Saturday, September 26, 2009

Recovery After Psychosis (RAP): A Compassion Focused Programme for Individuals Residing in High Security Settings

The abstract of an article published online on September 21st by the journal Behavioural and Cognitive Psychotherapy:
By Heather Laithwaite (1,3), Martin O’Hanlona (1), Padraig Collinsa (1), Patrick Doylea (1), Lucy Abrahama (1), Shauneen Portera (1), and Andrew Gumleya (2)

(1) The State Hospital, Carstairs, Scotland

(2) University of Glasgow, Scotland

(3) Reprint requests to Heather Laithwaite, Rowanbank Clinic, Balornock, Glasgow G21 3UL, Scotland. E-mail:


The aim of the study was to evaluate the effectiveness of a recovery group intervention based on compassionate mind training, for individuals with psychosis. In particular, the objective was to improve depression, to develop compassion towards self, and to promote help seeking.


A within-subjects design was used. Participants were assessed at the start of group, mid-group (5 weeks), the end of the programme and at 6 week follow-up. Three group programmes were run over the course of a year. Nineteen participants commenced the intervention and 18 completed the programme.


Significant improvements were found on the Social Comparison Scale; the Beck Depression Inventory; Other As Shamer Scale; the Rosenberg Self-Esteem Inventory and the General Psychopathology Scale from the Positive and Negative Syndrome Scale.


The results provide initial indications of the effectiveness of a group intervention based on the principles of compassionate focused therapy for this population. The findings of this study, alongside implications of further research are discussed.

Posting of this abstract is for the purposes of research into psychosis and recovery.

Wednesday, September 23, 2009

Teens to learn about mental health

An article published in today's edition of The Chronicle Herald:
Pilot project could be coming to Digby County high schools in new year

By Brian Medel, Yarmouth Bureau

High school curriculum designed to teach students about mental illness may be coming to Digby County classrooms in January as a pilot project.

"This is new," said John Roswell, one of the program co-ordinators with the Digby-Clare Mental Health Volunteers Association.

"We hope to do it during the 2009-2010 school year, hopefully beginning in January," Mr. Roswell said about the project that will be conducted in four local high schools.

He hopes the curriculum will someday be included in all Nova Scotia high schools.

The curriculum was prepared by Dr. Stan Kutcher [pictured] in co-operation with the Canadian Mental Health Association.

"This is really a wonderful opportunity," said Dr. Kutcher, an adolescent mental health expert at Dalhousie University’s school of medicine.

The course will give students information on how the brain works and tell them how to maintain good mental health. Suicide prevention and depression will also be discussed, Dr. Kutcher said Tuesday.

He’ll help teachers better understand mental illness and the new curriculum in special workshops that will be held before the start of the course.

"They’ve been very enthusiastic about this," said Dr. Kutcher.

Next week, staff from the Education and Health departments, along with representatives from local school boards and health authority, will gather in Digby to talk about the new high school course and how it will be implemented.

"We’re not quite sure where it will fit . . . that’s part of what this discussion is going to be about," said Mr. Roswell. "We hope to make (it) a larger project . . . an overall approach to addressing adolescent mental health.

"We’re trying to create a dialogue around this issue in the community and make it OK for people to talk about mental health and mental illness."

Mr. Roswell said 80 per cent of all psychiatric disorders emerge in adolescence. He had mental illness as a young person but was undiagnosed until the age of 40.

"My life would have been so much different had I been diagnosed as a teenager," he said.

Elyn Saks Wins MacArthur Foundation Award

An article posted on September 22nd by USC News:
USC Gould School of Law professor and Associate Dean Elyn Saks [pictured] has been selected as a 2009 fellow of the MacArthur Foundation. Saks is the first fellow selected from the faculty of USC and one of only 24 selected for this year’s awards.

The prestigious fellowship, known informally as the "genius grant," provides each recipient with a $500,000 "no strings attached" award over five years. The awards were announced by the Chicago-based John D. and Catherine T. MacArthur Foundation.

Saks is a nationally recognized scholar in mental health law, criminal law and the ethical dimensions of medical research. She also has battled schizophrenia and acute psychosis. In 2007, after decades of hiding her illness, Saks published a memoir about her struggles and successes in The Center Cannot Hold: My Journey Through Madness. The book won far-reaching acclaim from literary critics and advocacy groups.

To read the entire article, please click here.

Photograph by Mark Berndt.

Saturday, September 19, 2009

Schizophrenia Patients Show High Rates of Comorbid Illness

An article published in the September 18th edition of Psychiatric News:
By Mark Moran

Metabolic conditions were common but so were such medical conditions as epilepsy and viral hepatitis.

Hospital discharge records of people with a primary diagnosis of schizophrenia showed higher proportions of all comorbid psychiatric conditions and of several general medical conditions than did those of people who did not have schizophrenia.

The general medical conditions included acquired hypothyroidism, obesity, epilepsy, viral hepatitis, type 2 diabetes, essential hypertension, various chronic obstructive pulmonary diseases, and contact dermatitis and other forms of eczema, according to data from the National Hospital Discharge Survey reported in the August Psychiatric Services by researchers in the Department of Epidemiology at Walter Reed Army Institute of Research.

The survey data confirm what has been reported before: that patients with schizophrenia have higher rates of morbidity associated with some general medical conditions.

However, the study authors pointed out that virtually all existing studies of comorbid disorders in schizophrenia test hypotheses and have focused on a single comorbid condition in relatively small and nonrepresentative samples. The current study appears to be the first systematic analysis of comorbidity in general with schizophrenia in the U.S. hospitalized population.

"Our study is hypothesis-generating rather than hypothesis-testing, with the main purpose of presenting a systematic review of comorbid conditions," said coauthor Natalya Weber, M.D., M.P.H. "Psychiatrists can see in this very large and representative sample what conditions are more frequently comorbid with a primary diagnosis of schizophrenia compared to any other primary diagnosis among the U.S. hospital discharges."

Weber is health science administrator in the Division of Preventive Medicine at Walter Reed Army Institute of Research.

To read the entire article, please click here.

Friday, September 18, 2009

Nova Scotia Speech From The Throne

From page 10 of yesterday's Nova Scotia Speech From The Throne:

My government will improve support for individuals with mental illness, and for their families.

We will collaborate with mental health service providers to identify, monitor, and refer youth requiring mental health supports.

Community-focused living bungalows will be developed to provide appropriate, respectful care for individuals coping with mental illness.

Next month, the first mental health court will open and will help people who need counselling and treatment instead of being held in custody or put in situations where conflict may arise.

Vancouver judge: Community court works

An article published in todays edition of The Chronicle Herald:
By The Canadian Press

VANCOUVER — It's the personal anecdotes that tell the story of Vancouver's community court for judge Thomas Gove [pictured].

One year after opening Canada's first court to fully integrate the legal process with health, housing and social services, Gove measured the project's success Thursday by recounting the impact on a drug addict who was nudged into a residential detox program while doing street cleaning as community service for theft.

Gove also spoke about a chronic offender, approaching 60 years old, who was in court on a theft charge.

With the assistance of court workers, he has held down a full-time job for the past six months and not committed any further crimes. Keeping that man away from crime is probably saving $100,000 a year in the cost to merchants, police, the court system and prisons, the judge said.

He recounted details, as well, about a case earlier this week that reflects how different the community court is from a traditional courtroom. The offender broke down in tears after the judge made a strong personal appeal to her.

``Don't you understand, all the people here are trying to help you?'' Gove recalled saying to her. ``What is it we are not doing right? What more can we do? What is missing?''

Vancouver's community court, located in the heart of the city's drug-infested, poverty-ridden Downtown Eastside, was opened one year ago with considerable fanfare.

The jury is still out on the new system. Statistics for the first year of operations have not yet been compiled.

James Threlfall, the acting chief justice of the provincial court, said Thursday an analysis of the impact of the community court on the court system will be completed later this fall.

But Gove, the presiding judge who has been involved with the project since it began, was positive about the court's track record so far.

The court has achieved ``real successes,'' he said in an interview. More cases are resolved sooner, offenders are required to make fewer court appearances, more appearances happen on the day they are scheduled, crime is reduced in downtown Vancouver and, he believes, the rate of reoffending has been reduced.

He was ``frustrated'' that more housing, detox centres and mental-health services were not immediately available for offenders, but he was reluctant to be critical.

The organizations are going in the right direction, he said, adding that more housing has become available in recent months.

Gove could not really think of anything the court should have done differently over the past year.

``The first year has been the experiment - how do we do this? The next year is going to be whether we really (pass) the test - how much impact are we going to have?'' he said.

Cases involving theft from autos, stores and homes, mischief, assaults, drug possession and shoplifting are heard in the community court, while more serious crimes remain in the traditional court system.

Gove said the court saw about 2,000 people in its first year. Around 25 per cent, according to a rough estimate, were repeat offenders.

Multidisciplinary teams devise a plan that is intended to respond to the offender's underlying problems, whether it is mental illness, drug addiction, homelessness or poverty. The court enforces the plan as an alternative measure to traditional court-imposed penalties.

In the first 10 months, 568 people were involved with social, health and mental-health programming, 209 received housing. Offenders did 6,055 hours of community service.

Photograph by Sam Leung, The Province.

Also see:

Thursday, September 17, 2009

More than meds & beds

A letter to the editor published in yesterday's edition of The Chronicle Herald:
Re: "Suicide prevention: Time to get on with what works" by Stan Kutcher (Sept. 12).

Lack of treatment was acceptable in children’s mental health when we didn’t know the difference. However, it is totally unacceptable when the knowledge and proof of improved capability of sustaining a productive life is within a proper treatment plan, but lacks the dollars and commitment to provide it. All children deserve proper treatment without prejudice and stigma over their mental health issues!

It is time for the torture, neglect and abuse to stop. It is time for psychiatrists to stop delivering inadequate treatment proposals to parents and caregivers for their mentally ill children, because the province does not support the mental health needs of its young people, or perhaps, the hospital itself covers its inadequacy.

It is time for our government to invest more dollars into treatment facilities, with not just meds and beds, but with the educated, experienced staff and specialized treatment programs when prescribed. It is time for our children’s hospital to invest in a psychiatric unit and all existing mental health treatment programs, an art therapy program, music therapy program, "in house" psychologists and "on-call psychologists" when in-patient youth are in trauma episodes.

Actually, it is past time!

Sherry Beck Ramey, New Germany

Wednesday, September 16, 2009

Your Recovery Journey: Train-the-Trainer Workshop

On September 15th, the Schizophrenia Society of Nova Scotia held a full-day train-the-trainer workshop for the Schizophrenia Society of Canada’s new and innovative program, Your Recovery Journey. The training introduced participants to a five-session peer-support program focusing on recovery from mental illness. The Your Recovery Journey program builds on the premise that there is hope, that people with mental illness can get well, stay well for long periods of time, and do the things they want to do with their lives.

The program is designed to be co-facilitated by people who themselves have experience with mental illness and have also experienced recovery in their own lives. Collaboration with a recovery-oriented service provider or a family member is also an option to consider for delivery of the Your Recovery Journey program.

The train-the-trainer workshop was led by Chris Summerville, CEO of the Schizophrenia Society of Canada, and covered the content of the program, as well as providing helpful information and tips about bringing the program to life into the participant's communities.

Chris Summerville leading the Your Recovery Journey Train-the-Trainer Workshop in Halifax on October 15th.

A total of 39 participants attended the Your Recovery Journey Train-the-Trainer Workshop (a full house). In addition to those from HRM, participants from Kentville, Truro, Windsor, and Yarmouth were also in attendance.

Participants watch one of the videos provided as content in the Your Recovery Journey program.

Please click on any photograph to magnify it.

The Schizophrenia Society of Nova Scotia will be delivering Your Recovery Journey in Halifax beginning in mid-October 2009. Please contact Laura Burke at 465-2601, 1-800-465-2601 (toll-free in Nova Scotia) or for further information.

Photographs by Stephen Ayer.

Monday, September 14, 2009

The media must stop ignoring suicide

An article published in today's edition of The Windsor Star:
By Mark Henick, Special to The Windsor Star

On the evening of Tuesday, Aug. 25, a well-known former Fredericton city councilor walked into the Emergency Room with a lot on his mind. It is not known if he told them he was going to take his own life. Whatever happened in the ER, one thing was certain: He did not get rushed past the queue for immediate psychiatric care.

Instead, he ended up leaving, just walking right out the door. He called the police from in front of the hospital and, with phone in one hand and 16-gauge shotgun in the other, told them that he intended to kill himself.

To read the entire article, please click here.

Also see:

He was always looking for the good in people

Friday, September 11, 2009

What clients want from treatment: Quality of life issues top list of desired outcomes

An article published in the Summer 2009 issue of CrossCurrents:
By Hema Zbogar

The Schizophrenia Society of Canada has recently released the results of North America’s largest-ever poll of people living with schizophrenia. The Quality of Life Survey asked 1,086 mental health consumers and family members what quality of life means to them and what they perceive as barriers to its attainment. The survey found that people with schizophrenia have similar hopes and frustrations as the general population.

The survey findings challenge other quality of life research on people with mental illness that has focused heavily on clinical issues and managing negative life events rather than on the concept of recovery. The respondents’ views indicate that service providers, policy planners and funders need to move beyond a narrow focus on treating symptoms of mental illness to also supporting clients’ hopes and goals in the areas of employment, housing, economic security and freedom from discrimination and violence. Respondents also wanted more community-based services, family education and social and recreational opportunities.

CrossCurrents conducted its own informal survey of people with schizophrenia and their families to find out what they want from treatment and treatment providers, and what they want from life. We posed three questions:
  1. Is there an aspect of your life related to having schizophrenia that treatment doesn’t address but that you wish it would?

  2. What does a good outcome for schizophrenia treatment look like to you? In other words, what is the most important outcome for you?

  3. Do you feel that the mental health professionals you have dealt with have different expectations and goals than you?
This is what some of our respondents, from across North America, had to say.

Byron, Toronto, Ontario

For me a good outcome means a return to relationships. The symptoms of schizophrenia often make it difficult or impossible to maintain and enjoy these necessary relationships. We, like everyone else, need the laughter, sharing, trust, companionship, and the perspective and objectivity that come from friendships and family. Sometimes as a sufferer of this disease it can be difficult to assess the veracity of our own perspective, to figure out whether or not what we feel and perceive is grounded in reality or is in part or wholly changed, shifted, modified by our disease. Surrounding ourselves with positive people gives us a sounding board. Without them it can be incredibly lonely. Thirty years ago it might have made sense to have lower expectations of people with schizophrenia because medication had such strong side-effects and many people were left undiagnosed and untreated. I’ve had several doctors who had clearly given up on me achieving the things I am now doing. One of them actually told my mother that she should “lower her expectations” of me. This was early in my recovery. If my mother or I had listened to the doctor I may not have believed in myself enough to make the efforts I have.

Mental health practitioners also need to realize that these outcomes occur in their own time and that progress may be slow and difficult to perceive, but that it is nevertheless happening. I’ve recently finished a redirection through education program with straight A’s. I socialize on a regular basis and organize social events; I’m learning how to live on my own; I have a girlfriend; I have creative and career ambitions; I make and keep all of my appointments. I’m getting closer to full recovery.

We shouldn’t be punished by unnecessarily low expectations because of assumptions that are based on old truths and old knowledge. Realistically and practically, hope for your patients to reach the stars, because they may need your belief and conviction to get there.

Tamara, Winnipeg, Manitoba

I am 26 years old and have been living with schizo-affective disorder for 11 years. The ideal outcome for treatment allows for good quality of life and achievement of goals and dreams. Being diagnosed with schizophrenia doesn’t mean we can’t achieve our goals and dreams. It just means that they require necessary adaptations and available opportunities.

Often people living with schizophrenia receive treatment in just one area of their lives and not others. The ideal treatment for schizophrenia includes necessary outlets such as having a psychiatrist for discussing medications and a counsellor to address issues inside and outside the realm of mental illness because mental illness affects all areas of life.

There should be more opportunities for obtaining education and career goals through adaptations and mentoring. I am a university student and have endured many obstacles over the past five years, but my family and workers believe in me and encourage me to pursue my goals, so that I may one day achieve my goal of becoming an occupational or recreational therapist.

Angela, Orlando, Florida

I was diagnosed with schizophrenia about four years ago when I was 25. A good treatment outcome is to be motivated to pursue life to the best of your ability. I wish more treatment would address how to cope with the real world. More education about the illness is helpful. We need awareness and ways to cope and challenge ourselves while living with this illness. Without constant motivation and sometimes even guidance there is little to look forward to. My advice to clinicians: Never expect too little or too much from your clients.

Natasha, Belleville, New York

I’ve had paranoid schizophrenia since 1991. A good outcome involves reduced hallucinations, delusions and paranoia to the point where we can function on the job or at home on a day-to-day basis. My ideal treatment for schizophrenia is a psychiatrist who will listen to us, educate us and our families and recommend supports and community resources. It is important that psychiatrists remind us that we can lead a happy, productive life. There is always hope of recovery, even if our symptoms don’t go away.

Jake, Boston, Massachusetts

No hallucinations and the ability to function without having paranoid thoughts is the ideal outcome. I would like better medication that can treat anxiety along with psychotic symptoms. I want fewer side-effects, especially weight gain and muscle stiffness. I’d also like to see more non-drug related treatments.

Anna, Seattle, Washington

I wish that more doctors would listen to the “patient” rather than telling them.

Raymond, Toronto, Ontario

Most psychiatrists focus on symptom reduction, without an image of wellness to drive a recovery-based model of care.

George, Annapolis, Maryland

Most of us with mental illness wish for a better life than just collecting disability. I want to work for a living and not be a disability recipient, even though I could live on the payments I get. Some of us gave up on work because of drug side-effects. I want more from life. I want more power. I want the power to be alive!

John, Regina, Saskatchewan

We need more coaching towards developing coping skills for school and work. On several occasions I attempted returning to school, only to drop out after I became depressed. I did try evening courses and when taking only one subject I often earned an A. Most of my learning since the psychiatrist advised that I should have “no more school” has involved self-teaching. Now, with supports in my life, I am successfully self-employed.

David, Winnipeg, Manitoba

I am 33 years old and have had schizophrenia for nine years. The best outcome is full participation in society, whatever the role. My goal was to find employment with an income that reflected my academic credentials and skills. I underwent psychological-social rehabilitation and now have a high-income job that matches my education and skills. My counsellor had the same view of empowering me to learn life skills (independent living, leisure, etc.) and to obtain and keep a job.

Dan, Midland, Ontario

One ideal treatment that doesn’t exist is medication that controls negative symptoms. I’ve had paranoid schizophrenia for 22 years (I’m 38), and my positive symptoms are under control with medication, but I’ve yet to find a drug that treats negative symptoms like blunted affect. I still struggle in my relationships and often would rather spend time alone. I also can’t concentrate the way I used to and was unable to progress in my education as well as I might have hoped. Negative symptoms should be as much of a priority as the positive ones.

Maureen, Toronto, Ontario

This morning I worked on an extensive survey for family members of residents of the supported home where my daughter, who has schizophrenia, lives. This itself speaks volumes. Staff welcome me and communicate with me about my daughter and the goals of the house for her. On the other side of the street, figuratively and literally, where my daughter receives treatment, I know nothing about her treatment and goals. I have never spoken with her doctor, though I have asked time and again, but I finally gave up.

Mike, White Rock, British Columbia

My daughter is 22 and has had schizophrenia for six years. The ideal treatment would provide constant support to both the person with the illness and the people who support them. Currently, support is sporadic at best for both. This illness is devastating, and without good support and education a successful outcome is difficult.

To download the Schizophrenia Society of Canada report, “Quality of Life: As Defined by People Living with Schizophrenia and Their Families,” visit

Thursday, September 10, 2009

Beacon for troubled daughter

An article published in today's edition of The Chronicle Herald:
Woman sees hope in centre being built for those with mental illnesses

By John McPhee, Health Reporter

Kim Clark spends a lot of time waiting for her daughter [pictured] to break the law.

It’s the only way she can get Koral off the street and back on her medication for paranoid schizophrenia.

"We are moving forward with the mental health courts and everything else, but trying to get a community treatment order in place is somewhat difficult at times," the Halifax woman said in an interview.

"The law does recognize them as independent and as an adult, although she’s not cognitively capable of making those decisions."

Ms. Clark hopes that a mental health transition centre under construction in Dartmouth will help people like Koral, 25, who has been on and off the streets many times over the past two years.

Work is set to begin this fall on four 10-bedroom bungalows at the former site of Simpson Hall at the Nova Scotia Hospital.

The hall was recently demolished.

The homes will serve as transitional spaces where people who have been hospitalized for treatment of mental illnesses can continue to receive care while practising the life skills they’ll need to live in the community.

Ms. Clark said the project will fill a big gap in the mental health system.

That system, she says, now leaves people like Koral on their own after being treated in hospital for mental health problems such as going off their medication.

"There’s no community support in the sense of re-teaching the skills that she needs," such as managing money, cooking and cleaning, she said.

"This new initiative will allow that transition and give them a higher sense of self-esteem.... When they leave, they will be a part of the community."

The former Conservative government originally announced the community living project three years ago.

Construction was expected to be finished last year at a cost of $6.7 million.

The plan was put on hold because bylaws prohibited construction of the homes on the desired waterfront site.

The NDP government is carrying through with the project, now expected to cost about $11 million because of rising construction costs and the need to demolish Simpson Hall.

The province has set aside $8,250,000 for the project.

The rest will be raised by the Mental Health Foundation of Nova Scotia as part of its capital fundraising campaign.

That effort got a big boost Tuesday from IMP Group. The aerospace firm contributed $150,000 to the foundation’s Open Minds fund.

The housing will accommodate 40 people at a time, for periods of several months and possibly up to two years, said Dr. Nick Delva, chief of psychiatry at Capital Health, who also works with the Mental Health Foundation.

It’s meant for people who have serious mental health conditions, but they must be stable enough at the time to fit in a home-like environment, Dr. Delva said in an interview.

"The whole look and feel of the place will be quite different" from traditional psychiatric facilities, he said.

Each bungalow will have a kitchen and common area, and the bedrooms will have small ensuite bathrooms.

The project is part of a move toward community-based treatment for mental health.

Five outpatient clinics have been established throughout the district, Dr. Delva said.

Besides this restructuring, there will be a push for more funding from the provincial government.

Dr. Delva said the Health Department should devote at least five per cent of its budget to mental health.

The department now spends about 3.8 per cent.

Ms. Clark agrees more needs to be done, saying there are long waiting lists for mental health services.

As for Koral, her mother saw her Saturday in person for the first time in six months.

"She’s not in good shape at all," she said.

Over the years, Ms. Clarke has kept tabs on her through a network of family and friends.

With little money, Koral usually ends up living in rooming houses.

"It’s been a hard road, making sure she’s alive and safe," she said.

Also see:

Site Selection, Financial Contribution Boost Community-Focused Living Residences

Wednesday, September 9, 2009

Focus on training, not terminology

An opinion piece published in today's edition of The Chronicle Herald:
By Marilla Stephenson [pictured]

A DEBATE OVER whether so-called "excited delirium" is a valid condition is a waste of time. What is more significant — in terms of how police and jail guards react to it — is the risk of death for a person in this state and how to best respond when high-risk situations unfold.

Last week Justice Minister Ross Landry released a report from an expert panel struck to review the condition last year. The panel was formed in response to the 2007 death of Howard Hyde of Dartmouth. He died in custody after a struggle with police. He had been shocked with a stun gun by them 30 hours earlier.

A death inquiry, led by Judge Anne Derrick, is already underway and its outcome is separate from the report. A pathologist has already concluded that Hyde died of excited delirium — a condition the panel says would be better labelled autonomic hyperactivity syndrome (AHS) — and not from the stun gun shock he received the day before.

We can expect from the inquiry, at the very least, another truckload of recommendations targeting how first responders deal with mentally ill people. A doctor who checked out Hyde after he was shocked with the stun gun has already testified that she would never have released him to the police had she known he would not receive the psychiatric assessment she had requested. Hours later, he was dead.

Dr. Stan Kutcher, a psychiatrist at Dalhousie University, served as chairman of the panel. He told The Chronicle Herald in an interview that "the most important thing here is to realize that this is a medical emergency and that this situation requires the combined efforts of law enforcement and medical first responders."

Police and jail guards will get extra training to ensure they are better equipped to recognize the symptoms of AHS and to call in medical assistance in those circumstances, says Landry. This is one of the key recommendations in a report that contains many useful guidelines for moving forward towards better responses to people experiencing AHS.

Symptoms — which can lead to hyperthermia, cardiac arrhythmia and sudden death — include extreme agitation, aggressive behaviour, paranoia or delirium, incoherent and rambling speech, extraordinary strength, numbness to pain, and profuse sweating.

The report says that "mortality rates are increased in the presence of the signs and symptoms of excited delirium — even with medical intervention or in the absence of use of restraints by law enforcement."

The panel also found that "it is reasonable to consider that, when further stressed by physical struggle or the application and continuation of physical restraints (including the CED), an individual exhibiting the syndrome of excited delirium may be at increased risk for sudden death.

"Similarly, the pre-existence of a medical or psychiatric condition (such as a psychotic illness, pre-existing cardiac condition, delirium with or without the use of psychostimulant drugs) may increase the risk for sudden death in an individual showing signs and symptoms consistent with excited delirium."

That is the nub of the issue: People who suffer from mental illnesses that end up in a state of excited delirium are at an increased risk of death. While police and jail guards may well be the people who are first required to be on the scene of such a situation, additional training is clearly needed to ensure they know when it is paramedics, rather than restraints and a physical struggle, that is more likely to bring a safe outcome to the situation.

Police officers and jail guards are often in very challenging, high-stress situations, where public safety, their own safety and the safety of the person they are trying to subdue must be judged at lightning speed.

They must be provided with every tool possible to make the right decisions in those moments. If that means more training to properly assess, arrest and/or subdue people with mental illness, then it should happen as soon as possible. Calling for medical assistance should be considered a first option, not a last resort.

Even one Howard Hyde outcome is one too many.

Also see:

Vulnerable targets

Sunday, September 6, 2009

Saturday, September 5, 2009

More training in mental illness

An article published in today's edition of The Chronicle Herald:
Report: Emergency workers need latest information on excited delirium

By David Jackson, Provincial Reporter

Police and jail guards will get more training to recognize mental illnesses and how to deal with people afflicted with them, Justice Minister Ross Landry said Friday.

The province commissioned an expert panel last year to look at the phenomenon called excited delirium and what role it could play in in-custody deaths, to examine the risks of using stun guns and other restraints on people in that state, and to recommend how law enforcement officials should deal with those people.

Mr. Landry said the most significant recommendation in the eight-member panel’s new report is ensuring that front-line justice workers are trained to recognize people with symptoms of excited delirium, or as the panel suggests calling it, autonomic hyperarousal state.

The minister, a former RCMP officer, said officers do get training in dealing with people with mental illnesses but new information is always coming along, as with this condition.

"A couple of years ago, who knew about this?" Mr. Landry said in a telephone interview. "It’s not that long ago. And yet, people over time have passed away in this condition."

It was the death of Howard Hyde, a Dartmouth man who had a history of mental health issues, that led to the panel’s review. Mr. Hyde died in November 2007, 30 hours after Halifax Regional Police Tasered him when he scuffled with them at the police station.

The province’s chief medical examiner, Dr. Matthew Bowes, said Mr. Hyde died of excited delirium due to paranoid schizophrenia. Dr. Bowes said the death was accidental and he found no evidence that the Taser caused the death.

The death led to a provincial review of Taser use, and that led to the review of excited delirium.

The panel, of which Dr. Bowes was a member, said the symptoms of excited delirium are common to other medical and psychiatric conditions and recommended that the term autonomic hyperarousal state be used for people showing those symptoms.

Panel chairman Dr. Stan Kutcher, a psychiatrist at Dalhousie University, said there’s been a useless debate about whether excited delirium is or isn’t a medical diagnosis. He said the panel found the phenomenon well-described in medical literature going back 120 years, just under different names.

The symptoms include extreme agitation, aggressive behaviour, paranoia or delirium, incoherent and rambling speech, extraordinary strength and numbness to pain, and profuse sweating, the report said.

Dr. Kutcher said the key thing to keep in mind in dealing with people in that state is they need medical attention.

"I think the most important thing here is to realize that this is a medical emergency and that this situation requires the combined efforts of law enforcement and medical first-responders," he said in an interview.

The panel recommends creating a provincial training program for all first-responders in recognizing signs of mental illness and responding appropriately.

The report also says call-takers and dispatchers should get special training to help them recognize whether a call involves someone with a mental illness.

Dr. Kutcher said a dispatcher can get an indication of that by asking certain questions, such as whether the caller knows if the person they’re calling about is aware of his or her surroundings. The information would help a dispatcher know whether to send police and paramedics to the scene right away.

The panel recommended first-responders first try to calm the person in a hyperaroused state by talking to them, but if that doesn’t work, to restrain them quickly because a prolonged struggle could jeopardize the person’s life.

Dr. Kutcher said the panel couldn’t find scientific evidence suggesting that one form of restraint is better or safer than another, including stun guns. He said that’s why the panel recommended the province create a database on incidents involving the use of force.

Halifax Regional Police already adhere pretty well to the review’s goals, said Const. Brian Palmeter, the force’s spokesman.

"Our training and practices are consistent with the recommendations," he said.

"That being said, we are looking forward to working with the province to review and update our training where necessary."

Still, Const. Palmeter doubts there will ever be a single case in which an officer would be able to handle the crisis and follow all the recommended advice completely.

Mr. Landry said his department will consult with police, jail guards and sheriff’s services in developing procedures for dealing with people with mental illnesses. He said officers often have to make split-second decisions when dealing with people, so he wants them to have the information to help them make good decisions.

Joanna Blair holds a photo of her brother Howard Hyde, taken when he was in his early 20s. (BRIAN MEDEL / Yarmouth Bureau)

Dr. Hunter Blair, whose wife Joanna Blair is Mr. Hyde’s sister, thinks a dispatcher won’t always be able to get enough information from an excited caller to know whether to send an ambulance to a scene involving a person with mental illness.

The main issue, he said, is how to handle that person once you get there, and the review doesn’t seem to contain much new information.

"They’ve produced what you would have expected them to produce, given the current state of knowledge or non-knowledge," he said from his Shelburne home Friday.

He is happy with the recommended plan to track all calls to study the outcomes of various restraint methods and treatments.

"That’s a good move," he said. "They started doing this in Ontario some time ago."

Health Minister Maureen MacDonald said officials in her department will consult with district health authorities and Emergency Medical Care Inc., which provides ambulance services, about the report.


The following is a summary of the nine recommendations found in the Panel of Mental Health and Medical Experts Review of Excited Delirium:
  • The panel prefers the term autonomic hyperarousal state (AHS) over excited delirium, which is confusing and incorrectly suggests a defined medical diagnosis.
  • People showing signs of AHS should be considered at risk of sudden death by hospital emergency staff who should be trained to identify and treat them. Once restrained, these individuals should undergo a thorough medical examination. Hospital staff should be ready to resuscitate.
  • When it comes to first-responders called to possible cases of AHS, whoever takes such a call should dispatch police and Emergency Health Services simultaneously. If police encounter someone who may have AHS, they should call for EHS and backup immediately. Officers should de-escalate the situation by removing potentially hazardous objects and people from the area and trying to calm the individual without challenging him or her. If restraint must be used, it should be applied quickly. Immediately take the person to hospital and monitor him or her along the way.
  • When restraints are used, they should be the least restrictive means that would bring the subject under control. If such a person is restrained, it should be treated as a medical emergency and EHS should be called immediately.
  • A database should be created to track the use of various restraint methods to see their effect on people with AHS.
  • Studies should be done to review the relationship between the characteristics of subjects and the outcomes of different methods of restraint.
  • There should be a unified provincial training plan to help first-responders recognize signs of mental illness and respond correctly. Dispatchers and other call-takers should be trained to recognize signs of mental illness.
  • A formal protocol should be developed in each area of the province describing the role of law enforcement and health professionals concerning mentally ill people, including those with AHS.
  • An evaluation process should be set up to evaluate the effectiveness of the above-mentioned recommendations.
Source: Panel of Mental Health and Medical Experts Review of Excited Delirium

With Dan Arsenault, crime reporter

Also see:

N.S. excited delirium report recommends first responders get more training

More police, paramedic training urged for excited delirium

Paramedics needed in delirium cases: report

Excited delirium is a real risk, Nova Scotia report into taser death warns

Excited delirium: Consideration of selected medical and psychiatric issues

Friday, September 4, 2009

Minister Releases Excited Delirium Report

A media release issued today by the Nova Scotia Department of Justice:
Department of Justice
September 4, 2009 11:31 AM

A report on excited delirium was released today, Sept. 4, by Justice Minister Ross Landry.

The province commissioned the 38-page Report of the Panel of Mental Health and Medical Experts Review of Excited Delirium in November 2008, to make recommendations to help law enforcement officers when responding to individuals showing excited delirium symptoms.

The report contains nine recommendations to develop new principles, protocols and procedures to deal with individuals who come into conflict with the law and display extreme agitation, aggressive and paranoid behaviour. It also outlines the need for further training and research.

The volunteer panel members included physicians, government staff and experts in the area of mental illness. Dr. Stan Kutcher from the department of psychiatry at Dalhousie University chaired the group.

"I want to thank the experts who offered their advice on this issue which is of great importance to those responsible for public safety and those who deliver medical help," said Mr. Landry.

Government will now consult other health and justice first responders.

The full report is available [by clicking here (PDF)].


A report on excited delirium was released today (September 4th), by Justice Minister Ross Landry.

The province commissioned the 38-page Report of the Panel of Mental Health and Medical Experts Review of Excited Delirium in November 2008.

It contains nine recommendations to help develop new protocols for Nova Scotia's law enforcement officers when responding to individuals displaying excited delirium symptoms.

The province will now seek input from Justice and Health first responders.


Media Contact:

Sherri Aikenhead
Department of Justice