Category Archives: Mental Health Awareness

The Good, the Bad and the Ugly of Social Work

By Marvin Ross

Social workers can and do play a significant role in helping the mentally ill to recover when they work with psychiatrists, nurses and occupational therapists. In my personal life, I’ve just witnessed how a knowledgeable and caring social worker can impact recovery from psychosis in an inpatient setting.

Sadly, the training that many social work students (and others like psychologists and counsellors) receive from some institutions does not aid in that role. Susan Inman, the author of After Her Brain Broke, Helping My Daughter Recover Her Sanity, has long complained about the lack of science and medical training for many of these professionals. She said:

Many credentialed mental health clinicians have never received science-based curriculum on severe mental illnesses. Too many are still being trained in the parent blaming theories which contemporary psychiatric approaches to schizophrenia have long since left behind.”

For a number of reasons, I had occasion to look at the mental illness course being taught at McMaster University in Hamilton Ontario and it confirms all that Susan had to say. The course is called “Critical Issues in Mental Health & Addiction: Mad & Critical Disability Studies Perspectives for SW”. Part of the course objective is to:

“explore contributions from critical disability studies, mad studies and the historical influences of sanism and eugenics on contemporary mental health practice. Addiction will also be briefly explored within these contexts.”

Then, this is added

“Throughout the course guest speakers may be invited to share experiences and analyses on course themes from ex-patient, survivor, consumer, service-user, and mad perspectives.”

Nowhere do I see anyone coming who can provide the medical perspective which would include the physiology and treatment of mental illness. Given that McMaster has a world-class medical school and one if its teaching hospitals is a psychiatric facility, this is very troubling. It would be so easy to find a psychiatrist to talk to the class or to take a field trip to the local psychiatric hospital.

One of the readings in the first week is Geppert, C. (2004). The Anti-Psychiatry Movement Is Alive and Well. Psychiatric Times 21(3), 21. Retrieved December 4, 2009”. This article is no longer on the Psychiatric Times website that I could find and the professor referenced it in 2009. It would be nice if the professor asked his students to read something like Psychiatry and Anti-Psychiatry by Dr Allen Frances. There are many comparisons of these two approaches in that article and students should have an opportunity to see both sides.

Another set of readings for this course is by Geoffrey Reaume who is a professor of disability studies at York University in Toronto. His view of Mad Studies can be summed up by a quote he gave to an article on Mad Studies in University Affairs in 2015. He stated that “People with PhDs had oppressed mad people throughout history. I wanted to help liberate this history from the shackles of the medical model.”

Dr Frances had this to say in the article I cited above (for psychologist also read social worker):

Psychiatry is far from perfect, but it remains the most patient-centered and humanistic of all medical specialties and has the lowest rate of malpractice among all specialties.

Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction—espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick.”

And he added:

For people with severe mental illness (eg, chronic schizophrenia or bipolar disorder), a broad biopsychosocial model is necessary to understand etiology—and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.”

Another author used quite a bit in this course is Bonnie Burstow of the Ontario Institute for Studies in Education (OISE) at the University of Toronto. Dr Burstow is the creator of a scholarship in Anti-Psychiatry Studies. I’ve done two Huffington Post blogs about Dr Burstow. The first was entitled The Truth Behind U Of T’s Anti-Psychiatry Scholarship and the second was Time For U Of T To Rein In Its Anti-Psychiatry Activist It is worth noting that OISE is a post graduate school on teaching, learning and research. Nothing to do with science or medicine.

In my second Huffington Post blog, I had this to say about Dr Burstow:

Burstow does not believe that the brain is capable of becoming ill, and that therefore mental illness cannot exist. Her doctoral thesis, according to the media spokesperson at her institution, was entitled “Authentic Human Existence: Its Nature, Its Opposite, Its Meaning for Therapy: A Rendering of and a Response to the Position of Jean-Paul Sartre” in 1982 at the University of Toronto.

Dr Burstow is the author of a book called Psychiatry and the Business of Madness which is not one of the readings for this course but exemplifies her position. Blogger, Mark Roseman wrote a very lengthy and detailed critique of this book which is well worth reading.

Roseman defines anti-psychiatry as:

a position that psychiatry is 100% flawed, has no redeeming features, is built on a stack of lies, necessarily does harm to all who encounter it, and must be abolished in its entirety. Moreover, the real proponents of antipsychiatry do not want to seriously engage in discussion with the broader community. They are not interested in critique, or divergent opinions, but only discouraging those seeking treatment, and attracting new followers to their movement.

The course does discuss medication but this is the description of that:

The Biological Mind: What are some of the critiques of the role of medication and the psychopharmaceutical industrial complex? How does neoliberalism matter in mental health? How do we think critically about suicide and self-harm?”

Here is the recommended reading:

Cohen, D. (2009). Needed: Critical thinking about psychiatric medications. Social Work in Mental Health, 7(1-3), 42-61.

Medawar, C. & Hardon, A. (2004). Sedative hell. In Medicines Out of Control? Antidepressants and the Conspiracy of Goodwill (pp. 11-27). N.P., Netherlands: Aksant.

Whitaker, R. (2001). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, Massachusetts: Perseus-p.3-19.

White, J., Marsh, I., Kral, M. J., & Morris, J. (Eds.). (2015). Critical Suicidology: Transforming Suicide Research and Prevention for the 21st Century. UBC Press. – Introduction

The titles give it all away. Whitaker, of course is an infamous anti-medication proponent and I have critiqued his views a number of times as have others more qualified that I am as in the debate between Whitaker and Dr Allen. The teaching of anti-psychiatry did not include anything pro-psychiatry and the discussion of medication contained no information on the benefits of medication. Should students not be given an opportunity to see the other side? McMaster and its teaching hospital has many first rate psychiatrists well versed in their specialties. I’ve observed the near miraculous results that properly prescribed medications can have on severe psychosis. Neoliberalism did not come up once.

The bottom line is that no one who graduates from this course will be capable of working in a psychiatric setting with patients. Hopefully, none of them will. The effective social worker I cited at the outset is a graduate of another university.

 

Reminiscences of Hockey and Schizophrenia

By Marvin Ross

This past week Johnny Bower, the 93 year old former great goalie for the Toronto Maple Leafs, passed away. One of the comments made of him was his charitable work along with the fact that he was goalie the last time the Leafs won the Stanley Cup. I’m old enough to remember that it was so long ago.

His passing twigged my memory of the time that the Hamilton Chapter of the Schizophrenia Society of Ontario were the recipients of the charity of old hockey players. I’m not sure when this began but I became involved in the chapter in the late 1990s and was chair for a few years. The largest and most successful fund raising event was the annual National Hockey League (NHL) Alumni Association golf tournament put on for us at a course north of Toronto.

The moving forces were our executive director at the time and Keith McCreary who was one of the founders of the NHL Alumni. Sadly, both are no longer with us. I attended two of the golf tournaments in 2000 and 2001 and Johnny Bower was there along with many of the hockey greats from my childhood. I certainly remember Red Kelly, Dennis Hull, Eddie Shack, at least one of the famed French Connection line for the Buffalo Sabres, and numerous others.

What struck me was their incredible generosity. Some donated memorabilia to be auctioned off and all of them were more than happy to peel off $50 and $100 bills to enter the many raffles that were held. Hockey players of that era did not make the big bucks that they do today as Dennis Hull mentioned in his after dinner stand up comedy routine. He commented that today’s players earn more in a day than most of the guys in that room made in their entire careers. But their generosity to a disease that most of them probably knew very little about was remarkable.

Another guest who was much beloved by the hockey crowd was Michael Burgess who often sang the national anthem at Leaf games and who played Jean Valjean in Les Mis. The players all loved his rendition of Danny Boy which he did that evening. The link above is to his singing on Youtube.

Also incredible was one mother who positioned herself on the first tee and subjected each and every foursome before they teed off with her lecture on the horrors of schizophrenia and the need for more treatment, family support and research. She was not a young woman but stood in the sun and heat for hours without either a pee break or a drink break so that she would no golfer would forget what they were supporting.

That night, I drove home with our executive director and what was left over from the day along with about $10,000 in cash for the bank when I was stopped in a police road block looking for impaired drivers. Fortunately, I had cut myself off early in the evening.

That was September 10, 2001 and we all know what happened the next day 9/11 that changed the world forever.

But, the moral of the story is that there are good people out there who can understand serious mental illness and do their bit to make the lives of those who suffer just a tiny bit better.

schizcover  For more on schizophrenia, see Schizophrenia Medicine’s Mystery Society’s Shame and other Bridgeross titles

When the Mental Health System Refuses to Listen

By  Maria Lorenzoni With Marvin Ross

Much of my writing on mental illness and the flawed system that we have to endure deals with privacy and the absurdity of keeping family and mostly parents in the dark about their loved ones diagnosis, treatment and progress. Maria Lorenzoni recently  gave this  edited presentation this past August to the Service Coordination Council on Mental Health and Addictions of the Central Ontario Local Health Integration Network (LHIN). The LHINs co-ordinate services in geographic areas.

She describes her families experiences with the secrecy of the treating officials and the impact that had on her family. Here is what she had to say:

Every serious sickness is stressful for family members, but caregivers of people with severe mental illness face challenges that are unique in some ways. Imagine for a moment that someone you love has been stricken with a devastating stroke and is in the hospital and can’t communicate, at least for the moment. Now imagine the doctors treating him or her and not giving you details of the diagnosis, prognosis, the exact information in their reports, or the treatment plan. Or just leaving you out of the picture completely. And then imagine the patient slowly recovering, but still not cognitively able to function properly, and perhaps unhappy that they are in hospital, and then being visited by a patient advocate to be informed that he or she doesn’t have to stay in hospital if they don’t want to.

You would argue that this is absurd.

According to a statement from the College of Physicians and Surgeons of Ontario, physicians can share information with others involved within the patient’s circle of care without asking for the patient’s consent if the doctor has no reason to assume that the patient would object.

Sadly, this does not apply to mental health!

In my case, it was only after three hospitalizations that I was able to press the family doctor to give me the diagnosis of my loved one. We finally got our son  into the Centre for Addiction and Mental Health and we were desperately trying to find the right meds and treatment plan. He doesn’t have insight into his illness, he doesn’t think he needs meds, so it took some hard work to get him to cooperate. And then, this vulnerable person that is in serious need of care is visited by advocates who tell him he doesn’t have to stay there.

Then what?

The onus is entirely on the family to persuade the person to stay in treatment. As a family member, you try to cooperate as best you can, BUT, you are not allowed to have any private discussions with the doctor unless the patient is in the room. Being spontaneous and giving some helpful comments is tricky when the person is right there. The doctors, therefore, make all their decisions based on communication with a patient who’s confused and will not share much because they don’t think they are sick.

He finally went to a Home for Special Care and was put under a team.  While we acknowledge the good work they did, there were a lot of misunderstandings and frustration due to a lack of communication.  No one is perfect, and families need to listen to constructive comments without being made to feel that they are just part of the problem.  In the time that he was there, we had three short meetings with the team , there were serious problems with reactions to meds, but we were not given input.  In fact, when I asked a question, I was told quite clearly…”look, you be the mother and we’ll be the treatment team.”  My family was shunned and made to feel that we were not cooperating, and in fact, we were discouraged from even visiting.

SO, POINT NUMBER ONE – family caregivers need to be able to give and receive information (unless there is a very clear reason not to), be given a diagnosis and prognosis, and consulted on a plan of action for the future.

SECONDLY, we definitely need a media campaign to focus on the obstacles faced by people with “hard core” mental illness. Sadly, the current campaign to destigmatize mentally ill is aimed at the people who have a more socially acceptable emotional problem like depression and who are in a position to ask for help. People are under the mistaken notion that everyone with a mental illness has easy access to good, consistent, hands on care. I’ve spoken to some in the health field who have asked me why my loved one isn’t in one of those residences that provide “professional rehabilitation”, and another health professional who recommended that I access a support group that helps caregivers with the tremendous grieving process that comes with caring for someone with serious mentally ill. They didn’t realize that there are no residences with professional staff, and while some support groups are good, none of them have a counsellor to help caregivers, and actually some of them are nothing more than lectures with information that you’ve read from a book a dozen times.

SO, POINT NUMBER TWO – we need to promote public awareness that people with illnesses like schizophrenia exist – that they are from every walk of life, they are people just like everybody else, they are not the dangerous individuals you imagine them to be and CONTRARY to popular opinion, they do not have easy access to services. Caregivers also need counseling as well to be able to deal with living with their loved ones on a day to day basis

NOW, THE THIRD POINT, and the most difficult, is the problem of housing. There are far too few residences and the ones that are available are overcrowded. A few are decent, others have low standards, and the people who live there are not in a position to stand up for themselves.

People with very serious mentally ill are most in need of supportive housing, yet they are the least likely to obtain it. They DO NOT GET MEDIA ATTENTION, AND DO NOT HAVE A VOICE. There is no easy solution, but with SOME BRAINSTORMING AND SOME PROPER REDIRECTING OF FUNDS, some pilot projects can begin to appear. Families would be delighted to help in any way they could, and IN FACT, THEY NEED TO BE PART OF THE PROCESS, so that a proper support system could be implemented.

I know so well that parents of adult children with serious mental illness are very concerned about the future of their kids and want to see them living in a place where there is hope, dignity and support.

If the public becomes more aware, and less afraid of mental illness, if there is more communication with families on the part of health professionals, more guidance and support for families and the hope for proper supportive housing, the future can be much more promising.

 

Harambe the Gorilla and Mental Illness

By Marvin Ross

Like many, I was saddened to see Harambe shot. Was he helping the toddler as the initial photo may have suggested or was the toddler in danger as the subsequent video suggested? I have no idea! But I am astounded that there are seven petitions out there for people to express their dismay. One petition is approaching 500,000 signatures as I write this while another is getting close to 200,000 signatures.

That’s a lot of people who want justice for the gorilla.

Sadly, there is far less of an outcry when someone with untreated mental illness gets shot by the police. According to the Washington Post, a quarter of those shot by the police in the US were mentally ill. In Canada, according to a recent documentary on police shootings, 40% of those shot by the police are in a mental health crisis.

Here is one example of Toronto Police shooting a poor man in his hospital gown after he ran out of hospital https://www.youtube.com/watch?v=RbWUnzvAgb4

Shootings of those with untreated mental illness is only one small part of the injustices suffered by those who develop a mental illness in our society. In Canada, 38% of incoming prisoners suffer with a mental illness. Their offences often result from a lack of proper treatment. In Ontario, 40% of prisoners in solitary were locked away for 30 or more straight days. This is twice the limit permitted by the UN in its Nelson Mandela Rules. The main reason for the solitary was mental health or special needs.

Homelessness in Canada is accounted for by mental illness or addiction in between 23 and 67%.

In the US, a recent report found that there are 10 times the number of mentally ill in prison than in hospital. The consequences of not treatment, according to the Treatment Advocacy Center is homelessness, incarceration and violence.

And so few people care about any of this! Instead, we angst over one shot and killed gorilla.

To paraphrase Stalin one dead gorilla is a tragedy, a million maltreated and ignored mentally ill is a statistic.

Isn’t it time we showed some compassion for the mentally ill and gave them appropriate treatment and support?

What if Mental Health Awareness Was Successful – Chaos?

By Marvin Ross

Mental health awareness week/month/whatever is designed, in part, to reduce the stigma towards what is called mental health issues and problems – a politically correct phrase. One commenter on my last post that was skeptical of mental health awareness pointed out that stigma prevents people from seeking treatment. “If more individuals with mental differences (a politically correct phrase if ever I’ve heard one) seek help, they will be less likely to commit crimes, or end up homeless.”

Let’s say that’s true. All those people who were afraid of stigma actually began to seek help. Where would they find it?

They won’t because It is not there!

As I pointed out in my blog on Mental Health Awareness, the Mood Disorder Society of Canada found that 91% of people who were seeking help in Canada wanted to have greater access to professionals. Over one third had to wait for over a year to get a diagnosis.

This past winter, a 17 year old girl was discharged from an Ottawa hospital still suicidal after spending 8 nights in the emergency room waiting for a psychiatric bed. That same month, the emergency room in the Ontario city of Guelph was at a standstill because they had a psychiatric bed shortage. There were over 10 people in a psychiatric crisis with no beds for them. In Vancouver, a man is discharged from hospital early and given a bus ticket. Within an hour, he jumps off a bridge.

Inuk artist, Beatrice Deer has recently complained that “it was difficult to get therapy, because there weren’t any therapists,” as she pleads for a state of emergency to deal with suicides

In the US, the Substance Abuse and Mental Health Administration reported that only 35% of the reasons given for failing to seek help was because of what we could call stigma – negative opinions from others was at 10.6% and negative impact on jobs was 9.5%. The absolute biggest reason was that they simply could not afford to get help at 45.4%. A little over a quarter thought they could deal with the problem on there own.

What if the US had universal health care like other industrialized countries and cost was not an issue? From everything that I’ve read, they do not have sufficient resources. The Treatment Advocacy Center has begun a national campaign to lobby for more psychiatric resources in that country.

In Canada, we do have universal health care. Psychiatric services and hospital stays are free. The problem is that we do not fund psychiatric care to the same extent as we do other illnesses. In my last blog, I cited this from the Centre for Addiction and Mental Health in Toronto:

While mental illness accounts for about 10% of the burden of disease in Ontario, it receives just 7 per cent of health care dollars. Relative to this burden, mental health care in Ontario is underfunded by about $1.5 billion.

The provincial auditor in British Columbia has just released a report pointing out that mentally ill people in that province need more services than they are getting now.

So, let’s forget about stigma and focus on getting proper funding for those who suffer from mental illness. A mental illness is no less worthy than cancer, heart disease or any other illness.

It’s time for parity.

 

A Dose Of Reality Is Needed For Mental Health Week

By Marvin Ross and 1st published in Huffington Post May 11, 2016

In Canada, the first week in May is designated “Mental Health Week,” and according to the Canadian Mental Health Association, the purpose is “to encourage people from all walks of life to learn, talk, reflect and engage with others on all issues relating to mental health”. We are encouraged to #getloud for mental health.

In the US, the entire month of May is devoted to “mental health”.

However, I have to say that I am perplexed about the reason we “celebrate” mental health in both Canada and the US. I assume we are celebrating, but I’m not really sure what we are celebrating or what we are doing.

What is not “celebrated” is our abysmal record on providing treatment and resources to those who suffer from serious mental illnesses like schizophrenia, bipolar disorder, severe depression and other illnesses. And note, I said illness not health. There is a difference. A poster circulating on the internet expresses the problem extremely well. It says:

Saying “Mental Health” for schizophrenia is like saying “Physical Health” for cancer

You can substitute serious mental illness for schizophrenia above.

Justin Trudeau had this to say at the start of the week, “Let us use our voices this week to help change the way society views mental health issues and those living with them. Now is the time to GET LOUD for mental health.”

And of course, he uses the word issue as in mental health issues. Hamilton psychiatrist and fellow blogger on Mind You, Dr. David Laing Dawson, discussed the use of the word issue in one of his blogs and commented that “by calling mental illness an issue we are placating the deniers of mental illness and we are reducing it to an abstraction, a topic for discussion and debate, rather than a reality in our midst….”

And he ended his blog by stating “But let’s stop with the “issue” when we are naming or describing a painful reality.”

The painful reality of mental illness in both the US and Canada is that we do not have enough resources like hospital beds, community treatment, housing, etc to provide the proper treatment that is currently available for these who suffer.

Readers of my blogs on Huffington Post know that many of them deal with the inadequate services that those with the most serious mental illnesses receive in Canada. It is hard to pick out one as so many of them deal with this problem. If we were to have a realistic group of people representing the faces of mental illness in Canada, we would have someone who is in solitary confinement in a prison and someone who is homeless.

One of Correction Services Canada’s top priorities is to deal with the mental health needs of its population. They estimate that 38% of incoming prisoners suffer with a mental illness. In his June 2015 report, the Correctional Investigator of Canada, Harold Sapers, found that “mental health issues are two to three times more common in prison than in the general community”.

In Ontario, the Globe and Mail recently analyzed the long-term solitary confinement of prisoners in Ontario and found that 40% were locked away for more than 30 or more straight days. This is twice the limit permitted by the UN in its Nelson Mandela Rules.

The Globe reported that:

On 40 per cent of the files, staff gave mental health or special needs as part of the justification for their prolonged segregation, a figure that seems to clash with provincial policy stating that segregation should never be used for inmates with mental illness until all other housing alternatives have been considered and documented.

In the US, a recent report disclosed that there are 10 times the number of mentally ill in prison than in state psychiatric hospitals. Most of them, the report states, would have been in psychiatric hospitals before they began to be closed. The largest mental hospital in the US is Cook County Jail in Chicago.

And what about homelessness? According to the Centre For Addiction and Mental Health in Toronto, surveys of various Canadian cities put the percentage of homeless who suffer from mental illness at between 23 and 67 per cent. Furthermore, “While mental illness accounts for about 10% of the burden of disease in Ontario, it receives just 7 per cent of health care dollars. Relative to this burden, mental health care in Ontario is underfunded by about $1.5 billion”.

Again, in the US, about one third of the homeless are people who suffer from untreated mental illness

In a 2015 survey done by the Mood Disorders Society of Canada, the top priority for the respondents (91 per cent) was the need to have greater access to professionals. Over one third (38 per cent) said that the wait for diagnosis was over 12 months. In the most recent tragedy that took place in the middle of Mental Health Awareness Week, a 38 year old man was released from Burnaby, BC General Hospital where he had resided for three days due to suicidal thoughts. His mother had asked hospital staff to release him to her care but they did not do that. They gave him a bus ticket and sent him on his own. He committed suicide shortly after.

Clearly, as a society, we need more than simply being aware of mental health once or twice a year. We need a time when we can reflect collectively on how inadequately we treat those amongst us who have a brain illness. And we need to lobby to right that wrong. The money spent on these awareness campaigns could be put to better use providing more services for those who desperately need them.