Marvin Ross2013-06-18T19:38:33-04:00Marvin Rosshttp://www.huffingtonpost.ca/author/index.php?author=marvin-rossCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Marvin RossGood old fashioned elbow grease.Where Is Justice When Someone With Schizophrenia is Wronged?tag:www.huffingtonpost.com,2013:/theblog//3.33776422013-06-03T11:21:17-04:002013-06-03T12:15:20-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/early April, Douglas Brown of Burlington, Ontario who suffers from schizophrenia was found not guilty of assaulting two Joseph Brant Hospital staff and of attempting to grab a police officer's revolver. The judge, in his findings stated "this case is an indictment of the treatment of mentally ill individuals in our public health system and in our judicial system."
The judge had very harsh words for the two hospital staff and for the five cops and their Tasering of Mr Brown. Of the testimony by Sgt Carroll, the senior police sergeant, the judge concluded that he "was not giving truthful evidence when he testified that he did not deploy the Taser to Mr. Brown's back or to his groin," as generated by the data from the Taser software itself.
The judge went on to say that Sgt. Carroll used unnecessary and excessive force by continuing to Taser him at full force in the back, abdomen and groin. The judge then added that what was even more disturbing to him was that the evidence by Sgt Carroll "appears to be given untruthfully and that other officers on the scene unwillingly or willingly appear to be a part of this cover up."
Shortly after the judge's verdict, Halton Regional Police told the Hamilton Spectator that "the Crown is currently conducting a review, and as such, it would be inappropriate for the (police) service to comment at this time."
Well that may not be true. I followed up with Sgt. Dave Cross, the Halton Regional Police media spokesperson and, while telling me that all the officers involved are still on active duty, I would have to call the Crown Attorney's office to find out about the review. The Crown Attorney's office then referred me to Brendan Crawley, the media spokesperson for the Attorney General. His response was:
"After a careful review of the judge's decision, the Crown has decided not to appeal.
With respect to the comments made by the trial judge about witness credibility, I can make this general comment:
According to Crown policy, where there has been judicial finding or comment that an officer has been deliberately untruthful under oath, the trial Crown will refer the matter to his/her Crown Attorney for review.
If the Crown Attorney determines there are grounds to believe the officer has been deliberately untruthful under oath, the matter is forwarded to the Director of Crown Operations for the Region, who will review the matter and decide whether it should be forwarded to police.
The Ministry does not comment on the results of any such review."
When I told him that the Crown's office refused to talk to me and referred me to him, he replied that:
"As I said below, the ministry does not comment on the results of any such review."
So, of course I asked him who could or would. The reply was:
"Neither the ministry nor the Crown will be making any further comment."
Seems to me that some accountability to the public is required. As theHamilton Spectator said in a lead editorial on April 20, "Actions of police, hospital need full scrutiny."
As for the hospital, the nurse and the social worker who the judge also suggested were not truthful in their testimony, have been suspended. The judge described the evidence given by nurse Katherine Sharman (formerly Katherine Szostak) and social worker, Carol Veecock, as having "an utter lack of credibility." He found their evidence "so replete with inconsistencies, both internally and externally, their demeanour in testifying so unsatisfactory that I can attribute little if any weight to anything they say."
Finally, after close to two months, the hospital announced, that they are investigating what happened to Mr. Brown. But, I must say that they do seem to be playing games in who they tell. On May 23, hospital vice president Mario Joannette replied to my email request for an update with "Just to follow up on our earlier conversation we will be making a statement in the next couple weeks on who is leading our outside team investigation. I will send that to you when it happens."
The next day, he emailed me to say "We will be sending out a media release next week with our next steps that will include an announcement of who is leading our review and when it will be done. I will send you a copy of the media release when it goes out."
I followed up with him on Thursday, May 30 as the announcement was to have been made that week. His reply "Next week we will be putting new information out. I will inform you at that time on who are the four people doing the review, when the review will begin, and the process we will be following for the review."
On Sunday, June 2, Douglas Brown sent me an email that the Hamilton Spectator was running another article on the case and asking for a comment. And on June 3 the Spectator reported that the hospital is investigating the incident under Dr. Eric Letovsky the chief of emergency services at Mississauga's Credit Valley Hospital. He will be assisted by three unnamed staff -- an ER nurse from his own hospital, a social worker from St Michael's Hospital in Toronto and a psychiatrist from the William Osler Health System in Brampton.
Douglas Brown told the Spectator that "it (the report) won't be truthful. They treated me inhumanely. Their care for me was no care. It was inflicting pain and brutality."
If the hospital can't even be forthcoming with the media in announcing the investigation, you have to wonder. And nobody, Mr. Brown told me, has ever apologized to him for what happened.
]]>Why Are People With Schizophrenia Receiving Worse Health Care?tag:www.huffingtonpost.com,2013:/theblog//3.33198042013-05-22T12:03:06-04:002013-05-22T12:10:29-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/
May 24th is Schizophrenia Awareness Day in Canada -- and the month of May is Mental Health month -- but a disturbing study just presented at the American Psychiatric Association (APA) meeting in San Francisco demonstrates just how prejudiced many health providers are towards those with serious mental illnesses.
And it is not simply stigma but prejudice, according to Dr Jeffrey Borenstien, the chief medical officer at the Brain and Behavior Research Foundation in Great Neck, New York, and chair of the Council on Communications of the American Psychiatric Association.
"We use the word stigma, but I would use a different word -- prejudice," he said at a press conference. "In our society, we don't allow prejudice anymore based on a variety of factors, but we still, to whatever degree, tolerate prejudice when it comes to people with psychiatric conditions, and that has to change."
Dr Borenstein was referring to the results of a study presented at the APA by Dr. Dinesh Mittal, a psychiatrist at the Central Arkansas Veterans Healthcare System and associate professor at the University of Arkansas, in Little Rock, and his colleagues.
What the researchers did was to create a mythical patient sent to four groups of health care professionals -- psychiatrists, general practitioners, mental health nurses and primary care nurses. The mythical patient was a 34-year-old man with hypertension, obesity, insomnia, and chronic back pain returning for a follow-up visit and seeking stronger medication for pain. He was a cafeteria worker, attended church, and enjoyed fishing and reading magazines but in one scenario he had a history of stable schizophrenia. In the second scenario, he had no indication of schizophrenia.
Unfortunately, the results did not come as a surprise to many of us who deal with the medical system and a relative with schizophrenia.
Overall, the health care professionals anticipated less adherence to medications in those with schizophrenia even though adherence rates between those with and without mental illness are similar. Those with schizophrenia were less likely to be referred to weight management programs than those without. The researchers pointed out that weight management programs are as successful with those with schizophrenia as those without. Again, those with schizophrenia were less likely to be referred to sleep clinics but pain clinic referrals were equal.
Those with schizophrenia were seen by the health professionals to have lower social functioning and lower competence to make treatment and financial decisions. The researchers expected that the mental health professionals would do better than the primary care workers but that was not the case. Both the psychiatrists and the primary care nurses had the lowest expectation that the schizophrenia patient would be able to understand educational material.
Dr. Borenstein stated:
"On average, people with severe psychiatric illnesses such as schizophrenia end up dying at a significantly earlier age than other people due to medical problems. So it's very important -- and that's why this study is an important study -- that we make sure that people with psychiatric conditions like schizophrenia receive the best possible medical care along with their psychiatric treatment."
It is sad and even reprehensible that those who are paid to care for the sickest of the mentally ill have such attitudes. The Mental Health Commission of Canada and the Canadian Medical Association do have programs to teach health providers which is a positive step. I suspect that more work needs to be done.]]>Parents of the Mentally Ill Need Recognition Tootag:www.huffingtonpost.com,2013:/theblog//3.31885342013-05-01T12:25:12-04:002013-05-01T12:25:20-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/one week devoted to mental illness awareness and one day devoted to schizophrenia awareness. But, nothing for the parents of the mentally ill who suffer almost as much as their children. We parents carry much of the burden for the care of our ill offspring but we are ignored. And, we are often ignored and shunned by the professionals.
There is no tragedy worse than losing a child to death but losing a child to a chronic debilitating illness that robs your child of his/her future comes a close second. And, without wishing to pit one disease against another, I don't think there is any worse tragedy than having a child with a serious mental illness. Laura Pogliano, a mother of a child with a serious mental illness in Maryland, described those differences.
Her first of many is:
"Your child's illness gets 500,000 likes on Facebook when you post a picture or ask for prayers while my child's illness gets about five, from people who already know us and know of our struggle."
Kathy Mochnacki, a mother in Richmond Hill, ON, in a letter to theToronto Star pointed out that "since the deinstitutionalization of hospital mental health services, family caregivers of people with serious mental illness have shouldered most of the responsibility of care and have become the default mental health system. Furthermore, we often do our work in isolation, coping with discrimination and unrealistic privacy legislation that could potentially put us and our ill relative in harm's way."
In an email to me she said:
"I feel that we in Mental Health Week need to celebrate ourselves. We are the mental health system. People need to know about how we are the first responders, that we save the taxpayer money, that we can put our own safety at risk to protect the public and that we pay for this with our own health."
And part of the reason that much of this occurs is that the system puts up barriers against us in the form of very restrictive privacy legislation so that, while we do all the work, we are excluded by the professionals. And in this regard, the People's Republic of China is light years ahead of us (see below).
The parents are the ones who provide the emotional support, the counselling, housing, financial support and all else that is required and we often see our kids on a daily basis. In fact, they often live with us. But, the health care people who see our kids on infrequent appointments for brief periods, shun us save for a few progressive ones.
Writing in USA Today, Rachel Pruchno, a New Jersey mother of a daughter with serious mental illness, said "America's mental health system is in crisis largely because families are excluded from participating in the care of loved ones." She added that "once she (her daughter) turned 18, however, I went from valued member of the health care team to its pariah."
Lloyd Sederer, a U.S. psychiatrist writing in The Atlantic, said "It is families who are the true experts, the people who have learned all too well from experience what they need to help their loved one get help."
His suggestion is that we consult "families in engineering the most effective systems for involving their early warnings, using their leverage with their loved ones, and capitalizing on their ongoing support of the treatments that, if delivered early and consistently, will reduce the risks for tragic events."
Rachel Pruchno suggested that "When families are involved, health care providers gain a more accurate understanding of the patient's history. This, in turn, guides better treatment decisions" And that "Research shows that when families are involved, rates of treatment adherence are higher and rates of hospitalization are lower."
A paper by Billy Wing Yum Chan and Ann-Marie O'Brien of the Centre For Mental Health and Addictions in Ontario propose an Ontario Caregiver Recognition Act (OCRA) to formally recognize family caregivers as informal health information custodians based on the practice of other jurisdictions which incorporate the rights of family members actively engaged in providing care to their mentally ill relatives. That was in 2011 but nothing has come of it. They pointed out that "involving family members in the care of their mentally ill relatives improves treatment outcomes..."
But then, the Ontario Select Committee on Mental Health and Addictions Report of August, 2010 also made that recommendation. That was almost three years ago. See recommendation 22 which proposes that families be given access to information to give support and to prevent the further deterioration. But then, as committee member and NDP health critic, France Gélinas said in April to theHamilton Spectator, "only half of one recommendation of the select committee has been adopted by the health ministry."
The Mental Health Commission of Canada states that "Failure to support caregivers undermines mental health across the entire population, leading to poorer outcomes, both for people living with mental illness and their caregivers. This also leads to increased health and social service costs."
As a result, the commission is presently establishing a set of guidelines to be released in the Summer of 2013. We can only hope something comes of it. But, while all these recommendations are being made and, as in Ontario, ignored, China is promoting closer family-doctor co-operation to treat schizophrenia. According to Yan Jun, head of the mental health division under the disease control department of the Ministry of Health "The therapeutic alliance formed between doctors and a patient's family will help patients receive continuous treatment and prevent relapses."
The Chinese can do it so why can't we? And, a word of advice to our health bureaucrats. This is such a simple matter to implement that you really do not need to take a trip to China at our expense to see how this is done. Just ask us and then do it!
]]>No One Should Be Treated As This Schizophrenic Man Wastag:www.huffingtonpost.com,2013:/theblog//3.30693182013-04-12T12:24:51-04:002013-06-12T05:12:01-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/not guilty of assault against hospital staff and for attempting to steal a police officer's weapon. In his ruling, the judge stated that "this case is an indictment of the treatment of mentally ill individuals in our public health system and in our judicial system."
But the suffering is not over for Douglas Brown. As he said to me in an email on April 12, "I still fear the sirens of police, fire and ambulance. I sometimes worry about being in public, but not horribly enough to prevent me going outside, non-agoraphobic." The Minister of Health, Joseph Brant Hospital in Burlington and the Halton Regional Police all need to apologize publicly to Mr. Brown and to the people of Ontario. And, those responsible need to be held accountable.
To back up for a minute, I first came across Douglas in 2005 when he had a very good op-ed piece published in the Hamilton Spectator on his experiences with schizophrenia. I arranged to have it reprinted on the schizophrenia.com website which I wrote for at the time. He would email me occasionally and I knew that he had taken a writing course at Mohawk College in Hamilton and he is now studying criminal justice and psychology at Athabaska University and has a GPA of 3.7.
On April 9, he sent me and one of the senior editors at the Spectator, the judge's decision in his criminal trial. We were both stunned with what happened to him. His problems began on December 15, 2010 when he was taken to Joseph Brant because of a suicide attempt -- not unusual for someone with schizophrenia. Unfortunately, things escalated due to what appears to be the inappropriate handling of him by the hospital social worker, Carol Veecock and the ER nurse, Katherine Szostak. Both are presently under suspension with pay.
They called police and a total of five Halton Region cops attended and, while the evidence is sketchy, Mr. Brown was tasered a number of times and beaten about the head. During the altercation with the police, it was claimed he tried to grab for the officer's weapon and was charged with that as well as assault. The testimony of the hospital staff was dismissed by the judge as being "replete with inconsistencies" and their demeanour unsatisfactory. The social worker, Carol Veecock, he said had breached her professional responsibilities and he described her testimony as ludicrous. In my opinion from reading the transcript, she may have precipitated it all, but more on that below.
The judge also stated that the two senior police officers also failed to testify truthfully and, as a result, the junior officers felt compelled to follow along. The judge stated that he was disappointed in them for doing so. The most condemning statements made by the judge in a lengthy list of condemnations was reserved for officer Carroll, the now retired police expert in dealing with the mentally ill. The judge stated that Stephen Carroll was called because:
"He was held out as an officer who had considerable expertise in dealing with people with mental health issues but I believe that his views and procedures were more suited to decades long past. I truly hope that the standard that he has passed is to officers who have a better understanding of the delicate needs required in dealing with enforcing the law in a more humane and understanding way towards people with mental health issues than were employed in this case."
How this was botched was explained by the psychiatrist on call that night, Dr. Don Colonne. Of his testimony, the judge said "his candour and truthfulness was a welcome relief from the parade of witnesses that preceded him."
When Douglas Brown was admitted, Dr. Colonne was called and he ordered that he be given oral medication and that the nurse should explain what is being offered, why, and the benefits and side effects. The patient would then have to agree to this. If the patient became quite disturbed, acutely psychotic, aggressive or threatening, then he had ordered intramuscular injections which could be given on an emergency basis and consent would not be required.
There was a two stage treatment plan. First, offer the oral medications and, if Douglas Brown became or was acutely psychotic and dangerous, then he could be given without permission the injections. But, what seems to have happened is that either the nurse or the social worker, and Dr. Colonne could not remember who he gave these instructions to, went and told Douglas that he was going to be injected whether he was willing or not. And that set him off understandably.
In his judgement, Justice Brown said:
"Both of these health care providers knew that they had contributed to a situation that had escalated out of hand and I suspect that they thereafter enlisted the police to administer chemical restraints to this individual whose basic human care and safety they had ignored up to the point in time when the police were called."
And so, this writer calls upon Ontario's health minister, the Hon. Deb Matthews, to launch a transparent, public investigation into how to finally improve the treatment for those with schizophrenia. You have quite a number of reports going back for years that as I've said previously, have all been mostly ignored to act as background. It is about time that the shame of our deficient mental health system was listed among the other problems in our health system from the overspending on e-health, to the waste in the Ornge fiasco, to the wrong does of chemotherapy drugs given to patients.]]>Leave the Schizophrenia Diagnosis to the Experts, Please!tag:www.huffingtonpost.com,2013:/theblog//3.29489692013-04-02T08:29:24-04:002013-06-02T05:12:01-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/ Robert Whitaker, the popular (in some circles) critic of psychiatry.
As an example, one of his fans when I debated Whitaker on his facebook page responded to my comment that ad hominem arguments were not appropriate with "Oh, and Marvin, I am not engaging in ad hominem 'arguments' here on Mr. Whitaker's site. I am flat-out atacking (sic) you because you and your hateful lies disgust me. I'll leave the 'arguments' to other capable contributors here."
And then, this same person, Suzanne Beachy, responded to a comment on Susan Inman's Huffington Post article that made reference to Dr E Fuller Torrey, a highly respected research psychiatrist, with: "No, I argue that Torrey's critique is invalid because it is full of lies, which are clearly exposed here.
It is rare, if not unheard of, for a medical writer to gain such fame and following as does Robert Whitaker in his critiquing of psychiatry and treatment for schizophrenia. In February, he gave a presentation to lawyers in Boston entitled "The Scientific Case Against Forced Drug Treatment." I don't have enough space to fully critique this, but will just highlight problems with some of his assertions.
Blog continues after slideshow
Whitaker cites the World Health Organization (WHO) long term studies in the above presentation and states that among other things "being in a developed country was a strong predictor of not attaining a complete remission." In developing countries that did not use antipsychotics, those with schizophrenia do better. However, a WHO undated publication states that "A substantial body of evidence shows a more benign course and better outcome in developing countries." (P 15). Schizophrenia may be less severe in those countries.
Two of the authors of the WHO studies wrote in 2008 that:
"The outcome of patients in the developing countries was not uniformly better, as compared to the outcome in developed countries. While high rates of complete clinical remission were significantly more common in developing country areas (37 per cent) than in developed countries (15.5 per cent), the proportions of continuous unremitting illness (11.1 per cent and 17.4 per cent) did not differ significantly across the 2 types of setting. Patients in developing countries experienced significantly longer periods of unimpaired functioning in the community, although only 16 per cent of them were on continuous antipsychotic medication (compared with 61 per cent in the developed countries)"
A study published in the British Journal of Psychiatry in 2007 found that there was a very high death rate for people with schizophrenia in outcome studies in India and that this had not been taken into account. They state:
"In schizophrenia outcome studies spanning 15-25 years, the proportion of patients who died or were lost to follow-up ranged from 23 per cent in Chennai to over 50 per cent in Chandigarh and Agra." And, they added "The mean age at death was 34.2 years, which is well below the national average life span of 60.5 years."
So, maybe those who did not die had less severe forms of schizophrenia. Dying during followup is a very bad outcome.
Whatever the answer, these studies are not definitive but do suggest, as many of the authors have said, that other factors are at play such as cultural differences in how families, friends, and society deal with those who are ill.
Whitaker also cites the work of Martin Harrow in Chicago to demonstrate that people not taking antipsychotic medication do better than those who do. Harrow followed a group of people diagnosed with schizophrenia for 15 years and assessed them at 5-year intervals. Whitaker talks about the comparison for those who were on antipsychotics at each time point with those who were not on and that those not taking medications did better.
Quite true, but what he fails to explain is that 79 per cent and 64 per cent of the patients were on medication at 10- and 15-year follow ups. Those who were not on medication, did better on the outcome measures than those who were on but would that not be expected? Why they stopped the medication or were removed from it by their doctors was not explained, but we can presume that it was because they did not need the medication. In fact, Harrow states that not all schizophrenia patients are alike and that one treatment fits all is "not consonant with the current data or with clinical experience." His data suggests that there are unique differences in those who can go off medications compared to those who cannot. In a paper Harrow just published in March, he points out that it is not possible to predict who may be able to go off medication and those who need the long term treatment. Intensified research is needed.
Whitaker also talks about people becoming sensitized to antipsychotic medication and not being able to stop its use without becoming worse from the medication itself. Harrow touches on this in his latest paper and points out that this is not uncommon for many drugs and not just antipsychotics. Insulin resistance is not uncommon for diabetics, there is resistance over time to asthma medication and tamoxifen for breast cancer as well as others. What he does not say but I will is that we do not stop treatment for diabetes or asthma or cancer because the medications as all medications, have problems.
Neuroscience, medicine and pharmacology are complex and evolve as more is learned. And scientists never make, from my experience, definitive statements like Whitaker does. Dr. Harriet Hall, a physician writing as skep doc, pointed out that "A scientist knows that if you search hard enough you can find studies to support almost any belief. Scientists strive for an unbiased evaluation of all the scientific evidence to determine "if" something is true." Treatments for schizophrenia are far from perfect and, as I have written before, doctors do not always follow their own treatment protocols as they should but the medications have benefited many.
"No credible neuroscientist doubts that the schizophrenic syndrome arises from genetically influenced brain abnormalities present at birth that interact with subsequent brain development and environmental contributors in a manner that increases the risk of undergoing a psychotic transition sometime in adolescence or early adulthood." As for Mr Whitaker, she says "His arguments are not convincingly supported by evidence, but they do suggest directions for research."
I have to wonder if Mr Whitaker has any personal experience with a family member with schizophrenia. Those of us who have lived with the horrors of untreated psychosis in a loved one, seen the transformation that takes place when the medication kicks in and the return to the horror of psychosis if it is stopped, can attest to the efficacy. It's not perfect, but it is better. Mr Whitaker should walk in the shoes of any parent with a son or daughter with schizophrenia to learn what that reality is. Or, as a psychiatrist suggested, he should spend a few months in Cook County Jail or Rikers Island with unmedicated psychotics.]]>Good Mental Illness Policy Includes the Violence Tabootag:www.huffingtonpost.com,2013:/theblog//3.28030502013-03-04T12:17:07-05:002013-05-04T05:12:01-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/ Not Criminally Responsible Reform (NCR) Act (Bill C-54). Debates on the changes have just begun but his proposed changes ignored a significant group. The families of those declared NCR are at potential risk and they would still like to see better safeguards.
It is families who bear the brunt of care for those with serious mental illnesses. Many find themselves in the very difficult position of either trying to care for them or abandoning them to the streets, jail or even leaving them to die. Banishing them does not always work as they may return home periodically while in extreme psychosis.
In trying to care for their ill relatives, they leave themselves open to potential violence from those loved ones they are trying to help. After all, there are few hospital beds and few resources to treat them particularly if they deny they are ill and refuse treatment. As one of the mothers I spoke to said in an e-mail, "We slept with our bedroom door locked for many years, and hid the kitchen knives. I still remember when, at 4 AM, X was pounding on our door shouting 'I know that you are humanoids in there'."
Her experiences are borne out by research. A study conducted at the University of Pennsylvania in 2005 found that families of people with untreated psychotic illnesses "experience violence at a rate estimated to be between 10% and 40%, which is considerably higher than the general population."
A 2012 study found that, "There is substantial evidence that individuals with schizophrenia are at increased risk for violent criminal behavior and an even higher risk for committing murder, relative to the general population." That study compared a group that murdered with a group that did not and concluded, "The schizophrenic murderers demonstrated significantly worse neuropsychological impairment, involving executive dysfunction and memory dysfunction, relative to nonviolent schizophrenic men."
As I pointed out in my previous blog post, one of many problems with this proposed new legislation is that it still retains absolute discharge once the individual demonstrates that he/she is well and is taking medications.
Once discharged, there are no restrictions and no provision for ongoing monitoring to ensure that treatment is adhered to so that the individual will not regress and become a danger again. As another relative awaiting the absolute discharge of her loved one said, these proposed changes are an illusion to make victims feel safer.
She went on to say that the only way this can be achieved is to make it a provision of an absolute discharge "that the person is seen by a team or managed by a case manager." If the person stops seeing their psychiatrist and stops taking their medications then they should be returned to secure care. Also, blood testing should be carried out to ensure medication adherence and that the individual is not abusing alcohol or street drugs. Untreated psychosis coupled with drug and/or substance abuse is a prescription for violence.
As an aside, I wrote about this family in my book. They desperately tried to get help for the ill person and could not. As a result, the young man murdered both his parents. Had resources been available, this likely would never have occurred.
I will undoubtedly be lambasted for fostering increased stigma towards those with mental illness by talking about the existence of real and potential violence. Those who are politically correct contend that the mentally ill are less violent than other groups in society and they are right to a point.
The problem is, however, that those who are untreated are often violent and nothing is to be gained by ignoring reality. As DJ Jaffe of Mental Illness Policy Organization pointed out, most studies that show persons with mental illness are not more violent include a large percentage of those who are treated. He explains that this shows that treatment works and not that they aren't more violent.
The mother who lived behind a locked bedroom door observed that, "Stigma was the result of living with an ill person who was not being helped." And her other son who does not have schizophrenia said, "The reason that there is stigma is that some people with schizophrenia do these things!"
As many have said, including MP Irwin Cotler, the best solution is treatment and sufficient resources to provide that treatment to prevent these problems in the first place. Despite all the lip service from all the politicians, no one is doing this and the burden falls on the families to contend the best they can.
A Canadian Psychiatric Association Position Paper released in 2011 states that access to hospital care should be in place for all who need it and for as long as they need it but then points out that bed pressures and costs prevent this from happening. They recommend that, "Resources and services are put in place to provide appropriate and sufficient nonforensic, noncorrectional mental health treatment to prevent the criminalization of people with serious mental illness."
We all know that this has not happened. Until it does, we are not dealing with these matters appropriately. We would not ignore the elderly with dementia or to those with cancer, so why do we persist in not providing treatment to those with a brain disorder.
As the Canadian Psychiatric Association said in the above paper:
"Societies are often judged by how their disadvantaged members are treated. People with serious mental illness within the criminal justice system clearly fall within the disadvantaged group, with the double stigma of their mental illness and a criminal justice label. Stigmatized and discriminated against, this is a population that begs for social justice and our urgent attention."
]]>Harper's Mental Health Changes Are Too Simplistictag:www.huffingtonpost.com,2013:/theblog//3.26892812013-02-20T11:18:12-05:002013-04-22T05:12:01-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/ (Bill C-54) is overly simplistic. It is an effort to bring about changes in how we deal with violent behaviour on the part of a very small percentage of those suffering from serious mental illness and it is doomed to failure.
The bill proposes establishing a high risk, not criminally responsible category and to seemingly delay release by holding review board hearings every three years rather than annually for this group. Reforms in the treatment and accessibility of psychiatric care are needed but Harper is going about it the wrong way. The problem is not the Criminal Code (Federal legislation) but rather the Mental Health Acts and the administration of health care for those with serious psychiatric disorders both of which are under Provincial and not Federal Jurisdiction.
The government's knee-jerk reaction is focused to a large extent on the case of Vince Li, the Greyhound Bus beheader of 2008. As an aside, the number of people with serious mental illness who do commit violent acts is small. Violence is typically committed by those not being treated and who are also abusing alcohol and/or drugs as pointed out in an earlier blog post. And in the Li case, he was not being treated despite at least one earlier encounter with the police. Li first began experiencing psychotic episodes in 2003. In 2005, he was picked up by the police in a psychotic state while walking down busy Highway 401 in Toronto believing that he was following the sun. He was taken to hospital but was discharged when he refused treatment or to even admit he had an illness (a common condition with those with psychosis called anosognosia).
Had the health care system been able to put him on a Community Treatment Order (CTO) when he refused hospital treatment, he would likely not have deteriorated to the point where he believed that his seatmate on the bus was a "force of evil" about to execute him unless he attacked first.
Having him, and a few others, declared high risk solves little. What would help is to bring the various mental health acts in Canada and the use of CTOs into line with the rest of the world. The flaws in our current legislation are exemplified in a recent paper called "Reforms to Ontario's Mental Health Act: Lessons from the story of the man who killed Brian Smith" by Richard O'Reilly, Robert Solomon and John E Gray of Western University in London, Ontario.
Brian Smith was the Ottawa sportscaster killed by Jeffrey Arenberg in 1995. Arenberg has schizophrenia and that killing led to the introduction of Brian's Law establishing CTOs in Ontario. Arenberg had a history of psychotic episodes in his native Nova Scotia and in Ontario. In 1994, he was convicted of assaulting a radio staff person in Nova Scotia who he thought was broadcasting his thoughts. He was given probation as the court assumed he would be getting psychiatric care. They assumed wrong.
He moved to Ottawa with a rifle which he then used to kill Smith. After treatment in the Royal Ottawa Hospital, he was deemed fit to stand trial in 1997, found not criminally responsible, and sent to the psychiatric hospital in Penetang, Ontario. During that time, he was effectively treated with anti-psychotic medication and then released to a group home in 2003. In May of 2005, he was conditionally discharged. Although a psychiatrist testified in 2006 that if he stopped his meds, his psychosis would return within weeks or months, he was granted an absolute discharge despite objections from the Crown Attorney.
A year later, Arenberg was arrested after assaulting a U.S. border guard while trying to cross the border at Buffalo and seemingly in psychosis, based on his statement to the court that MGM Studios was hiding the drug trade in his name through radio stations. He then questioned witnesses about secret broadcasts which he called the microwave channel. He was sentenced to two years in prison to be followed by deportation to Canada and he returned to Ontario in September 2009.
Despite this history, Ontario law does not allow him to be placed on a CTO to ensure that he remains on medication. Nor would Brian's Law have ensured that he was placed on a CTO prior to his killing Smith. Before the killing, he was only hospitalized once in Ontario and the law calls for two hospitalizations. His hospitalizations in Nova Scotia do not count and, he was only hospitalized for 26 days rather than the required 30 days. The legislation in Ontario, Saskatchewan, Nova Scotia and Newfoundland and Labrador all require that these conditions be met. Only Alberta allows for someone to be given a CTO for recurrent behaviour that is likely to cause harm to others. Similarly, none of the eight states in Australia, most of the 44 states in the U.S. with CTOs or New Zealand require prior hospitalizations.
Presently, when a person receives an absolute discharge, there are no mechanisms to ensure that the person continues treatment. Without treatment, there is considerable likelihood that they will regress back into psychosis. The proposed changes do not ensure that follow up will take place.
Given these facts, how are the proposed changes to the Criminal Code going to protect anyone and ensure that those who are too ill to realize they are ill get necessary treatment? The Western University authors cited above suggest that committal is also dependent on the availability of psychiatric beds which are being reduced thanks to the long standing policy of deinstitutionalization. There are not enough resources to provide treatment for those who need it.
If the Harper government was truly concerned about the need for people to be treated and to protect the public, they would sit down with the provincial health ministers. They could attempt to get sufficient hospital and community resources to provide proper treatment and mental health acts that respond to the real issues of people who are ill and are likely to deteriorate but whose illness prevents them from understanding this.
While Mr. Harper is well intentioned and sympathetic to the victims of untreated mental illness, he is not going to achieve his intent with these proposed changes.]]>Treating Mental Illness Will Prevent Future Tragediestag:www.huffingtonpost.com,2013:/theblog//3.26055532013-02-05T17:51:07-05:002013-04-07T05:12:01-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/Alex Conte, a 21-year-old Sooke, B.C. man was found not criminally responsible for killing his mother due to his mental illness.
According to press reports, Conte was convinced that there was some sort of evil being inside his mother and so he killed her with an axe and a knife. B.C. Supreme Court Justice Malcolm Macaulay described the event as "ghastly and bizarre." He went on to say that, "He (Conte) did not think his mother was human at the time."
According to his lawyer, William Heflin, Conte had exhibited previous violent behaviour and had seen a doctor a few days before the murder. He was given a prescription and sent off with no support. Heflin believes that this tragedy could have been prevented had the system been better equipped to deal with the offender. After the trial, he said, "The obvious holes in the system are that when you have a violent offender who's clearly psychotic, the initial thing you should be doing is holding him, assessing him and then trying to stabilize him, rather than just shooing him off home." A psychiatrist at the trial testified that he is schizophrenic.
Heflin went on to point out to the Victoria Times Colonist that, "At the present time, we have people wandering the streets with mental disorders, and they're being preyed upon by the worst elements of our society."
Of course, those of us who are concerned for treatment of the most serious of mental illnesses know this. I can only wonder how those who proclaim that the mentally ill are more likely to be victims of violence rather than perpetrators of violence account for incidents like this. What they often fail to comprehend is that this statement that the mentally ill are less violent than others is true for those who are treated but not for those who are untreated. Appropriate treatment is key.
Research has shown that homicides during a first episode untreated psychosis was 1.59 per 1,000 patients. For those receiving treatment, it was only 0.11 homicides per 1,000 patients. And for those who say that the violence is caused by the prescribed drugs these people are given, it should be noted that the higher homicide rate is for those who are not on prescribed drugs while the lower rate is for those who are.
As CBS News reported on Jan. 31 and now in a Huffington Post article, about 95 per cent of violence is committed by those with no mental illness. But, those with schizophrenia are 2-4 times as likely to commit violent acts. This tendency towards violence is decreased by treatment. These facts are not acknowledged by many in the mental health field who insist on repeating their mantra that the mentally ill are less violent than others. In fact, last year I criticized the Mental Health Commission of Canada for its efforts to convince the media to stop reporting on violent acts committed by those with mental illness rather than focusing on getting treatment for those who are untreated.
In this most recent British Columbia preventable tragedy, a spokesperson for the Vancouver Island Health Authority, Sarah Plank, told the Victoria Times Colonist that a "broad range" of services are offered in the area of mental health and addictions, including crisis response, psychotherapy and housing. The Vancouver Island Crisis Line is available 24/7 for support with mental-health concerns. She went on to say that VIHA spent $108 million on mental health and addictions programs in 2012 -- funding that has gone up 20 per cent in the past five years.
But, psychotherapy and housing are not going to help someone who is psychotic and not treated and neither is a crisis line unless it can ensure hospitalization and adequate treatment. That is particularly so for those who do not even understand that they are ill as is often the case in severe mental illness (anasognosia). And, in those cases, some form of Community Treatment Order is needed to ensure compliance with treatment. NBC in Buffalo interviewed the man with schizophrenia who pushed Kendra Webdale in front of a subway train and Kendra's parents. This is the tragic event that led to the effective Kendra's Law in New York State (a form of Community Treatment Orders). It is very informative and very moving and should be seen by all.
As for funding, it may have gone up as Ms. Plank said but what was the money spent on? How much went to ensuring proper treatment and resources for the sickest? That is crucial as spending significant money on addictions or on services for those with "mental-health concerns" as she described it does not help the sickest of the sick.
This question of allocation of resources is not unique to Vancouver Island. Most, if not all, jurisdictions do not allocate sufficient funds to those with the most serious mental illnesses and they need to in order to prevent these tragedies. According to the Canadian Alliance on Mental Illness and Mental Health, the downsizing of institutional care was not matched with a complementary upsizing of community-based services, resulting in significant gaps of service for those with severe illness.
]]>When It Comes to School Shootings, Drugs Aren't the Problemtag:www.huffingtonpost.com,2013:/theblog//3.24671822013-01-15T08:49:55-05:002013-03-17T05:12:01-04:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/Toronto Star headlined "Preventing Another Newtown" pointed out that "The perpetrators of almost every mass shooting were on psychotropic drugs." An article in the conservative online magazine The American Thinker on January 9, by Charles Grant and Greg Lewis is titled "It's The Drugs, Stupid!"
Dr. Grant is an alternative medicine practitioner who deals with addictions. He specializes in "molecular health and healing, especially as it supports psychospiritual growth and mental health recovery from problems." Greg Lewis works with Grant but there is no biographical information for him. What they say in this article is "in every single gun massacre over the past several decades for which we have reliable information about drug use, the shooter has been taking psychotropic drugs prescribed by a physician." Note that the "proof" they cite is based on an article published on Citizens Commission On Human Rights International website. According to Wikipedia, this is a Scientology front that campaigns against psychiatry.
On the CNN show State of the Union on January 13, Tennessee Republican Congresswoman, Marsha Blackburn, stated that psychiatric drugs are linked to individuals who carried out these crimes. She was not challenged by the host, Candy Crawley, or any of the other panelists.
Earlier writings about medications and drugs came from author Robert Whittaker. In aPsychology Today blog, he talks about the role of antidepressants causing violence (not anti-psychotics used to treat the delusions of psychosis) and states:
"In light of this finding (of reported violent adverse events and antidepressants), the many past shootings at school campuses and other public venues should perhaps be investigated anew by government officials, with an eye toward ascertaining whether psychotropic use may have, in the manner of an adverse event, triggered that violence."
He does not provide evidence that shootings involved the use of medications but only that this link should be investigated.
So, what are the facts based on the best evidence available? A study published in June of 2012 concluded that antidepressants reduced suicidal thoughts and behaviour. There were over 9,000 patients in the study using two different antidepressants -- fluoxetine (Prozac) and venlafaxine (effexor). This confirms the results of other studies with young people.
As for anti-psychotics which are used to treat the delusions of psychosis and schizophrenia, a study published in 2010 found that the rate of homicides committed during a first episode psychotic break before treatment was 1.59 homicides per 1,000 patients. "The annual rate of homicide after treatment for psychosis was 0.11 homicides per 1,000 patients." The authors concluded, "the rate of homicide in the first episode of psychosis appears to be higher than previously recognized, whereas the annual rate of homicide by patients with schizophrenia after treatment is lower than previous estimates. Earlier treatment of first-episode psychosis might prevent some homicides."
The Treatment Advocacy Center in the U.S. has done a backgrounder on the topic of violence and schizophrenia looking at all studies around the world on the subject. They conclude that "a small number of individuals with serious mental illnesses commit acts of violence, including 5 - 10 per cent of all homicides. Almost all of these acts of violence are committed by individuals who are not being treated, and many such individuals are also abusing alcohol or drugs."
They cite 12 studies that demonstrate that most acts of violence are committed by people who are not being treated. The most recent study, from 2010, showed that most acts were carried out during the person's first psychotic episode before they were treated.
A common expression in society to describe strange behaviour is "he must be off his meds." I've yet to hear anyone say "he must be on meds to act that way." The average person understands.]]>What the Media Should Be Saying About Mental Illnesstag:www.huffingtonpost.com,2013:/theblog//3.23923842013-01-01T09:40:21-05:002013-03-03T05:12:01-05:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/
But, as I pointed out in an earlier post, the Mental Health Commission of Canada's usual response is to try to convince the media not to report these violent acts for fear of increasing stigma towards the mentally ill. The Commission has been quiet about Newtown but not Dr. Catherine Zahn, the CEO of the Centre For Addiction and Mental Health in Toronto. In her Christmas blog, she stated:
"In the rare instance when violence arises from an acute mental illness, it's a health problem. We need to help people in this situation to master their illness rather than condemn them. They, along with everyone who has a psychotic illness, deserve a well-resourced system of mental health care with services based on recovery principles, bolstered by policies of social inclusion that reduce prejudice and discrimination. When harm comes to innocent people, it must be acknowledged and addressed. But, the goal is to move toward better health care, not amplified rejection and exclusion."
D. J. Jaffe, the executive director of Mental Illness Policy Org, writing in the National Review wondered just who is crazy. He points out that, "In the wake of incidents such as the one at Newtown, the experts immediately issue press releases claiming that people with mental illness are no more violent than others." He then added that "Studies of the 5 per cent subgroup of the most seriously mentally ill who are not in treatment and are psychotic, delusional, or hallucinating, or are off treatment that has previously prevented them from being violent, are in fact more prone to violence than others. When people ask whether the mentally ill are more violent, they usually mean this group of severely ill individuals and not about their friends on Zoloft, Prozac, etc."
Lumping in a small potentially violent untreated group with a larger non-violent group statistically eliminates the tendency for violence. How to lie with statistics 101.
Writing in the Washington Post, Asra Q Nomani, described how her own mother lived in fear of her son's violence from untreated schizophrenia "taking blows through the years, one time landing in the emergency room with cracked ribs" as many mothers do who struggle to help their psychotic kids when society will not. Today, Nomani's brother is treated and is doing well.
Paul Steinberg, a psychiatrist writing in theNew York Times stated, "Too many people with acute schizophrenia have gone untreated. There have been too many Glocks, too many kids and adults cut down in their prime. Enough already." He added:
"Medication and treatment work. The vast majority of people with schizophrenia, treated or untreated, are not violent, though they are more likely than others to commit violent crimes. When treated with medication after a rampage, many perpetrators who have shown signs of schizophrenia -- including John Lennon's killer and Ronald Reagan's would-be assassin -- have recognized the heinousness of their actions and expressed deep remorse."
Dr Steven R. Pliszka in the Statesman said that, "Today we have thousands of mentally ill persons wandering our streets or living in decrepit boarding homes, refusing to take needed medications and, in some cases, committing acts of aggression against themselves, their families and the community. Many people have 'a state hospital in the back bedroom' -- a child or sibling who withdraws from society and shows signs of serious mental illness."
He ended his article with:
"Some patients need long-term care. This is not denying liberty to any person; it is freeing a mind enslaved by mental illness. Most critically, legislators should reject those who seek to put restrictions on psychiatric hospitalization or treatment with psychiatric medication. If we will place more barriers to treatment of the mentally ill, then the tragedy of Newton may be repeated many times more."
And, again in the New York Times, Joe Nocera wrote that rules about involuntary treatment "are built upon a delusion: that the sickest among us should always be in control of their own treatment, and that deinstitutionalization is the more humane route. That is not always the case."
But, in light of two recent murders on the New York subway system when innocent people were pushed in front of trains, we should give a final word to infamous subway pusher Andrew Goldstein who killed Kendra Webdale in 1999 and ushered in New York State's Kendra's Law.
As Goldstein said in a New York Post article, "Should you let a mental patient like myself be in freedom so an incident like train-pushing can occur? If you are a harm to anyone, even yourself, you should be hospitalized." Goldstein is now lucid because he's forced to take his medication.
Let us not allow the deaths of so many innocent young lives to be wasted without some good coming of this loss. Maybe this tragedy can force our lawmakers and mental health bureaucrats to start working to ensure that those who live in an untreated psychotic hell and have the potential to cause harm to themselves, their families and to innocent bystanders can be treated.]]>What Canada's Government Can Learn from the Connecticut Shootingtag:www.huffingtonpost.com,2012:/theblog//3.23117712012-12-17T08:41:32-05:002013-02-16T05:12:01-05:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/Andy Electroboy Behrman, but is the head for the press release put out by the Treatment Advocacy Center (TAC) in Arlington, VA.
Canadians should not feel sanctimonious about this tragedy. The problem is not only guns. Granted, the Americans have much greater access to automatic weapons than we do unless, of course, you are in a youth gang in Toronto wanting to shoot up a suburban barbeque or a food court in a busy mall. What we do share with our grieving cousins south of the border is a lack of access to appropriate mental health services.
The TAC news release pointed out that Connecticut has an estimated 140,000 people with severe mental illness, of whom approximately one-half are untreated at any given time. It is one of only six states without a law authorizing court-ordered outpatient treatment for qualifying individuals with severe mental illness. Between 2005 and 2010, the state eliminated 17 per cent of its public hospital beds, leaving it with only 43 per cent of the number deemed minimally adequate to meet public needs, and has twice as many people with severe mental illness behind bars as in psychiatric hospital beds.
The CBC reported earlier this Fall that in Windsor, ON, there are two beds in the emergency room for psychiatric patients but that "Psychiatric patients can occupy as many as 15 beds at any given time." The Canadian Institute for Health Information suggest the average length of stay for mentally ill patients admitted to general hospitals dropped by more than half in the five years ending in 2006, to 16 days from 36 days. In 2009-10, the average stay remained at 18.3 days (p15).
Meanwhile, the number of those with mental illnesses in our prisons continues to grow. The latest report from the Office of the Correctional Investigator released in June of this year stated that
"the proportion of offenders with mental health needs identified at intake has doubled in the period between 1997 and 2008. Thirteen per cent of male inmates and 29 per cent of women were identified at admission as presenting mental health problems. And 30.1 per cent of women offenders compared to 14.5 per cent of male offenders had previously been hospitalized for psychiatric reasons."
My first article for Huffington Post, in fact, was entitled "Mental illness in Canada: forty years of neglect and it will not get any better." Not content to take away health care from refugee claimants or to put children of refugees into playgrounds surrounded by razor wire, our Prime Minister is planning to make it even harder for those with mental illness involved with the justice system. In early 2013, they are planning to expand the time between review board hearings for those found not criminally responsible from one year to three citing public safety.
No one disputes the need for public safety and yet government plans are not supported by anyone with knowledge for the issues. In an hour long exploration of this issue on TVO's The Agenda, host Steve Paikin talked to the executive director of the Canadian Resource Centre For Victims of Crime, mental health lawyer, Anita Szigeti, forensic psychiatrist, Dr Sandy Simpson and a patient in the system. None of them agreed with the government.
So, while our sympathies go out to those who lost a loved one last week, we should start to get our own house in order.
]]>For Those With Mental Illness, the Facts Mattertag:www.huffingtonpost.com,2012:/theblog//3.22178872012-12-03T12:52:33-05:002013-02-02T05:12:01-05:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/Mad in America people are using an academic paper by Dr. Robert Zipursky of McMaster University as proof of the evils of antipsychotic medication. Their website states "decreases in brain tissue volumes are attributable to antipsychotic medication, substance abuse, and other secondary factors. The authors conclude that the majority of people with schizophrenia diagnoses have the potential to achieve long-term recovery."
And, one of the comments on the site states "Thank you for finding these studies -- for helping build a catalogue of research on MiA -- one that helps dispel the 'myth' of biospsychiatry." MiA is Mad in America. I happen to know Zipursky and even quoted him in my own book on the need for medication in schizophrenia so I was intrigued.
I've now read his paper in its entirety and he is not advocating against medication use. In fact, the paper says "with appropriate care, including the skillful prescription of antipsychotic medication, the early years following a FEP (first episode psychotic break) are not typically periods of decline but rather of substantial ongoing improvement in symptom severity and functioning." About 70-74 per cent of patients achieve remission in the first year.
He then states that the rates of remission up to nine years of follow-up is 78 per cent but that for those who discontinue medication early, the relapse rate is up to 78 per cent compared to 0-12 per cent for those who remain on medication.
The paper differentiates between remission (the reduction of symptoms), functional recovery (an adequate level of social and vocational functioning, capacity for independent living and social interactions at a regular frequency) and recovery. Recovery, he says, has had many definitions for schizophrenia but he uses it to mean levels of social and vocational functioning within the normal range and with the remission of symptoms.
Functional recovery can be achieved, the paper states, by about 40 per cent of people while recovery can be achieved by about 17 per cent. So, 60 per cent do not even achieve functional recovery and 83 per cent do not accomplish full recovery. The paper suggests that clinical deterioration is not inevitable but is the result of nonadherence (to medication) and the resulting relapses but also to factors such as poverty, homelessness, unemployment and lack of social support as well as other co-morbidities that complicate.
As for brain deterioration, he does state that MRI studies show significant brain volume reduction in chronic schizophrenia and in patients presenting with first episode psychosis and schizophrenia. Those changes seen in patients at first episode are developmental changes in the brain. The changes in the brain are present initially before any medication has been given. And, he points out that changes in brain volume are also caused by cannabis and tobacco use for everyone. Those with schizophrenia smoke more than those who do not. A sedentary lifestyle and stress in everyone also results in reduced brain volumes again, regardless of antipsychotic use.
That these medications cause brain changes should not be of any surprise. As Dr. Fuller Torrey states, "It is important to study the brain changes caused by antipsychotic drugs, since this may tell us how these drugs work and/or predict which individuals are more likely to experience side effects." He also points out that this effect is not unique to antipsychotics as structural brain changes are also caused by drugs used to treat Parkinson's disease, epilepsy, and other brain diseases.
What was truly interesting in this study was the reference to the Clinician's Illusion by Cohen and Cohen. Psychiatrists often have an overly pessimistic view of schizophrenia simply because the ones in their practices are the ones who are doing the worst. They then commit the fallacy of attributing these poor outcomes to all who suffer with schizophrenia. The same could be said of those who espouse anti-psychiatry views and believe that all who suffer can recover without medications. They see a small segment of the total but attribute the potential achieved by them to all.
As this paper says "schizophrenia is not a discrete illness with a single cause or course, rather it appears to be a syndrome with multiple interacting causes, both genetic and environmental, and a heterogeneous outcome."
The Mad in America comments on this article state "the majority of people with schizophrenia diagnoses have the potential to achieve long-term recovery." What this paper actually said in the abstract is "most people can achieve a substantial degree of recovery." There is a difference between "long-term recovery" and "a substantial degree of recovery."
Why more do not achieve recovery is stated in the paper and, for me, is key: "Sadly, many people with schizophrenia do not have access to the skilled mental health services and social supports that are needed for them to achieve recovery and a good quality of life."
In a phone interview with me, Zipursky reiterated the need for medication which he described as "critical" for anyone with schizophrenia. Medication is needed, he said, for life so that the person with schizophrenia can remain well. And, he was a bit surprised that his paper was being used to refute the need for medication. It is important for all (consumers, family and professionals) to have a shared understanding of all the facts.
]]>For Some With Mental Illness, There is No Recoverytag:www.huffingtonpost.com,2012:/theblog//3.21640692012-11-21T17:54:21-05:002013-01-21T05:12:01-05:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/ Lembi Buchanan of Victoria, B.C. released a new report called Emergence of the Recovery Movement: Are medications taking a back seat to recovery? She points out that the popular recovery model threatens to take centre stage at the expense of the urgent needs of the people diagnosed with severe and persistent mental illnesses such as schizophrenia and bipolar disorder. What sounds like a logical approach to the treatment of mental illness, recovery, is actually regressive because it does not focus on the evidence-based neuroscience of these brain disorders.
The report states that:
"Rather than embracing the advances in neuroscience research along with new and innovative medications with fewer adverse side effects, the recovery model reflects many of the antipsychiatry sentiments of the 1960s that questioned the fundamental assumptions and practices of psychiatry as well as the therapeutic benefit of psychiatric medications.
Recovery proponents support a consumer-driven, psychosocial holistic model that promotes hope, self-determination, empowerment, respect, responsibility and spiritual healing to enable people living with mental health problems and illnesses to lead meaningful and productive lives whether or not they are symptom-free. They dismiss the essential role of medications for individuals who are severely disabled by their illness and incapable of managing their own recovery."
They reject the emphasis of the biomedical model of mental illness. Instead, they believe the patient is the expert on treatment rather than the doctor and that there is no need for clinical evaluation or evidence-based treatment. This model does not accommodate the needs of individuals with severe mental illness (3 per cent of the population) who may lack insight into their illness and are unable to make appropriate treatment choices.
Individuals with untreated mental illness are susceptible to suicide, homelessness, incarceration, and, in some cases, extreme violence. Often they require hospital care and treatment to prevent further deterioration of their condition and long-term disability. Several Canadian jurisdictions have amended their mental health legislation in recent years using a more expansive interpretation of danger that encompasses the risk of serious mental, emotional, social or even financial harm to justify involuntary commitment and treatment.
LAC's objective is to reform mental health legislation across the country to limit involuntary committal and treatment only as a method of last resort for individuals that meet the strict dangerousness criteria. Such an amendment to our mental health legislation will harm the severely mentally ill who are not only dangerous to themselves or others but also lack the capacity to make appropriate treatment choices by denying them the right to treatment and the right to be well.
We clearly need, for a small subset of people who are incapable of recognizing that they are ill and who might deteriorate and/or become violent, a system with proper checks and balances, to ensure that they receive appropriate treatment.
The value of appropriate medication for schizophrenia is well accepted in science-based medicine. A recent report out of Johns Hopkins found that those with schizophrenia who took their medication had a 25 per cent reduced risk of death than those who did not. Study author, Bernadette A. Cullen said, "If your illness is under control, you can do a lot more."
And while many do not want to recognize this fact because they believe it will increase stigma, it is well known that a small proportion of people with untreated psychoses will commit violent acts which are uncharacteristic for them when not psychotic. Mother Jones Magazine recently completed an analysis of 61 cases of mass shootings in the U.S. in the past 30 years. They found that "Acute paranoia, delusions, and depression were rampant among them" and that "at least 38 of them displayed signs of mental health problems prior to the killings."
On a personal level, Buchanan told me in an email that she and her husband Jim will be celebrating their 40th wedding anniversary thanks to the lithium he takes for his bipolar disorder. In New York in 1973, Jim climbed to the top of St. Patrick's Cathedral in a psychotic state to wait for a helicopter to take him to God. He began taking lithium in a drug trial and still takes it to this day along with other psychiatric medications. Jim is well aware that he would not be alive today if it hadn't been for involuntary hospitalization and treatment on occasions when he has had psychotic episodes.
Early treatment enabled Jim to participate in his recovery as envisioned by the Mental Health Commission. "We are able to celebrate 40 years together (no mean feat these days under any circumstances), along with two fabulous kids and five remarkable grandchildren."
Would that accomplishment be replicated if the LAC gets its way?]]>"Undesirables" Face City Stigmatag:www.huffingtonpost.com,2012:/theblog//3.20052042012-10-24T09:24:01-04:002012-12-24T05:12:02-05:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/
The residence, Charlton Hall, was originally founded in 1919 by the Big Sister Association and is presently housed in a beautiful old house just west of Hamilton downtown. The young women it treats are struggling with a variety of problems such as eating disorders and self-harm. The building they are in is owned by the city and, according to Neil Everson, the city director of economic development, the building (pictured in the link) is "literally crumbling." Its commercial value is estimated at $450,000 but it requires $1.2 million in repairs.
Why the building was allowed to deteriorate to that extent by the city has never been explained. Had they maintained the building properly on an ongoing basis, it would not have reached that level of deterioration and the present crisis would have been avoided. Instead, the residence which recently amalgamated with another agency to form the Lynwood Charlton Centre, has to move and they had intended to move to an area near downtown Hamilton called Corktown that is undergoing gentrification. Again, I ask myself if a hospice would have been allowed to deteriorate to that extent.
The problem arose because of that planned move. The Corktown residents were not happy about having eight young women with problems in their midst. One, Dianne Smith, was quoted in the article linked above stating "I do not wish to have undesirables move back in. This has nothing to do with the good work that they're doing." Barry Bogusat, president of the Corktown neighbourhood association said in that same article "this is feeding a perception that it's an unsafe place to live. We're asking you today that you don't validate that ... we don't want them sleeping overnight in our neighbourhood."
And so city council voted 12-4 to keep the girls out invoking a bylaw that stipulates residential care facilities not be located within 300 metres of each other. But, to compensate, they offered to put up $200,000 towards the $1.2 million the existing building actually needs for repairs. The agency rejected the offer and is appealing the city decisions to the OMB.
That bylaw, according to the OHRC, is illegal. In a letter to the city, Barbara Hall, the commissioner said, "It is illegal to make planning decisions based on people, instead of on land use and other legitimate planning principles," Then, in an interview with the Hamilton Spectator, she said Hamilton, like many other municipalities with similar bylaws, is using zoning regulations to discriminate against residents with certain characteristics.
Earlier this month, the OHRC announced that they are asking the OMB to be allowed to intervene in the hearing and Barbara Hall was quoted saying "Often, in terms of housing, we see very negative, degrading, humiliating kinds of names and debates that occur around proposals for social housing, or housing for people with mental illness. People shouldn't have to experience that."
Needless to say, the city opposes this attempt and has said that the OHRC is overstepping its mandate.
But, from the letters to the Hamilton Spectator many do not agree with their elected city council. One letter writer suggested that the city's moral compass is absent. Another letter writer suggested that "Council should take a page from McGuinty's book (the provincial premier who just suspended the legislature and resigned) and "suspend" themselves, permanently, without pay."
The Hamilton Spectator ran an article earlier this month showcasing one of the graduates of Charlton Hall. The article opened with "Chelsea Rothwell is a university student, a painter, a volunteer, a world traveller and an award-winning peace activist. She's also a former resident of Charlton Hall." Ms. Rothwell is planning to do a masters degree at the University of Toronto and then a doctorate at Cornell. Of her experiences with Charlton Hall she said "It single-handedly altered the course of my entire life."
It is a shame that the young women in this residential treatment facility must be subjected to this debate as they likely have enough to do trying to get their lives in order. Kudos to the Ontario Human Rights Commission for stepping in. Meanwhile, a local media personality, Laura Babcock, has designed t-shirts reading "S O S" -- short for "Stomp Out Stigma" -- that are being sold to show support for Charlton Hall residents. "I didn't like the message council was sending to the girls and the people with mental illness in our community," Babcock said.]]>Debunking Two Myths About Schizophreniatag:www.huffingtonpost.com,2012:/theblog//3.19225582012-10-03T00:00:54-04:002012-12-02T05:12:01-05:00Marvin Rosshttp://www.huffingtonpost.com/marvin-ross/Mental Illness Awareness week in Canada and the organizers, the Canadian Alliance on Mental Illness and Mental Health, are to be congratulated for talking about mental illness rather than mental health problems and mental health issues. These are illnesses and we should recognize them as such rather than watering them down by suggesting they are merely problems and issues. They are problems and issues for those who suffer and their families but they are problems and issues because of the illness.
The five faces of mental illness who have been chosen to represent all who suffer are also to be commended for coming forth.
For mental illness week, I would like to dispel two of the myths of mental illness that are frequently mentioned -- that schizophrenia is not a disease and that medications make schizophrenia worse and/or are not needed.
There are some who say that as there is no simple test for schizophrenia, it is not a disease. However, many illnesses that no one disputes exist do not have simple tests for diagnosis. Diagnoses are based on clinical patterns exhibited by the patient. The diagnostic criteria for differentiating schizophrenia from other conditions is complex. Only after eliminating other causes, observing the patient and ensuring that the symptoms have lasted for at least 30 days and up to six months, is a diagnosis made.
The same procedure applies to fibromyalgia, Parkinson's, Alzheimer's Disease, MS, ALS and others. For none of these diseases is there a definitive test but rather the diagnosis is based upon a careful workup, a battery of tests and a process of elimination. And doctors do sometimes make mistakes but that does not mean that these are not real illnesses. Medicine is still an unsure science practised by a variety of people with different competencies. There is the old joke that is quite true that the student who graduated last from the worst medical school is still called doctor.
One sceptic commented that in the other diseases mentioned, autopsies will reveal the presence of disease but not in schizophrenia as there are no physical markers. Actually, scientists have discovered 51 blood biomarkers of schizophrenia and the Scientific American outlines changes in brain grey matter linked to schizophrenia. And this compilation of studies outlines the differences between those with schizophrenia never treated with medication and those who do not have schizophrenia.
The second myth is that there is no need for or little need for medication. Unfortunately, many forget history. The first antipychotic drug was introduced to the world in the early 1950s. At that time, the vast majority of those with schizophrenia spent their lives in asylums. The psychiatrist who was among the first to test chlorpromazine, the very first antipsychotic, was Dr. Heinz E. Lehmann in Montreal.
"For more than 10 years in my psychiatric work, I had been challenged and frustrated by hundreds of mentally ill patients for whom there were only shock treatments, that were sometimes dangerous and had only limited, temporary effects when they worked. Most mentally ill patients, once hospitalized, would remain confined for the rest of their lives."
As the result of his clinical trials, he was able to state:
"Our clinical results were so unique and surprising that they were almost incredible at that time. For the first time in history, there was now a drug that could suppress hallucinations -- frightening, morbid voices and visions that did not exist in the outside world but were very real to the patients -- and paranoid delusions of persecution."
Another pioneer in the 1950s was Dr. Ruth Kajander in London Ontario. She described treatments that involved immersing people in warm baths and holding them under canvas covers in the belief this would be relaxing for them. Patients were also drugged with morphine and opium and were left so sedated they couldn't eat or drink and in many cases they died.
For the first time, patients could be discharged from hospitals thanks to what some have described as the penicillin of psychiatry. Regrettably, more than the drug is required. While pharmaceutical intervention is the cornerstone of treatment, patients also require community support, cognitive remediation and other forms of psychosocial rehabilitation and that many do not get.
Unfortunately, many doctors are influenced in their prescribing by big pharma and some prescribe drugs inappropriately. Advertising costs for antipsychotics grew from $1.3 billion in 2007 to $2.4 billion in 2010 according to theNew York Times even though the number of people with serious mental illnesses for whom these drugs are intended is stable. They are now being given to people with insomnia and anxiety.
As the author, Dr. Richard A. Friedman said in the above article, "antipsychotics can be lifesaving for people who have schizophrenia, bipolar disorder or severe depression. But patients should think twice -- and then some -- before using these drugs to deal with the low-grade unhappiness, anxiety and insomnia that comes with modern life."
Proper treatment for people with serious mental illnesses can do wonders and it is cruel to deny that these illnesses exist. Mental Illness Awareness Week is important to help spread that message.]]>