Sunday, July 24, 2011

United front on mentally ill urged

An article published in the July 19th edition of the National Post:
By Joseph Brean

Canada needs a "dynamic, broadly based social movement" to improve its citizens' mental health, a "whole of government" approach that unites everyone from political leaders to "experts by experience," says a national strategy five years in the making.

The goal, says the Mental Health Commission of Canada (MHCC), should be a "cultural shift toward recovery," which favours real improvement over ideal cure, and is informed by "multiple sources of knowledge," including the traditions of restorative justice and the hard-won wisdom of people in recovery.

The 37-page draft strategy document, obtained by the National Post, also seeks to reduce the stigma of suicide; calls for an end to "seclusion and restraint" of psychiatric patients; and demands that, in criminal-record checks, police stop disclosing information about people they have driven to hospital in a mental health crisis.

"This practice inhibits people's ability to volunteer or get a job, and should be stopped," reads the report, Mental Health Strategy for Canada - Draft, Not For Circulation. A final version is expected to be presented to the MHCC's board in October, and released publicly next year.

The strategy acknowledges the federal government's arm's-length role in healthcare delivery, but argues that mental health is not purely a health issue, as it also involves criminal justice, housing, finance and child services. The MHCC's broad solution is to "shift upstream and across sectors" by taking a "whole of government" approach, in which actions are nationally co-ordinated, and "leadership [is] located at the highest level possible within government and the bureaucracy."

Clinically, the strategy calls for a "genuine partnership" between caregivers and people with mental illnesses, who should be offered "self-directed care-funding initiatives," so they can "directly manage part of their social service and health budgets."

"The expertise gained from lived experience should be complemented by professional expertise, not dominated by it," the report reads.

"Not only will this change in the distribution of power within the mental-health system benefit users of services, it will also create a more positive context in which mental health providers can deploy their skills, experience and knowledge."

Examples of self-directed care choices might include art or music therapy, or training in mindfulness techniques, said Howard Chodos [pictured], special advisor to the MHCC.

Finding the right balance, he said, "involves the skill and art of medicine as much as it does the science.

"Unfortunately, in mental health there are no blood tests and there are no medical tests which tell you what illness you have and what treatment to use," he said.

The strategy also calls for better training for so-called "gatekeepers" - teachers, doctors, clergy, police and prison staff - to help them recognize and react to warning signs of suicide, and to promote mental health.

This focus on prevention and health promotion is a target of early critics of the report, who say it offers little to people with serious mental illnesses, such as schizophrenia or bipolar disorder, which cannot be prevented by social policy, as they are organic diseases of the brain.

They cite New York State's Office of Mental Health as a cautionary tale of a system in which the "worried well" gained support at the expense of the truly sick.

Susan Inman, a Vancouver advocate for the families of people with serious mental illnesses, whose daughter recovered from schizophrenia, said the strategy's deference to lived experience will make things worse for people who are so mentally ill they are incapable of realizing it - a condition known as anosognosia. She fears the emphasis on personal empowerment will make involuntary treatment almost impossible.

"This plan is really about mental wellness," she said. "People with serious mental illnesses are ignored."

Mr. Chodos said research shows a range of factors can increase or decrease the risk of even the most serious mental illnesses.

"We do not yet know that there is anything more than a genetic predisposition," he said.

"Prevention [in the strategy] is not only prevention of onset, but also the debilitating consequences of it."

He gave the example of homelessness, often associated with schizophrenia and substance abuse, as an area where social policy can, in fact, prevent the worst of a mental illness.

He said another is cannabis use among youth, a known risk factor for schizophrenia.

The MHCC, which was established in 2007 by Prime Minister Stephen Harper on the recommendations of former Senator Michael Kirby, has a twin mission. Erasing stigma has always been the long-term goal, but this formalized national strategy is the immediate plan.

The strategy comes at a crucial moment for psychiatry, not just in Canada but globally, as the discipline's diagnostic manual undergoes a thorough revision.

There is also a strong climate of suspicion about the role of drug manufacturers in the proliferation of psychiatric drugs, and about the spike in diagnoses of childhood behavioural disorders.
Image credit

Also see:

An open letter to the Mental Health Commission of Canada - A response to their draft Mental Health Strategy for Canada

Identification of a biological signature for schizophrenia in [blood] serum

A 12-Step Program For Canada

Addressing stigma: An influence and leadership opportunity for our profession

An article published in the July/August 2011 edition of Alberta Doctors' Digest:

Please click on the image to magnify it.

To download a PDF version of the entire article, please click here.

Saturday, July 23, 2011

Editorial: A better way on mental illness

An editorial published in the July 22nd edition of The Times Colonist:
Make no mistake. The Archie Courtnall Centre has been a positive contribution to mental health care in this region. For all the problems, the centre marked a step forward in care. And the willingness of the Courtnall brothers - Bruce, Russ and Geoff [pictured] - to talk about their own father's suicide, while raising millions for mental health services, has brought an increase in awareness about the reach and grip of mental illness. Russ and Geoff Courtnall have used their status as former NHL hockey players to raise money and educate.

But there is much more to do, as the history of the Courtnall centre itself shows.

The centre - effectively an emergency room for people suffering from critical mental illness - was only built because the Courtnalls helped to raise the $2.2 million required.

Any other form of emergency room, like the one opened at Victoria General Hospital in 2009, would be funded by government as part of a functioning health-care system. Yet patients with mental illness rely on charity for emergency services.

The Courtnall centre opened in 2005. A Times Colonist editorial outlined the vision of offering patients "a quiet refuge in crisis situations." Four beds would offer shortterm care of up to 72 hours. Patients would be assessed and quickly provided with needed care in the community or admitted to hospital beds.

But demand quickly swamped the centre. Within two years, director Dr. Anthony Barale resigned. "The staff of the psychiatric emergency service struggle daily to provide even the most basic medical and psychiatric care for this suffering population," he said. "And they do so with little support and the pitiful resources provided by VIHA - resources which, even by so-called Third World standards, are entirely inadequate." In the same year, then premier Gordon Campbell acknowledged a province wide failure to provide adequate mental health treatment.

Today, mental health patients routinely spend days - some more than a week - waiting for admission to too few hospital beds, sleeping in reclining chairs in the Courtnall centre that were intended for a few hours' rest.

In any other emergency room, waits under such conditions would be considered intolerable. Again, people with mental illness are treated as second-class citizens - as if their illnesses are not real, or they do not matter.

The waits will likely worsen. VIHA has reduced the number of in-patient beds available for patients with mental illness, despite having acknowledged the shortage of beds before the cuts. Increased community resources, such as outreach teams dealing with people living with serious mental illness and addictions on the streets, have helped.

But patients and families continue to experience desperate waits for care and inadequate post-release support. Already serious conditions worsen. Some people abandon the effort to get help, or fall to the streets - or like Archie Courtnall, end their own lives.

The Courtnall centre has helped. And the fundraising events this weekend - see for details - deserve your support.

But we wouldn't accept, as a society, that care for people with heart problems or cancer would depend on the success of golf tournaments or fundraising auctions.

Our neglect carries a huge human cost, as the Courtnalls and so many others can attest. It also carries a great economic cost, as untreated illnesses worsen and people's potential is lost.

We have talked, for decades, about removing the stigma from mental illnesses and providing equitable care, as we do for most others with a medical condition. Our actions have fallen far short of that reality.
Photo credit

Up Close and Personal with the Courtnall Brothers

Also see:

Former Canucks star Geoff Courtnall opens up about father's suicide, his own depression

Mental-health patients betrayed by VIHA

VIHA cutting community mental health support

Courtnall psychiatric emergency centre overwhelmed since inception, service reductions

Which Doors Lead to Where: How to Enhance Access to Mental Health Service: Barriers, Facilitators and Opportunities for Canadians’ Mental Health

Please click on the image to magnify it.

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

Also see:

Mental Health Table

Saturday, July 16, 2011

Jon David Welland writes about the From Recovery to Discovery Peer Support Group

Posted on June 7th by Jon David Welland (pictured):

Last week I sat in on the Schizophrenia Society's Peer Support group. There, a drama instructor [Courtney Siebring] guided the members through a series of exercises to express, through non-verbal communication, their feelings regarding mental illness, and how their illness affects their lives and their place in society as a whole. In the final exercise, each member spontaneously played a part in a powerful dramatic scene that explored each individuals role in their shared situation and experiences. I made a series of quick sketches of the proceedings and intend to turn each one into a finished piece.
Photo credit

Also see:

From Recovery to Discovery Peer Support Group

Tuesday, July 12, 2011

Delaware Psychiatric Center to undergo overhaul

An article posted online on July 7th by The News Journal:
State, federal officials agree to five-year reform plan at state mental hospital

By Beth Miller and Esteban Parra

Delaware will revamp its state psychiatric hospital over the next five years, transforming it from a dysfunctional and sometimes-abusive warehouse for the mentally ill into an integrated mental health system that includes community life and vastly expanded support systems, according to terms of a settlement announced Wednesday by state and federal officials.

The ambitious agreement reached Tuesday ends a three-year investigation by the U.S. Department of Justice and arrives almost four years to the day after a News Journal investigation that revealed rape, assault and other abuse of patients, exaggerated overtime expenses and threats and retaliation against staff members who reported violations.

It would put an end to long-term institutionalization of those with mental illnesses, steering state resources and support instead to community services and residential settings, providing customized support to keep people out of institutions and help those who can leave such settings do so.

Gov. Jack Markell and Rita Landgraf [pictured], secretary of the state Department of Health and Social Services, said the agreement includes expanded community service, housing, supported employment opportunities, a statewide crisis team that -- by January -- will respond to a person in crisis anywhere in the state within one hour, intensive case management and a network of trained peer support specialists who understand mental illness by experience.


Delaware must:
  • Offer community-based services to prevent unnecessary institutionalization of those with serious, persistent mental illness
  • Develop a statewide crisis system, including a crisis hotline, mobile crisis response teams, walk-in centers, stabilization services (short-term inpatient care, with stays no longer than 14 days) and crisis apartments
  • Provide intensive support services and case management
  • Provide housing, with supports including rental subsidies or vouchers, and assurances that new housing created under the settlement terms will include no more than 20 percent of units occupied by those with a disability, to prevent isolation
  • Provide supported employment and rehabilitation services
  • Provide family and peer support
  • Develop transition plans for each individual now in or being admitted to an institutional setting
  • Publish annual reports identifying the number of people served in each type of service, with evaluation of unmet needs and quality of services
  • Accept a court-appointed monitor to review and report on state compliance, issuing public reports at least twice a year, settling disputes and offering recommendations
  • Meet timeline requirements from January 2012 to July 2016
To read the entire article, please click here.

Also see:

State wins in Delaware Psychiatric Center deal

Image credit

Saturday, July 9, 2011

New National Mental Health Standards Focus on Community Services

An April 14th media release from Accreditation Canada:
Accreditation Canada has released new national health care standards for community-based mental health services. The Community-Based Mental Health Services and Supports Standards cover a wide variety of services including mental health promotion and education, early intervention services, crisis intervention, counselling and therapy, peer and self-help programs, diversion and court support, and social rehabilitation and recreation.

“Mental health illnesses affect all Canadians, either directly or through someone close to us. The impact mental illness has on the day-to-day lives of individuals, families, and friends can be very significant,” says Wendy Nicklin, President and CEO of Accreditation Canada. “Often, the support people need isn’t found in a hospital, but rather at a clinic or a community centre. These new standards will help community mental health organizations provide safe, high-quality services to their clients.”

Given the increased emphasis on the treatment of mental illness outside of an institution, it became apparent to Accreditation Canada that there was a need for a greater focus on community mental health services in its Qmentum accreditation program. An advisory committee made up of clients, surveyors, and sector experts lent their expertise to this initiative. Further guidance received through national consultation and pilot testing ensured the standards would meet the quality and safety needs of the health care professionals who would be putting them in place.

Accreditation Canada is a not-for-profit, independent organization that provides health services organizations with a rigorous and comprehensive accreditation process. We foster ongoing quality improvement based on evidence-based standards and external peer review. Accredited by the International Society for Quality in Health Care, Accreditation Canada has helped organizations strive for excellence for more than 50 years.

Also see:

Community-Based Mental Health Services and Supports Standards
Image credit

Friday, July 8, 2011

Points to Remember

From the June 17th edition of Psychiatric News:
Mental Illness Is a Brain Disorder
  • “Multimodal” techniques using EEG and functional magnetic resonance imaging are providing a comprehensive picture of the structural, functional, and temporal connectivity in the brain.
  • Medications, cognitive-behavior therapy and other interventions appear to affect different parts of brain circuitry involved in mental disorders. 
    Mental Disorders Are Developmental Disorders
    • Onset of mental illness is almost entirely before the age of 25.
    • Emerging evidence shows that ADHD is a developmental disorder characterized by delay of cortical maturation.
    Mental Disorders Result From Complex Genetic Risk Plus Experiential Factors
    • Genetics of mental illness are characterized by very rare but potent variations.
    • These rare variations result in changes in brain circuitry that, in complex interaction with environmental influences, result in many pathways to phenotypes of mental illness.

    Related articles

    Brain, Gene Discoveries Drive New Concept of Mental Illness
    Psychiatr News June 17, 2011 46:1-33
    Full Text
    Image credit

    Wednesday, July 6, 2011

    Grand challenges in global mental health

    An article published in the July 7th edition of the journal, Nature:
    Schizophrenia, depression, epilepsy, dementia, alcohol dependence and other mental, neurological and substance-use (MNS) disorders constitute 13% of the global burden of disease (Table 1), surpassing both cardiovascular disease and cancer (ref. 1). Depression is the third leading contributor to the global disease burden, and alcohol and illicit drug use account for more than 5% (ref. 2). Every seven seconds, someone develops dementia (ref. 3), costing the world up to US$609 billion in 2009 (ref. 4). By 2020, an estimated 1.5 million people will die each year by suicide, and between 15 and 30 million will make the attempt (ref. 5).

    The absence of cures, and the dearth of preventive interventions for MNS disorders, in part reflects a limited understanding of the brain and its molecular and cellular mechanisms. Where there are effective treatments, they are frequently not available to those in greatest need. In 83% of low-income countries, there are no anti-Parkinsonian treatments in primary care; in 25% there are no anti-epileptic drugs (ref. 6). Unequal distribution of human resources — between and within countries — further weakens access: the World Health Organization’s European region has 200 times as many psychiatrists as in Africa (ref. 7). Across all countries, investment in fundamental research into preventing and treating MNS disorders is disproportionately low relative to the disease burden (ref. 8).

    To address this state of affairs, the Grand Challenges in Global Mental Health initiative has identified priorities for research in the next 10 years that will make an impact on the lives of people living with MNS disorders. The study was funded by the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, supported by the Global Alliance for Chronic Diseases (GACD), headquartered in London. Answers to the questions posed will require a surge in discovery and delivery science. We use the term ‘mental health’ as a convenient label for MNS disorders. We exclude conditions with a vascular or infectious aetiology (such as stroke or cerebral malaria), because these fell within the scope of the two previous grand challenges initiatives — in global health and in chronic non-communicable diseases (ref 9).

    This initiative differs from previous priority-setting exercises for mental health (refs. 10–12) in four ways. First, its scope is global. Second, it is the first to employ the Delphi method (ref. 13), a structured technique using controlled feedback to arrive at consensus within a dispersed panel of many participants. Third, it covers the full range of MNS disorders. Finally, the effort hopes to build a wide-ranging community of research funders — much as the challenge for non-communicable diseases led to the creation of the GACD.

    Bold emphasis above is mine.

    1. World Health Organization The Global Burden of Disease: 2004 Update (WHO, 2008).
    2. WHO Atlas on Substance Use (WHO, 2010).
    3. Ferri, C. P. et al. Lancet 366, 2112–2117 (2005).
    4. Wimo, A., Winblad, B. & J├Ânsson, L. Alzheimer’s & Dementia 6, 98–103 (2010).
    5. Bertolote, J. & Flieschmann, A. Suicidologi 7, 6–8 (2002).
    6. WHO Country Resources for Neurological Disorders 2004 (WHO, 2004).
    7. WHO Mental Health Atlas (WHO, 2005).
    8. Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. Lancet 370, 878–889 (2007).
    9. Daar, A. S. et al. Nature 450, 494–496 (2007).
    10. Lancet Mental Health Group Lancet 370, 1241–1252 (2007).
    11. Sharan, P. et al. Br. J. Psychiatry 195, 354–363 (2009).
    12. Tomlinson, M. et al. Bull. WHO 87, 438–446 (2009).
    13. Jones, J. & Hunter, D. Br. Med. J. 311, 376–380 (1995).
    To download the entire article, please click here (PDF).

    Also see:

    Thinking Globally to Improve Mental Health

    Mental Health: Think Globally, Act Locally

    Image credit

    Tuesday, July 5, 2011

    Sharing info helps patients: N.S. doctor

    An article posted on July 4th by CBC News:
    New guidelines about sharing patient information will make it easier for some families that support adults with mental illness, a senior health official in Halifax says.

    Capital Health is adopting a sliding scale of information sharing, where patients can decide how much to share and with whom. It's a move away from the all-or-nothing approach.

    "This is different from before. Now we're looking to share some information with some people and be specific about it," said Dr. Ian Slayter [pictured], clinical director for general psychiatric services.

    Slayter said patients may refuse to divulge any health information, but health-care providers will encourage them to share some details with those who support them.

    He said studies have shown that communicating with family members results in a better outcome for the patient.

    "We're saying that providers need to sit down with the patient and say, 'You're receiving some support from this person and they could be more effective if they understood a little something about your illness, what it's all about, what your treatment is and how they can help.'"

    For example, Slayter said, if a relative or friend knows that a patient is having suicidal thoughts, then maybe they can provide more support to help them.

    He said it's also useful for families to know about a certain medication so they can help the patient get it or administer it.

    Joanne Zinck's youngest daughter was diagnosed with schizophrenia at age 20. She says one of her biggest hurdles with mental-health care providers has been around privacy.

    "We were depended on to help her to get well, but yet we weren't able to get the information that we needed to be able to support her," said Zinck.

    Slayter said the guidelines were drafted by a group of patients, their families and the specialists who treat them. He said they also consulted with the Meriden program, a family-oriented mental-health service in England.

    The district health authority approved the guidelines last week. Some staff are working with the new rules already, but more will be trained this fall.
    Also see:

    CDHA Mental Health Program - Information Sharing Guidelines (PDF)

    Collaboration in the Triangle of Care (PDF)

    Peer support: what is it and what makes it different?

    An article posted July 4th on the Scottish Recovery Network (SRN) website:
    In a specially commissioned article for SRN, international author, trainer and peer support expert Shery Mead [pictured] talks about some of the distinct features of the peer relationship and considers implications for practice. Shery is the keynote speaker at the forthcoming Experts by Experience conference being held in Perth on 21st September 2011.

    Peer support is becoming an established practice in mental health. It is being used in informal settings as well as in hospitals and other services. But what is it about peer relationships that make them different to just having a good friend or for that matter another service worker? I will talk in this article about some of the distinct features of the role of peer support and implications for practice.

    Peer Support is not new. As long as there have been people on earth, they have come together around shared experience to learn from each other. In mental health we have added a more formal layer to peer support by making it a specific role that is often paid. This is where it may get confusing. In paid peer support you and I come together to learn from each other (like some friendships) but you (the paid peer support worker) actually need to practice a few things.

    After many years’ experience working and writing in the field of peer support, I’ve produced the following guide for prospective and active peer workers to some of the core principles of peer support practice:

    1. Learning vs Help

    In the best of all worlds we are altruistic, compassionate beings. We don’t like to see others suffering or in pain, and we want to make a difference. All too often, however, these beliefs and desires get in the way of building deeper understanding between people and can actually thwart learning and growth. When we go into a relationship with the intention of helping or even assisting or supporting we go in with some kind of agenda about you and your “problems.” Perhaps I know a little bit about you from some of my colleagues and before I’ve even met you I decide who you are and what you need. Even if I don’t know anything about you, when my attention is focused on helping we may well end up in a power struggle.

    Instead, most people hope that we’ll learn more about them and how they’ve learned to make sense of their experience, learn about the cultural conditions that maintain their reality, and most importantly, what their ideas are about what might make a difference. Then – and only then – are they willing to understand or listen to where we’re coming from. Learning together takes time; it’s about building relationships where new information and new knowledge can emerge.

    2. Focusing on the relationship vs. focusing on the individual

    Paying attention to the relationship is an altogether different phenomenon. It’s a bit like a dance or a jazz band where the sum of the parts is greater than all the individuals added together. It is not about playing the right notes (saying the right thing), it’s actually being fully present to the other (listening for the story, the context of the story, what’s unspoken in terms of feelings and meaning) and then responding not with the answers but intuitively, creatively bringing something that is both authentically you AND that is also from the place where you connect with the other person to the conversation. This flow of increased mutual understanding, as well as generation of new meaning, is the goal of peer support. And so we seek to discover what goes into building this type of conversation.

    One of the keys is giving up the idea of pre-determined outcomes (such as goals or symptom-reduction) and instead, learning to think laterally about the quality of our relationship. For example, instead of trying to persuade, seeking to understand, reflecting on our responses, and then speaking authentically from the heart what seems most important to us to contribute.

    3. Responding out of hope vs. reacting out of fear

    Let’s face it, when we feel frightened we do whatever we know how to alleviate the fear or the discomfort. We even go so far as to try to prevent situations that might potentially be uncomfortable. In peer support, as in the rest of community, this translates into coercion – subtle or otherwise.

    Fear reactions come in all forms -- from avoiding, persuading, and knowing what’s best, to controlling, assessing and force. These reactions are hardwired by our animal instincts as well as from cultural norms that reinforce difference as dangerous (e.g. people from cultures different from our own). Fear has even influenced how we think about safety and has left us anxious about what’s not safe rather than comfortable with creating our own sense of safety.

    This is where the idea of hope comes in. In order to sit with the discomfort of a difficult situation we must have some hope that something interesting or even positive will come out of going right through the middle of it. We may not know what that is (trying to control the outcome would be a fear based response) but gradually begin to trust that there is learning in our discomfort. This learning then creates possibilities that give us options – options that didn’t exist when our goal was just to get through this frightening time.

    While these principles are just a basic outline of what peer support might encompass, they give us a chance to reflect on what factors contribute to making it unique. As we build these skills across a paid workforce of peers we actually increase our ability to self reflect on all our relationships and what makes them work. In doing this we’re working towards social change. Maybe, at the end of that day, that is a role for peer support.

    Find out more about the Experts by Experience conference, including how to register.

    Find out more about SRN's work on peer support.
    Also see:

    Defining Peer Support

    Oldham Stresses Importance of Integrated Care

    An article published in the June 17th edition of Psychiatric News:
    By Mark Moran

    John Oldham, M.D., reminds APA members and other annual meeting attendees to see the “person behind the disorder” who can be a partner in integrated care.

    To incoming APA President John Oldham, M.D. [pictured], “Integrated Care”—the theme of his presidential year—is no empty catch phrase.

    “To me, integrated care has many important meanings—integrating work with the rest of medicine, integrating education and teaching and the latest research findings into our clinical work, and integrating the stages of a patient's treatment into a coherent, progressive plan,” he said at the Opening Session of this year's annual meeting in Honolulu last month.

    Oldham outlined four priorities that he said will guide his presidential year: integration of psychiatry with the rest of medicine, the right of patients to quality treatment, the unacceptability of fragmented care, and the importance of research and education (see New APA President's Four Focus Areas). He related a remarkable clinical vignette to remind psychiatrists of the timeless importance of seeing “the person behind the disorder,” a person who can be a partner in integrated treatment.

    As an example, Oldham noted that he had recently received an e-mail from a patient (“Mr. R”) whom Oldham had treated when he was a resident at Columbia. In the e-mail, Mr. R—who had been 22 years old and a student at the time of his illness—told Oldham that “he had done OK in life, which he thought would surprise me.”

    Oldham added, “He remembered me as arrogant, distant, pessimistic about his future, and not very helpful. I was stunned, since he was one of those patients we can all recall from our training years who had made a profound impression on me and was indelibly fixed in my memory.”

    Mr. R, an Orthodox Jew, had fallen in love with a woman outside of the Jewish faith, and his father had told him that if he married her, it would be “the death of him.” But the young man persisted in his love and married her—and on the wedding day, the father died of a heart attack.

    “I first met Mr. R shortly thereafter, when he was hospitalized in an acute psychotic state,” Oldham recalled. “What I remember from those days was how concerned I was for Mr. R—I was, after all, a student too at the time. I didn't know enough yet to appreciate the power of human resilience and the recovery potential within us all. What Mr. R saw as coldness or arrogance was, in hindsight, a defensive formality that I needed to hide my anxiety and uncertainty about how I could help him. What I also had trouble seeing at the time was the person behind the psychosis, though he was there watching me and wanting to connect with me all the time.”

    After mulling over Mr. R's recent e-mail, Oldham decided to respond. “I told him that his message was valuable to me. I apologized for having been so unavailable to him, and I wished him well. A few days later he e-mailed me again saying how pleased he was that I had replied, and not to worry, that ‘all was forgiven.’ I haven't heard from him since.

    “I think it conveys important messages for us all, reminding us of the power of hope, the potential for recovery, and that we must never lose sight of the whole person, who, for the time being, is not only our patient but also our partner in the treatment enterprise.”
    Image credit

    Monday, July 4, 2011

    Help reverse the neglect & exclusion of mental disorders to save lives

    Join the fight for the inclusion of mental health in the United Nations High-level Meeting on Non-Communicable Diseases

    Please visit

    Nearly half a billion people are affected by mental disorders which account for nearly 15% of the disease burden in the world - more than heart disease, lung disease, cancer or diabetes – more than TB, HIV and malaria combined! Yet, the historical neglect and exclusion of mental health from local, regional, national and global agendas continues and the exclusion of the neuropsychiatric disorders from the United Nations High-level Meeting on Non-Communicable Diseases represents a major social and economic injustice to the hundreds of millions of citizens suffering from neuropsychiatric disorders who are robbed of the opportunity to reach their life’s potential and are condemned to lives of vulnerability.

    In the continuing story of humanity to create a just and equitable world, we have failed too many people everywhere, and poverty, expressed through persistent inequities and social injustices, remains our major failure as humanity. In this poverty story, neuropsychiatric disorders, with its story of economic hardships to those living with mental and neurological illnesses and their caregivers and families, play a critical role in the evolution and persistence of poverty. We must discontinue our penchant for a good talk, but no action.

    - Dr. Leslie Ramsammy, Honorable Minister of Health, Guyana
    Photo credit