Young People A Priority...

UPDATED at 5:28 a.m. Thursday
Mental health clinicians will work out of some schools in Nova Scotia to identify troubled children and teenagers, treat mild to moderate problems, and make referrals.

This is one of 33 actions the provincial Health and Wellness Department is taking as part of its five-year mental health and addictions strategy announced Wednesday.

“If we place clinicians in schools and we’re able to work with kids who have mild and moderate anxieties, depressions, behavioural problems at that level, then those wait times (for mental health services) will drop,” Health Minister Maureen MacDonald said at a news conference in Halifax.
“(They) won’t need to go to a hospital for service. That will allow the hospital to deal with really serious, chronic or acute cases. That is the whole purpose of what we are doing.”
Other highlights include the screening of every child in the province at the age of 18 months to pick up problems like autism, and expanding a toll-free crisis line across the province for those with mental health issues who need to speak with someone immediately.
“Research tells us that one in five Nova Scotians will be impacted by a mental illness and one in seven will experience a problem with alcohol and drug use,” MacDonald said.
“This (strategy) takes a broad, government-wide approach to ensure that Nova Scotians living with mental illness and addictions have the care, the services and supports they need to live healthier lives and get on the road to recovery.”
About $5.2 million in new funding has been set aside in the 2012-13 budget toward implementing the strategy called Together We Can: The Plan to Improve Mental Health Care and Addictions Care for Nova Scotians, MacDonald said.
The provincial budget for mental health and addictions is $246 million for 2012-13, she said.
Reducing wait times for mental health services to meet standards is part of the strategy, said Patricia Murray, a special adviser on mental health issues with the Health and Wellness Department.
Some initiatives contained in the plan for 2012-13 include $1.4 million toward placing mental health clinicians in schools with an Education Department SchoolsPlus designation (the exact number of clinicians has not yet been determined), $500,000 toward a certified peer support program, $500,000 to expand opiate substitute (methadone) programs, $500,000 toward community agency projects for people with a mental illness or substance abuse, $350,000
toward a telephone coaching program for families who have children with behavourial or anxiety difficulties, $300,000 to improve mental health and addictions services for First Nations Communities, and $190,000 toward a mental health crisis line.
MacDonald said the government has recently put some funds into the opiate substitution (methadone) program in the Annapolis Valley area, and will target other areas with large wait lists.
“We will be looking at other parts of the province, including the Capital district health authority, where there have been wait lists”
The advisory committee charged with making recommendations to the province was made up of 14 health experts, researchers, mental health clinicians and people living with or affected by mental illness. The committee was co-chaired by Michael Unger, a professor of social work at Dalhousie University, and Joyce MacDonald of the Schizophrenia Society of Nova Scotia.
Paul d’Entremont, a member of the advisory committee, said Wednesday the government plan contains all the committee’s recommendations.
“We are very pleased,” he said.
“The number of recommendations that we had are basically all reflected in the action plan that (MacDonald) has for the next five years.”
However, Liberal health critic Leo Glavine said Wednesday that he has concerns mental health care is still not a priority for the province.
“We are just getting around this September (to having) 20 per cent of the schools covered in the province with some level of mental health expertise. That is an area that could have been acted on many years ago,” Glavine said
“We are talking a $5.2-million injection. It is still only about four per cent of the health budget.”
Under the new plan, more mental health problems will be identified at an early stage, but Nova Scotia doesn’t have a sufficient number of mental health experts to treat people, Glavine said.
“Outside of Capital Health, right across from Sydney to Yarmouth, we do not have enough mental health experts to work with other supportive people in the mental health system.”
Progressive Conservative health critic Chris d’Entremont said the overall strategy “looks OK.”
He said he wonders what the funding will look like after the first year and thought there could be more attention to addictions services.
“We need to be looking at methods in providing services to these individuals to truly get them healthy, get them back in the community,” he said.
“These are marvelous people, I think, that fall into certain issues.”
Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, said he is pleased with the government’s plan and especially “overjoyed” with the $500,000 toward peer support programming and other funding for families.
The peer support program provides help to people living with a mental illness who are making the transition from a hospital to the community.
“This is a day of celebration. We have been waiting so long for this,” Ayer said.
“There is no negative story (in this). I think the minister has done a great job and the advisory committee has done a great job and we are moving forward with mental health care in this province and hopefully taking a leading role in the rest of the country.”
The move to revamp the mental health system was sparked by concerns about long waiting lists for treatment and how mentally ill people are treated in the justice system, as highlighted by Judge Anne Derrick’s report in December 2010. Hyde died in 2007 after a violent conflict at the Central Nova Scotia Correctional Facility in Dartmouth.
With David Jackson, provincial reporter

(cmellor@herald.ca)

About the Author

By CLARE MELLOR Staff Reporter

Clare Mellor is a general news reporter with more than 20 years experience. She has reported from Bosnia, covered health, business, courts, the Canadian military and politics.

Removing mental health stigma bigger priority than funding: health minister

Heather Scoffield, The Canadian Press  May 22, 2012 – 4:10 PM ET

Chris Wattie / The Canadian Press

Canada needs to deal with the stigma surrounding mental health issues before it can go on to tackle funding questions, says federal Health Minister Leona Aglukkaq.

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OTTAWA — Canada needs to deal with the stigma surrounding mental health issues before it can go on to tackle funding questions, says federal Health Minister Leona Aglukkaq.
Now that the country has a new, national, mental health strategy, all levels of government, businesses and health-care professionals need to confront the prejudices that prevent many people from seeking help, Aglukkaq told The Canadian Press in an interview on Tuesday.
Then, authorities should restructure their services accordingly, to make sure people struggling with mental health issues feel confident enough to seek help and receive the appropriate attention, the minister said.

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“The first step is to get past the stigma and get people talking about mental health to determine better what kinds of services we can provide,” she said in an interview from Geneva, where she led a round table on mental health during a global discussion on improving health care.
The Mental Health Commission of Canada released its much-anticipated national strategy earlier this month, recommending billions of dollars more in investment — along with a radical overhaul in the way Canadians interact with mental health professionals.
The commission’s work shows that everyone involved in the mental health system needs to do things differently, but confronting damaging stereotypes comes first, Aglukkaq said.
“These are different models that can only be developed as we get past the stigma.”
While the commission’s recommendations for change have been well received, its calls for more money are contentious.
That’s because provincial governments are already dealing with rising health-care costs. At the same time, the federal government has announced plans to significantly scale back its annual increases in health care spending over the coming decade — even as some provinces struggle with debt.
As a result, provinces are expected to increase pressure on Ottawa to add a new mental health funding stream to its transfer payment package. The premiers meet in July in Halifax and appeals for specific and increased mental health funding will likely be front and centre, several Ottawa sources say.
But in the interview, Aglukkaq deflected every question about increased federal funding.
Instead, she said the federal role is to fund research into depression, dementia, homelessness and efficient delivery of care.
“We are taking the leadership role by creating the Mental Health Commission of Canada,” she said.
Providing better mental health care does not necessarily mean more money, she added. It could also mean that provinces take existing funding and make mental health care more of a priority, as Nova Scotia has done recently, she said.
The head of the Canadian Psychological Association says there’s no doubt that the stigma over mental health needs to be a central focus for everyone involved in the delivery of services — but not to the exclusion of funding and access to proper care.
Karen Cohen says stigma is only one challenge people face as they struggle to confront mental health issues. The other big problem is that the country has a well-established, two-tier system of mental health care that desperately needs a change.
“It’s a minority of people with mental health problems who seek help,” she said in an interview. “Part of that is related to stigma. People think you should just get over it, they’re ashamed to admit it to themselves, they feel people won’t be accepting — and often they’re not.
“The other piece is access. Even when people come out and ask for services, there are great barriers.”
Psychologists are the largest group of specialized mental health care providers, she said, but they are often only available to people who can afford to pay them more than $100 an hour, or work for a company that includes extended health care benefits.
That’s because psychological services are not covered by medicare unless the psychologist in question is on the payroll at a public institution such as a hospital, school or correctional centre, Cohen said.
And in those cases, the waiting lists are often so long that the will power it took for someone to actually seek help evaporates, she said.
She agreed that existing funding can be put to much better use. But she thinks governments will see the case for more investment too.
Since research shows that early intervention in mental illness can prevent serious developments over the long term, governments will see the wisdom and economy of setting up teams that can address mental health issues thoroughly, Cohen said.
“It really is going to take a village. We have a collaborative responsibility.”

Knowing Causes Can Help in Curing Schizophrenia

Knowing Causes Can Help in Curing Schizophrenia
Factors responsible for Schizophrenia and steps to cure it
Schizophrenia is a mental disorder involving a distorted or abnormal perception of reality. These distortions could involve any of the five senses but are most often auditory hallucinations, paranoia, disorganized speech and thinking, or bizarre delusions. The disorder impairs cognition and in turn impacts emotional or behavioral problems. It can coincide with anxiety disorders and major depression.
Patients often have a difficulty telling inner speech from what is actually said to them, and have impaired reasoning about social situations.
At present, there is no clinical test for schizophrenia. Diagnoses are usually from reported experiences of the patient. However, increased dopamine activity in the brain is usually found. Imaging scans have also been able to find differences in the brains of schizophrenic people, which do not indicate the disease itself, but the memory and problem-solving issues associated with it.
Patients sometimes think they are being controlled, their thoughts are being transmitted to other people, or that thoughts are inserted or withdrawn from their minds. The delusions can be different from those described.
The causes of schizophrenia could be both genetic and environmental, but the specific combination of factors is not yet known.
1. Genetic factors would involve more than one type of gene working in tandem to cause the problem, but these same genes may develop bipolar disorder or another problem instead. Since known patients seem to have fewer children than average, it is not known how the condition could continue to exist if it has a strong genetic component.
2. The early development of the brain while in the womb is considered a possible factor. Prenatal exposure to infections can increase the risk of developing schizophrenia later in life.
3. Living in an urban setting is a risk factor, as is poverty, poor housing conditions, or migration due to racism or family dysfunction.
4. A childhood of trauma or abuse may be a factor, but parenting style is not the definite cause.
5. Drug abuse is not a proven cause, but may be related.
Currently, there is no existing cure for schizophrenia, but there are antipsychotic medications with varied effects. Some cases will resist more than one medication.
1. Typical antipsychotics can reduce psychosis and take 7 to 14 days to start working.
2. Atypical antipsychotics are now preferred for initial treatment but can induce weight gain.
Both types of medication are considered equally effective. The former type can, in rare cases, lead to potentially fatal neurological problems, and it is not yet known if the latter type does the same.
Two countries, the United States and Australia, are legally allowed to administer medications to uncooperative patients who are otherwise stable and living within the community.
Some patients may in the long term do better by not taking antipsychotics.
There are also therapies to alleviate symptoms which may have a greater appeal than medications and their side-effects.
1. Cognitive Behavioral Therapy, available since the mid 1990s, can increase self-esteem and insight. Brain scans have shown significant improvements in cognition when patients use this therapy.
2. Family therapy is used to help patients socialize better in the context of a family system. The burden on the family is recognized.
3. Creative therapies such as music therapy have some benefit.
4. The Soteria method is a community therapy that creates a stable, quiet space for people recovering from mental crises, with minimal medication. It is just as effective as full medication in some cases.
5. Electroconvulsive Therapy still exists for patients who do not respond to other treatments, but it is not generally recommended.
In addition to these methods, the Hearing Voices and Paranoia networks provide a self-help approach outside the mainstream medical model. As large support groups, they attempt to encourage responsibility and a positive self-image. Hospitals are increasingly working with these groups to help patients integrate back into society.

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