Monthly Archives: March 2016

Moderate and Extreme Religions – An Easter Blog

By Dr David Laing Dawson cartoon

Today in the local paper I read a well written, thoughtful op-ed extolling inclusion, the multi-cultural tolerance of Canada, our peaceful acceptance of one and all. And this article, of course, was written as a bulwark against over reacting to the recent crimes in Brussels.

In the article the author referred to “extremists”, “extreme Islam”, and “radicalization.” – words that appear regularly in our papers and magazines and internet posts.

And I thought about them. The words themselves.

Extreme and extremist. Inherent in these words is the implication that there can be something that is “moderate”, or “in moderation”.

A moderate diet can become an extreme diet. Inherent in the concept of the moderate reduction of sugar in one’s diet, there exists the possibility of extreme reduction, elimination. Similarly inherent in the “reduction of calories” is the possibility of the elimination of calories. Which could be called a “radical” diet and would be suicidal.

I can make the same point with exercise and sports. We have moderate forms of both, and extreme forms. The extreme forms are a little crazy but harmful to no one but the participant.

There once was an extreme Christianity as harmful as extreme Islam, but not today as far as I know. Today extreme Christianity implies a gross excess of forbiddens. Thou art forbidden to dance, uncover thy hair, swear, drink, have transfusions, work on Sunday, use electricity, drive a motor car. It does get dangerous when it includes in its forbiddens, vaccination, medical treatment, planned parenthood and homosexuality. And like all closed systems, such rule-bound extreme collectives are vulnerable to takeover by a charismatic psychopath.

But the point I am making is that when we find an extreme form of something, extremist views and actions, radical views, the seeds of those ideas and actions can be found in the moderate form. They are already there.

There are violent, crazy, criminal ideas in the Old Testament of the Bible. There are violent, crazy, criminal ideas and directives in the Koran. These are the seeds of extremism that moderates ignore, re-interpret, and gloss over. But they remain available to form the foundation of thought and action for the dispossessed, the angry, the lost, and the sociopathic. And, to a horrifying degree, they inform the civil law of many Muslim countries.

It behooves all moderates of all faiths to look carefully at the seeds of extremism in their own holy books and teachings and remove them. Teach love and forgiveness, kindness and generosity. Tell fables that illustrate these lessons. Dump all the stupid stuff about retribution, apostates, infidels, purges and pogroms, stoning, beheading and an exclusive heaven. It would be a start.

 

Advertisements

Reforming Mental Illness Services is not Rocket Science

By Marvin Ross

Last week’s blog in Mind You by Dr Dawson on rationally planning services made me realize that creating and implementing services for mental illness is not rocket science. Part of my realization arose from two psychiatric emergencies that my own family had to deal with in the past year. Both had fast and positive outcomes unlike so many others. The reasons, I think, are quite simple.

Starting at the front line of service for serious mental illnesses are the police. Every community needs (as my own community has) a police/psychiatric professional team to respond to emergencies. The city of Hamilton has a Crisis and Outreach Support Team called COAST. Their phone line is 24/7 but they also have a mobile team, consisting of a mental health worker, and a police officer, and will respond to crisis calls between the hours of 8 a.m. and 1 a.m. daily.

To supplement that, a properly trained police force sensitive to the reality of serious mental illness and with compassion is required. Yes there are exceptions that receive a lot of publicity but from what I’ve seen personally and from what people tell me, we mostly have that now. I am continually amazed at the extent that many ordinary patrol officers go, to help in these situations.

What many communities lack is an emergency department reserved for psychiatric patients and staffed by specialists which Hamilton does have. Of course, it has to be well integrated with the regular ER with considerable consultation so that people are not wrongly pigeonholed. As so many of you can testify to, the standard reception in ER is to isolate the psychiatric patient and keep them waiting. Then, they are more often than not discharged over the wishes of their family. If they are admitted, it is only for a brief period of time and they are not allowed to properly stabilize. There are never enough beds in most communities.

Recently, a young suicidal girl in Ottawa spent eight nights in the ER and was discharged because their were no beds. In Guelph, Ontario, the emergency room was brought to a standstill recently because there were so many psychiatric patients there waiting for the too few beds available for them. One mother in Vancouver told me how her son with schizophrenia was “tossed out of” an ER in Toronto as the nurse told the mother via long distance that all he needed was a sandwich.

And that is the other crucial piece – hospital beds. I’m fortunate to live in a community with one of the few stand alone psychiatric hospitals left in Ontario. There are beds and while there may be shortages, people usually get to stay if they need to in order to become stabilized. While not every community can have its own psychiatric hospital, they should have sufficient beds in other hospitals reserved for people with psychiatric problems.

Sadly, they don’t and because of that people often get discharged long before they should as the pressure for more emergency beds increases. Thus, what we get are very sick people hospitalized long enough to take the edge off the worst of their symptoms and then tossed out so more emergencies can be handled. It is the revolving door that we have now. The Vancouver mother I cited above also told me that:

Ten years ago, again in Toronto, my son was turfed out of hospital (St. Mikes) after a couple of weeks, at night, into freezing February winter, with no money, no friends or relatives at hand … nothing. It was a terrifying scramble for us, 3,000 miles away, to try to get him into a hotel so he wouldn’t freeze to death on the streets. Looks like nothing has changed.

What is important for those who do have the fortune to stay long enough to be stabilized is to have a caring competent staff who treat them and their families. Hiding behind fake privacy to exclude families from treatment and discharge decisions saves no one other than incompetents who fear oversight. Finally, the last piece is proper discharge planning. No one should be discharged without a place to stay, follow up with an outpatient clinic or community medical staff, and sufficient supports to help them maintain their improvement.

When governments don’t want to do something but want to give the appearance of doing something, they set up a task force or committee to investigate and bring back a report. It looks good to some but does nothing and that is what so many jurisdictions do. Maybe it is because I live in Ontario but this province is the master when it comes to this. Between 1983 and 2011, there have been 16 reports done by the Ontario government on reforming mental health care and few changes. I haven’t bothered to add in all that has gone on since then but it would add to the numbers.

The solution is easy but getting there is not. We will only get there when we continue to press the politicians and drag them into doing what any civilized community should do and that is to properly care for those who are ill. And by that, I mean all the ill. 

Planning Mental Health Services Rationally

By Dr David Laing Dawson

Over the years I have been several times involved in planning mental health services, sometimes in a general and wide sense, sometimes specific programs. In each case I usually ask, “How much money do we have to spend? What is the budget?” And usually there is no answer to this question. The game is not played that way. First the proposal to compete with other proposals and then, within a highly politicized process, the allocation of funds.

This means of course, that the words are being sold, promoted. Not the actual evidence based possibility of major effectiveness with consideration of budget. But rather the most pleasing, hopeful, expansive words of promise (with fewest political complications) are being sold and often funded. This may be a good way to fund an arts program, but for health, we really should turn to science.

If we say, instead, “We have 10 million dollars to spend to prevent suicide in a particular state or province; how should we spend it for best results?” then our thinking might be clarified for us. What do we actually know about suicide and suicide prevention? What do studies from various parts of the world show? Where are the high risk populations? Which ones can we actually target?

Then we might look at the large range of social and economic factors that comprise risk factors that indirectly, or at a distance, contribute to a high suicide rate, and pass on these. They are usually broad conditions that can be gradually improved, and should be gradually improved through political action and do require political will and good economic times. (housing, minimum wage, employment, social programs, education)

Then we could look at specific high-risk populations and figure how we could spend that 10 million effectively to measurably reduce the suicide rate.

Then we might notice that a very high risk group for completed suicide comprises people too-late identified as suffering from severe mental illness, recently discharged psychiatric patients, and especially those suffering from a severe and chronic mental illness who drop out of treatment and/or stop their medications.

And then we can ask if there is a way of spending that 10 million dollars to improve and repair the services offered this group of people. They are identifiable. They are at high risk. And it is possible with limited money to enhance the programs that serve them. Especially during visits to emergency, drop-in clinics, and family doctors, and then in the years following diagnosis and/or discharge from hospital.

Of course we need to improve the resilience and mental health of our children, if we can. But not as a means to reduce the suicide rate, but rather for overall success of our children as adults. And this means, not a suicide prevention program, but rather more money and support for the educational system and improvements in this system utilizing all we know about learning, nutrition, physical health, exercise, social growth, stress management, disability accommodation, ensuring each child has some success and a chance to belong.

When it comes to suicide then, we don’t need a “national strategy”. We need to continue to improve all our services and our lives, with improvements in our educational systems, income support and equality, a healthy economy and good jobs, improved general health care systems and easy access to same, addictions programs, income and social support for the elderly, affordable housing…… And we need to turn our attention to those people we know to be at especially high risk for suicide (sufferers of severe mental illness, recently discharged patients) and improve our services and access to services for these people.

 

 

 

 

The Sisters of Perpetual Determination

By Katherine Flannery Dering From her Blog Word From the Trenches

IMG_1303

Sunday after Sunday, year after year, our Mother drove the one hour ride from our home in White Plains to the Wingdale Psychiatric facility to visit my brother Paul and to prod the staff to take good care of him. Paul, the eighth child of our family of ten children, suffered his first psychotic break at 16 and for the next thirty two years, despite all treatment attempts, he never had more than a few moments of sanity. As our father sunk into a deeper and deeper depression, unwilling to face what had happened to his young pride and joy, Mother just gritted her teeth and did what had to be done. Dad died. Paul got sicker. But sun or snow, rainy or blustery day, Mother drove the two hour round trip and gave Paul his one day per week of almost normalcy. Picnics for sunny summer days, diner or pizza shop on bad days, an occasional excursion to a pool or bowling alley. Mother could recite every gas station, burger joint, antique shop, hardware store, exit, entrance, diner, motel, bank, putting range or ski equipment shop along the 50 mile route.

When Paul was 34, Mother died, very suddenly, of a burst aortic aneurism, and the ten of us “kids” were in shock. We stumbled through funeral preparations, copying what Mother had done for Dad. She had sung in the church choir for years, and her pals did a great job singing at her funeral mass. During the priest’s homily, he spoke repeatedly about what a determined mother she was in not only raising her ten children but also for ensuring that her mentally ill son was properly cared for. After Mother’s burial, the choir and at least 80 other friends and family members gathered at Mother’s house for a funeral luncheon.

At some point that afternoon, four or five of my sisters and I went for a walk around her neighborhood to escape the crowd of mourners who, fueled in part by a large quantity of bourbon and wine, had progressed from munching on catered chicken parmesan and crudités to singing show tunes around her baby grand piano. It was a beautiful, sunny fall day.  A short way down the block, realtors were holding an open house. Since we would have to sell Mother’s house, we decided to check it out. Recalling how the priest at Mother’s Mass had gone on and on about what a determined woman she was, we signed in as a group of nuns looking for a new home and called ourselves the Sisters of Perpetual Determination. It became our family joke. The next year, after I’d settled Mother’s will and distributed everyone’s share, my siblings gave me a plaque inscribed “To the executrix extraordinaire, with thanks, from The Sisters of Perpetual Determination.”

As the months and years went by after Mother’s death, we siblings took up the mantle of trying to look after our brother.  However, this was the age of the deinstitutionalization movement, and despite the lack of a suitable half-way facility to care for him, we were unable to prevent his release from the psychiatric facility. Without constant supervision and tweaking of his medications, he went steadily downhill. His schizophrenia was severe and persistent. He was unable to make it through the maze of “freedoms” he was given, and he cycled in and out of hospitals and group homes. We had always hoped we could keep him safe until some new treatment was discovered that would bring him back to us. But poor diet, constant smoking and general aimlessness caught up with him. Despite our efforts, he died six years ago at the age of 48.  We miss him still.

Current laws, meant to protect people from unjust confinement, now condemn many people with serious mental illness to a shadow life of delusions, confusion, and homelessness, horrible group homes and/or early death. Despite promising advancement in early intervention and new cognitive treatments, many with schizophrenia never really recover.  The care of a family member in this age of almost no long term mental health care puts a tremendous burden on people trying to keep their loved ones off the streets and out of jail.  In consideration of all these caregivers do, my sisters and brothers and I have decided to share our sisterhood name with all the other families of people suffering with serious mental illness.

To the Mothers, Fathers, Sisters and Brothers of Perpetual Determination, we salute you.  We have pledged our support for legislation like HR2646 and vow to fight for improved care for our loved ones.

picture:  to r back row: Pat, Charlotte, Sheila, Paul, Ilene; front row: John, Katherine, Julia, Grace, Monica.

For more information on HR2646 and a letter you can copy and paste and send to your representatives go to www.shotinthehead.com and click on the advocacy page.

To learn more about schizophrenia and what is needed to improve our mental health system go to http://www.paulslegacyproject.org

To order my book, please go to Amazon.com