Posts tagged depression
Posts tagged depression
The study raises questions about the military’s screening of recruits. Another study looks at rising suicide rates among soldiers.
Nearly 1 in 5 U.S. soldiers had a common mental illness, such as depression, panic disorder or ADHD, before enlisting in the Army, according to a new study that raises questions about the military’s assessment and screening of recruits.
More than 8% of soldiers had thought about killing themselves and 1.1% had a past suicide attempt, researchers found from confidential surveys and interviews with 5,428 soldiers at Army installations across the country.
The findings, published online Monday in two papers in JAMA Psychiatry, point to a weakness in the recruiting process, experts said. Applicants are asked about their psychiatric histories, and those with certain disorders or past suicide attempts are generally barred from service.
"The question becomes, ‘How did these guys get in the Army?’" said Ronald Kessler, a Harvard University sociologist who led one of the studies.
A third study looked at the increased suicide rate among soldiers from 2004 to 2009. The study, which tracked nearly 1 million soldiers, found that those who had been deployed to Afghanistan or Iraq had an increased rate of suicide.
But it also found that the suicide rate among soldiers who had never deployed also rose steadily during that time. The study did not explain the cause.
The Pentagon did not make officials available Monday to discuss the studies.
The three studies are the first from a massive research initiative started in 2009 by the Army and the National Institutes of Mental Health in response to the surge in suicides.
In 2011, a representative sample of soldiers was extensively questioned and assessed for a history of eight common psychiatric disorders.
Traditionally, the Army has been psychologically healthier than the rest of society because of screening, fitness standards and access to healthcare. Soldiers committed suicide at about half the rate of civilians with similar demographics.
But researchers found that soldiers they interviewed had joined the Army with significantly higher rates of post-traumatic stress disorder, panic disorder and attention deficit and hyperactivity disorder than those in the general population.
Most notably, more than 8% of soldiers entered the Army with intermittent explosive disorder, characterized by uncontrolled attacks of anger. It was the most common disorder in the study, with a pre-enlistment prevalence nearly six times the civilian rate.
"The kind of people who join the Army are not typical people," Kessler said. "They have a lot more acting-out kind of mental disorders. They get into fights more. They’re more aggressive."
The researchers found that despite screening, pre-enlistment rates of depression, anxiety, bipolar disorder and substance abuse were on par with civilian rates. Rates of suicidal ideation, planning and attempts were lower than in the general population but still significant, given the military’s practice of excluding recruits with a known suicidal history.
During their military service, the soldiers’ rates of most psychiatric disorders climbed well past civilian levels, several times the rate for some disorders.
A quarter of soldiers were deemed to be suffering from a mental illness — almost 5% with depression, nearly 6% with anxiety disorder and nearly 9% with PTSD. The percentage of soldiers who had attempted suicide rose from 1.1% to 2.4%.
Matthew Nock, a Harvard University psychologist who led the study on suicide, said more than 30% of suicide attempts that occurred after enlistment would have been prevented if the Army had excluded recruits with pre-existing mental health conditions.
Nock said he believed the Army should improve its screening of recruits, not to exclude them but to provide treatment to those who acknowledge a history of mental illness.
Screening out mentally ill recruits is not as simple as it sounds because the military largely has to rely on applicants to disclose their mental health histories.
"People who want to come into the Army are no fools," said Dr. Elspeth Ritchie, a former chief psychiatrist in the Army. "They know if you say you had a past suicide attempt, you’re probably not going to get in."
Dr. Eric Schoomaker, who served as surgeon general of the Army until 2012, said more stringent screening “would just lead to driving the problems further underground.”
In addition, the military would not meet its recruiting targets if it were able to identify and exclude everybody with a history of mental health problems, experts said.
During the peak years of war, as the military was struggling to fill its ranks, some recruiters were known to discourage applicants from disclosing such problems.
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By Megan Davies Mennes; English teacher, writer, mother
Sometimes life is hard. I think I’m luckier than most in this world, and yet I still struggle with my own demons. I suppose that’s true of all of us, but not everyone faces the crushing weight of depression when things go wrong. I recently discovered that my dear friend is struggling to stay afloat and I want so desperately for him to know — for everyone experiencing the pain of depression to know — I’ve been there.
Depression isn’t something we like to talk about in our society. Mental health in general is a rather taboo topic, perhaps because for those with no history of mental illness, it seems as simple as a change in mindset. But depression is very real, and often very difficult to control.
I’ve struggled with depression, anxiety, and mood swings my whole life. I learned in early adulthood that I suffer from some pretty serious chemical imbalances that peak in the winter and ebb in the warmer months. I also know that stress can put me in a funk regardless of the weather. The past few years have been hard on me given the many changes we’ve experienced in our family. In fact, I suffered from late-onset post-partum depression when my first son, Atticus, was around 6 months old. The medicine my doctor prescribed made my skin crawl, so I lived with the sadness until things leveled out. And then when we moved to a new city, turned our entire lives upside-down, and received our unborn son Quinn’s Down syndrome diagnosis, the depression returned, this time with a severity I had never experienced. But the only drugs that we knew to fight the funk without the desire to pull my hair out or walk around like a zombie all day weren’t recommended for pregnant women (especially those with a high-risk pregnancy like mine), so I was forced to power through.
It’s difficult to cope with something that many people feel is easy to fix. Over the years, I’ve had friends insist that I need learn to count my blessings, as if I hadn’t tried that before. Or they expect to snap me out of it with a quick hug, a phone call, or even chocolate cake. But depression doesn’t work that way. Depression is an all-encompassing reality that no amount of silver linings can overturn. Moreover, sometimes it feels normal to be sad. I know that’s not something that most of you can understand, but for those with chemical imbalances, they know how right it can feel to give in and allow the wave of hopelessness to take over. To fight it is to sink lower when you lose.
The bright side is that there is a bright side. I’ve learned over the years to ride the waves of depression that come my way and seek help when they get too serious. I’m lucky in that my family keeps me close and ensures that recovery is swift. My husband is my rock in this. He knows what works and what doesn’t. And he never tries to fix me. He just listens. I’m also lucky that my depression has never affected my work, as walking into my classroom is like a refuge, as if I’ve suddenly found a life raft after treading water for days. But others aren’t so lucky. Others struggle to recover, regardless of their support system. If that’s you, then please seek help. It’s amazing how quickly depression can lead someone down a dead-end path. And once you start that road toward drug abuse, alcoholism, or even suicide, it’s hard to come back.
Many of you will read this confession and feel embarrassed for me, or even sad. Don’t. I’m not ashamed. In fact, I’m actually pretty damn proud of my ability to overcome it and live a successful life. I’m proud of my coping mechanisms, my bursts of happiness in which I can appreciate the sun on my shoulders in late February, or the sound of my children’s giggles on Sunday mornings. Those are the moments I live for. Those are the moments that keep the depression at bay for longer stretches of time. In order for more people to find their moments, we need to talk about mental illness without shame or fear. We need to help more people become aware of the struggles so that we can be more aware of ways to help each other cope.
If you’re struggling with depression, anxiety, or any other mental illness, seek a strong support system. Here are some good places to start:
For more mental health news, Click Here to access the Serious Mental Illness Blog
Shameful Profiling of the Mentally Ill
By Andrew Solomon, author of “Far From the Tree: Parents, Children, and the Search for Identity”
A Canadian woman was denied entry to the United States last month because she had been hospitalized for depression in 2012. Ellen Richardson could not visit, she was told, unless she obtained “medical clearance” from one of three Toronto doctors approved by the Department of Homeland Security. Endorsement by her own psychiatrist, which she could presumably have obtained more efficiently, “would not suffice.” She had been en route to New York, where she had intended to board a cruise to the Caribbean.
“I was so aghast,” Ms. Richardson told a Toronto Star reporter. “I don’t understand this. What is the problem?’ I was so looking forward to getting away. I’d even brought a little string of Christmas lights I was going to string up in the cabin.”
The border agent told her he was acting in accordance with the United States Immigration and Nationality Act, Section 212, which allows patrols to block people from visiting the United States if they have a physical or mental disorder that threatens anyone’s “property, safety or welfare.” The Star reported that the agent produced a signed document stating that Ms. Richardson would need a medical evaluation because of her “mental illness episode.” A spokeswoman for United States Customs and Border Protection told the Star that the agency was prohibited from discussing specific cases because of privacy laws.
This is not the first time such measures have been reported. In 2011, Lois Kamenitz, a Canadian and a former teacher, was barred from entering the United States because she had once attempted suicide. Ryan Fritsch, former co-chairman of the Ontario Mental Health Police Record Check Coalition, told the Star that he had heard of eight similar cases that year. After the incident, he wrote to me: “My sense is that there are a great many people being turned away. I’ve also heard of executive-level reps from various Canadian and provincial mental health advocacy and awareness organizations being turned away at the border on their way to conferences and other official functions and appearances,” presumably because of their own medical histories.
Ms. Richardson’s health information should never have been available to United States authorities, and many Canadians are outraged at the thought that their government may have divulged it. It’s not clear at this point, however, what the customs agent saw.
Her ruined vacation could have been a result of his access to law enforcement databases. Ms. Richardson explained to me that when she was hospitalized in June 2012, the police were involved because she had made a suicide attempt that led to a 911 call. But even if it is police data rather than medical data that has been shared, the use by immigration authorities remains troubling.
Much more troubling, however, is the notion that information about a person’s depression, no matter how legitimately obtained, might have any bearing on her ability to visit the United States.
People in treatment for mental illnesses do not have a higher rate of violence than people without mental illnesses. Furthermore, depression affects one in 10 American adults, according to estimates from the Centers for Disease Control and Prevention. Pillorying depression is regressive, a swoop back into a period when any sign of mental illness was the basis for social exclusion.
The Americans With Disabilities Act of 1990 prevents employers from discriminating against people who have a mental illness. If we defend the right of people with depression to work anywhere, shouldn’t we defend their right to enter the country? Enshrining prejudice in any part of society enables it in others. Most of the people who fought for the right of gay people to serve in the military did so not because they hoped to become gay soldiers themselves, but because any program of government-sanctioned prejudice undermined the dignity of all gay people. Similarly, this border policy is not only unfair to visitors, but also constitutes an affront to the millions of Americans who are grappling with mental-health challenges.
Stigmatizing the condition is bad; stigmatizing the treatment is even worse. People who have received help are much more likely to be in control of their demons than those who have not. Yet this incident will serve only to warn people against seeking treatment for mental illness. If we scare others off therapy lest it later be held against them, we are encouraging denial, medical noncompliance and subterfuge, thereby building not a healthier society but a sicker one.
We have already seen such a situation: For more than 20 years the United States prohibited people with H.I.V. from entering the country. We were one of a very few countries to take this bigoted stand. An activist lobby fought against the ban, which was finally lifted in 2009. President Obama expressed his belief that the ban had led to bias against people with H.I.V., which discouraged people from getting tested.
Ms. Richardson, who attempted suicide in 2001 and as a result is parapalegic, has asserted that she has had appropriate treatment, and that she now has a fulfilling, purposeful life. We should applaud people who get treatment and manage to live deeply despite their challenges. It is both humane and in our self-interest to ensure that as many people as possible avail themselves, without governmental disapprobation, of the array of supports that may help them. The president needs to speak out against Section 212 as he did against the H.I.V. ban and to put to rest the idea that people with mental health conditions who pose no danger are unwelcome in our country.
For more mental health news, Click Here to access the Serious Mental Illness Blog
[Film of Interest] Here One Day
In 1995, Nina Williams Leichter, the brilliant wife of a New York state senator, committed suicide by jumping from the 11th floor of her apartment building. Though she had struggled with manic depression, Williams had always been an energetic figure who tried to bring public attention to mental health issues. Her suicide shattered the lives of her family: her husband and two children, Josh and Kathy. Sixteen years later, Kathy Leichter, now a filmmaker, returns to stay in her parents’ apartment. Amid the collected letters, clothes and empty medication bottles, Leichter makes a discovery. In a plastic case, she finds dozens of audio cassettes made by her mother, emotional often rambling messages attempting to understand the madness overwhelming her. Over time, Leichter begins to chronicle, then come to terms with the full depth of her mother’s mental anguish. Here One Day is a powerful personal statement, threading together the disparate strands of Williams’ sorrow, ultimately becoming a moving evocation of life itself.
Here One Day attempts to educate and reduce stigma around mental illness and suicide, to link audiences to support, and to teach how mental illness and suicide impacts families. The film is available for DVD purchase and for community screenings facilitated by the film’s award-winning director, Kathy Leichter. For more information go to: http://www.hereoneday.com or contact her at email@example.com.
For more mental health news, Click Here to access the Serious Mental Illness Blog
[In the News] Inside the National Suicide Hotline: Preventing the Next Tragedy
By Josh Sanburn
As U.S. suicide rates rise, experts are divided over which strategies save more lives
Kevin Hines paced along the Golden Gate Bridge, trying to figure out whether to obey the voices in his head urging him to jump. Anyone paying the slightest attention to Hines should’ve seen that something was horribly wrong. Sure enough, after about a half-hour, a woman approached him. Hines thought she was there to save his life.
Instead, she was a tourist wanting Hines to take her picture. The look of desperation on his face apparently didn’t register. Elation crumpled into despair. “Nobody cares,” he thought. “Absolutely nobody cares.”
Hines soon hurdled a railing, stepped out onto a ledge 25 stories above San Francisco Bay and jumped. He immediately regretted it. Falling 75 miles an hour headfirst toward the water, Hines realized that if he was going to save himself, he had to hit feet first. So he threw his head back right before he plunged 80 feet into the cold waters, shattering two of his lower vertebrae. He eventually surfaced and was rescued by the Coast Guard. Only one out of 50 who jump survive.
Thirteen years removed from his attempt, Hines is now an author and lecturer, and doing quite well considering his experience. Hines frequently travels around the country talking about what happened on September 25, 2000. Diagnosed with bipolar disorder, he still has auditory and visual hallucinations as well as paranoid delusions. But today, he has a support network of family and friends that check up on him and identify early warning signs that could lead to Hines harming himself again. He logs his symptoms into an online document he shares with others so they can keep an eye on him. Hines says that’s what separates him from so many others who have suicidal thoughts.
“When you learn to be self-aware with mental illness, you can save your own life,” Hines says.
In May, the Centers for Disease Control released data showing that in 2010, 38,364 people weren’t able to save themselves. For the first time, the number of suicides surpassed deaths from motor vehicle accidents and most researchers believe that number is low, if anything, because many suicides go unreported. The suicide rate for Americans aged 35 to 64 rose 28.4 percent from 1999 to 2010. According to the CDC, $35 billion is lost due to medical bills and work loss costs related to suicide each year. And while suicide rates are not as high as they were in the early 1990s, they’ve climbed steadily upward since 2005.
As more Americans commit suicide, some in the field question the effectiveness of current prevention programs. Over the last 15 years, public policy and federal funding have shifted toward a broader mental wellness movement aimed at helping people deal with anxiety and depression that could eventually lead to suicidality. But that shift may have left those most at-risk of suicide, like Hines, without the support they need.
One program sits at the intersection of those two approaches. The National Suicide Prevention Lifeline, which expects 1.1 million to 1.2 million calls this year and receives about 15 percent more callers each year, is broadly marketed to the general public through billboards and ads that reach those suffering from anxiety, depression and loneliness but are often not actively suicidal. At the same time, it’s an emergency resource for those who are at immediate risk of killing themselves and who struggle with chronic mental illness. But some in the field question its effectiveness, along with the effectiveness of many other services and programs funded and promoted on a national scale. Those in the field often use the metaphor of a river to illustrate the divide: Is it worth getting to more people upstream or narrowly targeting those like Hines downstream?
At the Waterfall
The bridge phone inside New York City’s suicide prevention call center only rings about once a month. But when it does, often in the middle of the night, it emits distinct, deep chirps – as if the phone itself is in distress. The operators manning the 24/7 LifeNet hotline recognize the ring immediately. It means someone’s calling from one of the area’s 11 bridges, and they’re likely thinking about jumping.
LifeNet, a suicide prevention hotline servicing New York’s metropolitan area, also serves as one of 161 call centers that make up the National Suicide Prevention Lifeline network, headquartered in the same building. During its busiest hours from 9 a.m. to 7 p.m., the hotline has roughly 20 operators working the phones inside their unassuming L-shaped office space in lower Manhattan. The operators could easily be mistaken for a collection of telemarketers. The large computer screen at the head of the call center showing the number of lines being processed could easily reside inside QVC’s customer service center.
You don’t get a sense of what truly happens in this room until you run across the bridge phone, which is a direct line to the call center. It’s LifeNet’s equivalent of the Oval Office’s mythical red phone. On the wall above it, black Ikea picture frames display detailed information for each bridge and the locations of its call boxes: “Northbound 3rd Avenue Exit,” “Westbound Light Pole 60.” If someone calls, they can use the caller ID, check the information above the phone and immediately locate the caller and send help.
If it were up to those who work at LifeNet, however, they would get rid of the bridge phone altogether. “What we want is to get people upstream,” says John Draper, director of the National Suicide Prevention Lifeline. “We don’t necessarily want to get people who are on the edge of the waterfall. If they are, we can help them. But it’s a huge cost savings for the entire mental health system if you can get people further upstream.”
Draper is the National Suicide Prevention Lifeline’s soft-spoken, goateed, pony-tailed director and a whole-hearted advocate for early treatment. Talk to him and you realize why he’s in this field, something, he says, chose him. Draper speaks calmly but with purpose. He looks you in the eye. He routinely uses your name in conversation.
In the 1980s, Draper was part of a mobile crisis team, a group of clinicians that goes into the homes of people who are psychiatrically ill but unable or unwilling to get help. He says he soon came to the realization that the country’s mental health system operated behind bricks and mortar, “where it waits for people.”
“It says, ‘Ok, you’re mentally ill?’ I’ll see you Tuesday at 9 a.m. Hope you can make it.’ The system is not set up for the convenience of the user,” he says. “And as a result, two-thirds of the people with mental health problems in this country never seek care. So here was this program that goes into people’s homes. I was like, man, this is the way it should be.”
A decade later, the Mental Health Association of New York City established a 24/7 crisis information and referral network and hired Draper. Several years later, the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services and now partially funds the national lifeline, assessed callers who had contacted crisis centers like New York’s and found that most of them felt less distressed emotionally and were less suicidal after the call. Draper calls it a groundbreaking finding.
LifeNet came into its own in 2001 when it became a central resource for those affected by the Sept. 11 terrorist attacks, which in New York City was just about everybody. People were reporting depression, anxiety and other traumatic responses in massive numbers. LifeNet’s call volume and staff doubled, and it’s never gone down. That time in the spotlight positioned the hotline to administer the national suicide prevention lifeline starting in 2004.
Today, Draper and his staff oversee more than 160 networked call centers around the country. Call 1-800-273-TALK, and you’ll be routed to the call center closest to the phone number from which you’re calling. The staff, funded with $3.7 million a year by SAMHSA, helps develop risk assessment standards for operators around the country so they can consistently and quickly determine the seriousness of a situation over the phone.
Draper expects call volume to increase again this year. About 8 million adults in the U.S. are thinking seriously about suicide, but only 1.1 million actually attempt it. So when Draper sees the volume actually reaching that 1.1 million number, which he expects it to this year, he views it as a good thing.
“If your calls are increasing, does that mean more people are in distress?” he says. “That’s not necessarily true. It means more people may have been in distress all along but didn’t know this resource was there. So the more we promote awareness of this resource, once it gets out, then it stays out there.”
The problem for people like Draper is definitively determining whether suicide prevention efforts are working. The only way you ever know if you’re saving someone’s life is if they come out and say so, and that makes it difficult to truly gauge the effectiveness of the lifeline or any other prevention program or service.
“The lifeline is a valuable addition to our efforts,” says Dr. Lanny Berman, executive director of the American Association of Suicidology (AAS). “It’s indeed a resource for people in suicidal crisis to reach out immediately and get help. Whether it is effective in saving lives remains to be seen.”
But some of the available data seems to indicate that the lifeline is having a positive effect. Studies done by Columbia University’s Dr. Madelyn Gould have found that about 12 percent of suicidal callers reported in a follow-up interview that talking to someone at the lifeline prevented them from harming or killing themselves. Almost half followed through with a counselor’s referral to seek emergency services or contacted mental health services, and about 80 percent of suicidal callers say in follow-up interviews that the lifeline has had something to do with keeping them alive.
“I don’t know if we’ll ever have solid evidence for what saves lives other than people saying they saved my life,” says Draper. “It may be that the suicide rate could be higher if crisis lines weren’t in effect. I don’t know. All I can say is that what we’re hearing from callers is that this is having a real life-saving impact.”
You may think that a suicide prevention office would be a dreadful place to work, but it’s really just like any other around the country: idle chatter near the water cooler, lunch breaks with co-workers, cinnamon rolls in the break room. It’s just that from this room, lives are being profoundly affected every day. And even though the exact number of people who have truly been helped will never be known, the lifeline has very strong advocates, including Kevin Hines.
Hines’ story is not merely dramatic; it’s a test case in how the mental health system broke down. There are essentially three main ways to prevent suicide: treatment; means prevention; and access to prevention resources. At the time, Hines wasn’t properly being treated for bipolar disorder; the Golden Gate Bridge has no physical barriers to prevent suicide attempts; and as for the bridge’s suicide prevention call box, Hines didn’t know it was there.
“Had I known, I’m sure I would’ve called,” he says, “because I desperately wanted to talk to somebody.”
Back in New York City’s suicide prevention call center, I ask Draper if it’s difficult to come in to work each day, to motivate his employees to take another call and assure them that what they’re all doing is actually working.
“When I tell people what I do, they say, ‘Oh, Draper, that must be really depressing,’” he says. “And I say, man, I’m in the suicide prevention business, not the suicide business. What I see every day and what our crisis center staff hears every day is hope. And they know that they’re a part of that.”
He says it’s important to remember that 1.1 million adults are attempting suicide every year, but 38,000 are actually dying by suicide.
“What that is telling us is that by and large, the overwhelming majority of suicides are being prevented,” he says. “And those stories are not being told.”
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[Article of Interest] Mental health needs realistic treatment – or we face decades of wasted time
By Rich McEachran
NGOs can play a decisive role in ensuring that those with mental health problems aren’t misdiagnosed, and receive treatment that takes cultural and educational barriers into account
The United Nations regularly declares that “there is no health without mental health.” It’s a statement that holds much truth, yet little meaning in relation to mental health’s standing in the development sector and governmental policies.
About 13% of all global illnesses are said to be related to mental health, and in low and middle-income countries it’s reported that up to four in five people fail to receive proper treatment or care. This, combined with the fact that a majority of the developing countries dedicate less than 2% of their health budget to mental health care, is a reflection of how inadequate awareness of the issue is.
NGOs can play a decisive role in ensuring that those with mental health problems aren’t neglected; they can help rebuild community resilience, develop relationships between patients and carers, or those administering treatment, and create greater awareness of mental health issues. Understanding mental health as a disability is beneficial. Yet, even organizations who work with the world’s 1 billion disabled population can often fail to deal with disability at a macro-level – for example, lack of awareness of the issue in their literature – so mental health as part of field work, at a micro-level, is vulnerable to being mismanaged too. This mismanagement is partly the result of a lack of comprehensive data and the way data collation is implemented.
Trying to reach some of the most vulnerable people in society, many of whom are unwilling to talk sue to the stigma of their conditions, is tricky. The situation can be made worse if a patient has acquired sensory problems, such as difficulty speaking. Finding common ground and ways to develop universal forms of communication can provide a strong basis to carry out research, collate data and to even help deliver better treatment to patients. Mobile and SMS technology, for instance, has become a vital tool in reaching out to people in low resource environments and who otherwise might be inaccessible.
”In Kenya, for example, there is one psychiatrist for every 500,000 people and one psychologist for every 1 million people. However, we have the mobile phone, whose penetration in Kenya is 74% … smartphone usage is steadily growing too,” says Gladys Mwiti, founder of the Oasis Africa Centre for transformational psychology & trauma expertise.
The centre is currently collaborating with the Women’s College Research Institute, at the University of Toronto, on a mobile app that will provide information for adult survivors of child abuse and neglect. The app will focus on trauma and its impact, personal trauma management, links to professional care and coping with and knowledge of on-going trauma management and resiliency building.
The project has recently applied for a grant from the Canadian government, though generally, funding hasn’t been easy to come by – a situation that isn’t uncommon for any development project looking for financial backing. Mwiti does forecast a change in attitude though. “Indeed, development agencies are beginning to believe that without mental health, years of grant activities in Africa will only produce wasted decades unless holistic solutions are realised,” she says.
How then can western-based NGOs implement holistic solutions, and how practical would they be? Failure to do this efficiently could lead to NGO employees entering a foreign country without a suitable grasp of the language or cultural differences, and ending up introducing westernised treatments that don’t compute and misunderstand local attitudes, such as a trauma patient being possessed by a devil. Not understanding the local context is also true of southern NGOs who may have an “urban bias” and to whom the cultural practices in rural areas a completely foreign.
"Language is definitely a barrier. Terms which seem simple to us, such as ‘depression’ or ‘trauma’, may not translate easily," says Natalie Mehrgott, a psychotherapist who has worked in Kampala and Lusaka and has first-hand experience of dealing with trauma patients and refugees.
"Experimenting with words that [patients] may better relate to could help overcome these barriers; like substituting ‘depression’ for ‘sadness’. I also find focusing on body language can ease the process of dealing with patients who have difficulty communicating – especially hand gestures. When talking directly about ‘depression’ or ‘trauma’ I may clench my fist against my chest and then rub my eye with the other hand as if I were wiping away a tear."
Treatment can be a bit of a misnomer, particularly if it’s poorly thought out and fails to communicate sympathetically with the patient. Mehrgott indicates that it could do more damage than good and can reinforce the problems that it’s trying to address. Adopting simpler language and hand gestures can be ways to actively work with the wider community too. Improving how locals perceive mental health is imperative to how patients may see themselves and understand their condition. At the same time, treatment can also become a bit of a distraction if NGOs fail to realize that mental health problems aren’t just symptomatic of conflict or post-traumatic stress disorder. Even though mental health is closely linked to events such as war, it shouldn’t be assumed that they have caused the health problem. Rather the situation patients find themselves in makes them more pronounced.
Realizing the complexities of mental health is critical to understanding how it coalesces with poverty, education, employment, general health and conflict itself. By doing this and acknowledging cultural sensitivities and potential language barriers, NGOs can work towards realistic holistic solutions that can provide relief to mental health patients.
For more mental health news, Click Here to access the Serious Mental Illness Blog
For more mental health news, Click Here to access the Serious Mental Illness Blog
[Article of Interest] Good Marriage Can Buffer Effects of Dad’s Depression On Young Children
Story reprinted from materials provided by University of Illinois College of Agricultural, Consumer and Environmental Sciences
What effect does a father’s depression have on his young son or daughter? When fathers report a high level of emotional intimacy in their marriage, their children benefit, said a University of Illinois study.
“When a parent is interacting with their child, they need to be able to attend to the child’s emotional state, be cued in to his developmental stage and abilities, and notice whether he is getting frustrated or needs help. Depressed parents have more difficulty doing that,” said Nancy McElwain, a U of I professor of human development.
But if a depressed dad has a close relationship with a partner who listens to and supports him, the quality of father-child interaction improves, she noted.
“A supportive spouse appears to buffer the effects of the father’s depression. We can see it in children’s behavior when they’re working with their dad. The kids are more persistent and engaged,” said Jennifer Engle, the study’s lead author.
In the study, the researchers used data from a subset of 606 children and their parents who participated in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development.
When their child was 4½ years old, parents ranked themselves on two scales: one that assessed depressive symptoms and another that elicited their perceptions of emotional intimacy in their marriage. Parents were also observed interacting with their child during semi-structured tasks when the children were 4½, then 6½ years old.
“At this stage of a child’s development, an engaged parent is very important. The son’s or daughter’s ability to focus and persist with a task when they are frustrated is critical in making a successful transition from preschool to formal schooling,” Engle said.
Interestingly, depressed mothers didn’t get the same boost from a supportive spouse.
That may be because men and women respond to depression differently, she added. “Men tend to withdraw; women tend to ruminate. We think that high emotional intimacy and sharing in the marriage may encourage a woman’s tendency to ruminate about her depression, disrupting her ability to be available and supportive with her children.”
Depressed men, on the other hand, are more likely to withdraw from their partners. “This makes emotional intimacy in the marriage an important protective factor for fathers,” McElwain said.
The study emphasizes the need for depressed parents to seek support, if not from their spouses, from friends, family, and medical professionals, she added.
[Article of Interest] Psychiatrists under fire in mental health battle
By Jamie Doward
British Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness
There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the leading body representing Britain’s clinical psychologists.
In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry.
Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP’s statement, said it was unhelpful to see mental health issues as illnesses with biological causes.
“On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,” Johnstone said. The provocative statement by the DCP has been timed to come out shortly before the release of DSM-5, the fifth edition of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders.
The manual has been attacked for expanding the range of mental health issues that are classified as disorders. For example, the fifth edition of the book, the first for two decades, will classify manifestations of grief, temper tantrums and worrying about physical ill-health as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively.
Some of the manual’s omissions are just as controversial as the manual’s inclusions. The term “Asperger’s disorder” will not appear in the new manual, and instead its symptoms will come under the newly added “autism spectrum disorder”.
The DSM is used in a number of countries to varying degrees. Britain uses an alternative manual, the International Classification of Diseases (ICD) published by the World Health Organisation, but the DSM is still hugely influential – and controversial.
The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP’s decision to speak out against psychiatric diagnosis and stressed the need to move away from a biomedical model of mental distress to one that examined societal and personal factors.
Writing in today’s Observer, James declares: “We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity.”
But Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, said it was wrong to suggest psychiatry was focused only on the biological causes of mental distress. And in an accompanying Observer article he defends the need to create classification systems for mental disorder.
“A classification system is like a map,” Wessely explains. “And just as any map is only provisional, ready to be changed as the landscape changes, so does classification.”
[Article of Interest] Mental Illness a Frequent Cell Mate for Those Behind Bars
By Amanda Gardner
Former inmate describes efforts to stay emotionally healthy after his release
Eugene King ran away from home at the age of 16, the start of a lifelong pattern of drug abuse, crime and incarceration.
In retrospect, King said, he realizes he was using illicit drugs at least in part to self-medicate a variety of psychiatric conditions. But he also realizes that prison, with its lack of adequate medical treatment and what he called a generally abusive environment, only made his problems worse.
“It exacerbated [the mental illness] without a doubt,” said King, now 62.
That King’s mental health, already precarious, only worsened in prison is not an unusual story.
According to a recent study published in the Journal of Health and Social Behavior, the link between prison time and mental illness is a two-way street. Although many incarcerated people exhibit such problems as impulse control disorders — which normally first appear in childhood or adolescence — before they enter the correctional system, incarceration itself seems to cause major depression.
And this may help explain why so many inmates have trouble re-entering society when they are released, said the authors of the study.
“Prison made them depressed and that depression undermined their ability to re-enter — made it hard to find a job, hard to be motivated — and this is precisely the time they need to be motivated,” said lead author Jason Schnittker, an associate professor of sociology at the University of Pennsylvania. “We think that mood disorders are an important barrier to re-entry.”
According to background information included in the study, about 16 million people — or 7.5 percent of the U.S. population — are felons or ex-felons.
Meanwhile, people in prison have up to six times the rate of significant mental illness as the general population, said Dr. Spencer Eth, a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine. Eth also treats inmates at a local jail.
And although it has long been suspected that prison aggravates pre-existing psychiatric problems, experts have had trouble untangling this chicken-and-egg question, especially given that early childhood experiences are linked to both incarceration and mental illness.
For the study, Schnittker and his co-authors looked at a national database of nearly 5,700 men and women to assess both the prevalence of psychiatric disorders and any time spent in jail or prison.
Their conclusion? Incarceration was associated with a 45 percent increase in the risk of having depression.
The findings did have some limitations, namely that the authors couldn’t control for all other factors that might affect the incidence of depression. And because it’s so difficult to conduct studies in prison populations, it’s possible that the data did not pick up on worsening of conditions other than depression, said Eth, who was not involved with the study.
The data were also at least a decade old, Eth said, even though “it’s likely that if the study were to be repeated now there would be similar findings.”
Although the study authors advocate for more treatment while people are in prison and before being let out onto the streets, in reality conditions in correctional facilities are often pitiful, said Eth, echoing King’s sentiments.
“There’s very, very little treatment available to people who are in jails and prisons. At most, it’s medication, and for many conditions it’s nothing at all. It’s terrible,” Eth said. “If you didn’t have a serious mental illness going in, the conditions of jails and prisons are so deplorable, you’d have to be a hardy soul not to be depressed or worse.”
Unfortunately, psychiatric treatment for ex-offenders “on the outside” is also limited, said JoAnne Page, president and CEO of the Fortune Society in New York City, which helps individuals re-enter society after prison.
“We couldn’t get people into mental-health treatment in the community when it was available, and it’s less available than it used to be,” Page said.
In 2011, the Fortune Society, which already provided housing and other services for ex-offenders, opened its Better Living Center, which they said is the first agency in New York City to cater exclusively to individuals with a criminal history.
“Most of our people come to us after their release when we have a window of time,” Page said. “There’s a hopefulness that things could be different. It’s a wonderful time to work with people if you give them a fighting chance.”
It is through this Better Living Center that King got his chance. He now takes medication every day and sees a therapist weekly for bipolar disorder, post-traumatic stress disorder and depression.
"I have access to excellent mental-health treatment now and I’m also mindful of the fact that there are [many] prison inmates who could benefit from the same level of care, or something close to it," King said. "Last week was my last day on parole. Over 25 years, I have been living on this cloud either in prison or on supervision. I am no longer. I am totally free.”
Fountain House is about the power of community. It was created to relieve the loneliness and stigma that affect so many people who are living with serious mental illnesses, like schizophrenia, bipolar disorder, and major depression. Serious mental illness disrupts lives - people lose their jobs, they drop out of school, they alienate their families and friends, and they end up alone.
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[Film of Interest] "Running from Crazy"
Mariel Hemingway Tackles Family History of Suicide, Mental Illness in New Doc
The new documentary “Running from Crazy” chronicles the life of actress Mariel Hemingway, the granddaughter of the great novelist Ernest Hemingway. The film focuses on Mariel’s family history of mental illness and the suicides of seven relatives, including her grandfather and her sister, Margaux.
iThe film is directed by the two-time Academy Award-winning filmmaker Barbara Kopple, whose documentary “Harlan County U.S.A.” has become a classic and won an Oscar in 1977.
[Article of Interest] Hooked on the Web: Internet Addiction
By Melanie Eckhoff
Recent studies of college students begin to clarify the relationship between Internet compulsion, depression and other serious problems.
Word is spreading about the dangers of texting while driving. But what about texting and walking? Walking into someone when you’re sending a text or playing angry birds on your iPhone may be rude, but at least it’s not fatal. Walking against the light and straight into the path of a moving car is another story. Internet addiction (IA) is a disorder with symptoms similar to those found in pathological gambling and, to a lesser extent, substance abuse. Colleges nationwide are seeing the negative consequences of IA on their students. Reports estimate that 8% to 13% of undergraduates are addicted to the Internet, resulting in serious harms including impaired psychological health, family and peer relationship difficulty and lower academic performance. In addition, a link has been found between problematic Internet use and depression in college kids. There is considerable confusion about what Internet addiction is (is not). Here are answers to common questions that may get you started:
1. How does a healthcare professional spot Internet addiction?
There are eight criteria for diagnosing IA; these symptoms include preoccupation with the Internet, unsuccessful efforts to control or cut back Internet use, staying online longer than originally intended and using the Internet daily as an escape. Internet addicts can spend anywhere from 40 to 80 hours per week online, with sessions lasting up to as much as 20 hours. Some observers suggest that given the nation’s high unemployment rate over the past five years, a growing number of people are turning to online experiences to fill the empty hours and to escape the anxiety and depression of not having a job or a paycheck.
2. Does what we use the Internet for make a difference?
Certain online activities, such as cyber-relationships and online gaming, seem to be particularly potent in inducing compulsive use. A recent New York Times article reported on a study finding that in a sample of 216 undergraduates, an individual’s scores on a depression scale rose with increased levels of sharing files (movies, music, etc.) and of email usage. The authors spoke of their intention to develop a software application that could be installed on computers and smartphones to monitor your Internet activities and alert you if depressive patterns emerge. (It is far from certain that many people would consent to such an intrusion into their privacy)
3. Do Facebook and other social networking create a feeling of togetherness?
Social networking is truly changing the way people communicate and interact with one another. Facebook is the largest social networks, and “Facebooking” has practically reached epidemic proportions among the college population. In a 2009 University of Missouri survey of some 1,000 college students, more than 95% had a Facebook page and 78% of them accessed the site at least twice a day. The study also found that in terms of relatedness, Facebook use is—somewhat paradoxically—correlated with both connection and disconnection. As for addiction, the researchers suggested that their subjects were habituated to a coping device that distracts from rather than resolves everyday problems.
4. Are texting and tweeting included in the IA diagnosis?
It is an open question whether the IA spectrum should include mobile, phone-based activities such as texting and tweeting. A 2010 study of college students in Pakistan found that many texted during class lectures; the majority of their texting activity occurred during late evenings and early morning hours. Several students said that their parents have tried to stop them from texting during meals and study time. If you’re the parent of adolescents in the US, you would probably not be surprised if one child texted the other one sitting next to him or her at the dinner table rather than bothering to vocalize, “Pass the chicken.”
Texting while walking can in fact be dangerous. A recent study of 138 college students using an online test found that when listening to music, texting or having a conversation on a smartphone, they were more likely to look away from the virtual street they were crossing than were the subjects with no distraction.
5. Are colleges being “taken over” by the online universe?
Not yet. But the signs are there: for example, college professors are using Twitter as a way to encourage discussion of subject matter among students, according to a 2010 US News and World Report article. Yet abuse of the Internet on college campuses has received relatively little attention, compared to substance abuse. And given that the Internet is an increasingly integral component of the typical college curriculum, college may be a risky environment for vulnerable students.
6. What are the risks if a person engages in abuse of both substances and the Internet?
In a study I conducted of 165 undergraduates (126 women and 39 men) at the New School for Social Research, in New York City, I found that students in the control group (i.e., no problematic substance or internet use) had fewer negative outcomes than those engaged in problematic use of both substances and the Internet. However, no differences were found between the students in the control group and students who had only one of the two habits.
The negative outcomes included psychological distress and decreased satisfaction with college. Yet not all online activities were associated with the same negative outcomes—and some actually correlated with positive results. Examples: online gambling, downloading files and texting were all associated with less academic success or other negative events. High college satisfaction was associated with chatting online and using the Internet for school.
Future studies might home in on behaviors like downloading or sharing files to learn why they particularly are detrimental. Answers could help mental health professionals gain insight into how best to work with these individuals. Some observers suggest that a lack of in-person social contact initiates the depressive symptoms, which in turn are exacerbated by continued face-to-face avoidance.
7. Are those of us who are past our college years at risk?
Age doesn’t exempt anyone from the problem since most of us rely on the Internet in our jobs and our home life. Ask yourself if your use is compulsive. Do you spend more time online than you originally intended? Do you go on Facebook because you prefer it to actual face-to-face contact? If combining Internet addiction with substance abuse can lead to more negative consequences for college students, the odds are that it will have the same effect on all of us.
[Video of Interest]
By Ruby Wax
Diseases of the body garner sympathy, says comedian Ruby Wax — except those of the brain. Why is that? With dazzling energy and humor, Wax, diagnosed a decade ago with clinical depression, urges us to put an end to the stigma of mental illness.
[Article of Interest] Psychiatry Manual Drafters Back Down on Diagnoses
By Benedict Carey
The New York Times
Excerpt: The [doctors on a panel revising psychiatry’s diagnostic manual] dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems. They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would not be mistaken for a mental disorder.
“At long last, DSM 5 is correcting itself and has rejected its worst proposals,” said Dr. Allen Frances, a former task force chairman and professor emeritus at Duke University who has been one of the most prominent critics. “But a great deal more certainly needs to be accomplished. Most important are the elimination of other dangerous new diagnoses and the rewriting of all the many unreliable criteria sets.”