|DSM Diary: Part 3
|Jun 17, 2013
For a change, I decided to spend the morning at a research session unrelated to DSM5.
And I am amply rewarded, reminded that research and debate on classification systems is among the least interesting and clinically meaningful areas of research.
William Bunney is preoccupied with techniques to relieve depression within 24 hours rather than 4-6 weeks, and reviewed such low-tech interventions as sleep deprivation (and a theory that it changes gene expression in clock genes that control circadian rhythm), deep brain stimulation (not for first-time callers to the mental health system!) and ketamine intravenous infusions. All of these techniques produce reliable and reproducible improvements in 24 hours, but the challenge is to keep someone well.
A presentation on tic disorders in children covered the evolution from psychoanalysis through antipsychotic drugs to the latest in behaviour therapy (habit reversal therapy), with the head of child psychiatry at Weill Cornell arguing that drugs are rarely needed now. It's good to see child psychiatry moving beyond its late arrival to medications toward other evidence-based interventions. Similarly, a leader in obsessive compulsive disorder showed persuasive evidence that exposure and response prevention is likely the best approach to obsessive compulsive disorder, either alone or as an adjunct to antidepressants, and in her latest study antipsychotic drugs as an adjunct were no better than placebo and far worse than exposure and response prevention. The room never filled for this very rich and clinically relevant symposium.
I took my usual front-row seat early for a session I was sure would be packed to the gills: perspectives on good psychiatric management in the treatment of borderline personality disorder.
Presenters included my friend and CAMH colleague Shelley McMain who has done one of the major research clinical trials of dialectical behaviour therapy versus good psychiatric management in borderline personality disorder, along with Paul Links, a former Toronto colleague who is now Chair of Psychiatry at the University of Western Ontario. They were joined by John Gunderson of Harvard and the woman who runs Gunderson House, the extraordinarily expensive, 60-day inpatient unit at McLean Hospital. Surprisingly, the crowd was sparse - despite most attendees being clinicians.
Shelley presented the results of her major trial comparing dialectical behaviour therapy and good psychiatric management (GPM) in a randomized design. The bottom line at the end of treatment and two years later was no difference between the two.
John Gunderson went on to characterize GPM - or, as I described it in a question afterward, being a “generic psychiatric mensch”. It is now packaged as a specific form of treatment, complete with manuals, workshops, etc. It appears to be little beyond being a good psychiatrist. And, when I asked, they had not evaluated the GPM model for any condition other than borderline personality disorder.
For my final APA encounter, I attended a session on psychiatrists who write for the public, since this is something I do from time to time. About 100 people showed up.
It was chaired by Richard Friedman, who has written for the New York Times regularly over the last 10 years. Lloyd Sederer spoke next. He is now the mental health editor of the Huffington Post. Norman Rosenthal, a prolific author, followed him.
Sally Satel was the final speaker. She is the author of Drug Treatment: The Case for Coercion, PC MD (how political correctness is corrupting medicine) as well as the forthcoming Brainwashed: The Seductive Appeal of Mindless Neuroscience. She speaks skeptically of "neuro-entrepreneurs", who promote things like neuromarketing. She wrote her new book with some trepidation because she respects the vast majority of neuroscientists.
Ten years ago, she was the subject of a protest at the APA in San Francisco, describing her as a "right wing fanatic" because of her PC, MD book in which she critiqued the psychiatric survivor movement. The American Enterprise Institute gives her the freedom to write what she wants, especially in the policy realm. She acknowledges it as a right of centre place but describes herself as a centrist.
Her book One Nation Under Therapy is a challenge to the assumption of vulnerability in the wake of trauma. In her style of challenging assumptions, she finds thinking about addiction as a chronic and relapsing brain disease neither clinically helpful nor satisfying. She has also critiqued disability payments for veterans with PTSD who haven't been through any treatment at all. She gave a marvelous analogy to giving people full disability for a motor vehicle accident before they have had any surgery and rehabilitation. Diagnosis is not the same as prognosis. Despite all this, she doesn't embrace the title "right wing psychiatrist".
She spent the first five years of her academic career in substance abuse at Yale testing out new drugs for addiction. She was turned off by the “entitlement culture” at the VA where she worked and saw it as a barrier to rehabilitation.
People seemingly upset with her talk - the most engaging and provocative talk of the symposium - kept walking out as she spoke. It was an amazing display of intolerance.
I didn't learn anything special from this symposium, although it was interesting to see these very public voices in psychiatry in person. But it was an appropriate finale to the conference for me, after sitting for six hours per day over the last four days in windowless aircraft hangars.
The conference and the trip are over for me; I've discarded my admission badge and packed up my bag. I'm eager to be home. My suitcase is now weighted down with DSM5 publications – along with the sense that the new classification system is neither a major advance nor a major difference to the practice of my profession. It won’t make previously well people ill or previously ill people well. It’s a tool which, like all tools in medicine, requires clinical judgment in its use and respect for the larger individual, family and social context in which its many described symptoms reside.
DSM Diary: Part 2
|Jun 13, 2013
Another sunny and warm day, even at 6:45 a.m. as I approached the hall, where a 12-kilometre fun run (from the Bay to the Breakers) had started. There were over 50,000 participants (some running, some walking, some being carried aloft) having a ball, mostly in outlandish costumes and many men and women in no costume. As in completely naked. Jogging and being completely naked are not entirely compatible in terms of attractiveness, but relaxed pride in nudity was really something to see. It may have been a Guinness Book of Records event for collective happiness.
Fortunately, I got to the room for my morning symposium 30 minutes before it started, securing a front-row seat. Ten minutes before it started, every one of the hundreds of seats were taken. By 8 a.m., there were at least 100 people sitting on the floor.
Fun fact re DSM: They have changed from Roman to Arabic numerals from DSM-IV to DSM 5 in order to be in the lingo of upgraded computer software: there is already talk about DSM 5.1.
The session focused on treatments for bipolar disorder.
Roger McIntyre, a former resident of mine who is already a full professor, gave a talk full of evidence and rococo turn of phrase - "disambiguating data" - to make arguments for antipsychotic medications as primary treatments. Antidepressants took a drubbing and lithium was modestly sustained.
John Geddes, the Oxford psychiatrist who designed the BALANCE effectiveness trial of lithium in Europe (which showed it to be superior to Epival), sat near me in the front row. Afterward, he and I had a chat and I asked why ECT
(electroconvulsive therapy) had not been mentioned once in a discussion of treatment of acute mania and depression in bipolar disorder. He agreed and it is included in his Lancet review
of treatments for bipolar disorder published last week.
DSM5 and Depression:
The session on DSM5 and depression
featured major luminaries. Once again, the changes to depression seemed stunningly minor, even the controversial removal of the bereavement exclusion criterion for making a diagnosis - which is offset by ample text in DSM5 that explains the differences between grief and depression, more so than in past editions (including the one edited by Allen Frances).
My notes from a talk by Sidney Zisook, an expert on grief, on Major Depressive Disorder and the bereavement exclusion include this statement: THE DECISION INEVITABLY REQUIRES THE EXERCISE OF CLINICAL JUDGMENT BASED ON AN INDIVIDUAL'S HISTORY AND CULTURAL NORMS. There are also some helpful tools in a footnote to differentiate grief from a Major Depressive Episode (MDE) and p.168 has more on normal sadness.
According to Sidney Zisook, Allen Frances saw DSM5 approval by the Board of Trustees of APA as "the saddest day" of his career. His objections (and Sidney Zisook's responses in parentheses) are summarized below:
- Bereavement is a normal response (most bereaved individuals do not experience MDE)
- Bereavement symptoms not likely to recur (not upheld by science; they do recur if you control for severity and persistence)
- Even with bereavement exclusion in place in DSM-IV, diagnosis of severe cases is still possible (but MDE is a diagnosis with a range of symptoms)
- Medicalizes sadness and grief (Huh? studies show that deaths in breast cancer and heart disease are higher in bereaved individuals. Does that medicalize grief?)
- DSM5 limits bereavement to 2 weeks (grief can last a lifetime without being MDE, or if grief lasts> 2 weeks it will not automatically be diagnosed as MDE)
- Pharma bonanza (studies have shown for years that antidepressants work for bereaved individuals with MDE symptoms and there is no rush for a new indication; plus, the DSM is not a treatment manual).
Acute grief is a difficult, emotionally taxing process that often lasts longer than two months, whether or not there is a co-occuring MDE. Removing the bereavement exclusion criterion does not medicalize grief, does not stigmatize the bereaved person, does not imply that grief morphs into depression after two weeks or two months, does not place a time limit on grief, and does not mean antidepressants should be prescribed. It opens the door to careful clinical attention and allows the clinician to provide education, support and treatment, according to Zisook.
I left the room with the sense that the "sky is falling" pronouncements on DSM5 were over-vaunted.
This is the second of three blogs written by Dr. David Goldbloom about his experience at
the annual meeting of the American Psychiatric Association where the
DSM5 was officially released. Stay tuned for Part 3 that will expolre new research into clinical treatments for depression and borderline personality disorder. Click to read Part 1.
DSM Diary: Part 1
|Jun 10, 2013
I have always kept travel diaries, if only to remind myself of where I have been, what I’ve eaten and what I’ve done, given the unreliability of my memory. They are not usually about work but rather about escape from work. What follows is a distilled account, leaving out excruciating details of my hotel room and meals that bookended the 6 hours per day of psychiatric meetings in windowless rooms that I dutifully attended. The launch of a new diagnostic coding system seemed a nodal event in psychiatric history, at least based on media coverage. It turned out to be something rather less than the discovery of penicillin, fire, or even falafel.
May 17, 2013
It has been probably a decade since I attended the annual meeting of the American Psychiatric Association
(APA) – a mammoth, overwhelming conference, typically attracting 20,000 psychiatrists from around the world.
This year heralds the release of DSM5,
an event that should be dry and technical but instead has captured the public imagination and stirred controversy and fear about the encroaching medicalization of human experience – not to mention the fear of the threat to our identities that mental illness poses. As I am in the midst of writing a book about psychiatry for the general public, this seemed like an opportune "field work" research endeavour.
On the evening flight to San Francisco, the plane was loaded with more psychiatrists than the 13/100,000 population ratio that exists in Canada. Had the plane gone down there would have been a sudden and major service gap.
May 18, 2013
The massive Moscone Convention Center, which spreads out over many city blocks, was jammed by 8 a.m. with psychiatrists from around the globe registering for the meeting. I stood in the kind of line usually associated with airport security to get my badge, guidebook and bag. The course on DSM5 I wanted to attend was sold out.
Then I moved into the eye of the storm - the APA bookstore. Thousands of copies of DSM5 and the cottage industry of related books were flying off the shelves, with long queues to pay like people waiting for tickets to a rock concert. I joined in, lured by the 20 per cent discount for members as well as the need to "drink the Kool-Aid" and familiarize myself with the new diagnostic criteria.
I emerged into the warm sunlight and a large protest group chanting "Hey, hey, APA, how many kids did you drug today?" and waving placards that said “Childhood is not a disease”. Nearby, a truck with a large video screen and loudspeakers played a film denouncing the DSM, complete with interviews with psychiatrists and psychologists describing the committee work and voting process as less than science. In other words, the annual conference was in full session.
I went back inside for an afternoon session on anxiety disorders and DSM5. There are now fewer such diagnoses, a vaunted but only technical victory - because OCD
have been moved to other chapters and agoraphobia has been simplified. These are imperceptible alterations, like invisible weaving. The same applies for panic attacks, panic disorders, generalized anxiety disorder and social anxiety disorder. It made me realize that I didn't know the old criteria in the kind of talmudic detail that would allow me to recognize each of the slight changes.
This is the first of three blogs written by Dr. David Goldbloom about his experience at the annual meeting of the American Psychiatric Association where the DSM5 was officially released. Stay tuned for Part 2, when the controversial new
bereavement amendment will be put under the spotlight.
Saturday Star section on CAMH: the inside scoop.
|Jun 06, 2013
Over the past four weeks, the Toronto Star has taken an inside look into some of the stories that shape CAMH. On June 8, CAMH will be featured in a special supplement themed ‘closing the gap’ which profiles the many ways we work to help transform the lives of those we serve. From research and innovation to clinical treatment and community supports, CAMH is breaking new ground and giving hope to those with addiction and mental illness.
CAMH client Cassandra is interviewed by the Toronto Star about her experience in the Partial Hospital Program.
Science that serves people and leads to more effective treatment is at the core of CAMH’s research enterprise. This is made evident by Dr. Jim Kennedy’s work in the area of personalized medicine and Dr. Romina Mizrahi’s work on stress factors and psychosis. The special supplement looks at the work happening at CAMH’s PET Centre and the Tanenbaum Centre for Pharmacogenetics to show the impact behind the science, speaking with clients who have benefitted from CAMH innovations.
Affecting change to help our clients live their best lives is a theme that emerges from CAMH’s clinical programming. The special Toronto Star section provides an exclusive look at CAMH’s new Irma Brydson Inpatient Unit for Youth with Concurrent Disorders and how staff work closely to provide specialized, client and family-centred care to some of the most vulnerable youth in the province. Client stories including Cassandra (pictured above) from CAMH's Partial Hospital Program show that with treatment and support, people with mental illness and addictions can live successfully in the community.
It’s the people who make an organization great, and CAMH is privileged to have many outstanding leaders who are shaping the future of mental health. This includes Dr. Peter Szatmari, head of our new collaboration with Sickkids to develop an integrated Child and Youth Mental Health Program. Dr. Aristotle Voineskos who has risen from student to leading scientist guiding the work of new residents in the Kimel Family Translational Imaging-Genetics Laboratory, is also featured.
These and many more CAMH stories will be featrued in the Toronto Star this weekend, so pick up a copy and let us know what you think!
What is clozapine’s role in treatment of schizophrenia?
|May 16, 2013
Although the antipsychotic drug clozapine was released in the early 1970s for the treatment of schizophrenia, there is still debate on when the drug should be used.
Clozapine remains the treatment of choice for schizophrenia when other drugs have only an incomplete response; however, in Canada, clozapine can only be prescribed when two other drugs have failed. In part, this is because of a low risk of adverse effects on white blood cell production that requires mandatory blood testing in patients receiving the drug.
CAMH’s Gary Remington and colleagues recently reviewed the research literature on clozapine, with the aim of advising clinicians whether the drug should be the first-, second- or third-line treatment of first-episode schizophrenia. Since early and effective treatment in schizophrenia is known to improve outcomes, the group felt that early use of clozapine – proven more effective when other drugs fail – might enhance and maintain response sooner, improving the illness’s outcome.
In the results, published in the American Journal of Psychiatry, Dr. Remington concluded that there are still “simply not enough data” in the clinical literature to answer this important question. The authors strongly argue for new clinical drug trials to provide the answer, as “many individuals with schizophrenia continue to do poorly.”
The review findings will probably disappoint most readers who might well assume that evidence-based clinical guidelines would already have been established for a 40-year old antipsychotic drug. The publication also illustrates the continuing need for rigorous clinical trial studies to determine whether clinical impressions of drug effectiveness are based on sound evidence.
SAPACCY Reaches out to LGBTQ Youth
|May 10, 2013
CAMH therapist Leo Edwards knows the work he’s doing in the Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) is important. Treating African Canadian and Caribbean youth who have substance use and mental health challenges is significant and now they have also taken on the task of treating black youth who identify as LGBTQ.
“We saw that LGBTQ youth were falling through the cracks,” Leo says. “We felt there was an opportunity for SAPACCY to focus on this group and provide them with care and support.”
The first program of its kind in Canada, SAPACCY provides clinical care for clients who have substance abuse and mental health challenges as well as issues around identity and sexual orientation. Clients can refer themselves or be referred by family members, schools or other LGBTQ organizations like the 519 Church Street Community Centre or the Black Coalition for AIDS Prevention.
At times work with LGBTQ black youth precedes traditional addiction and mental health treatment. Including elements of the Nugzo Saba, seven principles of African heritage that include unity, self determination and faith to create a sense of community, makes the SAPACCY program unique. Using these principles in collaboration with mainstream theoretical framework such as cognitive behavioural therapy and motivational interviewing give clients a well rounded experience.
“As black people we are a community. Our experiences are community based. Because we are wrapped in the same skin, though our individual experiences may be different, we share a common community based on our racial identity,” Leo says that this makes clients feel comfortable. “When the youth come in, you can see a sense of relief, a sense of familiarity. This person might get my story.”
In addition to therapy, community engagements and advocacy for clients, the program works with youth to create a treatment plan, set goals, help to integrate them back in to a school system and improve family dynamics. It works to provide a safe place for youth to express themselves and feel empowered in a society that they constantly feel rejected in.
For youth in this community, stigma is a serious problem
“There’s a lot of stigma in our community around being LGBTQ,” Leo explained, “LGBTQ black youth that misuse substances or have mental health issues have a multi-layered and intersecting experience of oppression of not just being black but being a minority based on their sexual orientation.” The work to change attitudes begins in the black community at large, “There needs to be a shift in our own communities. In the dominant black community there’s still a lot of stigma and homophobia within. Once those attitudes start to shift, it will open up doors for our youth that are LGBTQ to get the help they need."
Parents of youth in this program are also offered support. “Many times parents of LGBTQ clients have issues accepting that their child is LGBTQ. On top of an addiction or substance misuse there’s a lot of stigma for parents.” Parents are invited to participate in therapy sessions where their feelings can be addressed and can begin to do the work to accept their child for who they are and work with the child to make the right choices in their life. Working with family members has proven to be successful.
Upcoming SAPACCY Programs
Going forward, SAPACCY hopes to create workshops for black LGBTQ youth in areas like relationships, career assistance and school. From May 15 until July 17 between 4:30 p.m. and 6 p.m. SAPACCY is running a support group to understand substance abuse triggers at 80 Workman Way. They are also running a family support group in June.
Mental illness and the law: a revealing look at the NCR process
|May 09, 2013
This past weekend I found myself in a sold-out theatre taking in John Kastner’s film NCR: Not Criminally Responsible at the Hot Docs Film fest. The documentary tells the story of a man, Sean Clifton, who is found NCR after stabbing a woman in a mall parking lot. The timing of its release is perfect. We couldn’t be at a more critical time in history given the federal government’s proposed changes to the NCR defense.
The film was an unprecedented look into the lives of the patient, the victim and the staff of the Brockville Mental Health Centre where Sean Clifton was treated. In my view, the development of the film came with great risk. During a time of sensationalized stories and emotional debate, revealing such intimate details and personal stories can serve to further drive a wedge between opposite sides of the issue.
As we strive to eliminate the criminalization of mental illness, are we courting more controversy by showing the dimensions of these complex illnesses and revealing the vulnerabilities of the patients, victims and the mental health care system?
I don’t think so.
I was personally overwhelmed with the extraordinary courage shown by the patient, the victim and her family, and the health care professionals. The human face that Kastner portrays is compelling, and as someone who advocates on behalf of the mentally ill, it is exactly what is missing in our day-to-day efforts to break down prejudice and discrimination and advocate for better treatment and supports in the mental health care system.
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As any good documentary does, it left me with lots of questions to ponder. During one of my favourite moments, a local resident strikes up a “normal” conversation with Clifton in a coffee shop where he reveals to her that he struggles with mental illness and there is a film being made about him. She asks him for his autograph and wishes him well. It made me wonder if the small size of the community of Brockville and the visibility of the mental health centre helps to close the gap in the understanding of these illnesses. Is the visibility and proximity to serious mental illness the antidote to discrimination and stigma? If that is true, how can we close the gap in understanding within large and diverse communities right across the country?
There was one important issue that Kastner glosses over – the fact that Clifton tried to get help right before committing the offense and was turned away from the health care system. While it’s difficult to know what happened in this situation without the details, it certainly hints at the great challenges we have to overcome in providing timely care and supports right across the health care system.
For a sector that needs more personal stories, this film lends a powerful narrative at a critical point in time. In the discussion after the film, Kastner encouraged people to write to their political representatives about the NCR legislation. With Clifton himself sitting in the audience, isn’t that a great way to honour his road to recovery and his courage to tell his story?
Taking a human rights look at mental health
|May 08, 2013
Last fall, the Ontario Human Rights Commission released Minds that Matter, a report on our consultation on human rights, mental health and addictions. This was the biggest consultation in our history; we heard from more than 1,500 people across Ontario, who told us their stories of discrimination, harassment and inequality.
We heard how stereotypes and negative societal attitudes are found in legislation, institutional policies and practices. And we heard how these attitudes cause widespread discrimination in housing, employment and services.
We learned that many people don’t know they have the right to be free from discrimination because of mental illness, and, if they do, they’re not sure what to do when their rights are violated. In workplaces, many employers don’t know they have a legal duty to accommodate workers with mental illness or addictions.
People told us about the lack of children’s mental health services, about problems getting help in the years between childhood and adulthood, and problems in schools, colleges and universities.
So what can we do? Our report has 54 recommendations for government, employers, housing providers, service providers and other organizations. For example, municipalities need to look at their zoning and licensing bylaws to make sure they treat housing for people with mental health issues or addictions the same as other housing, and work to get rid of NIMBYism.
Many people talked about not getting jobs or volunteer positions because police record checks included health issues. That’s why we recommend that the Ontario Association of Chiefs of Police (OACP) actively promote their new police record check guidelines across police services, vulnerable sector agencies and other employers including the Government of Ontario.
OHRC's commitment to eliminate discrimination:
We also made 26 commitments for ourselves. Our forthcoming Mental Health policy will provide concrete steps for people and organizations to eliminate the barriers and discrimination that are so common today. We need more education on human rights for employers, employees and unions. We will provide it and focus on human rights, mental health and addictions. We’ll take legal steps when people are being discriminated against because of mental illness, in workplaces, schools and healthcare.
Getting rid of barriers faced by people with mental health issues or addictions is a big job – changing attitudes and behaviour that have existed for a long, long time. Many people are working on it. The consumer/survivor movement and people with addictions advocate for equality. They too are drivers for change – and must be active partners in making real systemic change.
The OHRC brings a human rights perspective to how to bring down the walls. We all have responsibility for making things better for tomorrow. Minds that Matter sets the stage for us to do that … one step at a time.
You can follow the OHRC on:
The time for youth leaders is now
|May 07, 2013
“I have the right to Mini-Wheats instead of Shreddies for breakfast”, that was my first complaint to Ontario’s Office of the Provincial Advocate for Children & Advocate a decade ago. A lot has changed since I was a teenager but what hasn’t changed is my passion for the rights of children and youth with mental illness or advocating as a former Crown Ward.
To give you some background, I was born to a single mother with mental illness, witnessed the toll my grandmother’s Alzheimer’s diagnosis took on our family, and when I was 13 I was diagnosed as having clinical depression and severe anxiety. I became a Crown Ward of Children’s Aid at the age of 9 and lived in 16 different group homes and foster homes until being discharged when I was 18.
Throughout my time as a client of the mental health system my style of advocacy has been described as outspoken, progressive, and a small minority has even called me aggressive. The fact of the matter is that I am fed up with the lack of youth leadership when it comes to mental health advocacy.
Youth are the ultimate stakeholders when it comes to the care they receive and could be life changing. I’ve been involved in a lot of initiatives when it comes to giving feedback on implementing much needed changes to the youth mental health system. Few organizations have taken the steps to creating change, except one.
Last September I was offered the chance to sit on CAMH’s Service User Expert Panel which will collectively be making recommendations on how to improve the youth mental health and addiction’s system in Ontario. I made it clear that a panel about youth needed to have one leading the panel. After all, young people have life experiences that are just as valuable as professional experience.
I am proud to have been appointed the co-Chairman of this Panel. CAMH has always been a leader when it comes to mental health and addictions. This is just the beginning and I encourage all mental health executives to take the chance on youth leadership. CAMH has, and you too could be pleasantly surprised!
Explore Mental Health with CAMH and TVO
|May 02, 2013
To mark Mental Health Week, CAMH and TVO have partnered for the second Mental Health Matters series. From May 3 to 12, tune in to TVO’s The Agenda for a week of programming dedicated to mental health issues and featuring CAMH clients and experts. The Agenda airs weeknights at 8pm.
Join the discussion on social media:
You can also participate in the discussion on social media by using the Twitter hashtag #MHmatters and through the CAMH and The Agenda’s Facebook pages.
Friday, May 3: Innovations in Mental Health
A look at some of the innovations driving the future of mental health. Viewers and attendees will get the chance to learn about some of the cutting-edge research being conducted at CAMH and to see its practical and clinical applications with patients and clients.
CAMH innovators include:
- Dr. George Foussias, co-inventor of a virtual reality tool used by CAMH scientists to gage motivational factors in clients with schizophrenia to help patients live better in the community.
- Dr. Jim Kennedy positioning CAMH as a leader in delivering personalized medicine for people with mental illness.
- Dr. Jeff Daskalakis, whose work in experimental brain stimulation therapies is poised to bring non-invasive, non-pharmaceutical treatments for severe depression and bipolar disorder to the mainstream.
- Dr. Sean Kidd and Narinder Dhami, whose efforts in micro financing are helping put meaningful employment – and its related psychosocial benefits – within reach of entrepreneurs with mental health and addictions challenges.
Monday May 6: The Risk of Immigration
Is immigration good for your mental health? How do immigrants cope with the emotional pressures of leaving home? How resilient does one have to be to be able to create a new life for oneself in a foreign country? How does a country like Canada, which depends on the ongoing inflow of immigrants, deal with immigration-induced mental illness?
Dr. Kwame McKenzie, Senior Scientist with the Health Services and Health Equity Research.
Tuesday May 7: Resilience in Children
Why do some children seem to constantly worry while others seem to breeze through life? Do those traits follow people into adulthood? We will look at why some individuals are more resilient than others and look at the importance of developing resiliency in the efforts to attain good mental health.
David Wolfe, RBC Chair in Children’s Mental Health and CAMH Centre for Prevention Science in London, Ontario .
Wednesday May 8: Aboriginal Mental Health
Last month, the Neskantaga First Nation in northern Ontario declared a state of emergency following two suicides in one week, the fourth suicide in a year, not counting 20 other attempts. Neskantaga, and some of the other remote First Nations in Nishnawbe Aski Nation face a much higher suicide rate than the rest of Canada. Yet, other First Nations saw a decline in the number of suicides and some, no suicides at all. Why are some communities overwhelmed with suicides and others suicide-free? How can communities in crisis cope and prevent further suicides? Can traditional mental health approaches treat the hopeless and despair in these First Nations communities?
Dr. Cornelia Wieman, psychiatrist, Indigenous Health Research.
Thursday May 9: When Anxiety Attacks
Anxiety disorders may be as pervasive a condition as depression and yet, still not publically discussed as widely as depression has been in the past few years. We’ll examine the research around anxiety disorders, the best treatments for it and talk to people who have learned to live with and manage it.
Dr. Judith Laposa, psychologist, Anxiety Disorders Clinic.
Dr. Zindel Segal, head of the Cognitive Behaviour Therapy Clinic.
Friday May 10: More Anxious Than Ever?
Are we collectively more stressed and anxious than ever before? Is it because of the rapid pace of technological change, economic pessimism, stories of ecological doom, or just a feeling of being individually disconnected? Join us as we analyze our collective angst and discuss what our cities and communities need to help people cope.
Children’s Mental Health Week 2013: Our Kids Deserve More
|May 01, 2013
May 5-11 is Children’s Mental Health Week in Ontario. Dr. Peter Szatmari, Chief of the Child and Youth Mental Health Collaborative, describes how we are moving forward to improve mental health care for young people.
It’s hard to read the newspapers these days and not be struck by the way in which mental health challenges faced by children and youth pervade all aspects of modern life. The names of Ashley Smith, Amanda Todd and Rehtaeh Parsons provide obvious examples of events with incredibly tragic outcomes. The suffering of these young people and the way in which the mental health system failed them is painful to read. But there are other stories in the papers in which mental health challenges are an important undercurrent. Stories about traffic accidents caused by “reckless” youth, reports about the epidemic of obesity in young people “addicted to the internet” or the rates of unemployment in those who leave high school early, all force us to realize that the only way to tackle these issues is to address the mental health challenges of children and adolescents in the21st century in Canada.
We often hear that 1 in 5 children and youth suffer from a mental health challenge. This is true but it is based on data which are more than 30 years old. We have no idea whether these rates have gone up or down with the increasing fragmentation of families, the recession, and the challenges that families face to find good housing and a safe environment. Only a small minority of children and youth with mental disorders are able to access services for mental health (20%) but again this is based on old data. It is possible that this figure is even lower today, as the mental health system for children and youth becomes even more overloaded, fractured, and characterized by intolerable wait lists.
It is ironic that along with these challenges in the system, the evidence base in child and adolescent mental health has exploded in recent years. We now have a range of effective treatments for disorders that were considered “intractable” a few years ago. Our knowledge of the social determinants of mental health and the developmental neuroscience of mental illness in children and youth has grown at a pace comparable to any other field in health over the last few years. The contrast between what we know and what we need to do is a chasm that is hard to view without increasing frustration.
The role of the Child and Youth Mental Health Collaborative supported by CAMH, SickKids and the University of Toronto, of which I am Chief, is to address this chasm in partnership with the community. This is a problem that we as a community need to address.The role of the Collaborative is to be a model of an efficient, evidence based service, to provide mental health expertise that cannot be accessed elsewhere in the city, and to be a knowledge translation broker bringing a critical, but constructive, view of the empirical evidence so that the newspapers are no longer filled with the stories of the failure of our system. Our children and youth and their parents deserve more than opinions, they deserve a new determination among all of us to make our communities a safe and nurturing, and “kid friendly” place to grow up.
|Apr 16, 2013
By: Dr. Catherine Zahn, CAMH President and CEO Tuesday April 16, 2013
Yesterday, CAMH and MaRS Discovery District partnered with TVO for our second of three “Innovations in Mental Health” events. We’re proud to bring you catalytic conversations about the health issue of our century – mental health.
When thinking about innovation, our minds usually go straight to technology – to machines and computers. But innovation also lives in ideas and approaches. When it comes to the complexities of mental illness, there’s been a dramatic innovation in the last decade – and it’s not all about equipment.
The “what” of the new thinking is that mental illness resides in the processes we develop to adapt to our environment. It includes an acknowledgement of the way society identifies, labels and deals with our reactions to a life situation. It’s the interface between the brain and its environment.
The past decade has yielded major advances in our understanding of brain structure and function. Of course, there’s a long tradition of inquiry into the impact of environment and social factors – of life experiences and human interaction – on mental health. Now, we appreciate that the approaches are not mutually exclusive!
What’s really exciting is the “how.” In the past, we talked about a particular region of the brain or brain chemicals. Now, we talk about the way the brain develops, forms and actually changes in response to an environmental challenge.
We used to talk about genetic traits or the order of base pairs in our DNA. Now, we talk about phenotype (the way we present to the world) and epigenetics (the way genes become active or inactive – the way stem cells are stimulated to differentiate and brain circuits motivated to reorganize).
New approaches will produce targets for intervention in mental illness from health promotion and prevention to rehabilitation and recovery. Those approaches will be based on a solid understanding of the causes of mental illness. We showcased a few of these at our CAMH-MaRS Innovation event yesterday: virtual reality, personalized medicine, magnetic brain stimulation, social enterprise and patient entrepreneurship – exciting, inspiring, hopeful.
Hope is essential in creating a movement. In the spring of 2013, there’s every reason to be hopeful.
Mental Health Matters to Canadians
|Apr 09, 2013
Last year, CAMH collaborated with TVO to create Mental Health Matters – an award-winning
series devoted to the in-depth exploration of mental health in our society right across the network, including children’s and documentary programming. We are proud to share the news that CAMH is again working closely with TVO and The Agenda with Steve Paikin
on the second Mental Health Matters series to be broadcast every evening at 8pm and again at 11 pm during Canada’s National Mental Health Week
(May 6 – 12, 2013).
Throughout the week, CAMH clients and experts will discuss the impact of mental health issues including anxiety disorders, suicide among Aboriginal youth, building resilience in young people, and the emotional pressures of immigration to Canada. Addiction and mental health issues will also be explored through exclusive online content to be featured on the Mental Health Matters website beginning April 22.
TVO’s live webcast on April 15 of the CAMH/MaRS/TVO event “Innovations in Mental Health: Igniting Discovery, Delivering on Hope” featuring some of the most innovative developments in mental health care kicks off Mental Health Matters 2013.
Join the discussion on social media:
You can also participate in the discussion on social media by using the Twitter hashtag #MHmatters and through the CAMH and The Agenda’s Facebook pages.
Igniting Discovery at MaRS
|Mar 26, 2013
MaRS, CAMH, and TVO's The Agenda with Steve Paikin are pleased to present Innovations in Mental Health: Igniting Discovery, delivering on hope on April 15 at 6pm.
From personalized medicine to social enterprise, an expert panel will present some of the most innovative developments in care, and their exciting implications for our world today and tomorrow.
Dr. Catherine Zahn, President and CEO of CAMH, and Dr. Ilse Treurnicht, CEO, MaRS Discovery District, will be joined by panelists:
- Dr. George Foussias, co-inventor of the virtual reality tool used by CAMH scientists to help patients live better in the community.
- Dr. Jim Kennedy, who leads Canada’s most promising foray into delivering personalized medicine for people with mental illness.
- Dr. Jeff Daskalakis, whose work in experimental brain stimulation therapies is poised to bring non-invasive, non-pharmaceutical treatments for severe depression and bipolar disorder to the mainstream.
- Dr. Sean Kidd and Narinder Dhami, whose efforts are helping put meaningful employment – and its related psychosocial benefits – within reach of entrepreneurs with mental health and addictions challenges.
available seating for this MaRS/CAMH/TVO event has now been SOLD OUT.
Online access to the live event will be available on TVOs Mental Health Matters website starting at 6:00 pm on April 15, along with a live web chat, and on Twitter #marscamh.
Can web-based therapy help college students who are perfectionists?
|Mar 14, 2013
When I attended college it was a rare student who worried whether a “B” grade on a test indicated “failure.”
Today, many university st
udents now set such impossibly high standards and overly critical self-evaluations that they suffer from stress, anxiety,
other psychiatric illnesses, and lack of success, because of this often disabling “maladaptive” perfectionism.
CAMH scientists Natasha Radhu, Jeff Daskalakis, and York University professor Dr. Paul Ritvo screened nearly 1,000 students at an urban Canadian university finding that, surprisingly, about 25 per cent qualified as perfectionists.
Then they measured maladaptive perfectionism among students who had received an internet web-based cognitive-behavioural therapy (CBT) lasting 12 weeks. They were compared to a control group who were on a “wait-list” (see the American Journal of College Health
for more details). At the end of the therapy, the CBT group showed decreases in anxiety and negative thoughts versus the control group.
This study suggests that a web-based CBT intervention might help some students who are overly perfectionist—especially those who find it difficult to interact in person with a health professional. The study does need to be replicated in a larger number of participants, but web-based interventions have the advantage of being low cost and easily accessible.
It seems to me, however, that although such behavioural therapy may well be helpful, there should be just as much emphasis on trying to change the external factors responsible for the belief that anything "less than perfect is unacceptable." These include parents and college teachers having unreasonable expectations, peer pressure and competition, and the economic recession with limited employment.