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Winter 2007/08 | Vol 11 No 2

A view from CAMH

Dr. David Goldbloom

Changing the trajectory. Those three words encompass much of the mission of early intervention programs in mental illness and substance abuse. We are all too familiar with the long-term sequelae of untreated and/or under-treated disorders – on our downtown street corners, on our disability support lists and in our egregious outcomes of those who have seen no better option in a dark moment than to kill themselves. While the literature on the brain impact of untreated illness is still evolving, the personal, familial and even societal impact needs little further elucidation.

And yet there is reason for hope. This issue of CrossCurrents highlights some innovative programs that should fuel our optimism – that these young people need not suffer the ravages of disorders in the ways that earlier generations have. Some of them will never see the inside of a traditional psychiatric or addiction inpatient facility – for all the right reasons.

Part of early intervention often includes identifying populations at increased risk. Our concepts of risk must be broad, ranging from genetic vulnerability to early suggestive symptoms to poverty and psychosocial disadvantage – which may themselves be byproducts of stigma and discrimination.

These initiatives are part of a larger trend in health care toward early intervention. Children’s hospitals now have lipid clinics with an aim to lowering adult atherosclerosis; biopsies, blood tests, dietary changes and the like are part of a more global effort to control one’s body and one’s destiny with regard to disease and mortality. But as we try harder and harder to intervene before problems are formally declared in the traditional sense, the ethical issues loom large. Every diagnostic identification, every therapeutic intervention, carries the possibility of both error and risk. We must grapple with the ethical dimensions of what may intuitively seem like worthwhile efforts.

David S. Goldbloom, MD, FRCPC
Executive Editor, CrossCurrents;
Senior Medical Advisor, Education and Public Affairs, Centre for Addiction and Mental Health;
Professor of Psychiatry, University of Toronto