The articles in this issue of CrossCurrents feature McGorry's work, as well as highlighting Canadian efforts to make sure that youth get help when they need it most.
]]>Asylum by the Lake, 1890-1979 (Ontario, Canada)
Explore Bethlem: Inside a Nineteenth-Century Psychiatric Hospital (Bethlem Royal Hospital Archives and Museum Service) (UK)
The Lives They Left Behind: Suitcases from a State Hospital Attic (New York)
The Most Famous and Notorious Insane Asylums in History (US and UK)
]]>We've developed two surveys - one for therapists and one for consumers. Your responses will help inform the story. Please answer the survey that applies to you. If we would like to publish your responses, I will contact you for permission. You can remain anonymous in the story. You can submit your responses as a comment on this blog, or email them to me at hema_zbogar@camh.net by June 17.
]]> Therapist survey:Please be as specific as possible in your answers to these questions:
1. Do you think the therapist's office contributes to the therapeutic process and outcomes? How?
2. What message do you want to send clients through the way you have set up your therapy room? How, specifically, do you convey this message through design (ie, furniture, objects, art)?
3. Do you want your office to show your personality, or do you try to make it as impersonal as possible? Why?
4. Do you think some physical elements in office design are more therapeutically relevant than others?
5. What are potentially harmful physical elements in office design or ones that make clients uncomfortable?
6. Do you think there are different considerations involved in how therapists set up their therapy spaces than existed, say, 50 years ago? How specifically can design reflect these considerations?
Consumer survey:
1. In your experience, does the therapist's office affect the therapeutic process and outcomes? How?
2. Does the therapist's office tell you a lot about the therapist's personality?
3. In your experience, do most therapists do a good job of creating a positive physical environment in their office? Give specific examples of good or bad design or décor.
4. Are there any potentially harmful physical elements of a therapy office - things therapists should avoid?
5. If you've had a negative reaction to something in the therapist's office, do you talk about it with the therapist? For example, a painting that makes you uncomfortable.
]]>What perhaps gripped readers most, from what the Comments section reveals, is the fear that Dr. Levin has injured the profession's image. Most readers were thinking less about the state of psychiatry and more about Dr. Levin, and hoped that he isn't the norm. Whether it was a good idea for Dr. Levin to acknowledge his practice publicly and whether he represents psychiatrists in general is one question. But I return to the issue of the changing nature of psychiatric care, which seems to have pushed aside talk therapy to make way for more pharmacotherapy.
It's a fact that psychiatrists are talking less and prescribing more. The NYT article cites a 2005 government study which found that 11 per cent of psychiatrists in the United States no longer provide talk therapy, focusing instead on prescribing medication.
The irony is that talk therapy is emerging as a precise science that relies less on the therapist's experience and judgment and more on evidence-based interventions. Recent research, for example, has found that talk therapy and mindfulness may be as good as or better than drugs in treating depression.
The focus on medication also seems to be at odds with new curricula in medical schools. Many offer electives and even mandatory courses in narrative medicine, the humanities, ethics and doctor-patient communication. Are students prepared for the reality of clinical practice, or will they become a new breed of caring practitioners who can prescribe medication without losing sight of what's most important in their work -- their clients and patients?
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In 2008, outreach workers from around the United States gathered in Boston to discuss the skills needed for effective outreach. They came up with some tips for other outreach workers. Here they are -- some may be obvious; others are more subtle but just as important:
]]> 1. First and foremost be human. Be yourself. People know whether you are being authentic and genuine.2. Be comfortable outside your comfort zone.
3. Don't tell people "I know what they are going through," "I understand," or "I've been there." Even if you have been homeless yourself, everyone's story is different.
4. Shine the flashlight in your face, not theirs -- little things make a big difference.
5. Wear layers.
6. Be responsive, not reactive. Don't get defensive. Often negative situations have nothing to do with you. Take a few seconds to think before you speak. Reactive is about you; responsive is about the other person.
7. If you find yourself going into an emotional or physical place that might trigger you, don't go there.
8. Know the limits of your own skills.
9. Remember that dehydration and sunburn are issues in the winter and in the summer.
10. Create survival packs to give out. Include ziplock baggies, gloves, hat socks, toiletries, non-perishables, condoms, seasonal items, flashlights that don't require batteries and fingernail clippers.
11. People often jump to conclusions and diagnoses too quickly. Don't assume that just because someone is homeless that you know what's going on with them.
12. Give without expecting anything in return.
Beyond such simple considerations, training can go a long way in honing skills for working with this population. The Calgary Homeless Foundation, Alex Pathways to Housing and the University of Calgary Faculty of Social Work have developed the Certificate in Working with Homeless Populations, perhaps the only program of its kind in North America.
The program incorporates best practices in the field, including the housing first model. It prepares front-line practitioners to navigate the complex system of government, mental health, medical and social service agencies. The program examines mental health and substance use issues, and includes a diversity element, including a focus on Aboriginal communities and immigrants and refugees. This introductory certificate is the first in a series of three certificates, which are now being developed.
]]>In an affluent country like Canada, it's surprising that 1.1 million Canadian households experience food insecurity at some point, according to the most recent Canadian Community Health Survey. It's a concerning statistic because f
ood security is a key determinant of health, including mental health.]]> The Minding Our Bodies project of the Canadian Mental Health Association, Ontario, has taken on the challenge with its recently launched Eating Well for Mental Health pilot program. The program will increase the ability of the mental health sector to deliver programs that address healthy eating and food security for people with mental illness.CMHA Ontario has partnered with YMCA Ontario, York University's Faculty of Health, the Mood Disorders Association of Ontario and the Ontario Public Health Association's Nutrition Resource Centre. These six sites have received funding to run a pilot program between September and December 2010:
Keewaytinook Okimakanak (Thunder Bay)
Northern Initiative for Social Action (Sudbury)
Algoma Public Health: Community Mental Health Program (Elliot Lake)
CMHA Peterborough Branch (Peterborough)
Mood Disorders of Ontario Association (Toronto)
CMHA Huron-Perth Branch (Stratford)
For more information about Eating Well for Mental Health, visit http://www.mindingourbodies.ca/ and search "Eating Well for Mental Health."
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UK project addresses mental health needs of black and minorith ethnic men
The UK-based Improving the Mental Health of BME Men project aims to enhance understanding of black and minority ethnic men's beliefs, attitudes and behaviours around mental health and their experiences of mental health services. The project report will be released later this year. Its findings will help health care professionals work better with BME men and will support the development of resources for BME men.
Not just a "dumb jock": Fit teenage boys are smarter
In the first study to demonstrate a clear positive association between adolescent fitness and adult cognitive performance, US and Swedish researchers found that better cardiovascular health among teenage boys correlates to higher scores on a range of intelligence tests -- and more education and income later in life. The results are published in the Proceedings of the National Academy of Sciences.
Macho men are a liability on the roads
The more "macho" the man, the more risks he may take on the road, according to a University of Montreal study in which men were asked in a driving simulation to catch another car. Interviews with the men also revealed a link between macho men and speed.
Deep, masculine voice not enough to challenge a man's dominance
Men with a deep, masculine voice are seen as more dominant by other men, but a man's own dominance -- perceived or actual -- does not affect how attentive he is to his rivals' voices, according to a study in the journal Behavioral Ecology and Sociobiology.
Prenatal and postpartum depression strike new fathers
About 10 per cent of fathers experience prenatal or postpartum depression, with rates being highest in the three- to six-month postpartum period, according to a meta-analysis appearing in the May 19 issue of JAMA.
Older men prefer talking to friends and spouses, not doctors, about sexual issues
A new study suggests that it may not help older men and women with sexual problems to talk to a doctor, but men who talk to their partner report greater happiness -- and those who talked with friends felt less depressed. The study is published in the April issue of the Journal of Gerontology: Social Sciences.
Aggression in boys may be triggered by earlier or later puberty
Puberty that arrives earlier or later in adolescent boys relative to their peers can trigger chemicals that are related to antisocial behavior, according to researchers, whose findings have key implications for parents with aggressive boys. The findings appear in the May issue of Psychoneuroendocrinology.
Fathers of sexually abused children need support
The preliminary results of a University of Montreal study show that fathers of sexually abused children can suffer from anxiety, depression and grief. These men are often overwhelmed by a desire for vengeance, yet little literature exists to help them deal with their pain.
Smoking cessation by Latino men influenced by acculturation
Latino men who are more adapted to U.S. culture are more likely to quit smoking than their less-acculturated counterparts, according to research at the University of Texas, published in the December issue of Cancer Epidemiology, Biomarkers and Prevention.
CAMH psychiatrist Dr. Goldbloom described how stigma disqualifies a person from full social acceptance and how social inclusion is part of our entitlement. "It is the full entitlement for each of us as a citizen," he said. Stigma is the attitude that people have, and discrimination is the behaviour that is a result. "Evidence shows that attitudes develop in a person by Grade three," said Goldbloom. "Stigmatizing attitudes therefore are seen in children by the time they are 8 years old."
This is why implementing early anti-stigma programs with youth is so critical and why the Mental Health Commission's Opening Minds anti-stigma strategy is focusing on two target groups: children and youth, and health care professionals.
Goldbloom spoke about the adjectives that are used to describe someone with cancer - such as courageous or strong. These are also germane to someone battling a mental illness or a substance use problem, but those adjectives are rarely used in describing people living with these issues. Similarly, sometimes stigma is more about what we don't see than what we do see. For example, if we were to visit a hospital and count the number of get well cards and flowers on the surgical unit, and then compare it to the number found on the psychiatric unit - well, there they scarcely exist. The cards and flowers are signs of hope, connectedness and love. Their absence often reflects the stigma and lack of support experienced by people living with mental health or substance use problems.
Goldbloom shared with the group three ways we as health care providers can all fight stigma and discrimination: through education, through protest when we see discriminatory language or behaviours, and through contact - by getting know people who have substance use or mental health problems. "It's very hard to discriminate against someone when you really get to know them first!" said Goldbloom.
Tom Regehr, founder of CAST Canada, which provides workshops for health care providers, is a trauma survivor who has struggled with addiction, homelessness and mental health issues. He knows very well the stigma people can feel in trying to receive support from health care providers. Regehr spoke about the many unsuccessful times he would reach out for help.
But he also recounted how, during a time of murky recollection, he nonetheless recalls one specific thing very clearly. He made a phone call from a pay phone to a local health agency and told the woman on the other end of the line that he was an alcoholic and needed help. Unlike his past experiences, this time he got help that worked. And it started with compassion at this first point of contact. "The woman on the other end of the line had time for me," said Regehr. "There was no condescension; there was no 'I'm busy.' And I can still hear her words: 'Tom, here's our number. And you can call back anytime you want.'"
Regehr described the impacts of non-verbal communication and how little control we all have over our body language. If we are not aware of all the ways that we communicate with clients, we can say one thing and show another. He encouraged participants to be aware of their own body language in working with clients and said that what had saved him was not a "tool" or "strategy learned in a book," but rather the fact that the people helping him were "present." They were able to check in with their own feelings and were able to be honest and respectful.
Participants at the forum came from a variety of helping backgrounds, including police, corrections, education, health and social work. But one sentiment was shared by all of them, best expressed by one participant when asked what they had learned from the forum: "That compassion and deep listening are a foundation for anyone in the helping field."
CAMH in the Community events are organized by CAMH's Provincial Services staff, part of Policy Education and Health Promotion, as part of its responsibility to provide professional education across the province. Check here for upcoming events.
]]>2. Actually read/listen/watch non-stigmatizing content. Assuming the content is helpful or interesting, do one or more of the following:
3. Vote on it or rate it.
4. Socially bookmark it in sites like Stumbleupon, Delicious, etc.
5. Submit it to sites like Digg, Yahoo Buzz, Reddit, Mixx, Propeller, etc.
6. Forward the content to others, either without a comment, or with a personal comment by e-mail, Twitter, on Facebook, Friendfeed, etc.
7. Comment on the original article, post, video, etc., in one of the following ways, depending on your comfort level: anonymously, with your first name, with your full name, with your full name and the name of your blog/website/Twitter account, etc.
8. Respond to the original content by a blog post, tweet, or video on your blog or social media account.
9. Respond to someone stigmatizing a person with a mental health condition or the actual condition itself. This can be done in a variety of creative ways, depending on your personality, subject knowledge, and comfort level. Perhaps involve your social media friends in the effort.
10. Create some original content that's factual and stigma-busting on one or more of your social media accounts.
11. Participate in a social media mental health campaign, for example through awareness activities, fund raising, political action, signing online petitions and contacting politicians. This could be all online or a combination of online and offline, or involving traditional media.
12. Create a social media mental health campaign. Promote it far and wide.
You have until April 20.
Publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a hugely anticipated event in the mental health and addiction field. The final document, which has already been 10 years in the making, is expected to be released in 2013. As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are available for public review and comment. The proposed draft will be available for public comment until April 20 at www.dsm5.org/
]]> There are many pages of proposed changes to wade through. For a good summary and provocative criticism of these changes, read "Opening Pandora's Box: The 19 Worst Suggestions for DSM5," a commentary by Dr. Allen Frances, who was chair of the DSM-IV Task Force.Then visit the DSM5 site and have your say.
]]>2. Involve people with mental illness and their family members in all aspects of program development, evaluation, and communication so that programs address the most meaningful aspects of stigma and discrimination.
3. Accept that education modifies literacy, and sometimes attitudes, but rarely behaviour - and keep in mind that real change is contingent on behavioural change.
4. Programs that are modest in scope - that is, targeted to a specific audience; capable of delivering complex and emotionally charged interventions; and sustainable - enjoy a greater chance of success. Campaigns that are generic, that is, impersonal, literacy-based, targeted at the general public, short lived and expensive, are largely ineffective and discouraging for all involved. They may also impart the false message that psychiatric stigma and discrimination cannot be beaten.
5. Recognize that there is no such thing as the general population when it comes to stigma reduction. One size does not fit all. Target programs to the needs of explicitly defined subgroups and deliver them in carefully focused ways.
6. Think big, but start small. Target the things that can be controlled (such as local policies and practices) and leave alone the things that can't (such as negative views).
7. Accumulate small successes. Not only do these provide momentum for program activities, they create a sense of possibility and prevent burnout. Accumulated successes also create a platform for sustainability and reinforce the message that stigma and discrimination can be beaten.
8. Use the media as allies in the process rather than as objects of intervention or the sole means of transmitting messages.
9. Build on the work of others in Canada, other countries, and internationally; cooperate, communicate, and coordinate.
10. Contribute to Canada's store of best-practice knowledge; first through careful program development, then by rigorous self-evaluation, and finally through scholarly communication.
Stuart also led the development of the Schizophrenia: Open the Doors Training Manual for the World Psychiatric Association's Global Program to Fight Stigma and Discrimination Because of Schizophrenia. The manual summarizes the steps to follow to set up and evaluate anti-stigma interventions, illustrated with experiences from countries participating in this program.
But health care providers are beginning to acknowledge their role in perpetuating stigma and discrimination and talk about what they can do to stop it. In the last two weeks I've heard about two forums in Ontario that will address this exact issue. Humber River Hospital in Toronto is hosting a workshop with Reconnect Mental Health Service and the Central LHIN about combating stigma among health professionals on March 19, from noon until 1:30 p.m. For more information, contact Yashyka Broomes at Humber River Regional Hospital at 416 658-2012.
A similar forum is happening in Ontario's North Simcoe Muskoka region on April 7, hosted by the Centre for Addiction and Mental Health. The speakers will be psychiatrist Dr. David Goldbloom, vice-chair of the Mental Health Commission of Canada, and Tom Regehr, president of CAST Canada, which gives mental health and addiction workshops, and who himself has experienced trauma, addiction, homelessness and mental health issues.
Join the forum on April 7, from 1:30 p.m. to 3:30 p.m., in various locations of the Ontario Telemedicine Network across North Simcoe Muskoka. Register for this free event here.
In the meantime, I want to hear from frontline professionals across the country about what you are doing to fight stigma and discrimination in the health care system and in your professions.
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