Hyde report: Call to action

An editorial published in the December 10th edition of The Chronicle Herald:

In Judge Anne Derrick, Howard Hyde finally has an advocate who sees the bigger pic­ture. Sadly, proper perspective is the very thing he desperately needed from someone — anyone — the day he died three years ago.

That much is obvious from reading Judge Derrick’s findings into the chain of events that led to the death of this emotionally disturbed man. But those who comb through the inquiry report looking to pin blame will be disappoint­ed. Howard Hyde — who suffered from schizo­phrenia, was off his medications and experi­encing psychosis — was not a victim of in­competence. He was a victim of incoherence.

During every step of his odyssey in police, medical, court and correctional custody, Mr. Hyde came across professionals acting profes­sionally. Even the most controversial and publi­cized episode — which led to Mr. Hyde’s mul­tiple Tasering at a Dartmouth police station — is not a slam-dunk of police misbehaviour.

Judge Derrick notes that the booking officer who produced a tool with which to cut the lace on Mr. Hyde’s shorts before putting him in a cell did not mean to provoke or panic him.

“S/Cst. MacCormick uttered the words: ‘We’ll have to cut one of those balls off’ innocently, with no appreciation of the effect they would have on Mr. Hyde," she wrote.

Judge Derrick makes it clear that the Taser­ing did not cause Mr. Hyde’s death. Nor did he die of schizophrenia, as the medical examiner unhelpfully concluded. He did die some 30 hours later as a result of a struggle with Burn­side jail correctional officers whose use of force, and of a restraint hold, she determined to be “reasonable and proportionate."

Ultimately, the real problem was not the performance of Mr. Hyde’s custodians per se, but crucial omissions cascading through the chain of custody. From the moment he was first picked up by police on a domestic abuse com­plaint, a pattern developed whereby relevant facts weren’t passed along. Legal and medical professionals got their wires crossed, made incorrect assumptions, acted on incomplete information. Cops were unaware of mental health resources available to them and guards didn’t know how to de-escalate confrontations with the emotionally disturbed.

Clearly, the province must begin by training its sights on retraining front-line staff.

(edits@herald.ca)

Hyde’s partner praises inquiry findings

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

By Clare Mellor

Karen Ellet [pictured] says she still mis­ses Howard Hyde’s amazing voice.

“I miss his voice, his beauti­ful singing voice," the Dart­mouth woman said Thursday.

Ellet, who was Hyde’s com­mon- law wife, said she has been dealing with her grief since he died on Nov. 22, 2007, after a violent conflict with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.

But she is taking comfort in the recommendations result­ing from the provincial inquiry into his death.

If the suggestions outlined in a report released Wednesday are adopted, they will make a huge difference in the way mentally ill people in crisis are dealt with, Ellet said.

“I am very pleased. She is a very compassionate judge," she said of Anne Derrick, the provincial court judge who helmed the 11-month fatality inquiry.

She said Hyde would be pleased with Derrick’s report, too.

“He would be ecstatic about it," Ellet said. “He would like to see (the recommendations) implemented, so the (report) is not sitting on a library shelf."

In her report, Derrick rejected a medical examiner’s conclusion that Hyde died of excited delirium and found in­stead that the struggle with the jail guards played a role in his death.

Hyde, a 45-year-old musician who was diagnosed with schizo­phrenia in his 20s, was having a psychotic episode at the jail when he was forced to lie on his stomach with his hands behind his back. The restraint technique may have interfered with his ability to breathe, Derrick found.

“He did not die because he was mentally ill," she wrote in her report.

Ellet said she still has difficulty thinking of the emotional and physical pain that Hyde endured in the last 30 hours of his life.

On the night of Nov. 21, 2007, Ellet called a crisis hotline to complain that Hyde had assault­ed her while in a psychotic state.

Police arrested Hyde, but not before Ellet told them her hus­band had not been taking his medication and needed psychiat­ric help.

“Howard didn’t understand why he was in jail," she said. “He couldn’t comprehend his sur­roundings."

Ellet said she has been keeping a low profile due to her grief, but she believes it is important for her to speak up about the changes she thinks Hyde would have wanted to see in the justice system and in society at large.

“I believe he would want to have a professional such as a mental health provider to be with people who have a mental illness when they are in crisis, to speak on behalf of them," she said.

Ellet said Hyde would want all professionals to be issued hand­books so they could learn more about the signs and symptoms of mental illness and how to handle somebody who is having a psy­chotic episode. “Howard would want more housing available (for mentally ill people)," she said. “Howard found it horrific to know that people with mental illness are living in shelters and on the streets. It really upset him. He wished he could have done something but he didn’t know what to do."

Ellet said Hyde also would have wanted more research into the development of psychiatric drugs.

“Not all medications agree with each particular person," she said. “There are so many side­effects."

More mental health funding and clubhouses, support groups and associations in support of the mentally ill would also be on Hyde’s list, Ellet said.

“I believe there is a large amount of fundraising that can make miracles happen to help (prevent) people with mental challenges from living on the streets," she said.

“Mental illness is no different from somebody walking around with diabetes."

Some of Derrick’s recommen­dations concern stun guns — she said they should not be used on people in a state of agitation due to a psychological disturbance, and changes should be made in the training for how to use them.

The judge also recommended that crisis intervention training be provided to all correctional officers at the Dartmouth jail and that several aspects of training in general be improved for jail guards in the province and for front-line police officers and doctors.

Ellet said it is poignant that the report on Hyde’s death came out on the 30th anniversary of the murder of John Lennon.

Hyde, who sang and played the saxophone, was also an extraor­dinary musician, she said.

“Howard had the musical ability to play anything," she said. “He had the most astound­ing voice you can imagine."

Also like Lennon, Hyde de­spised war. “He just wanted peace in the world," Ellet said.

(cmellor@herald.ca)

Also see:

N.S. to factor Hyde inquiry into mental health plan


Photo credit

Culture shift needed in society, system

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

By Marilla Stephenson (pictured)

In the end, who failed Howard Hyde?

Perhaps, to some degree, we all did.

There is really no way to dress up the realities of mental illness. It is not pretty, and it can be a very tough challenge to support people in crisis. The people who live closest to those who suffer from mental illnesses are victims of the illnesses, too.

There is also no way to disguise or excuse how our society has continued to respond to people who experience mental illnesses. The stigmas are clear and well understood, even by young children in our schools. The branding begins early.

Hyde is the Dartmouth man who died in custody in 2007. He suffered from schizophrenia. The police were told of his mental illness when he was taken into custody over allegations of domestic abuse. He later died after an intense struggle with prison guards.

Provincial court Judge Anne Derrick released the fatal inquiry report into Hyde’s death on Wednesday. She firmly rejected a previous finding by a pathologist that he had died due to a condition termed "excited delirium."

Derrick dismissed that finding as a "red herring" that did not exist in Hyde’s case.

She also found that while the repeated use of a Taser on Hyde during his time in police custody "worsened the situation," it was not the cause of his death. She did, however, remind justice officials that so-called stun guns are to be used as an alternative to lethal force rather than as a front-line option to subdue suspects who are emotionally disturbed.

His death was accidental, Derrick found, but it came as a direct result of his struggle with prison guards.

In the comprehensive list of 80 recommendations, Derrick tossed the ball firmly into the hands of the provincial government.

She begins by calling for the establishment of a long-promised, but still absent, mental health strategy. It is clearly not by accident that this basic framework is at the top of the list as a necessary building block from which other improvements would naturally evolve.

The judge also calls on the province to increase funding for mental health, but not to do it by reallocating funds from within the existing envelope of health-care funding. This reflects the fact that mental health issues have for too long languished on the list of health-care priorities.

We are left with a fractured, often inaccessible mental health system where vanishing waiting lists are proudly waved around by government as proof of treatment for patients. Improvements are being made, and Derrick’s report makes note of policy changes that have already occurred in the justice system in the wake of Hyde’s death.

But it is hard to comprehend that none of the guards involved in the struggle with Hyde minutes before he died had any training to help them deal with prisoners who suffer from mental illness.

One seemingly innocuous recommendation, No. 49 on Derrick’s list, speaks volumes. Directed at justice system staff and other front-line officials who are in contact with prisoners who suffer from mental illness, it is brief and to the point:

"Training should have, as its overarching purpose, the development of a culture of respect and empathy for persons with mental illness in the justice system."

This is a statement that reaches beyond the justice system and into our society as a whole. While mountains have been moved in reducing the acceptance of stereotypes linked to mental illnesses, many of the most basic government services — justice and health among them — are still handcuffed by systemic ignorance.

The judge called for alternatives for people with mental illness who come in conflict with the law, and says the responsibility reaches well beyond the justice system.

"As the evidence before the inquiry has vividly illustrated, grasping this nettle is not just the responsibility of the justice system; creativity and commitment to change are required of the health system and the community, too."

The principles of respect and empathy provide a good place from which to start.

( mstephenson@herald.ca)

Also see:

Howard Hyde Inquiry Ignores Ableism As Cause of Death


Photo credit

Report: Fatality Inquiry into the Death of Howard Hyde

The Honourable Judge Anne S. Derrick (pictured) filed her report from the Fatality Inquiry into the Death of Howard Hyde on Wednesday, December 8th, 2010.

The report is available by clicking here (PDF).

Video recordings of all the Inquiry hearings are available by clicking here.

Image credit

Also see:

Jailhouse restraint blamed

Patients' Souls Called Medicine's Missing Link

An article published in the December 3rd edition of Psychiatric News:

By Mark Moran

Small changes, beginning with the attitude clinicians bring to a patient encounter, can transform psychiatric and other medical care.

The notion that your patients have a “soul” and that your treatments can touch or transform something less (or more) substantial than a neurotransmitter may sound, in the context of modern biomedical science, quaint today.

But author and psychotherapist Thomas Moore, Ph.D. {pictured], believes the souls of patients in the care of modern medicine are in need of urgent attention. And so too, he says, are the souls of their doctors.

Moore is the bestselling author of The Care of the Soul: A Guide for Cultivating Depth and Sacredness in Everyday Life, the 1992 book that asserted that the greatest poverty in today's technologically triumphant culture is a lack of attention to the soul.

In a new work, Care of the Soul in Medicine, published this year by Hay House Publishers, Moore asserts that this soul-poverty extends to modern medicine.

In an interview with Psychiatric News, Moore said modern medical care has come to be dominated by a highly mechanistic philosophy deriving from the relatively recent 18th century while jettisoning a far more ancient wisdom about care of the soul that dates to the time of classical philosophers.

Much of his new book is focused on care of the soul in general-medical settings, especially in hospitals and in the care of the dying. But Moore said the message of his book should resonate with psychiatrists.

“I understand the field has become more biological,” he said. “My sense is that people entering medicine today get this very intelligent, up-to-date training in biomedical science. And when I talk to psychiatrists about a spiritual approach to healing, it doesn't seem to them to have that intelligence behind it.

“But I would want psychiatrists to know there is a whole world of knowledge and wisdom outside the biological tradition that goes back several thousand years,” Moore said. “They should give a philosophical and spiritual approach to the patients in their care another look, and they may find that it can be very substantive and would complement their biological work.”

Transforming the Medical Setting

But what is the “soul,” and how does one care for it?

The question itself invites speculation that has kept philosophers busy for centuries. But for the purpose of his book and his message to physicians, Moore speaks of the soul as where one cradles the meaning of one's relationships and memories, the sense of mystery about one's own life, and one's understanding of the meaning of illness and death.

To care for the soul in medicine then would be to adopt practices that seek not just the “cure” of disorders, but care for and attention to patients' significant relationships, poignant memories, spiritual quests and interests, as well as their understanding of their illness. Such an approach, he believes, calls for changes in the way doctors are trained and in the way they approach their patients, but it also entails a transformation of the settings in which care is provided to include incorporation of nature, art, and music into the architecture of hospitals and doctors' offices.

His remedies for what ails modern medicine may seem to some either quixotic or “unscientific” (or even “antiscientific”), but his thoughts echo those of such respected thinkers as biomedical ethicist Daniel Callahan, Ph.D., who has written extensively of the need to return to “caring over curing.”

“You don't have to talk too long to patients and their families, as well as doctors and nurses, before they express a common feeling that contemporary medicine, for all its technological virtuosity, lacks something,” he said. “Patients and families will talk about how the medical establishment is just so huge and they feel like a piece of machinery. When I tell them about how images and architecture can transform a healing environment—about how the way a hospital room looks and feels can be a part of healing—they are a little surprised, but they know what I am saying. So I seem to be giving people a language for talking about things they know intuitively.”

Moore is careful not to be critical of physicians — “they get enough criticism,” he said—and noted that after the success of his 1992 book, it was the medical establishment that came to him. As part of his research for the book, he was invited to spend two days each month over a two-year period at St. Francis Hospital in Hartford, Conn.

“When I first wrote Care of the Soul, I didn't have medicine in mind at all,” Moore said. “But I began getting invitations to talk at medical schools, and right up to the present time I have been visiting medical schools, hospitals, and cancer wards all over the country and in Ireland.”

Reclaiming an Ancient Wisdom of the Soul

What does Moore, an admirer of Carl Jung (but he is not, he said, a Jungian), think of the widespread use of pharmacologic agents to treat psychiatric disorders?

“It's a complicated issue, and I have nothing against the use of pharmacologic treatments in conjunction with other approaches,” he said. “But I think it goes hand in hand with the prevailing philosophy of our time that is based on treating people as mechanical systems. If you see the brain as a collection of neurochemicals, you are going to use chemicals to treat people.

“That's the underlying mythology of our time. It is useful as far as it goes, but I think it leaves much to be desired and ignores a vast trove of wisdom about the soul that predates the 20th century.”

His recommendations for reform seem to require changes in a medical system that is itself vast and unwieldy. But Moore believes that even small changes—beginning with the attitude clinicians bring to a patient encounter—can be transformative, even of a 15-minute med check.

“I think psychiatrists would find their work so much more pleasurable and fulfilling if they could reach past the prevalent biological view of a human being and enjoy the complexity of human life,” Moore said. “They could allow themselves to be instructed by the arts, by fiction and drama, painting and music and allow those to inform their practice. It would humanize their work so that they would have a warmer and more fulfilling experience in a context that would be incredibly rich, even if they only had 15 minutes.”

It's not the amount of time spent with a patient that's key, he said. “I can spend 50 minutes with a patient and it seems like nothing. It's where you are coming from that makes the difference.”

Photo courtesy of Thomas Moore, Ph.D.

Gene-Environment Interactions Could Influence Several Psychiatric Disorders; 'Schizophrenia Gene' May Also Trigger Anxiety, Depression

A December 3rd media release from Johns Hopkins University:

BALTIMORE, Dec. 3 (AScribe Newswire) -- Male mice born with a genetic mutation that's believed to make humans more susceptible to schizophrenia develop behaviors that mimic other major psychiatric illnesses when their mothers are exposed to an assault to the immune system while pregnant, according to new Johns Hopkins research.

What was most surprising to researchers was that the mental illnesses the mice developed didn't look like schizophrenia, which they were genetically predisposed to, but more like mood and anxiety disorders, suggesting that one gene mutation can lead to different mental illnesses when influenced by the same environmental factor.

"Psychiatric diseases have genetic roots, but genes alone do not explain the entire disease," says Mikhail V. Pletnikov, M.D., Ph.D. [pictured], an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the study's leader. "When we study genes in conjunction with environmental challenges, we can better understand how diseases develop."

Pletnikov hopes his research, which appears in the December issue of the journal Biological Psychiatry, may be a small step toward eventually finding ways to prevent mental illnesses in humans. "The main goal here is to understand how gene-environment interactions take place on the molecular level so that you can find suitable drug targets, ultimately stopping these diseases before they happen," he says. "It all can start before birth."

Pletnikov and his team studied a mutant human form of the Disrupted-in-Schizophrenia 1 gene (mhDISC1), breeding mice in the laboratory with this mutation. This genetic variation is believed to be associated with vulnerability to major mental illnesses in humans. The mhDISC1 mice were impregnated, and at the ninth day of gestation (the equivalent to the middle or end of the first trimester in a human pregnancy), one group was given a drug to stimulate the immune system, forcing it to react as if it had been exposed to a virus like influenza or a parasite like toxoplasma. The rest of the pregnant mice - whose fetuses also had the mutated gene- were kept as a control group and their immune systems were left unchallenged.

The study found that prenatal immune stimulation in mhDISC1 mice produced behavioral abnormalities that were not present in the unchallenged mice: elevated anxiety, depression-like responses, an altered pattern of sociability and a weakened response to stress. The unchallenged mice did not show those behaviors, even though they also had the mutant gene. Pletnikov says the findings suggest that the same mutation, in this case mhDISC1, can lead to different illnesses, depending on interactions with environmental factors.

This may provide an explanation, he says, for why the extended Scottish family in which scientists first discovered this genetic mutation had members who suffered not solely from schizophrenia but also from major depression and bipolar disorder. "This one gene mutation can lead to very different clinical manifestations," Pletnikov says.

Along with the behavior differences, Pletnikov and his team also found that parts of the brain, including the amygdala and the hypothalamus, were smaller in the mice that had been prenatally challenged. A similar abnormality can be found in those same areas of the brain in humans with major depression and bipolar disorder.

Previous studies have suggested that the prenatal immune response to a microbe - be it a major illness or just transient flu-like symptoms barely noticed by the pregnant woman - may be responsible for the increased incidence of adult psychopathology in humans. But this hypothesis, Pletnikov says, has been difficult to prove. Using this mouse model, he suggests, is a valuable way to study the relationship between gene-environment interactions and mental illness, and should be replicated to find more of these interactions to gain a better understanding of these relationships.

Future studies, he says, will try to sort out whether different timing or stimulating different parts of the immune system might lead to specific types of mental illness, as well as explore the consequences of other environmental adverse events such as stress or drug abuse.

Other Johns Hopkins researchers on the study include Bagrat Abazyan, M.D.; Jun Nomura, Ph.D.; Geetha Kannan; Koko Ishizuka, Ph.D.; Kellie L. Tamashiro, Ph.D.; Frederick Nucifora, Ph.D.; Vladimir Pogorelov, Ph.D.; Chunxia Yang; Carlos Pardo, M.D.; Susumu Mori, Ph.D.; Atsushi Kamiya, M.D., Ph.D.; Akira Sawa, M.D., Ph.D.; and Christopher A. Ross, M.D., Ph.D.

The study was supported by the National Institute of Mental Health, Autism Speaks, the National Alliance for Research on Schizophrenia and Depression, the Mortimer W. Sackler Foundation, the Cell Science Research Foundation and the National Institutes of Health/National Institute on Drug Abuse-Intramural Research Program.

For more information: http://www.hopkinsmedicine.org/psychiatry/research/neurobiology/research_labs/behavioral_pletnikov.html

- - - -

CONTACT: Stephanie Desmon, Johns Hopkins Medicine Media Relations and Public Affairs, 410-955-8665, sdesmon1@jhmi.edu

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Government funding of mental health services in Nova Scotia

From a June 1st, 2010, PowerPoint presentation made by the Nova Scotia Department of Health:


Please click on the image to magnify it.

Ashley Smith - Overcoming Schizophrenia

Ashley Smith (pictured) writes about her experience as the plenary speaker at the SSNS's 22nd Annual Conference on her blog, Overcoming Schizophrenia:

The 22nd Annual Conference: Mental Illness- Why Me?, hosted by the Schizophrenia Society of Nova Scotia (SSNS), was wonderful! The event took place on Friday, November 26, 2010 at Pier 21. The SSNS Executive Director, Dr. Stephen Ayer, gave me a warm welcome along with the Board of Directors. Dr. Ayer gave me a tour of the city of Halifax, Nova Scotia.

I had an opportunity to dine with the Board of Directors and a couple of other speakers for the conference. The Board gave me a beautiful gift of a photograph taken by Mr. John Ross. In addition to that, I went to dinner with another presenter from the conference, Ms. Laura Burke and her family and friends.

Speaking at the conference enabled me to share my testimony of living with schizophrenia, and to give suggestions to other people directly affected by the illness. I titled my speech, A Distorted Perception to Reality: My Insight Into Recovery, because for me, schizophrenia forced me to think irrationally. However, the illness is manageable, and I am overcoming schizophrenia with the support of medication, support from others, and group therapy.

After delivering my speech, several people asked questions about my experience. I had a moment with some of the guests to elaborate on my experience and to exchange stories. Many of the participants thought my talk was inspirational, which I am glad because having an illness like schizophrenia can be tough, however, it is manageable.

Please click on the photograph to magnify it.

The SSNS's 22nd Annual Conference - Mental Illness: Why Me?

The Schizophrenia Society of Nova Scotia’s

22nd Annual Conference

Mental Illness: Why Me?

Held on Friday, November 26th, 2010

Joan Greenwood (left) receives the 2010 Janine Williams Memorial Bursary from Cecilia McRae, president of the SSNS.


Ashley Smith, Founder and Executive Director, Embracing My Mind, Inc.


Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health, Department of Psychiatry, Dalhousie University


Patrick Burke, QC, member of the SSNS Board of Directors, with Dr. Kutcher.


Aileen McGinty, Dip. Psych. (Open), M.T.A., Post-Graduate Diploma in Music Therapy, Certificate of Teaching, Dip.L.P., LL.B., M.A.








Phil Rogers, treasurer of the SSNS (left), with Dr. Tomas Hajek, Associate Professor & Dalhousie Clinical Research Scholar, Departments of Psychiatry and Anatomy & Neurobiology, Dalhousie University


Phil Rogers with Dr. Sherry Stewart, Killam Research Professor, Departments of Psychiatry, Psychology, and Community Health & Epidemiology, Dalhousie University


Left to right: Debby Gladstone, secretary of the SSNS, Ms. Laura Burke, MA Student in Creative Arts Therapies, Drama Therapy Option, Department of Creative Arts Therapies, Concordia University and Margaret Smith


Elainie Garland, vice president of the SSNS (left), with Andy Cox, Mental Health Advocate, IWK Health Centre and Member, Board of Directors, Mental Health Commission of Canada


Please click on any photography to enlarge it.

Photographs by Stephen Ayer.

Promises: Based On A True Experience With Schizophrenia

The synopsis of a recently published book by Novia Scotian author Adam Jack Pelley:

Turner Whynot is a psychiatrist looking for reason within his work. He is searching for more than the prescriptions and the textbooks that psychiatrists rely upon to treat the mentally ill. Why does he look after the sick? Is it something divine that's within us all, or some other driving force? Turner begins to find answers to these questions when he and his wife travel to the south shore of Nova Scotia and meet Adam, a patient in a psychiatric facility there who wants peace from a world that has brought him pain. Adam tells the Whynots the story of his own promise, an experience that may bring truth to the reality they all share, or to a reality that is perhaps just his own. Based on the authors own experiences and struggles with schizophrenia, Promises tells the story of how love offers the key to recovery and understanding of mental illness.

The Jack Project - Mental Health First Aid Canada - Youth Course

Also see:

The Jack Windeler Memorial Fund

Last March, Jack Windeler, a first-year student at Queen’s University, died of suicide. To help others, Jack’s family and friends have raised $300,000+ for the Jack Windeler Memorial Fund, administered through Kids Help Phone. The focus is on youth mental health to

1. educate ‘emerging adults’ aged 16-20 as they transition from high school to college/university, and


2. to build a micro-site to counsel youth who are suffering.(supported by Kids Help Phone counsellors)

Jack’s high school (Ridley College) and university (Queen’s) are leading efforts by providing training in “Mental Health First Aid”, which teaches skills so you can help someone who is developing or experiencing a mental health problem. The goal is to broaden the approach across Canada.

National survey reveals 45.1 million adults in the U.S. experienced mental illness in the past year

A November 18th media release from the Substance Abuse and Mental Health Services Administration (SAMHSA):

Study shows that nearly 1 in 5 people suffering from mental illness also have a substance use disorder

According to new results from a national survey, 19.9 percent of American adults in the United States (45.1 million) have experienced mental illness over the past year. The survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that 11 million adults (4.8 percent) in the U.S. suffered serious mental illness in the past year -- a diagnosable mental disorder has substantially interfered with, or limited one or more major life activities.

SAMHSA’s 2009 National Survey on Drug Use and Health (NSDUH) reveals that 8.4 million adults in the U.S. had serious thoughts of suicide in the past year, 2.2 million made suicide plans, and one million attempted suicide.

The survey also reveals that in many cases those experiencing mental illness, especially those with serious mental illness, also have a substance use disorder (abuse or dependence on alcohol or an illicit drug). Nearly 20 percent (8.9 million) of adults in the U.S. with mental illness in the past year also had a substance use disorder. Among those with serious mental illness in the past year, 25.7 percent had a substance use disorder in the past year -- approximately four times the level experienced by people not suffering from serious mental illness (6.5 percent).

"Too many Americans are not getting the help they need and opportunities to prevent and intervene early are being missed," said SAMHSA Administrator Pamela S. Hyde, J.D. [pictured] "The consequences for individuals, families and communities can be devastating. If left untreated mental illnesses can result in disability, substance abuse, suicides, lost productivity, and family discord. Through health care reform and the Mental Health Parity and Addiction Equity Act we can help far more people get needed treatment for behavioral health problems."

Administrator Hyde announced the survey’s findings during an address before the 6th World Conference on Promotion of Mental Health and Prevention and Mental and Behavioral Disorders in Washington, D.C. sponsored by the Education Development Center, Inc., The Clifford Beers Foundation, The Carter Center and the World Federation for Mental Health.

The survey provides other insights into the nature and scope of mental illness, including information on those segments of the population who may be at greater risk of experiencing mental illness. For example, the survey shows that mental illness is more likely among adults who were unemployed than among adults who were employed full time (27.7 percent versus 17.1 percent).

There is a marked difference in the percentages with mental illness between men and women as well, with 23.8 percent of women experiencing some form of mental illness, as opposed to 15.6 percent of men. In terms of age, young adults (ages 18 to 25) had the highest level of mental illness (30 percent), while those aged 50 and older had the lowest (13.7 percent).

Less than four in ten (37.9 percent) of adults in the U.S. with mental illness in the past year received mental health services. Service use was higher for adults with serious mental illness (60.2 percent); however, 4.4 million adults with serious mental illness in the past year did not receive mental health services.

Results from the 2009 National Survey on Drug Use and Health: Mental Health Findings is based on the 2009 NSDUH -- the latest in a series of scientifically conducted annual surveys of approximately 67,500 people throughout the country. Because of its statistical power, it is a primary source of information on the levels of a wide range of behavioral health matters including mental health and substance abuse issues.

A copy of the report is accessible at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf


SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Disability, Rental Housing, Registry Programs Inadequate

A November 17th media release from the Auditor General of Nova Scotia:

The Auditor General found problems with government services for persons with disabilities, provincial rental housing programs and government registries, according to his latest report to the legislature released today, Nov. 17.

Jacques Lapointe's report to the House of Assembly included three performance audits that were completed this summer in two departments as well as three chapters on government financial matters.

An audit of registries operated by Service Nova Scotia and Municipal Relations raised concerns about the security of computer systems protecting personal and business information, primarily in the land, business and joint stock registries. Weaknesses were found in the way passwords are controlled, computer accounts are set up and cancelled, and security changes are made. Disaster preparedness was also found to need strengthening.

On the other hand, the Auditor General said business processes to control the collection and recording of registry data were sound, and both business processes and IT systems in the Registry of Vital Statistics were well controlled. The report also noted that the recommended remedies require "relatively minimal resources to implement."

The audit of services for persons with disabilities at Community Services focused exclusively on the community-based options stream of the program, including family support, independent living and small options homes where three or fewer people with disabilities receive care.

The Auditor General said client-needs assessments were inconsistently completed and did not always provide adequate plans to meet identified needs. Reassessments were not always completed as required.

In addition, policies and procedures to investigate complaints about the homes or the services they offer are inadequate and there was no evidence that appropriate actions are taken to follow up and resolve complaints.

Mr. Lapointe said those weaknesses could result in persons with disabilities not receiving the level or type of services they require.

The report notes that the services for persons with disabilities program has been under review since 2002. While the department has made a number of improvements to the program as a result, many recommendations from these reviews have not yet been fully Implemented. A comprehensive plan for the future of the program has yet to be produced.

The audit of Community Services' rent supplement housing program found policies that have not been updated for 15 years, inadequate assessment and monitoring of rental units for safety and affordability, and inadequate evaluation of applications from housing developers applying for subsidies.

The department offers up to $75,000 per rental unit for new or renovated affordable housing. However, the auditors could find no evidence of a formal evaluation process for proposals received or, any evidence of how evaluations are conducted. In addition, once the units are constructed, the department does not follow up to ensure the units continue to meet program affordability requirements.

Other chapters in the report deal with government's financial reporting. One chapter provides the results of financial audits and reviews, and includes recommendations to improve financial controls.

The report also provides indicators of the province's overall financial condition, expanded this year to compare Nova Scotia with five other provinces. And a review of audit opinions of government agencies and Crown corporations highlights a need for them to pay more attention to implementing recommendations of their private sector auditors.

The full report and related documents are available online at www.oag-ns.ca.


FOR BROADCAST USE:

The Auditor General has found problems with government services for persons with disabilities, provincial rental housing programs and government registries, according to his latest report to the legislature released today (November 17th).

Jacques Lapointe's report to the House of Assembly raised concerns about the security of computer systems protecting personal and business information, primarily in the land, business and joint stock registries at Service Nova Scotia and Municipal Relations.

Mr. Lapointe says weaknesses with client-needs assessments and complaint investigation for persons with disabilities at Community Services' community-based options could result in persons with disabilities not receiving the level or type of services they require.

The audit of Community Services' rent supplement housing program found policies that have not been updated for 15 years, inadequate assessment and monitoring of rental units and inadequate evaluation of subsidy applications from housing developers.

The full report and related documents are available at www.oag-ns.ca.

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Media Contact:

Jacques Lapointe
Auditor General
902-424-5907
E-mail: lapoinjr@gov.ns.ca

Progress in the Elimination of the Stigma of Mental Illness

From the November 2010 edition of The American Journal of Psychiatry:

Changing Views of Mental Illness?

Public awareness of the neurobiology of mental illness increased between 1996 and 2006, yet the stigma associated with several major mental disorders did not decline. Pescosolido et al. (p. 1321) found that persons who have a neurobiological conception of schizophrenia or depression actually had increased likelihood of aversion or fear in their rating of vignettes of individuals with these illnesses. The perception of alcohol dependence as refl ecting "bad character" rose from 49% to 65% of survey respondents. Support for treatment increased, however, and in an editorial, Goldman (p. 1289) suggests that the outcome of the study would have been different if the vignettes had included individuals who have recovered from mental illness.

An editorial published in the November 2010 edition of The American Journal of Psychiatry:

By Howard H. Goldman, M.D., PH.D. [pictured]

Pescosolido and colleagues report on an interesting and informative study of public attitudes toward mental illness in this issue (1). They are the preeminent group of investigators working with the General Social Survey, a repeated survey of social attitudes of cross-sections of the U.S. population. Their data provide an empirical analysis of public attitudes toward mental illness using well-designed vignettes as stimulus material. The investigators systematically vary the characters in the vignettes to control for a range of sociocultural and demographic characteristics that might influence attitudes. However, the abnormal behaviors depicted in the vignettes, which present individuals with behavioral features of mental disorders, are both the strength and the weakness of the study.

The investigation tests the hypothesis that between the two observational time points—1996 and 2006, when mental health supplements to the General Social Survey were administered-public attitudes changed to favor a more scientific understanding of mental illness and that this change in understanding in turn is associated with two changes in attitudes. One putative change in attitude, associated with a more scientific—particularly a more neurobiological—conception of mental illness, is an increase in recommendations from those surveyed that the individuals in the vignettes should seek treatment. The other putative change is a decline in social stigmatizing attitudes about the individuals in the vignettes, particularly among respondents who view the illness as a manifestation of a neurobio-logical abnormality. Consistent with this hypothesis, those who attribute the abnormal behaviors to mental illness and those who increasingly view mental disorders as neurobiological are now more likely to endorse a referral for treatment. Contrary to the hypothesis, however, those with a more neurobiological understanding are also more likely to endorse socially stigmatizing and distancing attitudes about the people represented in the vignettes.

A theory of stigma reduction that motivates many of the antistigma interventions is that changes in attitudes about mental illness favoring a scientific understanding of specific disorders increase help-seeking behavior and that increased help-seeking behavior will lead to treatment that will reduce distress and dysfunction, promote recovery, and secondarily reduce social stigmatization. The mechanism for reduced social stigma is secondary to the effect of treatment in reducing the signs and symptoms of mental illness, which people perceive as alien and threatening. Thus, the behaviors are the source of stigmatization, and treatment makes them less visible or eliminates them. This recovery after treatment is not represented in the General Social Survey study vignettes. The responses to the vignettes tell us how people feel about individuals with active mental illness—not how they would feel about the more relevant vignette of an individual who has recovered from a mental illness. Admittedly, it is difficult to assess attitudes about an individual who has recovered from mental illness, because that individual has little or none of the abnormal behaviors manifest in the illness. A vignette of a normally behaving person who professes a previous history of mental illness would be the proper stimulus to determine the social stigma associated with an individual who has been successfully treated for a mental disorder. Indeed, the authors point out in the paper's discussion that the 1999 U.S. Surgeon General's report cautioned that acceptance of neurobiological causation alone might cause a backlash of stigma if it were not coupled with successful treatment of mental illness.

Despite this limitation, the study does tell us about some important attitudes and moderators of public opinion. The authors offer a wise warning that neurobiological explanations might not be a panacea for reducing stigma, but they may overstate the likelihood that such an approach will be stigmatizing. Given that many mental illnesses are only partially treated with current psychopharmacological and psychological interventions, widespread acceptance of a neurobiological understanding of mental illness may nonetheless usefully encourage further research funding and more financial support of treatment, as in the enactment of mental health parity legislation. We may not have eliminated social stigmatization of symptomatic individuals with mental illness, but improved treatment has helped many of them to make their symptoms and dys-function less visible and less problematic. Perhaps accordingly, we have seen dramatic increases in research funding, more service use, and better insurance coverage for treatment of mental disorders.

Footnotes

Editorial accepted for publication August 2010

Dr. Goldman reports no financial relationships with commercial interests.

Address correspondence and reprint requests to Dr. Goldman, Editor, Psychiatric Services, and Professor, University of Maryland School of Medicine; hh.goldman@verizon.net (e-mail).

Reference

1. Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, Link BG: "A disease like any other"? a decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry 2010; 167:1321–1330 [Abstract/Free Full Text]

Combating schizophrenia

Nature, one of the most prestigious science journals in the world, devotes its November 11th edition to schizophrenia:

Research has revealed daunting complexities in the psychiatric condition, but also new routes towards diagnosis and treatment.

A special collection of articles focuses on the challenges of schizophrenia, from spotting early symptoms during adolescence to changing the stigma associated with the disease.

Editorial

Combating schizophrenia
Research has revealed daunting complexities in the psychiatric condition, but also new routes towards diagnosis and treatment.

News

China tackles surge in mental illness
Psychological examinations added to selection procedure for government officials.

Features

The making of a troubled mind
Schizophrenia appears during adolescence. But where does one begin and the other end?

The drug deadlock
The biology is too complicated. Pharma companies are quitting. Where are schizophrenia drugs going to come from?

Comment

Short-lived campaigns are not enough
The stigma of mental illness will be reduced only if region-specific awareness initiatives become a permanent fixture of health and social services, argues Norman Sartorius.

Cognitive remediation therapy needs funding
More rigorous studies should be done on the effects of a therapy that seems to improve the everyday functioning of people with schizophrenia, says Til Wykes.

In retrospect: The five lives of the psychiatry manual
Roy Richard Grinker describes the military origins of the key reference work for diagnosing mental illness.

Audio

Nature podcast (24:36, Rethinking schizophrenia)
Thomas Insel, director of the National Institute of Mental Health, and Til Wykes, psychiatrist at Kings College London, talk about the symptoms, causes and best treatments for schizophrenia.

Perspectives

Rethinking schizophrenia
Thomas Insel, director of the National Institute of Mental Health, calls for schizophrenia to be emphasized as a neurodevelopmental disorder in which psychosis is a late — and potentially curable — stage.

From maps to mechanisms through neuroimaging of schizophrenia
Andreas Meyer-Lindenberg, director of the Central Institute of Mental Health, Mannheim, explains how neuroimagng and other systems-level techniques can help develop future treatment.

The environment and schizophrenia
Jim van Os, Gunter Kenis and Bart Rutten review our knowledge of the environmental factors that influence schizophrenia risk, and the major challenges that will be involved in teasing them out.

Image credit: The cover artwork is by Rodger Casier and NARSAD Artworks, a non-profit organization that showcases artists with mental illness. Proceeds from the art go to the research-funding body NARSAD.

Psychosis - Fact Sheets

From the Early Psychosis Prevention and Intervention Centre:

Fact Sheets

These fact sheets, in English, and 10 linguistically diverse languages, provide information specific to early psychosis. The information is most useful for young people, their family and friends. Anyone can print these fact sheets out and distribute them. The fact sheets provide information about the different types of psychotic disorders, and the phases of assessment, treatment, and recovery.

• What is psychosis?
• Getting help early
• Recovering from psychosis
• How can I help?
  

These information sheets are also available in other languages.

• French
• Arabic
• Croatian
• Greek
• Italian
• Serbian
• Spanish
• Turkish
• Vietnamese
• Simplified Chinese
• Traditional Chinese

Click here to go to the Free Downloads page

Advocates for the Not Criminally Responsible Schizophrenia Sufferers (ANCRSS)

From the Schizophrenia Society of Ontario website:

ANCRSS (pronounced anchors) is a program under the Schizophrenia Society of Ontario which operates as a Canadian based e-mail support group. Our members have a family member or loved one who suffers from schizophrenia, bipolar or clinical depression. They have come into conflict with the law as a result of their illness and have become involved in the forensic/criminal justice system.

They may be:

• Detained in custody in a detention center pending court remands.

• Waiting for court ordered assessments for fitness for trial and/or criminal responsibility.

• Found guilty or not guilty of summary convictions or indictable offences.

• Deemed Not Criminally Responsible for their actions on account of a mental disorder (NCR).

This confidential provincial network of friends and supportive relationships is offered through the use of e-mails and telephone calls without having to leave our urban or rural homes. We provide our members an understanding, empathetic ear. We provide information and support, to help them deal with the challenges of difficult life situations and social stigma. The acronym is intended to signify the stability offered by the group to each other and indirectly, to our loved one. Membership is free and offered by invitation in a non-listed private e-mail group for any involved family members who wish to apply.

ANCRSS offers an opportunity for family members to become empowered through education on the issues surrounding mental health and the laws that govern care and provides opportunities to become involved in:

• Advocacy issues in pertinent medical and legal areas.

• Breaking down barriers of stigma.

• Helping others overcome feelings of isolation and powerlessness.

ANCRSS promotes the "human needs perspective" on neurobiological brain disorders.

For more information, support or to join our email group contact ANCRSS@gmail.com.

"The anchor is a symbol of a well-grounded hope. As the anchor was often a seaman's last resort in stormy weather, it was frequently connected with hope. Being made of a solid body, the anchor was also identified with firmness, solidity, tranquillity and faithfulness. The anchor remains firm and steady amidst the stormy waters, symbolizing the stable part of a human "storms" of life. Therefore the anchor keeps us steady in the storms of temptation, affliction, and persecution."

This explanation of the symbolism of the anchor fits well for us.

B.C. Plan Focuses on Healthy Minds, Healthy People

Please click on the image to magnify it.


A November 1st media release from the Government of British Columbia:

VANCOUVER – The Province today released a 10-year plan to address mental health and substance use with a focus on prevention of problems, early intervention, treatment and sustainability.

“The 10-year plan is a road map to further build on our commitment to improving mental health for all British Columbians and addressing problematic substance use,” said Health Services Minister Kevin Falcon. “Government now spends over $1.3 billion annually – up 47 per cent from 2001 – to address mental health and substance use problems and we need to ensure dollars are aligned with leading practice and best evidence.”

Entitled Healthy Minds, Healthy People, the cross-ministry plan reflects both extensive public and stakeholder consultation and evidence-based research and practice. It is aligned with existing child, youth and adult mental health and substance use strategies across the province, as well as the national mental health framework.

Healthy Minds, Healthy People places a strong emphasis on children and families, based on research that shows that early engagement and access to targeted supports can prevent or reduce mental illness and substance use problems later in life.

“We know that mental health problems frequently originate in childhood, and that early intervention at a young age can help prevent future illness,” said Children and Family Development Minister Mary Polak. “A strong foundation in childhood sets the course for a healthy, fulfilling and productive life. The Ministry of Children and Family Development spends over $100 million annually on a continuum of child and youth mental health services for children up to age 19 and their families.”

The indirect costs of mental illness and/or substance use are also significant. Nationally, mental illness is estimated to cost the Canadian economy around $51 billion annually in lost productivity. B.C.’s proportional share of this burden would be more than $6.6 billion each year. Indirect annual costs of lost productivity related to alcohol use alone are estimated at $1.1 billion.

Healthy Minds, Healthy People acknowledges that mental illness and problematic substance use can affect people of all ages from all walks of life in school, work and at home. Around one in five adults in B.C. are affected by mental health or substance use problems over any twelve-month period. However, the stigma associated with these problems often means people do not seek out and receive the supports and services they need.

“The B.C. plan to address mental health and substance use reaches out to people at home, in school and at work,” said Michael Kirby, chair of the Mental Health Commission of Canada. “British Columbia’s plan focuses on prevention, early intervention as well as treatment. The commission congratulates the B.C. government for this comprehensive and innovative approach. We are proud to be working together toward the common goal of transforming the mental health system and improving the lives of everyone affected by mental health problems.”

Programs and services that promote maternal and family health and healthy early childhood development are crucial in prevention and early intervention.

As part of the continuum of supports and services to address mental health in children, the FRIENDS For Life program is an example of an evidence-based prevention program that increases resiliency and prevents anxiety available to grades 4, 5 and 7 students. Teachers and parents are educated about the prevalence, signs and impact that anxiety has on children and youth and learn skills to build children’s resilience and address the early signs of anxiety. FRIENDS in B.C. is funded and co-ordinated by the Ministry of Children and Family Development in partnership with school districts around the province.

Since its provincial launch in 2004, all school districts have participated, as well as many independent schools. Over 3,000 educators have been trained to deliver FRIENDS in classrooms, and more than 1,000 parents and caregivers have attended FRIENDS parent workshops – helping to increase mental health literacy in schools, families and communities.

“The FRIENDS program teaches children how to cope with fears and worries and equips them with tools to help manage difficult situations, now and later in life,” said Jonaire Bowyer-Smyth, a behaviour specialist in the Surrey school district and FRIENDS program trainer. “The FRIENDS program is fun learning for kids and will benefit them, their parents and their entire family.”

The plan will achieve results by realigning current resources to invest in what is proven to work, and linking with existing programs and projects across government to increase efficiency and effectiveness.

“We need to learn from the evidence and provide effective and efficient services to achieve the best outcomes for people,” added Falcon. “We need to stop doing what doesn’t work in favour of what does and to ensure services are evidence-based and cost-effective.”

The Province is focusing on delivering programs more efficiently and effectively, including:

• No waitlists at BC Children’s Hospital Eating Disorders program due to business process redesign.

• Video-conferencing for training and clinical consultation on community Child and Youth Mental Health teams to improve access to evidence-based treatment.

• A project underway to improve patient flow for adult clients with mental health and substance use problems at six Vancouver Coastal Health hospitals.

In addition, projects like the Homelessness Intervention Project and the Prolific Offender pilots show how better integration can enhance services without new dollars.

“Intervention and front-line outreach, to ensure B.C.’s most vulnerable citizens have access to supportive housing, is a crucial element to ending the cycle of challenges associated with mental illness and addictions,” said Social Development Minister Kevin Krueger. “The province has Homelessness Intervention Projects in five communities and 58 Homeless Outreach programs in communities throughout B.C. which have made a tremendous difference in over 770 people’s lives during the first few months of 2010 alone.”

Improvements in addressing mental health and substance use in B.C. include:

• 75 per cent more community beds for adults with mental health problems since 2001 for a total of 8,662 beds.

• Opening the 100-bed Burnaby Centre for Mental Health and Addiction to treat those with the most severe mental health and addiction issues.

• 182 per cent increase since 2003 in community beds for people with substance use problems to 2,550;

• Increasing the number of family doctors providing mental health and substance use services from 4,194 in 2001 to 4,574 in 2008-09.

• Being the first province in Western Canada to have dedicated withdrawal management beds for youth – there are currently 39.

• In 2003, B.C. became the first province to establish and then implement a Child and Youth Mental Health Plan that doubled the funding and significantly increased access to an enhanced continuum of services and supports.

Healthy Minds, Healthy People can be downloaded at: www.health.gov.bc.ca/library/publications/year/2010/healthy_minds_healthy_people.pdf.

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Three backgrounders follow.


Media Contacts:

Michelle Stewart
Communications Director
Ministry of Health Services
Public Affairs Bureau
250 952-1889

Christine Ash
Media Relations
Ministry of Children and Family Development
250 356-1639

To read the backgrounders, please click here (PDF).

New Medication Approved in the US for Schizophrenia

A November 1st posting by PsychCentral:

By Rick Nauert, PhD, Senior News Editor

Reviewed by John M. Grohol, Psy.D., on November 1, 2010

The U.S. Food and Drug Administration has approved Latuda (lurasidone HCl) tablets for the treatment of adults with schizophrenia.

“Schizophrenia can be a devastating illness requiring lifelong treatment,” said Thomas Laughren, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research.

“Some patients do not respond well to certain types of drug therapy, so it is important to have multiple treatment options available.”

Latuda is included in the atypical antipsychotic class of drugs. All atypical antipsychotics contain a boxed warning alerting prescribers to an increased risk of death associated with off-label use of these drugs to treat behavioral problems in older people with dementia-related psychosis.

No drug in this class is approved to treat patients with dementia-related psychosis.

Four six-week controlled studies of adults with schizophrenia demonstrated the effectiveness and safety of Latuda. In the trials, patients treated with Latuda had fewer symptoms of schizophrenia than those taking an inactive pill (placebo).

The most common adverse reactions reported by those in clinical trials were drowsiness, feelings of restlessness and the urge to move (akathisia), nausea, movement abnormalities such as tremors, slow movement, or muscle stiffness (Parkinsonism), and agitation.

Source: U.S. Food and Drug Administration

Province Hosts First Atlantic Mental Health Summit

An October 29th media release from the Nova Scotia Department of Health:

Health representatives from the Atlantic provinces gathered in Halifax this week for the first Atlantic Mental Health Summit.

They have been discussing ways the provinces can work together and raise the profile of mental health issues at all levels of government. During the summit they have also heard from national and international experts.

Health Minister Maureen MacDonald [pictured] offered to lead the summit at the Atlantic health minister's meeting in January.

"The great thing about a summit like this is we gather from all walks of life, social workers, practitioners and experts to share ideas and best practices," said Ms. MacDonald during her opening remarks. "The knowledge that is shared here will help us make the right decisions for our province's mental health strategy, as we work to provide better care, sooner."

Delegates are participating in sessions and workshops to discuss mental health and homelessness, child and youth mental health, mental health promotion and prevention, public policy and a national strategy.

One in three Canadians experience mental illness in their lifetimes, and many more are directly or indirectly affected through their relationships with friends, family and co-workers.

The province announced the 12 members of the Mental Health Strategy Advisory Committee in September to help fulfill a commitment to revamp mental health and addiction services.

The summit ends today, Oct. 29.


FOR BROADCAST USE:

Health representatives from the Atlantic provinces are meeting in Halifax this week to discuss ways to work together and raise the profile of mental health at all levels of government.

Health Minister Maureen MacDonald offered to lead the summit at the Atlantic health minister's meeting in January. She says it's a perfect opportunity to share new ideas and best practices in mental health care.

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Media Contact:

Nicole Brooks
Department of Health
902-424-2608
E-mail: brooksnl@gov.ns.ca

Two representatives from the Schizophrenia Society of Nova Scotia participated in the Atlantic Mental Health Summit. They were Stephen Ayer, Executive Director, and Cecilia McRae, President.

To view the Atlantic Mental Health Summit agenda, please click here (PDF).

Photo credit

Open Groups - Bayers Road Community Mental Health

The list below is up-to-date as of August 10th, 2010.


Please click on the image to magnify it.

For further information, call Bayers Road Community Mental Health at (902) 454-1400.