Mental health early intervention projects offer 'outstanding value'

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An article posted on April 20th by Children & Young People Now:

Having early intervention psychosis teams work with young people experiencing their first episode of schizophrenia or bipolar disorder can save as much as £18 for every £1 spent.

By Joe Lepper

Taxpayers save £8 for every £1 spent on parenting programmes, according to the latest study into the value of early intervention mental health projects.

The study by the Department of Health, London School of Economics and Political Science, the Centre for Mental Health and Institute of Psychiatry found savings increased as the mental health support became more specialised.

It is estimated that £18 is saved for every £1 spent on deploying early intervention psychosis teams to work with young people experiencing their first episode of schizophrenia or bipolar disorder.

Suicide training for GPs saves £44 and alcohol misuse schemes save £12 for every £1 spent.

Called Mental Health Promotion and Mental Illness Prevention: the Economic Case, the study puts the economic and social cost of mental health problems, through factors such as offending rates and benefit payments, at £105bn a year.

Care services minister Paul Burstow said: "Mental health is not a matter of them and us, it’s about all of us. At some point one in four of us will suffer a mental health problem.

"PCTs and GP Consortia should take a careful look at this study and use it to commission better mental health services."

The research team looked at 15 different mental health projects. Team leader Professor Martin Knapp said they all offer "outstandingly good value for money".

He added: "Most are low in cost and many become self-financing over time, saving public expenditure as well as radically improving the quality of people’s lives."

Also see:

What’s it worth now?

What causes schizophrenia?

Also see:

Schizophrenia, what are the symptoms?

Schizophrenia, what are the treatments?

Schizophrenia, when is hospitalization required?

Schizophrenia, what should be done if a loved one might have it?

Schizophrenia, is it hereditary?

Schizophrenia, is it the same as multiple personality disorder?

Is schizophrenia a fatal diagnosis?

Is schizophrenia preventable?

Jeffrey Lieberman, M.D.

Public to get say on Nova Scotia's mental health system

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

By John McPhee, Health Reporter

The committee charged with creating the province’s long-awaited mental health and addictions strategy will embark on a series of public meetings next week.

The provincial advisory committee will hold the first of six meetings Monday in Greenwood to get feedback on how programs and services can be improved.

The NDP government first announced its intention to create a strategy last spring. The committee co-chairpersons — Michael Ungar [pictured], a professor of social work at Dalhousie University, and Joyce McDonald of [The Empowerment Connection] — were announced in June and the rest of the committee in the fall.

It is composed of 12 health experts, researchers, mental health clinicians and people living with or affected by mental illness.

The committee kept a low profile since that time, but it has been holding consultations with health-care providers and advocacy organizations, said a spokeswoman from the Health and Wellness Department.

"We’re just letting them do their work and we don’t want to complicate that or distract them," Patricia Murray, acting executive director of mental health and addictions, said in an interview. "It’s a huge job they’re doing and we’re just anxiously anticipating the end result that they’re able to submit."

The committee has met with about 50 groups and more meetings are planned, a recent Health and Wellness Department news release said.

The move to revamp the system has been sparked by concerns about long waiting lists for treatment and how mentally ill people are treated in the justice system, as highlighted by Judge Anne Derrick’s report in December 2010 on the death of Howard Hyde. Hyde died Nov. 22, 2007, after a violent conflict with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.

Mental health advocate Stephen Ayer of Halifax has criticized the province for being too slow in dealing with the problems in the mental health system. Ayer, the executive director of the Schizophrenia Society of Nova Scotia, welcomed the consultations.

One committee member and staff from the Nova Scotia Health Research Foundation met with the society about three weeks ago. "It was very useful," Ayer said in an interview.

But he is concerned the consultation thus far has been with the people who provide the services, not with those who use the services. At his urging, the committee will meet with people with mental illnesses next month.

As for the strategy, "we are looking forward to seeing some movement in terms of improvements in access to services," he said.

Besides the public meetings, people can also provide input online or through the mail. For more information, go to www.nshrf.ca/mentalhealthandaddictionsstrategy or call 424-4043.

The committee is expected to submit its recommendations to Health and Wellness Minister Maureen MacDonald in the fall.


SCHEDULE

Schedule of public meetings on the province’s mental health strategy:

• April 18: Greenwood, 8 a.m. to noon, 14 Wing Greenwood, Birchall Training Centre, Chamber Room

• April 26: Amherst, 8 a.m. to noon, Tantramar Theatre, 98 Victoria St. E.

• April 27: Sydney, 8 a.m. to noon, Cape Breton University, 1250 Grand Lake Rd., multi-purpose rooms A and B

• May 3: Halifax, 1 to 5 p.m., Saint Mary’s University, Burke Building, Burke Theatre B (entrance off Inglis Street)

• May 5: Bridgewater, 9 a.m. to 12:30 p.m., South Shore Regional Hospital, lecture rooms 1 to 3 (third floor)

• May 16: Halifax, 8 a.m. to noon, Universite Sainte-Anne, Campus de Halifax, 1589 Walnut St. It will also be broadcast to campuses in Tusket, Petit de Grat, Church Point and Grand Etang.

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Schizophrenia Society of Canada - Annual Awards 2011

From the Schizophrenia Society of Canada website:

Our schizophrenia societies depend upon the perseverance, skill and devotion of dedicated volunteers, practitioners and staff members who help us to achieve our mission of promoting a quality of life for those affected by schizophrenia and psychosis. Without their dedicated efforts, we would be missing the leadership and direction essential for our organizations.

Each year, the Schizophrenia Society of Canada recognizes individuals and initiatives/programs within the schizophrenia community that are helping to fulfill our mission through the presentation of our Annual Awards.

Do you know someone who has made an outstanding contribution to our mission? Here is your chance to celebrate his or her achievements with a nomination for a 2011 Annual Award. A nomination form, along with the description and criteria for each award, is listed below.

If you require further information email info@schizophrenia.ca.

Nominations Deadline: July 31, 2011


Awards and Criteria:

Please note: Each endorser should also submit as a separate attachment, details on the activities of the individual or initiative/program and how the activities relate to the award criteria.

• Bill Jefferies Family Award

• Recovery of Hope Award

• Initiatives/Programs of Excellence Award

• Media Award

• Michael Smith Award [photograph of Michael Smith, above]

• Outstanding Achievement Award

• Outstanding Staff Award

• Nomination Form

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Unfortunate collapse of prefabricated roof trusses on a new structure being built on the grounds of the Nova Scotia Hospital

This happened this past week during an intense wind storm.


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Also see:

The Community Living Initiative (Bungalows)

Unveiling of the architectural drawings for the new Community Living Initiative

Province Invests in Community Living Initiative


Photograph by Stephen Ayer

Experiences of psychosis - website

From healthtalkonline.org:

This module is about people’s experiences of psychosis. Many of the people we interviewed had, at some point in their lives, received a diagnosis of schizophrenia. However there were a number of people we spoke to who had never received this diagnosis but who had experienced psychosis i.e. hearing or seeing things or holding unusual beliefs which other people don’t see or share. We interviewed 34 people (31 people with direct experience and three carers) about their experiences.

To visit the website, please click here.


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NAMI launches new schizophrenia website and brochure

An article posted on April 1st by News-Medical.net:

The National Alliance on Mental Illness (NAMI) has launched a new website on schizophrenia and published a new brochure on the medical condition which affects more than 2.4 million American adults each year.

Onset of schizophrenia often strikes men in their late teens or early twenties, while appearing in women in their late twenties or early thirties. The cause and course of treatment are different for each individual.

"NAMI has launched the new schizophrenia website and published the new schizophrenia brochure to provide up-to-date information to individuals, families and others," said NAMI Executive Director Michael Fitzpatrick.

"Everyone should know the nature of schizophrenia and its symptoms. Everyone should know the latest medical thinking on prevention, triggers and treatment."

The schizophrenia brochure can be downloaded from the website at www.nami.org/schizophrenia or ordered in packets of 25 copies each for local groups, physician offices, health fairs, conferences or workplace education.

The website highlights two areas of recent research relating to onset of schizophrenia:

• "Fish oil" supplements may help prevent psychosis during critical years of brain development. Further studies are needed, but NAMI Medical Director Ken Duckworth advises individuals in their teens or twenties with early symptoms of psychosis to take Omega-3 fatty acids—available in supermarkets and pharmacies. There appear to be few risks compared to the potential benefit.

• Smoking marijuana is increasingly seen as a causal factor that can trigger onset of schizophrenia in some people. NAMI cites three studies published in February and March 2011. As an environmental factor, marijuana is believed to "trigger" genetic factors, increasing the risk of psychotic incidents and ongoing experiences.

The schizophrenia web site includes discussion of anosognosia, more commonly known as a lack of insight. Individuals may lack awareness of their own illness—believed to be the result of problems with neurological processes in the frontal lobe of the brain. The condition can lead to tension within families and complicate treatment.

NAMI offers education and support programs to individuals and families confronting schizophrenia.

SOURCE: National Alliance on Mental Illness

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

Psychiatric Intensive Care Unit (PICU)

From the March 28th edition of the Capital District Mental Health Program's Mental Health Happenings:

The Mental Health Program and the Department of Psychiatry are opening a Psychiatric Intensive Care Unit (PICU) at the East Coast Forensic Hospital (ECFH). This is for short-term stabilization of highly-agitated individuals, admitted to other mental health units with involuntary status, who are exhibiting aggressive and harmful behaviour towards others on their current unit. On April 1, 2011, the PICU will open for patients from inpatient psychiatry units in Capital Health. Referrals will be from the current attending psychiatrist to an ECFH psychiatrist.

The Psychiatric Intensive Care Unit is located in one of the Rehabilitation Units at the East Coast Forensic Hospital. The PICU has six single bedrooms, a spacious dayroom with lots of natural light, and a secure patio area. The whole of ECFH is specifically designed to create a calming atmosphere. The unit is staffed by clinicians who work effectively with a population whose specific needs include de-escalation of behaviours that pose a risk for harm to themselves and others.

The PICU will soon become a provincial resource - open to all the district health authorities across the province. Referrals will be made by a physician in the referring district, usually a psychiatrist, to a psychiatrist at the East Coast Forensic Hospital.

Please find attached the referral form and patient information handbook [actually a handbook for families]. [Links to these two documents are found below.]

If you have any questions, please contact James MacLean or Dr. Scott Theriault [460-7343; scott.theriault@cdha.nshealth.ca].

You are also welcome to call or email either of us.

Thank you.

Peter and Nick

Peter Croxall, Director
Capital Health Mental Health Program
464-4147
peter.croxall@cdha.nshealth.ca

Nick Delva, Professor and Head
Dalhousie University Department of Psychiatry
473-2464
Nicholas.Delva@cdha.nshealth.ca

PICU Handbook - March 2011

PICU Referral - March 2011


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Understanding schizophrenia: researchers uncover new underlying mechanism

A March 28th media release from The Hospital for Sick Children:

TORONTO – A new way of thinking about the fundamental pathobiology of schizophrenia could one day lead to improved therapeutic approaches to treating this disorder. Researchers at The Hospital for Sick Children (SickKids), the University of Toronto and Tufts University School of Medicine have linked proteins and genes that are implicated in schizophrenia in a novel way. The study is published in the March 27 advance online edition of Nature Medicine.

Schizophrenia is a disorder that affects one per cent of Canadians and 24 million people worldwide. A team of researchers led by Dr. Michael Salter [pictured], SickKids Senior Scientist and Professor of Physiology at the University of Toronto, identified a biochemical pathway in the brain that may contribute to the neurobiological basis of schizophrenia.

“This is a paradigm shift in the way that we view the neural mechanisms of schizophrenia,” says Salter, Head of the Program in Neurosciences and Mental Health at SickKids Research Institute. “With our discovery we have brought together in a new way pieces of the schizophrenia puzzle. We hope that the understanding we have put together will lead to new forms of treatment that are more effective than the ones that are currently available.”

The scientists studied in mice two partner proteins, NRG1 and ErbB4, and the effect they have on a key brain receptor known as the N-methyl D-aspartate glutamate receptor (NMDAR). While NRG1 and ErbB4 have been genetically implicated in schizophrenia, the new study finds an unexpected link to NMDARs.

The NMDAR is a major component of synapses -- the highly specialized sites of communication between the brain’s billions of individual nerve cells -- that is critical for many brain functions including learning and memory. Suppressed functioning of NMDARs was suspected in schizophrenia because drugs that block NMDARs cause the hallucinations and disordered think, that occur in schizophrenia.

It had been suspected that NRG1 and ErbB4 might suppress generally NMDAR function but the present study found this was not the case. Rather, the researchers discovered that NRG1 and ErbB4 work together through inhibiting another protein, Src. The link to NMDARs is that Src normally increases NMDAR function under circumstances when this is needed such as in learning and memory. The researchers found that by blocking Src, NRG1 and ErbB4 selectively prevented that critical boost in NMDAR function.

The researchers also studied the responses of nerve cells during brain activity that mimicked normal brain oscillations known as theta rhythm. Theta rhythm activity, which is critical for learning and memory, is impaired in individuals with schizophrenia. The researchers determined that by acting through Src, NRG1 and ErbB4 greatly reduced the nerve cell responses to theta rhythm activity.

The findings suggest new approaches to schizophrenia treatment by reversing the effects of NRG1 and ErbB4 through enhancing the Src boost of NMDARs. “The tricky part is that all of these proteins are involved in other functions of the body; we can’t randomly enhance or inhibit them as this would lead to side effects,” says Salter. “The key will be to develop clever ways to target the proteins in the context of the synapse.”

This study is funded by supported by the Canadian Institutes of Health Research, the Deafness Research Foundation, Howard Hughes Medical Institute and SickKids Foundation.


About The Hospital for Sick Children

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit www.sickkids.ca.

About SickKids Research & Learning Tower

SickKids Research & Learning Tower will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs. The Tower will physically connect SickKids science, discovery and learning activities to its clinical operations. Designed by award-winning architects Diamond + Schmitt Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Tower will create an architectural landmark as the eastern gateway to Toronto’s Discovery District. SickKids Research & Learning Tower is funded by a grant from the Canada Foundation for Innovation and community support for the ongoing fundraising campaign. For more information, please visit www.buildsickkids.com.

For more information, please contact:

Matet Nebres
Manager, Media Relations
Communications and Public Affairs
The Hospital for Sick Children
Phone: 416-813-6380
Fax: 416-813-5328
email: matet.nebres@sickkids.ca

Suzanne Gold
Communications Specialist - Media Relations
Communications and Public Affairs
The Hospital for Sick Children
Phone: 416-813-7654 ext. 2059
Fax: 416-813-5328
email: suzanne.gold@sickkids.ca

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Schizophrenia, “Just the Facts” 6. Moving ahead with the schizophrenia concept: From the elephant to the mouse

The abstract of an article published in the April 2011 issue of Schizophrenia Research:

By Matcheri S. Keshavan, Henry A. Nasrallah, and Rajiv Tandon

Abstract

The current construct of schizophrenia as a unitary disease is far from satisfactory, and is in need of reconceptualization. The first five papers in our “facts” series reviewed what is known about schizophrenia to date, and a limited number of key facts appear to stand out. Schizophrenia is characterized by persistent cognitive deficits, positive and negative symptoms typically beginning in youth, substantive heritability, and brain structural, functional and neurochemical alterations including dopaminergic dysregulation. Several pathophysiological models have been proposed with differing interpretations of the illness, like the fabled six blind Indian men groping different parts of an elephant coming up with different conclusions. However, accumulating knowledge is integrating the several extant models of schizophrenia etiopathogenesis into unifying constructs; we discuss an example, involving a neurodevelopmental imbalance in excitatory/inhibitory neural systems leading to impaired neural plasticity. This imbalance, which may be proximal to clinical manifestations, could result from a variety of genetic, epigenetic and environmental causes, as well as pathophysiological processes such as inflammation and oxidative stress. Such efforts to “connect the dots” (and visualizing the elephant) are still limited by the substantial clinical, pathological, and etiological heterogeneity of schizophrenia and its blurred boundaries with several other psychiatric disorders leading to a “fuzzy cluster” of overlapping syndromes, thereby reducing the content, discriminant and predictive validity of a unitary construct of this illness. The way ahead involves several key directions: a) choosing valid phenotype definitions increasingly derived from translational neuroscience; b) addressing clinical heterogeneity by a cross-diagnostic dimensional and a staging approach to psychopathology; c) addressing pathophysiological heterogeneity by elucidating independent families of “extended” intermediate phenotypes and pathophysiological processes (e.g. altered excitatory/inhibitory, salience or executive circuitries, oxidative stress systems) that traverse structural, functional, neurochemical and molecular domains; d) resolving etiologic heterogeneity by mapping genomic and environmental factors and their interactions to syndromal and specific pathophysiological signatures; e) separating causal factors from consequences and compensatory phenomena; and f) formulating or reformulating hypotheses that can be refuted/tested, perhaps in the mouse or other experimental models. These steps will likely lead to the current entity of schizophrenia being usefully deconstructed and reconfigured into phenotypically overlapping, but etiopathologically unique and empirically testable component entities (similar to mental retardation, epilepsy or cancer syndromes). The mouse may be the way to rescue the trapped elephant!

Keywords: Schizophrenia, Models, Heterogeneity, Etiology, Pathophysiology, Phenotype, Treatment, Biology

Posting of the abstract is for the purposes of research into schizophrenia.

No health without mental health: a cross-government mental health outcomes strategy for people of all ages (UK)

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Published February 2nd, 2011. To download the entire document (PDF), please click here.

For related documents, please click here.

Information about NICE clinical guideline 120

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To download the full document, please click here.

Also see:

Psychosis with coexisting substance misuse

New NICE Guidance To Help Manage Psychosis With Co-Existing Substance Misuse

Metabolome in schizophrenia and other psychotic disorders: a general population-based study

A provisional abstract posted on March 23 by Genome Medicine:

By Matej Oresic, Jing Tang, Tuulikki Seppanen-Laakso, Ismo Mattila, Suoma E Saarni, Samuli I Saarni, Jouko Lonnqvist, Marko Sysi-Aho, Tuulia Hyotylainen, Jonna Perala and Jaana Suvisaari

Abstract (provisional)

Background

Persons with schizophrenia and other psychotic disorders have a high prevalence of obesity, impaired glucose tolerance, and lipid abnormalities, particularly hypertriglyceridemia and low HDL. More detailed molecular information on the metabolic abnormalities may reveal clues about the pathophysiology of these changes, as well as about disease specificity.

Methods

We applied comprehensive metabolomics in serum samples from a general population-based study in Finland. The study included all persons with DSM-IV primary psychotic disorder (schizophrenia n=45, other nonaffective psychosis (ONAP) n=57, affective psychosis n=37) and controls matched by age, sex, and region of residence. Two analytical platforms for metabolomics were applied to all serum samples: (1) global lipidomics platform based on Ultra Performance Liquid Chromatography coupled to mass spectrometry, which covers molecular lipids such as phospholipids and neutral lipids and (2) platform for small polar metabolites based on two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GCxGC-TOFMS).

Results

Compared with their matched controls, persons with schizophrenia had significantly higher metabolite levels in six lipid clusters containing mainly saturated triglycerides and in two small-molecule clusters containing, among other metabolites, (1) branched chain amino acids phenylalanine and tyrosine and (2) proline, glutamic, lactic and pyruvic acids. Among these, serum glutamic acid was elevated in all psychoses (P=0.0020) as compared to controls, while proline [moleculecular structure illustrated] upregulation (P=0.000023) was specific to schizophrenia. After adjusting for medication and metabolic comorbidity in linear mixed models, schizophrenia remained independently associated with higher levels in seven of these eight clusters (P<0.05 in each cluster). The metabolic abnormalities were less pronounced in persons with ONAP or affective psychosis. Conclusions

Our findings suggest that specific metabolic abnormalities related to glucoregulatory processes and proline metabolism are specifically associated with schizophrenia and reflect two different disease-related pathways. Metabolomics may become a powerful tool in psychiatric research to investigate disease susceptibility, clinical course, and treatment response, sensitive to both genetic and environmental variation.


The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

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

Mental health care for the few

An article posted on March 22nd by MacLeans.ca:

Each year, seven million of us experience mental illness. Many can’t get help.

By Ken Macqueen and Julia Belluz

On March 29, Maclean’s hosts “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the Winspear Centre in Edmonton. The conversation on health care, held in conjunction with the Canadian Medical Association and broadcast by CPAC, continues in coming months in Maclean’s and at town halls in Vancouver and Ottawa.

Mental illness, and what passes for Canadian mental health policy, has been called the “orphan of health care,” and perhaps that’s true. It’s also been called an invisible disease, but that’s not really the case. The mentally ill have many faces. They are in our schools, our homes, our emergency wards. They are in our jails, in our graveyards; they are on our Olympic team.

They are people with names. Jack Windeler, a Queen’s University student of great promise, began to miss classes, skip assignments, withdraw from friends. A year ago on March 27, he killed himself in his residence room. He was 18. BobbyLee Worm [pictured], a deeply troubled 24-year-old Aboriginal woman from Saskatchewan, has spent some three years locked in solitary confinement in a B.C. prison, counting the bricks of her cell. Speed skater and cyclist Clara Hughes overcame a troubled adolescence to compete for Canada at the 1996 Olympics. Afterwards, she fell into a profound depression, slogging “through quicksand and hopelessness.” She sought help. She fought back to become one of Canada’s greatest athletes, and the kind of role model who can shatter stereotypes and stigmas surrounding mental illness.

This, then, is the state of mental health policy in Canada: scattered flashes of brilliance amid quicksand, hopelessness and waste. Canada is the only G7 country without a national mental health strategy, says Louise Bradley, president of the Calgary-based Mental Health Commission of Canada, a four-year-old agency mandated to finally draft a coherent approach to the issue. She blames the shame surrounding mental health issues for the lesser priority and lower funding accorded treatment of psychiatric disorders. Bradley, a nurse and former front-line mental health worker, sees the stigma in the public, but even among health care workers and those with mental illnesses. It’s tragic, she says, since hardly anyone is untouched by the problem. When people discover her job, they always have stories. “Every time it starts out in hushed tones,” she says. “And yet here we are in 2011 still with it shrouded with embarrassment and fear.”

The need is obvious. The annual cost to the economy in lost productivity was pegged at $51 billion in a report last year by researchers at the Centre for Addiction and Mental Health (CAMH). Some seven million Canadians will experience a mental illness this year, including depression, substance abuse and psychotic episodes. Many go undiagnosed, some suffer silently, others self-medicate with drugs or alcohol. They overwhelm family doctors or jam emergency wards ill-suited to their needs. They face long waits for counselling.

“Access to mental health services overall is pretty poor,” says Steve Lurie, executive director of the Canadian Mental Health Association. “In Ontario, basically one in three adults get access. If you’re a child, it’s worse. It’s one in six,” he says. “We wouldn’t accept that for cancer. We wouldn’t accept that for heart [disease] or if you have a broken leg.” Psychiatric care is far more likely to be provided to wealthy adults, says Dr. Michael Rachlis, a Toronto-based health policy consultant. “Children and youth is much harder work,” he says, “and it tends not to pay as well as sitting in your office and seeing people who have less serious problems.”

Many of the needed public services are delivered piecemeal or they fall outside of medicare. Sarah Cannon of St. Catharines, Ont., executive director of Parents for Children’s Mental Health, lost her husband to suicide eight years ago. He suffered from bipolar disorder. Their daughter Emily received a similar diagnosis at age five. Finding quality treatment was a struggle. Emily’s teachers used different treatment strategies from those offered by her community mental health workers. “[There's] a lack of consistency,” she says, “lack of them speaking with each other.” At times, Cannon was spending as much as $800 a month on drugs not covered by Ontario’s health plan. Emily, now 14, is being effectively treated with mood stabilizers, in combination with counselling and occupational therapy. “I want a system that is integrated, that communicates and coordinates,” Cannon says, “that is funded the same way they would fund a system that treats a child with physical health problems.”

Most psychological care, for example, is paid privately, putting it beyond the reach of many. About seven per cent of government health expenditures go to mental health, well below most developed countries.

Suicide is the second leading cause of death for young Canadians. Some, like Jack Windeler, never even seek help. His heartbroken family has launched a youth public awareness campaign, honouring his final wish that others benefit from his story. Bill MacPhee, 48, of Fort Erie, Ont., is alive because he got help, eventually. He was diagnosed with schizophrenia at 24. “After that, I was hospitalized six times, lived in three group homes, had a suicide attempt,” he says.

It was medication and the help of a mentor that got him on track. In 1994, he founded SZ Magazine, for those affected by schizophrenia. As an advocate for those with mental illness, he sees many flaws in the system. Newer, more effective drugs aren’t covered by Ontario’s assistance plan for the disabled, and support systems are uncoordinated, he says. The Ministry of Health operates in one “silo,” the welfare system in another, community housing in another still. Misplaced ideas about patient confidentiality isolate parents. “Many people are being discharged out of hospital without a place to stay, without letting parents know,” he says. “They are trying to help sons and daughters—they’re not able to do that.”

Far too many who need treatment instead end up in jail, often with addictions compounding their mental illness. The number of male federal prisoners receiving drugs for mental illnesses has more than doubled in a decade, to 21 per cent. For women prisoners, the medication rate is an astonishing 46 per cent. The estimate of prisoners with psychiatric disorders ranges from 64 per cent to 81 per cent in one study by the Correctional Service of Canada. Among them is BobbyLee Worm, serving more than six years for robbery and other offences. She arrived at B.C.’s Fraser Valley Institution addicted to drugs and with a history of physical, emotional and sexual abuse. She’s spent years in segregation after repeated fights with prisoners. The isolation has caused “significant signs of psychological deterioration,” claims the British Columbia Civil Liberties Association in a lawsuit filed this month against the federal government.

The news isn’t all grim. There are good strategies in place, though they are often “well-kept secrets,” says Bradley of the mental heath commission. The commission itself is in the midst of an ambitious campaign to reduce the public stigma of mental illness, and aims to release its national mental health strategy by this time next year.

It is likely to build on the success of programs scattered across the country. Saskatchewan has been changing its delivery of services for children and youth, where mental health issues often begin. It includes parent mentoring and “preventive intervention programs” at 16 sites across the province for vulnerable children under five years old, and outreach programs in Aboriginal communities. In Saskatoon, psychologists and counsellors work from inner-city schools. Mental health is part of a larger “school wellness initiative” where speech pathologists, occupational therapists, nurses and counsellors work together. In addition, addiction workers operate in the inner city, says Rob Strom, coordinator for community and youth addiction teams in Saskatoon. “Our workers are out helping our clients get to appointments, get hooked up to the right services, taking them out for lunch or coffee, building relationships.”

Hamilton, meantime, has become a model for breaking barriers between family doctors and mental health services. Counsellors and psychiatrists are integrated into the offices of 150 family doctors in the area, in a program started in 1994, under the guidance of Nick Kates, a psychiatrist and professor at McMaster University. The program is as effective as it should have been obvious. Doctors are usually the first point of contact for those with mental issues, diagnosed or otherwise. Rather than a referral and a long wait, there’s immediate mental health counselling available, says Kates, “in an environment that people find is less stigmatizing and more comfortable.” Doctors in the program refer 11 times as many people for mental health assessments as they did before. Hospitalizations for mental health have dropped 10 per cent for patients of participating doctors, says Kates. The good news is patient-focused care saves money. “The key to successful change is not just throwing more and more resources into the system,” he says. “It’s redesigning the system and using existing resources differently.”

The same optimistic note is sounded by Dr. David Goldbloom, medical adviser for CAMH, and vice-chairman of the mental health commission. While there is a desperate need to improve services, especially for children, he says the issue is finally on the political radar. The cost of mental illness, to individuals and families, and its impact on society and the economy is too massive to ignore, he says. “Both a humanitarian and business argument can be made for doing a better job in this country around the provision of understanding, of help and of hope.”

Also see:

Sask. woman sues over solitary confinement


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More than a quarter of a million votes by Canadians choose 2011 Mental Health Stamp design

The 2011 Mental Health Stamp!

A March 22nd media release from the Canada Post Foundation for Mental Health:

More than a quarter of a million votes by Canadians choose 2011 Mental Health Stamp design

For the first time in history, public makes final selection on Canadian stamp

OTTAWA (ON) – THE PUZZLE, an original design by Terrebonne resident Miriane Majeau, has been chosen as Canada Post’s 2011 Mental Health Stamp, the first time in the post office’s history a stamp design was chosen by public vote. Ms. Majeau’s design received the most points, to win the stamp design competition. Overall, more than 286,000 votes were recorded.

“I’m very proud that my design connected with people. Dealing with mental health issues can be like putting a puzzle together,” Ms. Majeau noted. “But as the puzzle comes together, as you find the right pieces and connect them in the right way, something beautiful and whole is revealed.” Ms. Majeau will receive a framed commemorative enlargement of the final stamp featuring her design, and a $500 honorarium will be donated to La Fondation les petits trésors de l'Hôpital Rivière-des-Prairies, a mental health charity chosen by Ms. Majeau.

Of the more than 300 stamp designs submitted last fall, 75 were chosen as semi-finalists by a panel of mental health consumers, advocates, philatelists and designers. The Stamp Advisory Committee (a national committee that guides Canada Post in selecting stamp subjects and designs) narrowed that selection down to the five designs that were voted on by the public.

Concepts and design elements from the four remaining designs will be used on the Official First Day Cover envelope, and the souvenir sheet, for the 2011 Mental Health Stamp issue. “Each of these designs does an excellent job of raising awareness of the mental health issue and breaking down the stigma attached to it,” said Honourable Rob Merrifield, Minister of State (Transportation) and Minister responsible for Canada Post.

The other finalist designs are: BEAUTIFUL HOPE (designed by Richard Green of Toronto (ON)), FORECAST HOPE (designed by Marie Tomeoki of Toronto (ON)), NO NEED TO HIDE (designed by Brian Blatnicki of London (ON)) and THE FACE OF MENTAL ILLNESS (designed by Norbert Lisinski of Courtice (ON)).

The 2011 Mental Health stamp will be issued on September 6, as part of the kick-off for the company’s annual fundraising campaign, which last year raised $2.2 million dollars. More than 4 million of the stamps will be printed with a dollar from every booklet of 10 stamps sold donated to the Canada Post Foundation for Mental Health.

Canada Post made mental health its cause of choice in 2008. Since then, customers, employees, suppliers and the public have raised more than $4.8 million for the Canada Post Foundation for Mental Health. Almost $1 million of that was from sales of the 2008, 2009 and 2010 mental health stamps.

The Lunenburg County Chapter of the SSNS has a new weblog

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To visit the Lunenburg County Chapter's new weblog, please click here.

Eleanor Owen's tireless battle for mental-health care

An article published in the March 12th edition of The Seattle Times:

Having a son with schizophrenia, Seattle's Eleanor Owen knows firsthand the heartache and worry families face. She joined others to found the National Alliance on Mental Illness.

By Maureen O'Hagan

HE IS your child.

You watch him go from artist to hermit, from scholar to stranger. He starts sleeping in the basement, in a box. You tell yourself it's an adolescent phase.

He walks the streets, barefoot and disheveled, a blanket around his shoulders and letters shaved into his head. Could it be drugs?

Then one day you find a noose he'd hung from a pipe.

Another day, he gets arrested after creating a disturbance at the train station, trying to get from Seattle to San Francisco on a movie-ticket stub.

Eleanor Owen [pictured] was teaching and staging children's plays. Her husband, John, was an engineer. They were well-educated and comfortable and endlessly resourceful. Yet they felt helpless.

Their son's life, Eleanor says, "became more and more tragic."

At some point, she realized two things.

Her son had schizophrenia.

And she would fight for him with all her might.

To read the entire story, please click here.


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Mental health system 'fragmented'

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

Canada lacks strategy, public forum told

By John McPhee, Health Reporter

Canada is the only G8 country that doesn’t have a national mental health strategy, a public forum was told Monday.

In fact, it would be a stretch to say we have a mental health system at all, said Louise Bradley (pictured), president and chief executive officer of the Mental Health Commission of Canada.

"It’s too fragmented to be called a system," Bradley told more than 250 people who packed two large rooms in the Halifax Forum complex for the forum.

The commission, made up of 50 staff members and 120 volunteers, was created three years ago as a result of the Kirby report on mental health and addiction in 2006. It was given a 10-year mandate to address such issues as homelessness, stigma and mental health "first aid," which seeks to identify and address problems as early as possible.

But it is up to grassroots organizations and the provinces to make the commission’s plan a reality, said Bradley, the former head of mental health services at the Capital district health authority.

"If we have no ability to implement anything, it’s going to be a waste of time and a waste of money."

The forum was jointly sponsored by Dalhousie University’s psychiatry department and the Mental Health Coalition of Nova Scotia, made up of individuals and organizations focused on addressing mental health issues.

The province puts about 3.8 per cent of roughly $3.5 billion in health spending into mental health services.

"The system has to work, the capacity has to be built up," Nick Delva, the head of the Dalhousie psychiatry department and co-leader of Capital Health mental health services, said in an interview.

"I don’t think that’s occurring right now. Many people aren’t getting care."

Delva spoke at the forum along with other care providers and advocates from the province and Capital Health.

He singled out the need for housing and treatment in the community for people dealing with complex problems.

"Any particular day here (in Capital Health), we have 50 to 70 people in our in-patient beds who could be placed in the community if there were adequate support."

During question-and-answer sessions, Delva and other speakers heard criticism about access to mental health services, particularly in rural areas.

"There’s plenty of mental health services, but there’s no way people can access them," said Randy Carter of East Jeddore, Halifax County, who noted the lack of public transportation outside of urban centres.

"Something has seriously got to be done because I’ve been involved in this for 40 years and it’s still the same as it was back then."

Collaboration among all government levels are crucial to addressing these kinds of problems, said Susan Kilbride Roper, the co-chairwoman of the mental health coalition.

She particularly welcomed the national commission’s work and that of the Nova Scotia mental health strategy advisory committee.

"We’ve got a bunch of advocates, federal advocates, we’ve never had that before," Kilbride Roper said in an interview. "This is the good news. Getting back to the bad news, the issues are still there and they’re becoming increasingly (serious). Hospital wait times, services in the community, there’s not enough funding. Provincially, we have a lot more work to do."

(jmcphee@herald.ca)

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Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study

The abstract of an article published in the March 1st edition of the British Medical Journal:

By Rebecca Kuepper, research psychologist (1), Jim van Os, professor (1), visiting professor (2), Roselind Lieb, professor (3,4), Hans-Ulrich Wittchen, professor (4,5), Michael Höfler, research statistician (5), Cécile Henquet, lecturer (1)

1. Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, Netherlands
2. King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
3. Department of Psychology, Division of Epidemiology and Health Psychology, University of Basel, Switzerland
4. Max Planck Institute of Psychiatry, Munich, Germany
5. Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Germany
   

Objective

To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis).


Design

Analysis of data from a prospective population based cohort study in Germany (early developmental stages of psychopathology study).


Setting

Population based cohort study in Germany.


Participants

1923 individuals from the general population, aged 14-24 at baseline.


Main outcome measure

Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI).


Results

In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The incidence rate of psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively.


Conclusion

Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.

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

Also see:

Cannabis use 'raises psychosis risk' - study

Cannabis use 'doubles risk of psychosis for teenagers'

Marijuana Use Linked to Risk of Psychotic Symptoms

Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study


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Schizophrenia risk is increased with a particular gene mutation

An article posted on February 23rd by the Los Angeles Times:

By Shari Roan

Schizophrenia is a severe, complicated illness. There are no obvious explanations for what causes the condition, which causes hallucinations and delusions. Genes are known to play a big role. The condition is often clustered in families.

Scientists announced a significant step in understanding the genetics of the disease this week. A large nationwide consortium of scientists led by Jonathan Sebat of UC San Diego has identified a gene mutation that is strongly linked to the disorder. Understanding the signaling pathway of this mutation creates a target for future therapies.

Previous research has shown a number of rare gene mutations that increase the risk of schizophrenia. In the new study, researchers looked for specific gene variants, called copy number variants, in 8,290 people with schizophrenia and 7,431 healthy people. Among the discoveries was a duplication in the tip of chromosome 7q. This duplication was found in people with schizophrenia at a rate 14 times that of healthy people.

The duplication affects a particular gene called the vasoactive intestinal peptide receptor 2 gene, which is known to play a role in behavior and learning. In people with schizophrenia, the expression of this gene is much higher, the researchers found. The VIPR2 gene mutation, therefore, will be an important target in developing medications that might alter the symptoms of the illness.

"This discovery might be the best target yet to come out of genetic studies of mental illness," Sebat said in a new release. The research was published online in the journal Nature.

Image courtesy of the National Library of Medicine.

Broken Promises

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Also see:

Operation Maple

Nova Scotia Mental Health Strategy Background Document

An email received on February 21 from the Nova Scotia Health Research Foundation:

In March, 2010, the Nova Scotia Government announced that it would be preparing a Mental Health Strategy to revamp mental health and addiction services in the province. The strategy will address concerns raised in the May 2010 Auditor General’s report. We were asked by the Minister of the Department of Health and Wellness to support the development of a Mental Health Strategy. In our role, we will oversee a neutral, comprehensive consultation process to ensure that the knowledge and input of stakeholders is included. We are also acting as secretariat to the Mental Health Strategy Advisory Committee, which was appointed by the Minister.

As part of our work, we have developed a background document, the Mental Health Strategy Background Document: A summary of the current state of mental health and addictions services in Nova Scotia. The purpose of this document is to describe the current state of publicly funded mental health and addiction services in Nova Scotia. The document will be a living document and will be updated and modified throughout the consultation process as more information becomes available. We will use the document to focus initial discussions with key stakeholders and will use an updated version to inform public consultations. The document will be updated regularly.

We thought that your organization would be interested in reviewing a copy of the enclosed background document.

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

Also see:

Mental Health Strategy

Is Canada making progress in treating mental illness?

Listen to the episode aired yesterday, February 21st:

On Cross Country Checkup: mental illness

It used to be the condition nobody would talk about. Five years ago a Senate report ... the first-ever national study of mental health and addiction, said Canada badly needed a strategy to deal with mental illness.

What has changed since then? Is support for mental health improving?

With guest host Andrew Nichols.


Introduction

Five years ago a Senate report, the first-ever national study of mental health and addiction, said Canada badly needed a strategy to deal with mental illness.

Today we want to talk about mental health services in Canada.

When that report came out, Cross Country Checkup did a program on it asking Canadians for their views on the subject. The reponse was overwhelming. From people who themselves battled with mental illness, to families having difficulty trying to manage one of their own, to professionals who have identified solutions but don't see them instituted in their work places.

Since then we have been checking back in every few years to see how things are going. To see what has changed since and to find out whether support for mental health is improving?

The co-author of the report was Senator Michael Kirby and he has joined us on each program to update us on the progress. He will join us again later in today's program ... but this is also your chance to talk about the issues and stories ... things that you have seen or experienced that might provide some insight and help the process along.

The Senate Report, called "Out of the Shadows at Last", contained the following quotation:

In no other field, except perhaps leprosy, has there been as much confusion, misdirection and discrimination against the patient, as in mental illness... Down through the ages, they have been estranged by society and cast out to wander in the wilderness. Mental illness, even today, is all too often considered a crime to be punished, a sin to be expiated, a possessing demon to be exorcised, a disgrace to be hushed up, a personality weakness to be deplored or a welfare problem to be handled as cheaply as possible.

Those words were not original to the report. They came from a 1963 study by the Canadian Mental Health Association. DO those words still ring true today? If they do then one of the first hurdles has not been cleared ... removing the stigma that surrounds the disease many would rather not discuss.

There are other hurdles which our guests will outline ... and you, if you have some experience or insight you'd like to share, then give us a call.


Guests

• Louise Bradley, President and CEO of the Mental Health Commission of Canada.
  

• Dr. Stan Kutcher, Professor of Psychiatry, Dalhousie University & Sun Life Financial Chair in Adolescent Mental Health.
  

• Michael Kirby, Chair of the Mental Health Commission of Canada.
  

• Honourable Mr. Justice Edward Ormston, Ontario Court of Justice, currently the Chair of the Law and Mental Health Advisory Committee for the Mental Health commission of Canada. Prime mover in the development of the First Mental Health Court in Canada in the City of Toronto.
  

To listen to this episode, please click here.

Today's Ultrashort Stays Raise Questions About Effectiveness

An article published in the February 4th edition of Psychiatric News:

By Mark Moran

The scant research that exists tends to support shorter-term hospitalization over long term, but in most studies what was once considered short term would be long term today.

Twenty-five years ago when Steven Sharfstein, M.D. (pictured), came to the Sheppard and Enoch Pratt Hospital in Maryland, the average length of stay there was 80 days.

In that time, the patient received a diagnosis and an individualized treatment plan including medication and psychotherapy addressing acute symptoms as well as intrapsychic and psychosocial factors, with the active engagement of family members and the formulation of an aftercare plan. It was a protocol that was not atypical for many other freestanding psychiatric hospitals; at general hospitals, the length of stay was often 20 to 30 days.

But today, the same patient entering almost any hospital in the United States for psychiatric care will likely be out the door in five or six days, in what Sharfstein calls the “ultrashort stay.” Such treatment as can occur in that time focuses on crisis stabilization, relief of the most acute symptoms, and de-escalation of dangerousness.

Between Sharfstein's arrival at Sheppard Pratt in 1986 and today, a perfect storm of factors—managed care, the expansion of insurance coverage for outpatient treatment, and a belief in the efficacy of the least-restrictive therapeutic environment—has reduced psychiatric hospitalization to something that looks less like treatment than a kind of holding action or police function whose purpose is ensuring patient and public safety.

“When I give a talk today, I tell people that hospital treatment is an oxymoron,” Sharfstein said in an interview with Psychiatric News. “We no longer really do treatment. What we do is stabilize, evaluate, and keep the patient as safe as we can.”

In an “Open Forum” essay that appears in the February Psychiatric Services, Ira Glick, M.D., Sharfstein, and Harold Schwartz, M.D., argue that the ultrashort five- to six-day hospital stay may actually subvert the goals of recovery and may contribute to the criminalization of mentally ill individuals by releasing patients to the community with no real recovery-oriented, long-term treatment plan.

The authors offered a model for reform of psychiatric hospitalization that revives the therapeutic function of the hospital and leaves enough time for accurate assessment, real engagement with the patient and family, and formulation of an individualized treatment plan aimed at long-term recovery (see How to Make Hospitalization Useful).

“We don't want a return to long-term hospitalization,” Sharfstein said, “but five or six days is too short. The purpose of the article is to raise the concern that in thinking about health reform, the hospital piece has been left out.

“Hospitalization is an opportunity, not a disaster,” he said. “It's an opportunity to bring high-tech resources to bear on the patient's illness and to come up with a better outpatient plan, one that will help the patient adhere to treatment and be better connected to psychotherapy and psychosocial interventions.”

Where Should Recovery Occur?

Yet the belief that recovery-oriented treatment should happen outside the hospital walls is persistent, and in an editorial accompanying the article, Psychiatric Services Editor Howard Goldman, M.D., Ph.D., argues that the appropriate role of inpatient care in the range of services for mental illness has yet to be resolved.

“Not all patients who need 24-hour supervision or confinement . . . need [hospital-level care],” Goldman wrote. “For some patients, freestanding psychiatric hospitals, affiliated with academic centers, are a more appropriate, lower-cost alternative to the general hospital. For many others, 24-hour alternatives may be more appropriate than the acute care hospital.”

In an interview with Psychiatric News, Marvin Herz, M.D., a longtime advocate for outpatient psychosocial interventions, said that while rigid adherence to a five- to six-day protocol serves no one well, he does not favor an expanded role for inpatient care as outlined by Glick and colleagues.

“I see the hospital as part of a broader system of care that ideally provides a continuum,” Herz told Psychiatric News. “In my opinion the definitive treatment in terms of helping the patient function should be in an ambulatory setting, not in the hospital. [Glick and colleagues] proposed an expanded role for the goals and methods of acute inpatient treatment that will inevitably increase length of stay and costs compared to the current inpatient model of crisis stabilization followed by appropriate ambulatory care.”

Anticipating those arguments, Glick and colleagues argued that lower-cost, low-tech models of care for patients who need 24-hour supervision do not now exist outside the hospital. In the meantime, they wrote, many patients have cognitive problems plus psychotic symptoms that prevent them from being “full partners on the treatment team” and from functioning in an outpatient setting.

Schwartz, psychiatrist in chief at the Institute of Living in Hartford, Conn., emphasized that the intensity of resources that can be brought to bear in an inpatient setting — and the crucial “holding environment” of the hospital — are especially important for influencing the trajectory of illness and recovery following a first-episode psychosis.

“We know that rapid, intense, and early intervention with the most resources possible is critical in the long-term outcome of first-episode psychosis,” he told Psychiatric News. “The evidence is very strong that an inadequately treated first episode predisposes to a second and to a downward trajectory. When we discharge people after five days because they are ‘safe,’ even if they remain psychotic and inadequately prepared for adjustment to life in the community, are we sending these patients on a downward course?”

How Much Hospitalization?

What everyone agrees is that research on the role of hospitalization and the appropriate number of days in a hospital for a given diagnosis is sorely lacking. (Goldman, in his editorial, noted that inpatient research “has disappeared.”)

What research exists tends to favor short-term over longer-term hospitalization. One study published in 1979 in Archives of General Psychiatry by Herz and colleagues looked at 175 newly admitted patients to the Community Service of the New York State Psychiatric Institute. Patients were randomly assigned to standard inpatient care, brief hospitalization followed by the availability of transitional day care, or brief hospitalization.

All patients were offered follow-up outpatient treatment. Initial length of stay was 11 days for both brief-hospitalization groups and 60 days for the standard-care group.

The long-term results indicated little differential effect between treatments, but when differences occurred, they generally favored the brief-care groups, according to the report. Similar results were found in a 1980 British study by Hirsch and colleagues published in the British Journal of Psychiatry.

Glick was principal investigator on studies in the 1970s and 1980s looking at long- and short-term hospitalization for patients with schizophrenia and those with other disorders. Generally, those studies showed that some subgroups of patients benefited from longer hospitalization, but that overall no differences in outcome were detectable when taking into account length of stay and diagnosis.

However, it is noteworthy that in all these studies what was considered “short term” at the time would be a long-term stay today.

“Today, patients admitted to inpatient care are either new cases or chronic patients who get readmitted because they are not complying with treatment,” Glick told Psychiatric News. “What happens with these ultrashort stays is that even the diagnosis is deferred — physicians are reluctant to render a diagnosis so the patient is classified as NOS (not otherwise specified). Then they get a blast of drugs — an antidepressant, antipsychotic, and antianxiety medication — told ‘good luck,’ and get sent out the door.

“What we are arguing for is spending the extra time to make a diagnosis, contact the previous doctor to get a careful history of what has been done or not done in the past, and prescribe an individualized treatment,” Glick said. “As in any other area of medicine, you have to do something active and therapeutic. In the case of psychiatric patients, the treatment team needs to include family, significant others, or a case worker—or it won't work.”

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Cannabis May Influence Onset of Psychosis

An article posted on February 7th by Scientific American:

Research to be published this summer finds that the use of cannabis is associated with the early onset of psychosis.

By Christie Nicholson

Pot is one of those drugs that appears to maintain a fairly good rep, despite its growing bad rep. Consider this research that will be published this June in the Archives of General Psychiatry.

This particular study found that marijuana use is associated with early development of psychosis. Scientists analyzed 83 studies involving over 8,000 subjects who used pot and over 14,000 subjects who did not. They compared the age of onset for psychosis between these groups. And they found that those who used cannabis developed psychosis nearly three years younger than those who did not use any pot.

The researchers proposed some theories behind the pattern. One that cannabis use is a causal factor for schizophrenia, or that it precipitates psychosis in vulnerable people. They also theorize that cannabis might simply exacerbate symptoms of schizophrenia. Or the link could come from the other direction of course, those suffering from schizophrenia may be more likely to use pot.

The evidence here suggests that limiting marijuana use could delay or even prevent some cases of psychosis. And timing is important, since earlier onset of schizophrenia is linked to a worse prognosis overall.


Please click here to listen to the podcast.

Also see:

Cannabis Use and Earlier Onset of Psychosis

Mental Health Commission of Canada - Winter 2011 Newsletter

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To view the entire newsletter, please click here (PDF).