Tag Archives: Huffington Post

What Families of Serious Mental Illness Need (and often don’t get)

By Marvin Ross

joanna cheung at panel event.
Joanna Cheung, art therapist giving presentation while Drs Lori Trianno and David Dawson look on.

I decided to write this after the feedback from an event in Richmond Hill, Ontario put on by Home on the Hill, an organization which serves families and loved ones affected by serious mental illness. On May 10, this agency north of Toronto held a luncheon in honour of Mental Health Week. In the words of the president, Kathy Mochnacki, “This event featured a panel consisting of a psychologist, psychiatrist and a social worker/art therapist and the goal was to give families information about schizophrenia and psychotic illness. Our panel was stellar with psychologist, Dr. Lori Triano (president of the Schizophrenia Society of Canada), psychiatrist, Dr. David Dawson and Certified Art Therapist/Social Worker, Joanna Cheung from Markham Stouffville Hospital’s mental health system. Our local MP Majid Jowhari (member of Parliament in Ottawa) was there as were Richmond Hill Councillors, Karen Cilevitz, Godwin Chan, and Tom Muench from our municipal council, the York Regional Police,” and various mental health agencies.

Both David and I have spoken to this organization on a number of occasions and David commented to me after that the families just could not get enough information.

Talking to Kathy after, I was surprised to discover that most if not all the families received nothing like the support my family has received over the years. I thought I would share what I think would be an ideal situation for a family learning that their loved one has schizophrenia, bipolar or some serious mental illness.

When the person is diagnosed and that is usually in a hospital setting, the family should be told in a meeting with the staff who have cared for and diagnosed the person. You should be given information about the condition, an idea of treatments, prognosis, and what to expect down the road. You should also be provided with resources like books, pamphlets, courses and whatever might be of value. We got most of this.

Discharge should involve housing if that is needed and referrals for follow up care to doctors and agencies that will continue with the care and the road back to what may be a new normal. Of course families should be involved with the follow up care. In my family’s case, appointments not only initially involved the psychiatrist but a nurse educator and referral to an excellent program called Family Education and Training.

I am not sure if that still runs but there are considerable resources for families at my local hospital. This is a link to those In addition to a library, there are programs such as family peer support.

Families should always be involved on any ongoing care and treatment unless there are unique circumstances that prevent that. We have almost always been involved and able to talk to doctors or others. There was one time during a crisis where this did not happen and the result almost led to a very disastrous outcome. Fortunately, this was overcome much to everyone’s surprise and relief.

The doctor and the staff whose stupidity caused that problem were all reprimanded by the hospital and I was told that the incident was recorded on their personnel file.

The young psychiatrist who was left to pick up the pieces and put them back as well (along with a young social worker) said that there are better outcomes when families are involved. He also added that he has many patients with no family involvement and that makes recovery far more difficult.

What I have described here are things that those with problems like cancer, diabetes, MS, and on and on mostly already receive now. There is no reason that psychiatric illnesses do not get those too. I can only suggest that all of you make those demands of your health care providers and be as insistent as you have to be. Don’t be afraid to threaten legal action or of notifying the press.  Never worry about what they may think of you but just do all you can to make them do the right thing. What do you care if they may not like you and not want to go have a coffee with you.

While I may be painting my own local hospital in a favourable light, it gets there partly because they get pressure from the community. A few years ago, one of the doctors leaked that there were plans to move a satellite unit servicing an area with limited resources to the main hospital. I wrote about it and others complained and the unit is still there today.

In April this year, three psychiatrists quit the local psychiatric ER and the medical school pulled their residents out. Four days later, the hospital announced major changes. The safety problems were pointed out to the hospital a few years ago but suddenly, they had a solution.

As the result of the overcrowding at the ER, Arthur Gallant was made to sit in the general waiting area, hands cuffed behind his back with a police officer on either side of him, He is suing the hospital for $25,000. I’ve corresponded with Mr Gallant over the years as he used to write a regular blog on mental illness for Huffington Post. Arthur was 1 of 5 Canadians named as a Face of Mental Illness by the Canadian Alliance on Mental Illness and Mental Health which is an initiative of Bell Let’s Talk. Arthur has been featured several times on TVO’s The Agenda with Steve Paikin and in The Toronto Star, CBC’s The National , CTV News Channel, The Globe and Mail, CHCH’s Square Off, and an educational video for the Canadian Mental Health Association (Ontario Chapter).

And I should mention that he was a member of an Ontario Government advisory panel on mental health.

If you want improvements, fight for them!

An Addendum by Kathy Mochnacki MSW RSW of Home on the Hill

I did attempt recently to have coffee with the President of the Board of an organization which appears to be positioning itself as being an example of “evidenced based community treatment” for mental illnesses.  I had hoped to make him aware of the 50%  of people with schizophrenia and the 40% of people with bipolar who have the symptom of “anosognosia” and therefore lack insight and cannot access the voluntary services of his agency.  There needs to be the political will to find innovative ways to help these individuals.

Perhaps there would be fewer  homeless mentally ill people if his agency was a little more flexible.  I was not upset that he did not have coffee with me, but very concerned. as a family caregiver and a taxpayer, that he and his Board are responsible for allocating millions of our tax dollars to his agency’s programs yet he does not appear to be interested in learning about the symptoms of these horrendous illnesses.

I later met with my MP, Majid Jowhari, who has arranged for  Home on the Hill to have input into his mental health platform for the upcoming federal election. We will be asking that there be more awareness of the symptoms of mental illness among mental health service providers and more effective mechanisms of accountability.

This short video (17 minutes) is of the Q and A with answers on how drugs work, dealing with lack of insight and cognitive remediation ( “Video by Billy Dennis”)

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.

Family Day, Serious Mental Illness and Murder

By Marvin Ross

I’m posting this on Family Day in Ontario. This is a new statutory holiday promised by former Premier Dalton McGuinty during the election campaign of 2007. It was, of course, part of his platform so that he could win re-election by giving people an extra day off between New Year and Easter and sold as an opportunity for people to celebrate family.

Unfortunately, families with serious mental illness in them lost out when the recommendations of an all party Select Committee on Mental Illness and Addictions Report of 2010 was largely ignored by that government. There is little for many of these families in Ontario to celebrate as you will see from my Huffinton Post blog that follows. It was published on February 9 and I will update it at the end.

Was Ontario Complicit in a Father’s Murder?

Last Spring, I mentioned the problems that a Richmond Hill, Ontario family was having with acquiring adequate service for their son with schizophrenia in one of my Huffington Post blogs. That was one of the many blogs I write on the pathetic state of care that we have for the treatment of those with serious mental illness.

Sadly, the father in this case, Bob Veltheer, was murdered on Sunday evening February 7 and, the next day, his son Jacob was arrested. Bob and his wife talked to me before I wrote the blog wanting to reveal just how badly people with serious mental illness are treated by the health system but decided to remain silent other than what I reported then.

Before I outline what I know of the care their son received, I should mention that Bob was the founding member and president of Home on the Hill, an agency set up to try to get housing for the mentally ill when their families could no longer keep them at home. I had been invited to speak at their monthly meetings a few times as had my blogging partner in another blog we share, Dr David Laing Dawson.

Last year, Jacob, who suffers from schizophrenia, was found sitting on a bus at the end of the line in Newmarket, Ontario presumably having failed to get off when it passed through Richmond Hill. He was suicidal, so the police were called and he was taken to South Lake Hospital. After a week and still suicidal, according to the family, he was discharged against the wishes of his family and that is what I reported.

Upon discharge, he ran off, as do many people with schizophrenia, and the York Regional Police went looking for him. He was found after three days and returned home only to disappear again. This time, when he was found, he was admitted to MacKenzie Health in Richmond Hill. After a brief stay, he was discharged with a community treatment order to a residence. A community treatment order is a legally binding order that the individual must accept regular medical help and medication. If they fail to abide by this, they can be returned to hospital by police.

Jacob, it seems, was too sick for the residence to cope with (but not sick enough to be in hospital) and was evicted from the residence. What should the parents do but what all parents do and that was to take him home. Just recently, the team that supervised his orders (the South Lake Assertive Community Treatment team), wanted him discharged to the care of the family doctor. His mother had just made contact with a local Richmond Hill psychiatrist and was waiting to hear back to see whether that doctor would see him.

Friday night, Bob had a meeting with a member of Home on the Hill executive at his house and I was told that Jacob was so distraught that he was pacing about the house talking to himself (or his voices or demons) in a loud voice. That Sunday night, the police allege that Jacob murdered his father.

This horrific tragedy could probably have been prevented had Jacob been kept in hospital long enough to stabilize him properly and, if that was not possible, to give him a secure place where he could live. The number of psychiatric beds in Ontario has been declining considerably over the past few decades but the total extent is not available since statistics on that can’t be found. And I’ve tried. The most recent Ontario report released in December of 2015 called Taking Stock found that access to services varies across the province and is inconsistent.

Late last year, the brand new psychiatric hospital in Hamilton closed a ward because of budgetary problems although that hospital has 6 vice presidents, 31 directors, a medical director earning $500K a year and a CEO making $750K a year. And, as I wrote a year ago, Ontario has had 17 reports on the sad state of mental health care between 1983 and 2011 but little has been done.

This is not the first preventable death, nor will it be the last unless we finally start to care. In my book on schizophrenia, I describe a case where a family in Mississauga, Ontario desperately tried to get help for their son. They could not and he ended up killing both his parents. I met the son a couple of years ago and found him to be a very pleasant and sane individual. But that was after years in a forensic psychiatric hospital where he has been getting treatment. Imagine if his family were able to get that when they first tried.

I am not Emil Zola nor was Bob Veltheer, but I accuse the complacency of the Ontario government for his death. Government bureaucrats have been informed repeatedly both verbally and in writing about the need for accountability, program evaluation, transparency regarding mis-spending, mis-use of privacy legislation and the historical resistance to partner and collaborate with families. The Central Local Health Integration Network where Bob resided, I’m told, had recently been notified about the profound need for hospital beds by Home on the Hill.

Home on the HIll has been attempting to meet with the new Health Minister, Jane Philpott, whose constituency is near Richmond Hill but have not heard back yet.

I would like to see either a Coroner’s Inquest or a Royal Commission into the circumstances that led up to this horrific event. And I would like to see Ontario finally do something other than commission studies which they then ignore.

Update

This blog received a great deal of attention as it was distributed widely and to a number of politicians where the Veltheer family live. I attended the funeral on February 13 along with politicians from the all three levels of government. The local town councillor who is a supporter of the work of Home on the Hill plans to bring this to the attention of the Ontario Minister of Health as is the local representative in the Ontario legislature. The representative who sits in the Canadian House of Commons is planning to raise this event in the House of Commons and a meeting has been arranged with the Federal Minister of Health.

We all hope that Bob’s death and the pain that his family is going through will result in some positive changes. Ontario which has direct responsibility for providing health care needs to get off its duff, stop generating reports which they ignore, and start providing the services that have been recommended so many times by so many reports.

The Federal government needs to take the money they are wasting on a Mental Health Commission that has no direct authority and does nothing but generate its own reports and put it to providing funding programs in the provinces. And just maybe, Prime Minister Justin Trudeau whose mother, Margaret suffers with bipolar disorder, will understand and do something.

Doing something would be a welcome change and would honour the memory of Bob and all the others who have been sacrificed by our lack of resources.

Am I A Reductionist? Part I

By Marvin Ross

I must confess that I’m not really sure what that means other than that it has been an accusation leveled at  me. One of my advocacy colleagues told me recently of a conversation she had with a member of the mental health bureaucracy and my name came up. The bureaucrat said he read me and that I was a controversial writer (I try) but that I was a reductionist. I wasn’t sure if that was a complement or an insult.

Then, just recently, someone who did not like Susan Inman’s latest Huffington Post blog critical of the Hearing Voices Movement, accused her of also being a reductionist. I guess it is an insult. Ms Inman is the author of After Her Brain Broke: Helping My Daughter Recover Her Sanity which my company publishes. 

What does our being accused of being reductionists mean? Richard Dawkins, in The Blind Watchmaker (1996) said Reductionism is one of those things, like sin, that is only mentioned by people who are against it.” This was quoted in Reductionistic and Holistic Science by Ferric C Fang, the editor in chief of the journal Infection and Immunity.

The abstract for this paper states:

A reductionistic approach to science, epitomized by molecular biology, is often contrasted with the holistic approach of systems biology. However, molecular biology and systems biology are actually interdependent and complementary ways in which to study and make sense of complex phenomena.”

And then the paper goes on to say:

Few scientists will voluntarily characterize their work as reductionistic. Yet, reductionism is at the philosophical heart of the molecular biology revolution. Holistic science, the opposite of reductionistic science, has also acquired a bad name, perhaps due to an unfortunate association of the word “holistic” with new age pseudoscience.”

The author substitutes system biology for holistic biology because it lacks the pejorative nature of holistic. And I don’t want to try to give a precis of this paper but simply to say that molecular biology is an example of the triumph of reductionism. But holism goes back to Aristotle and the two are not mutually exclusive. Again, the author states that:

Each approach has its limitations. Reductionism may prevent scientists from recognizing important relationships……..Holism, on the other hand, is inherently more challenging due to the complexity of living organisms in their environment.” And, “When fecklessly performed, systems biology may merely describe phenomena without providing explanation or mechanistic insight or create virtual models that lack biological relevance”.

Furthermore, “It is difficult to imagine how a number of important scientific discoveries could have been made by any method other than a reductionistic approach.” However, the author points out that the “reductionistic and holistic methodological approaches have been coexisting and thriving for centuries. One can argue that Darwin’s theory of evolution represents an early example in which many reductionist observations on finches and domesticated pigeons were synthesized into a system that unified all of biology……….Nevertheless, there is no denying the revolutionary impact of holistic thinking on the field, both in calling attention to situations in which reductionistic approaches have been deficient and in the generation of new experimental approaches for the analysis of complex systems .”

There are many other sources on the reductionist/holistic dichotomy and you can peruse them if you wish. It is only through reductionistic scientific enquiry that we may find a specific and necessary cause  of a problem  though many other factors contribute. But, it is also wise to have a holistic perspective.

There is no either/or in our search for answers and explanations and to abide by one methodology while ignoring others, is stupid and narrow minded. So, thinking, as some seem to do, that they can dismiss my views or those of Ms Inman as reductionist serves absolutely no purpose whatsoever. It says far more of them than it does of us.

Anyone who is honestly seeking truth needs to be open to reasoned arguments and to the unbiased evaluation of fact.

Next On Models, Concepts, Power, and Politics – Part II by Dr David Laing Dawson

Mental Illness Literacy

By Marvin Ross

In a recent Huffington Post blog, Susan Inman (After Her Brain Broke: Helping My Daughter Recover Her Sanity), wrote about the need for greater literacy about mental illness. And, like me, Susan often gets inundated with comments from opponents. One was from John Read, a psychologist at the University of Melbourne.

Susan was arguing that we need greater understanding of the biological causes of serious mental illness and I agree. Read, however, commented that:

“The evidence is over 50 studies all showing that biological beliefs increase fear and stigma. I’m afraid you are swallowing drug company propaganda, there is no evidence that these drugs prevent violence.”

When challenged to provide sources, he countered with:

“If anyone is interested in what the reserch (sic) says on this issue……

READ, J. (2007). Why promulgating biological ideology increases prejudice against people labeled ‘schizophrenic’. Australian Psychologist, 42, 118-128.

READ, J., HASLAM, N., SAYCE, L., DAVIES, E. (2006).Prejudice and schizophrenia: A review of the ‘Mental illness is an Illness like any other’ approach. Acta Psychiatrica Scandinavica,114, 303-318.”

In an article  that I wrote for the World Fellowship for Schizophrenia and Allied Disorders in 2010, I mentioned the Read approach. Basically that approach states that we should ignore the illness in favour of viewing mental health problems as part of our shared humanity. One of the research papers by Read that I commented on was a 2002 paper which compared the biological explanation of mental illness to a psychosocial explanation. And while Read points out that the psychosocial explanation helped reduce stigma more that the biological, he admits there was no statistical difference between the two.

This is the link to his first article that he cited in his comments to Ms Inman. You can decide but note the lack of objectivity in his title. Biological explanations are cited as ideology that are promulgated and schizophrenia is in quotes. The second paper he cited deals mostly with surveys  asking people what they considered to be the causes of mental illness. Many of them believed that the causes were psychosocial which just proves that Susan Inman is correct in wanting to see greater literacy.

But again, to prove his point, he says that a study that showed a video of a person describing their psychotic experiences increased perceptions of dangerousness and unpredictability in viewers. However, a video explaining the same experiences in terms of adverse life events, led to a slight but non significant improvement in attitudes by those who viewed it.

Again with the non significance. It means there was no difference between the two. The responses were the exact same! Someone who acts scary and displays very abnormal and aberrant behaviour is going to be shunned regardless of the explanation for that behaviour. He does cite a number of papers but they date from 1955 to the latest in 2005.

In my 2010 article, I quoted Dr Heather Stuart, an expert in stigma at Queens University in Kingston, Ontario who said that there have only been six controlled studies of stigma. One of them by Patrick Corrigan found that education did lead to improved attitudes. I could not find a reference to that paper in the one by Read.

As an example, those with advanced symptoms of Hansen’s Disease looked very frightening and were isolated from society. The Leper Colonies existed because no one understood the disease and were afraid they might get it too. But then, modern medicine came along, discovered Leprosy was caused by a bacteria, learned to treat it early and we no longer have people disfigured when treated early. We might still cringe at the thought of leprosy but likely no one has ever seen an advanced case.

In a similar vein, the solution for schizophrenia stigma is not to pretend it isn’t what it is but to provide treatment. As Queen’s University psychiatrist Julio Arboleda-Flores said in his 2003 editorial in the Canadian Journal of Psychiatry, “the best approach is to limit the possibilities for people to become violent via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence;” he writes that “this could be the single most important way to combat stigma.”

And one way to ensure that is to have greater mental illness literacy as Susan suggested.

Now I also have to comment on a post to Susan’s blog by someone who is continually criticizing both Susan and I for our writing on the medical model for schizophrenia. Suzanne Beachy did post a number of comments which you can see for yourself but my favourite is her announcement that another critic of the medical model, Rossa Forbes, has just announced that her son is cured of his schizophrenia.

It seems that his cure was delayed by their being “sidetracked by institutional psychiatry perpetrating the false belief that there was something gone horribly wrong with his brain and only they knew the magic formula to set things right again.” If you go to Ms Forbes blog, you will see her extolling how well her son now is which is wonderful. In fact, she says, he is so well that he has reduced his Abilify to half its dose and is planning to go completely off slowly over time. Abilify, of course, is an anti-psychotic used to treat schizophrenia and is prescribed by psychiatrists.

I am dumbstruck as I am with all the critics of modern science.