Possible Markers For Mental Illness Discovered

Here is a link to a research article which says that they might have discovered the genetic markers that causes mental illness. This discovery will improve treatment outcomes for those with a mental illness.

http://www.sciencedaily.com/releases/2007/12/071203190604.htm

What Does Recovery Mean to Me?

When I was sick I was always suffering from something. I used to go back and forth between positive and negative symptoms.

I used to suffer from both visual and auditory hallucinations. I used to hear voices telling me to kill myself. I used to see transparent animals move around and change shapes on the ceiling.

I spent all my time just pacing the floor, smoking, and drinking coffee. I never sat down any longer than five minutes and I never hardly sat down at all. The reason for this was the side effects of my medication.

There were also times when I abused drugs and alcohol. I was stoned and drunk from the time I woke up until the time I went to bed. As a result of this my hallucinations were more severe than they were when I wasn't using.

I also used to suffer from delusions. I thought that God and Satan were living inside me battling for control of my mind. Either to do good or to do evil. I also thought that I was possessed by a legion of demons. There were times that I believed that I had to die because I was an evil and wicked person. As a result of this I was suicidal and did attempt suicide here and there.

As a result of negative symptoms I didn't do much concerning activities. I only got a shower every two or three weeks. When I tried to read I didn't even last five minutes and I couldn't remember one word that I read.

I wasn't able to cook any meals. When I attempted to do housework I had to stop after five minutes. When Dad wanted me to take wood in I didn't last any longer than five minutes for this activity either. I couldn't even concentrate to watch movies. When I was able to watch a movie I had to pace the floor back and forth while I watched it. I just couldn't sit still.

I was also paranoid quite often. I used to think that people were talking about me. I could hear their thoughts and words inside my mind. Their thoughts used to tell me disturbing things. I also thought that they could read my thoughts thus knowing all my evil secrets I kept in my mind.

Many times when I went out into public like to a restaurant to have coffee I couldn't stay. I had to leave because of my paranoia. Because of this I didn't go out much and just stayed home. But I did have a couple of friends that used to visit me at home. I also used to visit them too. The only people I had contact with was my family, and the few friends that I had.

So: What does recovery mean to me? Overcoming all of these experiences. There is no cure for schizophrenia but recovery is still truly possible. I am presently recovering from both my schizophrenia and my addiction problem.

How am I recovering? First of all my positive symptoms are under control as a result of my medication. I no longer suffer from both visual and auditory hallucinations. I no longer suffer from delusions that defy reason.

I also no longer suffer from negative symptoms. My wife and I cook meals together. We do laundry together. We do housework together. I spend many hours writing for my blogs and the schizophrenia newsletter that I have started. I worked full time at a Candle Factory for five years. At the present moment I have been laid off from that job for a year now. But I still work when given the opportunity. I also spend a fair amount of time reading. I can now concentrate to read for long periods of time. I no longer have to pace the floor. I can sit and relax for long periods of time. I also have a real good social life. I go out to different get together's to socialize with others. I have many friends in my life. I also have a wonderful relationship with my wife. We love each other more than words can describe. She is my companion and my best friend in this world. When I was sick I wasn't able to maintain an intimate relationship with the opposite sex. As a result I didn't have that many girlfriends in my life. I was very lonely because of this. But I am not lonely now because I have my wife.

This is what recovery means to me. I hope that my story gives you faith, hope, and courage not to give up and continue to seek recovery from whatever mental illness and/or addiction that you may have.

Involuntary Psychiatric Treatment Act

An Interview by Tony Legere with
Dr. David Mulhall Concerning the
Involuntary Psychiatric Treatment Act


Q. Dr. Mulhall, at the beginning of the Act it says that in order to receive involuntary treatment you need to have a psychiatric disorder, to be a danger to yourself or others, to suffer from serious physical impairment or serious mental deterioration. What does serious physical impairment and serious mental deterioration mean?

A. An example of serious physical impairment would be if somebody with a physical illness, such as diabetes, refuses to take their diabetic medication because, as a result of their psychiatric illness, they believe that the medication is poison, the diabetes could get out of control. It means that if there’s a failure to treat now there might be deterioration of the person physically..

An example of somebody with mental deterioration is that if they are failing to follow treatment including taking their medication, their fears and false beliefs become greater and greater. They would take less care of themselves, or be more fearful, or be angry towards others, and become more lost in their illness. The Act allows for people to have treatment before their illness progresses.

For voluntary admission the Act says that the person must understand and have the capacity to make a treatment decision concerning the nature of their condition for which treatment is proposed, the nature and purpose of the treatment, the benefits involved in the specific treatment, and the risks of not going into treatment.


Q. How does a physician determine if the patient has the capacity to understand these treatment options?

A. First of all it’s important to remember that most patients, 90% or more, are voluntary patients. They recognize that they have difficulties, they are agreeable to treatment, and they are making voluntary and capable decisions regarding coming into hospital to accept whatever treatment is recommended.

Under the Involuntary Treatment Act people can be admitted for a three day period for assessment. During that time it is simply an assessment and the issue of their capacity does not have to be finally determined.

If however they are in for involuntary treatment, that would be determined by the end of the three day assessment. For them to be treated on an involuntary basis they have to lack capacity. How you determine someone’s capacity? Do they understand the nature of the illness? Do they understand the nature of the treatment, and the risks involved in having the treatment? Do they understand the risks involved of not having the treatment? That is how you determine the capacity for any medical decision.

For example, you have an illness such as severe angina. The angiograms show that you have blockage of your arteries. I’m recommending that you have by- pass surgery. The patient has to understand what it is. Particularly the patient has to say it back in their own words. What is it you’ve been told you have? What does that mean? What is the treatment you are being offered? Do you understand the risks involved in the treatment? Do you understand what the risks are if you don’t have the treatment? The patient has to show that they understand and appreciate the decision they have to make.

So far as the Community Treatment Orders are concerned, the prerequisite for involuntary treatment in the community are the same as those for involuntary treatment as an inpatient.


Q. Looking at the CTO from a practical point of view, how will the services required for a person to live in the community be set up?

A. If somebody fulfills the criteria that they have a significant illness, that they lack capacity, that without treatment that they are likely to deteriorate, then they can, in addition to having treatment enforced inside a hospital building, treatment can be organized and arranged on their behalf in the community.

A Community Treatment Order most commonly would start from somebody who has been in hospital and is now organizing plans for their return to the community. These patients in the past have done well with treatment in hospital but have never followed through with treatment in the community, so have become unwell on a number of occasions. What people used call the revolving-door patients. It’s that group of patients where a Community Treatment Order would be of value. These are patients who do well in treatment but they don’t themselves stay in treatment. Treatment works if they are willing to be in treatment.

The Community Treatment Order allows for those cases. It’s expected to be rarely used. The estimate of the Nova Scotia Department of Health is that only about twenty patients at any one time would likely be on a Community Treatment Order.

It involves planning. Everybody who is declared incapable who is either in hospital or under community treatment as an involuntary patient will have a substitute decision maker. That substitute decision maker is normally a relative and will be making decisions on their behalf. There must be agreement of the local mental health system and particularly agreement of the substitute decision maker. They are the ones that will be hearing from the treatment team.

What’s the most appropriate treatment? How is it going to happen? Who are the people involved? With a community treatment order all those things have to be in considered. There has to be a team available and willing to undertake that treatment, and would involve at the very minimum a Psychiatrist. Other members of the team could involve a community mental health nurse, a social worker, and a community support worker. It depends on the individual client. The treatment order would name the treatment being offered, such as the types of medication, the general frequency of appointments, and the support people who would be involved in the treatment. It would not be naming things such as where is the person is going to live, or where they spend their day.

This order is in place for up to six months, and can be renewed or can be set aside. If there is a situation during that time, such as the person becoming unwell, then there are grounds to have the person return to the hospital.

Sometimes a person will become unwell because their illness is worse, even though they are following treatment. There is no resistance to treatment, they are just getting unwell. It allows them
to return to the hospital directly rather than having to go through another assessment. The team can make that decision with the substitute decision maker being involved.

The second group is the group who are becoming unwell because they are not remaining involved in treatment, they are not coming for their appointments, they are not taking their medication. There is facility to say we need to see that person. We need to know that we can rescue the situation in the community.

Can we get to see the patient? Will the patient agree to co-operation with the community treatment order? Sometimes it might be as simple as arranging a meeting. and coming to a decision. If their situation is not stable in the community they would be brought back into the hospital to improve their situation with the expectation that they return to the community in a short time. All those decisions have to involve the substitution decision maker.

Again, the idea behind it is to prevent things going wrong all the way. It’s like seeing something going wrong and stepping in early. That’s the purpose and the intent of the Community Treatment Order. It allows for the treatment to be enforced in the community.

New Legislation: The Involuntary Psychiatric Treatment Act

By LeRoy Lenethen

This provincial legislation took effect in Nova Scotia on July 3, 2007. The broad general purpose of the Act is to ensure that those who are unable to make treatment decisions, due to severe mental health illness, receive appropriate treatment.

The Act makes significant changes to provisions that used to be included in the Hospital Act. The new Act has Guiding Principles setting out how the Act is to be applied. Among the nine guiding principles are the following:

• Patients are to be treated with dignity and respect
• Patients have the right to make treatment decisions (if the patient has the capacity to do so)
• The patient should be allowed to live in his/her community.
• Promotion of self-reliance by the patient.
• Confirmation that the primary mode of hospital admission is to be voluntary.
• Confirmation that mental health services should be provided as close to a patient’s home as practical.
• Involuntary admission must be based on evidence.
• Lack of capacity to consent to treatment must be determined on the basis of evidence.

The Act deals with “mental disorders” which are defined as:

• any substantial disorder of behaviour, thought, mood, perception, orientation or memory
• that severely impairs judgment, behaviour, capacity to recognize reality or the ability to meet the ordinary demands of life
• in respect of which psychiatric treatment is advisable

Hospital admission to access mental health services can be voluntary in the same way as hospital admission for any physical illness i.e., through your family doctor or the Outpatient process. In addition hospital admission for an involuntary psychiatric assessment can be ordered by any two licensed doctors following an examination of the patient. If the patient refuses the initial examination or to attend for such an initial examination then, in an appropriate case, an order for an initial examination can be obtained from a Family Court Judge (on application by any person) or can be initiated by a police officer (if certain conditions are found to exist). The new Act contains special provisions setting out how the initial medical examination can be obtained through a Family Court Judge or through the police. At the time of the examination by two doctors (not necessarily psychiatrists) any further admission for an involuntary psychiatric assessment must be based on the determination by those doctors that

• the patient has an apparent mental disorder, and
• would benefit from inpatient psychiatric treatment, and
• will not submit voluntarily to a psychiatric assessment, and
• meets the old “dangerousness” criteria (harm or threat or attempt to self or others), or
• is likely to suffer “serious physical impairment” or “serious mental deterioration”.

If the medical examination results in a finding, on the above criteria, by the doctors of a need for an involuntary psychiatric assessment, the patient can be forcibly taken to a facility and held for a maximum of 72 hours to permit an assessment to be done by a psychiatrist.
In order for a patient to be placed in a psychiatric facility on an involuntary basis for a period beyond that psychiatric assessment, the psychiatrist must then conclude that the patient does have a mental disorder, is in need of psychiatric treatment, that the treatment needed can be provided at a psychiatric facility, that the “dangerousness” test is met or that the “serious physical impairment” or “serious mental deterioration” test is be met. In addition, the psychiatrist must conclude that treatment in a psychiatric facility is required (as opposed to in the community) and that the patient will not or is not capable of consenting to such admission.

Finally, the patient will not be admitted unless the psychiatrist concludes that the patient does not have the capacity to make admission and treatment decisions on his or her own. A patient who has the capacity to make his or her own admission and treatment decisions will no longer be “on hold” in a psychiatric facility while refusing treatment. Involuntary admission under the new Act will not occur if the patient has capacity to make his or her own admission/treatment decisions. Unless the psychiatrist can reach all of these conclusions within the 72-hour holding period, the patient must be advised of his/her right to leave the facility. Any declaration by a psychiatrist of involuntary admission beyond the initial 72 hour assessment period must, under the new Act, be reviewed on a stipulated regular basis.

In deliberations to determine whether or not a patient has the capacity to make a specific treatment decision the psychiatrist must consider whether the patient fully understands and appreciates
• The nature of the condition
• The nature and purpose of the treatment
• The risk and benefits involved in taking the treatment
• The risk and benefits involved in not taking the treatment

The new Act also provides for, and sets out a list of those who can act as, a Substitute Decision Maker for an involuntary patient. The Act covers the process for the appointment of such a person and how that person’s authority is exercised on behalf of the patient.

The new Act now specifically provides for “Certificates of Leave” (for a maximum of six months) to permit involuntary patients to live outside the psychiatric facility. The Act spells out how this process works and sets out a process for canceling such certificates.

In addition, the new Act provides for the treatment of an involuntary patient in the community by way of a Community Treatment Order (CTO). The Act spells out the process involved and conditions that must be met for any treatment order that releases the involuntary patient into the community. There is also a process for amending, canceling and renewing a CTO.

Finally, the new Act also provides for a Patient Advisor Service (independent of any hospital or any District Health Authority) and for recognition of patient rights. The Advisor can work with the involuntary patient or the patient’s Substitute Decision Maker. As yet there are no regulations in place under the Act to implement this service.

This has been a brief overview of some of the significant provisions of this new Act. Additional details and facts sheets for patients, police and hospital administrators along with a copy of the Act and the regulations and the various forms involved can be found on the Department of Health website at- http://www.gov.ns.ca/health/mhs. When the page opens on your screen on the right side of the page is a list of patient services, just click on the item entitled “Involuntary Psychiatric Treatment Act”

Stigma In Mental Illness

By: Dr. David Mulhall

There is a high level of stigma associated with mental health problems. Stigma comes from a Greek word meaning “a mark of shame or discredit”. It is an attempt to label a group of people who are less worthy of respect than others. People with mental health problems are often stigmatized due to a lack of knowledge, misinformation and fear. Stigma against people with a mental illness often involves negative labels or inaccurate and offensive representation in the media portraying them as violent, comical or incompetent.

The most common misconceptions about mental health problems are:

1) Fear. Fear of violence and unpredictability. Fear of what mental illness represents and the way it attacks the faculties (emotions, thoughts and behaviors) and the part of us (the brain and mind) that define our very humanity.

2) Blame. It is the view that people with mental illness have brought the problems upon themselves.

3) Poor prognosis. The view that there is little hope for recovery from mental illness.

4) Disruption of social interaction. The view that people with mental illness are not easy to talk to and have poor social skills.

Some people affected by mental illness say the effective stigma can be as distressing as the symptoms. Stigma can be a barrier to individuals in getting the help that they need due to fear of being discriminated against. Recent surveys showed that half the population would not want anyone to know if they developed a mental health problem; likewise, half the respondents in the survey thought that media portrayal of people with mental health problems was more negative than positive. This has negative affects in many ways. People with serious mental illness have the highest rate of unemployment and underemployment of all people with disabilities at a rate of around 85%. When people with mental illness find work, their work tends to be sporadic, poorly paid and lacking employee benefits. They all too often find themselves in the three “F” occupations (food, filing and filth). Also, mental illness is the second leading cause of work-place discrimination complaints. Surveys have found that from one-third to one-half of people with mental illness report being turned down for a job for which they are qualified after their illness was disclosed or of being dismissed from their job and were forced to resign as the result of a mental illness. Contrary to common myths, Schizophrenia is not a split personality, nor does the behavior of people with the diagnosis swing dramatically between “normal” and “dangerous”. People with Schizophrenia are rarely dangerous but are experiencing things that can be extremely unpleasant or frightening to them. Recovery rates for mental health problems are between 70 and 80%.

There have been a number of campaigns overseas to address stigma; i.e. in England, Changing Minds; and in Australia, SANE. Much of the emphasis of these programs is to let the general public know that the myths are not true and that terms like “demented/loony/madman/nutter/schizo” are offensive. The positive messages are that people who have mental illness have the same needs as everyone else; that they can and do recover and lead productive lives; that they make valuable contributions to the society and that discrimination against people who have mental illness keeps them from seeking help. These campaigns have many features in common. They include information leaflets for the public and media about mental illness and are often backed up by monitoring programs that encourage people to report examples of stigmatizing language in the media, supplemented with letter templates for people to write to the perpetrating organization. There are also guides for employers that detail the benefits of hiring people who have mental illness, providing suggestions for recruiting and training people who have mental illness, outlining action plans for educating employees about mental health illness and creating a “healthy environment”.

In Nova Scotia (in 2005), a similar survey was done on the media’s portrayal of mental illness. 2% of all stories showed some inappropriate content with either outdated, negative or inappropriate language. Often, subjects like “suicide” would be sensationalized with reference to celebrities, photograph or description of scene, description of methods, interviews with the bereaved family and with little information on how someone could get help or any contact numbers of appropriate organizations, etc.

Programs that look to change attitudes are hard to evaluate and change comes slowly; however, there is evidence that it is possible to improve attitudes towards illnesses such as Schizophrenia and behavior such as suicide with consistent changes in how the media portrays these issues.

The Department of Health and the Mental Health Program sees this area as an important part of the Mental Health Program playing a role in both mental health promotion and prevention.

For further information, please see the Department of Health website under “Our Peace of Mind” document.

Walk the World for Schizophrenia

The local Kentville Chapter of the Schizophrenia Society had our Walk the World for Schizophrenia today. Things went really well and everyone had a real good time. The weather was excellent. It wasn't to cold and it wasn't to hot.

The walk was held in Wolfville. We met at the park to register. While everyone was registering we had a live band called Rust Bucket play some music for us. The music was great. I think everyone liked the music.

After the registration we started the walk. We followed the path along the water. Eventually we got on Main Street and walked along Main Street. Then we turned right and the walk ended at the Lions Club.

We all went inside. We had another live band playing called The Mud Creek Boys. It was a blue grass type band. Their music was great too.

Everyone had a bite to eat. We were all mingling and socializing. After everyone was finished eating they had some draws for prizes. They give out nice prizes. After the draws were done the band played some more music.

After that the crowd started diminishing. Finally everyone left and went their merry way. It was a great day and everyone had a real good time.

We also raised a good chunk of money for the Schizophrenia Society.

Depression

Often times people with schizophrenia go through periods of depression. I have been depressed and discouraged all day. The reason being that I am laid off and haven't worked in nine months. I've been so distraught I haven't been able to do anything at all today. I haven't been able to concentrate on my reading, my writing, and I haven't done much housework today.

But I have made a decision. Even if I never work again I do not have to be depressed or discouraged. I can still live a life of meaning, purpose, and be a productive member of society. I have my wife as my best friend in the world. I can get meaning out of life in my marriage. As time goes on our love for each other grows more and more. We become closer and closer with each other. Even if I never work again I will never be alone in life because I have Kim for companionship.

Outside my marriage I can still have meaning, purpose, and be a productive member of society. I can devote my life to my writing. I can continue writing for my blogs. I have a few of them on the net. I can use my writing skills to help my fellow consumers, family members of consumers, and educate the general public about schizophrenia to help remove some of the stigma against us consumers.

I am the editor of the Schizophrenia Newsletter put out by the local Kentville Chapter of the Schizophrenia Society of Nova Scotia. I will continue working on our newsletter. We put it out three times a year.

I can also go to the Acadia University Library to do research there on various topics. I will use this research for writing essays, and articles for my blogs and newsletter.

If I never work again there is still hope that I can live a life of meaning, purpose, and be a productive member of society.