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