Involuntary Psychiatric Treatment Act: July 3, 2007

The new Involuntary Psychiatric Treatment Act will be proclaimed in effect in Nova Scotia on July 3, 2007. The regulations that accompany this Act can be found here (downloads a PDF file; note: parts of some pages are missing).

International Caregiver Survey Results

From the Mood Disorders Society of Canada website:

Results from the first International Caregiver Survey provide significant insight into the experiences and concerns of families caring for individuals with mental illness.

Key among the findings were the harsh physical, emotional and financial consequences that occur within families when an individual’s treatment is disrupted.

The survey was developed by the World Federation of Mental Health and Eli Lilly and Company, and conducted by Ipsos-Insight and All Global Ltd. It included 200 Canadian families, as well as families in Australia, France, Germany, Italy Spain, the United Kingdom and the United States.

Keeping Care Complete: International caregiver survey

View PDF File

Psychiatrists Join Wait Time Alliance to Advocate for Benchmarks for Psychiatric Care

Ottawa, Ontario (April 19, 2007)

For immediate release – Today the Canadian Psychiatric Association (CPA) joined the expanded Wait Time Alliance to step up its advocacy for wait time benchmarks in psychiatry.

“Benchmarks establish what is adequate care and this makes it easier to hold the system accountable to patients and their families,” says Dr. Manon Charbonneau, President of the Canadian Psychiatric Association. “We want the federal government and health ministers to include serious psychiatric illnesses on their priority lists.”

More people die by suicide than from motor vehicle accidents. Most people who die by suicide have some history of psychiatric illness—and those who die by suicide are disproportionately young. We also know untreated depression is the greatest cause of disability in women of working age. “The tragedy is that too often such illnesses do not get treatment in time to prevent these horrible consequences,” says Dr. Charbonneau.

CPA published wait time benchmarks for patients with serious psychiatric illnesses last March. Timely access to psychiatric health services is critical for the 20 per cent of Canadians who will need mental health services in their lifetime.

The Wait Time Alliance of Canada (WTA) is a partnership of specialty associations and the Canadian Medical Association.

The Canadian Psychiatric Association (CPA) is the national voice for Canada’s 4,100 psychiatrists and more than 600 psychiatric residents. Founded in 1951, the CPA is dedicated to promoting an environment that fosters excellence in the provision of clinical care, education and research.

View the CPA policy paper on wait time benchmarks by clicking here.

Information: Hélène Côté, Canadian Psychiatric Association
Cell: (613) 797-5488

A Wake Up Call

By John David Welland

Earlier this month, American society imploded. In a cultural environment teeming with intense violence and in a country rife with lethal firearms available to just about anyone, another young man has lashed out at a society he believed had destroyed and rejected him. There was a wide range of reactions to this tragedy. Some are calling for stricter gun laws, others are pointing to violent computer games. There are many people who are calling for armed guards in their schools, and a policy of zero tolerance against young people with emotional problems.

The problems with the later approach are many. The main ones are the implications of punishing people or restricting their freedoms because of something that they might do. There is also the danger that, seizing on the fact that the individual was being treated for a mental illness, many people will come to believe a that all people with a mental illness are capable of such an act, when in fact that they are generally less prone to violence than ordinary individuals, if they are being properly treated.

The stigma attached to mental illness is only going to be reinforced by these events, especially in our schools, and make young people even more reluctant to get help if they have a problem, for fear of being seen as a psycho and a killer. This sort of attitude will only serve to make things worse by making other such tragedies even more likely.

This is no time for the mental health community to shrink from the task of educating the public about mental illness; rather it is a wake up call. People need to know the facts about mental illness now more than ever. This tragedy needs to be placed within a larger context, so that people do not respond to it in a way that will increase stigma. This is a wake up call.

The opinions expressed here are those of the author and do not necessarily represent those of the Schizophrenia Society of Nova Scotia.

For another opinion click here.

Orange Broadband Award for New Writers: Poppy Shakespeare shortlisted

From Bloomsbury.com:

'Poppy Shakespeare could never have been written had I not spent nigh on a third of my life as a patient in the psychiatric system...'

Author Clare Allan tells us about the unusual background which was the inspiration for her debut novel, Poppy Shakespeare. Read on for more...click here.

Thanks go to John Devlin for bringing this book to my attention.

Kings County Chapter: March 2007 Newsletter

To view the Newsletter, click here (downloads a PDF - please be patient, it is a rather large file at approximately 5 MB).

News Release – Schizophrenia Societies adopt joint mission statement

Schizophrenia Societies join forces on new mission statement to promote improved quality of life

The Schizophrenia Society of Canada and the Provincial Schizophrenia Societies across the country are proud to announce the launch of a new, joint mission statement that promotes improved quality of life for individuals and families affected by schizophrenia.

The new mission inspires the societies to improve the quality of life for those affected by schizophrenia and psychosis through education, support programs, public policy and research.

“This exciting new mission statement recognizes the significant changes in our understanding of and approaches to mental illness over the last 20 years,” said Chris Summerville, Interim Chief Executive Officer of the SSC.

“Today, the emphasis is rightly upon the possibility of recovery, not the mere reduction of suffering. Thus a shared mission statement more accurately reflects the purpose of the work of the schizophrenia societies across Canada,” Mr. Summerville said. “It represents our shared passion to advocate for mental health services that are recovery oriented and enhance quality of life, that advance the needs, rights and abilities of people living with and affected by schizophrenia and psychosis.”

The new statement expands beyond symptom reduction alone to promote the fact that there is hope for individuals and families to improve their quality of life. It integrates the importance of medical and psychiatric treatment to achieve maximum symptom relief and control with the myriad of other health, social and economic factors that can also add to a person’s quality of life, including but not limited to: community-based psychiatric rehabilitation with access to psychological support services; peer support; family education; safe and affordable housing; adequate income security; meaningful work; court diversion programs and mental health courts.

Quality of life and recovery are very individual, noted SSC President Michael Thomson. “The new mission statement incorporates that individuality and it promotes the idea of working towards a quality of life and recovery level that is possible and appropriate for each individual.”

The focus on the individuals and their quality of life is particularly meaningful for many impacted by the illness.

“I think the new mission statement is more proactive,” said 24-year-old Tammy Lambert of Winnipeg, Manitoba, who was diagnosed 10 years ago. “It doesn’t focus on symptoms alone; it focuses on the future and it gives people hope that they may be able to achieve a better quality of life.”

“As parents of a son who is living with schizophrenia, we welcome this new mission statement and its broader emphasis on the person rather than the illness,” said Dennis and Amy Butcher. “It conveys the hope and the opportunities that exist for many individuals – with the right supports and services – to return to a quality of life that is meaningful and fulfilling.”

The adoption of a shared mission also enhances the societies’ ability to speak with one united voice on behalf of those affected by the illness.

“As we promote the work of our societies, both individually and together, the shared mission statement enables us to promote the same message across the country and this will be a significant advantage in our ongoing efforts to educate, raise awareness and reduce the stigma and misperceptions that abound about schizophrenia,” said Mr. Summerville.

Schizophrenia is a serious biochemical brain disorder characterized by delusions, hallucinations, disturbances in thinking and emotional and social withdrawal. Statistics show that one person in
100, or about 300,000 Canadians, will experience an episode of schizophrenia in their lifetime.

The Schizophrenia Society of Canada and the 10 Schizophrenia Societies across the country work independently and together to improve the quality of life of those affected by the illness through education, public policy, support and research.

NIMH Perspective on Antipsychotic Reimbursement: Using Results from the CATIE Cost Effectiveness Study

A recent press release from the National Institute of Mental Health:

The recent publication (December 1, 2006, American Journal of Psychiatry) of the cost-effectiveness results from the National Institute of Mental Health (NIMH)-funded Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) has raised questions among advocates, families, and clinicians about reimbursement policies for antipsychotic medications.

Antipsychotics have now become the fourth largest group of medications prescribed in the United States, with a collective cost expected to surge past $10 billion this year. About 80 percent of the prescriptions for antipsychotics are paid via the public sector. The new atypical medications, representing 90 percent of the current market, are approximately 10 times the cost of the older conventional antipsychotics.

In a report in the September 22, 2005, New England Journal of Medicine, the CATIE research team compared discontinuation rates with four atypical antipsychotics (olanzapine, quetiapine, risperidone, ziprasidone) and one older conventional antipsychotic (perphenazine). The results demonstrated few differences overall among the various medications. The older medication, perphenazine, was as well tolerated as the newer compounds and as effective as three of the four newer drugs. The fourth compound, olanzapine, was slightly better than all the others in terms of discontinuation and hospitalization rates but was also associated with higher rates of weight gain and metabolic side effects.

The December 1, 2006 study analyzed the economic implications of the CATIE results and found that, because perphenazine was as effective overall and less expensive, the older antipsychotic medications such as perphenazine still have a valuable role in treating schizophrenia. The results should encourage doctors to reconsider the use of these older medications as another choice for patients with schizophrenia. This study should help expand the current list of medications most commonly used for schizophrenia, rather than restrict or reduce access to any of the antipsychotic medications. NIMH believes that this is important for the following reasons:

• Although the CATIE results suggest little difference in the overall effectiveness for the entire cohort, individual patients respond differently to different medications. To say the medications are equivalent is not to say they are identical. There is substantial variability in the response of individuals to these treatments. Future studies will focus on predicting individual patterns of response.
  


• There are additional outcomes to consider. Upcoming reports will describe the effectiveness of these various medications on quality of life and cognitive deficits. Cognitive impairment is a central clinical feature of schizophrenia and is strongly associated with functional outcomes.


• CATIE was limited to people with chronic schizophrenia who were moderately treatment-resistant. People with acute, first onset schizophrenia and those with other psychotic disorders were not included in this study. These patients may respond differently to antipsychotic medications.


• CATIE was an 18-month study. While this is longer than most clinical trials it is not long enough to fully consider whether patients would develop serious long-term side effects such as tardive dyskinesia, diabetes, or other medical conditions that can develop even years after starting medication.

Taking all these points into consideration, NIMH holds that families and physicians need more, not fewer, choices for addressing schizophrenia. A one-size-fits-all approach for treating schizophrenia could be harmful, essentially turning the clock back 40 years to an era when conventional antipsychotics were the only medications available for patients with this chronic, disabling disorder affecting 3.2 million Americans.

For additional SSNS Blog posts on the CATIE results, click 1, 2, and 3.

Advanced Family Work for Schizophrenia: An Evidence-Based Approach

by Julian Leff; London, Gaskell Publications, 2005, 160 pages, $29.46 softcover

Harriet P. Lefley, Ph.D., reviews this book in the April 2007 issue of Psychiatric Services.

Update on the Healthy Minds Initiative

From the March 2007 edition of the Healthy Minds Cooperative's The Blue Horse Chronicles:

By Amanda Crabtree

In this month’s column, I have two exciting and long awaited announcements. In May, the Abbie Lane Mental Health Outpatient Department will move some of its services to Bayers Road Centre (the former Bayers Road Shopping Centre) in Halifax. The result will be the opening of Community Mental Health Services, Bayers Road on Tuesday, May 8th, 2007. We have also just confirmed that Dartmouth Community Mental Health will relocate to Belmont House [pictured above] on Alderney Drive in Dartmouth. We do not yet have a move date.

Information about Community Mental Health Services, Bayers Road is being provided to clients of the Abbie Lane Mental Health Outpatient Department and their families, community organizations, family physicians and others. All clients who will need to go to Bayers Road Centre to receive services will be contacted. We have set up a phone line where people can leave messages with questions about the move. The phone number is 473-4847. Messages left at this number will be returned within two business days.

We are in the early planning stages of moving Dartmouth Community Mental Health to Belmont House. This is why a move date is not yet confirmed. Once the move date is confirmed, clients will be notified.

We are very excited about both of these moves because through mental health strategic planning, we heard that clients wanted services located in their communities as much as possible. This is a first but significant step toward building relationships with residents, leaders and service providers in those communities. It will be these relationships that give us the knowledge we need to tailor our services to meet the needs of clients and their communities.

For more information on the Initiative, please e-mail or call me: amanda.crabtree@cdha.nshealth.ca or 460-7401.

A Mentally Healthy Workforce—It’s Good for Business

From the Partnership for Workplace Mental Health, A Program of the American Psychiatric Foundation:

Most employers know that a mentally healthy workforce is linked to lower medical costs, as well as less absenteeism and presenteeism. And most employers know that a mentally unhealthy workforce is associated with increased loss of productivity. What employers may not know, however, is how to get from A to B: How does a company change a mentally unhealthy workplace — or a marginally healthy one — to a healthy workplace? Where does it start?

The Partnership provides some insight into that question with its just-released publication, A Mentally Healthy Workforce—It’s Good for Business. The document is unique because it weaves together stories from the workplace world with research findings to build a coherent picture of workplace mental health.

Click here to download a PDF version of A Mentally Healthy Workforce— It’s Good for Business.

Latest CATIE Analysis Shows Patient Response Suggests Pathway

As a continuation of two previous postings on this blog (1, 2), the latest issue of Psychiatric News has an article written by Jim Rosack on the latest "Clinical Antipsychotic Trials of Intervention Effectiveness" (CATIE) results.

SSNS Member Publishes Article

John Devlin writes in to the Schizophrenia Society of Nova Scotia:

A while ago I was asked by the editor of a Cambridge University publication - the NEWSLETTER - to do up a little blurb on my thoughts on King's College, Cambridge architecture. It appeared online yesterday in their April/May 2007 issue and is here [click the word here].

You scroll down to the very bottom to the last page and it is there [near the top left hand side of page 16]. This newsletter is not an alumni office publication but is an in-house magazine "for the staff of the University of Cambridge" as it says on the front cover.

I thought you might find it a bit interesting.

Indeed we do, John. Congratulations!

How common is psychosis?

According to a recent review article written by Peter Byrne (right), Early Intervention Team for Ealing, Southall, United Kingdom, and published in the British Medical Journal:

The one year prevalence of non-organic psychosis is 4.5 per 1000 community residents (Ref. 1). Most new cases arise in men under 30 and women under 35, but a second peak occurs in people over 60 years. Psychotic symptoms had a 10.1% prevalence in a non-demented community population over 85 years (Ref. 2). Schizophrenia has a one year prevalence of 3.3 per 1000 people, and a lifetime morbidity risk of 7.2 per 1000 people (Ref. w1). Independent of known associations with migration and ethnic origin, increased economic inequality in areas of high deprivation also predicts a higher incidence of schizophrenia (Ref. 3). Some people who become depressed (one in five of us over a lifetime) also develop hallucinations and delusions, related to and “congruent with” their low mood.

Bipolar affective disorder has a lifetime prevalence of 1.3-1.6% (Ref. 4), and it is characterised by episodes of psychosis during both high (“manic”) and low (depressive) relapses. The misuse of substances, notably cannabis (Ref. 5), raises the prevalence of psychotic symptoms further — substance misuse partly explains the 10 times higher prevalence of psychosis in prison populations (Ref. 1). Psychosis occurs frequently in all forms of dementia including Parkinson’s disease. Other causes of organic psychoses are neurological disorders (epilepsy, head injury, haemorrhage, infarction, infection, and tumours) and most causes of delirium.

Altogether, therefore, acute psychosis is one of the most common psychiatric emergencies. There are explanations of psychotic “symptoms” other than the biomedical model of this review; medicalising psychosis as “an illness like any other” increases both public pessimism about outcome and the stigma attached to people with psychosis (Ref. 6).

References:

1. Brugha T, Singleton N, Meltzer H, Bebbington P, Farrell M, Jenkins R, et al. Psychosis in the community and in prisons: a report from the British national survey of psychiatric morbidity. Am J Psychiatry 2005;162:774-80. (Download a free PDF of this paper by clicking here.)

2. Ostling S, Skoog I. Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old. Arch Gen Psychiatry 2002;59:53-9. (Abstract available by clicking here.)

3. Boydell J, van Os J, McKenzie K, Murray RM. The association of inequality with the incidence of schizophrenia: an ecological study. Soc Psychiatry Psychiatr Epidemiol 2004;39:597-9. (Abstract available by clicking here.)

4. Müeller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. Lancet 2002;359:241-7. (Abstract available by clicking here.)

5. Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, et al. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ 2005;330:11. (Abstract available by clicking here.)

6. Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the “mental illness is an illness like any other” approach. Acta Psychiatr Scand 2006;114:303-18. (Abstract available by clicking here.)

w1. Saha S, Chant D, Welham J and McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med 2005; 2(5): e141. (Download a free PDF of this paper by clicking here.)

Province backtracks over 'delusional' website

Tones down satire of Calgary ads after mental-health advocates object

To read the full article, published in the March 31st edition of the Halifax Daily News, click here.

Opening May 2007: Community Mental Health Services, Bayers Road

The Schizophrenia Society of Nova Scotia received the following letter, dated March 26, 2007, from Cheryl Billard, Program Manager, Community Supports, Capital District Mental Health Program:

"I am very pleased to advise you that in May, 2007, the Abbie Lane Mental Health Outpatient Department will move some of its services to Bayers Road Centre in Halifax. The new mental health clinic will open on Tuesday, May 8th.

"Opening Community Mental Health Services, Bayers Road is consistent with the Mental Health Program's commitment locate services, whenever possible, in the communities as way of improving access and client satisfaction. Moving more services to community-based locations will better enable us to build relationships with residents, leaders and service providers in those communities. It will be these relationships that give us the knowledge we need to tailor our services to meet the needs of clients and their communities.

"This is a starting point to fostering Community Resource Networks, networks of mental health and related services and supports which are defined by the needs of individual communities. The concept of Community Resource Networks stemmed from mental health strategic planning and the Health Minds Initiative.

"We appreciate the move to Bayers Road Centre may initially cause difficulties for some. Clients who will go to Community Mental Health Services, Bayers Road will be contacted and information on the location, parking and bus routes will be provided. I am hoping that you too will inform your members of the opening of Community Mental Health Services, Bayers Road whenever possible.

"We have provided a letter with the attached questions and answers to clients [please call the SSNS to receive a copy of the questions and answers]. We have also set up a phone line for clients and others to call with questions. The number is 473-4847. We will return messages within two days."

Relating with professionals

Below is the abstract of an article written by C. Clarke, SRN, SCM, MSSCH, MBCHA, Independent Lecturer and Carer, Sheffield, UK, and published in the October 2006 issue of Journal of Psychiatric and Mental Health Nursing:

This paper addresses my difficulties as a carer in engaging with many professionals in mental health, both locally associated with my son's acute inpatient care, and nationally where policies are being developed and their implementation is pursued. All of us are affected by The Department of Health (DoH) Mental Health policies and their implementation by professionals has formed the way in which professionals relate with my son and myself. The way in which my son is impacted inextricably affects the way I relate to professionals. I think my difficulty in engaging lies in the relationships we all have with each another. In focusing on the process within our relationships, I attempt to raise professionals' awareness of what constitutes a relationship when we dialogue. As it takes two to engage in a dialogue, I perceive my difficulty is also the difficulty of the professionals. Carers are becoming increasingly involved in the training of mental health professionals and our combined difficulty needs to be resolved, so that we all benefit. In order to achieve positive progression, there needs to be a radical change within our relationship to provide ease of engagement from all parties. In this paper I tentatively suggest how this process can be achieved.

If you are interested in receiving more information about this article, contact the Schizophrenia Society of Nova Scotia by sending an email to ssns@ns.sympatico.ca to call 1-800-265-2601 (toll-free in Nova Scotia).

Caregivers Nova Scotia Association and others respond to budget provisions for the caregivers of seniors

For Immediate Release

March 27, 2007

Halifax, N.S. - Caregivers Nova Scotia and its allied organizations applaud the government of Nova Scotia for its intent to establish a Department of Seniors, expand respite programs, implement a provincial adult day program, and launch a pilot program to help caregivers look after ailing seniors in their own homes.

Caregivers Nova Scotia and its allied organizations would like to emphasize, however, that the 1 in 3 adult Nova Scotians who are unpaid caregivers care for friends and family of all ages, not just seniors.

"Families of people with neuromuscular disorders are faced with many challenges,” said Ken Thompson, Executive Director, Atlantic Region, Muscular Dystrophy Canada. “Depending on the age of onset, they may face the prospect of providing attendant care to their loved ones for 30 years or more. Combine this with the need for highly customized medical and mobility equipment, and you will find many families in Nova Scotia and across the Atlantic Region, facing serious financial and emotional hardship."

“Many challenges also impact those Nova Scotians who provide support and care for a family member or friend affected by schizophrenia, termed youth’s greatest disabler,” said Stephen Ayer, Executive Director of the Schizophrenia Society of Nova Scotia. “Resources are required to provide these oftentimes forgotten caregivers with: (1) up-to-date information on schizophrenia and psychosis; (2) family education and peer support; (3) adequate and timely respite services; and (4) alternative housing options for their affected loved one. A mechanism is also needed to have the role of these caregivers recognized by the mental health system.”

“According to the Canadian Mental Health Association, over one million working Canadians take care of a person diagnosed with mental illness,” adds Ayer. “Because Nova Scotia accounts for 2.9% of Canada’s population, one could conclude that at least 29,000 working Nova Scotians – equivalent to the entire population of Yarmouth County – provide care to a person diagnosed with a mental illness.”

“Caregivers play an important role in enabling their loved ones to remain in their homes and communities,” said Sarah Cowan of the Multiple Sclerosis Society of Canada. “Multiple sclerosis is a disease of the brain and spinal cord which most often strikes between the ages of 15 and 40. Its effects last a lifetime, as does a caregiver’s duty. The MS Society recommends increasing the provision of services such as respite and attendant care to support those who care for family members with MS,” Cowan adds.

These allied organizations call upon the government of Nova Scotia to recognize the challenges faced by all family and friend caregivers in Nova Scotia and provide increased resources to help them.

Contacts:

Sharon E. Reashore, LL.B., EPC
Executive Director
Caregivers Nova Scotia Association
Ph: (902) 421-7390
Email: director@caregiversns.org

Ken Thompson
Executive Director, Atlantic Region
Muscular Dystrophy Canada
Ph: (902) 429-6322 ext 226
Email: ken.thompson@muscle.ca

Stephen W. Ayer, Ph.D.
Executive Director
Schizophrenia Society of Nova Scotia
Ph: (902) 465-2601
Email: ssns@ns.sympatico.ca

Sarah Cowan
Manager, Communications and Government Relations
Multiple Sclerosis Society of Canada, Atlantic Division
Ph: (902) 468-8230
Email: Sarah.Cowan@mssociety.ca

What it's like to have schizophrenia

Click here for a report from BBC News.

The latest two CATIE publications

By Carolyn Susman
Palm Beach Post Staff Writer
Wednesday, March 21, 2007

The American Journal of Psychiatry has published two studies representing the most recent findings of the "Clinical Antipsychotic Trials of Intervention Effectiveness" (CATIE) funded by the National Institute of Mental Health (NIMH) concerning the treatment of schizophrenia.

Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness (NAMI) issued the following on the studies:

"The latest findings provide two important guideposts for doctors and consumers. First, choices exist among medications for schizophrenia. One size does not fit all.

"Second, medication alone is not enough to overcome the illness. Medications reduce symptoms, but no difference exists between medications in moving beyond modest improvement to restoration of interpersonal and community living skills.

"Like earlier CATIE findings, the latest results show that older generation antipsychotic medications remain as effective as newer drugs.

"Choosing medications is a medical decision that must be made on an individual basis. Access to both older and newer generation medications must be preserved in Medicaid and managed care plans, to ensure maximum choice for maximum effectiveness.

"No matter what medication is prescribed, intensive rehabilitation and support services are essential to improve the functioning of people who live with schizophrenia. Those services include family education, permanent supported housing, vocational rehabilitation, and assertive community treatment (ACT) - which traditionally are neglected in our overall system of care.

"Individuals and families living with schizophrenia have known these facts for years. We know counseling and job services are underplayed and underpaid by insurance and public investments."

Austin Mardon honoured with the Order of Canada

From Western Catholic Reporter:

A person with a mental illness can still excel," maintains Austin Mardon. And he is living proof of it.

Since diagnosed with schizophrenia 15 years ago, the former Antarctic explorer with NASA has received three notable decorations, including the Queen's Golden Jubilee Medal in 2002.

On Feb. 20, Gov. Gen. Michaelle Jean announced another important distinction for Mardon when she said the 44-year-old man will be inducted into the Order of Canada in recognition of his tireless efforts to raise public awareness about schizophrenia.

A gift of hope

"I feel very humbled and honoured by this (recognition)," Mardon said March 15. "I see this as a gift to those 300,000 Canadians with schizophrenia. In a small way this may give them some hope."

Born in Edmonton in 1962, Mardon, a member of St. Alphonsus Parish, is the holder of several degrees, including a master of education from Texas A&M University and a doctorate in geography from Greenwich University, Australia, in 2000. He is the author of more than 40 books and 130 scholarly publications. His works have dealt with such diverse areas as astronomy, Alberta history and Antarctic research. He explored the Antarctica as part of the United States NASA/NSF-sponsored Antarctic Meteorite Recovery Expedition in 1986, investigating meteorite impacts.

Mardon was diagnosed with schizophrenia in 1992, at the age of 30. Since then, in addition to continuing his academic work, he has worked tirelessly to help other Albertans with schizophrenia and mental illness. In 1993 he co-founded Prosper
Place Clubhouse for people with mental illness.

He has also served on the board of directors of Unsung Heroes, an Edmonton self-support group for people with schizophrenia, and on both the Edmonton and Alberta chapters of the Schizophrenia Society of Alberta.

A member of the Premier's Council on the Status of Persons with Disabilities for many years, Mardon is currently chair of Champions Centre, a Christian interdenominational society dedicated to providing permanent housing for homeless people with mental disabilities. "I always feel I'm not doing enough, but I have to limit myself," said Mardon, who will be invested into the order in October.

Appointing Mardon to the Order of Canada "is very appropriate because he has distinguished himself in the academic field and now as a person who cares and who is reaching out to help others," said John MacDonald, an archdiocesan official who serves with Mardon on the board of Champions Centre.

A valiant man

"He has responded to schizophrenia very courageously and is doing everything he can to work for people with disabilities. He is a man who has refused to be curtailed by major obstacles like schizophrenia, which could be incredibly debilitating."

Michael Kirby named to head new Canadian Mental Health Commission

Provided by: Canadian Press
Written by: ANNE-MARIE TOBIN
Mar. 19, 2007

TORONTO (CP) - Finance Minister Jim Flaherty called for "respect and dignity" for people with mental illness as he announced in the budget Monday the establishment of a Canadian Mental Health Commission.

"Health care goes beyond physical well-being," he said as he addressed the House of Commons in Ottawa.

"We must reach out in practical and compassionate ways to those struggling with mental illness."

The new commission will be led by retired senator Michael Kirby, who is chairman of the Global Business and Economic Roundtable on Addiction and Mental Health.

Bill Wilkerson, CEO and co-founder of the roundtable, said there will be $10 million in funding now, and $17 million a year for the duration of the commission's existence - a minimum of 10 years.

The commission will have its headquarters in Calgary, he said.

"This will be the first time in Canadian history that there has been a high level, a strongly-led national body supported by government but arm's length from it to be the catalyst for the advancement of research, improvements in clinical care, prevention of (mental) illness, and in fact the prevention of disability," Wilkerson said in Toronto.

Kirby will provide leadership in the area of reducing chronic job stress as well as bring together the scientific and business communities that need to be part of the solution, said Wilkerson.

"The commission is not intended to be a large bureaucratic enterprise," he said.

"It will function as a catalyst and as a unifier to make sure that all those parties in the mental health field come together around prevention, recovery and education."

There are five priority areas as the commission revs up, including mental health in the workplace, aboriginal and children's mental health, the creation of a Knowledge Exchange Centre and stigma reduction.

The home care organization VON Canada applauded the government for recognizing the importance of individuals suffering from mental health issues.

"Treatments, supports and services vary greatly from region to region so it is vital that a Mental Health Commission be put in place to address the current disparate system and develop a national approach to mental health issues," VON Canada president and CEO Judith Shamian said in a statement.

Wilkerson said the economic costs of mental illness exceed $35 billion a year in terms of lost industrial production alone.

Thirty-seven per cent of Canadians experience a mental illness in the course of their lifetime, he added.

The most vulnerable are those in their teens and early to mid-20s.

"Depression today is the fastest growing source of disability in the Canadian labour force, representing 75 per cent of long-term disability and about 40 per cent of short-term disability," he said.

While VON Canada congratulated the government for the mental health funding, it called for more money to be allocated to home and community care support services.

Source: Canada.com and CBC.ca

Loss of antipsychotic efficacy is linked to an increase in D2 receptor number and sensitivity

In a paper published in the March 14th edition of The Journal of Neuroscience, Samaha et al. describe results that "are the first to demonstrate that 'breakthrough' supersensitivity during ongoing antipsychotic treatment undermines treatment efficacy."

Pictured on the right is the molecular structure of dopamine, the endogenous ligand of the D2 receptor.

Probing the Biology of Psychosis, Schizophrenia, and Antipsychotics

From Medscape Today, November 15, 2006:

An Expert Interview With Dr. Philip Seeman, MD, PhD

Philip Seeman, MD, PhD, made the breakthrough discovery of the D2 receptor, a target for all antipsychotics. In this interview with Medscape's Jessica Gould, Dr. Seeman, Professor Emeritus, University of Toronto, explains the significance of this finding and three other advances he and his colleagues made that have contributed to our knowledge of dopamine.

Diagram courtesy of CNSforum by The Lundbeck Institute

Information Technology Corner

By Stephen Ayer, Executive Director

Modern computer technology, which includes the Internet (also known as the World Wide Web), has greatly expanded the Schizophrenia Society of Nova Scotia’s ability to provide announcements and information in a timely and very cost-effective manner. The limitations to the use of computer technology include that fact that not all individuals who are interested in receiving this information have access to the Internet, and some people, if they do have access, are unfamiliar with how to use email and Web browsers.

A recent (snail mail) letter to all members of the Schizophrenia Society of Nova Scotia (SSNS) requested that a return message be sent to the provincial office, by email, so that all members could be added to an email communication list. The response to this request was very low indicating that many SSNS members were not interested in receiving SSNS-related information by email. Nevertheless, an email communication list has been created and regular information updates are now provided to SSNS members on this list.

As a second option, the SSNS created this blog for the posting of information and announcements of interest to members. A blog is defined by Merriam-Webster's Online Dictionary as “a Web site that contains an online personal journal with reflections, comments, and often hyperlinks provided by the writer.” The word blog is derived from the words Web log, or Weblog.

The purpose of the SSNS’s blog is to provide timely information and announcements of interest to members of the SSNS in a manner which is easy to use and visually appealing. This blog is also interactive; you can comment by clicking on the "comments" hyperlink below each posting.

In the next issue of Information Technology Corner, I will discuss RSS feeds, a nice way to view your favourite blogs using Internet Explorer 7.

The SSNS's Online Library Catalogue

The SSNS has almost completed placing its entire library catalogue online. To browse the catalogue, click here.

If you are interested in borrowing a book, send an email to ssns@ns.sympatico.ca or call 1-800-465-2601 (toll-free anywhere in Nova Scotia).

We thank Caregivers Nova Scotia for bringing LibraryThing to our attention.

(Note: The SSNS library is not exactly as illustrated :)

Mental-health services shortchanging children of our soldiers

A March 8th opinion piece in The Globe and Mail that includes another call for creation of the Canadian Mental Health Commission.

Necessary Force

A short story by Jon David Welland, Copyright 2007

The rusty old Pontiac made grinding sounds whenever his mother changed gears. The shock absorbers were so ancient that ever bump on the pavement jarred the two occupants like they were on a fun-house ride. This particular ride, however, was no fun at all.

Her passenger was her son, a man in his late twenties. His hands and hair had gone unwashed for weeks. His stained, smelly trousers had a tear running all the way up his right leg. His eyes were swollen and bloodshot from many nights without sleep. He was wearing only one shoe and had mismatched socks.


He had stopped taking his medication, like he had many times before. His condition had improved in the past few months, so he had decided he didn’t need them anymore. His mother had witnessed her son walking in this endless circle for many, many years. Every time, she would spend sleepless nights worrying that he might become suicidal, or worse. The first sign of trouble was the ranting and raving.

“Think about it, what if the pills don’t correct any imbalance? What if they are nothing but an addictive substance? That way they can control us by controlling the supply. I’m not going to be a patsy again; I’m going cold turkey. Even now, the voices are coming back. As soon as I can hear them clearly they will tell me what do. The voices are my spirit guides, they keep me in touch with God. No shrink is going to stop this now; I’m going all the way.”

Spittle flew as he spoke. It was late in the afternoon and he had been talking like this for hours. It had already become background noise to his mother, who was parking the car in the lot of a local mall. This was her shopping day, and he had insisted on coming along for the ride.

Neither of them noticed a young man approaching them as they stepped out of the car. He was at tall black teenager with a hood concealing most of his face and the standard baggy pants of a gangster rapper. The assailant grabbed his mother by the hair and held a gun to her head.

Her son acted instinctively, with the insane strength of someone who’s mother was in danger. He reached up and twisted the gun out of his hand, and then, using an arm lock for leverage, slammed him into the car. He then repeatedly slammed the door against his head until he went limp and collapsed on the asphalt. A pool of blood quickly collected around his head.

Our society has always had a double standard regarding aggression. They tell us that some things are worth fighting for, that we should stand up for ourselves and that we shouldn’t take crap from anyone. They encourage us to fight, but God help us if we do. The kind of violence seen now on TV and in video games has gradually become more intense and dangerous. Any fight that occurs that way in real life inevitably ends with one of the combatants in prison and the other in a body bag.

Even if someone is only defending himself, there are always questions to answer, and criminal charges can be laid if he used any more than necessary force. This was what he faced now; a formal hearing to determine if he needed to kill his mother’s attacker.

It was determined early in the proceedings that his presence was very disruptive to the hearing, so he was led into a waiting area until such a time he would be called upon to testify. He was taking his medication again, and was mortified by the memory of his recent behaviour. He appeared to be a changed man. He was clean and well groomed. He wore black clothes out of respect for the deceased.

There were many people milling around, most of them were complete strangers. He could catch snippets of conversions: “ …it was racially motivated…” “ …a danger to himself or others…” None of it sounded good.

Meanwhile, in the courtroom, the family of the teenager were having histrionics over his death. Some of this talk was making its way into the waiting area, making him very uneasy. Then, a young woman in a batik dress and wearing beads entered the room with a guitar and began to play a folksy version of “Ebony and Ivory”. Then someone forced his way into the room with a video camera and stuck it in his face. “How long have you been insane?” the investigative journalist asked before being dragged out by one of the guards.

Finally, he was called to the stand. When he was led into the packed courtroom loud insults and threats erupted while the judge pounded his gravel and demanded order. As he took the stand, he searched the crowd for his mother, and saw instead a middle aged black woman weeping on her husband’s shoulder, who was eying him with daggers.

After he was sworn in, the DA, a lean hungry man in a blue suit and a red tie began his attack. “In the statement you made to the police, you claim that Mr. Williams was carrying a gun, and that he threatened your mother.” He nodded. “Then, how do you explain the fact that there was no gun recovered at the scene?” His eyes grew wide and he squirmed in his seat. “ It’s the conspiracy” he began. “They’ve been after me for years.”

The DA then picked up a stack of paper from the table and handed it to him. “Do you know what this is?” He looked down at it. “Yes. It’s a story I wrote called Necessary Force.” “Can you read the highlighted section to the court?”

He started reading paragraphs five and six from the manuscript. “ Neither of them noticed a young man approaching them as they stepped out of the car. He was at tall black teenager with a hood concealing most of his face and the standard baggy pants of a gangster rapper. The assailant grabbed his mother by the hair and held a gun to her head.”

“Her son acted instinctively, with the insane strength of someone who’s mother is in danger. He reached up a twisted the gun out of his hand, and then using an arm lock for leverage, slammed him into the car. He then repeatedly slammed the door against his head until he went limp and collapsed on the asphalt. A pool of blood quickly collected around his head.”

“How can you explain how the attack you described to the officers who arrived at the scene is exactly the same as a story you wrote two weeks ago?”

“I get these flashes” he replied. “I saw this in a dream and wrote it down.”

“Did you find it significant that the assailant in the dream was African-American?”

He shrugged. “I didn’t think it mattered, I just wrote down what I dreamt.”

‘Yes, but you didn’t dream that no gun was found at the scene, and that your mother has testified that she never saw a gun.”

Things only got worse for him after that. His legal aid defence cited diminished capacity, so the judge sent him to the State Hospital for evaluation and care. Everyone went home and the media circus that had gathered for the hearing scattered back into the woodwork. Everything seemed to be over, except for one man who still had his doubts.

He was the police detective who was first at the scene and took the statement. He and his partner visited the home of Mrs. Carmichael, the young man’s mother. When she answered the door, they were invited into her modest bungalow where she had lived for many years alone. The detective said that had more questions that needed answering, which left her perplexed

“I don’t understand officer,” she asked over a cup of tea. “I thought the case was closed.”

“I thought so too, but then I decided to read the rest of your son’s manuscript, something nobody else bothered to do. Tell me, do you know how it ends?”

‘No, I found the first page more than enough. It was too disturbing to read, even before the attack.”

He leaned forward and looked her directly in the eye. “Mrs. Carmichael, where is the gun? In the story, it turns out that you took and hid the gun before we arrived at the scene.”

She set her teacup down and stood up, looking out of her picture window. The late afternoon sun shone on a face that looked desperately tired. “My son is ill, Detective. He has been that way since he was teenager. He hears voices, he thinks the government is after him, he behaves like a lunatic in public. It was bad, even before my husband’s death, and now it is simply impossible to care for him.”

“He needed to be hospitalized, but the institution just turns him away, they say he isn’t dangerous, so they can’t commit him against his will. Now he is in hospital, and getting the care he needs. That is all I have to say. Will that be all, officer?”

He pondered what she said for a moment. She hadn’t admitted to anything, and she couldn’t be charged with obstruction based solely on a prophetic short story. In a way, he couldn’t blame her for what she did. He had seen many mentally ill people in his line of work and felt powerless to help them.

“All right. I guess we are finished here.” He and his partner rose.

“One more thing,” she asked at the door, “How does the story end?”

“It ends like this ma’am, goodbye.”



Jon David Welland (above, left) is editor of Information Matters, the SSNS's quarterly newsletter. More of Jon's work can be found at Electric Fire and mediawatch. To the right of Jon is Randy (Patrick Roach) of Trailer Park Boys.

How You Can Help: A Toolkit for Families

You may benefit from reading this toolkit if:

• You are seeing your family member engage in behaviours that you instinctively know are not quite right
• You’ve noticed that quirks or behaviours haven’t improved despite your child getting older
• Your adolescent or teenager is showing unusual behaviours that are interfering with their school, social life or relationship with the rest of the family
• Your family member (child, youth, or adult) has been recently diagnosed with a mental or substance use disorder
• Your family member is struggling with their mental health problem and you would like to know how you can help them to have a better quality of life
• You are seeking general information about how you can support a family member who has an ongoing mental illness

Traps into which psychiatrists can fall

Click here for a list of behaviors or actions that increase a psychiatrist's risk of a malpractice lawsuit or a board complaint.

Graph courtesy of Psychiatric News.

Antipsychotic Adherence Data Counter Common Belief

In the March 2nd edition of Psychiatric News, Aaron Levin writes:

Psychiatric patients are reputed to be less adherent than others to medication regimens, but a new study may upend that assumption.

A study of 1,686 veterans revealed that the extent of adherence to antipsychotic medication regimens was significantly better than to hypoglycemic and antihypertensive medications, but shorter prescription refill intervals were found to be more closely correlated with nonadherence than were types of medication.

"With adjustment, we found that people with schizophrenia are not any worse about sticking to their medications than people without schizophrenia," lead study author John Piette, Ph.D., an epidemiologist and an associate professor of internal medicine at the University of Michigan, told Psychiatric News. The study appeared in the February Psychiatric Services.

For the full article, click here.

Remembering Genine Holznagel-Leary

A sad turn of events as reported by The Trouble With Spikol.

More information can be found by clicking here.

A quote from the Fairbanks Daily News - Miner:

“People who are mentally ill, who are trying to avoid the unjust stigma on mentally ill people, it’s an awful setback,” he [Billings] said.

Photo courtesy of André Karwath.

February 2007 Update on the Healthy Minds Initiative

From the February 2007 edition of the Healthy Minds Cooperative's The Blue Horse Chronicles:

By Amanda Crabtree, Project Manager

One of the main aims of the Healthy Minds Initiative is to increase access to appropriate supports and services. This includes everything from mental health information to mental health care to housing. I would like to highlight some examples of what we’re doing now to improve access. These will give you a sense of some of the new things we would like to start and changes we would like to make over the next weeks and months to improve access.

Last year, the [Capital District] Mental Health Program started a supported housing project through Connections Clubhouse. This project has now helped five clients to move from hospital to the community and ten others are expected to move to the community soon.

The Two Hundred Fifty Homes Committee, whose members aim to increase housing options for people living with mental illness or mental health issues, will be reaching out to more community organizations and agencies over the next month [contact has already been made with the Schizophrenia Society of Nova Scotia]. They are interested in working with these groups to develop a plan to improve access to safe and affordable housing.

Community Mental Health is working with the IWK Health Centre, the Healthy Minds Cooperative, Halifax Public Libraries and other community organizations [including the Schizophrenia Society of Nova Scotia] to provide mental health workshops in March and April. The workshops are free and open to everyone (for a schedule, click here). Registration is not required.

For more information on the Healthy Minds Initiative, please e-mail or call me: amanda.crabtree@cdha.nshealth.ca
or 460-7401.

Schizophrenia and Co-Occurring Substance Use Disorder

The American Journal of Psychiatry's Treatment in Psychiatry section begins with a hypothetical case illustrating a problem in current clinical practice. The authors review current data on prevalence, diagnosis, pathophysiology, and treatment. The article concludes with the authors' treatment recommendations for cases like the one presented.

From the March 2007 issue:

A 29-year-old Caucasian man was brought to the emergency department by the police after he was found wandering barefoot through the snow on Main Street. The police had been called after passers-by reported that the man seemed intoxicated and was acting strangely.

When an officer approached the man, he became belligerent and agitated and angrily exclaimed that they had no reason to question him.

Using some force, the police brought him to the emergency department. The psychiatrist who interviewed him noted a strong smell of alcohol and signs of psychosis; the man demonstrated a clear thought disorder, and he appeared to be responding to internal voices. A physical examination was unremarkable. His urine was positive for cannabis by dipstick test, and an alcohol breath test was positive.

Given the absence of further information about him, the patient was admitted to the crisis service, where he promptly fell asleep. Four hours later, he was less intoxicated. A history was obtained and a mental status examination was performed. As far as could be determined, he had been receiving treatment at a local mental health center, but he had stopped taking his medication (risperidone) 4 weeks earlier and had relapsed to heavy use of alcohol and cannabis. During this period he had been essentially homeless, a situation that presented increasing difficulty for him given the recent cold weather and snow.

The article by Green et al. continues by posing the following questions:

1. How commonly does schizophrenia co-occur with substance use disorder?


2. What are the implications of substance use for the course of the psychosis?


3. What do we understand about the basis of the co-occurrence of substance use disorder and schizophrenia?


4. How best can a psychiatrist work with this type of a patient?


5. What medications are most likely to be helpful?

If you are interested in receiving a copy of this complete article, contact the Schizophrenia Society of Nova Scotia by sending an email to ssns@ns.sympatico.ca.

An excellent audio summary of the schizophrenia-related articles in the March 2007 edition of The American Journal of Psychiatry can be found be clicking here (note, the audio takes a few minutes to download).

Health Canada: Information Update

Reports of adverse reactions in patients with serious mental health conditions suspected in association with use of prescription medications and EMPowerPlus

OTTAWA - Health Canada is updating Canadians about adverse reaction reports it has received concerning the use of EMPowerplus, a vitamin mineral supplement, for serious medical conditions.

Health Canada has received nine case reports of serious adverse reactions associated with the use of EMPowerplus. Most of the adverse reactions relate to worsening of psychiatric symptoms in those patients with serious underlying mental health problems, such as bipolar disorder and depression. The worsening of these symptoms could be related to taking the product and discontinuing prescription medications or taking the product in conjunction with prescribed medications. As a result, Health Canada is advising consumers with these serious conditions that there is a potential risk to health associated with the use of the product EMPowerplus.

Health Canada is concerned about the health risk posed by this product’s promotion, including unauthorized health claims, and medical advice being provided by non-medically qualified staff of Truehope Nutritional Support Ltd. to patients with serious medical conditions to discontinue their prescribed medications. This may result in serious adverse health consequences.

It is important to discuss the treatment of serious medical conditions with a medically qualified practitioner.

A Health Canada public advisory and an information bulletin were previously issued in 2003, concerning the use of EMPowerplus for the treatment of serious medical conditions. With the receipt of the adverse reactions, Health Canada remains concerned about the health risks associated with the use of this product.

Consumers requiring more information about this Health Canada Information Update can contact Health Canada's public enquiries line at (613) 957-2991, or toll free at 1-866-225-0709.

To report a suspected adverse reaction with this or any other health product, please contact the Canadian Adverse Drug Reaction Monitoring Program (CADRMP) of Health Canada by one of the following methods:

Telephone: 1-866-234-2345
Facsimile: 1-866-678-6789

CADRMP
Marketed Health Products Directorate
Tunney's Pasture, AL 0701C
email: cadrmp@hc-sc.gc.ca