Capital Health changes guards

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

Paladin to take over from RMAC, commissionaires

By Brian Medel

Most Capital Health hospitals will be protected by a new security company beginning Oct. 1.

Paladin Security, Canada’s largest supplier of health facility security, will begin a five-year contract that will cost Capital Health more than $18 million, paying out $3.63 million annually, said a recent notice to staff.

Capital Health now pays about $3 million annually for security, spokesman Peter Graham said Thursday.

The existing contract with two suppliers, RMAC Security and the Nova Scotia division of the Canadian Corps of Commissionaires, will expire Sept. 30.

"We did go out with a (request for proposals) earlier this year," said Graham.

The existing security providers did submitted bids.

"Neither of them were successful," said Graham.

The memo to staff said "RMAC Security and the Corps of Commissionaires have provided us with quality service, for which we are very grateful."

The current security providers will be on the job until midnight Sept. 30, when Paladin Security will take over.

About 100 security officers, 78 of whom are commissionaires, work in Capital Health buildings.

Security staff employed by either the Corps of Commissionaires or RMAC Security will be given opportunity to apply for positions with Paladin, with interviewing and hiring expected to begin almost immediately, said the memo.

The job search website now-hiring.ca said Paladin Security held a job fair in Halifax over two days last week at the Lord Nelson Hotel & Suites, where the company recruited health-care security officers.

Paladin recently opened an office on Spring Garden Road in Halifax.

Two hospital departments that have special security needs are the mental health and emergency units.

Paladin managers will meet with staff from the emergency and mental health departments to ensure the transition is smooth. All Paladin staff receive training that enable them to work in mental health and emergency settings, said the memo.

Health-care security is different from all other types, often involving aggressive patient behaviour, said Leo Knight, chief operations officer with Paladin Security.

"We’re about halfway through our (hiring) process, so we’re probably looking for another 50 to 60 people," Knight said Thursday from Vancouver.

"We got into the Nova Scotia market by doing an acquisition of a local company. . . . Reliant (Security Services)."

It was not a requirement to work here, he said.

"We were coming to the Nova Scotia market anyway. We’re the largest full-service security provider in Canada and we’re the fourth-largest guard company in the country.

"We’re the largest provider of health-care security in the country."

Paladin provides security for every hospital in Alberta and many in British Columbia and Ontario, he said.

Col. Mike Brownlow, chief executive officer of the Nova Scotia division of the corps, said the organization has provided security at Halifax hospitals for many years.

"We’re extremely disappointed, as you can imagine," Brownlow said about not being retained.

"Our relationship has always been a very positive one,"

He said the corps was always concerned with the safety of staff, patients and visitors.

The corps must now look for alternate employment for the 78 veterans hired to work at Capital Health, Brownlow said.

Most commissionaires are military veterans, with some coming from RCMP and municipal police force backgrounds.

Of the 1,700 commissionaires in Nova Scotia, 1,200 are in the Halifax area.

"We’re presently engaging in getting them all placed in different locations," said Brownlow. "There’s a number of them that are retiring.

"Our main mandate is to get employment for veterans."

(bmedel@herald.ca)

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Police learn to use words instead of force

An August 23rd posting by bryancountynews.net:

A recent Crisis Intervention Team graduate went to work one day earlier this month, expecting just another day on the job, but the situation he faced could have ended in violence had he not been part of Georgia’s CIT training program.

The CIT-trained police officer recently shared his story:

“We were called to a situation where a male was physically abusing his mother. He had been drinking and was armed with a gun. The individual was known to be schizophrenic and had been noncompliant with his treatment,” the officer said. “Using our CIT training skills, we de-escalated the situation and got him to give his gun to us. I couldn’t believe it. We had just graduated the week before from CIT training.

“Through the intervention skills we learned, we were able to bring a safe conclusion to this potentially deadly situation for the mother, the individual and our team.”

Law enforcement from the sheriffs’ offices of Tattnall, Toombs and Bulloch counties, along with the police departments of Pembroke, Glennville, Reidsville, Vidalia and Baxley, spent 40 hours in CIT training to help them effectively and humanely interact with persons affected by mental illness, developmental disabilities, Alzheimer’s disease and addictive diseases.

Since 2004, the Georgia CIT program has sought to equip Georgia law-enforcement officers with the skills to recognize and assist people with behavioral-health disorders in crisis, thereby advancing public and citizen safety and reducing stigma, according to a news release.

The recent training class was hosted Aug. 8-12 by the Tattnall County Sheriff’s Office and staffed by local Georgia Association of Community Service Boards member Pineland MH/DD/AD, with assistance from NAMI.

It included clinical classroom instructions, practical de-escalation role-play exercises, experiences of consumers and family members and site visits to Pineland facilities.

The training covered a variety of subjects, including understanding and preventing suicide, signs and symptoms of mental illness, de-escalation techniques, legal issues and mental health law, addictive diseases and child and adolescent interventions.

“CIT is vital for law enforcement to take part in, and our goal is to have our whole team trained,” Capt. Kevin Keyfauver of the Tattnall County Sheriff’s Office said. “On a day-to-day basis, we not only encounter individuals on calls that may be experiencing behavioral issues, but we also regularly transport individuals to our community mental-health care facilities. CIT helps our team learn how to use words instead of force when diffusing situations. It makes it safer for everyone involved.”

Through Georgia CIT partnerships, more than 4,000 law enforcement officers have received special training since the program’s inception.

“The specialized training of CIT enables officers to better understand and relate to individuals with mental disabilities or disorders when in the field,” said GBI Special Agent Debbie Shaw, CIT coordinator for state law enforcement. “This program brings law enforcement, mental-health providers and the community at large together to provide the best service possible to all its citizens.”

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Rochester group launches website devoted to schizophrenia

An article posted on August 22nd by the Rochester Democrat and Chronicle:

By Michael Zeigler

A Rochester-area organization that raises money for research and education about schizophrenia is marking its 25th anniversary by taking to the Internet.

CARES (Committee to Aid Research to End Schizophrenia) has launched cares-web.com, a website offering information about the complex mental disorder that can cause depression, delusions and paranoia.

The site includes more than 100 videos by medical professionals about symptoms, diagnosis and treatment; the emotional impact on families; dealing with stigma; and community resources for families and caregivers.

Beginning this fall, the site also will include "CARES Corner," a monthly feature in which viewers can interact with health professionals on specific subjects.

"We'll be able to reach hundreds and thousands more people than we have before," said the organization's president, John Delehanty of Penfield.

CARES was started in 1986 by Barbara Swigert of Penfield after her daughter was diagnosed with schizophrenia.

Since then, the organization has held fundraisers and donated $250,000 to assist more than 90 research projects.

CARES had planned this year to end large fundraising events, such as golf tournaments, because its members were aging.

The group still planned to accept donations, however.

But at a luncheon in June, Dr. J. Steven Lamberti, a professor of psychiatry at the University of Rochester Medical Center, and health educator Thomas Conant unveiled a proposal to develop a website that would be a resource for people with schizophrenia and their families, Delehanty said.

The organization agreed and the site was up and running by early August.

The website includes a donation function. The organization also will continue its plans to conduct mail-in fundraisers, Delehanty said.

MZEIGLER@DemocratandChronicle.com

A Moment of Silence for Kelly Thomas in Beverly Hills

Also see:

Kelly Thomas' father fights for justice

The Canadian Medical Association Awards Medal of Honour to Dr. Austin Mardon

An August 16th media release from the Canadian Medical Association:

OTTAWA, Aug. 16, 2011 /CNW/ - The Canadian Medical Association (CMA) will present the 2011 CMA Medal of Honour to Dr. Austin Mardon, PhD, who has demonstrated outstanding public commitment to raising awareness of mental health issues and diminishing the stigma and discrimination faced by Canadians living with mental illness.

"The CMA Medal of Honour recognizes personal contributions to the advance of medical research and education," said CMA President Dr. Jeff Turnbull. "Dr. Mardon has worked tirelessly to help Canadians better understand the issues around mental illness. In courageously talking openly about his own experiences, he is truly making a difference in coaxing mental illness out of the shadows in this country."

Diagnosed with schizophrenia at the age of thirty, Dr. Mardon uses his own experience and his road to recovery in advocating in the areas of stigma, service delivery, awareness and education. He tries to improve the lives of those with schizophrenia through public education. His efforts have led him meet with politicians, clergy, academics and others in positions to effect change. He has influenced public policy in Alberta through his service as vice-chair of the Alberta Disabilities Forum steering committee and as chair of its low-income working group; as a member of the Premier's Council on the Status of Persons with Disabilities; as an addiction and mental health committee member of Alberta Health's service integration working group; and as chair of the Edmonton Champions' Centre advisory committee. He also was instrumental in winning changes to Alberta's income assistance program for the severely handicapped.

"I have put my experiences out there for all to see, but it hasn't been easy and for some people it's impossible," said Dr. Mardon. "My goal continues to be to see the unfair and debilitating stigma our society holds against the mentally ill wiped out for all time."

Austin Mardon, PhD, has been a public educator and tireless advocate for the mentally ill, particularly those with schizophrenia, since he was diagnosed with that illness in 1992. At the time he was a promising graduate student and Antarctic explorer, and the diagnosis of schizophrenia could have ended his academic career and severely limited his prospects in life. Instead, he survived many setbacks through his sheer determination to continue his studies, to make a difference, to contribute to society, and to help others.

Dr. Mardon graduated with a major in geography from the University of Lethbridge in 1985. The following year, at age 24, he was investigating meteorite impacts 170 km from the South Pole as a junior field member on an Antarctic meteorite recovery expedition sponsored by NASA and the National Science Federation. He received the U.S. Antarctic Service Medal for his work. However, the extreme hardships of the expedition affected him mentally and physically. While he went on to earn masters degrees in science (South Dakota State University) and education (Texas A&M University) and published a number of articles and books, his health issues persisted. At the age of 30 he was diagnosed with schizophrenia.

Although some of his abilities are compromised by the disease, he earned a PhD in geography from Greenwich University, Australia; continued his remarkable publication record, including articles in both Science and Nature; was elected an International Fellow and Corresponding Fellow of the Explorers Club of New York; and was inducted into the International Academy of Astronautics.

Equally impressive has been his work on behalf of the mentally ill. In addition to giving countless interviews to the media on the topic of mental illness, he has published articles about faith and schizophrenia, homelessness, medication, and income support. He has provided leadership as a member of the board of directors of both the Edmonton and Alberta chapters of the Schizophrenia Society, and for a number of years he was coordinator of the Alberta Mental Health Self-Help Network.

"I hope to soon see the day when schizophrenia is treated like any other disease and is finally detached from the stigma that makes a difficult burden to bear even worse," added Dr. Mardon.

Dr. Mardon has received a number of awards, including the Order of Canada (2007). Others include: the Flag of Hope Award (2001) and the Bill Jefferies Family Award (2007) of the Schizophrenia Society of Canada; the Distinguished Alumni Award of the University of Lethbridge (2002); the Presidents Award of the Alberta chapter of the Canadian Mental Health Association (2002); the C.M. Hincks Award from the national division of the Canadian Mental Health Association (2007); and the Medal of Honour of the Alberta Medical Association (2010).

A popular member of the Speakers' Bureau of Alberta, Dr. Mardon has publicly assisted the medical profession by supporting development of policy positions that have helped medical providers treat those with mental illness.

Dr. Mardon is the 28th recipient of the CMA Medal of Honour, the highest award bestowed upon someone who is not a member of the medical profession. He will receive the award at a ceremony at the D.F. Cook Recital Hall, Memorial University, in St. John's, N.L., on Aug. 24 as part of the CMA's 144th annual meeting.

For further information:

Lucie Boileau, Manager, Media Relations
Tel: 613-731-8610 or 1-800-663-7336 ext. 1266
Mobile: 613-447-0866
lucie.boileau@cma.ca

Photo credit

Also see:

Austin Mardon to receive honorary Doctor of Laws degree from University of Alberta

Austin Mardon on Schizophrenia

Government cuts hurt people with disabilities

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

By Wayne MacNaughton [pictured]

Last week, the government announced that it was "clarifying" the rules around "special needs" for people living in poverty (re: "Social assistance won’t cover pot," Aug. 10). However, the news coverage thus far has failed to explain the scope and severity of the government cuts that have occurred, and the fact that they will hurt people living with disabilities, on fixed incomes, who cannot afford to pay for their own medical needs.

Far from simply "clarifying" the previous law, the amendments significantly reduce government assistance for essential health needs. In addition, people will be subject to a cookie-cutter approach: If their need does not fall within a pre-existing list, it will not be considered, no matter how essential for health or necessary to alleviate pain and suffering. The government cuts were made without notice, public consultation or input from health or disability rights groups.

The cutback on special needs will have a number of repercussions. On an individual basis, it will undermine people’s health, and increase pain and suffering. This is not good for society, but in addition it will increase the social burden on the health care system, as people struggle with poorly managed medical conditions and illnesses without access to the services they need.

People who had no other alternatives, who had a recommendation from their doctor and needed medication or other services to alleviate pain and suffering, or because it was essential to their health, could apply for "special needs" assistance. As a result of government amendments to the law, that access to those medications and services is now no longer available.

The Department of Community Services has suggested the cuts won’t have a big impact. But ask any person with disabilities who needs to pay higher rent to obtain allergen-free housing, or needs to meet the cost of the only medication that works but isn’t on the list of approved medications, or needs access to counselling for post-traumatic stress, and they will tell you these needs are essential, not frills.

Let’s look at the single biggest justification the government relies on in making these cuts: medical marijuana. Medical marijuana is prescribed by doctors for pain management. Patients who are permitted to use medical marijuana do so on a doctor’s recommendation, under a licence from Health Canada, where no other method or drug for pain management has worked. In denying access to medical marijuana, the government forces people back to reliance on Dilaudid and Oxycontin, drugs that have many more side effects and fewer positive individual outcomes, and have been the subject of inquiries and concerns regarding social costs and addictions. Big Pharma wins, and people with disabilities lose and the rest of us see Pharmacare costs escalate.

Don’t believe the government’s portrayal of "special needs" requests as frivolous wastes of taxpayers’ money. Under the previous regulations, needs that are "essential to health" and "necessary to alleviate pain and suffering" were recognized as "special" and people living in poverty were forced to meet a stringent test to qualify for assistance. These were needs that many of us take for granted because they are essential for health. (In an era when people are trying to decide whether to buy an iPhone 5 when they come out this fall, recipients of social assistance are not even given funding to have a basic telephone in order to look for a job.)

Why is the government cutting back on essential health services for people with disabilities? Figures cited by Community Services in a media release identify only 20 to 25 cases. The release fails to provide comparison figures for increases to other, already listed special needs and Pharmacare (formulary costs), or what we can expect in increased costs to the Pharmacare program and other health services as a result of these cutbacks. The auditor general’s report cited in the release criticizes government accounting procedures, but makes no recommendations concerning the merit of the requests and cannot be interpreted to justify these cutbacks.

Special needs assistance must be restored. When the law was introduced in 2001, special needs for people with disabilities was described as the "cornerstone" of the program. That cornerstone needs to be rebuilt, and fast, to avoid pain and suffering and protect the right to health of all Nova Scotians — including those living with disabilities.

Wayne MacNaughton is an anti-poverty activist living in Halifax.

Photo credit

Also see:

Critics slam changes to special-needs funding

Clear, Consistent Access to Special Needs Funding for People on Income Assistance

Welfare Rights Guide

Income Assistance and Nutrition: Are You Getting What You Need?

Mental Health Commission of Canada - 2010/2011 Annual Report

Please click on the image to magnify it.

An email from the Mental Health Commission of Canada which the SSNS received today:

Hello,

On behalf of the Mental Health Commission of Canada (MHCC) I am pleased to present the English and French versions of our 2010-2011 interactive annual report.

Together we can. It is our theme this year because our accomplishments are due in large part to collaboration with a wide variety of individuals, groups and organizations. Alongside our partners we worked to promote mental health, reduce stigma and improve services and supports. With our hundreds of partners, we are helping to make mental health a priority for all Canadians.

MHCC Annual Report

Our Annual Report outlines the significant progress we have made towards achieving our goals. Among other updates, readers will learn that we have now housed hundreds of people in five Canadian cities through At Home/Chez Soi – our national research project on mental health and homelessness. We have now trained over 20,000 people across the country in Mental Health First Aid. This represents an increase of over 100% since it became an official MHCC program in 2010. These are just two milestones made possible through support from the Government of Canada.

I hope you will find this document engaging and informative and will enjoy flipping through its pages. Please forward it along to your colleagues, friends and families. I look forward to your feedback.

Yours sincerely,

Louise Bradley
President and Chief Executive Officer

To download the PDF version of the MHCC Annual Report, please click here.

Clear, Consistent Access to Special Needs Funding for People on Income Assistance

An August 8th media release from the Nova Scotia Department of Community Services:

Clearer regulations now make it easier for income assistance clients to understand what special needs funding they can receive, and ensure funding decisions are consistent and fair province wide.

The amended Employment Support and Income Assistance Regulations Around Special Needs funding take effect today, Aug. 8.

"We know that some people on income assistance have special needs and often need help with medical issues, or even to get to work," said Community Services Minister Denise Peterson-Rafuse [pictured]. "We are committed to meeting those needs, and have been increasing our budget to do so.

"At the same time, the criteria for receiving special needs funding must be clear, fair and consistent so that people are treated the same no matter where they live."

Over the past two years, the department has increased the special needs budget by 15 per cent, or about $6 million, bringing the total investment in funding to more than $45 million. These funds are intended to help income assistance clients with medical and employment-related special needs.

Over the years, the department has received special needs requests for items and services like hot tubs, gym memberships, and humming touch therapy. These were never intended to be covered under special needs, but because the regulations were not clear, about 20-25 of these requests were approved either by a caseworker or through an appeal.

The department has also received a number of special needs requests for medications and substances, such as medical marijuana. The amendments now make it clear that Community Services can only cover medically related items and services that are covered by MSI or listed on the Nova Scotia Pharmacare Formulary. This is consistent with how other provinces handle requests for medical marijuana.

The amendments are also consistent with recommendations from the auditor general who said clear systems and controls must be in place to ensure special needs funding is being spent as intended, which is to fairly meet the needs of income assistance clients.

The change only affects new applications for special needs funding received after Aug. 8. Income assistance clients now receiving special needs funding will continue to do so as long as the special need exists.

In addition to the more than $45 million invested in the Employment Support and Income Assistance Special Needs program, the department is also investing an additional $18.25 million this year to help income assistance clients and low-income Nova Scotians make ends meet. These include a 22 per cent increase per child, per month to the Nova Scotia Child Benefit, a $15 per month increase in the Income Assistance Personal Allowance, indexing the Affordable Living Tax Credit and the Poverty Reduction Credit to keep up with inflation, and allowing working income assistance clients to keep more money each month.

FOR BROADCAST USE:

Clearer regulations now make it easier for income assistance clients to understand what special needs funding they can receive, and ensure funding decisions are consistent provincewide.

Community Services Minister Denise Peterson-Rafuse says the criteria for receiving Special Needs funding must be clear, fair and consistent so that people are treated the same no matter where they live.

Community Services invests more than $45 million in special needs funding annually. The funds are intended to fairly meet the special needs of all income assistance clients.

The amendments now make it clear that Community Services can only cover medically related items and services that are covered by MSI or listed on the Nova Scotia Pharmacare Formulary.

The change only affects new applications for funding received after August 8th. People now receiving special needs funding will continue to receive it as long as the need exists.

-30-

Media Contact:

Susan Tate
Community Services
902-424-4038
E-mail: tatese@gov.ns.ca

Image credit


Also see:

Employment Support and Income Assistance Policy Manual (PDF) (Chapter 6 - Special Needs, pages 106 to 150)

Employment Support and Income Assistance Act

Employment Support and Income Assistance Regulations

Assistance Appeal Regulations

New mental health treatment worth fighting for

An opinion piece published in yesterday's edition of the Daily Record:

By Valerie Fox

I had planned to write about involuntary outpatient commitment (IOC) once it was finally up and running in New Jersey, but the editorial in the July 28 Daily Record (“Treatment funding is a good investment”) has prompted me to write at this time.

When Governor Corzine signed IOC into law, I was invited to the bill signing. Cathy Katsnelson [pictured], a Burlington County woman who lobbied for the new law, introduced herself to me. I felt honored. We both expressed our joy that, after many years, IOC was finally law. Over the years at legislative hearings in Trenton, I would hear Ms. Katsnelson testify as a mother who lost her son because of untreated mental illness. I am very pleased the IOC law is called “Gregory’s Law.”

I am not a family member. I am a person who has lived with schizophrenia since first being diagnosed in 1963. I have been fortunate that I can function pretty well, as long as I take my medication and take care of myself both physically and mentally.

Over the years, I only had one very severe setback, which changed the course of my life forever. I stopped taking my psychiatric medication for what I thought was a good reason — against the advice of my psychiatrist. I tumbled into homelessness and untreated schizophrenia for a two-year period.

A healthy, normal person cannot imagine living homeless in a schizophrenic state. It is not pretty. It is very dangerous to oneself and possibly others. Voices were my guide during this period. As a result, some decisions I made were risky. I was very vulnerable and I suffered tremendously. When I regained my health, I had to reconcile my healthy self with the trauma of living exposed with untreated mental illness. It was difficult. Good mental health supports helped me tremendously.

Almost immediately after I stabilized, I heard about involuntary outpatient commitment and knew I would advocate very hard to bring this treatment option to New Jersey because I believed it could help others from living with untreated mental illness that put themselves and possibly others in danger.

My first testimony was at least 20 years ago. Many mental health advocates were and still are against this treatment. It is my belief that, if any of these advocates lived the horror of untreated schizophrenia or other severe mental illness and homelessness, their opinions would change quickly — if they were lucky enough to have treatment and regain mental health.

Finally, IOC became law in 2009. Proponents of IOC had given the Legislature a good picture of untreated mental illness and the law passed unanimously.

Since the passage of IOC, unfortunately, it has faced a number of pitfalls. Implementation was stalled because the Department of Human Services waited until the day of supposed implementation to state there was no money allocated for it. IOC has been discussed in private, invitation-only meetings. I believe some who were invited were agaist involuntary commitment. I was not invited, even though I advocated tirelessly in an appropriate manner for IOC.

I once sat at a mental health conference at which a high-ranking state mental health administrator told a roomful of impressionable people that, while he does not want to implement IOC, it is law and he has to do it. It would have been so much better to say that he hoped IOC could make a difference in someone’s life. I further think $2 million will be too little money to do an adequate job of effectively rolling IOC out.

It is my hope that, when all the negative rhetoric about this treatment is proven untrue and some mentally ill people avoid the inevitable collision course of homelessness and voices because of this treatment, that those who have been so adamantly against IOC will see they did not fully understand the dangers that IOC can prevent — including violence, death and physical illness.

Photo credit

Also see:

Schizophrenia, Medication, and Outpatient Commitment

Personal Accounts: Schizophrenia and Socialization

OneInFive.ca - A Focus on Psychosis

To read more, please visit OneInFive.ca.

Also see:

Nova Scotia Early Psychosis Program

Nova Scotia Housing & Homelessness Network - First Annual Provincial Housing Conference

Tuesday & Wednesday, November 22nd & 23rd!

Please click on the image to magnify it.

From an email received from the Nova Scotia Housing & Homelessness Network on August 4th:

Theme: Fast Forward

The Conference will be an opportunity to strengthen the non-profit, private and public housing sectors by bringing together leaders from across the Atlantic Provinces. This event will be a leading regional resource, attracting a full spectrum of people living in and working within the affordable housing industry - people who are committed to advancing what Nova Scotians have asked for in their communities – safe and affordable housing.

Beginning on Tuesday, November 22nd, National Housing Day, the programme will include:

• Launch of the Nova Scotia Housing & Homelessness Network

• Plenary Session

• Keynote Speakers

• “Meet the Dragons” - bring your development project ideas to our expert ‘Dragons’ panel for qualified expert advice

• Open Space workshops

• Award Luncheon and Dinner

• Book Launch

Further programme details will be posted as they become available.

Who should attend?

Everyone involved in the housing industry, particularly builders and developers, finance specialists, policy-makers, municipal, provincial and federal government representatives, both elected and appointed, as well as those involved in community grassroots efforts to promote affordable housing:

• Architects and HRM city planners

• Housing authorities

• Affordable energy associations

• Neighbourhoodgroups

• Affordable housing advocates

• Professional associations

• Public agencies

• Service and shelter providers

• Sustainable development experts

• Tenants/subsidized housing consumers

Sponsors/Partners:

Canadian Mortgage and Housing Cooperation (CMHC)

Conference Program Planning Committee

• Network Steering Committee

• email the Committee

Overview - Mental Health Commission of Canada

Overview of the Mental Health Commission of Canada as posted on LinkedIn:

People living with mental illness have the right to obtain the services and supports they need. They have the right to be treated with the same dignity and respect as we accord everyone struggling to recover from any form of illness.

The goal of the Mental Health Commission of Canada is to help bring into being an integrated mental health system that places people living with mental illness at its centre.

To this end, the Commission encourages cooperation and collaboration among governments, mental health service providers, employers, the scientific and research communities, as well as Canadians living with mental illness, their families and caregivers.

The organization of publicly funded mental health services and supports to the general population is the responsibility of each provincial and territorial government, not of the Commission.

The Mental Health Commission of Canada will:

• Be a catalyst for the reform of mental health policies and improvements in service delivery;

• Act as a facilitator, enabler and supporter of a national approach to mental health issues;

• Work to diminish the stigma and discrimination faced by Canadians living with mental illness;

• Disseminate evidence based information on all aspects of mental health and mental illness to governments, stakeholders and the public.

United front on mentally ill urged

An article published in the July 19th edition of the National Post:

By Joseph Brean

Canada needs a "dynamic, broadly based social movement" to improve its citizens' mental health, a "whole of government" approach that unites everyone from political leaders to "experts by experience," says a national strategy five years in the making.

The goal, says the Mental Health Commission of Canada (MHCC), should be a "cultural shift toward recovery," which favours real improvement over ideal cure, and is informed by "multiple sources of knowledge," including the traditions of restorative justice and the hard-won wisdom of people in recovery.

The 37-page draft strategy document, obtained by the National Post, also seeks to reduce the stigma of suicide; calls for an end to "seclusion and restraint" of psychiatric patients; and demands that, in criminal-record checks, police stop disclosing information about people they have driven to hospital in a mental health crisis.

"This practice inhibits people's ability to volunteer or get a job, and should be stopped," reads the report, Mental Health Strategy for Canada - Draft, Not For Circulation. A final version is expected to be presented to the MHCC's board in October, and released publicly next year.

The strategy acknowledges the federal government's arm's-length role in healthcare delivery, but argues that mental health is not purely a health issue, as it also involves criminal justice, housing, finance and child services. The MHCC's broad solution is to "shift upstream and across sectors" by taking a "whole of government" approach, in which actions are nationally co-ordinated, and "leadership [is] located at the highest level possible within government and the bureaucracy."

Clinically, the strategy calls for a "genuine partnership" between caregivers and people with mental illnesses, who should be offered "self-directed care-funding initiatives," so they can "directly manage part of their social service and health budgets."

"The expertise gained from lived experience should be complemented by professional expertise, not dominated by it," the report reads.

"Not only will this change in the distribution of power within the mental-health system benefit users of services, it will also create a more positive context in which mental health providers can deploy their skills, experience and knowledge."

Examples of self-directed care choices might include art or music therapy, or training in mindfulness techniques, said Howard Chodos [pictured], special advisor to the MHCC.

Finding the right balance, he said, "involves the skill and art of medicine as much as it does the science.

"Unfortunately, in mental health there are no blood tests and there are no medical tests which tell you what illness you have and what treatment to use," he said.

The strategy also calls for better training for so-called "gatekeepers" - teachers, doctors, clergy, police and prison staff - to help them recognize and react to warning signs of suicide, and to promote mental health.

This focus on prevention and health promotion is a target of early critics of the report, who say it offers little to people with serious mental illnesses, such as schizophrenia or bipolar disorder, which cannot be prevented by social policy, as they are organic diseases of the brain.

They cite New York State's Office of Mental Health as a cautionary tale of a system in which the "worried well" gained support at the expense of the truly sick.

Susan Inman, a Vancouver advocate for the families of people with serious mental illnesses, whose daughter recovered from schizophrenia, said the strategy's deference to lived experience will make things worse for people who are so mentally ill they are incapable of realizing it - a condition known as anosognosia. She fears the emphasis on personal empowerment will make involuntary treatment almost impossible.

"This plan is really about mental wellness," she said. "People with serious mental illnesses are ignored."

Mr. Chodos said research shows a range of factors can increase or decrease the risk of even the most serious mental illnesses.

"We do not yet know that there is anything more than a genetic predisposition," he said.

"Prevention [in the strategy] is not only prevention of onset, but also the debilitating consequences of it."

He gave the example of homelessness, often associated with schizophrenia and substance abuse, as an area where social policy can, in fact, prevent the worst of a mental illness.

He said another is cannabis use among youth, a known risk factor for schizophrenia.

The MHCC, which was established in 2007 by Prime Minister Stephen Harper on the recommendations of former Senator Michael Kirby, has a twin mission. Erasing stigma has always been the long-term goal, but this formalized national strategy is the immediate plan.

The strategy comes at a crucial moment for psychiatry, not just in Canada but globally, as the discipline's diagnostic manual undergoes a thorough revision.

There is also a strong climate of suspicion about the role of drug manufacturers in the proliferation of psychiatric drugs, and about the spike in diagnoses of childhood behavioural disorders.

jbrean@nationalpost.com

Image credit

Also see:

An open letter to the Mental Health Commission of Canada - A response to their draft Mental Health Strategy for Canada

Identification of a biological signature for schizophrenia in [blood] serum

A 12-Step Program For Canada

Addressing stigma: An influence and leadership opportunity for our profession

An article published in the July/August 2011 edition of Alberta Doctors' Digest:

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To download a PDF version of the entire article, please click here.

Editorial: A better way on mental illness

An editorial published in the July 22nd edition of The Times Colonist:

Make no mistake. The Archie Courtnall Centre has been a positive contribution to mental health care in this region. For all the problems, the centre marked a step forward in care. And the willingness of the Courtnall brothers - Bruce, Russ and Geoff [pictured] - to talk about their own father's suicide, while raising millions for mental health services, has brought an increase in awareness about the reach and grip of mental illness. Russ and Geoff Courtnall have used their status as former NHL hockey players to raise money and educate.

But there is much more to do, as the history of the Courtnall centre itself shows.

The centre - effectively an emergency room for people suffering from critical mental illness - was only built because the Courtnalls helped to raise the $2.2 million required.

Any other form of emergency room, like the one opened at Victoria General Hospital in 2009, would be funded by government as part of a functioning health-care system. Yet patients with mental illness rely on charity for emergency services.

The Courtnall centre opened in 2005. A Times Colonist editorial outlined the vision of offering patients "a quiet refuge in crisis situations." Four beds would offer shortterm care of up to 72 hours. Patients would be assessed and quickly provided with needed care in the community or admitted to hospital beds.

But demand quickly swamped the centre. Within two years, director Dr. Anthony Barale resigned. "The staff of the psychiatric emergency service struggle daily to provide even the most basic medical and psychiatric care for this suffering population," he said. "And they do so with little support and the pitiful resources provided by VIHA - resources which, even by so-called Third World standards, are entirely inadequate." In the same year, then premier Gordon Campbell acknowledged a province wide failure to provide adequate mental health treatment.

Today, mental health patients routinely spend days - some more than a week - waiting for admission to too few hospital beds, sleeping in reclining chairs in the Courtnall centre that were intended for a few hours' rest.

In any other emergency room, waits under such conditions would be considered intolerable. Again, people with mental illness are treated as second-class citizens - as if their illnesses are not real, or they do not matter.

The waits will likely worsen. VIHA has reduced the number of in-patient beds available for patients with mental illness, despite having acknowledged the shortage of beds before the cuts. Increased community resources, such as outreach teams dealing with people living with serious mental illness and addictions on the streets, have helped.

But patients and families continue to experience desperate waits for care and inadequate post-release support. Already serious conditions worsen. Some people abandon the effort to get help, or fall to the streets - or like Archie Courtnall, end their own lives.

The Courtnall centre has helped. And the fundraising events this weekend - see courtnallclassic.org for details - deserve your support.

But we wouldn't accept, as a society, that care for people with heart problems or cancer would depend on the success of golf tournaments or fundraising auctions.

Our neglect carries a huge human cost, as the Courtnalls and so many others can attest. It also carries a great economic cost, as untreated illnesses worsen and people's potential is lost.

We have talked, for decades, about removing the stigma from mental illnesses and providing equitable care, as we do for most others with a medical condition. Our actions have fallen far short of that reality.

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Up Close and Personal with the Courtnall Brothers

Also see:

Former Canucks star Geoff Courtnall opens up about father's suicide, his own depression

Mental-health patients betrayed by VIHA

VIHA cutting community mental health support

Courtnall psychiatric emergency centre overwhelmed since inception, service reductions

Which Doors Lead to Where: How to Enhance Access to Mental Health Service: Barriers, Facilitators and Opportunities for Canadians’ Mental Health

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

Also see:

Mental Health Table

Jon David Welland writes about the From Recovery to Discovery Peer Support Group

Posted on June 7th by Jon David Welland (pictured):

Last week I sat in on the Schizophrenia Society's Peer Support group. There, a drama instructor [Courtney Siebring] guided the members through a series of exercises to express, through non-verbal communication, their feelings regarding mental illness, and how their illness affects their lives and their place in society as a whole. In the final exercise, each member spontaneously played a part in a powerful dramatic scene that explored each individuals role in their shared situation and experiences. I made a series of quick sketches of the proceedings and intend to turn each one into a finished piece.

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Also see:

From Recovery to Discovery Peer Support Group

Stopping the Revolving Door - A Civil Approach to Treating Severe Mental Illness

Stopping the Revolving Door - A Civil Approach to Treating Severe Mental Illness from Treatment Advocacy Center on Vimeo.

Delaware Psychiatric Center to undergo overhaul

An article posted online on July 7th by The News Journal:

State, federal officials agree to five-year reform plan at state mental hospital

By Beth Miller and Esteban Parra

Delaware will revamp its state psychiatric hospital over the next five years, transforming it from a dysfunctional and sometimes-abusive warehouse for the mentally ill into an integrated mental health system that includes community life and vastly expanded support systems, according to terms of a settlement announced Wednesday by state and federal officials.

The ambitious agreement reached Tuesday ends a three-year investigation by the U.S. Department of Justice and arrives almost four years to the day after a News Journal investigation that revealed rape, assault and other abuse of patients, exaggerated overtime expenses and threats and retaliation against staff members who reported violations.

It would put an end to long-term institutionalization of those with mental illnesses, steering state resources and support instead to community services and residential settings, providing customized support to keep people out of institutions and help those who can leave such settings do so.

Gov. Jack Markell and Rita Landgraf [pictured], secretary of the state Department of Health and Social Services, said the agreement includes expanded community service, housing, supported employment opportunities, a statewide crisis team that -- by January -- will respond to a person in crisis anywhere in the state within one hour, intensive case management and a network of trained peer support specialists who understand mental illness by experience.


SETTLEMENT HIGHLIGHTS

Delaware must:

• Offer community-based services to prevent unnecessary institutionalization of those with serious, persistent mental illness

• Develop a statewide crisis system, including a crisis hotline, mobile crisis response teams, walk-in centers, stabilization services (short-term inpatient care, with stays no longer than 14 days) and crisis apartments

• Provide intensive support services and case management

• Provide housing, with supports including rental subsidies or vouchers, and assurances that new housing created under the settlement terms will include no more than 20 percent of units occupied by those with a disability, to prevent isolation

• Provide supported employment and rehabilitation services

• Provide family and peer support

• Develop transition plans for each individual now in or being admitted to an institutional setting

• Publish annual reports identifying the number of people served in each type of service, with evaluation of unmet needs and quality of services

• Accept a court-appointed monitor to review and report on state compliance, issuing public reports at least twice a year, settling disputes and offering recommendations

• Meet timeline requirements from January 2012 to July 2016

To read the entire article, please click here.

Also see:

State wins in Delaware Psychiatric Center deal

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New National Mental Health Standards Focus on Community Services

An April 14th media release from Accreditation Canada:

Accreditation Canada has released new national health care standards for community-based mental health services. The Community-Based Mental Health Services and Supports Standards cover a wide variety of services including mental health promotion and education, early intervention services, crisis intervention, counselling and therapy, peer and self-help programs, diversion and court support, and social rehabilitation and recreation.

“Mental health illnesses affect all Canadians, either directly or through someone close to us. The impact mental illness has on the day-to-day lives of individuals, families, and friends can be very significant,” says Wendy Nicklin, President and CEO of Accreditation Canada. “Often, the support people need isn’t found in a hospital, but rather at a clinic or a community centre. These new standards will help community mental health organizations provide safe, high-quality services to their clients.”

Given the increased emphasis on the treatment of mental illness outside of an institution, it became apparent to Accreditation Canada that there was a need for a greater focus on community mental health services in its Qmentum accreditation program. An advisory committee made up of clients, surveyors, and sector experts lent their expertise to this initiative. Further guidance received through national consultation and pilot testing ensured the standards would meet the quality and safety needs of the health care professionals who would be putting them in place.

Accreditation Canada is a not-for-profit, independent organization that provides health services organizations with a rigorous and comprehensive accreditation process. We foster ongoing quality improvement based on evidence-based standards and external peer review. Accredited by the International Society for Quality in Health Care, Accreditation Canada has helped organizations strive for excellence for more than 50 years.

Also see:

Community-Based Mental Health Services and Supports Standards

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Points to Remember

From the June 17th edition of Psychiatric News:

Mental Illness Is a Brain Disorder

• “Multimodal” techniques using EEG and functional magnetic resonance imaging are providing a comprehensive picture of the structural, functional, and temporal connectivity in the brain.

• Medications, cognitive-behavior therapy and other interventions appear to affect different parts of brain circuitry involved in mental disorders. 

Mental Disorders Are Developmental Disorders

• Onset of mental illness is almost entirely before the age of 25.

• Emerging evidence shows that ADHD is a developmental disorder characterized by delay of cortical maturation.

Mental Disorders Result From Complex Genetic Risk Plus Experiential Factors

• Genetics of mental illness are characterized by very rare but potent variations.

• These rare variations result in changes in brain circuitry that, in complex interaction with environmental influences, result in many pathways to phenotypes of mental illness.

Related articles

Brain, Gene Discoveries Drive New Concept of Mental Illness
Psychiatr News June 17, 2011 46:1-33
Full Text

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Grand challenges in global mental health

An article published in the July 7th edition of the journal, Nature:

Schizophrenia, depression, epilepsy, dementia, alcohol dependence and other mental, neurological and substance-use (MNS) disorders constitute 13% of the global burden of disease (Table 1), surpassing both cardiovascular disease and cancer (ref. 1). Depression is the third leading contributor to the global disease burden, and alcohol and illicit drug use account for more than 5% (ref. 2). Every seven seconds, someone develops dementia (ref. 3), costing the world up to US$609 billion in 2009 (ref. 4). By 2020, an estimated 1.5 million people will die each year by suicide, and between 15 and 30 million will make the attempt (ref. 5).

The absence of cures, and the dearth of preventive interventions for MNS disorders, in part reflects a limited understanding of the brain and its molecular and cellular mechanisms. Where there are effective treatments, they are frequently not available to those in greatest need. In 83% of low-income countries, there are no anti-Parkinsonian treatments in primary care; in 25% there are no anti-epileptic drugs (ref. 6). Unequal distribution of human resources — between and within countries — further weakens access: the World Health Organization’s European region has 200 times as many psychiatrists as in Africa (ref. 7). Across all countries, investment in fundamental research into preventing and treating MNS disorders is disproportionately low relative to the disease burden (ref. 8).

To address this state of affairs, the Grand Challenges in Global Mental Health initiative has identified priorities for research in the next 10 years that will make an impact on the lives of people living with MNS disorders. The study was funded by the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, supported by the Global Alliance for Chronic Diseases (GACD), headquartered in London. Answers to the questions posed will require a surge in discovery and delivery science. We use the term ‘mental health’ as a convenient label for MNS disorders. We exclude conditions with a vascular or infectious aetiology (such as stroke or cerebral malaria), because these fell within the scope of the two previous grand challenges initiatives — in global health and in chronic non-communicable diseases (ref 9).

This initiative differs from previous priority-setting exercises for mental health (refs. 10–12) in four ways. First, its scope is global. Second, it is the first to employ the Delphi method (ref. 13), a structured technique using controlled feedback to arrive at consensus within a dispersed panel of many participants. Third, it covers the full range of MNS disorders. Finally, the effort hopes to build a wide-ranging community of research funders — much as the challenge for non-communicable diseases led to the creation of the GACD.

Bold emphasis above is mine.

References

1. World Health Organization The Global Burden of Disease: 2004 Update (WHO, 2008).
2. WHO Atlas on Substance Use (WHO, 2010).
3. Ferri, C. P. et al. Lancet 366, 2112–2117 (2005).
4. Wimo, A., Winblad, B. & Jönsson, L. Alzheimer’s & Dementia 6, 98–103 (2010).
5. Bertolote, J. & Flieschmann, A. Suicidologi 7, 6–8 (2002).
6. WHO Country Resources for Neurological Disorders 2004 (WHO, 2004).
7. WHO Mental Health Atlas (WHO, 2005).
8. Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. Lancet 370, 878–889 (2007).
9. Daar, A. S. et al. Nature 450, 494–496 (2007).
10. Lancet Mental Health Group Lancet 370, 1241–1252 (2007).
11. Sharan, P. et al. Br. J. Psychiatry 195, 354–363 (2009).
12. Tomlinson, M. et al. Bull. WHO 87, 438–446 (2009).
13. Jones, J. & Hunter, D. Br. Med. J. 311, 376–380 (1995).

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

Also see:

Thinking Globally to Improve Mental Health

Mental Health: Think Globally, Act Locally

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Sharing info helps patients: N.S. doctor

An article posted on July 4th by CBC News:

New guidelines about sharing patient information will make it easier for some families that support adults with mental illness, a senior health official in Halifax says.

Capital Health is adopting a sliding scale of information sharing, where patients can decide how much to share and with whom. It's a move away from the all-or-nothing approach.

"This is different from before. Now we're looking to share some information with some people and be specific about it," said Dr. Ian Slayter [pictured], clinical director for general psychiatric services.

Slayter said patients may refuse to divulge any health information, but health-care providers will encourage them to share some details with those who support them.

He said studies have shown that communicating with family members results in a better outcome for the patient.

"We're saying that providers need to sit down with the patient and say, 'You're receiving some support from this person and they could be more effective if they understood a little something about your illness, what it's all about, what your treatment is and how they can help.'"

For example, Slayter said, if a relative or friend knows that a patient is having suicidal thoughts, then maybe they can provide more support to help them.

He said it's also useful for families to know about a certain medication so they can help the patient get it or administer it.

Joanne Zinck's youngest daughter was diagnosed with schizophrenia at age 20. She says one of her biggest hurdles with mental-health care providers has been around privacy.

"We were depended on to help her to get well, but yet we weren't able to get the information that we needed to be able to support her," said Zinck.

Slayter said the guidelines were drafted by a group of patients, their families and the specialists who treat them. He said they also consulted with the Meriden program, a family-oriented mental-health service in England.

The district health authority approved the guidelines last week. Some staff are working with the new rules already, but more will be trained this fall.

Also see:

CDHA Mental Health Program - Information Sharing Guidelines (PDF)

Collaboration in the Triangle of Care (PDF)

Peer support: what is it and what makes it different?

An article posted July 4th on the Scottish Recovery Network (SRN) website:

In a specially commissioned article for SRN, international author, trainer and peer support expert Shery Mead [pictured] talks about some of the distinct features of the peer relationship and considers implications for practice. Shery is the keynote speaker at the forthcoming Experts by Experience conference being held in Perth on 21st September 2011.

Peer support is becoming an established practice in mental health. It is being used in informal settings as well as in hospitals and other services. But what is it about peer relationships that make them different to just having a good friend or for that matter another service worker? I will talk in this article about some of the distinct features of the role of peer support and implications for practice.

Peer Support is not new. As long as there have been people on earth, they have come together around shared experience to learn from each other. In mental health we have added a more formal layer to peer support by making it a specific role that is often paid. This is where it may get confusing. In paid peer support you and I come together to learn from each other (like some friendships) but you (the paid peer support worker) actually need to practice a few things.

After many years’ experience working and writing in the field of peer support, I’ve produced the following guide for prospective and active peer workers to some of the core principles of peer support practice:

1. Learning vs Help

In the best of all worlds we are altruistic, compassionate beings. We don’t like to see others suffering or in pain, and we want to make a difference. All too often, however, these beliefs and desires get in the way of building deeper understanding between people and can actually thwart learning and growth. When we go into a relationship with the intention of helping or even assisting or supporting we go in with some kind of agenda about you and your “problems.” Perhaps I know a little bit about you from some of my colleagues and before I’ve even met you I decide who you are and what you need. Even if I don’t know anything about you, when my attention is focused on helping we may well end up in a power struggle.

Instead, most people hope that we’ll learn more about them and how they’ve learned to make sense of their experience, learn about the cultural conditions that maintain their reality, and most importantly, what their ideas are about what might make a difference. Then – and only then – are they willing to understand or listen to where we’re coming from. Learning together takes time; it’s about building relationships where new information and new knowledge can emerge.

2. Focusing on the relationship vs. focusing on the individual

Paying attention to the relationship is an altogether different phenomenon. It’s a bit like a dance or a jazz band where the sum of the parts is greater than all the individuals added together. It is not about playing the right notes (saying the right thing), it’s actually being fully present to the other (listening for the story, the context of the story, what’s unspoken in terms of feelings and meaning) and then responding not with the answers but intuitively, creatively bringing something that is both authentically you AND that is also from the place where you connect with the other person to the conversation. This flow of increased mutual understanding, as well as generation of new meaning, is the goal of peer support. And so we seek to discover what goes into building this type of conversation.

One of the keys is giving up the idea of pre-determined outcomes (such as goals or symptom-reduction) and instead, learning to think laterally about the quality of our relationship. For example, instead of trying to persuade, seeking to understand, reflecting on our responses, and then speaking authentically from the heart what seems most important to us to contribute.

3. Responding out of hope vs. reacting out of fear

Let’s face it, when we feel frightened we do whatever we know how to alleviate the fear or the discomfort. We even go so far as to try to prevent situations that might potentially be uncomfortable. In peer support, as in the rest of community, this translates into coercion – subtle or otherwise.

Fear reactions come in all forms -- from avoiding, persuading, and knowing what’s best, to controlling, assessing and force. These reactions are hardwired by our animal instincts as well as from cultural norms that reinforce difference as dangerous (e.g. people from cultures different from our own). Fear has even influenced how we think about safety and has left us anxious about what’s not safe rather than comfortable with creating our own sense of safety.

This is where the idea of hope comes in. In order to sit with the discomfort of a difficult situation we must have some hope that something interesting or even positive will come out of going right through the middle of it. We may not know what that is (trying to control the outcome would be a fear based response) but gradually begin to trust that there is learning in our discomfort. This learning then creates possibilities that give us options – options that didn’t exist when our goal was just to get through this frightening time.

While these principles are just a basic outline of what peer support might encompass, they give us a chance to reflect on what factors contribute to making it unique. As we build these skills across a paid workforce of peers we actually increase our ability to self reflect on all our relationships and what makes them work. In doing this we’re working towards social change. Maybe, at the end of that day, that is a role for peer support.

Find out more about the Experts by Experience conference, including how to register.

Find out more about SRN's work on peer support.

Also see:

Defining Peer Support

Oldham Stresses Importance of Integrated Care

An article published in the June 17th edition of Psychiatric News:

By Mark Moran

John Oldham, M.D., reminds APA members and other annual meeting attendees to see the “person behind the disorder” who can be a partner in integrated care.

To incoming APA President John Oldham, M.D. [pictured], “Integrated Care”—the theme of his presidential year—is no empty catch phrase.

“To me, integrated care has many important meanings—integrating work with the rest of medicine, integrating education and teaching and the latest research findings into our clinical work, and integrating the stages of a patient's treatment into a coherent, progressive plan,” he said at the Opening Session of this year's annual meeting in Honolulu last month.

Oldham outlined four priorities that he said will guide his presidential year: integration of psychiatry with the rest of medicine, the right of patients to quality treatment, the unacceptability of fragmented care, and the importance of research and education (see New APA President's Four Focus Areas). He related a remarkable clinical vignette to remind psychiatrists of the timeless importance of seeing “the person behind the disorder,” a person who can be a partner in integrated treatment.

As an example, Oldham noted that he had recently received an e-mail from a patient (“Mr. R”) whom Oldham had treated when he was a resident at Columbia. In the e-mail, Mr. R—who had been 22 years old and a student at the time of his illness—told Oldham that “he had done OK in life, which he thought would surprise me.”

Oldham added, “He remembered me as arrogant, distant, pessimistic about his future, and not very helpful. I was stunned, since he was one of those patients we can all recall from our training years who had made a profound impression on me and was indelibly fixed in my memory.”

Mr. R, an Orthodox Jew, had fallen in love with a woman outside of the Jewish faith, and his father had told him that if he married her, it would be “the death of him.” But the young man persisted in his love and married her—and on the wedding day, the father died of a heart attack.

“I first met Mr. R shortly thereafter, when he was hospitalized in an acute psychotic state,” Oldham recalled. “What I remember from those days was how concerned I was for Mr. R—I was, after all, a student too at the time. I didn't know enough yet to appreciate the power of human resilience and the recovery potential within us all. What Mr. R saw as coldness or arrogance was, in hindsight, a defensive formality that I needed to hide my anxiety and uncertainty about how I could help him. What I also had trouble seeing at the time was the person behind the psychosis, though he was there watching me and wanting to connect with me all the time.”

After mulling over Mr. R's recent e-mail, Oldham decided to respond. “I told him that his message was valuable to me. I apologized for having been so unavailable to him, and I wished him well. A few days later he e-mailed me again saying how pleased he was that I had replied, and not to worry, that ‘all was forgiven.’ I haven't heard from him since.

“I think it conveys important messages for us all, reminding us of the power of hope, the potential for recovery, and that we must never lose sight of the whole person, who, for the time being, is not only our patient but also our partner in the treatment enterprise.”

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Help reverse the neglect & exclusion of mental disorders to save lives

Join the fight for the inclusion of mental health in the United Nations High-level Meeting on Non-Communicable Diseases

Please visit www.wfmh.com

Nearly half a billion people are affected by mental disorders which account for nearly 15% of the disease burden in the world - more than heart disease, lung disease, cancer or diabetes – more than TB, HIV and malaria combined! Yet, the historical neglect and exclusion of mental health from local, regional, national and global agendas continues and the exclusion of the neuropsychiatric disorders from the United Nations High-level Meeting on Non-Communicable Diseases represents a major social and economic injustice to the hundreds of millions of citizens suffering from neuropsychiatric disorders who are robbed of the opportunity to reach their life’s potential and are condemned to lives of vulnerability.

In the continuing story of humanity to create a just and equitable world, we have failed too many people everywhere, and poverty, expressed through persistent inequities and social injustices, remains our major failure as humanity. In this poverty story, neuropsychiatric disorders, with its story of economic hardships to those living with mental and neurological illnesses and their caregivers and families, play a critical role in the evolution and persistence of poverty. We must discontinue our penchant for a good talk, but no action.

- Dr. Leslie Ramsammy, Honorable Minister of Health, Guyana

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