Mental Disorders Cost Society Billions in Unearned Income

Press Release from the U.S. National Institutes of Health - May 7, 2008:

Major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institutes of Health’s National Institute of Mental Health (NIMH). The study was published online ahead of print May 7, 2008, in the American Journal of Psychiatry.

“Lost earning potential, costs associated with treating coexisting conditions, Social Security payments, homelessness and incarceration are just some of the indirect costs associated with mental illnesses that have been difficult to quantify,” said NIMH Director Thomas R. Insel, M.D. “This study shows us that just one source of these indirect costs is staggeringly high.”

Direct costs associated with mental disorders like medication, clinic visits, and hospitalization are relatively easy to quantify, but they reveal only a small portion of the economic burden these illnesses place on society. Indirect costs like lost earnings likely account for enormous expenses, but they are very difficult to define and estimate.

In the new study, Ronald C. Kessler, Ph.D., of Harvard University, and colleagues analyzed data from the 2002 National Comorbidity Survey Replication (NCS-R) , a nationally representative study of Americans age 18 to 64.

Using data from 4,982 respondents, the researchers calculated the amount of earnings lost in the year prior to the survey among people with serious mental illness (SMI). SMI is a broad category of illnesses that includes mood and anxiety disorders that have seriously impaired a person’s ability to function for at least 30 days in the year prior to the survey. It also includes cases of any mental disorder associated with life-threatening suicidal behaviors or repeated acts of violence.

Eighty-six percent of respondents reported earning income in the previous year. But those with SMI reported earning significantly less—around $22,545—than respondents without SMI, who averaged $38,852. Although men with SMI took a greater hit in earnings than women with SMI, men still earned more overall than women with and without SMI.

By extrapolating these results to the general population, the researchers calculated that SMI costs society $193.2 billion annually in lost earnings. The researchers attributed about 75 percent of this total to the reduced income that people with SMI likely earn, while 25 percent is attributed to the increased likelihood that people with SMI would have no earnings.

“The results of this study confirm the belief that mental disorders contribute to enormous losses of human productivity,” said Kessler. “Yet this estimate is probably conservative because the NCS-R did not assess people in hospitals or prisons, and included very few participants with autism, schizophrenia or other chronic illnesses that are known to greatly affect a person’s ability to work. The actual costs are probably higher than what we have estimated.”

The researchers concluded by recommending that future studies on the effectiveness of treatments should consider measuring employment status and earnings over the long term to document the effects of mental disorders on a person’s functioning and ability to remain productive.

Reference

Kessler, RC, Heeringa S, Lakoma MD, Petukhova M, Rupp AE, Schoenbaum M, Wang PS, Zaslavsky AM. The individual-level and societal-level effects of mental disorders on earnings in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, published online ahead of print May 7, 2008.

###

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

Lunenburg County Chapter of the SSNS: Featured Artist

Click on the images to enlarge them.

If you are interested in purchasing any of Richard Balsers' paintings, contact Janice House at (902) 527-1692 or by sending an email to janice.house@xplornet.com; or call Carolyn Eisner at (902) 543-5418. All paintings are priced at $300 each.

Report highlights impact of future brain drugs on society

From the University of Cambridge:

22 May 2008

A report by the Academy of Medical Sciences which was led by Sir Gabriel Horn FRS FRCP, Emeritus Professor of Zoology at the University states that an increasing number and variety of psychoactive drugs - drugs that act on the brain - will emerge over the next few decades.

Some drugs could bring new treatments for addiction and mental ill health, but others could also increase the burden of drug misuse.

To read the entire article, click here.

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

Overcoming the stigma

Group makes DVD about how mentally ill are treated

From the May 15th edition of The Chronicle Herald:

By Cathy von Kintzl (Truro Bureau)

TRURO — Joe was 15 and in high school when he was diagnosed with bipolar disorder.

"There’s a stigma in high school without mental illness," the young man says on a recently released educational DVD entitled Labelled: Mentally ill.

"It’s a hard place for a lot of kids. Throwing a severe bout of mania into that. . . . There was a lot of judgment from students and teachers. People thought I was on drugs or wanted attention. It was really difficult."

Experiences like Joe’s are reiterated time and again during the 30-minute documentary-style film created by five Colchester County residents who have experienced mental illness either personally, or through family or friends.

"Someone I knew approached me about four years ago with an idea for a video that addresses the stigma about mental illness," co-creator Geoff Alcock of Salmon River said in an interview Wednesday.

"People fear that if someone knows they have a mental illness, they’ll be discriminated against."

And sometimes they are discriminated against at work, in school, in social settings and beyond, he said.

Those situations drove the project team into action.

Mr. Alcock, Jane Bermingham of Truro, Christina Myhre of Central North River and Audrey Bailey and Belinda Meers of Bible Hill held their first meeting in 2005 and applied for funding from the provincial Health Department.

The team got $36,500 and spent three years and countless volunteer hours making the DVD with a professional production company, Densmore’s Video Presentations.

The result is a collection of testimonials from people, like Joe, who are living with mental illness and the health professionals who work with them.

For example, there is Ken, who was diagnosed with schizophrenia at 31.

"You don’t want to be mentally ill," he said on the DVD. "It’s a disability that we’ve got. It’s not our fault."

Ken blames the media for some public misconceptions he encounters, such as that mentally ill people are dangerous.

"People are unfortunately being educated by the TV and it doesn’t give a realistic portrayal."

Ms. Bermingham said during the same interview with Mr. Alcock that she’d like to see the DVD, which is available free of charge to organizations, in every school and library and in the hands of church, service and community groups so that people of all ages can see it.

"I think family and friends of people diagnosed with mental illness sometimes don’t know how to handle it, what to do," she said.

The group hopes the DVD will help, and members say it isn’t really about educating people about mental illnesses as much as better identifying and overcoming stigmas associated with them.

"I think we’ve come a long way, but we still have a way to go," Ms. Bailey said.

For information, Ms. Bermingham can be reached at 895-8947 and Ms. Bailey at 893-7636.

Audrey Bailey holds a copy of the DVD Labelled: Mentally ill. Other members of the project team are Geoff Alcock, Jane Bermingham and Christina Myhre. (Photograph by Cathy von Kintzel / Truro Bureau)

Canada Spends Less to Treat Mental Illness Than Most Developed Countries: Funding Uneven Across Provinces

Canadian Journal of Psychiatry - MEDIA ADVISORY - May 2008:

Canada lags behind most developed countries when it comes to mental health spending, an article in the May issue of The Canadian Journal of Psychiatry found. Dr. Philip Jacobs and authors’ research shows that only 4.8% of total health care spending in Canada (or $197 annually per Canadian) goes to mental health, which is slightly below the 5% that the European Health Economics Network considers to be the minimum acceptable amount. Canada is at the bottom of the barrel along with Italy—almost 2.5% behind the United States. At 12.1%, the United Kingdom spends the largest proportion of its health budget on mental health, although that includes social services costs.

The research also shows significant differences in mental health spending between the provinces. These ranged from an average annual low of $146 per person in Saskatchewan (3.5% of total spending) to a high of $258 in British Columbia (6.4%). The other provinces were: Newfoundland and Labrador, $200 (4.8%); PEI, $231 (5.8%); Nova Scotia, $203 (4.9%); New Brunswick, $242 (6.0%); Quebec, $166 (4.5%); Ontario, $185 (4.3%); Manitoba, $219 (4.9%); and Alberta, $242 (5.6%).

The research also highlights the important need for clear reporting of a consistent set of public and private mental health care expenditures across the provinces, as well as Western countries, so that meaningful comparisons can be made.

Further information:

Expenditures on Mental Health and Addictions for Canadian Provinces in 2003/04 (PDF)

From the street to Hollywood

Unlikely meeting between columnist, homeless musician results in movie

To read this entire article, written by Belinda Goldsmith and published in the May 13th edition of The Windsor Star, click here.

Also see:

Los Angeles Schizophrenia Story - Juilliard Musician Becomes Homeless

Downloading PDF's from this weblog

Opera has changed the way PDF files are downloaded from their website. All of the PDF files on this weblog were uploaded to Opera (a free service) for downloading by users of this weblog. You will now see the following page when you click to download a PDF file from this weblog:

Click on the image to enlarge it.

Simply click on the "Download file" button to download the PDF file.

I have noticed, however, that in some cases attempting to download a PDF file from this weblog now gives an error message in Adobe Reader. I will try to get an answer from Opera as to why this is happening. I will attempt to resolve this situation as soon as possible. Sorry for the inconvenience.

All PDF files on this weblog are readily accessible if you are using Opera as your web browser.

UPDATE - There is a solution:

To set Adobe Reader as the default program for a PDF download link when clicked in any web browser, follow these instructions:

1. Run your installed Adobe Reader program by clicking on its icon.
2. Click on Edit in the menu bar.
3. Then click on Preferences in the drop-down menu list.
4. Click on the Internet category on the left pane.
5. Uncheck / untick the check box for Display PDF in Browser (see image below).
6. Click OK when done.
7. Restart your computer.
   

The next time you download a PDF file, it will automatically open in Adobe Reader instead of Internet Explorer, Firefox, Opera, Safari or any other web browser.

Click on the above image to enlarge it.

If you need help, call the SSNS office at 465-2601 or toll-free in Nova Scotia at 1-800-465-2601.

Thanks go to My Digital Life for providing this solution.

Psychiatrist Daniel Fisher Talks About Hope and Recovery

Click on an arrow to start the video.

To visit the National Empowerment Center website, click here.

‘Mad Pride’ Fights a Stigma

To read this article in today's issue of The New Your Times, click here.




Photograph of Liz Spikol by Shea Roggio for The New York Times.

Jane Pauley to accept award

From the National Alliance on Mental Illness (NAMI):

TV Journalist Jane Pauley (pictured) will be honored at NAMI's National Convention in Orlando for her significant national contributions in the fight against stigma and discrimination. She is the author of Skywriting: A Life out of the Blue, in which she shared her personal experience with bipolar disorder. This month she will moderate a PBS panel discussion in conjunction with the premiere of the documentary, Depression: Out of the Shadows (May 21 at 9:00 p.m.).

New study measures links between mental health, youth delinquency and criminal behaviour

From the Canadian Institute for Health Information:

Hyperactivity, depression, harsh parenting linked to aggression and property delinquency among youth

What: Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity

April 29, 2008 — Mental health factors, such as one’s level of self-esteem or ability to handle stress, are linked to whether or not a young Canadian will display delinquent behaviour or become involved in criminal activity. According to a new study from the Canadian Institute for Health Information (CIHI), youth aged 12 to 13 who reported hyperactivity and depression were more likely to report high levels of aggressive behaviour, as well as high levels of delinquent acts involving property. In contrast, new analyses show that youth aged 12 to 15 with high levels of self-esteem, good stress management and self-motivation are more likely to report never engaging in aggressive behaviour.

The study, Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity, presents new analyses of the latest research, surveys and policy initiatives across Canada related to mental health and criminal behaviour among youth and adults.

“Understanding the links between mental health, mental illness, delinquency and criminal activity requires consideration of both risk and protective factors,” says Jean Harvey, Director of the Canadian Population Health Initiative (CPHI), a CIHI program. “With this understanding, there is greater opportunity for interventions and policies that may be effective at promoting mental health, preventing crime and reducing the risk of repeat offending among those with a mental illness.”

Parenting style and factors at the school and community levels also linked to delinquent and aggressive behaviour

At the school and community levels, feeling connected to one’s school and feeling a positive bond with society are linked to reduced delinquency. In contrast, feeling excluded and isolated can lead to involvement in criminal or delinquent behaviour. For example:

• 65% of youth who reported being highly involved with their school reported no aggression, compared to 47% of those not as involved; similarly, 66% of youth who said they liked school reported no aggression, compared to 47% of youth who said they did not like school that much.


• At the community level, risk factors for delinquent or violent behaviour include living in neighbourhoods with a high turnover of residents and high rates of violent crime, and feelings of hopelessness.
  

More than one in four patients hospitalized for mental illness have a history of criminal behaviour

Almost 10% of the more than 30,000 patients admitted to hospital for a mental illness in Ontario in 2006–2007 had either been charged with, or were involved in, a crime. More than one in four (28%) of these patients were reported to have some history of participation in a criminal act that resulted in police intervention.

“Mental illness affects many Canadians across a broad spectrum of the population, and most of them are not involved with the criminal justice system,” says Dr. Elizabeth Votta, CPHI Program Lead. “However, the numbers show that youth and adults with diagnosed mental illnesses are over-represented in Canada’s correctional facilities.”

Patients with a history of criminal behaviour had significantly more risk factors before their admission to hospital than patients with no criminal history. Most (70%) had been admitted to hospital for mental illness at least once before, just more than 40% had failed or dropped out of an education program and 44% were reported to have a dysfunctional relationship with their immediate family. At discharge, more than 1 in 10 did not expect to have supervision in place for personal safety, 4% expected to be homeless and 3% expected to return to a correctional facility.

Canadian Population Health Initiative

The Canadian Population Health Initiative (CPHI) is part of the Canadian Institute for Health Information (CIHI). CPHI conducts and supports research to foster a better understanding of factors that affect the health of individuals and communities; and to contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

Media contacts:

Jennie Hoekstra
613-694-7079
cell: 613-725-4097
jhoekstra@cihi.ca

Holly Lake
613-241-7860 ext. 4066
hlake@cihi.ca

I highly recommend listening to the webcast about this report available by clicking here.

Letter to the Editor from the SSNS

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

Re-engage society

In response to Ainslie MacDougal and Stanley Kutcher’s April 23 opinion piece, a mental health court will better serve the mentally ill by introducing, and sometimes re-introducing, a certain population of these individuals to much needed mental health care. The cost-effectiveness of these courts compared to the traditional means of incarceration is just another indicator of how beneficial these courts will be for everyone.

Our everyday involvement with people who live with schizophrenia/psychosis, as well as their family members and friends, and our expertise with the many issues all of these individuals encounter make the Schizophrenia Society of Nova Scotia a logical collaborator in the mental health court planning process. When the idea was conceived, we were asked to participate in preliminary talks. However, at this point, we have been left out of the planning process. We remain hopeful that the provincial government will re-engage the society as it moves forward with developing a mental health court.

Matthew H.W. Jack, policy adviser, Schizophrenia Society of N.S.

Inspiring Lives Awards

Ms. Gladys R. Wagner was nominated for an Inspiring Lives Award by Dr. Roger Cann and the Kings County Chapter of the Schizophrenia Society of Nova Scotia. The photographs below are from the Inspiring Lives Awards Luncheon held yesterday, May 7th.

Gladys Wagner

Gladys Wagner

Cyril Allan, president of the Schizophrenia Society of Nova Scotia

Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia

Rick Merrill

Photograph of the screen as Gladys is awarded her Inspiring Lives Award Nomination Plaque

Gladys goes to the podium to accept her Inspiring Lives Award Nomination Plaque.

Myrtle Corkum, executive director of the Mental Health Foundation of Nova Scotia, at the podium microphone.

Gladys with her Inspiring Lives Award Nomination Plaque.

Gladys admires her Inspiring Lives Award Nomination Plaque.

Pat MacLean, Rick Merrill, and Gladys Wagner (left to right) after the Inspiring Lives Awards luncheon.

Click on the photographs to enlarge them.

All photographs by Harold Porter.

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.

Rescuing ‘the Castle’ From Some Dark Days, Architecturally and Medically

From the April 29th edition of The New York Times:

The New York State Inebriate Asylum in Binghamton, N.Y. was built in 1858. Its original purpose was stark: to serve as a government-run treatment center for alcoholics and later "the chronic insane." The vast stone building, one of the early works of Isaac Perry, a prominent New York architect, had been abandoned since 1993. It is known to locals as "the Castle."

To read the entire article, click here.

Thanks go to John Devlin for bring this article to my attention.

Photography by Andrew Henderson for The New York Times.

Some recent clinical and research articles of possible interest

Program Marks New Direction in Schizophrenia Treatment

Science and Recovery in Schizophrenia

Ways to Promote Recovery, Prevent Recurrence

Paranoid Thoughts Don't Always Signal Serious Mental Illness

Schizophrenia recovery: Time for optimism? (PDF)

Photograph by alex~

Canada's Health System Draws Mixed Reviews From Psychiatrists

Although Canadian psychiatrists generally express satisfaction with their government-run health insurance program, not all are happy with the impact of the government's control over hospitals and medical education.

To read this entire article, written by Joan Arehart-Treichel and published in the May 2nd edition of Psychiatric News, click here.

Also see:

A Tale of Two Medicares

Image courtesy of Psychiatric News.

Taser studies sought

Medical journal calls for independent reports


Tasers in medicine: an irreverent call for proposals

Cardiac stimulation with high voltage discharge from stun guns

Also see:

House of Commons Standing Committee on Public Safety and National Security: Taser Study

Schizophrenia Annual Evidence Update 2008

From the Mental Health Specialist Library:

The Schizophrenia Annual Evidence Update 2008 brings together evidence-based guidelines, systematic reviews, important primary research, service development literature and patient information.

2008 Building Bridges to the Future Bursary Program

The Schizophrenia Society of Canada (SSC) and Janssen-Ortho Inc. are pleased to partner again in offering the Building Bridges to the Future Bursary Program. Though administered by Janssen-Ortho Inc., the program is now coordinated through the SSC. The Building Bridges to the Future Bursary Program seeks to encourage and support individuals living with schizophrenia as they pursue educational opportunities. The money from the bursary program (the maximum amount awarded is $800) can be used for tuition/registration fees, books and other costs related to completing education and/or training program. Please fill out the forms found by clicking here and fax or mail to the SSC.

Applications must be submitted by May 31st, 2008.

Photograph by Jacob1207.

Task Force Proposes New Bipolar Guidelines

From the April 1st edition of Psychiatric Times:

By Arline Kaplan

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

Bold emphasis is mine. To read the entire article, click here.

Reference
1. Ghaemi SN, Bauer M, Cassidy F, et al; ISBD Diagnostic Guidelines Task Force. Diagnostic guidelines for bipolar disorder: a summary of the International Society for Bipolar Disorders Diagnostic Guidelines Task Force Report. Bipolar Disord. 2008;10(1, pt 2): 117-128.

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.

Another use for the diabetes drug metformin: Helping people taking antipsychotics lose weight

To read this April 21st article by Julie K. Silver, M.D., of Harvard Medical School (pictured), click here.

News from the Lunenburg County Chapter of the SSNS

The April 2008 meeting of the Lunenburg Chapter of the SSNS featured entertainment by the group Bale O' Hey (pictured below).


Ellen Balser (below left) and Carolyn Eisner (back to camera) Dosado to tunes by Bale O' Hey.


Click on the photographs to enlarge them.

Mentalization-Based Therapy Shows Promise With Borderline Personality Disorder (BPD)

I'm moving away from this weblog's usual focus on schizophrenia and psychosis for one important posting.

From the April 18th edition of Psychiatric News:

by Mark Moran

Mentalization-Based Therapy Shows Promise With Borderline Personality Disorder (BPD)

All of the structured psychotherapies—including dialectical-based therapy, transference-based therapy, and schema-focused therapy—are proving superior to treatment as usual in randomized control trials.

To read the entire article, click here.

Related links:

8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual

Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Longer initial hospital stays positive for individuals diagnosed with schizophrenia

From today's edition of The Chronicle Herald:

By John Gillis, Health Reporter

The longer a person’s initial stay in hospital for schizophrenia, the less likely they are to be readmitted, says a new report from the Canadian Institute for Health Information.

The report found 38 per cent of people hospitalized for schizophrenia are readmitted to hospital within a year.

That figure shows a majority of people with the illness actually fare well outside hospital, said Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia.

"The amazing part, quite frankly, for me is that 62 per cent are not (readmitted)," he said. "When you have a first episode of schizophrenia or psychosis, it’s very, very scary."

Mr. Ayer said the report does not examine what care patients are getting while in hospital and what supports are available to them in the community.

Those people who were in hospital between a week and two weeks were 21 per cent less likely to be readmitted unexpectedly within 30 days than those whose initial stay was a week or less, the report says.

It notes the average length of hospital stays has been declining.

A week in hospital would be considered quite a short stay for someone admitted with schizophrenia, said Dr. Ian Slayter, clinical director for general psychiatric services for the Capital district health authority.

He said an admitted person would often be psychotic and needs time to stabilize.

"Someone who is (in) three or four weeks, they can often be helped to settle down and one can arrange things in the community."

Dr. Slayer said the length of stay for people hospitalized for schizophrenia in the Capital district averaged 28 to 30 days.

A person returning to hospital shouldn’t be assumed to be a bad thing, he said.

"Obviously, if they’re having problems, readmission is a good and necessary thing."

The services available to people after discharge include community mental health clinics and clubhouses, an assertive community treatment team, private psychiatrists and general practitioners.

Dr. Slayter said Capital Health also offers supportive services to check in with people in their homes and do things like drop off medication.

"That’s an area that we’re actively growing."

He said people who are hospitalized for very long periods are also likely to be readmitted due to instability.

Capital Health has recently changed the way it compiles statistics, so local readmission rates are unavailable.

Also see:

Schizophrenia patients with short hospital stays soon readmitted: report

Statement: The Schizophrenia Society of Ontario Supports CIHI's Findings on the Relationship Between Hospital Length of Stay and Readmission for Individuals with Schizophrenia

Short hospital stays failing schizophrenic patients

Which drugs best for schizophrenia?

An article from The Gazette (Cedar Rapids - Iowa City - Eastern Iowa). To read the entire article, click here.

I’m Here, Mom

I understand the game we’re playing. It’s how we keep from talking about the present, trading stories about when I was 10 years old and she was still whole.

By Anish Majumdar

For the entire story from Little India, the largest Indian publication in the United States, click here.

schizophrenia. let's talk about it.

A new website from Schizophrenia Digest. To view the website, click here.

From the website:

The "Let's Talk About It" campaign is an initiative of Schizophrenia Digest, Canada's foremost magazine for people with schizophrenia. For 14 years, Schizophrenia Digest has been providing inspiration and information about the issues surrounding this mental illness. The campaign is financed through an unrestricted grant from Pfizer Canada. Pfizer is dedicated to improving the health and quality of life of Canadians.

"Let's Talk About It" is intended to motivate Ontarians to begin a dialogue about mental illness and take action to improve access to new drug therapies that effectively treat the symptoms of schizophrenia. With your help we can focus a provincial dialogue on helping those affected by this tragic disease.

Stroke of insight: Jill Bolte Taylor on TED.com

From TEDBlog:

Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story of recovery and awareness -- of how our brains define us and connect us to the world and to one another. (Recorded February 2008 in Monterey, California. Duration: 18:44.)

She begins her talk by stating:

"I grew up to study the brain because I have a brother who has been diagnosed with a brain disorder, schizophrenia. And as a sister and as a scientist, I wanted to understand, why is it that I can take my dreams, I can connect them to my reality, and I can make my dreams come true - what is it about my brother’s brain and his schizophrenia that he cannot connect his dreams to a common, shared reality, so they instead become delusions?"




Click on the arrow to start the video.

Sainsbury Centre for Mental Health - Making Recovery a Reality

From the Sainsbury Centre for Mental Health:

March 2008

Abstract:

“Two or three years ago I realised that you really could recover…I thought that once you had it, that was it – but you can recover. I find that quite an amazing fact…”

‘Recovery’ is an idea whose time has come. At its heart is a set of values about a person’s right to build a meaningful life for themselves, with or without the continuing presence of mental health symptoms. Recovery is based on ideas of self-determination and self-management. It emphasises the importance of ‘hope’ in sustaining motivation and supporting expectations of an individually fulfilled life.

To download the entire publication, click here (PDF).

Restrictive drug policies often cause patients with schizophrenia to discontinue medication, study finds

NEWS ALERT
Harvard Medical School Office of Public Affairs

FINDINGS: {Patients with schizophrenia] in Maine’s Medicaid program experienced more frequent interruptions in treatment when the state began requiring physicians to seek prior authorization for medications not on the programs’ preferred drug list.

RELEVANCE: Schizophrenia is a devastating psychiatric illness that affects roughly three million Americans. Disruptions in medication compliance can be devastating for the patient. Despite this, prior authorization policies for antipsychotic drugs are used in about forty percent of state Medicaid programs and in one-third of the Medicaid Part D drug benefit in attempts to save costs.

BOSTON, Mass. (April 1, 2008)—Policies requiring authorization before physicians can prescribe newer medications to [patients with schizophrenia] may be counter-productive. According to a new study, patients in Maine’s Medicaid program who found themselves in this situation were 29% more likely to stop or disrupt medication use than patients not subject to the policy. In addition, although the policy was originally designed to cut costs, government savings were minimal at best.

These findings are reported online in Health Affairs [click here to download the entire article (PDF)].

The study, led by investigators from Harvard Medical School’s Department of Ambulatory Care and Prevention, looked at Maine Medicaid beneficiaries with schizophrenia on antipsychotic drugs before, during, and after a policy that required patients to use an authorized medication (step treatment) before they were allowed to use drugs not on the preferred list. They were compared to similar beneficiaries in New Hampshire, where there was no prior authorization regulation. The Maine policy was replaced by a provider education program after less than a year.

Study data indicated that the original Maine policy disrupted essential antipsychotic treatment for vulnerable patients with schizophrenia, with minimal or no cost savings.

“This study calls into question the effectiveness of many similar policies throughout the country,” says Stephen Soumerai (pictured), Harvard Medical School professor and senior author on the study. “Getting prior authorization requires paperwork and is time-consuming, so physicians may tend to switch to prescribing preferred medications even if they have concerns about the appropriateness of the medication for a specific patient.” However, as medication choice is restricted, more patients discontinue treatment.

Previous studies have shown that gaps in antipsychotic medication use are likely to result in recurrence of psychotic episodes and higher hospitalization rates and costs for these patients.

Schizophrenia is a disabling and costly illness that afflicts approximately one percent of the US population, or three million people. Without antipsychotic treatment, about 80% of patients will have a serious recurrence of their illness within a year. The study investigators believe that while there is a legitimate place for prior authorization and step treatment policies for some medications, patients with chronic mental illness are put at particular risk of receiving inadequate treatment.

“Given the tremendous variation in individual responses to these drugs as well as the devastating impact of treatment disruptions on schizophrenic patients, a policy that pushes all patients toward a limited number of preferred drugs may do more harm than good,” says Dr. Soumerai. “It would be much better to focus on ensuring that antipsychotic drugs are prescribed for evidence-based reasons and that preferred drugs are prescribed only to patients who can benefit from them.”

This study was supported by the Agency for Healthcare Research and Quality (AHRQ), Centers for Education and Research in Therapeutics (CERT) Public/Private Partnership Program and the HMO Research Network CERT, Eli Lilly and Company, and the Harvard Pilgrim Health Care Foundation.

Written by Ann Plasso

CITATION:
Health Affairs, April 1, 2008
“Use of atypical antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change”
Stephen Soumerai(1), Fang Zhang(1), Dennis Ross-Degnan(1), Daniel Erik Ball(2), Robert LeCates(1), Michael Robert Law(1), Tom Hughes(2), Daniel Chapman(3), and Alyce Adams(1)

1-Harvard Medical School, Department of Ambulatory Care and Prevention, Boston MA
2-Eli Lilly and Company, Indianapolis, IN
3-Centers for Disease Control and Prevention, Atlanta GA

CONTACT:
David Cameron
public_affairs@hms.harvard.edu
617.432.0442

Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School's Boston campus or in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

Living Healthy in Atlantic Canada

A new magazine published by the QEII Foundation contains an article on the Nova Scotia Early Psychosis Program. The article, entitled Mending Minds, appears on pages 28 to 31 and can be accessed by clicking here (downloads a large PDF).

For a hard copy of Living Healthy in Atlantic Canada, send an email to fndnew@qe2-hsc.ns.ca with your mailing address. (Note: The QEII Foundation provided an incorrect email address. The correct email address was posted here on April 5th. Thanks to Valarie R. for pointing this error out to me.)

Scientists probe meditation secrets

Scientists are beginning to uncover evidence that meditation has a tangible effect on the brain.

For the complete article from BBC News, click here.

Photograph courtesy of BBC News.

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