Troubled times for mental health: What can we do right now?

A letter to the editor published in today's edition of The Chronicle Herald:

By Stan Kutcher [pictured]

The recent series in The Chronicle Herald about the crisis in mental health highlighted a number of issues that are not new or unique to Nova Scotia. However, the question facing us in this province is: What are we going to do about it right now? Here are three immediate solutions to our problem that we could put into place quickly.

Focus on children and youth:

We know that approximately 70 per cent of mental disorders begin prior to age 25. We also know that early identification and effective treatment of these disorders is likely to lead to substantially better outcomes and may lead to long-term health cost containment.

So what can we do about this? First, we need to provide effective support to parents and communities so children receive the best early start they can. Then we need to train our teachers and all those who work with young people to learn how to identify children and youth who may be in the early stages of a mental disorder and provide seamless access to effective interventions.

This will require enhancement of human resources, of course, but this should be first developed in this age group. It is my impression that a modest increase in investment in child and youth mental health could lead to immediate short-term improvements with an additional long-term gain. The simple immediate solution: add additional human resources to child and youth mental health services.

Increase mental health care in primary health care:

The primary care sector is the foundation of our health care system. This is where the mental health needs of people are first brought for care. Yet our primary care sector is not set up to deal with such needs. Physicians require better training in the diagnosis and treatment of mental disorders, and primary care practices need to be supported with health providers who have the skills to provide ongoing psychological care. These providers do not need to be at the highest rank of the professional ladder. Rather, they need to have the competencies to counsel and support those who require mental health interventions.

Effective primary sector mental health care will not only address issues of access to care, but will also decrease the demand on specialty mental health services, leaving them more able to provide care for individuals who require more intensive interventions. The simple immediate solution: add counsellors and other trained therapists to primary care practices.

Stop investing in things that do not work:

Mental health care has long historical roots in many types of interventions for which there is little or no evidence of effectiveness or economic value. It is essential that we stop investing in things that we know do not work or for which there is little compelling evidence that they work.

While we have been moving towards greater awareness of the necessity for evidence-based care, we need to hasten progress in that domain and begin to provide funding on the basis of solid scientific evidence. If the evidence does not yet exist, then the funding could be provisional for a period of time until those who champion the intervention or program have had the opportunity to impartially determine its effect and value.

At the very least, no new programs or interventions should be applied without good, independent and most substantial evidence of their effectiveness and economic value. And all existing programs must be evaluated on what they achieve (their outcomes) not on what they do (their activities).

The simple immediate solution: base funding of mental health programs and interventions at least in part on substantive evidence of their effectiveness and cost-effectiveness and continue funding based on outcomes evaluation.

These three simple solutions may be a good place to start. Concurrently, there needs to be immediate and substantial structural change addressing how mental health services are conceptualized and how mental health care is delivered.

We need to stand back and critically and innovatively create a new system that meets the needs of people, provides care and not just services. It must be based on our national and community values and human rights, and be delivered using the best available scientific evidence by those providers best trained to provide care.

We need to also create a framework that can work alongside (but outside) the current health and mental health domains. This may be best realized by creating a Provincial Mental Health Commission (PMHC) that reports directly to the minister of health and that has as its one mandate the development of a provincial mental health strategy that is population needs-driven, innovative and based on best scientific evidence applied within values and principles that define us as caring, compassionate and considerate human beings.

The PMHC should have a sunset clause: five years. If we cannot do this in five years, we are not doing what needs to be done.


Dr. Stan Kutcher is Sun Life Financial Chair in Adolescent Mental Health and director, World Health Organization Collaborating Centre in Mental Health Policy and Training, Dalhousie University and the IWK Health Centre.

Much more must be done

A letter to the editor published in yesterday's edition of The Chronicle Herald:

The Feb. 9 story "Family tried to get teen murder suspect psychiatric help" reports that the family of the young man charged tried to obtain psychiatric care prior to the tragic event. It is often the shocking that draws attention to the commonplace. We need to do more, much more.

Parents, youth and health providers have known for a long time now that rapid, efficent access to effective, high-quality mental health care is a problem. We need to do much better to ensure that those who need care immediately receive high-quality care immediately. That may mean redesigning our health system. That may mean addressing mental health literacy in schools and in the community. That may mean better training in the diagnosis and treatment of mental disorders for all health providers.

One in five young people has a mental disorder requiring professional treatment. If the prevalence of heart disease in youth was that high, would there not be a heart clinic on every corner? Yet those in most need of mental health care do not receive it. What is wrong with this picture? Enough is enough. It is time to fix the problem!

Dr. Stan Kutcher [pictured]
Sun Life Financial Chair in Adolescent Mental Health
Dalhousie University

Mental-health program for Digby schools gains national attention

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

By Brian Medel, Yarmouth Bureau

Digby County proponents of an adolescent mental-health curriculum being included in area high schools have received national attention.

The Mental Health Commission of Canada has asked if they can use a local program in a new national anti-stigma campaign.

"We’re very excited about being part of this campaign," John Roswell, the co-ordinator of the Digby Clare Mental Health Volunteers, said Tuesday.

"Our mandate is to promote the mental health of Digby County residents and we are trying to overcome the prejudice and discrimination faced by people with mental illness in our community.

"We have been focusing on adolescent mental health in particular and this is one of the areas the commission is concentrating on."

Mr. Roswell said his group has been working for several months to introduce information about mental health and illness into the curriculum of Digby County high schools. It now looks like the program will begin during the 2010-2011 school year.

"The (Canadian) Mental Health Commission will be helping us measure the effectiveness of our program," said Mr. Roswell.

The Digby County group has also joined forces with the Sun Life Financial Chair of Adolescent Mental Health at Dalhousie University and the IWK Health Centre to help with their project.

Dr. Stan Kutcher, an adolescent mental health expert at Dalhousie University’s school of medicine, spoke to Digby County teachers Tuesday, providing information on mental health and disease.

Mr. Roswell said 80 per cent of all psychiatric disorders emerge in adolescence and it would be good for people to have some understanding of them.

"Mental illnesses affect more people, directly or indirectly, than any physical illness," he said, adding that 83 per cent of Digby County high school students surveyed by his association recently said they knew someone with a mental illness.

And yet mental illness is something people don’t like to talk about, said Mr. Roswell.

"We’re trying to overcome that by creating a dialogue in our community. We’re trying to help people see that it’s OK to admit that you might have a mental illness."

Province Introduces New Mental Health Resources in Schools

An October 5th news release from the Nova Scotia Department of Education:

Nova Scotia's students will gain a better understanding of mental health with the introduction of new resources to support health education in schools, Education Minister Marilyn More [pictured] announced today, Oct. 5.

The Healthy Mind/Healthy Body resources supplement the province's newly enhanced health education curriculum, which includes mental health as one of six priority areas.

"Healthy Mind/Healthy Body speaks to students in age-appropriate language, and teaches the difference between healthy and unhealthy feelings," said Ms. More. "It is intended to help both students and their families cope with the challenges that youth face as they grow and mature."

These resources, which include a pamphlet called Let's Talk About... Mental Health, encourage open and honest discussion around feelings and worries. The learning activities encourage students to talk to a trusted adult when they begin to feel overwhelmed by certain feelings.

Ms. More, accompanied by adolescent mental health experts Dr. Stanley Kutcher and Dr. Bianca Horner, who authored the materials, attended a class at Portland Estates Elementary School today where they shared their thoughts and feelings with Ms. Mamoona Brace's grade four and five class.

"The idea is that by learning to openly discuss emotions and concerns, students will begin to see mental health as an important and natural aspect of their overall health," said Ms. More.

In the earlier grades, Healthy Mind/Healthy Body has students track their feelings in a monthly calendar and identify what causes them to feel frightened, sad or worried. In grades seven to nine, students discuss common mental illnesses and learn to identify their warning signs.

These new resources are part of the recently developed Nova Scotia health education curriculum for grades primary to nine, and have been used in classrooms since spring. The resources further confirm Nova Scotia's position as the national leader in developing curriculum in child and adolescent mental health.


FOR BROADCAST USE:

Nova Scotia's students will gain a better understanding of mental health with the introduction of new resources to support health education in schools.

Education Minister Marilyn More announced today (October 5th) that the Healthy Mind/Healthy Body resources address child and adolescent mental health concerns and are intended to help youth and their families cope with the challenges of growing up.

The mental health materials are written in age-appropriate language and complement the health curriculum for grades four through nine already in place in Nova Scotia's public schools.

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Media Contact:

Nicole Brooks
Department of Education
902-424-5432
E-mail: brooksnl@gov.ns.ca

Also see:

Province introduces mental health strategy for schoolchildren

Teens to learn about mental health

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

Pilot project could be coming to Digby County high schools in new year

By Brian Medel, Yarmouth Bureau

High school curriculum designed to teach students about mental illness may be coming to Digby County classrooms in January as a pilot project.

"This is new," said John Roswell, one of the program co-ordinators with the Digby-Clare Mental Health Volunteers Association.

"We hope to do it during the 2009-2010 school year, hopefully beginning in January," Mr. Roswell said about the project that will be conducted in four local high schools.

He hopes the curriculum will someday be included in all Nova Scotia high schools.

The curriculum was prepared by Dr. Stan Kutcher [pictured] in co-operation with the Canadian Mental Health Association.

"This is really a wonderful opportunity," said Dr. Kutcher, an adolescent mental health expert at Dalhousie University’s school of medicine.

The course will give students information on how the brain works and tell them how to maintain good mental health. Suicide prevention and depression will also be discussed, Dr. Kutcher said Tuesday.

He’ll help teachers better understand mental illness and the new curriculum in special workshops that will be held before the start of the course.

"They’ve been very enthusiastic about this," said Dr. Kutcher.

Next week, staff from the Education and Health departments, along with representatives from local school boards and health authority, will gather in Digby to talk about the new high school course and how it will be implemented.

"We’re not quite sure where it will fit . . . that’s part of what this discussion is going to be about," said Mr. Roswell. "We hope to make (it) a larger project . . . an overall approach to addressing adolescent mental health.

"We’re trying to create a dialogue around this issue in the community and make it OK for people to talk about mental health and mental illness."

Mr. Roswell said 80 per cent of all psychiatric disorders emerge in adolescence. He had mental illness as a young person but was undiagnosed until the age of 40.

"My life would have been so much different had I been diagnosed as a teenager," he said.

More than meds & beds

A letter to the editor published in yesterday's edition of The Chronicle Herald:

Re: "Suicide prevention: Time to get on with what works" by Stan Kutcher (Sept. 12).

Lack of treatment was acceptable in children’s mental health when we didn’t know the difference. However, it is totally unacceptable when the knowledge and proof of improved capability of sustaining a productive life is within a proper treatment plan, but lacks the dollars and commitment to provide it. All children deserve proper treatment without prejudice and stigma over their mental health issues!

It is time for the torture, neglect and abuse to stop. It is time for psychiatrists to stop delivering inadequate treatment proposals to parents and caregivers for their mentally ill children, because the province does not support the mental health needs of its young people, or perhaps, the hospital itself covers its inadequacy.

It is time for our government to invest more dollars into treatment facilities, with not just meds and beds, but with the educated, experienced staff and specialized treatment programs when prescribed. It is time for our children’s hospital to invest in a psychiatric unit and all existing mental health treatment programs, an art therapy program, music therapy program, "in house" psychologists and "on-call psychologists" when in-patient youth are in trauma episodes.

Actually, it is past time!

Sherry Beck Ramey, New Germany

Focus on training, not terminology

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

By Marilla Stephenson [pictured]

A DEBATE OVER whether so-called "excited delirium" is a valid condition is a waste of time. What is more significant — in terms of how police and jail guards react to it — is the risk of death for a person in this state and how to best respond when high-risk situations unfold.

Last week Justice Minister Ross Landry released a report from an expert panel struck to review the condition last year. The panel was formed in response to the 2007 death of Howard Hyde of Dartmouth. He died in custody after a struggle with police. He had been shocked with a stun gun by them 30 hours earlier.

A death inquiry, led by Judge Anne Derrick, is already underway and its outcome is separate from the report. A pathologist has already concluded that Hyde died of excited delirium — a condition the panel says would be better labelled autonomic hyperactivity syndrome (AHS) — and not from the stun gun shock he received the day before.

We can expect from the inquiry, at the very least, another truckload of recommendations targeting how first responders deal with mentally ill people. A doctor who checked out Hyde after he was shocked with the stun gun has already testified that she would never have released him to the police had she known he would not receive the psychiatric assessment she had requested. Hours later, he was dead.

Dr. Stan Kutcher, a psychiatrist at Dalhousie University, served as chairman of the panel. He told The Chronicle Herald in an interview that "the most important thing here is to realize that this is a medical emergency and that this situation requires the combined efforts of law enforcement and medical first responders."

Police and jail guards will get extra training to ensure they are better equipped to recognize the symptoms of AHS and to call in medical assistance in those circumstances, says Landry. This is one of the key recommendations in a report that contains many useful guidelines for moving forward towards better responses to people experiencing AHS.

Symptoms — which can lead to hyperthermia, cardiac arrhythmia and sudden death — include extreme agitation, aggressive behaviour, paranoia or delirium, incoherent and rambling speech, extraordinary strength, numbness to pain, and profuse sweating.

The report says that "mortality rates are increased in the presence of the signs and symptoms of excited delirium — even with medical intervention or in the absence of use of restraints by law enforcement."

The panel also found that "it is reasonable to consider that, when further stressed by physical struggle or the application and continuation of physical restraints (including the CED), an individual exhibiting the syndrome of excited delirium may be at increased risk for sudden death.

"Similarly, the pre-existence of a medical or psychiatric condition (such as a psychotic illness, pre-existing cardiac condition, delirium with or without the use of psychostimulant drugs) may increase the risk for sudden death in an individual showing signs and symptoms consistent with excited delirium."

That is the nub of the issue: People who suffer from mental illnesses that end up in a state of excited delirium are at an increased risk of death. While police and jail guards may well be the people who are first required to be on the scene of such a situation, additional training is clearly needed to ensure they know when it is paramedics, rather than restraints and a physical struggle, that is more likely to bring a safe outcome to the situation.

Police officers and jail guards are often in very challenging, high-stress situations, where public safety, their own safety and the safety of the person they are trying to subdue must be judged at lightning speed.

They must be provided with every tool possible to make the right decisions in those moments. If that means more training to properly assess, arrest and/or subdue people with mental illness, then it should happen as soon as possible. Calling for medical assistance should be considered a first option, not a last resort.

Even one Howard Hyde outcome is one too many.

Also see:

Vulnerable targets

More training in mental illness

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

Report: Emergency workers need latest information on excited delirium

By David Jackson, Provincial Reporter

Police and jail guards will get more training to recognize mental illnesses and how to deal with people afflicted with them, Justice Minister Ross Landry said Friday.

The province commissioned an expert panel last year to look at the phenomenon called excited delirium and what role it could play in in-custody deaths, to examine the risks of using stun guns and other restraints on people in that state, and to recommend how law enforcement officials should deal with those people.

Mr. Landry said the most significant recommendation in the eight-member panel’s new report is ensuring that front-line justice workers are trained to recognize people with symptoms of excited delirium, or as the panel suggests calling it, autonomic hyperarousal state.

The minister, a former RCMP officer, said officers do get training in dealing with people with mental illnesses but new information is always coming along, as with this condition.

"A couple of years ago, who knew about this?" Mr. Landry said in a telephone interview. "It’s not that long ago. And yet, people over time have passed away in this condition."

It was the death of Howard Hyde, a Dartmouth man who had a history of mental health issues, that led to the panel’s review. Mr. Hyde died in November 2007, 30 hours after Halifax Regional Police Tasered him when he scuffled with them at the police station.

The province’s chief medical examiner, Dr. Matthew Bowes, said Mr. Hyde died of excited delirium due to paranoid schizophrenia. Dr. Bowes said the death was accidental and he found no evidence that the Taser caused the death.

The death led to a provincial review of Taser use, and that led to the review of excited delirium.

The panel, of which Dr. Bowes was a member, said the symptoms of excited delirium are common to other medical and psychiatric conditions and recommended that the term autonomic hyperarousal state be used for people showing those symptoms.

Panel chairman Dr. Stan Kutcher, a psychiatrist at Dalhousie University, said there’s been a useless debate about whether excited delirium is or isn’t a medical diagnosis. He said the panel found the phenomenon well-described in medical literature going back 120 years, just under different names.

The symptoms include extreme agitation, aggressive behaviour, paranoia or delirium, incoherent and rambling speech, extraordinary strength and numbness to pain, and profuse sweating, the report said.

Dr. Kutcher said the key thing to keep in mind in dealing with people in that state is they need medical attention.

"I think the most important thing here is to realize that this is a medical emergency and that this situation requires the combined efforts of law enforcement and medical first-responders," he said in an interview.

The panel recommends creating a provincial training program for all first-responders in recognizing signs of mental illness and responding appropriately.

The report also says call-takers and dispatchers should get special training to help them recognize whether a call involves someone with a mental illness.

Dr. Kutcher said a dispatcher can get an indication of that by asking certain questions, such as whether the caller knows if the person they’re calling about is aware of his or her surroundings. The information would help a dispatcher know whether to send police and paramedics to the scene right away.

The panel recommended first-responders first try to calm the person in a hyperaroused state by talking to them, but if that doesn’t work, to restrain them quickly because a prolonged struggle could jeopardize the person’s life.

Dr. Kutcher said the panel couldn’t find scientific evidence suggesting that one form of restraint is better or safer than another, including stun guns. He said that’s why the panel recommended the province create a database on incidents involving the use of force.

Halifax Regional Police already adhere pretty well to the review’s goals, said Const. Brian Palmeter, the force’s spokesman.

"Our training and practices are consistent with the recommendations," he said.

"That being said, we are looking forward to working with the province to review and update our training where necessary."

Still, Const. Palmeter doubts there will ever be a single case in which an officer would be able to handle the crisis and follow all the recommended advice completely.

Mr. Landry said his department will consult with police, jail guards and sheriff’s services in developing procedures for dealing with people with mental illnesses. He said officers often have to make split-second decisions when dealing with people, so he wants them to have the information to help them make good decisions.


Joanna Blair holds a photo of her brother Howard Hyde, taken when he was in his early 20s. (BRIAN MEDEL / Yarmouth Bureau)


Dr. Hunter Blair, whose wife Joanna Blair is Mr. Hyde’s sister, thinks a dispatcher won’t always be able to get enough information from an excited caller to know whether to send an ambulance to a scene involving a person with mental illness.

The main issue, he said, is how to handle that person once you get there, and the review doesn’t seem to contain much new information.

"They’ve produced what you would have expected them to produce, given the current state of knowledge or non-knowledge," he said from his Shelburne home Friday.

He is happy with the recommended plan to track all calls to study the outcomes of various restraint methods and treatments.

"That’s a good move," he said. "They started doing this in Ontario some time ago."

Health Minister Maureen MacDonald said officials in her department will consult with district health authorities and Emergency Medical Care Inc., which provides ambulance services, about the report.


HANDLING EXCITED DELIRIUM

The following is a summary of the nine recommendations found in the Panel of Mental Health and Medical Experts Review of Excited Delirium:

• The panel prefers the term autonomic hyperarousal state (AHS) over excited delirium, which is confusing and incorrectly suggests a defined medical diagnosis.

• People showing signs of AHS should be considered at risk of sudden death by hospital emergency staff who should be trained to identify and treat them. Once restrained, these individuals should undergo a thorough medical examination. Hospital staff should be ready to resuscitate.

• When it comes to first-responders called to possible cases of AHS, whoever takes such a call should dispatch police and Emergency Health Services simultaneously. If police encounter someone who may have AHS, they should call for EHS and backup immediately. Officers should de-escalate the situation by removing potentially hazardous objects and people from the area and trying to calm the individual without challenging him or her. If restraint must be used, it should be applied quickly. Immediately take the person to hospital and monitor him or her along the way.

• When restraints are used, they should be the least restrictive means that would bring the subject under control. If such a person is restrained, it should be treated as a medical emergency and EHS should be called immediately.

• A database should be created to track the use of various restraint methods to see their effect on people with AHS.

• Studies should be done to review the relationship between the characteristics of subjects and the outcomes of different methods of restraint.

• There should be a unified provincial training plan to help first-responders recognize signs of mental illness and respond correctly. Dispatchers and other call-takers should be trained to recognize signs of mental illness.

• A formal protocol should be developed in each area of the province describing the role of law enforcement and health professionals concerning mentally ill people, including those with AHS.

• An evaluation process should be set up to evaluate the effectiveness of the above-mentioned recommendations.

Source: Panel of Mental Health and Medical Experts Review of Excited Delirium

With Dan Arsenault, crime reporter

Also see:

N.S. excited delirium report recommends first responders get more training

More police, paramedic training urged for excited delirium

Paramedics needed in delirium cases: report

Excited delirium is a real risk, Nova Scotia report into taser death warns

Excited delirium: Consideration of selected medical and psychiatric issues

Minister Releases Excited Delirium Report

A media release issued today by the Nova Scotia Department of Justice:

Department of Justice
September 4, 2009 11:31 AM

A report on excited delirium was released today, Sept. 4, by Justice Minister Ross Landry.

The province commissioned the 38-page Report of the Panel of Mental Health and Medical Experts Review of Excited Delirium in November 2008, to make recommendations to help law enforcement officers when responding to individuals showing excited delirium symptoms.

The report contains nine recommendations to develop new principles, protocols and procedures to deal with individuals who come into conflict with the law and display extreme agitation, aggressive and paranoid behaviour. It also outlines the need for further training and research.

The volunteer panel members included physicians, government staff and experts in the area of mental illness. Dr. Stan Kutcher from the department of psychiatry at Dalhousie University chaired the group.

"I want to thank the experts who offered their advice on this issue which is of great importance to those responsible for public safety and those who deliver medical help," said Mr. Landry.

Government will now consult other health and justice first responders.

The full report is available [by clicking here (PDF)].

FOR BROADCAST USE:

A report on excited delirium was released today (September 4th), by Justice Minister Ross Landry.

The province commissioned the 38-page Report of the Panel of Mental Health and Medical Experts Review of Excited Delirium in November 2008.

It contains nine recommendations to help develop new protocols for Nova Scotia's law enforcement officers when responding to individuals displaying excited delirium symptoms.

The province will now seek input from Justice and Health first responders.

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Media Contact:

Sherri Aikenhead
Department of Justice
902-424-3313
E-mail: aikenhsl@gov.ns.ca

Province Releases Report on Suicide, Attempted Suicide

A July 15th media release from the Nova Scotia Department of Health Promotion and Protection:

A new report will better position government and its partners to help Nova Scotians at risk of attempting suicide.

The report, Suicide and Attempted Suicide in Nova Scotia, was released today, July 15. Its purpose is to help those who work in the areas of suicide prevention, intervention and support.

"Suicide is a very complex and sensitive public health issue," said Dr. Robert Strang, Nova Scotia's chief public health officer. "We need to talk about it more and better understand it to ensure the right programs and supports are in place to help Nova Scotians."

The report describes the conditions surrounding suicide and attempted suicide in Nova Scotia. The data is based on hospital and vital statistics records of suicides and suicide attempts from 1995 to 2004. It examines demographic factors, how people attempt suicide and complete suicide, and the types of health-care services used by Nova Scotians at risk.

"This report is a baseline we can use to evaluate future efforts on this important issue, and we've made good progress since 2004," said Dr. Strang. "We've developed a suicide prevention framework to reduce suicides and attempted suicides, we're doing additional research with the medical examiner's office, and we fund our community partners who work with Nova Scotians."

Dr. Stan Kutcher, Sun Life Financial chair in adolescent mental health, a partnership with the IWK Health Centre and Dalhousie University, said that even though suicide and suicide attempt rates are decreasing, and Nova Scotia is experiencing lower suicide rates than most Canadian provinces, there is more to be done.

"Improving care for people with mental disorders, enhancing the capability of health care and education professionals to identify people at risk, promoting overall good health and resiliency, and improving access to good mental health care, can all help further reduce Nova Scotia's suicide rates."

Highlights of the report include:

• the rate of hospitalizations for suicide attempts declined by 30 per cent over the 10-year period

• 55 per cent of those hospitalized were female

• Lower income was associated with higher rates of both hospitalizations for suicide attempts and suicide deaths

• The rate of suicide death declined from 11 to nine individuals per 100,000

• Nova Scotia's suicide rate was lower than the national average, nine out of 100,000 individuals compared to 11 out of 100,000

• 84 per cent of suicide deaths were male

• 55 per cent of suicide deaths were previously diagnosed with a mental disorder

The report is available online at www.gov.ns.ca/ohp/publications/Suicide_Report.pdf.

Media Contact:

Rachel Boomer
Health Promotion and Protection
902-424-5323
E-mail: rachel.boomer@gov.ns.ca

Also see:

Panel: Report says programs to prevent suicide working

Positive barrier

A letter to the editor published in today's edition of The Chronicle Herald:

Thanks to Steve Snider, CEO of the Halifax-Dartmouth Bridge Commission, for finally moving to install a barrier that will substantially increase the difficulty of completing suicide from the Macdonald Bridge. Since the impetus to complete suicide often waxes and wanes, actions that can delay the final act leading to suicide may deter the suicidal individual from acting and may increase the probability of choosing life instead. Indeed, many people who have decided not to complete suicide or who have survived a suicide attempt go on to live positive and productive lives.

Restriction of lethal means is one of the few public health measures that have been associated with decreasing suicide rates. Although method substitution is technically possible, research has not been able to demonstrate a clear pattern of this occurring when a bridge barrier is erected. So will putting up a barrier on the Macdonald Bridge save lives? Probably. Will it send a clear message of concern for this important health issue? Totally! Is it about time this happened? Absolutely!

As important as Mr. Snider’s role was in moving this agenda forward, the true heroes are Carol Cashen and a group of concerned citizens and mental health advocates. Ms. Cashen is a public health nurse and the mother of a young man who took his life by jumping from the Macdonald Bridge. With other members of the community, with the input of the Canadian Mental Health Association and with responsible reporting, Carol and the citizens of HRM were able to accomplish what the professionals and government were not able to do. They are the people we all have to be thankful to.

Dr. Stan Kutcher
Sun Life Financial Chair in Adolescent Mental Health
Dalhousie and IWK Health Centre

Also see:

Macdonald bridge to get safety barrier

Halifax-Dartmouth Bridge Commission to Install Barrier on the MacDonald Bridge (Teen Mental Health Blog)

Two Steps Forward, One Step Back: The Case of Vince Li

Posted today on Teen Mental Health Blog:

By D. Venn & Dr. Stan Kutcher

The case of Vince Li [pictured], the man who beheaded a victim aboard a Greyhound bus last year, made international headlines yesterday as judge ruled Mr. Li was not criminally responsible due to mental illness. The ruling means that Vince Li will be treated in a mental institution instead of going to prison.

While the ruling is probably the right one, the resulting media frenzy is doing little to dispel the myth that people with mental disorders are violent. It also begs the question: what is the role and responsibility of media in reporting on cases that involve mental illness?

A selection of headlines from major news networks clearly seek to sensationalize the case of Vince Li and in the process make a link between violence and mental illness: ”Canada judge: Vince Li not responsible for bus beheading due to mental illness” (Associated Press), “Canada bus killer found mentally ill” (The West Australian), “Judge rules bus beheading suspect mentally ill” (CNN.com), “Crazy bus cannibal sent to mental institution” (Healthcare Industry Today). Even accompanying photographs (like the one above) attempt to “demonize” Li again reinforcing the idea that people with mental disorders look frightening.

While some people who suffer from mental illness do commit antisocial acts, mental illness does not equal criminality or violence - despite the media’s tendency to emphasize a suspected link (e.g. psychotic serial killers). In fact, people with mental illness are no more likely to commit violence than the general public, but they are 2.5 times more likely to be victimized and are more likely to inflict violent behaviours on themselves. Furthermore, the general public is more likely to be violently victimized by someone who does not have a mental illness rather than by someone who suffers from mental illness.

To read the entire posting, please click here.

Also see:

How the mental health system failed Vince Li (The Globe and Mail, March 6th)

Why a National Mental Health Strategy Is Critical to Preventing Future Tragedies (Reuters, March 5th)

Photograph by Woods of the Associated Press.

Face mental illness: a 10-step plan

From today's edition of The Chronicle Herald:

By Stan Kutcher and David Venn

What does the face of a person with mental illness look like?

That question is at the heart of this year’s national anti-stigma campaign "Face Mental Illness," which is the theme of Mental Illness Awareness Week (Oct. 5-11). In Canada, one in five people is living with a mental illness. Mental disorders are some of the most disabling medical conditions, with about 70 per cent of them onsetting prior to age 25. They exact a huge negative impact on health, society and our economy. Yet a strong and persistent stigma prevents thousands of adults and youth from accessing and receiving the help they need to get well and say well.

While the scientific understanding and treatment of mental disorders and the awareness of the importance of mental health in all aspects of life have advanced considerably in the past decade, the public perception of people with mental illness has been much slower to change. A recent national survey conducted by the Canadian Medical Association found extremely high rates of stigma against those who suffer from mental disorders, permeating all aspects of Canadian society. This stigma is largely present in our social structures and institutions – including our health, social services, education and justice sectors.

Stigma is essentially the polite word for discrimination. There is no room in our caring society for discrimination against those living with mental illness. There is no reason for those living with mental illnesses to be denied adequate housing or equitable health care or to spend their lives in the shadows.

The recently established Mental Health Commission of Canada has announced that it will be addressing stigma against the mentally ill through a national strategy. However, Nova Scotians should not need to wait until a national strategy is unveiled to begin to address the complex issues that need our attention. We could start with these 10 steps to immediately begin to improve mental health and the care for those who suffer from mental disorders in this province:

• Establish a consensus that promotion of mental health and recovery from mental disorders should be the framework for the development and delivery of mental health care across the province.

• Establish a child and youth policy and plan that commit to providing equity in health access to all young people suffering from mental disorders.

• Enhance funding for treatment of those with mental disorders, basing all interventions on best available scientific evidence.

• Address youth needs as the cornerstone of mental health promotion and prevention activities. Focus these activities in schools and community organizations and link these to enhanced community based mental health care capacity for young people.

• Support the creation and distribution of mental health literacy programs to enhance knowledge for the public, professionals and policy-makers alike.

• Allocate a specific portion of the Nova Scotia Health Research Foundation funding for mental health research – especially in areas traditionally receiving little research support.

• Establish innovative community-based and supported housing that meets the needs of the mentally ill – and link this to the development and delivery of peer support training for those who wish to obtain it.

• Establish novel competency training programs to upgrade the mental health treatment skills of all health providers – so people with mental disorders can get their care from the same people who look after their diabetes, cancers and heart disease.

• Establish youth engagement and intervention programs that will prevent young people from ending up in jails, and establish mental health courts for all offenders who are currently rotating through the legal system.

• Accelerate the process of de-institutionalization of those who have mental disorders and ensure that sufficient acute and long-term care resources are available in usual health care locations instead of stand-alone mental health facilities – thus decreasing the stigma of receiving mental health care.

Societies are judged by how they treat their most vulnerable citizens. Nova Scotians are too good a people to continue ignoring the needs of our brothers and sisters, husbands and wives, friends and neighbours because they live with mental illness. It’s time we faced the issue and did ourselves proud.

Dr. Stan Kutcher holds the Sun Life Financial Chair in Adolescent Mental Health. David Venn is project co-ordinator on the Sun Life Chair’s Knowledge Translation Team.

Photograph of Dr. Stan Kutcher courtesy of the IWK Health Centre.

Recognizing the priority of child and youth mental health

From today's edition of The Chronicle Herald:

Canada celebrates its second National Child and Youth Mental Health Day today, during Mental Health Week (May 5-11), to increase awareness about mental health issues facing young people.

The adolescent years are a critical period of adjustment for both youth and families. Young people go through many physical, mental and emotional changes during adolescence. According to the World Health Organization, mental disorders account for almost one-third of diseases among adolescents worldwide. In Canada, between 15 and 20 per cent of youth suffer from a mental disorder that would benefit from appropriate care. However, accurate and up-to-date information on the scope of this issue is lacking in Canada.

Early, effective identification and intervention for young people suffering from mental illness is essential. Half of all lifelong mental disorders onset before 14 years of age and 70 per cent by age 24. Although effective treatments for many of these disorders are known, for a variety of reasons they are often not readily accessible to or accessed by young people who need them.

As parents and community members, it is important to be aware and understand how youth develop, the challenges they face, and the ways we can help them stay as physically and mentally healthy as possible. Parents are usually the first to notice the symptoms of a mental disorder in their child. But frequently they do not know what the problem is or what to do about it. Often, parents are struggling with their own mental health concerns that further tax their ability to help their child.

So figuring out what the problem is and getting the right kind of help in an effective and timely manner would be of value not only to the young people, but also to their parents and family. Talking to youth about the issue of mental health can be difficult, but it is the best way to understand what they are going through and if they need to get help.

At school, mental health problems can be equally challenging for children and adolescents. For many youth, the transition to new academic and social environments can be difficult and create stress that they are ill-equipped to deal with. Additionally, young adolescents may be experimenting with drugs and alcohol and beginning to engage in other risk-taking activity.

Learning to cope with these changes and build resilience is an important part of being successful in school, especially given that some of the most serious forms of mental illness emerge early in adolescence. Most schools do not supply students with the necessary support to help them address this transitional stage. Strong partnerships between schools and service providers can help educators identify and appropriately refer students who may be experiencing mental health problems.

The workplace is another area where the working parent, the parent’s child/family and the employer can contribute to mental health awareness. It is important for working parents to be well informed about mental disorders and treatments so they can advocate for their children and themselves. Enhancing mental health awareness of working parents and their children may promote mental health and well-being, improve early recognition of mental disorders, enhance appropriate early use of health services and lead to better health, social and economic outcomes for all.

The home, school and workplace are all important environments for advancing youth mental health, but none of these environments can hope to succeed without federal and provincial support. The recent establishment of the Mental Health Commission of Canada is a step in the right direction, as is the recent report Reaching for the Top by Dr. Kellie Leitch, which establishes a blueprint of recommendations for child and youth mental health care. But despite these advances, child and youth mental health care is still not high on many provincial or federal government agendas.

In Canada, only four of 10 provinces have created child and youth mental health policies/plans and there is no national child and youth mental health policy. Furthermore, only one in five of Canadian young people requiring mental health care receive it. Clearly the situation must change.

Mental health care for young Canadians is a right, not a privilege. What would happen in this country if only one in five adults needing hip replacements received them? Or how would we react if 15 to 20 percent of our young people suffered from cardiac disease? The access to mental health services and treatment should be no different for children and youth with mental health problems! The time has come to explore legislating access to timely mental health assessment and care based on the rights of children and youth.

Dr. Stan Kutcher is Sun Life Financial chair in adolescent mental health, director WHO Collaborating Center in Mental Health, Dalhousie University and IWK Health Centre. Dr. Simon Davidson and Dr. Ian Manion are on the executive, Provincial Centre of Excellence for Child and Youth Mental Health, Children’s Hospital of Eastern Ontario.

Addressing mental-health concerns fails in jails

From today's edition of The Chronicle Herald:

By Ainslie McDougall and Stanley Kutcher

The province of Nova Scotia has received some recent criticism regarding its detention facilities, such as accidental releases of inmates, an escaped inmate while transferred offsite, as well as the overcrowding of facilities. When considering the issue of overcrowding, it is important to highlight several issues. The answer is not to build more jails and employ more prison guards, but rather to take a closer look at the individuals who are overcrowding these jails and examine why they are there.

While the exact number is unknown, it has been estimated that as many as half of the incarcerated population suffers from mental illnesses, substance abuse problems, and/or learning disabilities. Because of a shortage of services and a lack of understanding by society, the mentally ill are not receiving the care they require and instead are being criminalized by being sent to prisons.

In a statement on March 8, 2007, Supreme Court Chief Justice Beverley McLachlin stated, "Such people are not true criminals, not real wrong-doers in the traditional sense of those words. They become involved with the law because they are mentally ill, addicted or both." Similarly, many police officers believe that mentally ill perpetrators represent a disproportionate number of individuals incarcerated for minor crimes. Some family members have noted that crimes may be committed or encouraged to be committed in order for the mentally ill person to be arrested. This may represent a "faint hope" that arrest will lead to treatment that for a variety of different reasons is not otherwise available.

There are alternatives to longer prison sentences (which studies show are not effective in decreasing repeat offences and stopping the "revolving door process"), such as drug treatment courts and mental health courts, which may meet the treatment needs of those with mental disorders. These courts attempt to identify and address the underlying causes of the criminal activity (such as behaviours associated with mental illness).

Mental health courts have been successfully implemented in many parts of Canada, as well as in the United States, and are specifically designed for those who have committed low level crimes (i.e. those who would be sentenced to incarceration in a provincial facility). These courts attempt to connect with community-based treatment through the interventions of mental health professionals. Studies in the United States show those who have gone through the mental health court received more access to mental health services and spent fewer days in jail than if they were sentenced in a criminal court.

These "problem-solving" courts are also more cost-effective for taxpayers. According to Juristat, Statistics Canada (2004-2005), the cost of incarcerating a federal prisoner was $93,000 per year, and $52,000 per year in a provincial institution. On the other hand, it costs approximately $8,000 for an individual to obtain addiction treatment through a drug treatment court. We are aware that the province of Nova Scotia is considering the development and implementation of similar courts and we encourage the Department of Health to move ahead quickly and thoughtfully in this matter.

We need to move away from the common misconception that locking someone up and throwing away the key is an appropriate manner by which to address mental health problems in our society. Mental illness and addiction are health issues and are not effectively dealt with by the criminal justice system.

The independent audit called for by Justice Minister Cecil Clarke is inadequate as it is not addressing the pressing issues facing provincial jails. Fundamental changes need to be made to the system.

Ainslie McDougall is with the IWK Health Centre. Dr. Stanley Kutcher is Sun Life Financial Chair in Adolescent Mental Health, IWK, and a professor in the department of psychiatry, Dalhousie University.

Photograph of Dorchester Penitentiary by Verne Equinox.

Rights of mentally ill youth must be a national priority

From the March 20th edition of The Chronicle Herald:

By Dr. Stan Kutcher, Dr. Simon Davidson and Dr. Ian Manion

According to the World Health Organization, mental disorders contribute almost one-third of the global burden of disease during adolescent years. In Canada, between 15 and 20 per cent of youth suffer from a mental disorder that would benefit from appropriate care. Early and effective identification and intervention for young people suffering from mental illness is essential because as many as half of all lifetime cases onset before 14 years of age and 75 per cent by age 24. Although effective treatments for many of these disorders are known, they are often not provided to young people who need them.

Furthermore, there may be insufficient attention being paid to fundamental human rights of some young people who are suffering from mental disorders. According to the United Nations Declaration of the Rights of the Child – 1959 (to which Canada is a signatory), "no child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment." This declaration goes on to state that "the child who is physically, mentally or socially handicapped shall be given the special treatment, education and care required by his particular condition."

The UN resolution [Principles for the] Protection of Persons with Mental Illness and the Improvement of Mental Health Care, 1991, states: "All persons with a mental illness, or who are being treated as such persons, shall be treated with humanity and respect for the inherent dignity of the human person."

The Canada Health Act (1985) similarly seeks to protect and promote the physical and mental well-being of all Canadians. The rights to protect young people with mental disorders are in place, but the shortcomings fall within the enforcement and provision of these rights.

There is a critical situation of mental health care for young people in Canada, resulting from stigma, lack of easily available mental health care, lack of health providers trained in mental health competencies, complexities of addressing multiple needs of the mentally ill, and chronic underfunding of mental health services, among many other things.

Due to substantial gaps in appropriate mental health care, many young people are being placed in detention facilities simply because there is nowhere else to go. Behaviours rooted in mental disorders are being punished rather than being treated. Alarmingly, some observers have noted that youth detention centres may be the newly emerging youth mental health care system.

Identified as the "orphan of the orphan" in the Kirby Commission Report (2006), child and youth mental health care is not high on many provincial or federal government agendas. The recent establishment of the Mental Health Commission of Canada is a step in the right direction.

If 15 to 20 per cent of our young people suffered from cardiac disease, there would be a national campaign for the treatment of heart problems in every community. Yet, only one in five of young Canadians requiring mental health care receive it. And the provided "care" is not necessarily effective or consistent with the recognition of the human rights of those who receive it.

Clearly, the situation must change. In Canada, only four of 10 provinces have created child and youth mental health policies/plans and there is no national child and youth mental health policy. Current human resources are inadequate to meet child and youth mental health care needs, and traditional means of providing specialist care by single professionals, as compared to multidisciplinary teams, may impede accessibility to mental health care for young people.

Providers of mental health services may require upgrading of clinical training, as substantial changes in the understanding of the development and treatment of mental disorders in young people have been made in the last decade. These advancements have yet to be fully translated into treatment approaches. Although research funding into child and youth mental health care through the Canadian Institutes of Health Research has increased over the last five years, enhanced and targeted funding is needed to allow for the further identification of the most effective treatments and delivery systems.

Mental health care for young Canadians is a right, not a privilege. It must be provided in a manner that is equally based on the best available scientific evidence, the developmentally unique needs of children and youth, and recognition of the principles of the human rights of the child and of those suffering with mental disorders.

It is a tragedy that young people expecting appropriate mental health care are treated in a manner that offends their basic humanity. It is a tragedy that young people suffering from mental disorders do not have the right to care provided in a way that adheres to developmental issues. And it is a tragedy that young people suffering from a mental disorder do not have the right to care based on best scientific evidence.

Children and youth must work in collaboration with their primary care givers to advocate for appropriate care and systematic change at the government level. The time for talking has passed. It is time for provincial and federal governments to do what is right by putting child and youth mental health on the federal-provincial health agenda as a national health priority.

Dr. Stan Kutcher is Sun Life Financial Chair in adolescent mental health and director, World Health Organization Collaborating Centre in Mental Health, Dalhousie University and the IWK Health Centre. Dr. Simon Davidson is executive director, planning and development, and Dr. Ian Manion is executive director, operations, at the Provincial Centre of Excellence for Child and Youth Mental Health, Children’s Hospital of Eastern Ontario.

Also see:
Mentally ill youth: meeting service needs

Standards for Mental Health Services in Nova Scotia. Revised and Approved March 22, 2004.

Photograph of Dr. Stan Kutcher courtesy of the IWK Health Centre.