On Mental Illness – Let’s Not Wring Our Hands But Actually Do Something

David Laing DawsonBy Dr David Laing Dawson

The last few days, thanks to our local newspaper and the television, I have been bombarded with mental health news. This could be a good thing. Heightened awareness, increased sensitivity, decreased stigma, having a public conversation about it, making politicians and lawmakers aware.

But it has almost all been over-inclusive wringing of hands, bemoaning the state of the nation, the suicidality of our youth, the stresses of modern life, the bad behavior and instability of our classrooms, the internet vulnerability of our children, the dramatically increased use of marijuana which is now, they say, ten times more powerful than the stuff we toked in the 60’s while singing “Puff the Magic Dragon.”

As is so often the case these days the words and phrases “mental health”, “mental health issues”, “addictions”, “behavioural issues”, “stress”, “anxiety”, “mental illness”, “addiction issues”, are used interchangeably.

The most egregious of these misnomers often comes in the form of “He is known to suffer from mental health.”

Am I too concerned with semantics here? I don’t think so. Because I think all this fraught hand wringing, vague euphemisms, contradictory word usage, broad generalizations, and statistically implied causal relationships can only lead to two kinds of unhelpful responses:

  1. The news itself, defined so broadly, so all inclusively, so vaguely, and with such a sense of urgency, becomes just another stress to bear.
  2. Money is found, a program is announced, some general response that will allow the politicians to appear to be doing something to “solve the problem” and boast in the legislature or town council, while knowing it will do nothing to help specific individuals who actually suffer from specific mental illnesses.

At least response number two will help alleviate the damage of response number one. But response number two is all too often some general manipulation of optics, some appearance of action to “eliminate crime”, or to provide a telephone number to call for those who are stressed or “experiencing suicidal thoughts.”

Okay. There are social, political, and economic factors that contribute to mental illness and disability. And we could and should gradually ameliorate these through social and political programs that reduce poverty (minimum wage, disability pension, and social assistance increases), increase the availability of affordable housing, make day care more affordable and accessible, ensure we have an educated population, help youth transition from childhood to full independence (support, training, internships, money management programs), stop sending young men and women to war and trauma, ensure some of the profits from alcohol and gambling go to alleviate the damage done by alcohol and gambling, fund and evaluate specific targeted programs to reduce the social cost of addictions, and to counter the misogynist messages our young men are now acquiring through social media, pervasively available pornography, and hateful song lyrics.

But there are a number of specifically identifiable and specifically treatable mental illnesses that we could target in a far more specific and effective way. These are:

Anxiety Disorder

Obsessive Compulsive Disorder

Depression

Bi-Polar Disorder

Schizophrenia.

These specific disorders (not withstanding the researchers’ and clinicians’ ongoing search for more clarity, specificity, and causality) can be very specific causes of disability, distress, failure, and suicide.

But we can identify them; we have the tools to detect them; and we have the tools to treat them. And doing this, providing funds and creating programs to do this, would be far more effective than hand wringing.

Take suicide for instance. There are a large number of social factors (loss, divorce, alcoholism, poverty, unemployment, debilitating illness, aging, trauma) that increase the risk of suicide. Some of these we can do nothing about. We can chip away at others through legislation and social programs.

But there are some specific causes of suicide (actual suicide, not threats and thoughts) for which we do have the tools to detect, intervene, and treat.  And these are the mental illnesses listed above.

(I think I must point out here that the proliferation of hot lines, crisis lines, help lines, phone numbers to call over the past twenty years, has NOT changed the actual completed suicide rate in any jurisdiction I know of.  But there have been studies demonstrating that helping and teaching family doctors in the detection and treatment of depression has lowered the rate of actual suicide.)

So what we should focus on are specific programs for early detection and comprehensive treatment of the mental illnesses listed above. Or better targeted funding for the services that do that now, and the linkages between them.  These linkages are crucial in order to move from suspicion, to detection, through assessment, to expert treatment: Parent and teacher to counselor and social worker to family doctor and pediatrician to mental health program with psychologists and psychiatrists.

Editor’s Note Dr David Laing Dawson has been practicing psychiatry for many years. He is a former professor of psychiatry in the Faculty of Health Sciences at McMaster University in Hamilton, ON and the former chief of psychiatry  at the Hamilton Psychiatric Hospital. He is the author of Schizophrenia in Focus, Relationship Management of the Borderline Patient and The Adolescent Owner’s Manual. He has also written and directed a number of films on mental illness.

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3 thoughts on “On Mental Illness – Let’s Not Wring Our Hands But Actually Do Something

  1. Family and friends are the largest group of caregivers of those living with mental illness though their role is often unrecognized and underappreciated (Trainor et al, 2004, Mental Health Family Alliance,2006). 50 to 90% of people with mental illness live with their family care giver (Chan & O’Brien, 2011). A 2012 report, noted in the recent EUFAMI survey, states than when caregivers get support the relapse rate at 2 years was 40% compared to a 75% relapse rate when caregivers do not receive support. The EUFAMI study also released disturbing statistics most notably that close to half (46%) are not satisfied with the support they get from medical/health care professionals. 38% do not believe they are taken seriously. 44% are not satisfied with their ability to influence decisions about the care of their relatives. 78% of these caregivers are women, and the average age is 61, which would suggest that sexism and ageism are factors in the overlooking of this resource. Recently, the Minister of Health and Long Term Care, Dr.Eric Hoskins announced the setting up of a Mental Health and Addictions Leadership Advisory Council as part of his efforts to improve mental illness care in Ontario, which did not have one family caregiver on it. This is an outrage!
    The number of untreated people with mental illness is alarming: 40 to 80% of people who have a mental illness do not receive treatment (Health Systems Intelligence Project, 2008)
    The medical knowledge and expertise is there to treat serious mental illness. But let’s cut to the chase. Forget about bringing in new programs. They do not seem to be evaluated for their efficacy for the most part. Why not use the resource that is already there, the family caregiver? By supporting her (and him) through education, listening to her input, including her in the treatment planning and discharge planning as recommended by the MHCC Family Guidelines, would seem like a reasonable response to a devastating social issue: untreated serious mental illness. I believe we need to rethink our strategy. Lawmakers and politicians appear to do what has always been done in the past which is to talk around the issue and not do anything. This is probably a reflection of the deeply ingrained stigma about serious mental illness.

    Liked by 1 person

  2. I can not begin to describe the shambles our crisis services are in. I know this first hand as I have a family member who lives with a severe mental illness, schizophrenia, paranoid disorganized. I plan to write my state representatives. I am appalled at how our family has been treated. An already extremely taxing situation has been exasperated it to inhumane levels, even causes extreme distress to my son’s neurological system due to misinformation and careless errors. There is no continuity or collaboration and so much bureaucracy that the process is cumbersome and inefficient, causing damage to families and patients . The systems designed to help only exasperate an already very difficult situation.

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