Modern Technology and the Brain – is it Chicken Little all over again?

I don’t know how may young people today are familiar with the story of Chicken Little, but for sure they will google it and then they will know.  Briefly it is the story of a chicken who thought the sky was falling and lost her/his head (metaphorically) about it.  It has given rise to the Chicken Little Awards and I would like to nominate Matt Richtel, writing in the New York Times for contributing to the hysteria around the impact of digital technology and the brains of young people.

Brought to you in the manner of most pseudoscientific writing, the story of Vishal is meant to be a modern take on a medieval morality play railing against the horrors of new digital technology that is supposed to create attention-deficit morally decrepit youth of today by destroying the brain’s ability to sustain attention and to make moral-emotive linkages.  Like the Luddites of the past, the story harkens back to some mythical imaginary Arcadia of the distant and never-existing past in which harmony between brain and nature thrived in pastoral villages supplied by streams flowing with milk and honey. Yesh!

So what is the real scientific story here?

Does the environment affect how the brains of young people grow and develop?  Totally.  Has it always been like that?  As far as we know.  Why?  Maybe because that is how we as a species adapt to our environments, including those we create ourselves and then need to adapt to.  This allows us to change with the times and contributes to our evolutionary success.

Will modern technology change our brains?  Yes it will, just like the discovery of fire, the discovery of the wheel, the creation of the printing press, and the invention of glasses (to name but a few of the trillions of historical impacts on brain function) have done.  And what is the moral message here?  There is none.

We are what we are because of where we have been and what we are doing.  What we will become is not known and how we will get there is unclear.  Can we make ourselves develop in a certain and pre-ordained way?

That has been tried for centuries by political and religious dictators alike without success.  So what do we do?  Let’s start by not writing such Chicken Little drivel and focus on better understanding how our brains work and how we can accomplish things that ensure we leave the world a better place for future generations.  Not in the manner of the Luddites nor with the fear mongering of the protagonist in the famous novel written by Mary Shelley (look it up!). But in honoring each other, respecting each other, celebrating who we are and understanding that we will change.  

--Stan

When is behavior an illness?

This sounds like a simple question, yet it is a fundamentally important one. It is a question that I for one have tried to answer to some degree of rational certainty over the many years of my work in the mental health field. It is a question that a recent news article I happened to read once again raised in my mind.

Briefly, the article: “Cheaters do prosper, but are they psychologically ill?” from the Globe and Mail: http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/cheaters-do-prosper---but-are-they-psychologically-ill/article4258538/. The study reported there found that university students who admitted to cheating scored high on personality traits of psychopathy. This suggests that psychopathy which in its most extreme forms can translate to Psychopath may be associated with self-reported cheating. The one obvious question that I would ask is why do we think that cheaters are honest about reporting if they cheat or not – but that is a question for the researchers.

Cheating clearly has adaptive value and in evolutionary terms probably has an evolutionary advantage. It happens in every society that I know of and I would not be surprised if it is common behavior in animals, particularly primates. So what does this say about how we think about “normal” behavior and “illness”?

Obviously this is very complex and one blog can not address this issue. But we can start. So here is one thought to help us think more. Most if not all behaviors that we exhibit, occur on a continuum or spectrum. The point at which a particular behavior “crosses” from “normal” to pathological depends on many things. Think of it as “carving nature at the joints”. How we decide where to carve is very complicated and lots of different perspectives come into play, including; statistics; probability theory; social and cultural frameworks; emotion; history; personal bias; etc.  One of the cutting points commonly considered, is: does it create harm to self or others, does it lead to impairment in functioning? Does stopping or diminishing the behavior lead to better outcomes for all concerned?

What do you think about this as a “cutting point”. What other “cutting points” do you think are useful?

Back to School

Recent newspaper articles and electronic media stories have drawn attention to the relationship between going to university or college and mental health problems and mental disorders. In both the USA and Canada this has been headline news.

It is really difficult to tell if the rates of mental health problems are going up or not but it is true that between the early 1990’s and early 2000’s, suicide rates have fallen. This has been closely associated with better identification and treatment of young people with mental disorders.

Certainly there is a clear need for universities, colleges and other institutions of higher learning to actively promote mental health literacy and provide contextualized information known to enhance knowledge and help seeking behavior for their students. Across Canada, over 30 institutions of higher learning have done so – using the “Transitions” program developed by our group. 

What is confusing to me is why so many have chosen not to do so, or have tried to reinvent the wheel by developing one-offs of undemonstrated value but with local small “p” political appeal. In my opinion this once again illustrates why it would be a good idea to have a single point national clearing house for mental health programs. But not just any kind of clearing house – one that only includes programs for which there is substantive evidence of effectiveness and cost effectiveness. Both are needed. And, this is not a “best practice” list of programs. I for one would like to see the whole idea of “best practice” scrapped and replaced by the framework of “best evidence”. I have seen to many “best practices” unable to demonstrate substantive value while at the same time costing us dearly in both implementation and opportunity lost.

This could surely be a role of the Public Health Agency of Canada. But it will take a bit of reforming to ensure it is responsibly carried out.

--Stan

Human rights, gender issues and suicide

The tragic story of Tyler Clementi’s suicide is well known to many by now . It was an event, not improved by the media circus that has erupted after it. And it raises a number of fundamental issues. Here are three that come to mind, I am sure that there are more.

First: human rights. The secret video and its subsequent broadcast of Mr. Clementi’s intimate activities violated his human rights – period. That is clear, regardless of whom his intimate partner (or partners) was. The electronic age has made it easier to both address and infringe on human rights. The digital world is a global world. We as a global society will have to deal with this, and quickly. 

Second: gender issues. My family, my community, my country and my world are places in which diversity is celebrated, where gender inequalities are not tolerated and where gender differences are embraced. It seems that we still have a lot of work to do on these issues. We cannot stop until they have been long relegated to the dustbin of history.

Third: suicide. Mr. Clementi’s suicide was certainly a tragic event. Yet we do not know all the details of his story and it is too easy to jump to certainty about what emotional turmoil and what other factors lead him to choose the tack that he did. We do not need to argue that we must respect and support human rights and gender differences by raising the specter of suicide. We need to address suicide on its own terms, in all its complexities and in all its layers. We need to do the right thing not just something.

 I for one, look forward to a time when I do not ever read a media story such as the one about Mr. Clementi. Not because the media has not made a circus about it, but because there are no more similar stories to tell. But in order to do that, we must work hard to make sure our friends and our neighbors are on a similar page. And who is my neighbor? Everyone is my neighbor, and everyone is your neighbor.

--Stan

The Healing Touch

The idea of the healing touch has a very long history. The New Testament recounts stories of miracles of healing resulting from touch. Pop psychology trumpets the necessity for “group hugs”. Mother infant bonding is enhanced by skin to skin “touch”. Different cultures have different approaches to “touch”, some celebrate it and some fear it. Metaphorically we are told to “reach out and touch somebody” and about a decade ago, a pseudo-science initiative called “therapeutic touch” caused all sorts of enthusiasm until controlled research studies showed that not touching someone was not the same as actually touching someone. And who has not felt the complex meaning of touch from a loved one? Few types of human interaction have been so well understood or so much misunderstood as “touch”.

As a recent news article has noted:http://www.npr.org/templates/story/story.php?storyId=128795325&ps=cprs, human touch is an essential component of the human condition. This is because we touch with our brains. Every touch is a perception that has meaning – and that meaning is created and applied in our brain. We no more touch with our fingers or skin than we see with our eyes or hear with our ears. And the meaning of touch results in the activation of specific brain areas, areas that can lead to a host of positive or negative emotions and cognitions. Basically put, touch is a key component of human connection. And, as I have often said: human connection is the key to improving the human condition.

As human beings we live in complex family and community settings. How we navigate those settings depends on many things. Hope and connection are fundamental to health. Touch is fundamental to healing. So why are we so afraid to give someone a hug?

So what is the allure of the drugs and alcohol and creativity connection?

So, there is recent report of research that shows that creativity in the arts and literature is not improved by drugs or alcohol. On the contrary, drugs and alcohol use have a negative impact on the quality and quantity of what writers and artists and musicians produce when under the influence: http://www.independent.co.uk/news/science/drunk-writers-were-better-sober-says-psychiatrist-2010053.html. 

Shucks. Ever since I was a teenager (and that was some time ago), I was always intrigued by the hard-living experiences of famous writers and musicians. It was hard to believe that all those amazing adventures and the impact of drugs and alcohol somehow did not make them better artists or give them deeper insights into the human condition. I can still remember reading (many years ago now) a study that compared musician’s playing on and off drugs and demonstrating that off drugs was so much better in quality.

So what is the allure of the drugs and alcohol and creativity connection? Hard to say. Some very talented artists live with significant mental health problems including mental disorders. There may be a fine line between creativity and bipolar disorder for example. Substance abuse can be part of this mix. 

However, I think that this myth of the substance fueled writer or painter or musician producing wonderful work when stoned or drunk is the result of simple logical mis-reasoning. Its confusing co-relation with causality! Because a writer uses drugs does not mean that the drugs make him or her a good writer. Actually, as we know, it’s the opposite.

Now, we need to stop thinking its “cool” and start learning to think in a way that does not depend on our subjective biases and does not support creating “causal” linkages where they are not present. If there are one million possible reasons for a person writing a good story and we focus on just one – drugs, we are likely completely wrong; on the basis of statistics alone.

So, there we go. Stop the drugs and write the great Canadian novel!

Suicide Prevention Programs, Do They Work?

A few weeks ago, the Ottawa Citizen Newspaper carried another sad story about youth suicide. This is a story that is still unfortunately all too common. It is a story that we would all like to never see again. We all would like to be able to prevent youth suicide.

Unfortunately we are not very good at that yet. Hopefully we are getting better at it. A recent guest editorial by Dr. Alan Apter in the Canadian Journal of Psychiatry ( Suicidal Behavior in Adolescence: 55: 271-273; 2010) pointed out that despite the plethora of so called suicide prevention programs we really have very little good evidence that any of them work. Or even that they may do no harm.

And these programs are very popular. Not only are they offered to individuals and organizations that think they are learning how to prevent suicide, but I understand that some health organizations and governments have mandated their application. And they are not inexpensive. I recently looked on the website of one of these so called “suicide prevention” programs and it was being offered for one hundred and sixty dollars per person! 

Recently our research group conducted an exhaustive and intensive assessment of the evidence that one of the most commonly used community suicide prevention programs actually prevents suicide. And, in contrast to the advertising, we were not able to find any substantive evidence that this was the case! We are in the process of writing up this research and will publish our findings in the next little while.

So what are we to do? Well, we should at least do what there some evidence of effectiveness for. We need to educate teachers and health care providers to better identify, refer and provide effective treatments for young people who develop a mental disorder. Will doing this prevent all youth suicides? Unfortunately not, but it would be a good start. And we need to do some good solid scientifically sound research to see if programs that say they prevent suicide actually do prevent suicide, before we spend a ton of public money on them.

--Stan

You Can Make a Difference

What comes to mind when you see the word health? For many, it might just mean one’s physical condition. While physical health is part of it, health is not only of the body, but also of the mind. A number of people of people are uninformed, or pay no attention to this equally important side of health. Physical health and mental health go hand-in-hand and it is extremely important to raise awareness for people to take care of their body and their mind.

Statistics and fast facts are often used as eye openers about health and different diseases. How much do you know about mental health? You can check numerous reputable websites with statistics on just how much we are all affected by mental health. Quick fact from the Canadian Mental Health Association website: 20% of Canadians will personally experience a mental illness in their lifetime. That’s more than 6 million Canadians – and mental illness is not just some cold that will bother you for just a few days. For some, it could last years and years of their life. People who are unaware and have an undiagnosed mental illness could go on for years without treatment and have their lives adversely affected.

I’d like to talk to you about To Write Love On Her Arms, an organization started by Jamie Tworkowski. Don’t recognize the name? He’s not exactly a celebrity. Jamie is an ordinary guy who turned a passion into something big. Another example is that of the group of 12-year-olds who started what is now known as Free The Children. Ordinary people do extraordinary things everyday. You don’t have to be famous to make a difference, and you don’t have to look far to see ordinary people doing remarkable things. Even in your own community, you can find people who are making a difference.

So what can YOU do? There is still much research to be done to improve the mental health system in our country – and your ideas are important. There aren’t always easy answers to problems, but combining our personal experiences and knowledge can help improve mental health for everyone.

There are endless ways for everyone to help. If we want to change something, we have to start with ourselves. You can take the time to learn more about the issues and share your thoughts. You can help and support projects or events that would also help raise awareness and stigma.

Stigma is a major issue experienced by those suffering from mental illness. People are stigmatized because of the lack of knowledge on mental health. In 2008, the national report card from the Canadian Medical Association stated that 46% of Canadians, almost half, believe that people use mental illness to excuse bad behaviour. It also states that one in four Canadians are afraid to be around people suffering from mental illness. What does this mean for people legitimately suffering from a mental illness?

It may be difficult to change the minds of adults but we must still try. It starts with education. As with abolishing problems such as racism and other kinds of prejudice, educating people at an early age about mental health is one of the most effective ways to reduce stigma.

Youth are also profoundly affected by mental health. It is a time when we’re fragile and undergoing changes and maturity. In a survey for youth with a diagnosed mental disorder, nearly 70% had their onset of symptoms at early ages.

These points all bring me to the most important question: Why should we care? We need to be concerned about the well-being of those affected by mental illness. We mustn’t stray away from this issue and start thinking of these figures and statistics as just numbers. We need to put a face to this problem and think of the people we care about. It could be your parent, sibling or perhaps a friend, who is suffering from mental illness. So, what will you do?

--Karl Yu

Check This Out

Her name is Laura Burke, and if you do not know her or what she does already, you will by the time you finish reading this blog. But before you go any further, check out this link: http://www.youtube.com/watch?v=23a18HKYLW4. Ok, so here we go.

Recently it was my privilege to present Laura with the first ever youth award in the Champions of Mental Health Awards history. And she is a worthy recipient. She has worked hard to get well and to stay well. She takes her challenges head on and addresses them. She does not look for pity or solace she looks for recognition of her strengths. In short, she fell down, she got up, she dusted herself off and she began all over again. Kudos!

I am not sure if this is what the legion of resilience researchers are talking about or not. It seems that not a day goes by that I do not read about a new program or a new direction that will transform the lives of young people by enhancing their resilience. Usually this is achieved (or more properly said to have been achieved without the solid evidence we need to critically determine the outcomes) by some kind of learning of how to be resilient, taught no doubt by a well meaning and well paid human services provider.

And what about people like Laura. How did she become so resilient? Maybe she had it in her all along. Maybe everyone does. Maybe we need to work at ensuring environments support the development of that. Maybe we need allow young people to fall down gently, so that they can learn to stand up, dust themselves off and start all over again.

--Stan

The police and mental health

Just was reading an interesting article on police and mental health.  Not the mental health of police, although that would be a very important issue to know more about.  Can you imagine the stresses of that occupation?  But about how police respond to individuals who are exhibiting mental health problems, or individuals with mental disorders who are in distress or acting in such as way as to be causing distress to others.  So here is the piece: http://www.theguardian.com/commentisfree/cifamerica/2010/jul/14/police-mental-health-training. As you can see the title is: US Police need proper training in mental health.  And the sub-title is: “People suffering mental health crises are too often subjected to brutality by poorly trained and frightened police officers”  According to the writer (in a UK paper by the way): “Every day in various American communities, people enter mental health crises and their friends and family members pick up the phone to call for help. Often, the first responders on the scene are police officers, and the resulting interaction does not go well. Poorly trained and frightened police officers may resort to excessive force, and sometimes this ends in death for a person who is guilty only of being in urgent need of psychiatric care.”

Although the piece is long on hyperbole and heart wrenching descriptions of police attacking individuals suffering from mental disorders, and short on any substantive data and overall balanced reporting regarding what police forces are actually doing, the writer does bring attention to an important issue. Certainly police officers should have more training in dealing with the unique needs of peole who have mental illnesses and who are behaving in a way that may put them or others at risk of harm. Certainly we need more and better community based mental health care services. These needs are real and we have to get working on doing more. 

But it is also important to recognize that much has been done in the last decade or so.  Here in Halifax, there is a mobile crisis service that I am proud to have been part of its launch.  It pairs police officers with mental health professionals.  It goes to where people need them and it works – not perfectly mind you, but it works.  One of my colleagues, Dr. Bianca Horner and members of the Department of Psychiatry and the Mental Health Program have developed a national training program for the RCMP, called “Recognition of Emotionally Disturbed Persons” regarding this matter.  Other police forces in Canada are now beginning to address this issue.  I have had the opportunity to be part of the Minister’s task force on TASER in Nova Scotia and the privilege to chair the sub-task force on excited delirium.  As a result of these reports there have been substantive movements towards improving all aspects of first responder approaches to individuals with mental disorders.

While these are a good beginning we certainly have to do more.  It is not appropriate nor is it fair nor is it right that our prisons have become holding bins for people who require mental health care.  The federal government has decided to build more prisons.  I for one would like to see them invest more in mental health care instead.  Don’t you think it’s preferable to treat someone who has a mental disorder in such as way as to assist and support their recovery instead of throwing them in jail?  I do.

--Stan

Who Makes the Decisions?

Recently there was a report of an extraordinary example of political interference in mental health treatment. A political interference based not on knowledge but as far as I can tell, based on stigma or perhaps with a bit of so called “law and order” pandering to the uninformed.

The story unfolds in this way. A person who is in secure treatment for a murder committed when he was psychotic applied to have supervised outdoor walks. The mental health treatment team supported that application and it was permitted by the Criminal Code Review Board who are charged with the responsibility for such decisions. Without these walks (remember that they would be supervised – that is, the person who as far as I know has improved with treatment would be accompanied by two trained mental health staff during short outings) the person would have to languish indoors all summer.

Upon hearing about this decision, the Minister of Justice in Manitoba – Andrew Swan, overturned the board’s decision, ordering that no supervised walks could be allowed! Why? According to Swan it was “contrary to the interests of public safety”.

What hogwash. Since when did Minister Swan get his credentials in mental health? And what possessed him to overturn a duly constituted and credible evaluative process? Could it be stigma against the mentally ill? Could it be the lowest form of political pandering to ignorance and fear? What kind of a message does this send to people living with mental illness? What message does this send to their families? What message does this send to society in general?

Shame on Minister Swan. This is something we could have expected in medieval times, not in 2010 in Canada.

--Stan

Advancing mental health through gender equality

When I read the piece in the Globe andMail about the G(irls) 20 Summit delegates, I was impressed. Kudos to Belinda Stronach and her Foundation for this innovative and necessary initiative.

Unlike the ongoing boondoggle involving fake lakes and public toilets well out of the reach of the public and denial of reproductive rights enjoyed by Canadian women to women in other countries, the Stronach initiative strikes the right notes.

Domestic violence, rape, the need for gender equality, the need for high quality easily accessible education, maternal health and well-being (including family planning) where all issues identified by the young delegates profiled in the Globe article. Of course these are all issues that are too familiar with here in Canada as well – not to the same degree as in low and middle income countries but certainly in kind. Guess what. These are mental health issues as well.

Empowering girls and women and ensuring gender equality in all social, civil and economic undertakings are interventions that will spill over into mental health promotion and prevention of negative social and health outcomes. This is an excellent way to address the social determinants of mental health – everywhere.

We have to do a much better job in this area globally and at home! The mental health of nations must be built in part on national policies that promote and ensure the well-being of girls and women. This is a task that we all must participate in. I for one would like to see very piece of federal, provincial and territorial legislation reviewed to ensure that it promotes this agenda. Sure we need mental health policies, programs and plans. But we need a pro-gender equality framework that informs everything we do.

--Stan

Girls not boys and definitely not in between or beyond (another opinion)

The G(irls) 20 Summit delegates, Globe and Mail article, resonates with me. There is no doubt that the equality of women should be a joyous and wonderful thing celebrated by all women everywhere! But what is this meeting of delegates missing? Focusing entirely on women fails to address women’s equality and health. What? That’s crazy! Women and girls are facing inequality resulting in health disparities—shouldn’t we then focus on women? No, actually we shouldn’t.

Focusing exclusively on women is bad for the health of men and women. It fails to provide the necessary variety of perspectives about how gender interactions are contributing to inequality and how this could be addressed in a comprehensive manner.

There are negative consequences of societal gender expectations on all members of society. This includes the people, too often forgotten (at least in North America) who don’t fall into this fabricated gender binary. What about people who are not male or female? What does that mean? You know, people who identify as something other than male or female, including (but not limited to) gender queer people, transmales, transfemales, and intersex people. These groups of people are often ignored completely and face oppression to an exponential degree in comparison to women.

Imagine this. You’re suffering with mental illness and searching for your identity in a society that doesn’t represent you on the washroom label. You’re unsure of your gender identity because examples of others like you are lacking and your existence is denied in innumerable ways. How do you then go about treating your mental health issues (in a society poorly structured to deal with mental illness in the first place) or for that matter any of your other health issues that largely fly under the radar of most mainstream doctors?

Many trans people face a complex web of health issues (mental, sexual and physical health). This is further complicated by the lack of research pertaining to trans people and plausible solutions to the issues they face. A potential starting point for society to tackle this challenge is by backing trans-supportive organizations to take the lead on an international initiative with money and resources. Taking trans initiatives international has potential to provide insights about how other cultures treat trans people and how to improve our society.

But most importantly, we should be tackling the problematic gender expectations and we should be doing it in an all-encompassing/collaborative manner. That is, if we want to address inequalities and related health disparities successfully. Or we could continue attempting to separate inseparable social issues (gender inequality vis à vis males) and members of society (female, male, or gender queer) to create an illusionary solution for the illusionary “separate” issue.

--Holly Huntley

Digital Media and Mental Health

Recently the Globe and Mail published a story about a study that purported to show that college students in the USA were 40 percent less emphatic than those of a few decades ago. Whether this is indeed correct cannot really be determined by the methodology used in the study quoted but that does not seem to stop enthusiastic speculation about what has “caused” this so called drop in empathy. As expected, the usual boogy-men have been trotted out. None of these have been demonstrated to be causal in this change but that does not seem to stop pontification, particularly if it leads to sales of programs or newspapers.

So what are the suggested causes? Of course, the digital media – facebook and myspace. The argument here is that they are “physically distant online environments” [that allow] people to “lionize their own lives” and “functionally create a buffer between individuals, which makes it easier to ignore others’ pain, or even at times, inflict pain upon others.” This hyperbole makes good theatre but is not very good social science.

Of course the usual cause for every generational “issue” is then also brought to the table. It’s the fault of the parents: “These kids were born around 1980. It could be a change in parenting style. … Kids are getting the implicit message from parents that success is what really matters. It’s hard to spend your life pursuing success and at the same time pursue empathy, because empathy takes work.” So here we are treated to more unproven hyperbole. It sounds plausible so therefore it must be true (that at least is the reasoning). And guess what – there is a program that can be purchased to fix this supposed deficit.

So what is the back story? First, is there really a significant change in empathy (even in the face of the research limitations of this study)? Well the first question is: what does a drop in 40 percent mean? Is this a relative drop or an absolute drop? A drop from 0.1 percent to 0.06 percent of the population is a 40 percent drop – but likely means very little. A drop from 100 percent of the population to 60 percent of the population is also a 40 percent drop but likely means a lot! Beware any news story that uses percentages! Stop confusing co-relations with causality. Sure facebook and myspace are new social realities. So are globalization and climate change. Parenting styles are blamed for every social ill. Darn parents, if only they could learn to do things right!

Well there are some very interesting things on the horizon in terms of understanding empathy and how it develops and how it may change over time. Research into children with the rare genetic condition called Williams syndrome (one of the features is extreme sociability) is peeling away the complexity of interactions associated with racial stereotyping.

Other research has identified mirror neurons in the human brain that are associated with abstract thinking, planning and ability to empathize. This type of research, linking our understanding of how brains develop in response to their environments will help us sort out these important issues. The rest provides lots of impetus for speculation and opportunities to spend our money on programs that work about 40 percent of the time.

--Stan

Preventing Tragic Outcomes Starts with Us

There was a tragic story in the Halifax newspaper, the Chronicle Herald this week. The story was both new and unfortunately very old at the same time. The gist of the story was that a young man who had killed a woman a number of months ago was found not criminally responsible because, as the story states: “the teen was psychotic when he killed a woman in February”.

Although there are few details of what happened in the paper, it seems as if the young man had been experiencing psychotic symptoms for some time prior to the event. Apparently, “his family had been trying to get him psychiatric help”.

What a shame. How tragic. How sad. How ironic, that Nova Scotia has one of the nation’s best first onset psychosis programs. What happened? What is the back story?

The Province of Nova Scotia spends about 3.5% of its annually recurring health care budget on mental health, and a fraction of that on child and youth mental health services. This is in spite of the knowledge that about 3/4th of all mental disorders arise prior to the age of 25 years and increasing realization that early intervention and effective treatment may prevent substantial long and short term negative outcomes and yes, maybe in this case would have prevented such a tragic outcome.

I for one am getting sick and tired of reading these stories and writing these blogs. I have decided to run for federal office in Halifax in part to make mental health a national health agenda item. This tragic case should not have happened. Why is it taking so long to do so little that can help so many so much?

--Stan

Show Me the Evidence

So I was just reading an interesting piece called “Protecting Teens in Crisis: Constructive Oversight of Programs”, in which a number of significant concerns were raised about what is called the “struggling teen industry”. Put bluntly, it seems that there are a number of institutions (mostly in the USA as far as I can tell) that may be or may have been involved in a number of non-therapeutic or perhaps even abusive practices, all in the name of “therapy” or “treatment”. Indeed one of the phrases used in the piece was “stories of mistreatment, abuse and even death…”

Wow. Shocking.

An American professor is quoted as saying that these concerns need to be addressed using state regulations and licensing. This makes sense for sure. I am personally astonished that such a regulatory framework is not apparently in place. How could “treatment” settings operate without oversight and standards of care?

However, this is not enough. Not by a long shot. Reading about some of what passed as “treatment” makes me shudder. It sounds brutal and harmful, not therapeutic and helpful. So, where do people who offer these “treatments” (whatever they are) dream them up? Who has studied these so called “treatments” and what have they found? Are these interventions helpful? Are they useful? Do they work? Are they safe?

In short, what is the scientific evidence for the so called treatments being used? And here, let me be very clear. We need strong, hard scientific evidence. This not the same thing as “best” evidence. “Best” evidence can be what someone thinks is a good idea shared with some other people who think it’s a good idea. It may even be a well-intentioned idea. But, the road to hell is paved with good intentions (as the saying goes).

So – bottom line. Show me the evidence.

--Stan

Should we fix child and youth mental health first?

The Province of Nova Scotia spends about 3.8 percent of its health care budget on mental health services. Well below the minimum recommended by the World Health Organization. A small proportion of this goes to child and youth mental health. As the week long series in the Chronicle Herald (March 8 to March 12) pointed out – the entire provincial mental health system is very broken. In my opinion, we have to tear it down and start again. If we had a blank slate there is no way that we would build a mental health system in the way we currently have it.

So, where do we start. Tearing and building will take a bit of creative thought and a bit of time, not to mention some very difficult slogging to move out of current rigidities and the control of vested interests. 

What should we do now?

Most mental disorders begin before age 25 years. Most of these are life-long. Most of these respond quite well to the evidence based treatments that we have. Early intervention with effective care has the potential to decrease short term morbidity and improve long term outcomes. The most effective way to decrease suicide rates is to identify and treat mental disorders. And the list goes on and on.

Yet we persist in back end investment. Lets stop this foolishness now. Of course we need to provide better care and services for post-youth and vulnerable populations (such as refugees, first nations, the economically and socially disadvantaged, etc), but we need to really ramp up our investment at the front end. So while we work on transforming the entire system we should immediately increase our investment in providing the best evidence based care with the best human resources we can allocate to children, youth and their families. And we should do it now!

--Stan

Let’s make everyone feel good and ignore those who need help!

I am sitting in the comfort of a rustling train as it bumpingly floats its way through the winter-white Nova Scotia countryside, heading back home after four days of work in a rural part of a neighbouring province.

I am reading yesterday's Globe and Mail. The lead editorial headlines: “Those who read well at 15 succeed”. And, the story is about a Canadian study reported by the OECD that young people who can read well at age 15 tend to do well in life and that young people who can not, do not. It also reports the truly amazing finding (here I am being facetious) that those youth who study do better than those who do not!

What insights! What revelations! What a surprise! Teenagers who read well and study hard do well? This is news?

Well, the news here is that reading ability is a good proxy measure for many problems. We have known for a long time that the inability to read at grade level in grade three is predictive of poor educational, social and vocational outcomes. Seems that is also the case at age 15. Reading is a complex skill. Reading difficulties can be the result of psychosocial adversity, mental disorder, learning disability, or combinations of many factors. Whatever the reason, reading ability is a “marker” that can be used to identify young people who may need help in sorting out what the problem is and then they can be given personal assistance in addressing the problem so that they can become successful.

So why are we not doing this? Why are we not assessing reading levels in grade three and at age 15 in every single school in this country and using that assessment to identify young people and develop personal interventions that can help them be as good as they can be? Why are we wasting large amounts of money on building self-esteem and other similar programs when the issue is not self-esteem? Why are so hesitant to put our money and our efforts into those areas that are likely to bring the best results, particularly for those who need it?

From what I have seen, one reason may be that it is difficult and costly to provide the assessment and intervention services that young people who are having difficulty need. So it is easier and perhaps cheaper to provide programs for the many that do very little, than interventions for the minority that may do a lot.

There is also a highly discriminatory ideology at play – not manifest but latent. We do not want to “label” those who need help so we do not identify them and we do not provide them with what they need for success. You see, “labeling” would hurt their self-esteem and would thus be unfair. Instead we shunt them aside in favour of “helping” everyone (including mostly those who do not need any extra help). This of course is more “fair” to those who need help as it denies them what they really need and sets them solidly on the road to poor outcomes. “Oh well, at least they were not labeled and their self-esteem did not suffer as a result”.

Is this fair? Is this the right thing to do? Not in my book.

--Stan

Anxiety: Flight or Fight?

Today I was teaching in a primary health care workshop.  Helping a variety of health care providers become comfortable with mental health competencies that could be used by family doctors, nurse practitioners, nurses, social workers and other to provide mental health care to those that need it.

During the discussion about anxiety, we chatted about the way that anxiety makes us feel.  Many of the examples that people gave included the phenomenon of withdrawal, that is, avoidance of the situations in which we feel anxious.  That is surely true, and is one way that anxiety causes great difficulty for people.  This is one way in which anxiety leads to what we call functional impairment: the inability to do what you want or need to do because of the mental disorder.

But, there is another way that anxiety shows itself.  That is through aggression.  Yes, sometimes anxiety can lead to lashing out at others.  Have you ever been worried about someone who is late for dinner or late in meeting you at a movie?  What about the parent who is worried about where their child is late at night when it is an hour past the time that they were supposed to be home?  What often happens when your friend shows up or the child slinks into the house?

Right.  You got it.  Instead of being hugging and warm it is often the opposite that occurs.  You get angry and act annoyed.  The parent yells at their child.  Yelling is verbal aggression.  The anxiety has resulted not in avoidance but in attack!

That this happens should not be a surprise.  Remember that anxiety leads to the fight or flight response.  Avoidance is part of the flight and anger is part of the flight.  Yet another way that anxiety can make lives more difficult for people.

We often forget how much of a problem overwhelming anxiety can be.  Panic attacks, social anxiety, generalized anxiety and obsessive compulsive disorder all have the potential to be quite disabling.  They can also all be treated and both avoidant behavior and attacking behaviors can be controlled.  In the next couple of months we will be posting a lot of new information on this website, much of it about anxiety.  Stay tuned!

Whatever Were They Thinking?

FINALLY, the Lancet (one of the world’s top medical journals) has retracted their publication of one of the most misleading articles in the history of modern medical science – the now totally discredited piece on the relationship between autism and the MMR vaccine. 

What took them so long? It seems that the Lancet editors where the last in the world to know that the article was basic bunkum. And why did they even print it?

If you can find me another article that uses the same low level of scientific evidence and flawed thinking that the Lancet has published in the last decade as this one used I will buy you a chocolate cookie. (Only one cookie per customer, just in case). I for one have no idea about what the answer to either of those questions is. But the fallout has been substantial. It seems that large numbers of children died because they were not vaccinated. And to what end? Because a researcher (who it seems was in the employ of lawyers making lots of money suing vaccine manufacturers) published such poor science and because a learned journal did the publishing?

So what is a possible lesson here? Although there are many, one most certainly is that one swallow does not a summer make. That is, scientific knowledge is not built on one study, but on many, conducted by different and independent investigators, using best methods and techniques and scrutinized by peer review. Is there the possibility that some studies will show one thing and others will show another? For sure. Science is nasty, brutish and long. Remember the word attributed to Mark Twain: “be careful reading a medical text book. You may die of misprint”

--Stan

How about a mental health day!

So it was late afternoon and I was chatting with some of my young, active and thoughtful research team members. And guess what came up? We need a mental health break during the “dog days” of winter. 

The more I thought about it, the more I liked it.

We know that the winter blues are very common at northern latitudes – such as all of Canada. We know that there is a mental disorder, called Seasonal Affective Disorder that is linked to the relative lack of sunlight during our winter months. We know how long that stretch of going to work when it is dark and going home when it is dark is – especially between Christmas and the first holidays in the spring. Apparently there is even some anecdotal evidence that work and school problems peak in February. And, we know how important a good down day – preferably one in which we can go exercise outside in the sunshine- is for our mental health.

So here is my proposal (actually it is the proposal of Jess Wishart and Christina Biluk), but I am putting forward as mine. Let’s have a national holiday in early February. Lets call it mental health day. Why not? We can just prorogue for a while. I bet that it will be good for all of us. And the researchers can study to see if the two weeks after the day show less work and school stress than the two weeks before the day. Or they could do a controlled trial – one part of the country with the day off and the other part without. Hah. Maybe we should just take the day off!