POSTS | depression hurts us

Opinion | Mental illness is another pandemic in the making – TheSpec.com

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Post published:April 5, 2021
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Cachelle Colquhoun, mother of four from Collingwood, Ont., is frustrated with the state of mental-health supports available to her children.

In the wake of the COVID-19 pandemic, Colquhoun has struggled to meet the needs of her nine-year-old with general anxiety disorder and attention deficit disorder and her six-year-old who has challenges with neurodiversity, including sensory disorder.

“I spend a lot of my days trying to find the right resources for my kids,” Colquhoun says. “Getting help is nearly impossible. And if you can access services, you price yourself out immediately.”

Pandemic measures have had adverse mental-health impacts on children, youth, and families. According to a report authored by Children’s Mental Health Ontario, nearly two-thirds of youth confirm their mental health has gotten worse since the beginning of the pandemic, with those already receiving help especially vulnerable. A recent study published in the Canadian Journal of Psychiatry found that 36 percent of Canadians aged 15-34 have experienced clinically significant levels of anxiety due to the pandemic.

Dr. Tess Clifford, director of the psychology clinic at Queen’s University, is not surprised.

“We see kids struggling with intense behavior and aggression toward others and self,” she says. “Kids not being able to participate in school.”

Clifford is a child and youth psychologist who is brought in when typical services are not working.

“Some of the things we are seeing are different than what we would typically see,” she says. “Agoraphobia, depression.”

She hears from community partners about kids lost to the system, having no contact with anyone.

“I don’t hear many positive stories,” she says. “I’m invited to support when things get really hard.”

She believes the surge in mental illness is partly due to community supports disappearing.

“We had solutions to help kids cope and manage and now those have been removed,” she says. “We need to think about what supports these children need and how to get those back in place.”

Clifford would like to see a greater focus on health promotion and mental-health crisis prevention strategies. She stresses we need to reintroduce recreation opportunities such as extracurricular activities, review school policies for proper supports, increase mental health services, and focus on positive personal connections.

“We need to figure out how to reduce the risk of COVID-19 but also reduce the risk of mental illness,” she says. “We must have more than one focus. We have to balance risks across all aspects of health.”

Marty Mako, commander of Mobile Integrated Health with Niagara Emergency Medical Services, sees firsthand the result when inadequate mental-health supports crash into unemployment and social isolation.

“People are feeling overwhelmed with these changes and these are exacerbated with underlying conditions,” he says.

In response to the pandemic, Niagara EMS received temporary funding to establish paramedicine outreach programs to support medically complex clients, including those experiencing mental health issues. The programs are new but have already decreased the number of transports to the ER by this cohort.

“We’re arriving on scene to provide a different suite of services,” Mako says. “We provide the right care at the right place at the right time by the right provider.”

In addition to responding to low-acuity cases and providing mobile medical services, the programs work to provide mental-health resources in a timely manner and reduce stigma among homeless and street populations. Mako is hopeful the programs will extend long after COVID-19 to help mitigate mental-health harms throughout the community.

“The full impact of this pandemic is still to come,” he says.

Research suggests long-lasting mental-health problems impact quality of life, physical health, and the onset of illness. These consequences are being experienced nationwide, according to Don Marentette, director of first aid education programs at the Canadian Red Cross. “Mental health is definitely a significant issue for Canadians,” he says.

Marentette manages psychological first aid and caring for others training — online national courses which support resiliency efforts and offer self-care strategies. The courses have been well received. In November-December 2020, the courses served nearly 1,500 participants — triple the amount typically seen during a similar period.

Marentette hopes to adapt these initiatives for both Indigenous and youth populations.

“We have heard from Indigenous communities that they are looking for supports in this space, to incorporate ceremony and traditions,” he says. And for youth: “Programs need to be built for youth by youth,” he says. “There are several community groups that are disproportionately affected. So, we need to make it OK to have conversations about mental illness.”

Despite challenges, Colquhoun says she has seen positive steps regarding mental-health supports.

“I know teachers that are incorporating yoga in the classroom, conducting mindfulness exercises, and prescribing journaling to help students regulate feelings,” she says.

She points to cities that offer physical activity challenges or have created online mental-health resources and discussion forums.

“All those little things can be helpful while building a robust mental-health system,” she says. “If everyone just admitted we’re all struggling, then this would change.”

Benjamin Rempel is a writer and essayist specializing in public health and social justice issues.

Op-Ed: Treating biology, and sociology, behind mental illness – Los Angeles Times

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Post published:April 4, 2021
Post category:POSTS

The Nepali doctor Rishav Koirala is, by his own admission, an unusual Nepali.

He’s a fan of Jim Morrison and the Doors, loves European philosophy and practices psychiatry in a country where medical schools offer little or no mental health training.

What makes him especially unusual is that as the world embraces the idea that mental illnesses should be seen as brain disorders, Koirala is pushing back.

Mental illnesses are the leading cause of disability in the world.

But in Nepal, mental illnesses are considered so shameful that few people get help.

After the 2015 earthquake, as doctors from other countries came to diagnose and treat survivors with post-traumatic stress disorder, few Nepalis wanted the diagnosis.

Local counselors believed that people with PTSD — which is translated into Nepalese as the stigmatized phrase “mental shock” — had brain diseases or bad karma and were predisposed to commit murder or die by suicide.

The unwillingness to accept the diagnosis or seek care might seem odd to some readers.

In any given year, close to 60% of people with any mental illness in the U.S. receive no mental health treatment or counseling.

Most scientists argue that stigma is the biggest barrier to mental health care in the U.S. and the world, and that stigma can be reduced if people understand that mental illnesses are neurological diseases, a proposition Koirala rejects.

As psychiatrist Nancy Andreasen argued in her landmark book, “The Broken Brain,” discrimination against people with mental illnesses derives from ignorance, “from a failure to realize that mental illness is a physical illness, an illness caused by biological forces and not by moral turpitude.”

Dr. Thomas Insel, former director of the National Institute of Mental Health, wrote of mental illnesses, “We need to think of these as brain disorders.”

The focus on the brain in mental health research today is understandable.

A person with a broken leg probably won’t hesitate to see a doctor, but the median time from first psychosis to psychiatric care in the U.S. is 74 weeks.

Perhaps, the logic goes, a broken-brain model will shift responsibility from the person to the organ.

There is no evidence that reframing mental illnesses as brain disorders reduces the associated stigma. Wherever doctors describe someone with a mental illness as having a chemical imbalance or abnormal brain circuitry, they provide reasons to fear that person.

A German survey showed that the more people learned about the biology of mental illnesses, the more they reported a desire for social distance from people with a psychiatric diagnosis.

A U.S. study showed that from 1996 to 2006, the American public increasingly saw mental illnesses as neurobiological, but this did not “significantly lower odds of stigma.”

Koirala does not reject the neurobiological bases of mental illnesses. What he rejects is the idea that such frameworks are helpful in breaking down barriers to care.

A few years ago, Koirala helped set up a temporary “mental health camp” in a remote area of Nepal.

Despite misgivings, he let his co-workers call it a “mental” health camp, using the Nepalese word dimaag for “mental,” a word that refers to the brain and its ability to function properly.

No patients came.

Someone with an impaired dimaag will be seen as seriously damaged and might be prevented from marrying, fired from a job or banished from the family.

When he set up the site again several months later, he called it a camp for “headaches.”

Patients showed up, almost everyone was diagnosed with depression or anxiety, and they were treated — and got better.

Koirala now talks to his patients less about the brain than their physical symptoms, like headaches and fatigue, or what he calls “the heart.”

He tells patients that within every person are two hearts, an inside heart and an outside, or observable, heart. “We are all aware of our outside heart,” he says. “

It comprises all the emotions and physical symptoms that we feel and that others can see.” The inside heart, however, the true source of mental illness, is often hidden from our awareness.

To treat the neediest, Koirala traveled to an isolated region of Nepal and encountered a man with schizophrenia. His family immobilized him with a wooden device secured around his foot that locked with a nail above the ankle, preventing his foot from slipping out. They said the device was for his own safety; without it he’d run away.

Koirala put the man on antipsychotic medication and met up with him a few months later.

He was a “totally different person” and had made a “remarkable” recovery, Koirala said.

Why did the family accept the treatment?

Because Koirala understood that culture, not biology, gives meaning to suffering: He depicted mental illness as a disorder of the heart.

Neuroscience may someday generate treatments so curative that mental illnesses will lose their stigma.

But we’re not there yet. The brain is far more complicated than any other organ.

Mental illnesses are not just biological.

They are shaped by more factors than we can imagine — biology, yes, but also childhood, poverty, social supports, and social stressors.

The experience itself changes the architecture of the brain.

We should, therefore, approach neurobiological models of mental illness with caution and, like Koirala, do what works.

That means addressing the lived experience of suffering.

Sure, we know that children with attention deficit hyperactivity disorder tend to have subtle differences in brain structure compared with their peers without ADHD, but that finding doesn’t translate into better special education.

We know that people with schizophrenia have brain circuits that develop differently, but that knowledge does nothing to diminish stigma or one’s history of being discriminated against.

We cannot and probably never will see mental illnesses through a microscope, or test for them in a laboratory.

That’s not because psychiatry has failed, but because experience isn’t written in our cells.

So let’s study the brain while also studying the societies in which we live and suffer. Culture is, at least, something we now have the power to understand and change.

Roy Richard Grinker is a professor of anthropology and international affairs at George Washington University and author of “Nobody’s Normal: How Culture Created the Stigma of Mental Illness.”

Okla. Dept. of Mental Health official says connecting mental health to mass shooting is problematic – KOCO Oklahoma City

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Post published:April 3, 2021
Post category:POSTS

OKLAHOMA CITY —

In March alone, there were more than 10 mass shootings across the U.S.; and in many cases, the suspect was said to have suffered from a mental illness.

But can that add to the stigma of people trying to seek help? KOCO 5 spoke with the Oklahoma Department of Mental Health to explore this.

Eight people were killed after a man targeted Asian-American-owned spas in Atlanta. Ten people were killed after a man began shooting at a grocery store in Boulder, Colorado.

In both cases, the suspects were said to have suffered from mental illness. But Jeff Dismukes, with the Oklahoma Department of Mental Health and Substance Abuse Services, said this is often a default – and a problematic one.

“You don’t really see that link between mental illness and mass shootings,” Dismukes said.

He told KOCO 5 that in most cases, there are multiple contributing factors to leading someone to commit a mass shooting. Dismukes also said people don’t often “snap.”

So, why does mental illness become a catch-all?

“We want answers. We want to make sense of something, really, you can’t make sense of,” Dismukes said.

Blaming mental illness for mass shootings can also discourage people who may really need help from getting it because of the stigma.

“When those illnesses come on and you start seeing these problems, you don’t want to admit that that is what is occurring,” Dismukes said. “It’s a barrier that keeps you from reaching out.”

If you or someone you know needs help, calling 211 is a great place to start.

Letter: Mental illness not cause of shootings – The Columbian

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Post published:April 3, 2021
Post category:POSTS

I am writing in response to the letter posted in The Columbian (“Mental illness requires treatment,” Our Readers’ Views, March 20), as it contains a commonly held societal misconception about the role mental illness plays in mass shootings.

I agree with the writer that services for the seriously mentally ill are sadly lacking, but I must disagree with her statement “in most cases, there is no motive. The mass shooter is mentally ill.” This is in fact not the case. Most mass shootings (and other acts of targeted violence) are carefully planned events, driven by any number of motivations, and are not the product of schizophrenia, hallucinations, etc.

The fact is that most people with these kinds of illnesses are much more likely to become the victims of violence rather than the perpetrators of it. For more information, go to www.secretservice.gov/protection/ntac.

Trans pathways: mental health care for transgender and gender diverse young people in Australia

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Post published:April 2, 2021
Post category:POSTS

Transgender and gender diverse people (TGD) are a highly stigmatised and minoritised group (Hughto et al, 2015; McNeil et al 2012). Healthcare service access is also poor amongst TGD people, and experiences once in services continue to be sub-standard. Carlile et al. (2020) reported on trans youth and their parents’ experiences of healthcare, finding that there were numerous examples of: 1) professionals lacking experience and knowledge of trans health issues, 2) increase in mental distress caused by long wait-lists, 3) cisnormative assumptions on gender, which refers to the assumption that being cisgender (not transgender) are the default, and 4) direct discrimination from healthcare settings, with examples such as misgendering and deadnaming (these terms relate to the use of incorrect pronouns and using names that the person no longer uses).

The stigmatisation, marginalisation, and discrimination faced by TGD people have resulted in elevated risk of poor mental health, including suicidality, depression, and anxiety (Rotondi et al, 2012; Budge et al, 2013). Recent surveys purport suicidal ideation at 84% across the lifetime for TGD people and attempt at 48% (McNeil et al, 2012). There is growing evidence that societal transphobia (anti-transgender bias, non-affirmation) underpins the elevated mental health disparity, and more attention is being placed on how mental health services can help prevent and intervene on these issues (Barr, 2018)

Now, I want to bring to your attention the paper I will review and offer my own insights today. Strauss et al. (2020) report on findings from the Trans Pathways study and their aim is to explore the experiences of TGD people in Australia who have accessed mental health support (including counsellors, therapists, psychiatrists, and/or inpatient healthcare providers).

The stigmatisation, marginalisation, and discrimination faced by TGD people have resulted in elevated risk of poor mental health, especially suicidality, but also other mental health conditions, such as anxiety and depression.

Methods

Trans Pathways is a national cross-sectional survey, which examines the mental health of TGD people and their experiences with services, based in Australia.

The study itself is co-produced with TGD community members, which included TGD people in the development of the study, and focuses questions on drivers of mental health difficulties, barriers to mental health services, and positive influences on mental health.

The study was conducted online and recruitment focused on various social media groups, support groups, gender identity clinics, and word of mouth. The authors give a brief overview of measures included, which consist of open-ended questions on reasons for accessing a service, age at when they attempted to access a service, how long they waited, and frequency of access attempts. Services were scored on a five-point Likert scale in terms of satisfaction, and whether service members were respectful of their gender.

Results

A total of 859 TGD people were recruited to Trans Pathways and were aged between 14 and 25:

29% reported their gender as trans male
15% as trans female
48.5% as non-binary.

Services

The authors provided a detailed summary of which services were accessed, giving differences by the sex assigned at birth, frequency, how long the participants had to wait before being seen at the service, satisfaction with services, and whether their gender was respected. They indicated that mental health services were commonly accessed by those under the age of 18, whereas psychiatric services were more commonly accessed by over 18 year olds. The authors highlight that “male assigned at birth” participants more commonly accessed psychiatric services (~52% compared to ~40%).

Therapy and counselling

A majority under the age of 18 had accessed therapeutic services (59%) with considerably high satisfaction with regards to respect of gender (72%). Participants also experienced relatively short waiting times for their appointments with ~77% waiting one month or less. The reasons for this are complex, with some being seen so quickly due to a recent suicide attempt and already being in a hospital, and finding that those with suicidal thoughts and behaviours acted as a catalyst for being seen promptly.

Immediately, as I was in crisis when I wanted to see [a mental health professional] so they let me see them right away which was very lucky.

Other reasons for accessing services centred around depression, anxiety, and gender specific needs, as well as non-specific mental health concerns. Many of the expressions centred on needing help with “navigating the world” in their affirmed gender.

Experiences with a variety of mental health services were either somewhat poor or overwhelmingly poor for trans and gender diverse people.

This Australian survey found that experiences with a variety of mental health services were either somewhat poor or overwhelmingly poor for trans and gender diverse people.

Psychiatric services

In the reverse of the findings with therapeutic services, the authors suggested that psychiatric services were more commonly accessed by those who were over 18 years old.

In their sample, 64% of TGD people felt that psychiatric services were respectful of their gender identity, showing support of the person’s gender. Other positive experiences centred on the participant feeling that the psychiatrist was truly helping them and providing further assistance in transition.

However, the role of gatekeeping access to transition-related healthcare was expressed and seen negatively. Experiences here highlight the feeling that psychiatrists restricted the young person’s access to transition, and “acted in an uncompromising and even patronising manner”. Non-binary young people also felt they needed to hide their identity in order to access any help:

I lied and said I was a binary trans man to gain access to the services I needed. The psych was very focused on gender norms and binary identities, and I felt judged and ‘not trans enough’ because some of my hobbies are traditionally ‘feminine’ things.

Mental health inpatient services

Mental health services were found to be particularly lacking in respect of the young person’s gender and were rated as mostly unsatisfactory. Those who were under the age of 18 were more likely to attempt access to mental health inpatient services (56%). However, 7% stated they could not access inpatient services, despite trying. Reasons for accessing inpatient services mostly related to self-harm and suicidal ideation and/or attempt. Gender dysphoria played a role in some people seeking inpatient services, whereas others discussed mental health issues in relation to their gender.

Experiences appear negative, with some TGD young people reporting that their name and pronouns were not used, with providers instead opting to deadname and misgender the young person. Furthermore, despite some clinicians acting in a respectful manner, there were frequent experiences of transphobia and non-affirmative approaches to gender diversity.

Conclusions

The Trans Pathway study highlights a need for further training to improve clinicians’ knowledge on trans issues and provides a call for help from clinicians to better address the mental health disparity.

The trans pathway study highlights a need for further training to improve clinicians’ knowledge on trans issues and provides a call for help from clinicians to better address the mental health disparity.

Strengths and limitations

Trans Pathways is a fascinating study that I believe has contributed greatly to our understanding of TGD youth mental health experiences. The large sample size is granting us the ability to highlight the clear disparity in access and service experience.

However, something I consider important to discuss is the use of “sex assigned at birth” (SAAB). It is unclear why the emphasis is placed on SAAB when gender would be better placed to respect the identities of the participants. This is a common issue within trans health research and is rarely challenged. What are we saying when we place emphasis on SAAB? Basing analyses on SAAB comes across as unnecessary when including self-reported gender.

Furthermore, arguments around representativeness are also contested because there is little understanding of the true prevalence of trans people, due to the inherent difficulty in sampling those who are “closeted” or may not seek support from services or support groups (Miner et al, 2012). After searching the Summary of Results paper by the same authors it was found that 3.7% of the participants were Aboriginal and Torres Strait Islanders (Strauss et al, 2017). The authors indicate that this is representative of the aboriginal and Torres strait islander communities in Australia; however, there are no other demographic distributions by different ethnicities. This makes me question the wider applicability of the results to other minority ethnic groups of TGD people, who face additional barriers to mental health services due to the intersection of race and gender (Khatun, 2018; National LGBT Partnership, 2016).

Trans Pathways is a fascinating study that has contributed greatly to our understanding of TGD youth mental health experiences, the incredible sample size granting us the ability to highlight the clear disparity in access and service experience.

Trans Pathways is a fascinating study that has contributed greatly to our understanding of TGD youth mental health experiences, while its sample grants us the ability to highlight disparities in access and service experience.

Implications for practice

There are multiple means for improving the provision of mental healthcare for TGD young people, with a glaring need for better education of healthcare professionals. The authors highlight that there is evidence that healthcare professionals with appropriate and specific training on TGD issues, tend to exhibit more affirmative and positive attitudes (Riggs & Bartholomaeus, 2016). Mental health services and the professionals who work within the system need to become more proactive in reducing the mental health disparity. There is a need for clinicians to acknowledge implicit bias and work on reducing negative interactions they have with trans service users.

There is evidence that healthcare professionals with appropriate and specific training on TGD issues, tend to exhibit more affirmative and positive attitudes

There is evidence that healthcare professionals with appropriate and specific training on transgender and gender-diverse issues, tend to exhibit more affirmative and positive attitudes.

Statement of interests

None.

Links

Primary paper

Strauss, P., Lin, A., Winter, S., Waters, Z., Watson, V., Wright Toussaint, D., & Cook, A. (2020). Options and realities for trans and gender diverse young people receiving care in Australia’s mental health system: findings from Trans Pathways. Australian and New Zealand Journal of Psychiatry.

Other references

Barr, S. M. (2018). Understanding the relationship between anti-transgender bias, non-affirmation, and post-traumatic stress: a model of internalized transphobia-mediated post-traumatic stress.

Budge, S. L., Adelson, J. L., & Howard, K. A. (2013). Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. Journal of consulting and clinical psychology, 81(3), 545.

Carlile, A. (2020). The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England, UK: Interviews with members of a family support group. International Journal of Transgender Health, 21(1), 16-

Hughto, J. M. W., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social science & medicine, 147, 222-231.

Khatun, S. (2018). The coming out experiences of South Asian trans people living in the UK: an interpretative phenomenological analysis(Doctoral dissertation, City, University of London).

McNeil, J., Bailey, L., Ellis, S., Morton, J., & Regan, M. (2012). Trans mental health study 2012. Scottish Transgender Alliance. Available at: http://www. scottishtrans. org/wp-content/uploads/2013/03/trans_mh_study. pdf [accessed: 20 January 2021].

Miner, M. H., Bockting, W. O., Romine, R. S., & Raman, S. (2012). Conducting Internet research with the transgender population: Reaching broad samples and collecting valid data. Social science computer review, 30(2), 202-211.

National LGBT Partnership (2016). Trans health factsheet on BAME people. https://nationallgbtpartnershipdotorg.files.wordpress.com/2015/02/trans-health-factsheet-bame-final-may2016.pdf

Riggs, D. W., & Bartholomaeus, C. (2016). Australian mental health professionals’ competencies for working with trans clients: A comparative study. Psychology & Sexuality, 7(3), 225-238.

Rotondi, N. K., Bauer, G. R., Travers, R., Travers, A., Scanlon, K., & Kaay, M. (2012). Depression in male-to-female transgender Ontarians: results from the Trans PULSE Project. Canadian Journal of Community Mental Health, 30(2), 113-133.

Strauss, P., Cook, A., Winter, S., Watson, V., Wright-Toussaint, D., & Lin, A. (2017). Trans-Pathways: the mental health experiences and care pathways of trans young people-summary of results.

Photo credits

Talen is a PhD researcher and trans woman who researches and discusses current issues around LGB mental health, trans and gender diverse mental health, healthcare service access, and the impact of discrimination on trans and queer people’s lives. Her research centres on the experiences of trans and gender diverse peoples mental health, particularly suicidality, and how micro-aggressions and other social determinants increase and maintain risk on suicidal ideation, self-harm, and suicide attempt. Talen is also a co-investigator on an NIHR funded study at the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service (GIDs). This is a longitudinal prospective study examining the mental and social wellbeing of trans and gender diverse young people as they navigate the waiting list and throughout their time at the service. She is interested in qualitative and quantitative approaches to experiences of transgender mental health, gender and sexuality (LGBTQ+), and loneliness and social isolation; particularly keen on LGBTQ+ and non-binary experiences.