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Living Right: The Genes of Mental Illness – 9 & 10 News – 9&10 News

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March 30, 2021

Hearing voices, paranoia, irrational and angry thoughts, these are just some of the symptoms people with schizophrenia deal with.

More than 2.6 million Americans are living with it right now.

There is no cure. Treatment involves medication and therapy, but more than 40% of people living with it do not seek help.

There are many questions as to what causes it.

One woman’s family is speaking out about their lifelong journey through mental illness and how they’re helping researchers get to the root of the problem.

We have their story in Living Right.March 30 5pm Lr Genes Of Mental Illnessmp400 00 00 12still001

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We can do so much more to help people with mental illness – The Globe and Mail

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Bill Wilkerson is executive chairman of Mental Health International. Stanley Kutcher is a child psychiatrist and a member of the Senate of Canada.

With the recent passage of Bill C-7, Canadians eligible for medical assistance in dying (MAID) will include, in two years’ time, those whose end-of-life journeys are characterized by intolerable suffering solely because of an irremediable mental disorder – not just those afflicted by other forms of pain.

The next two years will allow time for medical and nursing educators to update and accredit their MAID training in light of this development, and for governments and regulators to consider protocols and additional safeguards.

Plans to amend the criminal code to recognize the constitutional rights of those who live with mental disorders have cast a stark light on the inequities they experience in this country.

Inarguably, as it is a matter of Charter-protected rights and freedoms, MAID should be available equally to all those who qualify to receive it – but for those who live with mental disorders, access to effective care and preventive interventions should also be provided equitably.

This cannot be ignored any longer. The federal government could take a number of steps to address this inequality.

First, it must substantially improve rapid access to the best evidence-based and culturally appropriate mental health care for populations under its policy authority and jurisdiction: Indigenous peoples, the military, the RCMP and federally incarcerated persons. This has to include improving the social determinants of health/mental health for Indigenous people.

The federal government could also consider legislation such as amendments to the Canada Health Act or the introduction of a mental health parity act to encourage improvements in care. Alternatively, conditional funding for these improvements – as part of federal transfer payments – may be an appropriate “carrot” to help encourage provinces and territories to act.

Supporting evidence-based self care and mental health literacy would help improve Canadians’ understanding of how to identify mental disorders and what to do in response to early signs and symptoms. The federal government could continue to improve its own workplace mental health strategy and lead by example.

Of immediate value will be breaking down the mythology that mental health and physical health are distinct and unrelated entities. What is good for one’s bicep is also good for one’s brain.

Another key priority is creating a national database to provide robust, valid and useful information on the mental health status of the population; prevalence and distribution of mental disorders; and access to and use of services. This would help inform policy development and mental health care interventions at both national and local levels.

Mental disorders make up a large proportion of the global burden of disease and years lived with a disability. Yet Canada’s funding for research into effective therapeutics and prevention strategies is unaligned with this reality. Targeted funding enhancements through existing bodies such as the Canadian Institutes of Health Research is needed urgently.

While promising technologies are emerging to help improve outcomes for people who experience existential distress and some types of mental disorders, our knowledge about what works best and for whom is in its infancy. Developing a regulatory framework to ensure that marketed products and services are actually effective and safe is a needed safeguard in the dynamic new world of digital technology.

Finally, when we look at the needs of struggling Canadians, we know what needs to be done to provide enhanced, rapid access to mental health care, but we are not doing it. For this reason, an ombudsperson for mental health care or even a separate federal ministerial portfolio focused on mental health and substance abuse is worth serious consideration.

Whatever steps the federal government chooses to take for better access to improved mental health care, the time to take those steps is now.

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I Am An Alcoholic And I Am Not Ashamed To Say It

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When I had my kids in my 30s suddenly there was something else competing for my attention, other than alcohol. That was when I really noticed that all I did was think about drinking. I realized I was SO unbelievably sick of thinking about my next drink. Not to mention, ashamed of my behavior over the years of being a selfish addict which had cost me a number of close relationships. I needed help. I needed to stop drinking.

After many tries, I stopped drinking on July 18, 2017. My birthday. I haven’t had a drink since and, contrary to the popular opinion of alcoholics, I don’t WANT to. So, back to me thinking I “couldn’t” be an alcoholic- it seemed like such a dirty word. That doesn’t describe me. Or does it? A few months into sobriety, I started going to AA and saw my story again and again. I realized I wasn’t alone in suffering or In feeling consumed by alcohol.

I quickly realized I was in fact, an alcoholic. And so began my recovery. In secret, for the most part, save for a few close family and friends, no one knew I was in AA. Once I was comfortable socially, I would say I didn’t drink, sometimes I even uttered the word “sober” but even that can have negative connotations because it is assumed that you drink alcohol unless you specify otherwise.

How wild is that? But it goes to show how much alcohol is absolutely ingrained in our society. We incorporate it into everything: baby showers, weddings, funerals, birthdays, Monday, the unwinding at the end of a tough workday, how to get through a breakup, or a day of parenting. The reasons to drink are readily available. So I tended not to say “no thanks, I’m an alcoholic” when passing on a drink offered because of the judgment, the shame, the stigma. The word “alcoholic” itself is riddled with undertones of disgrace and assumptions of weakness and failure.

Continue ReadingI Am An Alcoholic And I Am Not Ashamed To Say It

We can safely deliver therapy to suicidal inpatients, but we still don’t know if it works

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shutterstock_1329331877

Trigger-warning.

Caring for people who are suicidal on acute mental health wards is challenging for the person receiving care and those caring for them. Most acute mental health wards are not safe places, despite the investment in removing ligature points from them. Risks can increase with periods of leave away from the ward, and in the first few days of discharge (Sakinofsky et al., 2014). There are few evidence-based interventions for staff working on wards to help people when they are suicidal, and staff are often required to observe people for long periods of time to manage the risk.

This study by Haddock et al., (2019) aimed to determine whether cognitive-behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared to treatment as usual (TAU) for in-patients who are suicidal.

Acute mental health wards need to be better equipped to deal with suicidal patients.

Acute mental health wards need to be better equipped to deal with suicidal patients.

Methods

This study comprised a single-blind pilot randomised controlled trial which compared TAU plus CBSP (cognitive-behavioural suicide prevention therapy) to TAU for people on acute mental health wards who were suicidal. The intervention consisted of up to 20 CBSP sessions delivered by a psychologist over 6 months, which continued in the community following discharge if necessary.

Cognitive-behavioural suicide prevention therapy (CBSP) is a one-to-one psychological therapy that aims to achieve a detailed understanding of an individual’s experiences of suicidality and to change the thinking processes involved in the activation, maintenance and elaboration of suicidal thinking and behaviour.

Participants were assessed at baseline, 6 weeks and 6 months with sixteen secondary outcome measures of psychopathology, suicidal and negative appraisal, and quality of life. Health economic data was collected through the EQ-5D-5L and use of services inventory.

Results

  • Of 178 potentially eligible patients only 51 were randomised.
  • 27 people received TAU, and 24 CBSP + TAU.
  • People received a mean of 11.3 sessions of approximately 52 minutes duration, ten sessions was deemed acceptable although 20 were offered.
  • None of the 255 serious adverse events were considered research related, and there were no significant difference between the two groups in the amount of serious adverse events.
  • No significant differences were observed between the TAU plus CBSP and the TAU group on any secondary outcome measures, across all assessment time points.
  • Overall 57% (29/51) of participants had complete costs and QALY data (CBSP n= 12/24; TAU n = 17/27). The findings were non-significant (no difference in cost or QALYs) although the authors suggest possible savings for TAU+CBSP
  • Qualitative interviews of acceptability indicated that both staff and patients viewed the intervention positively, but these findings were reported elsewhere (Awenat et al., 2018; Awenat et al., 2019).
No significant differences were found when cognitive-behavioural suicide prevention therapy was compared to treatment as usual.

This pilot RCT found that cognitive-behavioural suicide prevention (CBSP) therapy was safe and feasible, but no significant differences were found when treatment as usual (TAU) plus CBSP were compared to TAU alone.

Conclusions

The author’s briefly concluded that:

“Psychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.”

We can deliver cognitive-behavioural suicide prevention therapy to mental health inpatients, but we won’t know if it works until a bigger study is conducted.

We can deliver cognitive-behavioural suicide prevention therapy to mental health inpatients, but we won’t know if it works until a bigger study is conducted.

Strengths and limitations

  • Studies that try to deliver therapy on wards are always challenging. The environments can be chaotic, and lengths of stays are not predetermined.
  • As is common with underpowered feasibility studies hampered by missing data, the secondary outcome measures don’t indicate differences when compared to the TAU.
  • Clearly it seems feasible to develop and deliver such an intervention, but it was unclear whether the dose of therapy needed to be 10 or 20 sessions and this obviously would impact on the ability of staff to deliver it in future studies.
  • Researchers need to continue to develop interventions that are acceptable to patients, in this study only 50% of those approached agreed to take part.
Studies which try to deliver therapy on wards are always challenging, the environments can be chaotic, and lengths of stays are not predetermined.

Studies that try to deliver therapy on mental health wards are always challenging. The environments can be chaotic, and lengths of stays are not predetermined.

Implications for practice

Periods of leave, and discharge from hospital (first 72 hours) are known risk periods for suicidal patients. The continuity of engaging with patients on wards, and following them into the community whilst trying to help them deal with their suicidal thoughts is therefore important. That this study followed people into the community to continue to deliver the intervention was an important adjunct. However, that only psychologists where chosen to deliver the intervention is frustrating. Whilst wards would benefit from greater availability of psychological interventions, in reality few psychologists work in these environments.

Do we need cognitive behavioural suicide prevention or better community care?

Do we need cognitive behavioural suicide prevention or better community care?

Conflicts of interest

None of note.

Links

Primary paper

Haddock, G., Pratt, D., Gooding, P., Peters, S., Emsley, R., Evans, E., . . . Awenat, Y. (2019). Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: Randomised controlled trial. BJPsych Open, 5(1), E14. doi:10.1192/bjo.2018.85

Other references

Awenat, Y, Peters, S, Gooding, P, Pratt, D, Huggett, C, Harris, K, Armitage, CJ & Haddock, G 2019, ‘Qualitative analysis of ward staff experiences during research of a novel suicide-prevention psychological therapy for psychiatric inpatients: Understanding the barriers and facilitators.‘, PLoS ONE, vol. 14, no. 9, 14(9) e0222482, pp. 1 28.

Awenat, YF, Peters, S, Gooding, PA, Pratt, D, Shaw-núñez, E, Harris, K & Haddock, G 2018, ‘A qualitative analysis of suicidal psychiatric inpatients views and expectations of psychological therapy to counter suicidal thoughts, acts and deaths‘, BMC Psychiatry, vol. 18, no. 1.

Sakinofsky I. Preventing suicide among inpatients. Can J Psychiatry. 2014;59(3):131-140. doi:10.1177/070674371405900304

Photo credits

John Baker was appointed to Chair of Mental Health Nursing in 2015. John’s research focuses on developing complex clinical and psychological interventions in mental health settings. He is particularly interested in i) acute/inpatient mental health services and clinical interventions; ii) medicines management in mental health care; iii) the attitudes and clinical skills of mental health workers, iv) the mental health workforce. The good practice manuals which he developed have been evaluated, cited as examples of good practice, and influenced clinical practice in the UK and abroad. The training package for patients, service users and carers to promote research awareness and understanding has been cited by the MHRN and NICE as an exemplar of good practice.

John is a member of the NIHR post-doctoral panel, sits on the Editorial boards for Journal of Psychiatric and Mental Health Nursing & International Journal of Mental Health Nursing. He is a Registered Nurse Teacher with the Nursing, Midwifery Council (NMC) and is active within Mental Health Nursing Academics (UK).

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How Writing The Truth About Motherhood Was The Ultimate Self-Care

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Today’s Warrior Mom guest post comes from Sammie Prescott.

By Sammie Prescott

Before motherhood, I always thought self-care was about physical care, not mental. I pictured things like going to the salon or taking a hot, silent bath. Back then, it really was amazing what a fresh coat of nail polish and 10 minutes of Adele could do for the psyche.

Things became different after having a baby. A trip to the nail salon left me anxious, uptight, and nauseous. I had no time to take a bath, and I really didn’t want to sit in silence. As my mental illness reached its climax, the silence was scary.

I knew I had to take care of myself, or I couldn’t take care of my son. But how? How does one practice self-care when your whole world revolves around a baby? I did the typical Pinterest search on “self-care for moms,” and came across suggestions such as “talk to a friend” or “go to an animal shelter.” My stomach curled. I didn’t want to be anywhere near other people. The very idea of stepping out of my comfort zone, or even putting on pants actually caused me to experience the deepest, soul-clenching panic one could imagine. So I sat with my infant, and let my depression and anxiety build into something massive. There were days when hours would slip by and I wouldn’t move. My heart was heavy, while my head was messy. The darkness pulled me in, but I let it. After a while, the drive to do anything was just gone.

As my life progressed, I decided — well, actually it was my husband who decided — that I needed something. One day, it came to me. I opened my laptop and just started writing. I poured out every emotion I could. I spared no shameful frustration or dirty detail — and I mean dirty. I talked about the diapers, the vomit, the tears, and everything in between.

Here’s a passage I wrote during those days.

“Sometimes I use my feelings of total failure and anxiety to clean my house. I harness the evil for good, I suppose. I can’t always aggressively Swiffer, so when that doesn’t work, my mind runs wild. I argue with myself about how we will fix the scary things in our life, and how I will lose the weight. I worry about what dinner will be, and when the couch will get vacuumed.

Last night was one of those nights. I was worried, scared, and felt like I had truly failed. My group of mom friends had a rough day, and we took it out on one another. I feel like I failed as a friend. Tater wouldn’t stop crying, and I didn’t know why… another feeling of failure, and to top it all off, I forgot to cook dinner for B who was at work all day. That’s three “failures” on top of the others that loom over me.

I cried.

(I firmly believe that the universe is an amazing place, in which everything happens for a reason)

I looked up on my Facebook to see the post that said “I haven’t failed, I just found 10,000 ways that won’t work.” I laughed, said forget it! And proceeded to eat 400 Oreos and forget about my anxieties for a second.”

After writing just for myself for a while, I decided to share one of these informal essays with the ladies I had become close with on my Birth board. They all laughed while encouraging me to share more. I love the feeling of making people laugh. It’s almost soul-cleansing, knowing that your words or actions can change a person’s mood. I felt like my essays were relatable. There was no “perfect parent” talk, or showing off. It was all about real moments in my everyday life. So every night, I carved out at least 30 minutes where I could spill everything I was feeling. The more I wrote, the better I felt. My light was finally lit again, after being out for so long. I enjoyed my quiet time, and sometimes I even wrote when my life wasn’t quiet at all.

I decided to further share my words by starting a blog. I told myself that even if no one reads it, at least this will make me feel OK.

With the blog started, I just let it flow. Every emotion poured out of me, in the snarky, humorous way that I spoke. The more and more readers I got, the crazier it all got. The feedback was warming my damaged soul. Even when the negative feedback came in, it still meant someone was taking the time out of their day to read what I wrote.

Now, two years later writing is my safe space. I was lucky enough to be given a writing prompt journal from my best friend. It’s filled with 300 questions, and space to answer them. They make me dig deep into my emotions, and sometimes they make me laugh. I also journal, for when writing a post, or filling in a prompt just aren’t doing it for me.

Self-care isn’t the same for everyone. You have to soul search to find out what works best for you. It may take a few tries, but never get discouraged. Practicing self-care has made me a better wife, a more patient mom, and truer version of myself.

Want to start writing as self-care? Here are my tips:

  • Find a space in your home where you can write consistently. This will be your grounding zone. It’s a bit of stability in the forever unstable battle that is mental illness.
  • Carve out at least 15 minutes a day to write. I usually sit down in my reading corner after my little person is fast asleep. Some days I need 15 minutes, some days I need an hour. You can start journaling (here’s my favorite journal), or if that isn’t your style, there are a wide variety of notebooks that come with writing prompts in them. You have to find what kind of writing works for you.
  • Get comfortable. Throw on those yoga pants, and wrap a soft blanket around you. I often light a candle as well. The smell of sugar cookies seems to clear the mind and makes my bedroom smell less like a toddler.
  • When it’s time for me to write, I sit down and enjoy a few minutes of quiet first. I let the day leave my mind so I can give my full heart to what I’m doing.
  • Finally, let your mind go. Write what you feel, and feel what you write. With prompt writing, I always take a few minutes to really read the prompt before I let the pen go. With journaling, it spills out like water. Hold nothing back.
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