Monthly Archives: April 2019

Of Insects and Teenagers.

By Dr David Laing Dawson

The other day I sat with a father and his 16 year old daughter. She was curled up in her chair, head bent over her phone, constantly texting seven friends. She did listen to the conversation though and stated that she was quite capable of “multi-tasking”. Then her head would go down again and her thumbs would flit about the screen of her phone. She was not attending school.

And it occurred to me that what I was observing was a hive. I was thinking bees, garden variety bees, drones at work in swarms and single file.

Bees are not quite Borgs. Each bee is a single entity but capable of working, moving in unison, in tandem, in swarms, subsuming any individual needs or impulses to the needs and actions of the hive. And though we know some genetics may be involved we also know this is achieved through constant communication. Movement and pheromones, choreography and smell.

The other thing we know about bees is that a hive is a hive and that it does not play well with other hives.

And something we know about humans is that though they have evolved to the head of the food chain, each carries within him or her the seeds of regression, the DNA of the species that came before us.

Pulling these disparate thoughts together was the smartphone, for suddenly, at least quite suddenly in historic terms, an instrument has landed in the hands of our adolescents that allows them to be bees, to form hives, albeit fragile hives, through a constant (24/7) stream of communication, checking and monitoring and correcting behaviour, appearance, pecking order, membership, attitude and bond.

Like bees, membership in one hive precludes membership in another. Unlike bees though, one misstep in these communications can bring expulsion from the hive, and unlike bees these teens have a full range of non-hive impulses, other needs to satisfy, other loyalties to balance, often in conflict with the hive.

The tendency to hive was always there among us humans, especially our adolescents, but usually limited by other loyalties, activities, communication time, boundaries and realities. A gang might form only when those other loyalties were weak or poor or broken.

We used to talk of peer pressure, peer pressure in conflict with the expectations of parents, and sometimes in conflict with the health and welfare of the teen. But back then unsupervised peer communication was limited to a few hours a day.

And now, quite suddenly, it is far more than this. The constant buzz and hum of the smartphone turns “peer pressure” into hives.

No wonder our adolescents are collapsing with anxiety or hiding in their rooms with increasing frequency.

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Are Safe Injection Sites of any Value?

By Dr David Laing Dawson

Many years ago I attended a presentation on an illicit drug ban conducted in an Asian country. I think all the opium dens were closed. Over the next ten years, presented in graph form, the dramatic fall in Opium use was an almost perfect mirror image of the rise of heroin use. So, in reality, this intervention pushed people to engage in even riskier behaviour.

During those same years in North America, the rise in the numbers of therapists conducting marital therapy, exactly followed the rising number of (newly more acceptable) divorces. It seemed to me then that marital therapy was not an intervention to help people in their relationships, but rather an industry taking advantage of a social trend.

I recently wondered about Insite, the clean needle, safe injection site in Vancouver. After much controversy in the early 2000’s and battles with the Conservative Government of Canada, it has been funded and fully operational for over a dozen years. I understand the rationale, and it makes perfect sense, along with the fact that, on a survey, 75% of addicts said they would be willing to use a safe injection site. Clean needles will prevent the spread of hepatitis and HIV. Staff on hand can intervene with overdoses. Addicts can be referred to programs. Other health needs can be addressed.

So what has happened at Insite between 2012 and January 2019?

2015 stats show:

263,713 visits by 6532 individuals.

722 visits per day

440 injection room visits per day

768 overdose incidents

No overdose deaths.

2017:

175,464 visits by 7,301 individuals

537 visits per day

415 injection room visits per day

2151 overdose incidents

And, overall, deaths by overdose in B.C. have dramatically risen from 270 in 2012 to 1486 in 2017, and then 1510 in 2018.

During this same period death by overdose of prescribed drugs has fallen (and comprises only a small fraction of the total), while illicit fentanyl has flooded the market.

I am not trying to draw any cause and effect conclusion here, but rather to point out that we humans are a puzzling and contrary species. Interventions aimed at bucking trends and changing behaviour, no matter how much they are based on science, numbers, common sense, can be way off the mark, may even produce opposite results and many unintended consequences.

Just looking at the above raw data I would have to wonder A. Without Insite would the deaths by overdose in 2018 have been 2510, a thousand more? B. Has the presence of Insite and all the de- stigmatization/acceptance surrounding it, actually removed psychological barriers that would otherwise prevent people from becoming addicted and engaging in increasingly risky behaviour? and C. Has the tightening of prescription opioid practices simply opened a market for illegal fentanyl and carfentanyl and pushed a whole population toward more dangerous drugs?

Has it been a good intervention broadly speaking or has it actually contributed to or even accelerated a social trend?

Or is it, like marital therapy, good for a few people but absolutely ineffective bucking a complex social evolution?

There has been a bit of a plateau in deaths by overdose in 2018 continuing so far in 2019. So maybe this social trend is peaking, and maybe it has very little to do with any of our well intended interventions.

 

Smoking and Serious Mental Illnesses

By Marvin Ross

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Image by Free-Photos from Pixabay

Over the years, I’ve written about the fact that a majority of those with serious mental illness smoke. In one of my earlier articles I talked about the research that shows that for those with schizophrenia, nicotine can be beneficial. In that article, I pointed out that “Recent research at Yale has found that nicotinic α7 receptors in the brain, when properly stimulated, are essential for proper excitation of the working-memory circuits in the cortex. Inhalation of nicotine is an attempt to stimulate those nicotinic α7 receptors. Smoking is not therapy and drugs to stimulate that receptor are being investigated. Until then, many of those with schizophrenia will continue to smoke.”

In a later article, I castigated the political correctness of so many health institutions for banning smoking by those with mental illness. Yes, smoking is harmful but for those with mental illness, they do find comfort and it is cruel to prevent them from smoking in specialized rooms. Those who can go out on a short pass can go out to smoke but not those in isolation. Being prevented from smoking only adds to their stress.

The Centre for Mental Illness and Addictions in Toronto went so far as to ban tobacco from their property entirely.

I was just reading a new attempt to help those with serious mental illness kick their habit. It is laudable as there are health benefits to quitting but at the expense of mental health. Locally, one of the schizophrenia programs in Hamilton has long run a quit smoking program for its members and that has proven to be very difficult. I’ve been told that the participants can’t wait for a break so they can rush outside for a smoke and that some people have taken the course numerous times with no luck in quitting.

This new trial of a novel strategy is called SCIMITAR+ [Smoking Cessation Intervention for Severe Mental Illness] and was described by the American Psychiatric Association. The study involved 526 adults with SMI (which included schizophrenia, schizoaffective disorder, and bipolar disorder) who smoked at least five cigarettes a day. To quote from the report “The participants were randomly assigned to receive usual care (access to smoking cessation medications and a telephone helpline) or a tailored cessation intervention for 12 months. The tailored intervention included cessation medications and behavioral therapy adapted to meet the needs of people with SMI; these adaptations included providing assessments and nicotine replacement before setting a quit date, providing home visits, and providing additional face-to-face support following smoking relapse.”

The results are fascinating. After 6 months, 14% of the intervention patients had quit compared to 6% for the treatment as usual group. Clearly, this intervention helped more than the usual methods but 14% is not a very optimistic number. After all, 86% were still smoking. By the end of 12 months, the quit rate was 15% versus 10%. thus the majority of people were unable to quit.

I really have to wonder if any of this is of any value. Smoking is bad for health and of that there is no dispute but is it worth the effort to bug people with SMI to quit. As a society, we can still ensure their health with regular checks into lung capacity, blood pressure and blood sugar. A UK study found that just having a serious mental illness reduces life expectancy more than being a heavy smoker. One reason for that is that those with serious mental illness do not get as good medical assessments as those without a mental illness.

The importance of proper medical care was nicely illustrated by a US study. Researchers looked at cardiovascular deaths in states with expanded Obama Care (ACA) and found that there were 1800 fewer deaths per year in states that expanded Medicaid under the ACA.

The benefit of proper regular health assessments with appropriate interventions will go a long way to ensuring that those with serious mental illness benefit from modern medicine and it will extend their lives. That is where the emphasis should be. Forget wasting time and effort on smoking cessation.

Psychiatry in Scandinavia

By Marvin Ross

There must be something in the water in Scandinavian countries that produces some strange treatment modalities for serious mental illnesses. The latest is drug free units within psychiatric hospitals in Norway. Previously, we had (and still do) the open dialogue program in Northern Finland which claims to cure almost all of schizophrenia drug free.

This program has been touted for years by the anti-medication/anti-psychiatry proponents of the US journalist Robert Whitaker and his adherents in Mad in America. I wrote about this program in Huffington Post back in 2013 and pointed out that there is almost no research showing it to be effective. A Finnish psychiatrist confirmed that “most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise.”

At the time, some of my critics on social media attacked me for actually asking a Finnish psychiatrist what mainstream shrinks in Finland thought of the program. Just recently, I received a message from someone on Linkedin asking me if I was still negative about Open Dialogue as there is now new research showing how good it is. I replied that I was negative but would love to seen the research. I never heard from her again.

More recently (in 2015), Dr Dawson also wrote about Open Dialogue in this blog. He commented that “Even if some form of two year intensive counseling/therapy/group therapy worked as well as four weeks of Olanzapine, what on earth would be the justification for withholding the Olanzapine?” And he pointed out that “the psychiatrist and director of Open Dialogue in Finland, in interview, acknowledged that she prescribes neuroleptic medication for “about 30 percent” of their patients.”

Now, Norway has added to this anti-drug position and “By 2017 all health regions in Norway have established medication-free treatment services in mental health care, following a direct requirement from the Ministry of Health and Care Services.” (from correspondence from the Norwegian health ministry).

What is being offered is that “All the drug-free units emphasize creating recovery processes based on patients’ own experiences and wishes. Most services create treatment plans in collaboration with patients. The treatment in Vestre Viken HF in the South-Eastern Regional Health Authority and Vegsund DPS in the Central Norway Regional Health Authority have fixed schedules. Common treatment approaches of the drug-free units are psychotherapy; both individual therapy and group therapy, environmental therapy, art therapy, Illness Management and Recovery (IMR),psychoeducation, physical and social activity, exposure therapy, and networking; both in regards to relatives and work/education.”

Even though this program was first introduced starting in 2015 at the insistence of “user organizations” (and what they are is not defined), no evaluations have been done comparing those who do not get medication to those who do. That research is just recruiting patients and is not expected to have results until 2023.

The issue to me is should this drug free experiment have ever been begun in the first place and the answer is no. The evidence based consensus guidelines for the treatment of schizophrenia all recommend that anti-psychotics should be used in the acute phase and that they should be used in order to prevent relapses once the patient is stable. Not using accepted treatment for serious mental illnesses is as stupid, in my opinion, of oncology centres forgoing standard cancer treatment and allowing patients to try the type of quack remedies you find in alternative medicine.

The one survey that has been done is of psychiatrists and their view of this experiment. The research conducted by a Norwegian hospital was reported on by Mad in America who said “The research, which was funded by a grant from the Stavanger University Hospital, found that psychiatrists carried negative opinions of this initiative. They understood the programs to be unscientific and rooted in the perspectives of dissatisfied service-users within a patient group that “lacks insight” into their problems. These recent findings were published in the Journal of Psychopharmacology.”

Needless to say that Mad in America disagrees with the criticisms and argue that :

here exists substantial debate in the clinical and research literature over the long-term effects of antipsychotic drug treatment for psychosis and whether the significant safety risks outweigh any benefits. Also, critics have pointed to the impact of guild interests and institutional corruption on current guidelines recommending this treatment.”

Please not that the references they cite to demonstrate their points are all from Mad in America – a highly reputable source of all things scientific.

This entire situation is forcing me to go have a few pints of homeopathic lager!

Memory is a Construction – Donald Trump’s Struggling Brain

By Dr David Laing Dawson

When we remember an event we are synthesizing bits of information and feelings into a plausible whole, and when we speak that memory we organize those bits into a narrative to suit the present context.

We adults may catch ourselves in an implausible narrative and then correct it. (It could not have been my sister because she was not yet born and we still lived in the farmhouse in Harrisburg.)

But if the current context reinforces that narrative, responds to it positively, then it becomes memory and the basis for the next elaboration, especially for children and teens.

I have been thinking about this because of two very removed events: Though I have known about the culpability of my profession in the transformation of a device of fiction (dual or multiple personality) into a diagnostic category, I was not aware, until recently, of the role a Canadian psychiatrist played in fomenting the pandemic of “satanic ritual child abuse and sacrifice” that caused so much grief to parents and child care workers in the 1980’s/90’s. (Please note that though hundreds of parents and professionals were accused of this, and some sent to jail, it did not happen; there is absolutely no evidence it ever happened in North America in the 20th century) . These were all creative tales spun by children under the influence of naive and prurient therapists.

I remember almost falling off my chair when I heard, at the time, a prominent child psychiatrist pronounce that “Children don’t lie”. Not only do children and teens lie but they are especially susceptible to the implications of their context, the perceived wishes of the interviewer, the adult in the room, and to including bits of information from story books, folk tales, TV, film, video games along with actual experience to formulate a narrative. And the child and adolescent brain is not good at screening for implausibility.

Which brings me to Donald Trump and some of his most recent statements. The first is an interview in which he substituted the word “orange” for “origin” several times without, apparently, hearing himself do this. The second is his repeated story of his father being born in Germany, “a …wonderful.. place in Germany”. You can almost hear his brain struggling with some cliches such as “a little village” before leaving it at “wonderful”. (His father was born in New York City in 1905).

Two possibilities for that first one: Either he does not hear himself when he speaks, or his narcissism won’t allow him to catch and correct: “Did I say orange? I meant or i gin.”

For the second, well, he tells whatever story he feels will reap kudos, admiration, and praise from his current audience and he sticks with it because he has a child’s screening process for implausibility and no one, apparently, except the “fake news”, will point these falsehoods out to him.

Involuntary Treatment and British Columbia

By Susan Inman Guest Blogger with an Introduction by Marvin Ross

Introduction

On Monday, I discussed the recognition that Erin Hawkes-Emiru is receiving from British Columbia via their Courage to Come Back designation. As I pointed out, Erin was able to recover in large part because of forced treatment which she credits with saving her life. I was then going to write about the United Nations convention on the rights of people with disabilities which does not allow for the policies that saved Erin and saved countless others. However, Susan beat me to it in her article on the changes being proposed in BC which should concern us all as similar attempts are always being proposed in other jurisdictions. This is what Susan has to say:

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Susan Inman Author of After Her Brain Broke Helping My Daughter Recover her Sanity

 

BC Ombudsperson’s recommendations for improving involuntary treatment:

mostly good but also alarming

BC Ombudsperson Jay Chalke has released a new report: Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act. Most of its recommendations for protecting the rights of involuntary psychiatric inpatients are sensible. Chalke’s investigation, which led to this report, revealed that too often many of the procedures prescribed in the BC Mental Health Act aren’t being followed. Most of these involved failures to complete necessary legal documentation. Chalke’s plans call for retraining of hospital staff and physicians on these protections and regular audits of hospitals to ensure compliance is occurring.

However, Chalke has moved far beyond ensuring that current procedures are followed. He is now proposing that we introduce lawyers into involuntary care in ways that will likely be disastrous for many of the vulnerable people he is trying to protect. The new policy would see patients not just receive information about their options in regard to involuntary care, but actual advice (Recommendations #21 – #24). The supposedly independent staff supplying rights information and advice and then eventual legal counsel will be the taxpayer-funded services of the Community Legal Assistance Society (CLAS) , a branch of the Legal Services Society (Legal Aid BC). CLAS is not “independent” as the Ombudsperson requires. CLAS has a record of extreme opposition to contemporary, evidence-based psychiatry and therefore cannot give unbiased advice as required.

Last year, CLAS released a document about involuntary treatment, Operating in Darkness, that Chalke references in his report. A careful reading of the CLAS document shows how it is informed by an anti-psychiatry belief that involuntary treatment violates human rights. CLAS is the group, in the current charter challenge to BC’s Mental Health Act, that argues that all involuntary medical treatment of psychiatric patients, both inpatient care and mandated outpatient care, should be abolished. CLAS falsely claims, as will be discussed below, that proven antipsychotic medications are ineffective in helping recovery from psychosis and aiding release from involuntary hospitalization.

Chalke is clearly knowledgeable about mental illnesses. He writes that people who are detained are “suffering and in need of immediate treatment but, perhaps because of that illness, are unwilling or unable to accept it. In these situations, the state can step in with the greatest power it has – the right to remove a

person’s liberty by detaining and treating them.”

CLAS’s approach to severe mental illnesses is different than Chalke’s. In its 181-page document, it never acknowledges the existence of people who, when they become psychotic, are unable to understand that they need treatment. It is people with psychotic disorders, often schizophrenia or bipolar disorder, who often end up needing involuntary treatment at certain points as they try to manage these severe brain disorders.

CLAS’s approach to mental illnesses

CLAS’s Operating in Darkness strongly supports the controversial interpretation of the UN Convention on the Rights of Persons with Disabilities (CRPD) and its opposition to involuntary treatment. This interpretation is made by the CRPD Committee that is overseeing its implementation. Readers may think that because Canada ratified this document, provincial mental health acts that allow involuntary treatment are defying its principles. CLAS fails to mention that since Canada’s 2006 ratification, it has continued to maintain the right to use substitute decision makers (such as physicians) in cases where a person lacks the capacity to make a decision.

CLAS also never mentions that the CRPD Committee calls for the elimination of all mental health acts. CLAS never grapples with the consequences of these kinds of policies, which are the increasing incarceration of people with mental illnesses. The CRPD Committee goes even further and calls for the elimination of the “not criminally responsible” defense. This would mean that forensic hospitals, which treat people whose mental illnesses are understood to have caused their crimes, would be eliminated. Anyone convicted of crimes leading to incarceration, no matter how mentally ill they were or are, would be regarded as fully responsible for their actions and forced into the general prison population.

CLAS’s descriptions of medical treatments for mental illness do not reflect the neutral position the Ombudsperson wants. CLAS implies that medical treatments are worse than useless. It argues that anti-psychotic medications “do not combat psychosis like antibiotics combat bacteria” and instead are just used to “have a sedative effect that alters behavior.” This description fails to mention that antipsychotic medications are used to get people out of psychosis.

Psychosis is a condition characterized by delusions, hallucinations, and disorganized speech, thoughts or behavior that can make it impossible for people to manage daily life. CLAS’s source for its information is a psychiatrist for madinamerica, a site that rejects standard, evidence-based psychiatric practices. It focuses on the views of “psychiatric survivors,” people who believe they suffered from encounters with psychiatry and medications they didn’t need. CLAS’s approach to mental illnesses resembles the ideas promoted by this group. Its advice will encourage patients to reject involuntary treatment and to use CLAS’s legal services in review panels and in court challenges.

Vast research supports the benefits of antipsychotic medications to help people manage to live with severe psychotic disorders. One of the largest longitudinal studies (over 8,000 people) and longest (20 years) was recently conducted in Finland. In following up on patients treated for first episode schizophrenia, researchers found that “The lowest risk of re-hospitalization or death was observed for patients who received antipsychotic treatment continuously….”

Besides ignoring research that doesn’t fit with madinamerica’s views, CLAS also ignores testimony of people living with schizophrenia. While its document is full of comments from selected patients who don’t want involuntary treatment, it fails to include testimony from the growing number of people living with psychotic disorders who describe how involuntary treatment benefitted them. Some like Joseph Bowers ( have been learning to live with their illness over many years. Bowers writes,

I’m near seventy, healthy, a husband and father who is retired with enough money coming in. None of this could have happened without involuntary treatment. My civil liberties were not taken away when force medicated and treated. I was instead liberated from the tyranny of serious psychosis.

Vancouver based peer support worker and author Erin Hawkes recounts in her article “Forced Medication Saved My Life” the agony of her psychotic episodes before antipsychotic medication restored her sanity.

In this BC Schizophrenia Society educational video, Vancouver peer worker Bryn Ditmars describes what it was like to be psychotic and believe he was the messiah. Ditmars and a psychiatrist from Vancouver’s Early Psychosis Intervention program, as well as a parent, offer the kind of information that madinamerica and CLAS avoid.

Bowers, Hawkes and Ditmar, like many people in psychosis, had anosognosia, a brain based inability to understand that they were ill. Anosognosia is the reason psychotic people usually don’t want treatment. CLAS and madinamerica writers won’t acknowledge the existence of this condition, because once it is accepted, the flawed thinking in using a human rights argument to ban involuntary treatment can be seen. Leaving people trapped in psychosis and untreated is not a policy that a just, responsible society adopts; it ignores people’s rights to be treated and recover.

CLAS does mention the lack of adequate psychosocial treatments in psychiatric units. Introducing people to these additional treatments during this time can not only make the stay in the hospital more therapeutic, but can give them ideas about what to pursue in the future. However, CLAS supports the inclusion of the Hearing Voices Network. The Vancouver Hearing Voices Network’s study group, funded by taxpayers, studies the works favoured by those who agree with madinamerica’s approaches. For instance, this announcement advertises the kind of writer the group favours, in this case Will Hall. Hall is best known for explaining why and how people should stop taking anti-psychotic medications.

While CLAS’s anecdotes reject or minimize the value of antipsychotic treatment, my experiences in the community are very different. Antipsychotics, and brief involuntary treatment when needed, have allowed my daughter and her friends who live with schizophrenia to enjoy stable lives.

Why we need to learn from the US’s mistakes

The current situation in BC is part of a larger struggle in Canada, the US and internationally. Influential but misguided human and disability rights groups, with perspectives like those of CLAS, have exerted a wide influence on mental health legislation, policies and services. The US provides the most extreme example of what happens when these perspectives are allowed to be in control of federal government policies.

Despite its mandate to provide care for people with serious mental illnesses when it was established in 1992, the US Substance Abuse and Mental Health Services Administration (SAMHSA) experimented with promoting an increasingly de-medicalized approach to mental illnesses. It actively supported anti-psychiatry groups and policies. When a Congressional committee began investigating SAMHSA after the Sandy Hook massacre, it was headed by a lawyer. The investigations revealed that SAMHSA hadn’t include any psychiatrists or physicians among its over 500 federal employees; this discovery led to it appointing its first Chief Medical Officer, Dr. Elinore McCance-Katz. McCance-Katz eventually quit and wrote an expose ( in which she described the alternative beliefs, similar to those that CLAS supports, that dominated this powerful organization. In her article, “The Federal Government Ignores the Treatment Needs of Americans with Serious Mental Illness,” she wrote:

There is a perceptible hostility toward psychiatric medicine: a resistance to addressing the treatment needs of those with serious mental illness and a questioning by some at SAMHSA as to whether mental disorders even exist—for example, is psychosis just a “different way of thinking for some experiencing stress?”

The policies at SAMHSA had resulted in much less access to treatment for serious mental illnesses. The consequences are that individuals with serious mental illnesses like schizophrenia and bipolar disorder are now ten times more likely to be incarcerated than in a hospital bed. Finally, during the end of the Obama administration, Congress took action that resulted in the establishment of an Assistant Secretary of Health and Human Services. Appointed to that position, McCance-Katz now heads SAMHSA and a major goal is the treatment of serious mental illnesses. McCance-Katz not only recognizes the existence of anosognosia, but educates the workforce and the public about it.

One of SAMHSA’s major focuses now is the development of Assisted Outreach Treatment (AOT) programs, the extensively researched programs that reduce homelessness, re-hospitalizations and interactions with the criminal justice system. This is exactly the kind of program that CLAS actively opposes. In its challenge to the BC Mental Health Act, it made clear that it not only wants to stop any inpatient involuntary treatment, but opposes mandated outpatient treatment programs that now operate under extended leave services. People in these programs have shown that they need this additional support to avoid continual relapses. Participants are regularly assessed to see if mandated treatment is still needed.

In the US, prisons have gradually become the new mental institutions and federally funded legal advocates contributed to this problem. In its inception in 1986, the US Protection and Advocacy for Individuals with Mental Illness Act (PAIMI) was designed to protect this population from all kinds of abuses. It operates in the kinds of roles suggested for CLAS in the Ombudsperson’s recommendations. However, despite the intention, legal advocates focused on and became very skillful at blocking efforts to provide mandated treatment. PAIMI legal advocates persuade ill people who have been hospitalized to avoid treatment. In front of a Congressional committee, Joe Bruce ) explained how PAIMI legal advocates in Maine persuaded and assisted his very psychotic son to reject medications and get out of the hospital. The son went home and killed his mother whom he believed to be an al Qaeda operative. Once he was treated with medications he’d previously been persuaded he didn’t need, he came out of psychosis. He talked to reporters about how he misses his mother.

What Should Happen

The BC Ombudsperson’s recommendation for funding CLAS to provide rights advice to involuntary inpatients is dangerous. CLAS’s opposition to all involuntary psychiatric treatment will surely mean that they won’t simply provide information on rights and options for appeal. When we see how CLAS views contemporary psychiatry, we can understand how vulnerable people will be persuaded to resist treatments they need. Clinicians, like social workers and nurses, who have a background in working with patients with mental illness, can be trained to provide this service in a neutral manner. This would be much easier and less expensive than trying to train lawyers and legal advocates about severe mental illnesses if they are already ideologically opposed to involuntary treatment.

If, as recommended in the Ombudsperson’s report, legislation is proposed to hire CLAS to supply legal advocates to provide advice, to argue at every review panel, and to pursue court challenges of review panel decisions, there should be extensive publicity about these plans. Impartial lawyers on review panels are already present to ensure legal procedures are followed.

Investing significant funds to greatly expand the role of lawyers in mental health care will come at the expense of already underfunded mental health services.

For instance, for several years there has been great interest in having evidence-based cognitive remediation programs implemented in BC. The common cognitive losses accompanying schizophrenia and other psychotic disorders are extensively researched; these losses frequently appear before any other symptoms or any treatments begin. Cognitive losses include difficulty with concentration, problem-solving, short term and working memory, and judgment. It is these losses that are considered to be the biggest factors in the ongoing and widespread disability of this population.

The many families that I know who are supporting people with severe mental illnesses did not hear about any consultations that occurred in creating these alarming recommendations. Family caregivers for people with severe mental illnesses should be consulted about the services they want protected, those that need to be implemented, and their opinions about those that pose dangers. People struggling with severe illnesses are part of a population who are unable to represent themselves in contentious public debates, and they are certainly not represented by the psychiatric-survivor community with whom CLAS communicates.

Life is hard for people who, through no fault of their own, develop serious brain disorders. The larger community must ensure that misguided policies don’t make life even harder.

Blog Posts

Courage to Come Back Award for Bridgeross Author

By Marvin Ross

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Photo courtesy of the Vancouver Courier

Bridgeross author, Erin Emiru (Hawkes) and the author off When Quietness Came: A Neuroscientist’s Personal Journey with Schizophrenia has just been named recipient of the Courage to Come Back Award in Mental Health in British Columbia.

Erin is the second Bridgeross author to win this award. Sandra Yuen Mackay (My Schizophrenic Life) was the first. Sandra went on to become one of the 5 faces of mental illness in Canada as well.

Erin is an amazing young woman (and all my authors are). The promo for her book describes her life up to the time the book was published as:

The true story of a young woman studying neuroscience who, in her final undergraduate year, has a psychotic break, attempts suicide and ends up in hospital. Her struggles to get well and to pursue her PhD are described in this book. Her story is geared to people from a variety of backgrounds. As a neuroscientist, Erin reaches out to the medical community who need to hear this side of the patient. As a schizophrenic, she reaches out to others struggling with this disorder, hoping to draw alongside and offer empathy and hope. Finally, she wants the general public, family and friends of people with schizophrenia to be better able to understand and sympathize with those afflicted.

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Since the book came out, Erin has begun work as a counsellor in the Vancouver Assertive Community Treatment and giving talks to doctors, nurses, students and families. Two of the recommendations she was given for the award were quoted in the Vancouver Courier.

Leanne Maylam, a nurse who met Erin when she was very ill said that I “met Emiru in the mid-2000s and consistently saw Emiru at her worst. Emiru was dubbed “Houdini” because of her uncanny ability to free herself from the restraints needed to prevent her from self-harming.”

The pair now work together on the ACT team and Leanne added “I admire Erin. Through her courage, strength and tenacity, she has turned her struggle with her own mental health into a symbol of hope for those with their own struggles. Erin is not a ‘schizophrenic,’ she is a wife, a daughter, a sister, an aunt, a colleague… she is my friend.” .

One of her clients said “Erin understands me like I never thought anyone ever could. She is so kind and patient and compassionate and with her help I have been able to finally learn that my best is OK and to live a useful life.”

Erin is a staunch supporter of involuntary treatment which she once wrote saved her life.

This is her talk to a family conference in BC moderated by another Bridgeross author, Susan Inman (After Her Brain Broke)

Quebec is Making a Mistake and I am Ready for Legalized Marijuana

By Dr David Laing Dawson

It is not just an irony but also a lesson when we find the province of Canada most endowed with a religious past, the province with years of government entanglement, even co-dependency, with the Catholic Church, the province that still has a sculpted image of a crucified man hanging behind the Speaker’s Chair in the Legislative Assembly, that it is that Province that has passed a law banning the display of religious symbols by public workers.

Extremism breeds extremism.

As an old atheist, and one who can claim to be at least three generations away from any serious belief in an all mighty, I had been pleased to see, year after year, statistics Canada reporting a gradually increasing percentage of us with no church affiliation. This didn’t just mean less magical belief in the incredibly flawed messages of the bible, the infallibility of priests and popes, but an increasing faith in our own ability as a democratic nation to choose the nature of our own social contract, and allow it to evolve with increasing heart and generosity, fairness and inclusivity.

And I must admit, as the numbers of atheists grew and the churches emptied, I was dismayed to see a whole new set of religious symbols walking our streets and pandering to another ancient text as flawed as the bible. But, but, I thought, give them time, a generation or two, a broad liberal education, a chance to see how we can come together and form a generous, safe, enriching social contract of our own, without the need of old myths and the purgatory of absolute moralities.

And that social contract, as contrary as this idea seems, should and must include the freedom to wear harmless religious symbols.

My Quebec friends, you are taking the wrong path. Outlawing such symbols gives them more amulet status, more symbolic power. It hardens the heart.

A head scarf is just a head scarf until you pass a law that it either must or must not be worn.

And if that is not enough: why I am ready for legalized marijuana? :

Kenney in Alberta flirts with a proposal that smells a lot like “Stand your Ground.”

I have no idea what Philpott, Wilson-Raybould or Trudeau have done or are doing, or why they are doing it.

The Republicans launch investigations into the investigation.

Brunei decrees Stoning as punishment for gay sex.

Michael Avenatti is Breaking Bad.

The social media world is upset someone cut a bagel differently.

British politicians stumble drunkenly toward a cliff marked Bloody Obvious.

B.C. has given close to half a million dollars to an anti-vaccination group.

Betsy and Donald want to cut funding for Special Olympics.

Caitlan Coleman met Joshua Boyle in a Star Wars forum.

Female astronauts can’t go for a walk together because they’ve got nothing to wear.

30% of the citizens of the Congo think the Ebola virus is a hoax.

The FAA delegated airline safety certification to Boeing.

And we may get 5.8 more years of Donald Trump.