. Karmazyn is the president of the Consumers' Health Awareness Network, Newfoundland and Labrador, the vice-president of the board of directors of the National Network for Mental Health, and an executive committee member of the Canadian Coalition of Alternative Mental Resources.

Andy Cox: A resident of Milford Station, N.S., who has bipolar disease, Mr. Cox is employed as a mental-health patient advocate for children and youth at the IWK Health Centre in Halifax and is also a member of various boards and committees, advocating for mental health.

Jeannette Leblanc: A resident of Moncton, N.B., Ms. Leblanc has a child who has been diagnosed with schizophrenia. She is a registered nurse, university professor and a past chair of the community mental health advisory committee to the New Brunswick minister of health.

Tony Boeckh: A resident of Montreal who is a mental-health philanthropist with a mental illness of his own, Mr. Boeckh is president of Boeckh Capital Co. Ltd. and a former CEO and editor-in-chief of BCA Publications.

Chris Summerville: A resident of Winnipeg who lives with his own mental illness as well as that of a family member, Mr. Summerville is the interim CEO of the Schizophrenia Society of Canada as well as the executive director of the Manitoba Schizophrenia Society. He is a certified psychosocial rehabilitation practitioner, an ordained pastor credentialed with the Associated Gospel Churches of Canada, and past chair of both the Manitoba Provincial Advisory Council on Mental Health to the minister of health and the Alliance on Mental Illness and Mental Health in Manitoba.

Thanks go to Jan H. for bringing this article to my attention.

Photograph of Michael Kirby by Ashley Fraser.

Stigma

By Jon David Welland

I remember something that happened to me back when the smoking bans were new and not strictly enforced. A friend and I were sitting inside a bus shelter on a bitterly cold winter day. We were smoking and since it was so cold, we couldn’t hold our cigarettes in our hands because they would go numb. An elderly woman approached us and told us we were not allowed to smoke there. I pointed out a man in business suit who was smoking a few feet away. The woman replied: “The law doesn’t apply to him, just to you.”

This underscores the daily insults and humiliation that the poor have to suffer every day. I don’t know how many times I have had a complete stranger who wasn’t a guard or a police officer point out to me that I’m loitering or that I am smoking too close to the door. Sometimes bus drivers would ask me for identification when I showed them my bus pass. This may seem like whining, but what I want to write about is the cumulative effect these behaviours have on mental health consumers.

People sometimes may make an insensitive comment about a homeless person as they pass by, and think nothing of it, but if dozens of passer-bys make these comments every day, then it seems very cruel. For an individual suffering from paranoia or feelings of persecution this behaviour serves to confirm in their minds that their worst fears are true.

It is highly unlikely we can ever change this sort of behaviour, so we must find ways to change ours. We cannot take things too personally. They are complete strangers. They don’t know you. All they see is a stereotype. Over-reacting to this kind of treatment will only make matters worse. Caregivers have to know that stigma is real, and not a figment of our imaginations, and that it isn’t childish to be hurt or upset by it. It is a very real fact of our lives.

David Welland is editor-in-chief of Information Matters, the quarterly newsletter of the Schizophrenia Society of Nova Scotia.

Photograph of Jon David Welland by Andre Forget of the Halifax Daily News.

Eli Lilly drug lessens schizophrenia symptoms in trial

An article published in the September 2nd edition of the International Herald Tribune:

By Alex Berenson

In a clinical trial of about 200 patients, an experimental drug from Eli Lilly lessened schizophrenia symptoms without the serious side effects of current treatments, according to a paper published Sunday in the journal Nature.

The drug must still be tested on many more patients and is at least three to four years from completing regulatory review. But schizophrenia researchers said the trial's results were surprising and impressive, especially since the drug works in a different way from existing antipsychotic medicines, all of which have serious side effects including weight gain and tremors.

Lilly will begin a new and larger clinical trial for the drug this month. If that trial confirms the results seen so far, the new drug could mark a breakthrough in the treatment of schizophrenia - and open the way to a broad new class of treatments for the disease. Schizophrenia, a devastating mental illness that affects 1 percent of adults and usually begins in the late teens or 20s, is marked by psychotic delusions as well as social withdrawal and cognitive impairment.

"This is potentially one giant step forward for patients," said Dr. Jeffrey Lieberman, chairman of the psychiatry department at Columbia and the lead investigator on a federally sponsored clinical trial of schizophrenia medicines.

Lieberman has not been involved with the development of the Lilly medicine and does not receive any payments or consulting fees from Lilly.

The new drug also has the potential to be a blockbuster for Lilly. Medicines for schizophrenia and bipolar disorder had sales of $12 billion in the United States and $18 billion worldwide last year.

The troubled history of Zyprexa, another antipsychotic medicine from Lilly, will lead regulators and psychiatrists to scrutinize the new medicine closely for hidden dangers, Lieberman said. When it introduced Zyprexa in 1996, Lilly hailed it as a breakthrough with fewer side effects than older drugs. But Zyprexa causes severe weight gain, and the American Diabetes Association has linked it to diabetes. Internal Lilly documents show that the company played down Zyprexa's side effects, worrying that they would hurt sales.

Despite that history, psychiatrists will be eager to see whether the new Lilly medicine works, since the existing drugs are of limited help for many patients. Existing schizophrenia medicines, whether older drugs such as Thorazine or newer medicines like Zyprexa, all work the same way, by blocking the brain's dopamine receptors.

But the new Lilly drug does not directly affect dopamine. Instead, it modulates brain activity through a different set of receptors. As a result, it has the potential to be the first truly novel treatment for schizophrenia since Thorazine was introduced 1954, Lieberman and other researchers said.

Lilly's new drug - which does not have a name yet and is referred to only as LY2140023 - emerged from almost two decades of research into the similarities between symptoms of users of PCP, a street drug sometimes called angel dust, and schizophrenia. By the 1980s, scientists had discovered that PCP blocked brain receptors that are triggered by an amino acid called glutamate.

The Lilly clinical trial validated the theory that modulating glutamate receptors may control the symptoms of schizophrenia, said Dr. Joseph Coyle, a professor of psychiatry and neuroscience at Harvard Medical School.

Click here for a related story from BBC News.

Click here for more information from the Schizophrenia Research Forum.

Click here for a Psychiatric News article entitled Drug Bypassing Dopamine Could Broaden Antipsychotic Arsenal.

System in crisis

A letter to the editor in the September 1st edition of the Halifax Chronicle Herald:

Re: "Mom: Give my daughter help" (Aug. 30). It is greatly disappointing that in order for Sheila Morrison’s daughter to receive aid, the mother of this acutely ill woman had to fight so hard to expose the inadequacies in the mental health system. Ms. Morrison’s plight with the system is one many Nova Scotian families are left to face as mental health services don’t get the level of attention necessary from the Department of Health.

Although Peter Croxall, director of Capital district health authority, praised Ms. Morrison for her advocacy work, his comments that the Abbie J. Lane facility are inadequate for modern mental health care cannot be ignored. They correspond with what families, patients and groups like the Canadian Mental Health Association have been trying to say for so long.

Our mental health care system is in a crisis. The media reports and the voices of family members like Ms. Morrison further encourage an independent financial review of mental health services that CMHA NS and other community agencies demanded in a press conference on Aug. 8. The Department of Health responded to this demand through the media, stating that a review of all health care services, including mental health, was being undertaken. Inquiries made to the department about this review have not unearthed a single answer yet.

Community agencies have recognized this crisis for a long time and until the government of Nova Scotia does so as well, and joins us to correct these inadequacies, it will be advocates like Ms. Morrison who will suffer and struggle to have their voice heard.

Carol Tooton, Executive Director, CMHA NS

Mental illness focus of new strategy

From the September 1st edition of the Toronto Star:

Harper names experts to commission to `lead a national campaign to erase the stigma'

Tonda MacCharles
Ottawa Bureau

OTTAWA–Canada needs a new approach to diagnosing and treating mental disorders and illness, says one of the people who will bring his ideas to the newly formed Mental Health Commission of Canada.

Dr. Simon Davidson, chief of child and adolescent psychiatry at the University of Ottawa and the Children's Hospital of Eastern Ontario, was named yesterday to chair an advisory committee to the commission headed by retired Liberal senator Michael Kirby.

Davidson envisions such innovations as making schools the hub for early diagnosis and treatment of mental disorders.

Imagine, he says, a multi-disciplinary team of child and youth workers, nurses, social workers, psychologists, child psychiatrists, family physicians, pediatricians, and others going into schools to deal with problems as soon as they are detected.

"Early intervention is critical," Davidson said in an interview.

In front of an audience of international mental-health experts, Prime Minister Stephen Harper yesterday named 17 people to the board of the Mental Health Commission of Canada, an arm's length agency the Conservatives created and funded in the 2007 budget to the tune of $55 million over the next five years.
Calling it the cornerstone of his government's strategy to deal with mental-health issues, Harper described those appointed, including Kirby, as "the best minds in Canada's mental-health field today" and gave them tall marching orders.

"They will lead a national campaign to erase the stigma attached to mental illness," said Harper. "They will also serve as a national clearing house for information on the best medical practices for dealing with it."

Kirby co-chaired, along with former senator Dr. Wilbert Keon, a Senate committee that in 2006 reported on mental illness and mental-health services in Canada.

Noting mental illness strikes one in five Canadians, and afflicts nearly 1 million of them severely, Harper lauded advances in understanding and treatment.

"We now understand that mental illness is not a supernatural phenomena nor a character flaw. We recognize it can be caused by physiological as well as environmental factors. Most importantly, we know it can be treated and often cured."

Harper said the commission's job is to make a difference in people's lives, "to ensure Canadians in every part of Canada have access to the best prevention, diagnostic and treatment practices so that someone suffering from depression, say in St. John's, will obtain the same quality of care as someone suffering from schizophrenia in Victoria."

Kirby told reporters later that the mental-health system "really isn't a system at all. It's a series of isolated services which are not connected."

He says the social stigma, and not government funding, is the biggest problem facing patients, families and society. Existing services need to be better "integrated," but he predicted it would take two to three years before Canadians would see any real changes.

"It's just such a huge, complex issue that it can't be fixed overnight."

The announcement of the commission was applauded by many.

Dr. Paul Garfinkel, president and CEO of the Centre for Addiction and Mental Health in Toronto, said creating a national knowledge exchange network is crucial to improving mental-health services.

Currently, he said, the quality of mental-health care varies widely across the country. Only 50 per cent of people in Ontario who have depression will be properly diagnosed, for example, and only half of those diagnosed will get the correct treatment, he said.

"In the wealthiest province and with a treatable illness, only one in four people are getting the right treatment."

Garfinkel said more funds need to be funnelled into community services to make sure people who have been treated for mental illnesses get appropriate support after leaving the hospital, including help finding a job and stable housing.

People who can't find work are much more likely to become ill again or turn back to substance abuse, he said.

Dr. Manon Charbonneau, president of the Canadian Psychiatric Association, also praised the creation of the commission.

"This is the most significant national policy initiative around mental health since the post-war federal grants that were designed to improve conditions in provincial asylums," Charbonneau said.

With files from Megan Ogilvie