Freedom to be sick leaves families feeling chained

From today's edition of The Globe and Mail:

Caregivers who can't get mentally ill loved ones to seek help grapple with laws designed to protect civil rights

By André Picard

Mary Liz Greene [pictured] was in the midst of an animated conversation with her son when he suddenly lunged, grabbed her by the neck with two hands, then pushed his thumbs into the soft flesh of her throat, using the full force of his 6-foot, 200-pound frame.

Gasping for air, she felt the pressure let up for an instant, shoved him with all her might and fled to a neighbouring apartment to call 911.

“I'm lucky to be alive,” Ms. Greene said later, “although sometimes I doubt that.”

Her son, 24-year-old John Candow, suffers from severe bipolar disorder and, when untreated, is consumed by the delusion that he is Tony Soprano, the TV mobster. He has been living with his mother and, since he was diagnosed three years ago, has thrown knives at her, burned her with cigarettes, punched and kicked her repeatedly.

Last week's incident was the most violent yet. When police arrived, they were confronted with a psychotic young man holding a knife to his throat threatening suicide. They tasered, subdued and arrested him – and found 10 more knives in his knapsack.

When Ms. Greene, a Halifax social worker, visited her son at the East Coast Forensic Hospital a few days later, he reminded her, matter-of-factly, that he plans to kill her and chop her body to pieces.

“When John's not sick, when he's being treated, he's very loving. He's a sweet, beautiful boy,” Ms. Greene says tearfully.

But the central fact of the sordid tale is this: Mr. Candow refuses to get treatment, as is his right under Canadian law.

That right presents a dilemma for countless caregivers across the country whose loved ones have such severe mental illnesses as schizophrenia, bipolar disorder and addictions, especially when they also suffer from anosognosia – an inability to recognize they are sick.

To read the entire article, click here.

Photograph by Sandor Fizli for The Globe and Mail.

The loneliness of the psych ward

From today's edition of The Globe and Mail:

By Erin Anderssen

Ben Robinson [pictured] spent long months during his hospital stays pacing the halls alone, hoping someone would visit.

Hardly anyone did, except for his mother, even though he phoned friends specifically to ask for company. The people who eventually braved the locked ward at the Clarke Institute never stayed long. “Where are the white padded rooms?” they joked.

“It was a bit of freak show kind of thing,” says Mr. Robinson, a 24-year-old part-time student in Toronto who has been diagnosed with schizo-affective disorder – a condition defined by symptoms of both a mood disorder, such as depression, and schizophrenia. “Like, ‘Whoo, let's go see my friend in the mental hospital.' ”

Even so, those visits made all the difference, he remembers – a few moments to feel “semi-normal,” to talk to someone from the outside and forget that he wasn't free to leave. The nurses, he says, were too busy to spend much time on chit-chat; the patients didn't mix much except to watch TV in silence. Other than a daily 30-minute appointment with his psychiatrist and taking a few workshops, he spent most of his time drinking tea and walking. “It's incredibly lonely and boring in the hospital,” he says. “I needed people to be there as much as possible.”

Mr. Robinson was lucky to get any visitors: Studies suggest that as many as 40 per cent of psychiatric patients never see a family member or friend at their bedside. According to a recent survey conducted at Toronto's Centre for Addiction and Mental Health, one-third of hospitalized patients in the mood and anxiety program received no family visits – and 20 per cent were visited only once or twice. Friends were even less in evidence: More than 70 per cent of the people surveyed said they received no more than two visits, and the majority didn't see a single friend.

There's a reason why psychiatric hospitals don't usually have gift shops: Nobody buys gifts for their patients. “You go into any ward in any hospital, and you will see cards, a balloon or two, flowers, teddy bears,” says Karen Liberman, executive director of the Mood Disorders Association of Ontario. “The psych ward is virtually the only place where you see nothing and nobody.”

To read the entire article, click here.

Photograph by Deborah Baic of The Globe and Mail.

Psychiatry: A specialty relegated to the basement

An article published in the today's edition of The Globe and Mail:

By Carolyn Abraham

Jai Shah [pictured] could have been any sort of doctor he wished. Even before he graduated with honours from the University of Toronto's medical school, the 30-year-old Edmonton native had earned a master's degree in international health policy from the London School of Economics, published papers and worked for the Canadian Institutes of Health Research.

Praise follows him wherever he goes. Except for last fall – when he decided to specialize in psychiatry.

“A psychiatrist?” some of his supervisors said, “But you're smart! … You're taking the easy way out … Your patients will make your life hell … Your patients will make you depressed … What a waste of talent!”

Dr. Shah knew mentally ill people battle both their disorders and the social stigma their conditions carry. But it surprised him that psychiatrists confront a certain stigma, too.

“I'm sure the feedback has discouraged some young doctors from choosing this as their career,” said Dr. Shah, now at the Harvard Longwood Psychiatry Residency Training Program in Boston.

In fact, Susan Abbey, who heads the U of T first-year residency program in psychiatry, said the disparaging comments are “ubiquitous.”

“I don't think there's one of our incoming residents who hasn't been exposed to negative comments from family or friends or academic supervisors,” Dr. Abbey said.

Just as lawyers can face a barrage of bottom-feeder jokes, psychiatrists, both in film and real life, have long been seen as doctors of a lesser science. Even their own physician colleagues can view their patients as difficult and time-consuming. The negativity, experts say, is contributing to a national shortage of psychiatrists and shoddy care for mentally ill people.

To read the entire article, click here.

Photograph by Jodi Hilton for The Globe and Mail.

A 12-step program for Canada

From today's edition of The Globe and Mail:

Setting priorities and solutions to address the mental health crisis.

To read this excellent article by André Picard, click here.


From www.andrepicard.com:

André Picard is the public health reporter at The Globe and Mail and one of Canada's top public policy writers.

He is the author of the best-selling books CRITICAL CARE: Canadian Nurses Speak For Change and THE GIFT OF DEATH: Confronting Canada's Tainted Blood Tragedy. He is also the author of A CALL TO ALMS: The New Face of Charity in Canada.

André has received much acclaim for his writing, including the Michener Award for Meritorious Public Service Journalism, the Canadian Policy Research Award, and the Atkinson Fellowship for Public Policy Research.

In 2002, he received the Centennial Prize of the Pan-American Health Organization as the top public health reporter in the Americas. In 2005, he was named Canada's first Public Health Hero by the Canadian Public Health Association, and in 2007 he was honoured as a Champion of Mental Health.

André is also a four-time finalist for the National Newspaper Awards – Canada’s Pulitzer Prize.

He has been the recipient of the Canadian Nurses' Association Award of Excellence for Health Care Reporting, the Nursing in the Media Award of the Registered Nurses Association of Ontario, the International Media Prize of Sigma Theta Tau (Nursing Honor Society), and the Science and Society Book Prize.

His advocacy work has been honoured by a number of consumer health groups, including Safe Kids Canada, the Canadian Mental Health Association, the Canadian Alliance on Mental Illness and the Canadian Hearing Society.

He lives in Montréal.

Photo of André Picard courtesy of www.andrepicard.com.

The Scottish solution: 'Look good but feel crap?'

From today's edition of The Globe and Mail:

Scotland has become a leader in tackling mental illness, thanks to innovative legislation and high-profile public-awareness campaigns. The suicide-prevention effort features everyone from football teams to the pop duo the Proclaimers.

To read the entire article, click here.

Eleanor Trebilcock of Arbroath, Scotland, with her dog Jake. After suffering with depression, Ms. Trebilcock became a product of the country’s old thinking about mental illness, but she’s also benefited from its new approach. 'The stigma,' she said, 'is slowly disappearing.' (Randy Quan for The Globe and Mail)

BY THE NUMBERS

25 to 33 - Percentage of Scottish people experiencing mild to moderate mental-health problems, out of a population of five million 3 Percentage of the population with severe and enduring mental illness

1 - Ranking of suicide as the cause of death for Scots under 35 years old

765 - Number of suicides in Scotland in 2006

13 - Percentage decline in the suicide rate since 2002

20 - Percentage drop that Scotland wants to see in the suicide rate by 2013 (from the base year 2002)

Also see: The branding that devalues.

'The mad and the bad'

From today's edition of The Globe and Mail:

The mentally ill are often saddled with a double stigma, cycling through the justice system without getting treated for underlying disorders. As Dawn Walton reports, the prisons are full of people with mental problems, many of them so-called frequent fliers.

To read the entire article, click here.

Corry Grunsky, with granddaughter Cera Smith and mother Mary Lewis, in Edmonton. Drugs became Ms. Grunsky’s crutch – and livelihood – after she was diagnosed with depression and bipolar disorder. Convicted of drug dealing, she calls her time in federal prison 'a complete joke.' (John Ulan for The Globe and Mail)

The express route to mental illness

From today's edition of The Globe and Mail:

From the lab to the legislature, the push is on to recognize and treat addiction as a mental illness. A growing body of research finds addiction is not the result of bad behaviour or weak character, but the result of biochemical disruptions in the brain that genetically vulnerable people are, on their own, powerless to overcome. It distorts mood, clear thinking and compulsion control. People who suffer from it, scientists believe, can no more talk themselves out of their dependence any more than people can talk themselves out of depression.

To read the entire article, click here.

The push is on to recognize addiction as a mental illness (Tonia Cowan/The Globe and Mail)

Click on the image to enlarge it.

The orphans of medicare

From today's edition of The Globe and Mail:

Jennifer Clark has been living for two years in a stark room in Victoria's Royal Jubilee Hospital. In fact, patients with mental illness — unwanted and forgotten — account for an astounding one-third of all hospital time.

To read the entire story, click here.

Jennifer and her husband Rhys Clark in her room at the Royal Jubilee Hospital May 17, 2008. (John Lehmann/The Globe and Mail)

By the numbers

9: percentage of visits to the emergency room that are related to mental health

24 to 72: the number of hours a patient with severe depression can wait for care at the ER

16: percentage of hospital stays in Canada related to treatment for mental illness

75: percentage of patients treated at Victoria’s Archie Courtnall Centre who have substance-abuse problems

38: percentage of patients [diagnosed with schizophrenia] discharged from hospital who are readmitted within a year

80 percentage of sufferers of mental illness treated primarily by a family doctor

34,418: the dollars required to support someone with serious mental illness to live in the community for one year

170,820: the dollars required to keep a mental-health patient in hospital for a year

Sources: Canadian Institute for Health Information; Centre for Addiction and Mental Health

The working wounded

From today's edition of The Globe and Mail:

Mental illness is costing the Canadian economy a staggering $51-billion a year, and each day 500,000 people miss work because of psychiatric problems. What are employers doing about it? Not much.

To read the entire story, click here.

Sylvie Giasson, a Health Canada worker in Ottawa, [lives with] severe depression/anxiety disorder. (Brigitte Bouvier for the Globe and Mail)

By the numbers:

1 Rank of depression among the leading causes of disability in the world.

8% Percentage of workers taking medication in Canada to treat depression and other mental-health conditions.

20.6% Percentage of workers who suffer a bout of mental illness, most in the prime of their working lives

40% Percentage of short- and long-term disability claims that involve a mental-health problem.

60% Percentage drop in family income when a breadwinner is diagnosed with mental illness.

500,000 Number of workers off sick each day in Canada with mental-health problems.

$8.5-billion Amount that employers and insurers spend each year on long-term disability claims related to Mental illness.

$9.3-billion Annual cost of short-term leave for mental-health problems.

$51-billion Amount that mental illness costs the Canadian economy each year.

Sources: World Health Organization, Centre for Addiction and Mental Health, Canadian Public Health Agency, Great-West Life Centre for Mental Health in the Workplace, Statistics Canada

'We must never give up on the potential of people to recover'

An excellent video posted on globeandmail.com.

Psychiatrist David Goldbloom talks about the stigma surrounding mental illness in Canada and some essential first steps in changing things for the better

To view the video, click here.

Photograph of David Goldbloom courtesy of The Globe and Mail.

Breakdown: Canada's Mental Health Crisis

From today's edition of The Globe and Mail:

Follow me home

Four brave Canadians invite readers into their lives to shine a light on the human face of mental illness. The series Breakdown: Canada's Mental Health Crisis begins today.

To view the series Breakdown: Canada's Mental Health Crisis, click here.