World Mental Health Day - A Revolution, Simple

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

By Professor Richard Gray [pictured]

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

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

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

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

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

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

Where will new treatment advances come from?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Model-T image credit

Mental Health Commission struggles to find balance in developing strategy

An article published in the October 8th edition of the National Post:

By Joseph Brean

As Senator Roméo Dallaire [pictured], Canada’s best-known traumatized soldier, launches the Lieutenant-Governor of Alberta’s Circle on Mental Health & Addiction and Queen’s University unveils its own mental health commission in response to a series of suicides, both may cast a cautionary eye on the travails of the Mental Health Commission of Canada, a 10-year, $130-million federal project.

Since a draft of its national strategy on mental health was leaked this summer, the agency has been squirming under accusations of dysfunction, anti-psychiatry bias and neglect of the most serious mental illnesses.

Critics point out the 30-page document mentions “recovery” 67 times and “support” 125 times, but there is no reference to “psychiatry.” Or “schizophrenia” or “bipolar.”

In a “letter to Canadians” last month, Louise Bradley, the agency’s chief executive, promised to “correct” the strategy before its planned release next year, because “the current draft does not sufficiently reflect the essential role neuroscience, treatment and psychiatry have to play.”

In doing so, the MHCC is trying to strike a balance between the two major ideologies of mental health: empowerment, based in social science, in which recovery is seen as a personal growth experience; and psychiatry, based in neuroscience, in which recovery sometimes must be imposed against a delusional will.

At its most extreme, this clash of ideologies turns on the question of whether the fundamental problem of mental illness lies in the brain itself, or in the stigma imposed by society.

At stake is a key part of the MHCC’s dual mandate — to develop a national strategy on mental health — which will influence the allocation of research funding and the priorities provinces set on this unique issue, spanning health care and social policy.

The other part of its mandate is to combat the stigma of mental illness through public outreach and professional advocacy, which have largely focused on health-care providers, often the first point of contact between the mentally ill and the government.

As the strategy gets revised, the ideological balance continues to elude the MHCC, although a spokesman said the flawed draft is “relatively close,” and the Commission stands by it “fundamentally.”

Focused on “recovery,” the draft strategy highlights suicide prevention, self-directed care, improvement over cure, and calls for an end to the seclusion and restraint of psychiatric patients.

However, its focus on health promotion and prevention, including the role of employers in creating healthy workplaces, has fuelled criticism that this is not a strategy about mental illness, but rather mental wellness.

“They’ve stolen the word ‘recovery,’ ” said Herschel Hardin, president of the North Shore Schizophrenia Society in B.C., whose latest bulletin accuses the commission of hiding behind upbeat euphemisms and claims “those who understand severe mental illness no longer take [the MHCC] seriously — except to regard it as a menace.”

He said the agency exaggerates the notion recovery cannot be imposed by others and must be a self-directed personal achievement.

“For the seriously ill, that’s a small part of recovery that comes after treatment for the illness itself, which is part of recovery, which requires a lot of not just support but structure, provided by others,” he said.

“Here [at the MHCC] we have a bunch of people who really haven’t done the homework that they had to do, and buried the most important considerations in bureaucratic fluff and vague wording.”

More than most health issues, vocabulary clouds this debate.

Patients are recast as “survivors,” “consumers,” or “experts by experience” on the one side, and a schizophrenic’s lack of insight medicalized into “anosognosia” on the other.

“The idea of recovery in mental illness circles has a certain meaning that is not translated well for the general public,” said Bill Honer, head of the department of psychiatry at the University of British Columbia and a clinical expert on schizophrenia.

It is not like remission in cancer, in which the disease metaphorically retreats, or recovery from a cold, in which it disappears completely. Recovery in mental health, as the MHCC describes it, is an orientation, a way of life.

The danger, Prof. Honer said, is that a strategy in which individuals must guide themselves to recovery could be unfair to those who are unable to do so, because they cannot understand their own illness.

“On a strict interpretation [of that strategy], we risk not fulfilling our social responsibilities,” he said.

At the same time, there is rampant confusion about these words and what they imply, he said. “The social constructs of labelling and diagnosis are real, but it’s not the same as what we do [in psychiatry]. Having a diagnosis is not a bad thing. That’s how we work. But labelling and stigma are, and that’s how society works.”

Ms. Bradley refused to be interviewed, but strategic advisor Howard Chodos, who prepared the draft strategy, said it was developed through face-to-face meetings and an online survey.

The “vast majority” of participants in consultations were “supportive of the overall thrust of the strategy,” he said, but the review process now includes “some of more public discussion that’s taken place once the draft reached a wider audience than we originally intended.”

“Was everybody included? No. Did we have the resources to do that at this time? No,” he added.

“But we felt confident that we would get the kind of feedback from that group that would enable us to strengthen the document.”

Mr. Chodos acknowledged the criticism and said the draft’s language “is not where we would like it to be, in terms of connecting with people, resonating with people in a way that will help to galvanize support for the document.”

But he rejects the notion that the focus on consensus obscures the hard cases.

“What I don’t accept is that there is a fundamental opposition between those two elements,” he said.

“We can find a way to have that balance, and we’re not sacrificing one on the altar of the other.”

jbrean@nationalpost.com

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Also see:

Mental Illness Awareness Week: Canada Stands Ready for Positive Change

He Wants To Stop Taking His Medication

Dr. Xavier Amador has posted a new video on his website:

Question

Our son is 22 years old & diagnosed with schizophrenia. He first became ill at 18. He’s been hospitalized many time, 5 times within the last year. He’s also been arrested for miscellaneous crimes due to his thought disorder and delusions about what people are doing to him. He was given a guardian by the state last Dec and put in a long term care facility for 6 months and mandated medication. He was release several weeks ago, and immediately stopped taking medication. He’s all along said he does not feel he has schizophrenia, and will not take medication. He’s said he feels he has an anger problem. He does continue to see his psychiatrist. We see our son weekly, have a good relationship with him now, but are very afraid of when he gets ill again. Do you have any suggestions? – Carroll and her Husband from Alameda, CA

Dr. Amador's Answer

Mental Illness Awareness Week: opening Canadians’ eyes

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

By Stephen Ayer (pictured)

Mental Illness Awareness Week, Oct. 2-8, is an annual national public education campaign designed to help open the eyes of Canadians to the reality of mental illness. The week was established in 1992 by the Canadian Psychiatric Association. It is now co-ordinated by the Canadian Alliance on Mental Illness and Mental Health in co-operation with its member organizations, including the Schizophrenia Society of Canada, as well many other supporters across Canada.

As a kick-off event for the week, the Schizophrenia Society of Nova Scotia (SSNS) presented a special screening last Sunday of the movie The Soloist, based on the true story of Nathaniel Ayers, a musician who develops schizophrenia and becomes homeless. The screenplay by Susannah Grant is based on the book The Soloist by Steve Lopez, a columnist for The Los Angeles Times.

The same day, the society also highlighted the recovery journey of Laura Burke, a young Nova Scotian who lives with schizophrenia, by screening Superhero — A Visual Poem, a documentary short film featuring Ms. Burke’s spoken word poetry. Ms. Burke was honoured during Mental Illness Awareness Week in Ottawa last year as a 2010 Champion of Mental Health.

Today, the Schizophrenia Society of Nova Scotia is partnering with other local mental health organizations and supporters to present the Fourth Annual Festival of Hope, a celebration of hope, healing and recovery. This free event takes place from 3 to 8 p.m. at the Olympic Hall, 2304 Hunter St. (corner of Cunard and Windsor in Halifax).

The core belief of the SSNS is that people with mental illnesses such as schizophrenia can live a life of meaning and purpose. The society’s focus is to promote the goal that each individual will be able to return to a quality of life which meets each person’s own perception of needs and expectations.

The vision of the SSNS is to reach all Nova Scotians who are directly or indirectly affected by schizophrenia — to focus on the individual, not the illness, to promote wellness and recovery, and to reduce the stigma and discrimination so often associated with mental illness.

The society’s mission is to improve the quality of life for those affected by schizophrenia through education, support programs, influencing public policy, and supporting research. The SSNS provides a community-based network of knowledgeable and dedicated volunteers whose personal experience with the illness allows them to share their stories of hope and recovery with people affected by schizophrenia for the first time.

Stephen Ayer is executive director of the Schizophrenia Society of Nova Scotia. He lives with a mental illness and experienced homelessness in the 1990s. Dr. Ayer is a 2009 recipient of an Inspiring Lives Award from the Mental Health Foundation of Nova Scotia and the CMHA — Nova Scotia Division.

Photograph by Ryan Taplin / Metro Halifax

New videos featuring Dr. Xavier Amador

Dr. Xavier Amador has links to two new videos posted on his website:

2011 Nordic Psychiatry Academy Interview with Dr. Amador

"I am not Sick, I don't need help!" presentation at the 2011 Nordic Psychiatry Academy

To view Dr. Amador's presentation at the Schizophrenia Society of Nova Scotia's 2005 Annual Conference, please click here.

To order the book, I Am Not Sick, I Don't Need Help, please click here or here.

Also see the following videos:

Anosognosia 1 of 2 (Recorded July 3, 2010)

Anosognosia 2 of 2 (Recorded July 3, 2010)

Women & Wellness Nova Scotia

SAVE THE DATE

Thursday, March 22nd, 2012!

6:00 pm to 9:30 pm

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RSVP by contacting the CMHA Nova Scotia Division office at 902.466.6600 or by sending an email to suecmhans@eastlink.ca.


Also see:

Jessie Close

BringChange2Mind website

BringChange2Mind Facebook page

Mental Illness Awareness Week: Canada Stands Ready for Positive Change

An opinion piece posted on October 4th by the Mental Health Commission of Canada:

Op-Ed to coincide with Mental Illness Awareness Week

By Louise Bradley (pictured)

I have worked in the mental health field in Canada for over three decades, and I can say without exaggeration that never before have I seen such a high level of awareness about mental illness in this country. At last, mental health and mental illness are taking centre stage.

From coast to coast to coast, Canadians are stepping forward to talk publicly about their own personal experiences with mental health problems and mental illnesses, and by taking this courageous action, they are making a real difference to countless others.

In September, after 17-year-old high school student Chris Howell, who had been bullied since grade school, committed suicide, 150 friends and family gathered in front his school to mourn his loss and call for an end to bullying. “I just want to stop it,” Chris’s mother Judy told the Hamilton Spectator. “I don’t want anyone else to have to pay.”

For their part, after their son Jack, a first-year student at Queen’s University, took his own life last year, Eric and Sandra Windeler established The Jack Project, a national program to help Canadian youth achieve optimal mental health as they transition from late high school into their college, university or independent living years.

And then there are people like Harmony Brown, Jeremy Bennett, Roberta Price, Shana Calixte, and Steeve Hurdle, who are this year’s “faces” in the Face Mental Illness Campaign coordinated by the Canadian Alliance on Mental Illness and Mental Health as part of this week’s Mental Illness Awareness Week national public education campaign.

By sharing their personal stories, these five, too, are helping to end stigma and bring mental illness out of the shadows forever.

Today, hundreds of organizations across the country are working tirelessly to raise public awareness about mental health problems and mental illnesses through advocacy and by providing services and supports to those in need.

Canadian companies, including Bell Canada, RBC, Great-West Life and Canada Post, are investing millions of dollars to raise awareness about mental health, improve children’s and workplace mental health, and support organizations on the mental health front lines.

Governments across the country are also addressing mental health in more meaningful ways with new strategies, action plans and investments.

Thousands more individual Canadians are empowering themselves by learning how to spot the signs of mental health problems in family, friends and even themselves through courses being offered by Mental Health First Aid Canada. To date, over 42,000 Canadians have become mental health first aiders.

It is little wonder we are seeing such a ground swell of action and support for mental health.

Canadians have woken up to the fact that ignoring mental health is detrimental to individuals, families, and communities, as well as our society and economy as a whole.

They are becoming aware that there is no health without mental health, and that no one is immune from mental illnesses. This year alone, more than seven million Canadians—that is one in five people—will experience a mental illness personally, and in turn, this will impact family, friends and colleagues.

We are making progress in changing attitudes about mental health, but there is still much work to be done.

We need to be doing more to improve access to mental health services, decrease stigma, support the needs of families caring for ill relatives, invest in research spanning the full spectrum of issues relating to mental health and mental illness, promote mental health, and prevent mental illness so that every Canadian has the opportunity to achieve the best possible mental health and well-being. All this and more will be addressed in the first-ever Mental Health Strategy for Canada, which the Mental Health Commission of Canada will release next year.

What can you do to help?

To start, I urge all Canadians to pledge to the cause of mental health, not just during this Mental Illness Awareness Week, but 365 days a year, by supporting a family member, a friend, a colleague, or a neighbour living with a mental health problem or mental illness and helping them build a better life for themselves. And potentially everyone will have a role to play in bringing the Mental Health Strategy for Canada to life and ensuring it has maximum impact.

Now more than ever, we have an opportunity to build a society that values and promotes mental health and helps people living with mental health problems and mental illnesses to lead meaningful and productive lives.

This will require some fundamental changes to our systems of mental health care and also to our collective way of thinking about mental illness, but if the past year is anything to go by, Canadians are ready to take on this challenge and ready, willing and able to work together to achieve positive change.

Louise Bradley is President and CEO of the Mental Health Commission of Canada.

Image credit

Also see:

Housing first for the mentally ill: Former MP wants changes to assist those in need

Mind Games - How should we define mental illness?

An article written by Kurt Kleiner and published in the Autumn 2011 edition of U of T Magazine:

Mind Games

Doctors have been trying for decades to classify mental illnesses. So why do precise definitions still elude us?

Theories of human psychology influence not only how we treat mental illness, but how we understand ourselves. The ancient Greek notion of the four humours remains with us in our idea of sanguine or phlegmatic personalities. Freud’s ideas gave us unconscious motivations, egomaniacs, narcissists and more.

These days, if you know someone who’s suffered from major depression, or think you may have social anxiety disorder, or know a child with attention deficit disorder, you’ve been influenced by a more modern psychological viewpoint – one put forth by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM), which describes all recognized mental disorders. Psychiatrists in North America, and also elsewhere in the world, rely on the DSM to make their diagnoses and communicate them with others in the health-care profession.

But the manual’s immense influence is a problem says Edward Shorter, the Hannah Professor of the History of Medicine at U of T. He thinks that many of the disorders described in the DSM are not actual diseases discovered through the scientific method. Instead, they resulted from political deal-making among different factions in the professional community, each with conflicting ideas about causes and treatments of psychological problems. The result, he says, is a description of mental disorders with too little relation to real diseases.

In Shorter’s opinion, the manual sometimes pathologizes perfectly normal behaviour, while actual diseases get lost in a thicket of non-existent syndromes and disorders. And as the association works through a new revision of the DSM, it looks like things will only get worse, he says.

“The DSM continues to run off the rails in terms of its ability to come up with true disease entities that exist in nature,” Shorter says. “The problem is that the document itself is profoundly unscientific.”

Shorter is a social historian of medicine. He has written books on obstetrics and gynecology, the doctor-patient relationship, psychosomatic illness and psychiatry. His books include Written in the Flesh: A History of Desire, and Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness (which he wrote with psychiatrist David Healy). One reviewer, Dr. Nassir Ghaemi of Tufts Medical Center in Boston, called his A History of Psychiatry from the Era of the Asylum to the Age of Prozac (John Wiley & Sons, 1997) “the best single volume to read on that topic.”

To read the entire article, please click here.

Illustration by The Heads of State.

Reprinted with written permission.

Correspondence to:

U of T Magazine
J. Robert S. Prichard Alumni House
21 King's College Circle
Toronto, Ontario,
M5S 3J3

uoft.magazine@utoronto.ca

I thank Rev. Dr. Roger Cann for bringing this article to my attention.

Mental health group ‘hard at it’: Minister

An article published in yesterday's edition of Metro Halifax:

Health minister likes what she’s seen in mental health strategy

Liberal health critic says it’s time to focus on mental health issues

By Alex Boutilier

Nova Scotia’s minister of health says she expects a provincial mental health and addictions strategy by the end of the year.

Maureen MacDonald [pictured] said yesterday the volunteer working group putting together the strategy requested an extension of 30 days over their previous deadline of the end of September.

“The working group are hard at it, and I’m anticipating I should have this strategy certainly by the end of the year,” she said.

MacDonald said she was pleased at the pace of the working group.

“They’re a group of volunteers, they’re doing this on their own time, and I totally appreciate how much time it’s taken,” said MacDonald.

“They did a public consultation, they’ve seen more than 1,200 people participate in that process, they have some commissioned research.... It’s a big piece of work, and I’m very much looking forward to when they complete it.”

Some of the preliminary themes have been shared with MacDonald, and she said they look “great.”

MacDonald was responding to a call from the opposition Liberals, who demanded an update on the strategy’s progress.

Liberal Health Critic Leo Glavine said he suspects the strategy won’t see the light of day until 2012.

“There’s such a great need to get this out, to get it acted upon,” said Glavine.

“We’re hearing more and more from the school system and the early adult population that have major mental health needs … and we hope the strategy is going to address some of those.”

Upcoming Workshops at the Self-Help Connection

Ongoing!

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The Self-Help Connection

Chance encounters can change the world

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

Students listen to Steve Lopez, a Los Angeles Times columnist, as he speaks at Austin Peay State University Thursday night. Lopez wrote a book called The Soloist that was required reading for APSU's The Peay Read program / THE LEAF-CHRONICLE/ROBERT SMITH


Author Steve Lopez tells APSU, 'one person can make a difference'

By Karen Parr-Moody

The Dunn Center at Austin Peay State University was filled to the rafters with a crowd that included students wearing red T-shirts emblazoned with the words "The Soloist."

This sea of red was the class of 2015, which gathered Wednesday evening to hear Los Angeles Times columnist Steve Lopez speak about his book, The Soloist. In it he chronicles his relationship with Nathaniel Anthony Ayers, a formerly homeless, Juilliard-trained musician who has schizophrenia.

The speaking engagement was the culmination of The Peay Read, a program in which students of the introductory "First-Year Experience" class read a common book.

Prior to Lopez's keynote address, a group of 11 students joined him for a special dinner. Each had won a spot in an essay competition that included 1,200 entries. One winner, Nathan Borrero, said he was impressed that Lopez developed a friendship with a homeless man he met at random.

"That's not something you see every day," Borrero said. "Most people who pass a homeless person wouldn't give them a second thought."

In a variation on the theme, winner Destynee Horner said, "I was blown away by how he wasn't trying to gain anything for himself. He was truly concerned about Nathaniel's well-being."

Winner Lindsey Gudal focused on the transformative power of music in her essay.

"Music is the universal language, as corny as that sounds," she said. "I just think that's beautiful."

Samuel Cupp also wrote about music's healing.

"Music is ... the foundation of his soul," Cupp said of Ayers. "When (Ayers) loses everything else ... music keeps him sane."

When 7 p.m. arrived, Dixie Dennis introduced the award-winning students. Then university president Tim Hall took the stage, quoting Socrates from Plato's Apology: "The unexamined life is not worth living."

Hall then said, "I'm here to warn you that the examined life is a dangerous life ... dangerous, at least, if what you want to do is stay uncommitted and uninvolved and unattached."

The examined life is what pulls a person in to help another person, Hall explained, calling Lopez "an example of the perils and rewards of the examined life."

Lopez then took the stage.

"What a great T-shirt that is," he said of the red "The Soloist" shirts. "I got one actually a little earlier tonight and I'm gonna take that to a good friend of mine."

He was referencing "Mr. Ayers," which is how he went on to refer to the gifted musician throughout his speech.

"He loves wearing 'Soloist' T-shirts and hats," Lopez said.

Lopez also thanked the students who "made a commitment to this book" and complimented the winners of the essay contest, saying "I'm so flattered and honored and impressed by the work they did."

He then relayed his astonishment that it has now been seven years since he first met Ayers on a Los Angeles street, noting with incredulity the various places it has taken him, both literally and figuratively.

Early on in the hour-plus speech Lopez confessed: "I would love to be able to tell you that I did something out of the goodness of my heart, but I didn't."

He said that writing a newspaper column, which he has done for 35 years, "means you live in desperation," comparing the deadline pressure to that of owing a teacher an assignment. When Lopez first heard Ayers playing a 2-string violin, he thought it might make for a good column. He couldn't get the "compelling image of a guy playing his heart out on a violin" out of his head.

What followed was a one-man investigation into the squalid streets of Los Angeles' Skid Row, which at that time were "home" to thousands of homeless people, many mentally ill.

After Lopez published his first column about Ayers, sympathetic readers sent in six violins and two cellos for the former Juilliard prodigy. As he wrote more columns, his personal life became more intertwined with that of Ayers. Throughout his narration of the key events, Lopez sprinkled in inspirational invocations to the mostly student audience. He urged students to open their eyes to the many opportunities to be had.

"You don't know who might change your life forever," he said.

The speech led into a question and answer session, during which Lopez informed the audience that Ayers continues to live in a Los Angeles apartment, surrounded by musical instruments, rather than on the street.

One of the last things Lopez told the audience was "I get very tired of people congratulating me, because I have to remind them that this gentleman has done as much for me — more for me — than I have done for him. And I tell them that what this story tells us — and I'd like for you to keep this in minds, students — is that one person can make a difference ... there's grace in giving. It's a great privilege to (attend) a school like this. Think of giving something back. Each one of us has the power to make a difference in someone's life. Mr. Ayers has made a difference in mine."

Karen Parr-Moody, 245-0203
Features Reporter
karenparrmoody@theleafchronicle.com

Also see:

REVIEW: Wellspring of human beauty sprung in 'The Soloist'

11 APSU first-year students, middle college student named essay winners

Nathaniel Ayers plays the Foshay Learning Center

Steve Lopez on Nathaniel Anthony Ayers

Mr. Lopez Meets Mr. Ayers (60 Minutes Video, 2009)

The SSNS's 23rd Annual Conference

Registration is Open!

Friday, November 4th, 2011

8:45 am to 4:30 pm

The University Club

Dalhousie University

1 Alumni Crescent

Halifax, Nova Scotia

Topics to be covered:

• Cognitive remediation for schizophrenia - Dr. Susan R. McGurk, Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire

• An interactive session about antipsychotics and their side effects - Dr. David Gardner, Department of Psychiatry & College of Pharmacy, Dalhousie University, Halifax, Nova Scotia

• Peer support - Vince Daigle, Healthy Minds Cooperative, Halifax, Nova Scotia

• Psychosocial rehabilitation - The Beacon Program, Kentville, Nova Scotia

• Cognitive behavioural therapy and how it can help with relationships

• Employment - Gail Kelly, Connections Halifax, and staff of The Mindful Mango

• Promoting recovery through a Wellness Program - Dr. Zenovia Ursuliak, Nova Scotia Early Psychosis Program and the Department of Psychiatry, Dalhousie University

Registration fees (includes lunch and two refreshment breaks)

Secure online conference registration is available by clicking here

Regular: $150

SSNS Member: $100

Student: $50

Un-Waged: $25

All-day parking passes are available for $10.

To download a mail-in conference Registration Form, please click here.

Ten conference bursaries are available for individuals who live with mental illness.

To become a member of the Schizophrenia Society of Nova Scotia, please complete and mail in the Membership Form available by clicking here, along with a minimum tax-deductible donation of $15.00.

The chickadee was chosen to represent the theme of recovery because chickadees are friendly, hardy little birds that thrive in good times and bad. The bird is shown looking up to convey a feeling of hope.

Designer: Terri Vernon, SSNS member

Conference Sponsors

Please click on the sponsor's logos to visit their websites.

The Self-Help Connection - Fall 2011 Newsletter

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To download the entrire newsletter (PDF) please click here.

Also see:

The Self-Help Connection

International mental health conference opens today in Sydney, Nova Scotia

An article published in today's edition of the Cape Breton Post:

SYDNEY — For the past few weeks, Linda Alderson [pictured] has been working long hours to make sure an international conference on mental health goes off without a hitch.

As manager of rehabilitation services with the Cape Breton District Health Authority’s Mental Health Services, Alderson helped organize the district-sponsored annual conference of Psychosocial Rehabilitation Canada, a national association of individuals and organizations committed to the provision and growth of psychosocial rehabilitation services to support the recovery of persons with serious mental health issues.

Enhancing Recovery: Community, Culture and Family is the theme of the conference, which takes place from today until Thursday at the Membertou Trade and Convention Centre. Participants from across Canada as well as the United States, Sweden, United Arab Emirates and Singapore are taking part in the conference.

“The conference is not only a wonderful opportunity to network and share information,” says Alderson, “but it also allows people from Cape Breton to attend a high-quality event that features the latest research and advancements in the field.”

The conference is open to Cape Breton District Health Authority staff, anyone with mental illness and their families, community agencies and employers who have staff with mental illness.

Bursaries to help with registration are available for district staff, people with mental illness and/or their families. So far, fundraising efforts have managed to raise enough money to allow more than 30 Cape Bretoners to attend the conference who normally wouldn’t have the resources to pay the $350 needed for the entire registration package.

“We are really good at fundraising,” she says. “We were committed to giving the general public a chance to attend the conference.”

About 250 people are expected to take in the conference, a number which Alderson says reflects well on Cape Bretoners.

“That’s a statement in itself,” she says. “At last year’s conference in Ottawa, they had the same number of participants. Here we are, attracting the same number as in a major centre.”

The first full day of sessions on Tuesday begins with a presentation from Keith Anderson, a local lawyer who will discuss his journey through depression. Louise Bradley, president and CEO of the Mental Health Commission of Canada, will give an update on the commission. Concurrent presentations and workshops will take place throughout the afternoon.

Ambassador Awards will also be given out that day, including one to Alderson herself. Alderson will receive an Ambassador Award for making Cape Breton a leader in psychosocial rehabilitation in Nova Scotia. She is founding member of PSR Canada, past member of PSR Canada’s board of directors and past-president of PSR Nova Scotia. Alderson also currently sits on the PSR policy committee as well as several other committees and boards, locally, provincially and nationally.

“I’m quite humbled to be receiving this award,” she says. “I’ve been in the the mental health field for more than 30 years. My passion is in supporting people to live better and have more fulfilling lives. To receive an award like this is fabulous.”

Dr. John Higenbottam, clinical associate professor in the schizophrenia division of the University of British Columbia, will receive the other Ambassador Award.

The second day of the conference on Wednesday features presentations, concurrent sessions and workshops.

The final day of the conference on Thursday is a half-day session that features Sheila Morrison’s presentation “Lessons I Have Learned — A Mother’s Story.” In her presentation, Morrison will talk about how she helped and encouraged her daughter to move forward following treatment for a difficult psychosis. Jocelyn Greene from St John’s, N.L., will discuss social enterprise and building a community where those with mental illness are included. There will also be a presentation from the First Nations culture perspective.

Conference sponsors are include Addiction Services, Mental Health Services, Department of Psychiatry-Cape Breton District Health Authority, Family Working Group and the Department of Psychiatry-Capital Health/Dalhousie University.

If you are attending this conference, be sure to visit the Schizophrenia Society of Nova Scotia's Information Booth!


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The Schizophrenia Society of Nova Scotia - 2011 Annual General Meeting

The Schizophrenia Society of Nova Scotia’s 2011 Annual General Meeting was held in Springhill, Nova Scotia, on Saturday, September 24th, 2011.

Please click on any photograph to enlarge it.

Cecilia McRae, president of the Schizophrenia Society of Nova Scotia, delivers her President's Report

Phil Rogers, treasurer of the Schizophrenia Society of Nova Scotia, delivers his Treasurer's Report.

Hilary Thorne, the SSNS's project coordinator, speaks about the growth of the Schizophrenia Society of Nova Scotia.

Frank Allen, president of the Cumberland County Chapter of the SSNS introduces the guest speaker, Dr. Pippa Moss.

Dr. Pippa Moss, Chief of Psychiatry, Cumberland Health District, talks about strategies to reduce the stigma and discrimination so often encountered by people who have experienced mental illness, as well as by those who love them. To view Dr. Moss' PowerPoint slides, please click here (PDF).

Rev. Dr. Roger Cann, president of the Kings County Chapter of the SSNS, speaks about the activities of the Kings County Chapter.

Donna Methot, president of the HRM Chapter of the SSNS, speaks about the activities of the HRM Chapter.

Photographs by Stephen Ayer

Michael Kimber at the University of King's College media symposium

From the YouTube posting by the Mental Health Commission of Canada:

Michael Kimber, a King's College graduate, speaks about his personal experience with mental illness at the King's College media symposium.

Michael Kimber suffers from intense anxiety and isn't afraid to tell anyone. He writes about his experience in a personal, heart-felt and riveting blog and receives thousands of hits daily. Today Michael is still blogging, writing a book, and continuing to attract attention on the impact of stigma and mental health.

Schizophrenia: A Recovery

Recovery and Respect - Dr. Frank Shelp

Text accompanying the video:

Respect and recovery from a mental illness are inextricably linked, said Dr. Frank Shelp, Georgia's Commissioner of Behavioral Health and Developmental Disabilities. Dr. Shelp was addressing the 20th annual conference of the Georgia Mental Health Consumer Network at St. Simons Island, August 2011.

Also see:

RESPECT International: Joel Slack

RESPECT International

The History of the Georgia Mental Health Consumer Network: Larry Fricks

Peer-Run Employment Supports - Benefits, Roles, and Opportunities: George Brice

Visions for the Georgia Department of Behavioral Health and Developmental Disabilities: Dr. Frank Shelp

News from the Schizophrenia Society of Canada's national conference

The Schizophrenia Society of Canada held its national conference from September 13th to 15th, 2011, in Regina. The theme of the conference was Changing Minds.

Below are links to three news articles summarizing some of the presentations at the conference.

Taking away the stigma

Good housing linked to health

Pot poses psychosis puzzle

L.A. Times columnist, author of ‘The Soloist’ to speak September 29th in APSU Dunn Center

An article posted today by Clarksville Online:

Clarksville, TN – In 2005, Los Angeles Times columnist Steve Lopez [pictured] strikes an unlikely friendship with Nathaniel Ayers, a homeless musician with schizophrenia who slept each night on one of skid row’s most dangerous streets.

Lopez learned Ayers had been a promising violinist, and that he had left the prestigious music program at the Juilliard School because of his struggle with mental illness. The journalist chronicled Ayers’ struggle in several columns at the Los Angeles Times, inspiring readers to send instruments to Ayers through Lopez.

The friendship that Lopez formed with Ayers eventually helped the musician get off the street, settle into an apartment and find help for his schizophrenia.

This story since has inspired newspaper columns, a book titled The Soloist and a movie of the same name starring Robert Downey Jr. as Lopez and Jamie Foxx as Ayers.

Lopez will share his discovery of Ayers and how their relationship left a profound impact on the writer’s life at 7:00pm, Thursday, September 29th in the Dunn Center at Austin Peay State University. The talk is free and open to the public. A book signing will follow his talk.

Lopez joined the staff of the Los Angeles Times in May 2001 after four years at Time Inc., where he wrote for Time, Sports Illustrated, Life and Entertainment Weekly.

Prior to Time Inc., Lopez was a columnist at the Philadelphia Inquirer, the San Jose Mercury News and the Oakland Tribune. His work has won numerous national journalism awards for column writing and magazine reporting. In addition to The Soloist, Lopez is the author of three novels.

Lopez’s book and September 29th appearance are part of a reading initiative at APSU called The Peay Read, designed to provide a unifying experience and contribute to the academic experiences for freshmen students. However, the reading program also offers opportunities for sophomore, junior and senior students.

A committee reviewed several books and chose The Soloist as The Peay Read’s common reading book, with homelessness as the theme. Committee members also have worked with other academic departments to plan activities culminating in Lopez’s keynote address, all supporting the current theme of homelessness. For instance, student organizations have been encouraged to plan and implement campus-wide, theme-based programs related to homelessness. In addition, piggy banks have been distributed to all APSU 1000 First-Year Experience classes to raise money for organizations that support Clarksville’s homelessness population.

Other examples of The Peay Read student activities and memorabilia include the following:

• T-shirts with “The Soloist” printed on them and given to freshmen students enrolled in the APSU 1000 First-Year Experience program, which is including the book in its classroom discussions.

• Bookmarks with book quotations, which will be used in student discussion groups focused on those quotations.

• Faculty-student class discussions, including how to help the homeless population and the issues that affect them.

• Student book reviews, with authors of the “best 10” essays invited to a dinner with Lopez.

• A showing of the movie The Soloist.

A mobile app detailing all events and activities associated with The Peay Read has been developed and can be downloaded via Apple’s iTunes.

For more details about this year’s book reading selection or The Peay Read, visit www.apsu.edu/Read/ or visit Peay Read on Facebook.

For more information about Lopez’s upcoming talk, contact Dr. Dixie Dennis, chair of The Peay Read committee at APSU, by telephone at 931.221.7415 or by email at dennisdi@apsu.edu.

Photo by Giles Mingasson

Living with Schizophrenia

To view the entire video (25.5 minutes), please click here.

Also see:

Living with Schizophrenia: A Call for Hope and Recovery

Overcoming Schizophrenia

A New Blood-Based Diagnostic Aid for Schizophrenia

An letter to the editor published in the September 2011 edition of Psychiatric Services:

To the Editor: Many people with schizophrenia exhibit poor insight into and lack of acceptance of their illness (1,2). The absence of objective proof of this disease contributes to this problem. Investigators have been interested in developing a blood-based biomarker test to help identify a biological signature to aid in diagnosis of schizophrenia, particularly in the prodrome of the illness (3,4).

Such a test has recently been developed, validated, and marketed in the United States. This test, VeriPsych, uses a multiplex immunoassay technology that profiles a proprietary disease signature comprising 51 analytes. The test has been found to be 83% sensitive and specific in distinguishing persons with schizophrenia from those without the disorder; the study in which the test's validity was established included more than 500 patients in the development phase and more than 800 patients in the validation phase (5). However, little has been subsequently published about this test, and its clinical utility remains unclear.

Our treatment team administered the test to a 30-year-old woman with a five-year history of schizophrenia who did not accept the fact that she had schizophrenia and who had problems remaining adherent to antipsychotic medications. The test yielded a positive result for the diagnosis of schizophrenia (score of –9199), with a conditional probability score that indicated a 95% chance of having the illness. After being informed of these results, our patient began to accept that her symptoms could be attributed to schizophrenia. For the first time, she expressed interest in learning about schizophrenia, acknowledged a personal connection to her family history of the disorder, and accepted her need of antipsychotic medications. Her therapeutic alliance with her psychiatrist and treatment team has improved, she has enrolled in a college-level class, and her attitude toward antipsychotic treatment remains positive. Her psychiatrist notes that this remarkable change was the result of her confidence in the blood test results—for the first time she had objective data about her illness.

Improving insight and illness acceptance among patients with schizophrenia has proven to be no small task. Psychoeducation, meta-cognitive training, cognitive therapy, and family intervention aimed at developing an understanding and acceptance of schizophrenia have shown only some success (1). Our interest in the test was not to confirm a clinical diagnosis of schizophrenia but to help a patient with schizophrenia accept her illness. We feel that if this test or future serum tests are more widely utilized, then their use as an aid in helping people who have no illness insight or who lack acceptance of their illness may be an important application. We hope that our letter will bring attention to this new test and encourage further research to replicate and validate our results. We also need to develop a better understanding of the clinical and research uses of this blood-based diagnostic aid and of its potential role and place in the treatment of patients with schizophrenia.

Deanna L. Kelly, Pharm.D., B.C.P.P., Sheryl Thedford, Pharm.D. and Gopal Vyas, D.O.

Dr. Kelly is affiliated with the Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore.

When the test was administered, Dr. Thedford was with the Department of Pharmacy Practice, School of Pharmacy, University of Maryland. She is now with the Bernard J. Dunn School of Pharmacy, Shenandoah University, and the Pharmacy Department, Winchester Medical Center, Winchester, Virginia.

Dr. Vyas is with Spring Grove Hospital Center, Baltimore.

Acknowledgments and disclosures

Rules Based Medicine supplied the VeriPsych test but had no involvement in the use of the test, the results, or publication.

The authors report no competing interests.

References

1. Lysaker PH, Buck KD, Salvatore G, et al: Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Review of Neurotherapeutics 9:1035–1043, 2009 [CrossRef][Medline]
2. Buckley PF, Wirshing DA, Bhushan P, et al: Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 21:129–141, 2007 [Medline]
3. Schwarz E, Guest PC, Rahmoune H, et al: Identification of a biological signature for schizophrenia in serum. Molecular Psychiatry epub ahead of print PMID , 2011 [Medline]
4. Dudley E, Hassler F, Thome J: Profiling for novel protemonics biomarkers in neurodevelopmental disorders. Expert Review of Proteomics 8:127–136, 2011 [CrossRef][Medline]
5. Schwarz E, Izmailov R, Spain M, et al: Validation of a blood-based laboratory test to aid in the confirmation of a diagnosis of schizophrenia. Biomarker Insights 5:39–47, 2010 [Medline]

Mental health strategy draft doesn’t go far enough

An article published in today's edition of The Globe and Mail:

By André Picard (pictured)

Copies of the “confidential” draft of Canada’s highly anticipated mental health strategy are circulating widely among “targeted stakeholders.” So let’s take a look at what’s being offered up.

Canada is the only G8 country without a mental health strategy, so the document – and, more important, the underlying philosophy that we need to make life better for those with psychiatric and psychological illnesses – is long overdue.

After all, one in five Canadians will suffer a bout of mental illness; it is the principal cause of absenteeism and disability, and costs the economy a staggering $51-billion annually.

A strategy is essentially a way of setting priorities, of ensuring that no group is overlooked or neglected, that services are co-ordinated and that voices are heard in the corridors of power.

The Mental Health Commission of Canada, whose role it is to draft and implement the strategy, more or less has its priorities right, as evidenced by its six “strategic directions”:

1. Shift upstream and across sectors. This means emphasize the promotion of mental health (not merely the absence of mental illness), intervene early when people are sick – at school, at work or wherever – and tackle the stigma of mental illness.
2. Transform relationships and uphold rights. The draft document emphasizes recovery (most, but not all, people with psychiatric illnesses get better) and the need to get the sick out of the criminal justice system.
3. Strengthen capacity in the community. The strategy calls for a shift to community-based care and underscores the importance of housing and income support to aid the recovery of those with mental illnesses. 
4. Improve equity. Access to mental health services varies markedly across the country and among various age groups (with access to care for children being particularly abysmal), and the gaps need to be closed. 
5. Seek innovation with first nations, Inuit and Métis. Some communities, such as aboriginals, have specific challenges like sky-high rates of addiction and suicide that need particular attention. 
6. Mobilize leadership. The strategy calls for a “whole of government” approach, meaning mental health is not strictly a health issue – it affects the workplace, housing, justice and so on. The draft also calls for a strengthening of the mental health infrastructure.

The commission and the strategy have their genesis in a landmark 2006 Senate report entitled Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. The 567-page report was thoughtful, reasoned, forward-looking and, sometimes, even bold in describing the shortcomings of mental health treatment, dubbed the orphan of the health system, and in proposing solutions.

The committee, headed by then-senator Michael Kirby (who now heads the MHCC), made 118 recommendations, most of which find echo in the new document.

But there are some subtle, yet important differences between the tone and content of Out of the Shadows at Last and the draft strategy.

First, the language is more bureaucratic and wishy-washy. Mr. Kirby and his senatorial colleagues were refreshingly blunt on what needed to be done; the anonymous drafters of the strategy are far more circumspect.

Far more troublesome is what you can read between the lines of the proposed strategy. There is far too much emphasis on the “recovery model” – the notion that everyone will get better with support – and not enough emphasis on brain science. It’s a legitimate approach for those with mild and moderate mental health problems but not those with severe conditions such as schizophrenia.

In fact, reading the draft strategy, one is left with an unpleasant aftertaste: the distinct feeling that psychiatry and medications have no place in Canada’s approach to tackling mental illness.

There are distinct – and sometimes clashing – views in the mental health field. But the strategy gives too much credence to social science and not enough to neuroscience.

It also pays far too much attention to the views of “psychiatric survivors” who hide their vehemently anti-treatment views in the promotion of “peer support” and the language of “rights.”

But hope – and false hope – cannot be allowed to take the place of care. Where in the strategy, for example, is the call for investment in brain research, psychiatric beds and more addiction treatment facilities?

The draft also gives short shrift to the sickest of the sick, those with severe (and often intractable) cases of schizophrenia and bipolar disorder, who often suffer from anosognosia (where people don’t even recognize they have a mental illness).

This group, while small (less than 1 per cent of those with mental illness), are those who populate our streets and prisons. They don’t need the right to refuse treatment, they need the right to be well. And their families need to be empowered to help them, not cast aside.

Susan Inman, author of the memoir After her Brain Broke: Helping my Daughter Recover her Sanity, offers up a detailed critique of the strategy’s shortcomings in this regard in her article Suppressing Schizophrenia, published this week by The Tyee.

One of the MHCC’s key goals has been to help create a social movement, one that empowers people living (or having recovered from) mental illness. This is how women with breast cancer, men with prostate cancer and people living with HIV-AIDS have brought their issues to the forefront and made great strides.

But the mental health movement has to learn an important lesson from these other movements: You have to be inclusive, you have to embrace science, you have to be mainstream and you cannot allow those with ulterior motives to set the agenda.

There is a lot of good in Canada’s draft mental health strategy. But it’s not good enough yet.

Also see:

An open letter to Canadians from the Mental Health Commission of Canada

North Shore Schizophrenia Society Advocacy Bulletin (September 2011)

Suppressing Schizophrenia

An article posted yesterday by TheTyee.ca:

Schizophrenia is invisible in Canada's new mental health strategy.

By Susan Inman (pictured)

It is hard to imagine that life could get any harder for individuals living with schizophrenia (one per cent of the population) and the families who provide support to them. However, the controversial choices made by the Mental Health Commission of Canada (MHCC), in the latest draft of the new Mental Health Strategy, make it likely that their situations can actually get worse. These choices, which were not apparent in any earlier MHCC documents, are not receiving the public scrutiny that is needed because this draft is not available for the public. This draft, which was shared with a very small number of people, is currently being polished, and the Canadian public will not see it until it is unveiled in early 2012.

Through both what the strategy suggests and what it fails to support, this plan represents decisions that are dangerous to the well being of people with schizophrenia.

None of the MHCC documents have provided even the most basic information about this often misunderstood mental illness. For instance, the public has never learned that 40 to 50 per cent of psychotic people don't understand that they are ill and so have no reason to ask for or consent to treatment. Nor does any of the educational material promoted by the MHCC in its Mental Health First Aid program mention that 90 per cent of people with schizophrenia who stop taking their medications will have a relapse. A clearer understanding of this neurobiological disorder can help people understand the mental health policies that are most appropriate.

One major problem with the strategy is its approach to legal issues. The new draft strategy promises funds for court challenges to human rights abuses. The public deserves to have open access to this document to find out exactly what the MHCC intends with this action. Since the MHCC has allied itself with groups opposed to involuntary treatment of psychotic people, it is likely that federal funds could be made available to challenge involuntary treatment orders that have been made under various provincial mental health acts. Some human rights activists insist that no one should be treated for psychosis unless they choose this option; however, the notion of choice does not make sense in this context because people experiencing a profound psychosis do not have access to their rational thinking processes. They are not able to act in their own best interest, which is why mentally ill people frequently end up homeless or, increasingly, in prison.

To read the entire article, please click here.

Photo credit

Also see:

Mental Health Strategy for Canada - DRAFT (June 3, 2011)

Re: The lost, beautiful mind of Ivan Car, Aug. 21.

A letter to the editor published in yesterday's edition of the Ottawa Citizen:

After reading this article, I wish first to offer thanks to Anouk MontpetitCar for sharing her story about her husband Ivan Car's [pictured] struggles with depression - a battle he fought bravely but sadly lost.

Car's story is more common than one might think - and so often, these kinds of stories go untold and unnoticed. By sharing her husband's story with Citizen readers, MontpetitCar has not only provided a glimpse into what is a severe, chronic and disabling illness, but also the frustrations that someone with mental illness faces in seeking appropriate treatment as quickly as possible.

As with any other severe, chronic and disabling illness, quick response, expertise and ongoing care are all necessary if one is to recover. Unfortunately, it appears that by the time Car decided to seek the services offered at the Royal Ottawa Mental Health Centre, it was too late; he was too tired to face what lay ahead.

Perhaps he would have received the proper care and treatment if the waiting lists for psychiatric treatment at mental health facilities weren't so very long and if the Ministry of Health hadn't decided over 10 years ago that psychiatric emergency services should only be provided at local hospitals that have certain emergency-room capabilities. (An exception was made for the Centre for Addiction and Mental Health in Toronto, which still operates emergency services at the Clarke Institute on College Street.)

Because of this government decision, the Royal - which has obvious expertise in mental health - was forced to close its emergency services department in 2000. Former patients of the Royal speak fondly of the empathetic, caring environment and expert care received at the emergency room prior to this forced closure.

I and many other families I know have experienced the extreme difficulties of sitting for hours in a hospital emergency waiting room with a severely ill loved one who is in immediate need of psychiatric services. Often, very sick people never receive psychiatric services because, due to their illness, they are unable to wait and are unlikely to return, no matter how severe the symptoms.

There are real practical benefits to receiving emergency service at a mental health centre as opposed to an emergency room geared to treating fevers and broken bones. When someone is suffering from mental illness, it is imperative that appropriate mental health care begin at the first encounter between the health provider and the client. It can make the difference between success and failure.

Given the recent discussions about "client-centred" care, it is incumbent that two things happen - that the wait list for psychiatric services be addressed and that emergency services be returned to the Royal where specialized, therapeutic care goes beyond dispensing of medication.

Cynthia Clark, Ottawa Chair, Family Advisory Council, ROMHC

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