I am not sick, I don't need help!

Dr. Xavier Amador is an internationally sought-after speaker, clinical psychologist, professor at Columbia University Teachers College in New York City, the Founder and Director of the LEAP™ Institute and author of eight books including the national best seller I’m Not Sick, I Don’t Need Help!™

In this video he talks about dealing with anosognosia, the lack of insight regarding a mental illness. The video was recorded during the Schizophrenia Society of Nova Scotia's Annual Conference in 2005.

For a PowerPoint presentation on Dr. Amador's Listen-Empathize-Agree-Partner (LEAP) approach, click here.

Part 1 of 2 (57 minutes)

Part 2 of 2 (53 minutes)

This video was reviewed by Schizophrenia.com on December 27, 2006. To read the review, please click here.


Other videos featuring Dr. Amador:

Cambridge Talk on Helping People with Mental Illness - October 2, 2012 (NAMI Cambridge Chapter)

Keynote speech to the annual convention of the National Council for Community Behavioral Healthcare (May 2011)

2011 Nordic Psychiatry Academy Interview with Dr. Amador

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

Anosognosia Workshop — July 3, 2010 (NAMI Conference)

Also see:

I am Not Sick, I Don't Need Help! How to help someone with mental illness accept treatment. 10th Anniversary Edition

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)

Stopping the Revolving Door - A Civil Approach to Treating Severe Mental Illness

Stopping the Revolving Door - A Civil Approach to Treating Severe Mental Illness from Treatment Advocacy Center on Vimeo.

Dr. Xavier Amador speaks about anosognosia

Should state mental health institutions close?

An article published in the March 18th edition of the Asbury Park Press

By Valerie Fox

Recently I read a lengthy editorial from a mental health advocate who stated strongly that institutions should close and have all mentally ill people treated in the community. The writer works for a large mental health community provider, which has probably influenced her opinion. In this editorial, no thought was given for people who cannot live in the community, but instead need the shelter of a long-term care facility.

Having been involved in direct care in the mental health system as a consumer-provider and having visited many people in institutions and in the community while serving on boards and committees, it is my opinion that, unfortunately, not all mentally ill people have responded to medication. For some, a number of meds are tried, but none give freedom from serious symptoms to be able to seek and live a good quality of life.

I have met other people who do not have insight into their illnesses and the need to take medication. These people are very vulnerable to becoming victims or victimizing others because they are not living in reality, but instead are living in the grip of voices and delusions.

For myself, after living homeless for approximately two years, I initiated being sent to an institution. I did not know I was ill, but I did know enough that going to a community hospital would not help me. I would be treated very well but, once I was stabilized, I would be returned to the community as I had been a few times while homeless. For me, this short hospitalization was not enough time for healing to take a firm hold on me.

When in long-term care, I had more time to think about my life and where it had gone, and how to get back the good life I had known prior to homelessness; I had been very traumatized by homelessness, and I was given the chance to slowly adjust to re-entering the community with strong linkage, especially housing options.

I am happy that many people can live in the community while living with mental illness. However, I don't think we should lose sight that not all people can and will need sheltered care for some period of time, whether long-term or a few months.

Let us keep the option of long-term care for those who need it; and let us continue building innovative community programs. Both are needed in my opinion to continue to meet the needs of people living with mental illness in New Jersey.


Valerie Fox of Parsippany is founder and president of the Morris County Mental Health Coalition. She is in recovery, having lived with schizophrenia for many years. She is a mental health advocate and writes on mental health topics.

Also see:

Personal Accounts: Schizophrenia and Socialization

SSNS's 21st Annual Conference: Mental Illness and the Criminal Justice System

The Schizophrenia Society of Nova Scotia’s 21st Annual Conference was held on Thursday, October 1st. The theme of this year's conference was Mental Illness and the Criminal Justice System, with a focus on mental health courts.

To download a PDF verson of the Conference Program, please click here.

The plenary speaker was Judge Alfred H. Brien of the Saint John Mental Health Court.

Dr. Ruth Carter (right), Director of Forensic Services, IWK Health Centre, and Kimberley Brennan, Acting Manager of Forensic Services, IWK Health Centre, making a presentation on youth and the justice system.

Dr. P. Scott Theriault, Clinical Director, East Coast Forensic Psychiatric Hospital, Clinical Director, Specialty Programs, Capital District Mental Health Program, and Associate Professor, Department of Psychiatry, Dalhousie University, presenting on lack of insight.

Judge Brien answering a question from the audience during the Questions from the Audience / Panel Discussion session. Seated beside Judge Brien is the keynote speaker, Judith McPhee, Executive Director, Policy and Information Management, Nova Scotia Department of Justice.

Members of the panel listening to a question from the audience during the Questions from the Audience / Panel Discussion session. Panel members, from left to right, are Judge Brien, Judith McPhee, Patrick Burke (moderator), Kimberley Brennan, Dr. Carter, and Dr. Theriault.

The conference was held in the Ashley Lounge at the Sea King Club in Shearwater, Nova Scotia.

Conference Master of Ceremonies, Laura Burke (left), with Patrick Burke, a member of the Board of Directors of the Schizophrenia Society of Nova Scotia.

The Recovery Quilt on display at the conference. Congratulations to Dorothy Gregor, the winner of the Recovery Quilt raffle!

Nancy Vidito, the producer of Podium TV, taped both Judge Brien's and Judith McPhee's presentations for broadcast on EastLink Television in late October 2009.

Please click on any photograph to enlarge it.

All photographs by Stephen Ayer.

Conference Supporters

www.mylan.com

www.mentalhealthns.ca

www.gov.ns.ca/just

Nova Scotia sets up mental health court

An article published in today's edition of The Chronicle Herald:

Service intended to divert those who need help into treatment

By Michael Tutton, The Canadian Press

Nova Scotia is setting up a special court to divert some of the province’s mentally ill away from the criminal justice system and into treatment programs.

Justice Minister Ross Landry, standing in the gleaming new courtroom Thursday, said the new mental health court would balance the needs of the public and the mentally ill.

"It ensures public safety, and at the same time ensures the accused’s health needs are met," said Landry.

The once-a-week sitting at the court will not hold trials, but rather will serve as a setting where the court can work out alternatives to jail sentences and set up treatment programs, Landry explained.

Under the system, which begins Nov. 2, provincial court Judge Bill MacDonald will take cases recommended by a mental health court team.

The cases would include crimes normally brought to provincial court, like thefts and assaults, but not more serious acts such as murder and sexual assault.

The person being tried must either admit to the crime prior to appearing in the mental health court, or have been found guilty in a regular court and then referred.

In some instances, the mentally ill would have criminal charges against them withdrawn if they successfully complete their treatment program and fulfil the court’s conditions, Landry said.

The province’s handling of the mentally ill has come under scrutiny during the public inquiry into the death of Howard Hyde, who had a long history of schizophrenia and involvement with the courts.

Hyde died in jail on Nov. 21, 2007, about 30 hours after he was arrested for an alleged assault and Tasered during a struggle inside a Halifax police station.

Landry said he couldn’t say whether a mental health court system would have helped Hyde avoid his conflict with the law. But he said he believes that overall, it will improve the chances of treatment of mentally ill people who come before the courts.

He said a mental health court in Saint John, N.B., that has operated for over eight years has had positive results.

Statistics kept by that court for last year indicate that almost nine in 10 people using the court complete their treatment programs, and 86 per cent avoid further conflicts with the law.

However, during Thursday’s news conference the mother of a mentally ill man posed questions to Landry about whether the new court would be likely to accept people who have trouble recognizing their own illness.

Mary Elizabeth Greene, a Halifax-area social worker, told the minister her son has psychotic episodes and can’t recognize when he has done something wrong.

"He doesn’t believe he has a mental illness and he wouldn’t choose to go to a mental health court and there are many like my son who don’t have insight," she said.

The minister invited the woman to come to his office and talk, and said they would consult with medical experts. He said he hoped that once a mentally ill person receives treatment following a psychiatric assessment, he or she would agree to use the new court.

Greene said in addition to the courts, the province badly needs better group homes where her 24-year-old son could be monitored more often and treated.



Mary Elizabeth Greene watches as Justice Minister Ross Landry announces the province’s first court to help those with mental health issues during a news conference in Dartmouth on Thursday. Ms. Green’s son John Can­dow is in the mental health system as a patient.

Photograph by Eric Wynne, The Chronicle Herald.

Also see:

Hyde’s sister doubts mental health court would have helped

The web of delusion: a clinical vignette

If you are interested in knowing what psychosis is like, please read this posting by Dr. David Whitehorn on his blog Coming Back to Reality.

Psychosis goes untreated too often

A letter to the editor published in the September 9th edition of The Boston Globe:

While I appreciated the candid Sept. 6 editorial "More needless carnage," the editorial made only passing mention of an important contributor to preventable violence: the lack of pragmatic commitment laws in many states, including Massachusetts, for patients with treatable psychotic illnesses such as schizophrenia.

Our current law allows for involuntary emergency and inpatient treatment but cannot mandate long-term outpatient treatment for patients with psychotic illnesses. These patients often have little to no insight into their illness and will not consistently take medications, to their own and society's detriment. Unfortunately, some (not all) are also dangerous when untreated and psychotic.

Without a legal framework that acknowledges this clinical reality, even the most comprehensive and integrated mental healthcare system cannot function. Without legal reform leading toward mechanisms for longer-term assisted treatments (for example, court-mandated outpatient treatment), the Commonwealth will continue to abandon those members of our community who need our protection and care the most. Untreated psychosis is a preventable cause of human suffering and societal tragedy.

Dr. Oliver Freudenreich
Arlington

The writer is a psychiatrist in the schizophrenia program at Massachusetts General Hospital.

Also see:

Psychotic Disorders: A Practical Guide

Unawareness of Illness in Neuropsychiatric Disorders: Phenomenological Certainty versus Etiopathogenic Vagueness

An abstract from The Neuroscientist, Vol. 14, No. 2, 203-222 (2008):

Maria D. Orfei
IRCCS Santa Lucia Foundation, Rome, Italy

Robert G. Robinson
Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City

Pietro Bria
Institute of Psychiatry, Catholic University of the Sacred Heart, Rome, Italy

Carlo Caltagirone
IRCCS Santa Lucia Foundation, Rome, Italy, Department of Neuroscience, University of Rome "Tor Vergata," Rome, Italy

Gianfranco Spalletta
IRCCS Santa Lucia Foundation, Rome, Italy, Department of Neuroscience, University of Rome "Tor Vergata," Rome, Italy, g.spalletta@hsantalucia.it

Awareness of illness is a form of self-knowledge concerning information about the pathological state, its functional consequence, and the way it affects the patient and his interaction with the environment. Unawareness of illness has raised much interest for its consequences on compliance with treatment, prognosis, and the patient's quality of life.

This review highlights the great complexity of this phenomenon both at phenomenological and etiopathogenic levels in stroke, traumatic brain injury, psychosis, dementias, and mood disorders. In particular, the clinical expression is characterized by failure to acknowledge being ill, misattribution of symptoms, and noncompliance with treatment. Unawareness of illness may also be linked with characteristics that are peculiar to each individual disturbance, such as symptom duration and cognitive impairment.

Despite a long-lasting interest in the clinical characteristics of unawareness, only recently has the focus of research investigated pathogenic mechanisms, with sometimes controversial results. The vast majority of studies have pointed out a remarkable involvement of the right hemisphere. Specifically, functional and structural changes of the dorso-lateral prefrontal cortex and some other frontal areas have often been found to be associated with awareness deficit, as well as parieto-temporal areas and the thalamus, although to a lesser extent. These data indicate the present difficulty of localizing a specific cerebral area involved in unawareness and suggest the existence of possible brain circuits responsible for awareness.

In conclusion, phenomenological manifestations of poor awareness are well outlined in their complexity, whereas neuroanatomic and neuropsychological findings are still too vague and sparse and need further, greater efforts to be clarified.

Key Words: Unawareness • Insight • Neuropsychiatry • Dementia • Psychosis • Mood disorders

Correlates and Long-Term Consequences of Poor Insight in Patients With Schizophrenia. A Systematic Review

The abstract of an article published by Tania M. Lincoln, Eva Lüllmann and Winfried Rief in the November 2007 edition of Schizophrenia Digest:

Between 50 and 80% of the patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder. Although a causal chain connecting poor insight with poor treatment adherence and thus with poorer outcome and functioning is straight forward, numerous studies investigating correlates and long-term impact of insight have provided differing results. In addition, higher levels of insight in schizophrenia have been associated with depression and hopelessness, but the causal direction of the relationship is unclear and the data are inconclusive.

The current study provides a critical review of 88 studies on the assessment of insight and its impact on symptoms and functioning. Studies published by June 2006 were selected using a keyword search for English peer-reviewed articles in the databases PsycINFO and MEDLINE.

The majority of studies support the assumption that insight is associated with adherence during treatment phase, but the association with long-term adherence remains unclear. Insight correlates with better long-term functioning, but this might be explained by its association with symptoms. There is a positive cross-sectional and longitudinal relationship between insight and depression, but the underlying processes need further clarification.

In the concluding discussion, the problems relating to definition and study designs are considered responsible for many of the inconclusive findings. Suggestions for further research are derived.

Reference:
Schizophrenia Bulletin 2007 33(6):1324-1342; doi:10.1093/schbul/sbm002

The cover art (above, right) on the November 2007 issue of Schizophrenia Digest is entitled Another Face by an anonymous author. “Many times, I draw faces as a way to tell of my feelings about being so separated from myself and others. I am confused how to find my way back.”

Video - Health Matters: The Genetics of Schizophrenia and other Human Disorders

Dr. David Braff (pictured, right), Professor of Psychiatry at UCSD, discusses schizophrenia with an emphasis on the role genetics play in this disease. Schizophrenia is thought to result from a complex interplay of genetic, behavioral, and environmental factors. Understanding the genetic components of schizophrenia is crucial to finding out about the risk factors, and heritability of this illness. This may lend itself to the creation of more effective treatments.

To view the video (29 minutes), click here.

For more information, click here.