Province backtracks over 'delusional' website

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

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

Opening May 2007: Community Mental Health Services, Bayers Road

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

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

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

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

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

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

Relating with professionals

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

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

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

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

For Immediate Release

March 27, 2007

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

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

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

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

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

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

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

Contacts:

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

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

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

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

What it's like to have schizophrenia

Click here for a report from BBC News.

The latest two CATIE publications

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

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

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

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

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

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

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

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

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

Austin Mardon honoured with the Order of Canada

From Western Catholic Reporter:

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

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

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

A gift of hope

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

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

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

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

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

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

A valiant man

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

Michael Kirby named to head new Canadian Mental Health Commission

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: Canada.com and CBC.ca

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

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

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

Probing the Biology of Psychosis, Schizophrenia, and Antipsychotics

From Medscape Today, November 15, 2006:

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

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

Diagram courtesy of CNSforum by The Lundbeck Institute

Information Technology Corner

By Stephen Ayer, Executive Director

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

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

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

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

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

The SSNS's Online Library Catalogue

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

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

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

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

Mental-health services shortchanging children of our soldiers

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

Necessary Force

A short story by Jon David Welland, Copyright 2007

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“It ends like this ma’am, goodbye.”



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

How You Can Help: A Toolkit for Families

You may benefit from reading this toolkit if:

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

Traps into which psychiatrists can fall

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

Graph courtesy of Psychiatric News.

Antipsychotic Adherence Data Counter Common Belief

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

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

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

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

For the full article, click here.

Remembering Genine Holznagel-Leary

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

More information can be found by clicking here.

A quote from the Fairbanks Daily News - Miner:

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

Photo courtesy of André Karwath.

February 2007 Update on the Healthy Minds Initiative

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

By Amanda Crabtree, Project Manager

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

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

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

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

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

Schizophrenia and Co-Occurring Substance Use Disorder

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

From the March 2007 issue:

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

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

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

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

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

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


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


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


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


5. What medications are most likely to be helpful?

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

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

Health Canada: Information Update

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

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

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

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

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

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

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

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

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

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

Symptoms of Psychosis

Janssen-Ortho has produced an excellent one-page summary of the symptoms of psychosis. To access a copy, click here (opens a PDF file).

An Rx to thin California prison population

From The Los Angeles Times by way of The Trouble With Spikol:

Tomorrow [February 24th], state Sen. Darrell Steinberg, a Democrat from Sacramento, will introduce a bill that calls for a complete overhaul of mental health care behind bars, with the goal of putting a big dent in both the overcrowding problem and the high recidivism rates.

For the entire article, written by Steve Lopez, click here.

Schizophrenia: New Pathological Insights and Therapies

A recent article published by Annual Review of Medicine is available as a free download:

Abstract
The neuro- developmental hypothesis of schizophrenia posits an interaction between multiple susceptibility genes and one or more environmental insults in early life, resulting in altered brain development and the emergence of psychosis in early adulthood. Based on this framework, it has been argued that most neuropathological deficits observed in post mortem and neuroimaging studies of schizophrenia represent one or more lesions that originated in early life and remained static thereafter. However, recent longitudinal neuroimaging studies demonstrate a progressive component to the neuropathology of new-onset schizophrenia. This opens the possibility that the functional decline seen in many patients following the onset of illness may be halted or slowed. This review provides an update on developments in research on the neuropathology of schizophrenia and discusses recent advances in antipsychotic treatment and the potential impact on long-term outcomes.

Determining schizophrenia probability

From United Press International:

BINGHAMTON, N.Y., Feb. 22 (UPI) -- Abnormalities in eye movements and attention can be used to divide people into two groups in relation to schizophrenia-related risk, says a U.S. study.

The findings, presented in the Journal of Abnormal Psychology, suggest that the manner in which the eyes can follow a target and how well one can pay attention to a task together help to pinpoint risk factors related to schizophrenia.

"Schizophrenia affects one in every 100 people and has a strong genetic component; about 80 percent of what determines schizophrenia is related to genetic influences," said Mark F. Lenzenweger of Binghamton University, State University of New York.

"What was very exciting for us is that this method allows you to assign a probability to every person in the sample with respect to likelihood of risk for schizophrenia liability -- by doing this, one can generate very precise estimates of where individuals fall on the risk dimension."

Mind Your Mind - New Resource for Teens with Mental Health Questions

Posted January 24th on Schizophrenia Daily News Blog:

A new website has been launched in Canada to help teens with mental health problems.

MindYourMind.ca (MYM) is a non-profit award winning web site funded in part by the Government of Canada. MYM is dedicated to providing the necessary info, resources and skills to inspire youth to reach out, get help for themselves or give help to their friends who may be coping with stress, mental health issues, self-harming behaviours or suicide. MYM is committed to reducing the stigma often associated with reaching out for help.

The activity based coping tools and downloads appeal to youth who are looking for an interactive and non-intrusive way of receiving valuable mental health information.

Nobel Laureate John Nash to Give Convocation Lecture

From the February 16th edition of Psychiatric News:

During what is expected to be an unforgettable evening, Nash will present the William C. Menninger Memorial Lecture at American Psychiatric Association's Convocation of Fellows on Monday, May 21, at 5:30 p.m. in the San Diego Convention Center.

Copies of Schizophrenia Digest available

A significant number of copies of the Winter 2007 edition of Schizophrenia Digest have been donated to the Schizophrenia Society of Nova Scotia. If you are interested in receiving a copy, please send an email, including your name and mailing address, to ssns@ns.sympatico.ca.

Mental health clinic moving outside hospital

From the February 17th edition of the Halifax Chronicle Herald:

BRIDGEWATER - The South Shore's outpatient mental health unit is being moved from the hospital to leased space in a call centre.

The clinic will move into the Resolve building on Dufferin Street in Bridgewater in April, along with addiction services. The in-patient unit will remain in South Shore Regional Hospital in Bridgewater.

Kevin McNamara, CEO of the South Shore district health authority, said the move will make services more accessible to client and open up much-needed space in the hospital. The emergency and ambulatory care areas are particularly cramped.

Phil Langford, vice-president of operations for South Shore Health, said he is working on a plan to make best use of the space that will become available in the hospital and expects to present that to the board at the end of March.

Photograph courtesy of the Town of Bridgewater.

Youth mental health: time to act

From the February 6th edition of the Halifax Chronicle Herald:

By STAN KUTCHER and NONI MACDONALD

Young people are this country’s most valuable resource. We are obliged, for moral, economic and political reasons, to do our best to optimize the growth and development of our youth in healthy and productive ways. The Nova Scotia government’s response to the Nunn inquiry illustrates an increased awareness of this responsibility.

Youth travel through a period of major physical, emotional, social and financial changes as they move from childhood into adulthood. The youth years are among the most physically healthy. However, emotional and behavioural problems arise from many factors, which can result in high-risk behaviours. Many of the most severe and persistent brain disorders that manifest themselves as mental illnesses, such as depression, manic-depression and schizophrenia, come on during these years. These disorders are due to alterations in brain development that create difficulties in thinking, mood and behaviour.

Suicide is highly related to mental disorders – especially those unrecognized and untreated. Mental disorders beginning in these years tend to be chronic and persistent illnesses. They are also related to the onset and premature death from other medical issues – including diabetes and heart disease. Some youth may exhibit a variety of high-risk behaviours which, even in the absence of mental illness, will lead to both short- and long-term negative outcomes, including injury and death. About 20 to 25 per cent of youth may suffer from problems that will interfere with their ability to mature and develop.

Many young offenders have significant mental disorders, substance abuse or emotional/behavioural problems; they need better access to helpful programs and interventions.

The province’s response to the Nunn report lists about 75 programs that are available to address the needs of young people. Making appropriate changes to the Youth Criminal Justice Act, increasing youth accountability, improving the delivery of offender services, increasing accountability for youth services, and enhancing the integration among the many players in the youth services arena are necessary; but these, in and of themselves, will not be sufficient to meet the needs of youth.

To achieve success, programs and policies need to be more than well-intentioned. First, all interventions must be based on validated data from scientifically sound research. Second, programs or other interventions need to meet the developmental needs of youth and the social-cultural realities of the communities in which they live. Third, programs need to be integrated across jurisdictions – Education, Health, Justice and Community Services at the government level – as well as in communities and schools. Fourth, interventions must be evaluated to ensure they are achieving the expected effects. Finally, there needs to be an increased investment in high-quality research designed to study which interventions are most helpful, unhelpful or even harmful.

We are pleased the province has decided to address the needs of young people and to acknowledge that the justice/corrections system areas highlighted by Nunn must be urgently considered. We are heartened that the government is looking to prevent youth crime through identifying and dealing with root causes. The interdepartmental steering group to develop a child and youth strategy is a major step forward. We urge the province to implement effective programs that address the wider mental-health needs of young people, not just the mental health needs of those within the justice system or those at risk of criminal activity.

Our province is blessed with expertise that could be harnessed to meet the mental-health needs of our youth. Practitioners and researchers, who are nationally and internationally recognized, are available. What is required is a small amount of resources, and an infrastructure that has the authority and responsibility to lead, utilize and direct our collective expertise in a manner that will change youth mental health outcomes. The Nunn inquiry and the government’s response have set the stage – now we need action.

Dr. Stan Kutcher is Sun Life Financial chair in adolescent mental health and Dr. Noni MacDonald is professor of pediatrics, IWK Health Centre, Dalhousie University.

Mental Health Services and Supports in Communities Across Nova Scotia

The Nova Scotia Department of Health has a useful one-page summary of telephone numbers for mental health services and supports in Nova Scotia. I am not sure how up-to-date this document is, and, unfortunately, the Schizophrenia Society of Nova Scotia is not listed (something we will work on changing).

Margaret Trudeau fighting to end stigmas attached to mental illness

By Elianna Lev

VANCOUVER (CP) - Margaret Trudeau (left, in red) says she has chosen sanity and that's the choice she wants other Canadians suffering with mental illness to make.

The former wife of the late Pierre Trudeau is using her profile to bring attention to mental illness, which has affected her for 35 years.

"Acceptance. . . is the biggest thing for people to do, just to accept that there is a problem, to accept that they need help," Trudeau told a news conference Monday.

"With mental health issues we're reluctant to accept it because of the stigma that has been played out in the media and the movies."

Trudeau, 58, first experienced depression after giving birth to her second son, Alexandre. That was the first of three times she was hospitalized for her illness. The second time came after the death of her son Michel in 1998 and then after her ex-husband died two years later.

She said she was in such dire straits at that time that she was forced to accept her bipolar disorder and get the help she needed.

"I've chosen sanity, I've chosen to be well," Trudeau said.

She has also distanced herself from marijuana, one aspect of her life that was well-documented when she was thrust into the Canadian spotlight as a 22-year-old flower child and bride of the former prime minister.

She said she's since found the enlightenment she felt from drugs in the form of spirituality. Trudeau is interested in Buddhism and follows the works of the Dalai Lama.

Trudeau said people should treat mental health as they would their physical health, taking days off when they feel unwell.

If Canadians start to talk openly about mental wellness, the stigma will diminish and people help will get the help they need, she said.

"It should be a conversation at the kitchen table, it should be a conversation on the way to work," Trudeau said. "Because recognizing depression in the early stages, you can change the course of the disease."

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

Book Review

Cognitive Therapy of Schizophrenia

by David G. Kingdon and Douglas Turkington; New York, Guilford Press, 2004, 219 pages, $37

A book review published in the February 2007 edition of Psychiatric Services and written by Timothy B. Sullivan, M.D.:

It's hard to say how bad ideas, misinformed or misguided clinical saws, originate. One of the most enduring in psychiatry is the notion that talking to patients with schizophrenia about their symptoms or about their subjective experiences is potentially harmful. It is little wonder that so few medical students or psychiatric residents wish to specialize in work with patients who have seriously mental illness.

There have been studies and reviews, most famously the Patient Outcomes Research Team recommendations (1), which have directed our attention to the lack of efficacy (2), obvious paucity of controlled observation, and insufficiently documented putative harm associated with "uncovering therapies," by which is meant psychoanalytic therapy and its congeners. Kingdon and Turkington lament the effect these proscriptions have unintentionally had on creative engagement of persons suffering from disorders such as schizophrenia. They note that "many practitioners continue to believe that the content of psychotic symptoms should be ignored and that any psychological work ... is liable to lead to increased distress and exacerbation of symptoms, as a result of having opened up disturbing areas."

Of course the problem with past, well-intentioned, and compassionate efforts by a legion of gifted therapists is that the therapeutic model, and the theory of mind supporting it, did not accurately reflect the nature of the disorder. It was not the effort to be empathic that was flawed but the various notions about how symptoms were produced or could be ameliorated. If you don't understand what you're treating, you will misdirect, misinform, and inevitably disappoint.

Kingdon and Turkington set out to provide clinicians with a treatment model that will make the uncertain knowable and that which is alienating comfortable. They successfully present a cogent, approachable, and flexible model for psychotherapeutic engagement of persons suffering from serious psychotic illness. This is not a "manualized" treatment, and the authors explain why that approach is not appropriate. A careful exposition of the nature of the illness processes, and the theory of cognitive-behavioral therapy and its particular adaptation to this setting, is explicated. There are many clinical examples, guidelines, forms to use, and even patient handouts that can be copied and distributed are included. The succinct review of the psychology of schizophrenia is particularly useful, such as the discussion of "externalizing bias" and the central role of stigmatization in symptom development.

The fourth chapter, on therapeutic engagement, and later chapters on work with delusions and hallucinations, are not only brilliantly executed but come as close as one can, in print, to detailed individual case supervision. Even experienced practitioners will find these presentations extremely helpful, because they reflect the careful thought of talented clinicians who have immersed themselves in their subject and achieved valuable insights.

I do have one brief quibble. As a heuristic device, Kingdon and Turkington use four clinical subgroups to differentiate "types" of schizophrenia. In the context of the book, these subgroups are useful and unify their presentation. I am not sure I can agree that the subgroups encompass the range of patients I see.

Reviewers will often say that the book they are reviewing belongs on everyone's shelf. I urge you to please buy and read this book. Our patients deserve our attention to these issues. Those of you who are talented clinicians but who avoid this population out of confusion or lack of confidence in your ability to help will, I assure you, find this book crucial. You will find yourself able to approach a person with schizophrenia with confidence, and it will change how you think about your work.

Footnotes

Dr. Sullivan is chief of services for the seriously mentally ill at Saint Vincent's Catholic Medical Center, Westchester, New York, and assistant professor of psychiatry at New York Medical College, Valhalla.

References

1. Lehman AF, Steinwachs DM: Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin 24:1-10,1998 [Medline]



2. Gunderson JG: Effects of psychotherapy in schizophrenia: II. comparative outcome of two forms of treatment. Schizophrenia Bulletin 10:564-598,1984 [Medline]

Schizophrenia Risk Factor Found in Maternal Blood

Summarizing work published by Alan S. Brown, MD, et al., Joan Arehart-Treichel writes in the February 2nd issue of Psychiatric News:

An elevated prenatal blood level of homocysteine may double the risk of having a child who will develop schizophrenia. But rubella and flu infections during pregnancy seem to be even larger risks.

Update on the Healthy Minds Initiative

From the January 2007 edition of the Healthy Minds Cooperative's The Blue Horse Chronicles.

By Amanda Crabtree

Since my last column, the Mental Health Program and the Department of Psychiatry, have distributed two “Healthy Minds Initiative Update to the Community” letters. The most recent letter was distributed on January 12th. I hope you have received the letter and have taken the time to read through it. It gives you a sense of the work we are doing on the Initiative.

Recently, Community Mental Health began offering evening hours. All five community teams are each open one evening per week. We appreciate that offering evening hours is more convenient for people who have commitments through the day. We are trying to spread the word that evening appointments are available so, please pass the message on as much as possible.

Community Mental Health:

• Cole Harbour / Eastern HRM ~ 434-3263


• Dartmouth City Team ~ 464-3116


• Abbie Lane ~ 473-2531


• Bedford / Sackville ~ 865-3663


• Hants ~ 792-2042
  

In each of my columns, I touch on the Abbie Lane Mental Health Outpatient Department move to Bayers’ Village. In fact, in my last column, I mentioned that our goal was to relocate 55 per cent of the outpatient department to Bayers’ Village in January, 2007. Though the Mental Health Program and the Department of Psychiatry are committed to offering outpatient services at Bayers’ Village, we have adjusted our timeline. Once we have a new target date, I will be sure to include that in my column.

Moving both the Abbie Lane Mental Health Outpatient Department and the Dartmouth City Team to community locations is part of helping to create networks of mental health and related supports and services (Community Resource Networks).

A couple of closing notes:

1. We are making progress on developing a web site that will provide mental health information, education materials and referral resources (Citizen Support Web). We hope to announce a developer for the site in February and then to begin building the site soon after that, with the aim of launching it this summer.
   


2. The [Capital District] Mental Health Program will soon have a new director; Peter Croxall will begin with the Program on February 5th.

For additional information on the Healthy Minds Initiative, contact Amanda Crabtree by phoning (902) 460-7401, by email, or visit here.