Tuesday, December 27, 2011

Blessings from schizophrenia? Believe me, they exist

An article published in the today's edition of The Globe and Mail:
By Anne Aspler (pictured)

There was a ticking time bomb in my head that deactivated at the age of 26: the probability of schizophrenia. That’s when, for first-degree relatives, the statistical likelihood of developing the disease drops from 13 per cent to that of the general population: 1 per cent.

My mom is afflicted with schizophrenia. Despite never having had signs or symptoms, I used to live in constant fear that, one day, I might develop it. The path of my life was driven by this fear. I overworked myself to ensure a livelihood that would enable escape from the stigma of mental illness and unemployment. Becoming a doctor seemed the best I could do to champion my own mental sanity, and to further understand an illness that has never made sense to me.

For some, Christmas aggravates their heart failure – all those salty holiday indulgences. For others, the season precipitates their “brain failure” – the stress, anxiety and loneliness is amplified by the process of reflection on years past.

For part of last year’s holiday season, I found myself on the crisis-psychiatry team at one of the busiest inner-city centres in Canada: St. Michael’s Hospital in downtown Toronto. “Crazy” became the new norm, all day, every day, suicide and self-harm an acceptable and prevalent psychological exit.

My worst moment of flashback to my own experiences occurred when I had to make a phone call to the Children’s Aid Society. I’d just spent an hour developing a good rapport with a newly divorced, newly unemployed, suicidal single parent – courageous in seeking help. Calling CAS was a decision that would result in the removal of her children from her home – at Christmas.

To me, it was the ultimate betrayal of her trust. I felt as though I had betrayed my own mother. Instead of going home for the holidays last year, I externalized my distress by going to Haiti as a volunteer physician working on cholera-relief efforts.

As early as Grade 3, I had an understanding of the societal taboos around mental disease. That year, our art-project assignment was to “depict your parent’s career in a drawing.”

My mom? Unemployed. And so I developed a knack for creativity. I didn’t understand exactly what was wrong with my mother, so making up a career for her wasn’t a big stretch.

In high school, my sister and I were recruited for a University of Alberta study of children with a parent who had schizophrenia. Enrolling in this was like facing my biggest fear. I was sure the survey would uncover that, secretly, my mental stamina of steel had been blocking out symptoms that would eventually resurface with a vengeance.

Quite the opposite happened: It was a first step toward freedom. Not only did they declare my sister and I mentally “healthy”; they did something far more important to me – they normalized the disease.

I understand now that “mentally healthy versus ill” is an often unhelpful dichotomy. The psyche of the population exists on a spectrum. Scientifically, we have constructed an arbitrary standard. Past a certain point of dysfunctionality, some will be labelled, recommended for therapy and medically treated.

The rest of us can retain our status as “normal” and obtain socially acceptable therapy in the form of free counselling from family members and friends, self-therapy in the form of reflection, and perhaps moderate doses of self-medication.

Even for one individual, mental wellness fluctuates immensely over time. Practising medicine has reaffirmed for me that there is not one among us who is 100-per-cent mentally sound in all day-to-day exchanges and decision-making. Most of us could probably cite one or two mental hang-ups they could do away with. Thankfully, we escape any permanent labelling and write these off as a mood, an anxiety, impulse or worry.

I realized I'm tired of the silence around mental illness. I'm tired of contributing to the stigma by hiding the reality that these patients are our sisters and brothers, our parents, our closest friends – the ones in our lives whom we love but don’t know how to reach out to.

The reality? My mother is a great parent. With age, I’ve come to appreciate that her demeanour has given me a positive outlook on life; and it has imbued me with an inordinate capacity to tolerate chaos and disruption. They are traits that have served me well as an emergency resident physician in Toronto and working overseas in resource-poor settings in South America, Asia and Africa.

It's also taught me to value my clarity of mind and to put it to use. It gave me the opportunity to benefit firsthand from Canada’s social safety network. It has bred a doctor and a teacher (my sister) who will be strong lifelong advocates for redressing social inequity.

To my colleagues who work with those affected by mental illness: Thank you for showing them patience and understanding and treating them as equals, even when society, or sometimes their own family, doesn’t.

My mom has really done her best. She’s spent her entire life struggling to cope with the mind inside of her, as well as to cope with the reactions of the world around her.

She’s amazing, really. My sister and I will probably try to micromanage her symptoms until the end of her days. But we love her. And we owe her and her illness everything.

Anne Aspler lives in Toronto.
Photo credit

Monday, December 12, 2011

Mental Health First Aid Roleplay Video

From the YouTube posting:
The Jack Project at Kids Help Phone, in partnership with the Mental Health Commission of Canada / Mental Health First Aid has produced this role play video. It outlines the need for mental health awareness and the Mental Health First Aid helping actions that can be used to support someone who is struggling.

Sunday, December 11, 2011

The Honourable Michael Kirby speaks to the importance of peer support

From the YouTube posting:
Chair of the Mental Health Commission of Canada, the Honourable Michael Kirby spoke to the importance of peer support in the Mental Health Strategy for Canada at the Peer Project event in Ottawa on October 5th, 2011.

Sunday, December 4, 2011

Putting the focus back on the patient

An article published in the December 1st edition of The Chronicle Herald:
IWK hopes to whittle down wait for youth mental health services

By John McPhee, Health Reporter

Add value and keep it simple.

It sounds like a business marketing pitch but actually it sums up an increasingly popular system for treating young mental health patients.

Two child psychiatrists from Britain have been working with staff at the IWK Health Centre in Halifax this week to see if the Choice and Partnership Approach will work there.

About 1,100 people are on the waiting list for child and adolescent mental health services at the IWK Health Centre in Halifax. That wait can be as long as 18 months, compared with the standard acceptable wait of about a month.

"They’ve noticed some of their systems haven’t helped users as well as they would like," Steve Kingsbury [pictured], a child and adolescent psychiatrist based in London, said in an interview Tuesday during a break in the training session at a Halifax hotel.

"How you organize services (and) the paperwork you have to do? And I don’t think they could see any way of doing it better until they heard about this."

Kingsbury and Ann York, who also works in London, have taken the "reduce bureaucracy and focus on the patient" message to 11 countries in the past six years. They and other clinicians came up with the system as a way of tackling long wait times and unacceptable outcomes, York said.

"The central premise is how to design services to make things better for the young person and their family, a better experience and more effective for them. All the things we then do organizationally and clinically are around having them at the heart of it."

The usual treatment approach would see a doctor do a thorough assessment of the patient. But recommendations are often made based solely on such assessments, without finding out what makes sense to the family or the child or what they want, the doctors said.

The question of wants, not needs, is crucial to the Choice and Partnership Approach. If the patient is asked what they want, the list is usually short and can be addressed right away by giving the patient and family goals to work on at home.

"They wouldn’t be put on a waiting list for something," York said. "They would go away with an appointment in their hands to see somebody with the right skills to help them with the goals they wanted."

This method has reduced wait times at their London clinics from a year to several weeks. Similar successes have been reported in the countries where they have trained staff and managers. Those countries include the United Kingdom, Australia, New Zealand and Belgium.

York and Kingsbury came to Nova Scotia on the recommendation of a doctor now working in Halifax who underwent the training in New Zealand.

The IWK couldn’t provide an exact cost of the three-day session, but York and Kingsbury said they don’t charge full consultant’s rates. Rather they are paid the equivalent of what they would earn as clinicians in London. It is their first visit to Canada and they combined the working sessions with their vacation.

"It’s not our day job," joked York, who said they continue to work full-time as psychiatrists and devote an average of one day a month to their consultant work.

Sharon Clarke, clinical leader for mental health services at the IWK, said she was impressed by the Choice and Partnership Approach just from reading the material on the website.

"The exciting part for me is that they’re taking a business approach, in the sense of lean thinking, and using these ideas of demand and capacity to really be able to have an accurate assessment of what the needs are in the system — to put people in the right places, to do the right job at the right time."

The IWK will begin using the system in wait list interventions in January and it will be fully implemented by April.


Image credit

Also see:

The Choice and Partnership Approach Website

Evaluation Of The Choice And Partnership Approach In Child And Adolescent Mental Health Services In England

Thursday, November 10, 2011

Taking stock of schizophrenia

An article definitely worth reading.

Also, you might want to listen to the audio interview with Prof. Sir Robin Murray (pictured) accompanying the article .

Image credit

Tuesday, November 8, 2011

Your Recovery Journey

An article published in the Fall 2011 edition of SZ Magazine:

Please click on an image to magnify it.

To download the entire article (PDF), please click here.

Also see:

Your Recovery Journey

Schizophrenia Society of Canada

Saturday, November 5, 2011

23rd Annual Conference

The Schizophrenia Society of Nova Scotia's 23rd Annual Conference, held at the Dalhousie University Club on November 4th, 2011, was attended by over 160 people.

Please click on the image to magnify it.

Please click here to download the conference program
and presenter biographies

Conference Photographs

Please click on any photograph to enlarge it.

Cecilia McRae, president of the Schizophrenia Society of Nova Scotia, prepares to sell raffle tickets on the Recovery Quilt.

Hilary Thorne, the Schizophrenia Society of Nova Scotia's project coordinator, distributes parking passes outside the conference venue.

Annette Murphy (foreground, left), a member of the Conference Organizing Committee, registers a conference participant.

Chris Croke (left) accepts the Schizophrenia Society of Nova Scotia's 2011 Janine Williams Memorial Bursary from Cecilia McRae.

Christine Parsons (left) receives the Schizophrenia Society of Nova Scotia's 2011 Special Bursary from Debbie Gladstone, a member of both the Conference Organizing Committee and the SSNS's Board of Directors.

Dr. Susan R. McGurk delivers the conference's plenary presentation.  To download Dr. McGurk's presentation slides (PDF), please click here.

Dr. McGurk receives a thank you gift from Cecilia McRae, president of the Schizophrenia Society of Nova Scotia.

Dr. David Gardner speaks about antipsychotic medications and their side effects during his keynote address.  To download Dr. Gardner's presentation slides (PDF), please click here.

To purchase Dr. Gardner's book, Antipsychotics and their Side Effects, please click here or here.  For information on the MED ED booklet and accompanying passport, please click here and here.

Dr. Gardner is thanked by Phil Rogers, a member of the Board of Directors of the SSNS, as well as the Board of Directors of the Schizophrenia Society of Canada.

Vince Daigle, a peer support worker with the Healthy Minds Cooperative and co-facilitator of the From Recovery to Discovery Peer Support Group, speaks about peer support.

Donna Methot, a member of the Schizophrenia Society of Nova Scotia's Board of Directors and president of the HRM Chapter of the SSNS, thanks Vince Daigle.

Terry Vernon, a member of the Schizophrenia Society of Nova Scotia's Board of Directors and the Conference Organizing Committee introduces speakers from the Beacon Program.

Valerie Davis presents an overview of the Beacon Program. To download the Beacon Program's presentation slides (PDF), please click here.

Pam Langille, an occupational therapist, talks about the goals and activities of the Beacon Program.

Will Moerman talks about his experience as a participant of the Beacon Program.

Valerie Davis is thanked by Terri Vernon.

Terri Vernon thanks Pam Langille.

Will Moerman receives a thank you gift from Terri Vernon.

John Murphy, a member of the Schizophrenia Society of Nova Scotia's Board of Directors, introduces Dr. Jason Morrison.

Dr. Jason Morrison presents on cognitive behavioural therapy (CBT) and how it can help with relationships.

For a list of references for further reading on CBT for psychosis, please click here (PDF).  These references were provided to the SSNS by Dr. Morrison after the conference.

John Murphy presents Dr. Morrison with a framed Nova Scotia photograph by John (Randy) Ross.

Patrick Burke QC, a member of the Board of Directors of the SSNS, introduces presenters from Connections Halifax and the Mindful Mango Café.

Gail Kelly, an occupational therapist with Connections Halifax, speaks about social enterprises in general and the Mindful Mango Café in particular.

Jude Williams speaks about her life experience and her current position as kitchen supervisor with the Mindful Mango Café.

Marting Hoben talks about his job as supervisor at the Mindful Mango Café.

Patrick Burke thanks the speakers from Connections Halifax and the Mindful Mango Café.

Dr. Zenovia Ursuliak presents on a wellness program that she developed and helped deliver at the Nova Scotia Early Psychosis Program.  To download Dr. Ursuliak's presentation slides (PDF), please click here.

Patrick Burke thanks Dr. Ursuliak.

A big THANK YOU to our conference sponsors!

Conference Organizing Committee

Stephen Ayer
Executive Director
Schizophrenia Society of Nova Scotia

Debby Gladstone
Secretary, Board of Directors
Schizophrenia Society of Nova Scotia

Annette Murphy
Community Volunteer

Terri Vernon
Director, Schizophrenia Society of Nova Scotia

All photographs by Stephen Ayer

Thursday, November 3, 2011

Schizophrenia Society of Nova Scotia Conference - Recovery

Today's media advisory from the Schizophrenia Society of Nova Scotia:

Thursday, November 3rd, 2011
Halifax, Nova Scotia

Schizophrenia Society of Nova Scotia Conference: Recovery

With its theme of recovery, the 23rd Annual Conference of the Schizophrenia Society of Nova Scotia promises to deliver a message of hope. The conference takes place at the Dalhousie University Club, 1 Alumni Crescent, Halifax, from 8:45 am to 4:30 pm on Friday, November 4th, 2011.

Recovery from a mental illness involves progressing from a state of distress arising from active symptoms, through the stages of acceptance, rehabilitation, and reintegration into family, work, and societal roles. “Recovery is not an endpoint, but a process and a state of being,” says Vince Daigle, peer support worker with the Healthy Minds Cooperative. This conference will prove that recovery is not only possible, but expected in most cases.

A variety of experts will present on state-of-the-art approaches to optimizing recovery from serious mental illnesses. Cognitive remediation, psychosocial rehabilitation, psychopharmacology, peer support, supported employment, and a well-designed wellness recovery program will all be featured.

The plenary speaker, Dr. Susan McGurk (pictured) of Dartmouth Medical School, Hanover, New Hampshire, will present her recent research results on the Thinking Skills for Work program. This unique program involves combining supported employment with methods to help a person improve cognitive skills through focused practice using computerized cognitive exercises, and to develop cognitive compensatory skills to “work around” persistent difficulties.

“Clients target work as an important recovery goal,” says Dr. McGurk, who also notes that rejoining the workforce is destigmatizing and has many other benefits, including social and financial ones. Building on this theme, Gail Kelly from Connections Halifax, and staff from the Mindful Mango Café, will describe important advances that have been made locally in supporting people in returning to work.

Dr. David Gardner of Dalhousie University will address medication, “major part of the road to recovery.” Using his unique interactive presentation style, Dr. Gardner will open the floor to questions and use that opportunity to discuss antipsychotic medications and how they can be part of a “set of investments” for recovery.

Healthy, fun, active, and creative – this is how Dr. Zenovia Ursuliak describes the wellness program recently created for participants in the Nova Scotia Early Psychosis Program. “This program was very dear to my heart. I put so much energy into this program because I really believe that we can help people reach their full potential by providing environments and services that engage them as human beings, in addition to what I’ve been trained to do as a psychiatrist – give them medications, monitor their medications.” Dr. Ursuliak describes the participants’ regaining of hope, self-efficacy, and motivation as being critical to recovery.

The support of one’s peers and the guidance based on direct experience of a mental illness is invaluable. As Mr. Daigle points out, the role-modelling and insight that a peer support worker provides cannot often be matched by that of a mental health clinician who has no direct experience. A peer support worker’s example contributes hope – both for people challenged with an illness, as well as for their family members.

Healthy relationships are critical to anyone’s mental health, and Dr. Jason Morrison of Dalhousie University will outline how they can be promoted through cognitive behavioural therapy. Additionally, Valerie Davis and Pamela Langille of Kentville’s Beacon Program will present their organization’s multidisciplinary approach to empowering and supporting the development of individuals through psychosocial rehabilitation.

Describing possible outcomes of the conference, Dr. Ursuliak anticipates “that the audience comes out of there inspired that recovery is possible.” She adds, “From that positive attitude, people will advocate for change.”


The Schizophrenia Society of Nova Scotia is holding its 23rd Annual Conference beginning at 8:45 am on Friday, November 4th, at the Dalhousie University Club, 1 Alumni Crescent, Halifax. The theme of the conference is Recovery.

The objective of the conference is to demonstrate that recovery from a serious mental illness such as schizophrenia is not only possible, but, with treatment and other supports, can be expected. The plenary speaker, Dr. Susan McGurk of Dartmouth Medical School in Hanover, New Hampshire, will present her recent research results on the Thinking Skills for Work program. This unique program involves combining supported employment with methods to help a person improve cognitive skills through focused practice using computerized cognitive exercises. Other topics to be covered include peer support, psychosocial rehabilitation, medications, cognitive behavioural therapy, and a wellness program. On-site registrations are available. For further information visit www.ssns-conference.com.

About the Schizophrenia Society of Nova Scotia

The Schizophrenia Society of Nova Scotia works to improve the quality of life for those affected by schizophrenia through education, support programs, influencing public policy, and encouraging research. In addition to the provincial office located in Dartmouth, the Society has chapters conducting monthly support group meetings in Cumberland County, Halifax Regional Municipality, Kings County, and Lunenburg County.

Media Contact

Dr. Stephen Ayer
Executive Director
Schizophrenia Society of Nova Scotia

Phone: (902) 465-2601
Toll-free in Nova Scotia: 1-800-465-2601
Fax: (902) 465-5479

Room B23, E.C. Purdy Building
300 Pleasant Street
P.O. Box 1004, Station Main
Dartmouth, Nova Scotia
B2Y 3Z9

Website: www.ssns.ca
Weblog: www.blog.ssns.ca

To download a printable version of the media release (PDF), please click here.

Tuesday, November 1, 2011

Computerized Brain Training Can Produce Functional Changes in Schizophrenia

An article posted online on October 31st by Psychiatric News:
Successful training of the brains of people with schizophrenia in discrete attentional tasks is possible and appears to translate into improvements in quality of living, said Sophia Vinogradov, M.D., winner of APA’s Alexander Gralnick Award (pictured with past APA President and current APA American Psychiatric Foundation Treasurer Richard Harding, M.D.) At APA's Institute on Psychiatric Services in San Francisco, Vinogradov described research showing that computerized games aimed at training the brains of patients in very specific tasks can have effects on multiple interactive systems resulting in changes in global functioning. The finding marks a new direction in what has been called “cognitive remediation.” Further coverage of Vinogradov’s remarks will appear in a future issue of Psychiatric News. For further information about cognitive remediation, see "Neurocognitive ‘Training’ May Undo Schizophrenia's Brain Damage" and American Psychiatric Publishing's Essentials of Schizophrenia by Jeffrey Lieberman, M.D.
Photo credit

Sunday, October 23, 2011

Memoir About Schizophrenia Spurs Others to Come Forward

An article published in today's edition of the The New York Times:
Researchers have long wondered how some people with schizophrenia can manage their symptoms well enough to build full, successful lives. But such people do not exactly line up to enroll in studies.

For one thing, they are almost always secretive about their diagnosis. For another, volunteering for a study would add yet another burden to their stressful lives.

But that is beginning to change, partly because of the unlikely celebrity of a fellow sufferer. In 2007, after years of weighing the possible risks, Elyn R. Saks [pictured], a professor of law at the University of Southern California, published a memoir of her struggle with schizophrenia, “The Center Cannot Hold.” It became an overnight sensation in mental health circles and a best seller, and it won Dr. Saks a $500,000 MacArthur Foundation “genius” award.

For psychiatric science, the real payoff was her speaking tour. At mental health conferences here and abroad, Dr. Saks, 56, attracted not only doctors and therapists, but also high-functioning people with the same diagnosis as herself — a fellowship of fans, some of whom have volunteered to participate in studies.

“People in the audience would stand up and self-disclose, or sometimes I would be on a panel with someone” who had a similar experience, Dr. Saks said. She also received scores of e-mails from people who had read the book and wanted to meet for lunch. She told many of them about the possibility of participating in a research project.

She now has two studies going, one in Los Angeles and another in San Diego, tracking the routines and treatment decisions of these extraordinary people. The movie producer Jerry Weintraub has optioned the book.

It has been a remarkable response, considering that the book was almost abandoned. Dr. Saks surveyed friends and colleagues for years before publishing it and got very mixed advice. Her husband was against it; the risks were too high. Academic colleagues warned her that coming out with a disorder as serious as schizophrenia could only harm her. “You want to be known as the schizophrenic with a job?” one said.

Her friend Stephen Behnke, director of ethics at the American Psychological Association, was supportive of her decision. “I remember talking about it just on the cusp of when she was going to send off the manuscript,” Dr. Behnke said. “I said that we needed to sit down and make sure she was ready for this. It was like she was about to jump off of a cliff.”

Jump she did. With the MacArthur money, she founded the Saks Institute for Mental Health Law, Policy and Ethics to study mental health and society. She is now working on another book, “Mad Women: A Most Uncommon Friendship,” with the author Terri Cheney, who has written about her struggles with bipolar disorder.

“I was very lucky, being in academia, where people have been very accepting of this,” Dr. Saks said. “Most people struggling to manage a severe mental illness do not have the luxury to do what I did.”
Image credit

Also see:

A High-Profile Executive Job as Defense Against Mental Ills

Changing the face of Schizophrenia

Tuesday, October 18, 2011

FREE - Get your GED - Spryfield

Please click on the image to magnify it.

From an October 18th email received from Chebucto Connections:
The GED class is a go at the Captain William Spry Community Centre and we are recruiting students. Participants should be strong Level 2 students who are available and can commit to classes 4 days per week: Monday to Thursday / 9:30 am - 3:30 pm for 20 weeks. Those who call will be assessed for eligibility and classes will begin as soon as we have a small group.

Monday, October 17, 2011

Do you value the work of the Schizophrenia Society of Nova Scotia?

We hope you do.

Your donation will help us to continue our important and crucial work. To make a donation, please click here. Tax-deductible receipts are issued immediately.

Or send a cheque to:

Schizophrenia Society of Nova Scotia
Room B-23, Purdy Building
P.O. Box 1004, Station Main
Dartmouth, Nova Scotia
B2Y 3Z9

A photograph taken during the Schizophrenia Society of Nova Scotia’s
Annual General Meeting held September 24th, 2011, in Springhill, Nova Scotia (please click on the photograph to enlarge it)

The Schizophrenia Society of Nova Scotia is working very hard to improve the quality of life for those affected by schizophrenia and psychosis through education, support programs, influencing public policy, and encouraging research.

Friday, October 14, 2011

Psychiatrists Outline Plan to Tackle Stigma and Discrimination in Medicine: New Paper Released at Annual Conference of Canadian Psychiatric Association in Vancouver

An October 13th media release from the Canadian Psychiatric Association:

VANCOUVER, Oct. 13, 2011 /CNW/ - Today the Canadian Psychiatric Association (CPA) made public a paper that outlines how psychiatrists can tackle stigma and discrimination in medicine.

"Stigma and discrimination are one of the primary reasons that the one in five Canadians who will experience a mental illness in their lifetime either don't get help or delay getting help until their situation worsens," says Dr. Susan Abbey, author of the paper and member of the CPA Stigma and Discrimination Working Group. "People can recover from mental illness but until we address these issues, efforts to provide better mental health care will continue to be hampered," she adds.

Like their fellow Canadians, physicians, including psychiatrists, have been socialized with the same stigmatizing views towards people with mental illness. "Physicians are a reflection of their society when it comes to stigmatizing attitudes but it's devastating when patients who need help encounter such attitudes," explains Dr. Manon Charbonneau, Chair of the CPA Stigma and Discrimination Working Group. "That's why CPA chose to focus its efforts on tackling this issue in the house of medicine. As physicians and psychiatrists it is our responsibility."

Children and youth and health professionals are the two initial priority areas for the Mental Health Commission of Canada's anti-stigma, anti-discrimination initiative.

The three-prong approach on how physicians can reduce stigma presented by the paper can be summed up in three words, Protest, Educate and Contact. The CPA paper invites all psychiatrists to lead by example and protest stigma and discrimination when they encounter it, use education to counteract it and promote direct contact with people with lived experiences with mental illness.

"We need to protest discrimination at every level from the small injustices we witness in daily practice, in our clinics and hospitals, in our medical schools up to the federal and provincial level," says Dr. Abbey. The lack of funding for mental health is striking. While mental illnesses constitute more than 15 per cent of the disease burden in Canada, in the 2003-2004 fiscal year mental health care received only six per cent of total health funding—below the level in most European and developed countries.

Education is the second key to preventing stigma and making stigma it visible. "It's relatively easy to spot discrimination but it's harder to identify stigmatizing attitudes. Often people don't even realize they have these attitudes," notes Dr. Charbonneau.

The paper proposes education initiatives at many levels including making stigma and discrimination part of the formal medical school curricula, continuing physician education on the issue, talking about stigma with patients and engaging fellow physician organizations to effectively address discriminatory behaviour against psychiatric patients where they seek care—the emergency department, on inpatient medical and surgical wards, in walk-in clinics and when they see their family doctor.

Contact, the third pillar of the strategy, is crucial. "Research tells us that direct contact with people with mental illness who have recovered is a powerful tool that effects lasting change in attitudes," notes Dr. Charbonneau. The paper encourages medical schools to promote and teach direct personal contact with patients, both inside and outside the clinical context. It also advocates patients, as experts in their own care, be actively involved in their diagnosis and treatment and that patient advice be sought when new treatment and clinical structures are being planned.

"Tackling stigma and discrimination towards people with mental illness is the key to better mental healthcare. Canadian society and Canada's physician community efforts are in their infancy and much work remains to be done, but it can be done," says Dr. Charbonneau.

Read the position paper online: http://publications.cpa-apc.org/media.php?mid=1221

The Canadian Psychiatric Association is the national voice for Canada's 4,100 psychiatrists and more than 600 psychiatric residents. Founded in 1951, the CPA is dedicated to promoting an environment that fosters excellence in the provision of clinical care, education and research.

For further information:

Helene Cote
Bold emphasis is mine.

Wednesday, October 12, 2011

How to gain insight into schizophrenia and other mental illnesses

From the YouTube posting:
Bill MacPhee takes Don's question that asks how someone develops insight into their illness. Bill talks about how people think that they are alone, but once they are educated and see the big picture, they will gain insight into their illness.
Bill MacPhee lives with schizophrenia.

Also see:

SZ Magazine


Tuesday, October 11, 2011

More than daily bread

An article published in the October 10th edition of The Chronicle Herald:
At Stone Hearth Bakery, people restart their lives, build life skills

By Holly Fraughton

THE SMELL OF FRESHLY BAKED BREAD, bagels and sweet loaves wafts through the air in the lower level of The Village at Bayers Road shopping centre. If you follow your nose, the aroma will lead straight to the Stone Hearth Bakery.

Many Nova Scotians will recognize the brand. The kosher bakery has been producing freshly baked bread since 1982, but what many don’t know is the story behind the bakery.

Stone Hearth is just one of the programs operated under the MetroWorks umbrella, a non-profit organization that has been offering training since the late 1970s to people who face barriers to employment.

Chuck Weatherbee [pictured], 40, of Dartmouth, has worked at the bakery for over five years. Today, he is responsible for packaging and distributing the finished product. Bakery manager Shawn Patterson points out that Chuck is also their quality assurance monitor, making sure that every loaf is perfect.

"He’s the guy that makes sure the customers get the good stuff," Patterson said.

Weatherbee was diagnosed with schizophrenia 19 years ago when he was just 21. Before he found Stone Hearth, he had only done seasonal work, picking fruit.

Weatherbee had just finished a six-week, day-hospital stay when one of the nurses suggested he look into Stone Hearth’s program.

For Weatherbee, working at the bakery has created structure in his life and offers a sense of fulfilment. "Now, I’m to the point that I’m training other people, so that makes me feel good. It makes me a little sad when they leave, but it makes me feel good that I can actually pass skills on and help somebody out!"

The bakery used to be in north-end Halifax, but moved in September 2010 after MetroWorks centralized its operations to The Village at Bayers Road. The new state-of-the-art facility is perfect for training bakers and has been very good for business, allowing them to expand their product line and develop new working relationships.

"Because of our new facility and equipment, community colleges noticed us; they’ve put people here on placements, and then we’ve been able to hire those people, and then they’ve got the experience to expand our product list. It’s just a complete chain reaction," Patterson said.

That chain reaction has also been felt by participants.

"They’re very proud of their products and they’ll go to the grocery stores on their time off and straighten out the shelves," Patterson said with a smile.

Soon, more delicious aromas will also be emanating from the kitchen of the Stone Hearth Bistro.

MetroWorks is getting ready to expand their food service training program, opening a 7,000-square-foot restaurant in The Village at Bayers Road in late October. The bistro will offer participants hands-on training in a restaurant setting, preparing them for future employment in kitchens throughout the province.

The idea for the restaurant evolved out of research into Halifax’s current labour market, and will build on MetroWorks’ existing food service program, which is currently largely classroom-based. They plan to start with a class of 12 participants, and by the first quarter of 2012, have between 36 and 40 participants working in the bistro.

The bistro will also feature a small market section, where Stone Hearth can showcase bakery products and, Patterson hopes, the story behind Stone Hearth.

"I go to farmers markets on the weekends . . . and sell our bread and I’m always educating people that, ‘You can buy our product and support a program that’s helping people either restart their lives or help them better themselves,’ " Patterson said.

Stone Hearth currently sells to large retail commercial customers, local restaurants, and distributes outside of Halifax through Canada Bread. Since moving to the new facility, they’ve been able to take on more clients, and Patterson estimates the business from restaurants has doubled, as well.

"It’s a not-for-profit, but it is a business. . . . All the money that we make goes back into programming, so the more money we make, the more money we can invest in other programs," Patterson explained.

The main objective at the bakery and new restaurant is to build skills. Participants work alongside paid professionals, and many also take courses on job searching and resume writing.

Not all will go on to pursue careers as bakers or as kitchen staff. Some will realize that they want to go back to school, instead.

"Some people may never work, but to maybe learn to get along with people is a huge success for them. So each person’s success is measured differently," Patterson said.

But for those who do go on to get jobs, the economic spinoff can be significant.

"When we start to measure some of our impacts on the local economy and local tax burden, if you can take someone off of assistance that is costing real dollars, tens of thousands of dollars a year, and move that person from being entirely dependent on the public purse to a taxpayer, it’s huge!" pointed out Mark Lever, MetroWorks’ president and CEO.

MetroWorks does look to various levels of government for capital funding, but the idea is to work towards creating self-sustaining programs, like the bakery.

And Lever is quick to point out that they aren’t looking for charity: "We recognize that the product has to be, first and foremost, second to none and the best it can be."

Photograph by Adrien Veczan / The Chronicle Herald

Monday, October 10, 2011

World Mental Health Day - A Revolution, Simple

An article posted today by the UK edition of the Huffington Post:
By Professor Richard Gray [pictured]

"If I'd asked my customers what they wanted, they'd have said a faster horse." Henry Ford

To enable people with mental health problems to lead full and productive lives, we need a revolution in care and treatment.

Today is world mental health day. Looking at mental health practice right now it feels sadly devoid of the revolutionary, imaginative and creative thinking that we take for granted in so many other areas of our lives. In a very real sense the outcomes for patients with long term mental illnesses like schizophrenia are getting worse, not better.

This is a tragedy; mental illness is painful and distressing. It is hard to imagine the torment that someone with schizophrenia experiences when they hear voices telling them that they are evil and deserve to die. To understand the pain of these symptoms we have to recognise that this is their reality and it is absolutely terrifying. These are symptoms of an illness, an illness where there is dysfunction in the patient's brain.

Medicines are essential to alleviate the distress and torment of psychotic symptoms. Reducing the intensity of the delusion or pushing the voices into the background antipsychotic drugs rarely completely eliminate symptoms and are certainly no cure.

In many respects, the medicines we have now are little different to those like chlorpromazine, that we used in the 1950s. The new generation of antipsychotic drugs are more refined and cause fewer side effects, but fundamentally they work in the same way. Metaphorically drug researchers have bred slightly faster horses, there has been no great jump forward.

Where will new treatment advances come from?

There is a sense that investment, both intellectually and financially, in the development of new drug treatments has faded and shifted; in part because of the negative public perception drugs for mental illness have, and an increase in demand for talking treatments as an alternative to pills.

Sensational media stories of antidepressants making patients suicidal are ill informed but attention grabbing and have contributed to our negative image. Even among mental health professionals there is widespread "anti medication" sentiment. A senior and influential Clinical Psychologist suggested to me recently that pharmaceutical industry research was "little more than propaganda".

Do psychological (talking) treatments represent the paradigm shift from horse to car that we need? I want to argue that our current obsession with improving access to psychological treatments reflects society's Freudian belief that mental illness is located in the mind and not the brain and can be sorted out by talking.

Cognitive behavioural therapy (CBT) is probably the most popular talking treatment.

Researchers have demonstrated that when delivered by a skilled therapist, CBT is as effective as antidepressant medication in the treatment of depression. Against schizophrenia and bipolar disorder, CBT also seems to be effective for example in helping patients cope with voices. But, and it is an important but, CBT only works (in schizophrenia and bipolar disorder), if patients are already on medication.

CBT, like all talking treatments, are complex interventions that need to be provided by skilled therapists. The problem; there simply aren't enough to meet demand and there never will be. A major initiative to improve access to psychological therapies (IAPT) consumed £170 million of new money.

Three and a half thousand new therapists have been trained and over 600,000 patients have entered the programme. Impressive; but rather than receiving the 20 sessions of CBT necessary for the treatment to work patients on average get just 3. Unless patients get 20 sessions the therapy can't work; this is what the research tells us. So whilst CBT is effective it is not the mental health equivalent of the Henry Ford's Model-T [pictured] providing effective psychological treatment for everyone.

Mental health practice is littered with countless examples of effective but complex interventions that work in theory but not in practice. The reason that they don't work is that they are too complex. Perhaps rather than focusing on ever more complex intervention we should consider simple intervention that can be reliably provided to all patients with mental illness. In a time of austerity making sure that everything we do really counts makes a lot of sense.

Back to medication. Mental illnesses such as schizophrenia , bipolar disorder and quite often depression, are long term conditions that require patients to stick with their medication, often indefinitely.

Whilst we need new treatments we could get much more out of the medicines we already have. Virtually every patient with schizophrenia or bipolar disorder misses doses of medication; this increases the risk of relapse and the return of painful and distressing psychotic symptoms. In fact the single biggest cause of relapse is that patients stop taking medication. There are many simple things that we can do to enhance adherence to treatment. I passionately believe we should be more positive about promoting the benefits of medication to our patients and their families.

For many patients, those with schizophrenia and bipolar disorder particularly, medication is a foundation to effective treatment and we should do everything to make sure that they stick with treatment. This is perhaps one of the most important things we do as mental health professionals.

There are other things we can do to help patients manage their medication; help them make choices about which drug will suit them best; closely monitor the effects and side effects of medicines, offer long acting injections rather than daily pills, use mobile phone text prompts to remind patients to take pills, prescribing a tablet that can be taken once once rather than four times a day. Simple things that work and help patients stick with treatment.

Ever more complex treatments that can never be scaled up to meet the need within the population seems to me like flogging, if it's not extending a metaphor to far, dead horse.

Our customers (patients) want greater access to talking treatments. I am far from convinced that the investment in psychological therapies has reaped the rewards that were promised when the IAPT programme was launched.

We need new medications and this requires intellectual as well as financial investment. When Henry Ford launched the Model-T, when Apple launched the iPad, these were leaps of imagination.

I want to argue for a simple revolution; we stop doing the complex badly and focus of doing simple things exceptionally well. But my real plea on world mental health day is to stop listening quite so much and start imagining.

Now more than ever we need real invention in mental health care and treatment.
Image credit

Model-T image credit

Sunday, October 9, 2011

Mental Health Commission struggles to find balance in developing strategy

An article published in the October 8th edition of the National Post:
By Joseph Brean

As Senator Roméo Dallaire [pictured], Canada’s best-known traumatized soldier, launches the Lieutenant-Governor of Alberta’s Circle on Mental Health & Addiction and Queen’s University unveils its own mental health commission in response to a series of suicides, both may cast a cautionary eye on the travails of the Mental Health Commission of Canada, a 10-year, $130-million federal project.

Since a draft of its national strategy on mental health was leaked this summer, the agency has been squirming under accusations of dysfunction, anti-psychiatry bias and neglect of the most serious mental illnesses.

Critics point out the 30-page document mentions “recovery” 67 times and “support” 125 times, but there is no reference to “psychiatry.” Or “schizophrenia” or “bipolar.”

In a “letter to Canadians” last month, Louise Bradley, the agency’s chief executive, promised to “correct” the strategy before its planned release next year, because “the current draft does not sufficiently reflect the essential role neuroscience, treatment and psychiatry have to play.”

In doing so, the MHCC is trying to strike a balance between the two major ideologies of mental health: empowerment, based in social science, in which recovery is seen as a personal growth experience; and psychiatry, based in neuroscience, in which recovery sometimes must be imposed against a delusional will.

At its most extreme, this clash of ideologies turns on the question of whether the fundamental problem of mental illness lies in the brain itself, or in the stigma imposed by society.

At stake is a key part of the MHCC’s dual mandate — to develop a national strategy on mental health — which will influence the allocation of research funding and the priorities provinces set on this unique issue, spanning health care and social policy.

The other part of its mandate is to combat the stigma of mental illness through public outreach and professional advocacy, which have largely focused on health-care providers, often the first point of contact between the mentally ill and the government.

As the strategy gets revised, the ideological balance continues to elude the MHCC, although a spokesman said the flawed draft is “relatively close,” and the Commission stands by it “fundamentally.”

Focused on “recovery,” the draft strategy highlights suicide prevention, self-directed care, improvement over cure, and calls for an end to the seclusion and restraint of psychiatric patients.

However, its focus on health promotion and prevention, including the role of employers in creating healthy workplaces, has fuelled criticism that this is not a strategy about mental illness, but rather mental wellness.

“They’ve stolen the word ‘recovery,’ ” said Herschel Hardin, president of the North Shore Schizophrenia Society in B.C., whose latest bulletin accuses the commission of hiding behind upbeat euphemisms and claims “those who understand severe mental illness no longer take [the MHCC] seriously — except to regard it as a menace.”

He said the agency exaggerates the notion recovery cannot be imposed by others and must be a self-directed personal achievement.

“For the seriously ill, that’s a small part of recovery that comes after treatment for the illness itself, which is part of recovery, which requires a lot of not just support but structure, provided by others,” he said.

“Here [at the MHCC] we have a bunch of people who really haven’t done the homework that they had to do, and buried the most important considerations in bureaucratic fluff and vague wording.”

More than most health issues, vocabulary clouds this debate.

Patients are recast as “survivors,” “consumers,” or “experts by experience” on the one side, and a schizophrenic’s lack of insight medicalized into “anosognosia” on the other.

“The idea of recovery in mental illness circles has a certain meaning that is not translated well for the general public,” said Bill Honer, head of the department of psychiatry at the University of British Columbia and a clinical expert on schizophrenia.

It is not like remission in cancer, in which the disease metaphorically retreats, or recovery from a cold, in which it disappears completely. Recovery in mental health, as the MHCC describes it, is an orientation, a way of life.

The danger, Prof. Honer said, is that a strategy in which individuals must guide themselves to recovery could be unfair to those who are unable to do so, because they cannot understand their own illness.

“On a strict interpretation [of that strategy], we risk not fulfilling our social responsibilities,” he said.

At the same time, there is rampant confusion about these words and what they imply, he said. “The social constructs of labelling and diagnosis are real, but it’s not the same as what we do [in psychiatry]. Having a diagnosis is not a bad thing. That’s how we work. But labelling and stigma are, and that’s how society works.”

Ms. Bradley refused to be interviewed, but strategic advisor Howard Chodos, who prepared the draft strategy, said it was developed through face-to-face meetings and an online survey.

The “vast majority” of participants in consultations were “supportive of the overall thrust of the strategy,” he said, but the review process now includes “some of more public discussion that’s taken place once the draft reached a wider audience than we originally intended.”

“Was everybody included? No. Did we have the resources to do that at this time? No,” he added.

“But we felt confident that we would get the kind of feedback from that group that would enable us to strengthen the document.”

Mr. Chodos acknowledged the criticism and said the draft’s language “is not where we would like it to be, in terms of connecting with people, resonating with people in a way that will help to galvanize support for the document.”

But he rejects the notion that the focus on consensus obscures the hard cases.

“What I don’t accept is that there is a fundamental opposition between those two elements,” he said.

“We can find a way to have that balance, and we’re not sacrificing one on the altar of the other.”

Image credit

Also see:

Mental Illness Awareness Week: Canada Stands Ready for Positive Change

Friday, October 7, 2011

He Wants To Stop Taking His Medication

Dr. Xavier Amador has posted a new video on his website:

Our son is 22 years old & diagnosed with schizophrenia. He first became ill at 18. He’s been hospitalized many time, 5 times within the last year. He’s also been arrested for miscellaneous crimes due to his thought disorder and delusions about what people are doing to him. He was given a guardian by the state last Dec and put in a long term care facility for 6 months and mandated medication. He was release several weeks ago, and immediately stopped taking medication. He’s all along said he does not feel he has schizophrenia, and will not take medication. He’s said he feels he has an anger problem. He does continue to see his psychiatrist. We see our son weekly, have a good relationship with him now, but are very afraid of when he gets ill again. Do you have any suggestions? – Carroll and her Husband from Alameda, CA

Dr. Amador's Answer

Thursday, October 6, 2011

Mental Illness Awareness Week: opening Canadians’ eyes

A letter to the editor published in today's edition of The Chronicle Herald:
By Stephen Ayer (pictured)

Mental Illness Awareness Week, Oct. 2-8, is an annual national public education campaign designed to help open the eyes of Canadians to the reality of mental illness. The week was established in 1992 by the Canadian Psychiatric Association. It is now co-ordinated by the Canadian Alliance on Mental Illness and Mental Health in co-operation with its member organizations, including the Schizophrenia Society of Canada, as well many other supporters across Canada.

As a kick-off event for the week, the Schizophrenia Society of Nova Scotia (SSNS) presented a special screening last Sunday of the movie The Soloist, based on the true story of Nathaniel Ayers, a musician who develops schizophrenia and becomes homeless. The screenplay by Susannah Grant is based on the book The Soloist by Steve Lopez, a columnist for The Los Angeles Times.

The same day, the society also highlighted the recovery journey of Laura Burke, a young Nova Scotian who lives with schizophrenia, by screening Superhero — A Visual Poem, a documentary short film featuring Ms. Burke’s spoken word poetry. Ms. Burke was honoured during Mental Illness Awareness Week in Ottawa last year as a 2010 Champion of Mental Health.

Today, the Schizophrenia Society of Nova Scotia is partnering with other local mental health organizations and supporters to present the Fourth Annual Festival of Hope, a celebration of hope, healing and recovery. This free event takes place from 3 to 8 p.m. at the Olympic Hall, 2304 Hunter St. (corner of Cunard and Windsor in Halifax).

The core belief of the SSNS is that people with mental illnesses such as schizophrenia can live a life of meaning and purpose. The society’s focus is to promote the goal that each individual will be able to return to a quality of life which meets each person’s own perception of needs and expectations.

The vision of the SSNS is to reach all Nova Scotians who are directly or indirectly affected by schizophrenia — to focus on the individual, not the illness, to promote wellness and recovery, and to reduce the stigma and discrimination so often associated with mental illness.

The society’s mission is to improve the quality of life for those affected by schizophrenia through education, support programs, influencing public policy, and supporting research. The SSNS provides a community-based network of knowledgeable and dedicated volunteers whose personal experience with the illness allows them to share their stories of hope and recovery with people affected by schizophrenia for the first time.

Stephen Ayer is executive director of the Schizophrenia Society of Nova Scotia. He lives with a mental illness and experienced homelessness in the 1990s. Dr. Ayer is a 2009 recipient of an Inspiring Lives Award from the Mental Health Foundation of Nova Scotia and the CMHA — Nova Scotia Division.
Photograph by Ryan Taplin / Metro Halifax

New videos featuring Dr. Xavier Amador

Dr. Xavier Amador has links to two new videos posted on his website:

2011 Nordic Psychiatry Academy Interview with Dr. Amador

"I am not Sick, I don't need help!" presentation at the 2011 Nordic Psychiatry Academy

To view Dr. Amador's presentation at the Schizophrenia Society of Nova Scotia's 2005 Annual Conference, please click here.

To order the book, I Am Not Sick, I Don't Need Help, please click here or here.

Also see the following videos:

Anosognosia 1 of 2 (Recorded July 3, 2010)

Anosognosia 2 of 2 (Recorded July 3, 2010)

Women & Wellness Nova Scotia


Thursday, March 22nd, 2012!

6:00 pm to 9:30 pm

Please click on the image to magnify it.

RSVP by contacting the CMHA Nova Scotia Division office at 902.466.6600 or by sending an email to suecmhans@eastlink.ca.

Also see:

Jessie Close

BringChange2Mind website

BringChange2Mind Facebook page

Wednesday, October 5, 2011

Mental Illness Awareness Week: Canada Stands Ready for Positive Change

An opinion piece posted on October 4th by the Mental Health Commission of Canada:
Op-Ed to coincide with Mental Illness Awareness Week

By Louise Bradley (pictured)

I have worked in the mental health field in Canada for over three decades, and I can say without exaggeration that never before have I seen such a high level of awareness about mental illness in this country. At last, mental health and mental illness are taking centre stage.

From coast to coast to coast, Canadians are stepping forward to talk publicly about their own personal experiences with mental health problems and mental illnesses, and by taking this courageous action, they are making a real difference to countless others.

In September, after 17-year-old high school student Chris Howell, who had been bullied since grade school, committed suicide, 150 friends and family gathered in front his school to mourn his loss and call for an end to bullying. “I just want to stop it,” Chris’s mother Judy told the Hamilton Spectator. “I don’t want anyone else to have to pay.”

For their part, after their son Jack, a first-year student at Queen’s University, took his own life last year, Eric and Sandra Windeler established The Jack Project, a national program to help Canadian youth achieve optimal mental health as they transition from late high school into their college, university or independent living years.

And then there are people like Harmony Brown, Jeremy Bennett, Roberta Price, Shana Calixte, and Steeve Hurdle, who are this year’s “faces” in the Face Mental Illness Campaign coordinated by the Canadian Alliance on Mental Illness and Mental Health as part of this week’s Mental Illness Awareness Week national public education campaign.

By sharing their personal stories, these five, too, are helping to end stigma and bring mental illness out of the shadows forever.

Today, hundreds of organizations across the country are working tirelessly to raise public awareness about mental health problems and mental illnesses through advocacy and by providing services and supports to those in need.

Canadian companies, including Bell Canada, RBC, Great-West Life and Canada Post, are investing millions of dollars to raise awareness about mental health, improve children’s and workplace mental health, and support organizations on the mental health front lines.

Governments across the country are also addressing mental health in more meaningful ways with new strategies, action plans and investments.

Thousands more individual Canadians are empowering themselves by learning how to spot the signs of mental health problems in family, friends and even themselves through courses being offered by Mental Health First Aid Canada. To date, over 42,000 Canadians have become mental health first aiders.

It is little wonder we are seeing such a ground swell of action and support for mental health.

Canadians have woken up to the fact that ignoring mental health is detrimental to individuals, families, and communities, as well as our society and economy as a whole.

They are becoming aware that there is no health without mental health, and that no one is immune from mental illnesses. This year alone, more than seven million Canadians—that is one in five people—will experience a mental illness personally, and in turn, this will impact family, friends and colleagues.

We are making progress in changing attitudes about mental health, but there is still much work to be done.

We need to be doing more to improve access to mental health services, decrease stigma, support the needs of families caring for ill relatives, invest in research spanning the full spectrum of issues relating to mental health and mental illness, promote mental health, and prevent mental illness so that every Canadian has the opportunity to achieve the best possible mental health and well-being. All this and more will be addressed in the first-ever Mental Health Strategy for Canada, which the Mental Health Commission of Canada will release next year.

What can you do to help?

To start, I urge all Canadians to pledge to the cause of mental health, not just during this Mental Illness Awareness Week, but 365 days a year, by supporting a family member, a friend, a colleague, or a neighbour living with a mental health problem or mental illness and helping them build a better life for themselves. And potentially everyone will have a role to play in bringing the Mental Health Strategy for Canada to life and ensuring it has maximum impact.

Now more than ever, we have an opportunity to build a society that values and promotes mental health and helps people living with mental health problems and mental illnesses to lead meaningful and productive lives.

This will require some fundamental changes to our systems of mental health care and also to our collective way of thinking about mental illness, but if the past year is anything to go by, Canadians are ready to take on this challenge and ready, willing and able to work together to achieve positive change.

Louise Bradley is President and CEO of the Mental Health Commission of Canada.
Image credit

Also see:

Housing first for the mentally ill: Former MP wants changes to assist those in need