"60 Minutes" Focuses on Schizophrenia and Violence

From CBS's 60 Minutes:




Also visit:

Untreated mental illness an imminent danger?

Psychiatric News Alert: "60 Minutes" Focuses on Schizophrenia and Violence

American Psychiatric Association

Treatment Advocacy Center

Case for Funding Mental Health and Social Services in Canada

Please click on the image to magnify it.

Source:

http://strategy.mentalhealthcommission.ca/about/case-for-investment

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

IWK cuts waiting list by deleting names

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

1,100 child mental health patients affected

By Selena Ross

What does it take to get off a waiting list?

Of the 1,100 children removed since November from the IWK Health Centre’s waiting list for mental health services — an astonishing statistic the Halifax children’s hospital released widely on Monday — about half weren’t treated, and the hospital removed many of those without directly contacting them.

That’s because the IWK sent a letter to all families on the waiting list in September or October asking them to call back if they still wanted service.

Many didn’t call back. The list was instantly cut back by about half, the vice-president of patient care, Jocelyn Vine [pictured], said Thursday.

Since then, the hospital has screened hundreds of children for the first time, leaving 70 on the waiting list. But on Tuesday, Vine described that overall 94 per cent reduction as a "really very profound improvement in access to care" without explaining that hundreds of names had simply been deleted.

The hospital used the numbers this week to show its success under a reorganization that included the layoff of 22 youth-care workers.

Parents and mental health advocates challenged the math after reading about the hospital’s announcement this week.

"I had a feeling . . . I just wondered what had happened to that 1,030 people," said John Roswell of the Digby Clare Mental Health Volunteers Association.

"If they could see 1,100 people in three months, we could clean up the mental health waiting lists throughout the province in a big hurry."

Roswell said he called Vine on Wednesday to ask how the hospital came up with the numbers, and she explained the mass mail-out.

"I couldn’t believe what she said," he said. "I just thought it was a terrible misrepresentation of the facts.

"I understand their point about improving patient care and decreasing wait times. I mean, that’s all very applaudable, but I think we need to be upfront about it."

The mother of a 10-year-old Dartmouth boy who waited 14 months for a first appointment said she responded to several surveys the hospital mailed out during that time to reaffirm that the family still wanted care.

Last fall, the letter contained a deadline, said Carol Mack, whose son suffers from anxiety-related problems.

"It was something about how they were reorganizing their wait times . . . then you had to call this phone number, which is the Dartmouth clinic, I believe. (It said) if you are still requiring services, you have to call it by this certain date. Otherwise you’ll be removed from the wait list."

As Mack remembers it, she had about a month to call.

"But if they didn’t have the current phone number or address for someone, you were out of luck. Or, say, someone just missed it, you’d be totally kicked off the list."

Vine said Thursday that the hospital made extra efforts to get in touch with families who didn’t respond. Some also phoned to say they no longer needed care, she said.

Those who didn’t speak to the hospital were taken off the list, but they’re free to call and re-add their names any time they want, she said.

"Some chose to call in. Some didn’t," she said. "It’s totally up to them."

The numbers on the waiting list are not misleading, Vine said. Services were offered to all 1,100 families.

"We can only go by the data that we have. It’s a completely accurate number, based on the information that we had. We went back and re-engaged with people. . . . Based on their answer, we’re moving forward accordingly."

The hospital’s overall progress in the mental health unit is not in doubt, Vine said. Since November, the unit has sped up the rate at which it handles new patients and is seeing more children per week than previously.

She said she had no statistics showing that change.

Image credit

Also see:

Wait times too long for some (March 18th)

Mental health care more than hocus-pocus (March 17th)

IWK changes emphasize early intervention (March 15th)

Decision to dispense with 22 youth workers is disgraceful (March 15th)

22 layoffs in IWK mental health program (March 12th)

Mental health treatment for NS teenagers is in crisis! (June 10th, 2010)

World Mental Health Day - A Revolution, Simple

An article posted today by the UK edition of the Huffington Post:

By Professor Richard Gray [pictured]

"If I'd asked my customers what they wanted, they'd have said a faster horse." Henry Ford

To enable people with mental health problems to lead full and productive lives, we need a revolution in care and treatment.

Today is world mental health day. Looking at mental health practice right now it feels sadly devoid of the revolutionary, imaginative and creative thinking that we take for granted in so many other areas of our lives. In a very real sense the outcomes for patients with long term mental illnesses like schizophrenia are getting worse, not better.

This is a tragedy; mental illness is painful and distressing. It is hard to imagine the torment that someone with schizophrenia experiences when they hear voices telling them that they are evil and deserve to die. To understand the pain of these symptoms we have to recognise that this is their reality and it is absolutely terrifying. These are symptoms of an illness, an illness where there is dysfunction in the patient's brain.

Medicines are essential to alleviate the distress and torment of psychotic symptoms. Reducing the intensity of the delusion or pushing the voices into the background antipsychotic drugs rarely completely eliminate symptoms and are certainly no cure.

In many respects, the medicines we have now are little different to those like chlorpromazine, that we used in the 1950s. The new generation of antipsychotic drugs are more refined and cause fewer side effects, but fundamentally they work in the same way. Metaphorically drug researchers have bred slightly faster horses, there has been no great jump forward.

Where will new treatment advances come from?

There is a sense that investment, both intellectually and financially, in the development of new drug treatments has faded and shifted; in part because of the negative public perception drugs for mental illness have, and an increase in demand for talking treatments as an alternative to pills.

Sensational media stories of antidepressants making patients suicidal are ill informed but attention grabbing and have contributed to our negative image. Even among mental health professionals there is widespread "anti medication" sentiment. A senior and influential Clinical Psychologist suggested to me recently that pharmaceutical industry research was "little more than propaganda".

Do psychological (talking) treatments represent the paradigm shift from horse to car that we need? I want to argue that our current obsession with improving access to psychological treatments reflects society's Freudian belief that mental illness is located in the mind and not the brain and can be sorted out by talking.

Cognitive behavioural therapy (CBT) is probably the most popular talking treatment.

Researchers have demonstrated that when delivered by a skilled therapist, CBT is as effective as antidepressant medication in the treatment of depression. Against schizophrenia and bipolar disorder, CBT also seems to be effective for example in helping patients cope with voices. But, and it is an important but, CBT only works (in schizophrenia and bipolar disorder), if patients are already on medication.

CBT, like all talking treatments, are complex interventions that need to be provided by skilled therapists. The problem; there simply aren't enough to meet demand and there never will be. A major initiative to improve access to psychological therapies (IAPT) consumed £170 million of new money.

Three and a half thousand new therapists have been trained and over 600,000 patients have entered the programme. Impressive; but rather than receiving the 20 sessions of CBT necessary for the treatment to work patients on average get just 3. Unless patients get 20 sessions the therapy can't work; this is what the research tells us. So whilst CBT is effective it is not the mental health equivalent of the Henry Ford's Model-T [pictured] providing effective psychological treatment for everyone.

Mental health practice is littered with countless examples of effective but complex interventions that work in theory but not in practice. The reason that they don't work is that they are too complex. Perhaps rather than focusing on ever more complex intervention we should consider simple intervention that can be reliably provided to all patients with mental illness. In a time of austerity making sure that everything we do really counts makes a lot of sense.

Back to medication. Mental illnesses such as schizophrenia , bipolar disorder and quite often depression, are long term conditions that require patients to stick with their medication, often indefinitely.

Whilst we need new treatments we could get much more out of the medicines we already have. Virtually every patient with schizophrenia or bipolar disorder misses doses of medication; this increases the risk of relapse and the return of painful and distressing psychotic symptoms. In fact the single biggest cause of relapse is that patients stop taking medication. There are many simple things that we can do to enhance adherence to treatment. I passionately believe we should be more positive about promoting the benefits of medication to our patients and their families.

For many patients, those with schizophrenia and bipolar disorder particularly, medication is a foundation to effective treatment and we should do everything to make sure that they stick with treatment. This is perhaps one of the most important things we do as mental health professionals.

There are other things we can do to help patients manage their medication; help them make choices about which drug will suit them best; closely monitor the effects and side effects of medicines, offer long acting injections rather than daily pills, use mobile phone text prompts to remind patients to take pills, prescribing a tablet that can be taken once once rather than four times a day. Simple things that work and help patients stick with treatment.

Ever more complex treatments that can never be scaled up to meet the need within the population seems to me like flogging, if it's not extending a metaphor to far, dead horse.

Our customers (patients) want greater access to talking treatments. I am far from convinced that the investment in psychological therapies has reaped the rewards that were promised when the IAPT programme was launched.

We need new medications and this requires intellectual as well as financial investment. When Henry Ford launched the Model-T, when Apple launched the iPad, these were leaps of imagination.

I want to argue for a simple revolution; we stop doing the complex badly and focus of doing simple things exceptionally well. But my real plea on world mental health day is to stop listening quite so much and start imagining.

Now more than ever we need real invention in mental health care and treatment.

Image credit

Model-T image credit

Mental health early intervention projects offer 'outstanding value'

Please click on the image to magnify it.

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?

Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001—05: an epidemiological survey

The abstract of an article published in the June 13th, 2009, edition of The Lancet:

By Prof. Michael R. Phillips, MD; Prof. Jingxuan Zhang, MMed; Qichang Shi, BMed; Zhiqiang Song, BMed; Zhijie Ding, BMed; Shutao Pang, MMed; Xianyun Li, MMed; Yali Zhang, MD; and Zhiqing Wang, BMed

Background

In China and other middle-income countries, neuropsychiatric conditions are the most important cause of ill health in men and women, but efforts to scale up mental health services have been hampered by the absence of high-quality, country-specific data for the prevalence, treatment, and associated disability of different types of mental disorders. We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China.

Methods

We used multistage stratified random sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China; the sampling frame of 113 million individuals aged 18 years or older included 12% of the adult population in China. 63 004 individuals, identified with simple random selection methods at the sampling sites, were screened with an expanded version of the General Health Questionnaire and 16 577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist.

Findings

The adjusted 1-month prevalence of any mental disorder was 17·5% (95% CI 16·6—18·5). The prevalence of mood disorders was 6·1% (5·7—6·6), anxiety disorders was 5·6% (5·0—6·3), substance abuse disorders was 5·9% (5·3—6·5), and psychotic disorders was 1·0% (0·8—1·1). Mood disorders and anxiety disorders were more prevalent in women than in men, and in individuals 40 years and older than in those younger than 40 years. Alcohol use disorders were 48 times more prevalent in men than in women. Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents. Among individuals with a diagnosable mental illness, 24% were moderately or severely disabled by their illness, 8% had ever sought professional help, and 5% had ever seen a mental health professional.

Interpretation

Substantial differences between our results and prevalence, disability, and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed, country-specific situation analyses before they scale up mental health services.

Funding

China Medical Board of New York, WHO, and Shandong Provincial Bureau of Health.

Bold emphasis in the text of the abstract is mine.

Posting of this abstract on the weblog is for the purposes of research into the prevalence and treatment of mental disorders in China.

Also see:

Mental disorders in China underestimated

Margaret Clark Morgan Foundation grants $5 million to treatment center

An article published in the February 22nd edition of the Hudson Hub-Times:

The Northeastern Ohio Universities Colleges of Medicine [NEOUCOM] and Pharmacy announced Feb. 19 it received a $5 million grant from The Hudson-based Margaret Clark Morgan Foundation to establish The Best Practices in Schizophrenia Treatment Center at NEOUCOM.

"This important grant from The Margaret Clark Morgan Foundation will help identify best practices in schizophrenia treatment; this will fundamentally change the lives of people with schizophrenia in a very positive way," said Lois Margaret Nora, NEOUCOM president and dean, College of Medicine. "We are excited and proud to partner with The Margaret Clark Morgan Foundation in making this announcement. This initiative will further our mission of improving the health of Northeast Ohio."

The mission of The Best Practices in Schizophrenia Treatment (BeST) Center at NEOUCOM is to ensure that people with schizophrenia and related disorders maximize their ability to achieve recovery by receiving treatments shown to be best practices.

"The Margaret Clark Morgan Foundation seeks to raise the standards of prevention, treatment and recovery of mental illness in northeast Ohio," said Foundation President Rick Kellar. "We do this by investing in progressive organizations and innovative initiatives with the potential to transform mental health practices. Today, through the creation of the BeST Center at NEOUCOM, we are advancing our mission in a very significant and exciting way."

NEOUCOM is a community-based, public institution offering both a doctor of medicine and a doctor of pharmacy degree.

The Margaret Clark Morgan Foundation, with assets near $75 million, supports mental health endeavors and the arts in Northeast Ohio through grants.

Also see:

NEOUCOM gets $5M grant for schizophrenia center