Grief in Patients with Schizophrenia

An article published online by the journal Archives of Psychiatric Nursing:

Loss and Grief in Patients With Schizophrenia: On Living in Another World

By Maria Mauritz (a, b) and Berno van Meijela (b)

(a) Support and Psychosis Programme of the Mental Health Care Unit GGNet in Zevenaar, The Netherlands

(b) Inholland University in Amsterdam, The Netherlands

Aim
Schizophrenia enormously impacts the lives of the patients who have this psychiatric disorder. This study addresses the lived experience of grief in schizophrenia.

Method
A qualitative study based on the grounded theory was designed. Ten patients were interviewed in depth on their feelings of loss and ways of coping.

Results
All respondents experienced significant feelings of loss. Internal and external losses were distinguished. Respondents dealt with their losses by accepting their diagnosis and treatment, identifying with other patients, learning about schizophrenia, and searching for meaning.

Discussion
Respondents were able to identify their significant losses and verbalize the accompanied feelings. They went through an intensive grieving process that to a certain extent led to coming to terms. During the interviews, the presence of grief was evident, whereas clinical depression was excluded.

Clinical implications
Interventions may be improved by the following factors: (a) optimal assessment and treatment of symptoms; (b) adequate information about symptoms, treatment and its effects, and prognosis; (c) opportunities to identify with other patients; (d) strengthening of social support; and (e) a relationship of trust with care providers based on an accepting attitude.

Posting of this abstract is for the purposes of research into schizophrenia.

'Excited delirium' killed Tasered man

An article published in the March 27th edition of the Edmonton Journal:

Critics say supposed cause explains nothing

By Ben Gelinas, with files from Laura Drake

A crazed man brought down by a police Taser last October died from what the medical examiner calls excited delirium caused by drugs.

Trevor Grimolfson [pictured], 38, was hit twice by the Taser after he attacked a man who came into his Stony Plain Road tattoo parlour and then smashed up a nearby pawnshop. Witnesses said Grimolfson was combative, violent and couldn't be calmed. After he was hit with the Taser, police handcuffed him. He soon lost consciousness and was declared dead in hospital.

"The cause of death was excited delirium brought on by drugs he'd taken," Alberta Justice spokesman David Dear said.

No further details on the ruling were released.

A representative from the medical examiner's office could not be reached for comment.

Asked about excited delirium, Michael Webster, a police psychologist who gave testimony at the inquiry into the death of Polish immigrant Robert Dziekanski at Vancouver's airport, said that "it's a fantasy.

"Police and medical examiners have taken something that was initially descriptive and have made it into something prescriptive. And that's where the controversy comes from, because it's just not a diagnosis, nor is it a cause of death."

Webster said the vast majority of physicians, psychologists and psychiatrists do not recognize that excited delirium exists.

"I would challenge your medical examiner to show me excited delirium in that corpse."

It is Webster's opinion that the continuing diagnosis of excited delirium as a legitimate cause of death further drives a wedge between law enforcement and the majority of the medical community.

Alberta's chief medical examiner has been outspoken in his belief that excited delirium is a legitimate condition. Someone in the state could die without being touched or even when alone. It seems to have nothing to do with the method of restraint, Dr. Graeme Dowling told the Canadian National Committee for Police in November.

"They may die in spite of what we do."

Dowling said that it wouldn't be uncommon to need six to eight police officers to restrain someone in an excited delirium, as it is characterized by abnormal strength.

Following Grimolfson's death, the use of a Taser promptly became the public focus.

The medical examiner's ruling "once again shows that when these arrest-related deaths occur, jumping to conclusions is the wrong way to go," Taser International spokesman Steve Tuttle said. "We have seen this time and time again repeatedly, and it has sadly affected public opinion."

The Arizona company has been under intense public scrutiny in Canada since Dziekanski's death was captured on amateur video.

Tuttle said that incident ignited something that borders on hysteria in this country.

"We call it a crisis in Canada."

A fatality review board will determine whether a fatality inquiry will be recommended in Grimolfson's case.

The Alberta Serious Incident Response Team which looks into deaths involving police is still investigating.

Alberta Solicitor General spokesman Andy Weiler said no one from the response team will comment on the medical examiner's report until the investigation is complete.

Rethink warns that new schizophrenia guideline needs reality check

An article posted on March 24th by politics.co.uk:

Leading mental health charity Rethink severe mental illness today (March 24) welcomed a new guideline on the treatment of schizophrenia from the National Institute for Health and Clinical Excellence (NICE), but warned that it would fail unless local services were forced to offer real choice.

Rethink Director of Public Affairs Paul Corry said: "The guideline sets out 21st century treatment options that, if implemented, would support people's early recovery from an illness that too often condemns people to a life of isolation and poverty.

"The guideline promotes choice in medication, access to the latest psychological treatments and help to be made available as early as possible.

"Unfortunately, the reality on the ground is that too many people are denied choice of any kind, face 18 month long queues for their first contact with a psychiatrist and can’t even get on a waiting list for the latest psychological treatments.

"It is going to be an uphill struggle to get these guidelines implemented on the ground and NICE still lacks the teeth to enforce its guidelines within a National Health Service that treats mental health as the poor relation."

NICE has reversed its previous advice to make modern atypical medicines a first line of treatment for schizophrenia. It now says that doctors should offer a choice between a range of older and newer medications, because newer medications have been shown to have worrying side effects as serious as those associated with older medication.

Mr Corry said: "The newer medications can cost up to £2,000 for a year’s treatment. This is cheap by comparison with cancer drugs but still up to 10 times as much as the older drugs.

"Our worry is that unless NICE is given the teeth to insist on choice, the NHS will opt for the older, cheaper drugs that are associated with long-term debilitating and stigmatising side effects."

NICE calls for the psychological treatment Cognitive Behavioural Therapy (CBT) to be made available to people with schizophrenia.

Mr Corry said: "CBT should be available to everyone who can benefit from it. The government is investing over £170 million in making it available to people with anxiety and depression – which is welcome – but so far people with schizophrenia have missed out.

"The government needs to come up with the extra resources to enable clinicians to offer CBT as a matter of course to people with schizophrenia, otherwise NICE will leave a nasty taste in the mouth of those whose expectations are dashed."

FOR COMMENT OR CASE STUDIES CONTACT

Hilary Caprani 020 7840 3144 / 07870 204583 hilary.caprani@rethink.org

Also see:

NICE sets the standards for people with schizophrenia

On the Road to Recovery with Fred Frese

An article posted on March 19th by Miller-Mccune.com:

Mental health care "consumers" are taking a greater role in their own recovery, moving beyond merely being patients to being providers.

By Marcia Meier

Fred Frese was a young Marine Corps officer and graduate student when he started experiencing the psychotic delusions of paranoid schizophrenia. He was hospitalized, the first of what would be 11 such institutionalizations. But he also managed to complete graduate school and earn a doctorate in psychology from Ohio University. He married and had four children, and 12 years after his first hospitalization, he became a chief psychologist for the Ohio mental health system.

That was 30 years ago. Today, Frese is director of the Summit County Recovery Project in Akron, Ohio, and one of the most articulate and outspoken national advocates of mental health recovery programs.

A crucial part of that recovery is battling the stigma of mental illness, he said. About 6 percent of the population, or one in 17 Americans, suffers from a serious mental illness. One in five families are affected.

"It's important for us to get out on Front Street and talk about our experiences," Frese said. "Many of us have long experiences with hospitalization, institutionalization. In the '70s, many of us were simply put away."

Frese knows what he's talking about. When he had his first psychiatric breakdown, he was 25 and in the Marines. He started to experience classic symptoms of paranoid schizophrenia: delusions, hearing voices, inability to separate fact from fantasy, inability to think logically, an all-consuming paranoia. He came to believe that enemy nations had hypnotized American leaders in a plot to destroy the United States. He was sent to the naval hospital in Bethesda, Md., where he stayed for five months.

Since then, he has been hospitalized numerous times, but he's also been able to function with the help of medication. He earned graduate degrees in international business management and psychology, and served as director of psychology for the Western Reserve Psychiatric Hospital in Sagamore Hills, Ohio, for 15 years until he retired in 1985. Since the early 1990s, he has directed the Summit County Recovery Project.

To read the entire article, please click here.

Also see:

Recovery From Schizophrenia: With Views of Psychiatrists, Psychologists, and Others Diagnosed With This Disorder

Editorial: Understanding and Measuring Recovery (PDF)

Photograph by Simon des Forges.

Schizophrenia & Substance Use - A Q methodological study

An abstract from the February issue of Mental Health and Substance Use: dual diagnosis:

Self-reported reasons for substance use in schizophrenia: a Q methodological investigation

Mental Health and Substance Use: dual diagnosis, Volume 2, Issue 1 February 2009, pages 24-39.

By Lynsey Gregg, Gillian Haddock, and Christine Barrowclough

Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, UK

Abstract:

Large numbers of people with a diagnosis of schizophrenia use drugs and alcohol, resulting in poorer symptomatic and functional outcomes for many.

Aims: To examine the reasons that people with a diagnosis of schizophrenia give for their own alcohol and drug use.

Method: Q methodology was used to examine reasons for use. Forty-five people with a diagnosis of schizophrenia or schizoaffective disorder and comorbid substance misuse completed the sorting procedure.

Results: Analysis of the Q Sorts revealed three distinct groups of substance users:

1. those who predominantly used for social and enhancement reasons, to 'chill out and have a good time with others';
2. those who used to regulate negative affect and alleviate positive symptoms, to 'cope with distressing emotions and symptoms';
3. those who used substances to augment themselves and intensify their experiences, to 'feel bigger, better and inspired'.
   

Conclusion: People with a diagnosis of schizophrenia who use substances explain their substance use in different ways. The identification of subgroups of users may be useful in the development of interventions aimed at reducing substance use in this group.

Posting of this abstract is for the purposes of research into schizophrenia and dual diagnosis.

I thank the Lancashire Care Library & Information Service for bringing this article to my attention.

Gene 'has key schizophrenia role'

An article posted today by BBC News:

Two studies have pinpointed a single gene as key to the development and treatment of schizophrenia.

A US team from the Howard Hughes Medical Institute found that a mutated version of the DISC1 gene disrupts the growth and development of brain cells.

And a team from the University of Edinburgh showed that the gene affects how patients respond to treatment.

Both studies, published in the journals PLoS One and Cell, raise hopes of more effective treatment for schizophrenia.

To read the entire article, please click here.

Also see:

Disrupted in Schizophrenia 1 Regulates Neuronal Progenitor Proliferation via Modulation of GSK3(beta)/beta-Catenin Signaling

The DISC1 Pathway Modulates Expression of Neurodevelopmental, Synaptogenic and Sensory Perception Genes

I thank John Devlin and Dr. Roger Cann for bringing this article to my attention.

Information sessions, self-help groups provide timely support

An article posted on March 11th by The Kings County Advertiser:

Kings County Chapter of the Schizophrenia Society of Nova Scotia board members Pat MacLean (left) and Margaret Burton are raising awareness of an information program and a self-help group in our community dedicated to offering support to the family members and friends of people living with mental illnesses. Photograph by Kirk Starratt.

By Kirk Starratt

Sometimes dealing with a mental illness can make you feel isolated or leave you wondering where to turn for support.

Recognizing a need to share information, provide support and help debunk the myths and stigma associated with mental illness, the Kings County Chapter of the Schizophrenia Society of Nova Scotia is offering a 10-session information program and a self-help group to reach out to affected members of the community.

“We’re concerned about the fact that families often are the key caregivers to someone with a serious mental illness,” board member Pat MacLean said. “It’s not always easy to get the information they need.”

Because of this, the society has launched the information program, called “Strengthening Families Together”. It’s free to attend and is geared toward family members and friends of people experiencing serious mental illnesses. The sessions are being held at the offices of the Kings County Branch of the Canadian Mental Health Association (CMHA) in Kentville. The first will be held Tuesday evening, March 24 at 7 p.m. and each runs for two hours.

The sessions will provide information about mental illnesses, skill-building and support. Participants will learn about early intervention and recovery, treatments and supports, coping with challenges of daily living, navigating the mental health system and the importance of taking care of one’s self.

‘Not talking about a few people here’

MacLean said it’s important to reach the general public with information on what is available in terms of supports and services.

“We’re not talking about a few people here,” she said. “A lot of people have serious mental illnesses.”

There are about 600 people in Kings County living with schizophrenia, about 600 living with bipolar condition and about 1,000 living with depression. However, because of the stigma, people often remain quiet and don’t seek help.

Board member Margaret Burton said that one in five people will experience mental illness at some point in life and the numbers are much higher when you consider how many people will be affected indirectly. She said that, as a society, they see three components to their work: advocacy, education and support.

She said her family took the “Strengthening Families Together” program and recognized a need for ongoing support for family members and friends of those living with mental illness.

This past fall, a group of family members from within the society formed a self-help group. All the members are people who have been touched directly or indirectly by mental illness.

Burton said families need information about mental illness and about the services that may be available to them. They need help in coping over the long-term with the illness and its consequences, including acquiring skills for problem solving, conflict resolution and stress management.

Confidentiality a must

They need support to be able to cope with the challenges of caring for someone with a mental illness as well as to be able to address their own emotional needs.

As with other self-help groups, confidentiality is a must. Meetings take place once a month at the CMHA offices in Kentville.

If you or someone you know might be interested in the information sessions or the self-help group, call the Schizophrenia Society of Nova Scotia toll-free at 1-800-465-2601 for more information or visit www.blog.ssns.ca.

The society believes there is a greater need for understanding among members of the general public in order to overcome the myths and stigma associated with mental illness. They extend thanks to the Kings CMHA for providing their facilities for the information program and the self-help group.

Schizophrenia is a complex brain illness that affects one per cent of the general population and can be particularly devastating to young people. The Federal Kirby Report of May 2006, “Out of the Shadows at Last”, states that family members play an essential, sometimes lifesaving, role in caring for persons living with mental illnesses.

Almost 60 per cent of the families of people living with serious mental illnesses are estimated to serve in the capacity of primary caregiver, usually with little guidance, support, relief or respite.

The Timothy McLean and Ashley Smith tragedies: Getting beyond the fear and stigma of mental illness

A commentary recently released by the Canadian Alliance on Mental Illness and Mental Health (CAMIMH):

By Annette Osted, Executive Director, Registered Psychiatric Nurses of Canada

Two terrible tragedies have vaulted into public awareness during the past few weeks. Both involved individuals who suffered from a mental illness and elicited much response from the Canadian public. These tragic events have also highlighted grave weaknesses in our understanding and approach to mental health in Canada.

The first event was the court trial of Vince Li who carried out the horrendous killing of Timothy McLean on a Greyhound bus in Manitoba, but was found not criminally responsible for the murder because he suffers from a mental illness.

The other was the public release of a report on the death by suicide of 19 year old Ashley Smith in a federal women’s prison. The report concluded that her death was “preventable”, and partially provoked by instructions to correctional staff that they should not intervene with Ms Smith when she attempted to asphyxiate herself.

In the first case, we must ask ourselves whether the early diagnosis and appropriate treatment of Vince Li’s mental illness could have averted the death of an innocent person. Certainly the evidence is strong that people suffering from schizophrenia are rarely a danger to other people and, with proper treatment, can recover to live relatively normal lives.

Sadly this tragedy has mostly served to reinforce public stereotypes about the dangers of people with mental illness.

In the Ashley Smith case, a lack of understanding about the effects of prolonged emotional distress and the impact of incarceration on the emotionally vulnerable led to a situation where correctional officers stood by and watched as a young woman killed herself. It seems clear that better mental health training and protocols that protect people in emotional crisis could have averted this tragedy.

These two serious events reflect our society’s approach to mental health and mental illness. Mental health is, for the most part, ignored. We have programs that promote physical health, but little has been done to actively promote mental health, despite the fact that mental health challenges affect us all in one way or another.

One in four persons in Canada will require treatment for a mental illness and/or addiction. Most of us know someone who has suffered from depression, anxiety or other mental health problems. And yet mental illness is still an issue avoided in conversation.

Some have compared this avoidance to the vast public silence around HIV and AIDS twenty-five years ago or the hush that surrounded cancer in the past. With both diseases fear was a common factor: fear that we could ‘catch’ it; fear that the person who had ‘it’ was incurable and therefore doomed. Today, thanks to research, and open discussion on the part of survivors, we know that cancer and AIDS are illnesses that can be treated.

Mental illness today suffers from stigma that is at least comparable to that of cancer or AIDS in the past. There is still a tremendous reluctance in Canadian society to talk openly and learn about mental illness – and this must be overcome.

A strong mental health literacy program for all age groups would be a good beginning. Such a program would teach people what good mental health is, how to maintain it; how to identify the signs of declining mental health; what resources are available; and how to identify and assist people requiring help for their mental health issues.

We can only have tremendous compassion for Timothy McLean, his family, and all of the other victims on the bus that day. This compassion compels us as a society to use our institutions to investigate and institute measures that will safeguard Canadians from similar harm in the future.

But our compassion should also lead us to challenge the stigma against mental illness and other obstacles that so profoundly interfere with the treatment and recovery of affected people. We must also accept responsibility as a society to care for the victims of mental illness just as we care for people who have cancer or HIV/AIDS.

We cannot truly say that justice will be served in the cases of Timothy McLean and Ashley Smith until we also examine the fact that gaps in treatment, stigma, fear, discrimination and cultural perceptions of mental illness also played a role in these tragedies.


For additional information please contact:

Christopher Wilson
Media Relations
Canadian Alliance on Mental Illness and Mental Health
(613) 298-5464

Also see:

Canadian Alliance on Mental Illness and Mental Health issues open letter regarding recent mental health coverage in the Canadian media

It's an illness, not a monster

Patients' rights frustrate families

An article published in the March 12th edition of The Globe and Mail:

By André Picard (pictured)

The trial of Vince Li, the so-called "Greyhound bus killer," garnered a lot of media attention. There is no need to rehash the gruesome details.

But let's linger on one aspect of the case, because much was made of the fact that Mr. Li suffers from a severe mental illness, schizophrenia.

This is the story of someone else who suffers from schizophrenia.

His name is Matt. Like most [people with schizophrenia], he has never harmed anyone physically - except himself.

But he and his illness have caused his family and friends untold pain - a pain made more searing by the coverage of Mr. Li's trial. The descriptions of him as "psycho," a "sicko," a "nutcase" and so on hurt profoundly; so, too, did the focus on Mr. Li's "crazy" symptoms and the lack of attention paid to the fact that he was untreated for a treatable condition.

"Nobody deserves to die like that young man on the bus. But seeing the way schizophrenia was reported made me sick," said Steve, Matt's father.

They have a last name, but have asked that it not be used. There is a lot of stigma surrounding mental illness, and vilification of the mentally ill. "I'm self-employed and I can't afford having people think of me as the father of a 'freak.' That's the sad reality," Steve says.

But, at the same time, Steve wants the public to see another side of schizophrenia, one that will never be front-page news.

It is a story of frustration with Canada's patchwork mental-health system, one in which care is not available until there is a crisis. It is the story of the devastated family of the person with schizophrenia.

It is a story of anger with a legal system that gives people with severe mental illness the right to refuse treatment, and affords families no right to help their loved ones get well.

The family has lost count of how many times Matt, who is only 20, has attempted suicide, how many times he has overdosed.

Matt will ingest any drug he can get his hands on, from NyQuil to ecstasy. When he does, the demons that haunt him recede into the shadows for a while.

Like many people with severe, untreated mental illness, Matt has an ever-lengthening criminal record, most of it related to shoplifting over-the-counter drugs at pharmacies and public intoxication.

He spends nearly as much time in prison as he does in hospital - essentially jailed for being ill.

Who could have imagined it would come to this?

At one time, Matt lived a comfortable middle-class existence in suburban Toronto. He was a star athlete, a gifted musician, an army cadet, a popular classmate. But things began to unravel in high school.

He became withdrawn. Smoked and drank and did drugs with a little more gusto than his peers. Began acting weird. Dropped out of school. At first, it was dismissed as the growing pains of adolescence, but his behaviour soon spiralled out of control.

Matt bounced around various group homes and court diversion programs. The stress and frustration were such that his parents' marriage almost collapsed.

Then the diagnosis came - schizophrenia.

"Finding an explanation for his behaviour was a relief," Steve says. After all, parents tend to blame themselves.

"But then you find out what it really means - a mind-altering disease destroying a person you love - and it's heartbreaking," Steve says.

Trying to get his son the care he needed was more heartbreaking still.

The wait to get Matt into a psychiatric bed in the region of Ontario where he lives was 12 weeks or more. He bounced from crisis to crisis. When there was a glimmer of hope and the young man was willing to be treated, care was not available.

After a suicide attempt, Matt was treated in the emergency room then sent home. Not because he didn't need help, but because all the hospital's psychiatric beds were full.

Matt has now deteriorated to the point where he is hospitalized against his will; he has been committed, or "formed" as they say in the jargon of the milieu.

But he can still refuse treatment and he can still wander away from hospital to shoplift and get high. "He has lost the capacity to make rational decisions, but he still has the legal right to make those decisions," Steve says.

He is exasperated by this paradox, as are many parents of adult children with severe mental illness.

"In the end, all I want is my son back," Steve says mournfully.

He has nothing but praise for the health professionals who have cared for his son. The nurses and doctors, he says, have been phenomenal. So are the volunteers and staff from the Canadian Mental Health Association.

"But their hands are tied by consent forms and legal nonsense," Steve says. "The Charter of Rights and the Mental Health Act give my son the right to be sick."

Vince Li, too, had the right to be sick, the right to be guided by psychotic visions, the right to refuse treatment. In that case, the tragic consequence was the senseless death of Tim McLean on a Greyhound bus.

Two more victims of untreated schizophrenia, of a mental-health system with screwed-up priorities.

But there are many more victims of untreated mental illness, of a profoundly flawed system.

Far from the headlines, they are dying deaths by a thousand cuts, deaths by a thousand pills, deaths by a thousand missed opportunities to treat.

Also see:

The mentally ill who break the law deserve 'all mercy and humanity'

Grading the States 2009

From the National Alliance on Mental Illness (NAMI):

A Report on America’s Health Care System for Adults with Serious Mental Illness

Mental health care in America is in crisis. The nation’s mental health care system gets a dismal D. As the nation confronts a severe economic crisis, demand for mental health services is increasing -- but state budget cuts are creating a vicious cycle that is leaving some of our most vulnerable citizens behind. We must move forward, not retreat ...

For more information, please click here.

For a video, please click here (Windows Media Player).


Click on the image to enlarge it.

N.S. mental health court on hold

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

By Jennifer Stewart, Court Reporter

The province’s plan to open a specialized court to deal with mentally ill offenders has been temporarily put on hold.

The mental health court was set to open April 1 in the Dartmouth Justice Centre on Pleasant Street. But now a spokeswoman for the Justice Department says it could be as late as the fall before the court is ready to deal with adult and some young offenders suffering from mental illness.

Carla Grant said there are two reasons for the delay: renovations and construction of a new courtroom are behind schedule and the steering committee overseeing the project has asked for more time to work on the court’s policies and procedures.

“They want to ensure that it’s done right,” Ms. Grant said in an interview Monday.

She said moving the Justice of the Peace Centre and renovating the existing courthouse turned out to be a bigger project than the department anticipated. She estimates the construction will take until at least June.

“It’s been a major renovation,” Ms. Grant said.

It was the fall of 2007 when Premier Rodney MacDonald announced in a throne speech that the province would set aside money to establish a mental health court to help deal with the staggering number of mentally ill people who get in trouble with the law.

According to a report from the Office of the Correctional Investigator, 12 per cent of men in federal institutions in 2007 had a mental disorder, up from seven per cent in 1997. The rate of mentally ill women in prisons was even higher, at 21 per cent, compared with 13 per cent in 1997.

Judith McPhee, chairwoman of the steering committee, said in an earlier interview with The Chronicle Herald that the province had earmarked roughly $500,000 to start up the specialized court, which will be evaluated throughout its first year of operation.

The steering committee is made up of representatives from the departments of justice, health, community services and health protection and promotion, as well as members of local police agencies, the Public Prosecution Service of Nova Scotia and Canada, Nova Scotia Legal Aid, local police and the judiciary.

Ms. Grant confirmed that hiring began earlier this year and said the mental health court now has a dedicated Crown attorney, legal aid lawyer and probation officers. She said the department is in the process of hiring a judicial assistant and will be looking for administrative support staff.

The Capital District Health Authority and the IWK Health Centre, who are partners on the project, are also hiring clinical personnel, she said.

“This continues to be an important initiative for the department,” Ms. Grant said.

Also see:

Mental health court long overdue

Canadian Mental Health Association urges governments to develop more appropriate solutions for the mentally ill housed in today's prisons (March 9th, 2009)

Families of the Mentally Ill Ignored

A March 9th press release from Schizophrenia Fellowship New Zealand:

"Families of people experiencing a serious mental illness are not getting the recognition and support they need from mental health professionals for the pivotal role they can play in a relative's recovery. This is leading to avoidable relapses, with families left to pick up the pieces" said Florence Leota, Chief Executive of Schizophrenia Fellowship New Zealand (SFNZ).

In an address at the Wellington launch of Supporting Families Awareness Week, Ms Leota commented on feedback from SFNZ branches throughout the country which overwhelmingly pointed to inadequate consultation with families by mental health professionals. Over 90% of branches reported that District Health Boards included families in recovery planning only sometimes or not at all.

Research has shown that people who experience mental illness have fewer relapses when their family/whanau is involved in their care and treatment.

"SFNZ is a staunch advocate for integrated care – this means complementing the use of clinical support for someone with a mental illness, with support in other areas that impact on their overall health and quality of life.

"Ten years ago SFNZ recognized the need to reinforce the rights of families/whanau within the mental health system so we developed the Code of Family Rights. New Zealand is the first country to have one and other countries are looking to follow our lead," Ms Leota says.

"However experience has shown that in practice, the rights enshrined in the Code are either not being observed at all or at best, not being observed very well. This confirms the need to see the Code regulated in the same way that the Code of Health and Disability Services Consumers' Rights has been.

SFNZ is currently working with the Mental Health Commission in an effort to have the Code of Family Rights regulated.

"Families need a regulation that provides them with rights to services, information, consultation and support. The alternative is to undermine the recovery process for people with a serious mental illness, with an increasing number of relapses and families at the bottom of the cliff coping with the stress of the fallout," concluded Ms Leota.

MHCC NEWS: Spring 2009

To download the complete newsletter, please click here (PDF).

Two Steps Forward, One Step Back: The Case of Vince Li

Posted today on Teen Mental Health Blog:

By D. Venn & Dr. Stan Kutcher

The case of Vince Li [pictured], the man who beheaded a victim aboard a Greyhound bus last year, made international headlines yesterday as judge ruled Mr. Li was not criminally responsible due to mental illness. The ruling means that Vince Li will be treated in a mental institution instead of going to prison.

While the ruling is probably the right one, the resulting media frenzy is doing little to dispel the myth that people with mental disorders are violent. It also begs the question: what is the role and responsibility of media in reporting on cases that involve mental illness?

A selection of headlines from major news networks clearly seek to sensationalize the case of Vince Li and in the process make a link between violence and mental illness: ”Canada judge: Vince Li not responsible for bus beheading due to mental illness” (Associated Press), “Canada bus killer found mentally ill” (The West Australian), “Judge rules bus beheading suspect mentally ill” (CNN.com), “Crazy bus cannibal sent to mental institution” (Healthcare Industry Today). Even accompanying photographs (like the one above) attempt to “demonize” Li again reinforcing the idea that people with mental disorders look frightening.

While some people who suffer from mental illness do commit antisocial acts, mental illness does not equal criminality or violence - despite the media’s tendency to emphasize a suspected link (e.g. psychotic serial killers). In fact, people with mental illness are no more likely to commit violence than the general public, but they are 2.5 times more likely to be victimized and are more likely to inflict violent behaviours on themselves. Furthermore, the general public is more likely to be violently victimized by someone who does not have a mental illness rather than by someone who suffers from mental illness.

To read the entire posting, please click here.

Also see:

How the mental health system failed Vince Li (The Globe and Mail, March 6th)

Why a National Mental Health Strategy Is Critical to Preventing Future Tragedies (Reuters, March 5th)

Photograph by Woods of the Associated Press.

Jury awards $3M in death involving excessive force

From the March 2nd edition of the Houston Chronicle:

By Peggy O’Hare

A Harris County jury on Monday awarded $3 million to the Houston mother of a man [living with schizophrenia] who was shocked, hogtied and later died as Precinct 1 constable’s deputies took him into custody on a mental health warrant four years ago.

After a three-week trial, the jury concluded by a 10-2 vote that three of the four deputies named in Shirley Nagel’s lawsuit used unreasonable and excessive force as the deputies detained Nagel’s son, Joel Don Casey [pictured], on Feb. 18, 2005.

Casey’s death was ruled a homicide. An autopsy found the 52-year-old man died of psychotic delirium with physical restraint associated with heart disease.

He also suffered fractures to his seventh cervical vertebrae and the left horn of his thyroid cartilage, believed to have occurred when one deputy dropped a knee on Casey’s neck and pulled Casey’s head back, said the dead man’s attorney, Kent Spence.

After 4½ hours of deliberations that began Friday and continued Monday, the jury awarded $2.4 million to Nagel and $600,000 to her son’s estate, which she represents.

I edited the above to remove the word "schizophrenic".

To read the entire article, click here.

The web of delusion: a clinical vignette

If you are interested in knowing what psychosis is like, please read this posting by Dr. David Whitehorn on his blog Coming Back to Reality.

OurHealthyMinds.com is now online!

OurHealthyMinds.com is a website developed by the Capital District Mental Health Program (CDMHP). It was conceived and funded as part of the Healthy Minds Initiative strategic planning that was conducted by the CDMHP in 2004-2005.

Check it out!

Documenting a troubled mind

I highly recommend this article, written by Carol Smith, and published in the today's edition of the Seattle Post-Intelligencer.

Delaney Ruston is overcome with emotion while opening a box of items belonging to her late father, Richard Ruston, in her University District home. Ruston recently completed the film "Unlisted", a documentary about her father, who suffered from paranoid schizophrenia.

Photograph by Dan DeLong of the Seattle Post-Intelligencer.

Also see:

Unlisted: A Story of Schizophrenia

After Abuse, Changes in the Brain

An article published in today's edition of The New York Times:

By Benedict Carey

For years, psychiatrists have known that children who are abused or neglected run a high risk of developing mental problems later in life, from anxiety and depression to substance abuse and suicide.

The connection is not surprising, but it raises a crucial scientific question: Does the abuse cause biological changes that may increase the risk for these problems?

Over the past decade or so, researchers at McGill University in Montreal, led by Michael Meaney [pictured], have shown that affectionate mothering alters the expression of genes in animals, allowing them to dampen their physiological response to stress. These biological buffers are then passed on to the next generation: rodents and nonhuman primates biologically primed to handle stress tend to be more nurturing to their own offspring, Dr. Meaney and other researchers have found.

Now, for the first time, they have direct evidence that the same system is at work in humans. In a study of people who committed suicide published Sunday in the journal Nature Neuroscience, researchers in Montreal report that people who were abused or neglected as children showed genetic alterations that likely made them more biologically sensitive to stress.

The findings help clarify the biology behind the wounds of a difficult childhood and hint at what constitutes resilience in those able to shake off such wounds.

The study “extends the animal work on the regulation of stress to humans in a dramatic way,” Jaak Panksepp, an adjunct professor at Washington State University who was not involved in the research, wrote in an e-mail message.

He added that the study “suggests pathways that have promoted the psychic pain that makes life intolerable,” and continued, “It’s a wonderful example of how the study of animal models of emotional resilience can lead the way to understanding human vicissitudes.”

In the study, scientists at McGill and the Singapore Institute for Clinical Sciences compared the brains of 12 people who had committed suicide and who had had difficult childhoods with 12 people who had committed suicide and who had not suffered abuse or neglect as children.

The scientists determined the nature of the subjects’ upbringing by doing extensive interviews with next of kin, as well as investigating medical records. The brains are preserved at Douglas Hospital in Montreal as part of the Quebec Suicide Brain Bank, a program founded by McGill researchers to promote suicide studies that receives brain donations from around the province.

When people are under stress, the hormone cortisol circulates widely, putting the body on high alert. One way the brain reduces this physical anxiety is to make receptors on brain cells that help clear the cortisol, inhibiting the distress and protecting neurons from extended exposure to the hormone, which can be damaging.

The researchers found that the genes that code for these receptors were about 40 percent less active in people who had been abused as children than in those who had not. The scientists found the same striking differences between the abused group and the brains of 12 control subjects, who had not been abused and who died from causes other than suicide. “It is good evidence that the same systems are at work in humans that we have seen in other animals,” said Patrick McGowan, a postdoctoral fellow in Dr. Meaney’s lab at McGill and the lead author of the study.

His co-authors, along with Dr. Meaney, were Aya Sasaki, Ana C. D’Alessio, Sergiy Dymov, Benoît Labonté and Moshe Szyf, all of McGill, and Dr. Gustavo Turecki, a McGill researcher who leads the Brain Bank.

Because of individual differences in the genetic machinery that regulates stress response, experts say, many people manage their distress despite awful childhoods. Others may find solace in other people, which helps them regulate the inevitable pain of living a full life.

“The bottom line is that this is a terrific line of work, but there is a very long way to go either to understand the effects of early experience or the causes of mental disorders,” Dr. Steven Hyman, a professor of neurobiology at Harvard, wrote in an e-mail message.

Posting of this article is for the purposes of research into suicide.

Also see:

Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse

Childhood trauma has life-long effects on genes and the brain

Image and photograph courtesy of the Douglas Mental Health University Institute.

Margaret Clark Morgan Foundation grants $5 million to treatment center

An article published in the February 22nd edition of the Hudson Hub-Times:

The Northeastern Ohio Universities Colleges of Medicine [NEOUCOM] and Pharmacy announced Feb. 19 it received a $5 million grant from The Hudson-based Margaret Clark Morgan Foundation to establish The Best Practices in Schizophrenia Treatment Center at NEOUCOM.

"This important grant from The Margaret Clark Morgan Foundation will help identify best practices in schizophrenia treatment; this will fundamentally change the lives of people with schizophrenia in a very positive way," said Lois Margaret Nora, NEOUCOM president and dean, College of Medicine. "We are excited and proud to partner with The Margaret Clark Morgan Foundation in making this announcement. This initiative will further our mission of improving the health of Northeast Ohio."

The mission of The Best Practices in Schizophrenia Treatment (BeST) Center at NEOUCOM is to ensure that people with schizophrenia and related disorders maximize their ability to achieve recovery by receiving treatments shown to be best practices.

"The Margaret Clark Morgan Foundation seeks to raise the standards of prevention, treatment and recovery of mental illness in northeast Ohio," said Foundation President Rick Kellar. "We do this by investing in progressive organizations and innovative initiatives with the potential to transform mental health practices. Today, through the creation of the BeST Center at NEOUCOM, we are advancing our mission in a very significant and exciting way."

NEOUCOM is a community-based, public institution offering both a doctor of medicine and a doctor of pharmacy degree.

The Margaret Clark Morgan Foundation, with assets near $75 million, supports mental health endeavors and the arts in Northeast Ohio through grants.

Also see:

NEOUCOM gets $5M grant for schizophrenia center

No, Please, That's Not Me

Posted on February 20th by Ashley on her blog, Overcoming Schizophrenia:

Prior to my diagnosis of paranoid schizophrenia I did some things that I am not proud of. Now that I look back on things I blame my illness for my poor judgment. I am by no means condoning the behavior I carried out, and will share with you here. I will provide a few instances where my behavior was unlike me and caused an uproar. This post shows how schizophrenia affects other people. This post is for the family members and friends of people with schizophrenia, or showing bizarre behaviors.

To read the entire posting, please click here.

Outlook brighter for China's mentally ill

Posted on February 20th by WAtoday.com.au:

By Nick Miller

There are almost as many Chinese with psychotic mental illness as there are people in Australia.

In that enormous country, where in some areas the mentally ill are still chained to the wall awaiting the local witch doctor, one man bears the load of reforming China's mental health service. And he's using Victoria as the model.

Professor Yu Xin [pictured] grew up in Beijing but spent some post-graduate study time at Melbourne University.

Now, as executive director of Peking University's Institute of Mental Health and president of the Chinese Psychiatric Association, he regularly returns to Melbourne for support in building a new mental health service for one-fifth of the world's population.

To read the entire article, click here.

Photograph courtesy of The University of Melbourne.

Loss of Brain Protein in Mice Leads to Schizophrenia-Like Behavior

Posted on February 19th by Genetic Engineering and Biotechnology News:

Disrupting the function of a key cranial molecule leads to microscopic brain abnormalities and schizophrenia in mice, according to a team from The Scripps Research Institute. Neuregulin is an important developmental protein that helps the brain form its distinct structures early in development.

They also found that the schizophrenic mice could recover normal behavior when treated with clozapine, a decades-old drug sometimes used to treat schizophrenia in people. They thus suggest that these mice might provide researchers with a good model for studying the disease. This study also provides support for the schizophrenia hypothesis that implicates glutamatergic neurons, because the mice had problems with their glutamatergic synapses.

The abnormalities found the mouse brains were similar to those seen in the autopsied brains of people who were diagnosed with schizophrenia, the scientists note. Also, genetic studies have linked inherited forms of this protein and its receptors to schizophrenia and numerous other mental health problems, they add.

In the study, the team effectively removed the function of neuregulin by eliminating the receptor to which it binds. Because this is such an important developmental protein, they expected that eliminating its receptor would severely impact the development of the mouse’s brain. As it turns out, the brains were normal overall, but the loss of neuregulin did affect the brain on a microscopic level.

Investigators revealed that when mice are deprived of neuregulin, their dendritic spines start to form but do not completely mature. Instead they fall apart while the brain itself matures. The effect of this loss is evident in behavior tests, where mice display hallmarks of schizophrenia, such as social interaction problems and reduced anxiety.

Loss of the spines also kept mice from adapting to and anticipating a startling noise, which is a classic sign of a schizophrenia-like state, the Scripps team explains.

The findings were published this week in the early edition of the journal Proceedings of the National Academy of Sciences.

Also see:

Scripps Research Study Shows How Microscopic Changes to Brain Cause Schizophrenic Behavior in Mice

Schizophrenia symptom linked to gene mutation

Impaired maturation of dendritic spines without disorganization of cortical cell layers in mice lacking NRG1/ErbB signaling in the central nervous system

Photograph by Rasbak.

Looking for answers

From today's edition of The Chronicle Herald:

Fatality inquiry opens into death of man who collapsed in jail 30 hours after Tasering

Philip McLean [pictured] went to the first day of an inquiry into Howard Hyde’s death with one thing on his mind — a call for a total ban on the use of stun guns.

"I knew Howard and to me he wasn't a violent person and I feel like the use of the Taser is the wrong thing for anyone in general, really I’m against it," Mr. McLean told reporters at Halifax provincial court, where the inquiry opened Wednesday morning.

Mr. Hyde died on Nov. 22, 2007, shortly after collapsing at the Central Nova Scotia Correctional Facility in Dartmouth. The 45-year-old, who had schizophrenia, had been shocked with a stun gun some 30 hours earlier during a disturbance at the booking desk at Halifax Regional Police headquarters.

Mr. Hyde had been arrested and charged with assault stemming from a domestic dispute. His girlfriend, Karen Ellet, said at the time that he had stopped taking his medication.

Mr. McLean remembered Mr. Hyde as a friendly and intelligent gentleman and "an all-around nice guy."

The Halifax man said he had known Mr. Hyde for two years, after the pair met at a social club they both frequented.

Mr. McLean said the province needs to ban the use of stun guns before another tragedy occurs.

"It’s too late to bring Howard and other people back alive, but I just hope that the Justice (Department) will get rid of the Taser.

"Unfortunately, I think it can and will happen again unless the law is changed."

Also see:

Family, friends hope inquiry will shed light on death of mentally ill man (The Canadian Press)

Nine groups will have legal standing at Taser death inquiry (Metro Halifax)

Inquiry opens into death of mentally ill man shot with Taser (National Post)

Photographic of Philip McLean courtesy of The Chronicle Herald.

Pathways to schizophrenia. A new wave of prevention and early intervention strategies

From The Medical Journal of Australia:

Supplement

Characterising novel pathways to schizophrenia
Ian B Hickie and Patrick D McGorry — Med J Aust 2009; 190 (4): S5-S6.

New directions in the epidemiology of schizophrenia
John J McGrath and Ezra S Susser — Med J Aust 2009; 190 (4): S7-S9.

Brain changes during the onset of schizophrenia: implications for neurodevelopmental theories
Stephen J Wood, Christos Pantelis, Alison R Yung, Dennis Velakoulis and Patrick D McGorry — Med J Aust 2009; 190 (4): S10-S13.

Synapse formation and regression in the cortex during adolescence and in schizophrenia
Maxwell R Bennett — Med J Aust 2009; 190 (4): S14-S16.

Are common childhood or adolescent infections risk factors for schizophrenia and other psychotic disorders?
Ian B Hickie, Richard Banati, Catherine H Stewart and Andrew R Lloyd — Med J Aust 2009; 190 (4): S17-S21.

Amphetamine psychosis: a model for studying the onset and course of psychosis
Daniel F Hermens, Dan I Lubman, Philip B Ward, Sharon L Naismith and Ian B Hickie — Med J Aust 2009; 190 (4): S22-S25.

Therapeutic signposts: using biomarkers to guide better treatment of schizophrenia and other psychotic disorders
Richard Banati and Ian B Hickie — Med J Aust 2009; 190 (4): S26-S32.

A clinical trials agenda for testing interventions in earlier stages of psychotic disorders
Patrick D McGorry, Alison R Yung, Christos Pantelis and Ian B Hickie — Med J Aust 2009; 190 (4): S33-S36.

Oestrogen — a new treatment approach for schizophrenia?
Jayashri Kulkarni — Med J Aust 2009; 190 (4): S37-S38.

Are the cardiometabolic complications of schizophrenia still neglected? Barriers to care
Tim J R Lambert and John W Newcomer — Med J Aust 2009; 190 (4): S39-S42.

Mental health policy — stumbling in the dark?
David W Crosbie — Med J Aust 2009; 190 (4): S43-S45.

Also see:

Schizophrenia: It's Not Just "in The Genes"; The Environment May Also Matter

New RCMP policy says Tasers potentially lethal, limits use

Posted today on CBC.ca:

The RCMP is restricting how officers can use Tasers through a new policy that recognizes the stun guns can cause death, especially when fired on "acutely agitated" individuals, the head of the Mounties said Thursday.

RCMP Commissioner William Elliott outlined the policy shift on the devices known as conductive energy weapons, or CEWs, as he spoke to the House of Commons public safety committee in Ottawa.

"The RCMP's revised CEW policy underscores that there are risks associated with the deployment of the device and emphasizes that those risks include the risk of death particularly for acutely agitated individuals," Elliott told the committee.

To read the entire article, click here.

Video:

Terry Milewski reports: Tasers potentially lethal, RCMP head tells MPs(RealPlayer, Runs: 2:13)

Audio:

Listen to RCMP commissioner William Elliott's testimony before Standing Committee on Public Safety and National Security, as well as the subsequent question and answer session, by clicking here (Windows Media Player; be patient, there is one minute and ten seconds of silence before the testimony starts in the English audio provided).

Also see:

RCMP commissioner William Elliott's remarks on changes to taser policy

New RCMP policy says Tasers potentially lethal

Photograph courtesy of CBC.ca.

Community college hosts youth forum on mental health

Posted on February 10th by SouthShoreNow.ca:

Singer-songwriter Joe Leger related the story of his battle with mental illness in song during a youth forum held at the Nova Scotia Community College - Lunenburg Campus January 28.



By Robert Hirtle

BRIDGEWATER - It may be hard to believe, but statistics show that one in five Canadians will experience mental illness in their lifetime, with a large portion of those individuals being in the age range of 15 to 24 years.

That is the message Jean Covert, executive director of the Lunenburg County branch of the Canadian Mental Health Association (CMHA), brought to a youth forum on the subject that was held at the Nova Scotia Community College - Lunenburg Campus, January 28.

The gathering, which attracted over 100 participants, was designed to explore ways of reaching out to young people with mental illness.

Jan House, past president of the Lunenburg County chapter of the Nova Scotia Schizophrenia Society, said the forum was organized by South Shore Mental Health Services, South Shore Health, CMHA and the Schizophrenia Society.

The morning session was spent meeting with service providers whose goal was to develop an action plan to provide services they feel are needed by youth in the community.

"We've formed a committee that is going on a fact-finding mission to find out what services are out there that we don't know about, so that we can co-ordinate things and use all the facilities that we have in Lunenburg County to the fullest, and then approach government for the things we don't have," she explained.

Joining Ms. Covert as speakers at the afternoon portion of the event were Peter Duke, a co-ordinator at Laing House, a community support centre in Halifax for people ages 15 to 29 who live with mood, anxiety and psychotic disorders, as well as three young persons who utilize the facility, Ruthmarie Adams, Michael Smith and Joe Leger.

While adolescents and young adults are more prone to mental illness, particularly when it is caused by drug or alcohol addiction, it is not exclusively a problem of youth.

"Eight per cent of adults will suffer major depression sometime during their lives, [and] one per cent will experience bipolar disorder," Ms Covert explained, adding that, in terms of Nova Scotia, one per cent of the population is about 9,000 people.

She said, however, that the risk of suicide involving young people experiencing mood disorders is highest and, at 24 per cent, represents the second-leading cause of death among youth ages 15 to 24 in Canada.

"Onset of mood disorders usually occurs during adolescence," she said. "Hospitalization rates for bipolar disorder are increasing among youth."

Ms. Covert said schizophrenia affects about one per cent of the population worldwide, and is "the greatest disabler of youth because it commonly strikes at a time when they are just graduating high school, just going to university and just deciding what their career choices are going to be."

She said 12 per cent of the population live with anxiety disorders and 6.9 per cent suffer from some form of personality disorder.

"So, mental disorders are not rare."

It was during his adolescent years that Mr. Smith, now 28, first began experiencing bipolar 1 disorder, the result of alcohol and marijuana abuse, which led to numerous hospitalizations.

"That means I either get real manic, like a maniac, or I get so depressed all I can do is just drool on the couch," he said. "I take 12 pills, mood-stabilizing, anti-psychotic medication, every night before I go to bed and I regularly see a psychiatrist."

He said the biggest key to recovering from mental illness is recognizing that you have an affliction.

"Laing House is great because I have friends who are always supportive and nice to me, but they can never understand talking about mania or depression," he explained. "They may have studied it in school … but they can never understand it. At Laing House, if you're going through something, you can connect with people right there, automatically, who say 'oh yeah, I understand,' so your experience is much more validated."

Mr. Leger, who relates his struggles with mental illness in song, agreed, saying the peer support mental illness sufferers receive at Laing House is very important.

"You talk about mental illness, but it's really more about mental health. We all need to work on maintaining it," he said.

In dealing with youth, he believes the biggest challenge is explaining their illness to them on a level which they can understand, and to get them to accept the fact that they need medication.

"And by far, the best way to do that is through peer support," he added.

Photograph of Joe Leger by Robert Hirtle

To view the above article as it appeared in the Bridgewater Bulletin, click here.


Judy Bell (left, Laing House), Jan House (middle, Lunenburg County Chapter of the Schizophrenia Society of Nova Scotia). and Peter Duke (right, Laing House)


Ruthmarie Adams (left) and Michael Smith - Youth speakers from Laing House

Click on the images above to enlarge them.