Treat mental health problems early, avoid trouble later

Good article in today's Herald by John Gillis.

Mental illness exacts a staggering toll in Canada, but many of its effects on individuals and society could be avoided, says a Halifax expert on adolescent mental health. Caught early, the mental disorders that might otherwise derail young lives can be treated very effectively, said Dr. Stan Kutcher, an IWK Health Centre psychiatrist and Sun Life Financial Chair in Adolescent Mental Health at Dalhousie University. But often, that just doesn’t happen. "There is a huge gap between the need and the capacity to meet that need," he said. "That gap is at every single level." Dr. Kutcher said about 70 per cent of all mental disorders appear before a person reaches age 25. And the figures on the fallout of those illnesses are "gobsmacking," he said. The World Health Organization says about a third of the burden of illness among young people worldwide is due to mental disorders such as depression, bipolar disorder, schizophrenia and panic. The Mental Health Commission of Canada has said mental illness among working-age Canadians drains $51 billion each year from the economy in lost productivity. Yet just a fraction of health spending goes toward mental health. This year in Nova Scotia, it was only about 3.5 per cent of the overall health budget, a smaller portion of which would go to child and youth mental health. "Instead of paying at the back end, why don’t we pay at the front end?" said Dr. Kutcher, who is also a member of the Mental Health Commission of Canada’s child and youth advisory panel. "It’s actually a very simple thing to do." In many cases, mental health problems could be handled by family doctors, but as it stands, they’re often not well-trained or equipped to manage mental illness, he said. And some children experiencing stress or anxiety could even learn coping skills through leaders at community organizations like Boys and Girls clubs or the YMCA, he said. Teachers and other school staff could be trained to identify those with early signs of mental illness and steer them toward care. In the absence of that early system of identification and management, there are few places for young people to get help except through places like the IWK, where services are geared toward the seriously ill, Dr. Kutcher said. "Right now, we’re using very expensive resources to intervene for kids who don’t need that level of intervention and we have kids who need that level of intervention that can’t get it," he said.

“Off Label” Medication Use: What does this mean? (Part I)

Recently, there has been a plethora of media reports about the “off label” use of medicines for the treatment of child and adolescent mental illnesses. Invariably these reports note that such use is inappropriate if not downright dangerous and often counsel parents, patients and others to refrain from using medications prescribed “off label”.

Overall the impression is that such use is not part of usual medical practice and that for some reason it is being preferentially applied with psychotropic medications. The latent argument is that physicians may be acting irresponsibly or recklessly and putting the lives of their patients at risk. But, what actually is “off-label” use? Does it only apply to medications used to treat young people who have mental disorders? Is it an aberration in medical practice? Is it an attempt by physicians to control patients rather than treat them?

The answer is complicated and goes back to understanding the historical development of systems designed to regulate the sale and distribution of medications.

Over time, regulation of prescription medications has moved from providing a degree of certainty that these compounds were relatively safe, to providing a degree of certainty that these compounds were also likely to be effective. And, believe it or not, these developments are relatively recent and continue to be refined by all national regulators (such as: Health Canada - Canada; Food and Drug

Administration – USA).

As part of this process, companies that make products that they wish to be submitted for regulatory approval gear their drug discovery and development programs to meet the standards demanded by regulators. Once a compound has met these standards it receives regulatory approval, which is accompanied by detailed information about the medication issued under the direction of the regulator. This is what is meant by the medicine being “on label”.

Following introduction into the marketplace, the regulator conducts or oversees post-marketing surveillance that is designed to identify possible safety or effectiveness concerns that initial development research was not able to address. Regulators do not dictate how medications may be used by physicians for conditions outside those identified in the regulation approval process, however, companies that make or distribute medications are not allowed to advertise their use in areas outside those already approved by regulators.

What does this mean in real life? Once a medication has received regulatory approval it is said to be “on label” for use in a particular disorder or condition. For example, medication “A” has been approved for the treatment of medical condition “Z”. However, physicians and researchers may discover that medication “A” is also effective and safe in the treatment of conditions “X” and “Y”. However, for many different reasons (such as cost, business development plans, market issues, etc.) the company holding the patent on that medication (or the generic company making that medication) decides not to conduct the studies required for registration of that medication for conditions “X” and “Y”. This means that the medication does not receive regulatory approval for the treatment of conditions “X” and “Y”, even if it has been found by independent researchers and clinicians to be effective and safe in those conditions. Thus the medicine does not receive a “label” for use in conditions “X” and “Y”.

But, the studies on the use of the medicine have been published in medical journals and experts in the treatment of those conditions have decided that in their experience the medication is a useful addition to the treatment options for that condition. Therefore, many physicians begin using that medication in those conditions – even if it has not received a “label” for use in those conditions. They are using the medication “off label”.

~ Dr. Stan Kutcher

Dreaming of Mental Health Parity

Came across this effusive post entitled "I, Too, Have a Dream" by Therese J. Borchard whose blog Beyond Blue is one of the top blogs about Depression. Here's a quick excerpt:

I have a dream that one day I won't hold my breath every time I tell a person that I suffer from bipolar disorder, that I won't feel shameful in confessing my mental illness. I have a dream that people won't feel the need to applaud me for my courage on writing and speaking publicly about my disease, because the diagnosis of depression and bipolar disorder would be understood no differently than that of diabetes, arthritis, or dementia.

What's your dream for child and youth mental health???

Teens Taking Responsibility: Ways for Teens To have Successful Lives

Thought this article about Mark Hansen and his philosophy for teen success was worth sharing:

Harry Potter author J.K. Rowling encapsulated the recent presidential election when she said "Age is foolish and forgetful when it underestimates youth." By many accounts, it was the youth vote that carried the election for Barack Obama, a young candidate facing off against a man in his 70s. An estimated 23 million young Americans under the age of 30 voted in 2008's presidential election, an increase of 3.4 million compared with 2004, according to overall vote count projections by a study released by Tufts University. This update is reflective of the responsible, more active role in the world around them. Responsibility is one of the seven traits that Mark Hansen, author of Success 101 for Teens: 7 Traits for a Winning Life from Paragon, believes is important for teens to take the reins of their future adulthood. Hansen was gratified, but not surprised, by the data. "Everywhere you go you hear many confusing messages as it pertains to our youth," Hansen said. "Our youth are hearing daily about gangs, drugs, crime, violence and see images of each of these in different movies, lyrics in songs they hear, and shows they watch. We hear so much talk about what we want for our youth, but have not provided a road map to get there. However, the role played by youth in the last election was remarkable, in that their activism and participation in the democratic process helped steer the leadership of the most powerful nation on Earth. So, maybe this is the time to fully engage them in a discussion about how to make their futures even brighter." Hansen's conviction is that we need to take advantage of this momentum, and teach our youth the seven traits he feels are important to making the most of their lives. They are:

1. Determination means being committed to what you want to achieve and making sure you are mentally and physically prepared.
2. Responsibility revolves around accepting full responsibility for ourselves. We are each the only example of who we are, we are each in charge of our own behavior and actions.
3. Confidence is about believing in yourself, because if you don't believe in yourself, no one will.
4. Love means understanding the power of that emotion. It has the power to drive us to do both wonderful and dreadful things, and we must be able to manage that power with wisdom and judgment.
5. Persistence maintains that you must stick to what you are looking to achieve and continue forward with making sure what you are doing is supporting what you want to accomplish.
6. Dreams are important, because they are the fuel for our engines. We must keep each of our dreams alive, each of our personal dreams that we have for ourselves.
7. Attitude is about making choices. Each morning when we wake up we have a choice and that attitude we take for ourselves is our choice. A consistent positive attitude is the attitude we need to have in order to accomplish all of our dreams.

"Every day there are discussions in are media about problems with our youth," Hansen said. "Just read the papers each day. My belief is that we must counter that attack and provide a step by step guide for our youth to follow, empowering them for a winning life."

Jerry Greenspan Student Voice of Mental Health Award

Check out this opportunity from the Jed Foundation, which works nationally to reduce the rate of suicide and the prevalence of emotional distress among college and university students.

Jerry Greenspan Student Voice of Mental Health Award The Jerry Greenspan Student Voice of Mental Health Award was established to honor a student who is reducing stigma around mental illness, raising awareness of mental health problems on campus, or encouraging help-seeking among his or her peers. The student selected for this award will receive:

• $2,000 cash scholarship
• Recognition through The Jed Foundation’s website and events
• Trip to New York to attend The Jed Foundation’s annual gala in June 2009
• An opportunity to appear on MTVU**

This award is designed to encourage dialogue about mental health on campuses and reduction of stigma around emotional disorders, and to raise visibility of the amazing people who are tackling these issues at schools across the country. This year, award applicants are asked to submit a video about their work. The winning video and other notable video submissions will be shared across our social networking platforms to further encourage action and dialogue around mental health awareness. REQUIREMENTS We are accepting video submissions that highlight a student’s efforts and activities in raising awareness around mental health. The videos can focus on a range of topics including depression, bipolar disorder, anxiety disorders, self-injury, eating disorders, suicide or other mental health issues. The video should demonstrate how the applicant is:

• Creating and/or leading campus programs or events that decrease stigma or encourage help-seeking,
• Sharing a personal story about dealing with a mental health issue or helping a friend with an emotional problem, or
• Working to improve campus policies, programs and services

Entries will be judged on the merits of the student’s efforts, and on the creative use of the video format. Videos can be submitted electronically or by mail in a DVD format and should be no longer than 5 minutes in length. The judging panel will include a mental health expert, a television/film professional, a campus professional and individuals with a personal connection to mental health or suicide. 

Awards Honor Outstanding Cutting-Edge Health Care Books In 15 Categories

The American Journal of Nursing (AJN) recognized the best nursing and healthcare publications of 2008 with an announcement today of its Book of the Year Award recipients. Winners in 15 separate categories appear in the journal’s January issue. Many of the winning publications address a variety of controversial consumer health topics and nursing industry issues that span medical-surgical nursing, psychiatric-mental health nursing, maternal and child health, and other areas. Two of the top three consumer health books awarded by the AJN were about mental health issues:  Helping Teens Who Cut: Understanding and Ending Self-Injury, by Michael Hollander, which brings to light the serious and potentially devastating issue of self injury which affects the quality of life of teens and their parents. The author suggests interventions for families to use.

What Works for Bipolar Kids: Help and Hope for Parents, by Mani Pavuluri, takes an optimistic, evidence-based "how to" approach to help parents and children manage a bipolar child's behavior, understand medications and therapies and reduce family stress

Why Teens Need Their Sleep

Holidays for teens usually mean one thing ... lots and lots of SLEEP!! But why the heck are teens so tired all the time?

One of the most significant changes linked to brain development that occurs during the teenage years, is related to sleep pattern alterations. Sleep patterns change during adolescence because the brain’s circadian system (biological clock) changes.

This change occurs as a result of a complex dynamic interaction between genetically determined brain development and the impact of the environment on that development. During the teen years the usual childhood pattern of get up early and go to bed early (the so called “lark” pattern) changes to a go to bed late and get up late (the so called “owl”) pattern. This natural change in circadian rhythm is accentuated by the teenager’s environment. Teens are often awash in bright lights late at night, electronic and social stimulation that keep them active into the wee hours, and weekend gatherings that push well into early morning. These factors all converge to set a new go-to-sleep-late and wake-up-late cycle.

Because teenagers stay up much later than younger children do, yet are still forced to wake up early on school days, their total sleep time is shorter (sometimes much shorter) on school days than on weekends, and this disrupts the rhythm of sleep. Teens need about 9 to 9 ½ hours of sleep every night, more than pre-teens need. But because they don’t get anywhere near this amount during the week, many teenagers try to catch up on lost sleep by sleeping in on weekends, which typically annoys their parents. It is important to remember that teenagers do not sleep late on weekends because they are lazy or antisocial, but because they are sleep deprived. They have created a huge sleep debt during the week and are paying it off on the weekend.

During the week many teens are actually sleep deprived. But what does that mean? Sleep deprivation in adolescents can negatively affect the control of behavior, emotion and attention, and is a significant impediment to learning, attainment of social competence and quality of life. Not getting enough sleep can also affect a teenager’s performance in school and other activities that require concentration and focus. Because school schedules are not based on the sleep/wake patterns of teenagers, many students in early morning classes report being less alert, more weary, and having to expend greater effort to pay attention. Reaction times and performance of adolescents are much better in the afternoon than in the morning. With all this sleep deprivation no wonder teens are late for class, sleepy at school, reluctant to be involved in extracurricular activities and cranky. And no wonder many parents find their teenagers to be a royal pain in the mornings!

Decreasing the amount of stimulating activities late at night (TV, phone, internet) is one way to recover lost sleep hours. Unfortunately, many of the social developments that might help correct the problem of adolescent sleep deprivation involve big social policy changes. These include restructuring school curriculums and policy, such as starting school later and ending school later (some school districts have tried this), and creating a broader awareness of the sleep deprivation problem among parents, teachers and physicians.

~ Dr. Stan Kutcher