Crawshaw, Caitlin. 2009-09-12. “Caring workers pay price: Compassion fatigue flies under radar.” Edmonton Journal.

“Compassion fatigue is often associated with nurses, who care for the sick and dying, but any worker who regularly deals with human suffering can become desensitized and detached. Beyond employees in the obvious professions–such as social work, nursing and counselling–chaplains, teachers, humane workers, midwives, personal support workers, lawyers, workers at women’s shelters, journalists and even those manning the phones at social insurance organizations can also be affected. Even those caring for others outside of the workplace, such as an elderly parent or sick spouse, can feel drained of their emotional and physical energy. “People who provide care with compassion and empathy can experience compassion fatigue,” explains Devon Tayler, an Edmonton social worker and compassion fatigue consultant. “That’s the good news about it — it’s a consequence of caring, and human beings care for each other. The downside is, we often don’t recognize that cost.” Those who suffer from compassion fatigue, or secondary traumatic stress disorder, often isolate themselves at work and limit communication with their clients or coworkers. They can become sick often and miss work, and ultimately become completely burned out, taking stress leave or quitting their jobs suddenly. “Burnout is a physical, social, emotional and spiritual situation where people have really lost themselves and lost meaning,” says Tayler. Those being cared for can also be severely affected. Some people with compassion fatigue start to dehumanize their patients, choosing to view them as case studies or clients, rather than as human beings. This can “block the story” of those receiving care and increase the likelihood of caregivers making mistakes. “We might gloss over something, thinking it’s not that important, when another person might think it really is important,” says Tayler. But this isn’t just a workplace problem. “Compassion fatigue impacts work . . . but it also impacts how we are in our families and in the community,” she says. Sufferers often stop doing the things they once enjoyed, as they feel utterly spent at day’s end. Many can do little more than zone out in front of the TV, disconnecting from their loved ones. Francoise Mathieu, a counsellor in Kingston, Ont., says awareness of compassion fatigue has improved since she started giving sessions on the subject in 2001, but many professionals still know very little about it. Also, she says students aren’t being prepared for this professional inevitability. “To me, it’s a huge issue that needs to be recognized as an occupational health and safety hazard in the workplace.” While compassion fatigue can be confusing for people who have dedicated their lives to the service of others, Mathieu assures people that it’s a symptom of caring. “The irony is that the best and most caring employees are the most at risk (Crawshaw 2009-09-12).”

Crawshaw, Caitlin. 2009-09-12. “Caring workers pay price: Compassion fatigue flies under radar.” Edmonton Journal.

shortlink http://wp.me/P2UqB-11

This is a partial truth, more like a flicktion, or a dream, or the virtual than the real. It’s not science or art, more like an invention or innovation. Pieces of this a flicktion are scattered throughout my semi-nomadic cybercamps like tiny inukshuk on a global landscape. It mimics visual anthropology but isn’t. It imitates ethnography but lacks the objectivity. There are words written, pictures taken of events, dates, settings, stages and characters without an author. Maybe it’s the wrong venue in a photo album of beaming faces, stunning scenery, professional photographers, travelers, techies, retirees. But we can all choose to follow each others sign posts in this cyberspace or move on. This is the power of this new social space spun in CyberWeb 2.0.

Cultural ethnographers are supposed to return to their academic spaces, sharpen their methodological tools to a tip that almost cuts the paper they write on (and too often the culture, pop or otherwise they are writing about). You’re not supposed to return from the field with their your mind numbed from the frosted words of those who were seduced by the gold mine of benign colonialism, their voices confident, mocking, paternalistic, jaded by years, or decades of northern experience (1970s-2002). Your were supposed to leave the field with the pace of your beating heart uninterrupted inside your embodied self. You weren’t supposed to leave your a chunk of your soul in that graveyard in Pangnirtung on the Cumberland Sound. This is just lack of professionalism. Get a grip. Just write that comprehensive, proposal, dissertation. Move on. It’s just the way it is.
In this coffee shop sipping a cup of freshly brewed French Roast, (better than a Vancouver Starbucks!), SWF listened with her eyes. She was compassionate but ever so slightly distant. She doesn’t seem to realize how much others from the outside can perceive her knowledge. It is what at times makes her intimidating. Her three generation life story is the stuff of Inuit social history. She seems to almost be unaware of how important that story is. She was surprised that the First Nations cared about the creation of Nunavut. I remember our first class together. She spoke so softly but she was so firm, so insistent, modest and dignified. The wails I had heard by the open graves that still echo in my mind, were all too familiar to her. Slowly, insistently she explained to me as if I really needed to listen, remember, register this. “We do not need your tears. We have enough of our own. We do not need you to fix this. We need your respect. We need you to not make it worse. We need you to listen to us, really listen. Alone, with no resources an elder has been taking them out on the land. She gets no funding. What she has done works. The funding is going elsewhere on projects that are promoted by the insiders. Inuit like her are not insiders.”

Uploaded by ocean.flynn on 2 Dec 2006, 11.00AM MDT.

1913 Moreno, Dr. Jacob Levy, (1889-1974) originated psychodrama, sociodrama, role training, sociometry, group psychotherapy. Moreno left Vienna and moved to America in 1925. He was influential in the social sciences. He originated psychodrama in 1921 a forerunner of creative arts therapies. He founded the American Society of Group Psychotherapy and Psychodrama (ASGPP) in 1942. In 1918 Moreno was using the term ‘drama’ to refer to “the activation of religious, ethical and cultural values in spontaneous-dramatic form”. It has been argued that the Austrian physician, social philospher, and poet Jacob Moreno was a pioneer in developing the idea of practitioner research (Gunz, 1996).”McTaggert (1992:2) cites work by Gstettner and Altricher which has a physician named Moreno using group participation in 1913 in a community development initiative with prostitutes in Vienna. “

1940′s Kurt Lewin is often credited with being the “father” of action research, especially in social psychology and education (for example, Kemmis, 1988: 29). When Lewin went to the US, he had been much influenced by Moreno, the inventor of group dynamics and sociodrama and psychodrama. Moreno had already developed a view of action research in which the “action” was about activism, not just about changing practice or behaviour understood in narrowly individualistic terms. Moreno was interested in research as a part of social movement. “Despite the clouded origins of action research, Kurt Lewin, in the mid 1940s constructed a theory of action research, which described action research as “proceeding in a spiral of steps, each of which is composed of planning, action and the evaluation of the result of action” (Kemmis and McTaggert 1990:8). ”

1945 – 1975 The new First Nations middle class emerged in Canada during the period of rapid growth following WWII (1945 – 1975) and includes managers, administrators, professionals and technicians. Cree bureaucrats in James Bay and the Alaskan business class emerged and reproduced itself. These groups mastered the technical idiom and directed PAR. They shared middle-class values with non-aboriginals and recognised that a fully-participatory research process which included all classes of aboriginal society, would challenge the status quo. (Jackson 1993:55) 

1960 “The Rockefeller Foundation opened a field office in Cali, Colombia in 1960, ten years after the establishment of the Colombian Agricultural Program in Bogota. Guy S. Hayes, an Assistant Director in the Medical and Natural Sciences division, held the post of Field Director in Cali from 1960 until 1970. After 1970, the office was headed by Foundation Representatives Patrick N. Owens (1970-1974) and Farzam Arbab (1974-1978). The office closed on December 31, 1983.”

1973 International Council for Adult Education: Toronto, ON founded by J. Roby Kidd. In 1975 this organization became a major advocate of participatory action research. The ICAE involved local communities in data collection and problem identification. Academics, who were also community workers, collaborated with local community participants on research projects. “The overall objective of the Council is to promote human resource development, to enable people to participate more fully in determining their economic, social, political and cultural development.” International Council for Adult Education  The aim of the Council is to promote the education of adults in accordance with the development needs of individuals, communities and societies as a way of enhancing international understanding; achieving economic and social development; advancing the skills and competencies of individuals and groups.

1960s Migration of Aboriginal people to urban areas grew in 1960s and 1970s. (Jackson 1993:58)  “Fin des années ’60, se développa une rébellion contre le savoir universitaire, notamment par la recherche appelée en Allemagne “Aktivierende Befragung” (enquête mobilisatrice). Il s’agissait, par exemple, d’aller de porte à porte dans les quartiers pour entamer une conversation dont le but était d’inviter à la réflexion. Ainsi, tel agent dit “il paraît que le club de jeunes du quartier cause des problèmes car il y a eu vandalisme. Qu’en pensez-vous ?”. La synthèse des conversations ayant été faite, celle-ci est restituée aux gens du quartier, par pâté de maison. Cette enquête débouche sur une action en commun. Convergence the International Journal of Adult Education, has been providing a forum for international exchange on current developments in adult education since 1968. An issue was devoted to Participatory Research in 1988: 1988. “Participatory Research” Convergence Vol.XXI:2/3.

1970′s Aboriginal leadership and the new middle class: Throughout the 1970s aboriginal members of the new middle class initiated and directed PAR. (Jackson 1993:55) 

1970′S Critiques of positivistic research paradigms emerged in the work of Habermas, Adorno and the Frankfurt School.

1974-? Edward Jackson worked for several years as field coordinator for Frontier College in the Atlantic Provinces of Canada. 

1971 Paulo Freire visited Tanzania in 1971 and observed the Participatory Research work as self-defined by Marja Liisa Swantz.

1971 Paulo Freire visited Tanzania in 1971 and observed Swantz’ methodologies which he then introduced to international social scientists. (Hall 1994:3331).

1960′s? – 1970′s Marja Liisa Swantz. worked with students and women village workers in the Tanzanian coastal region using a method which she self-defined as Participatory Research. Paulo Freire visited Tanzania in 1971 and observed Swantz’ methodologies which he then introduced to international social scientists. (Hall 1994:3331). Budd Hall credits Swantz work with influencing his own. “Marja Liisa Swantz was a social scientist attached to the Bureau for Land Use and Productivity (BRALUP) of the University of Dar es Salaam. She and a group of students from the University of Dar es Salaam including Kemal Mustapha who was later to become the African coordinator for participatory research were working in an engaged way with women and others in the costal region of Tanzania. Through this practice she and the others began to articulate what she called “participant research”.” (Hall, Budd 1997) 

1970-74 Budd Hall worked at the Institute of Adult Education of the University of Dar es Salaam, Tanzania. Hall described how he and many co-workers were transformed by the “…ideas, strategies and programmes of the Tanzanian government of the day articulated most effectively by President Julius Nyerere. Nyerere himself a former teacher had written much about the capacity of education to unchain people just as it had been used by the colonial powers to enchain a people. The philosophy of Ujamaa and Self-Reliance, concepts of what we would call today Afro-centric development and local economic development were open challenges to the way that the rich countries saw the world. Tanzania and Tanzanians were is so many ways telling the world that the ‘emperor has no clothes’. Nyerere and a generation of articulate and gifted leaders such as Paul Mhaiki in adult education challenged all who were working in Tanzania, national and expatriate alike, to look through a different lens to understand education, agriculture, development, history, culture and eventually for some of us even research and evaluation methods. We were all encouraged to ‘meet the masses more’ and while on a day to day basis this was difficult to understand, over time many of us were profoundly transformed.” (Hall, Budd 1997) 

1974 Fundacion para la Aplicacion de las Ciencias (FUNDAEC), a nongovernmental development agency in Colombia was founded by a group of professionals from a variety of disciplines, concerned about the negative impacts of the development processes set in motion after WWII, outlined in their frequent deliberations what eventually became a model for the integral development of rural areas, rooted in a meaningful participation of its inhabitants. The group was led by Farzam Arbab, a renowned physicist who had arrived as a visiting professor to the Universidad del Valle in 1970.” “The Rockefeller Foundation opened a field office in Cali, Colombia in 1960, ten years after the establishment of the Colombian Agricultural Program in Bogota. Farzam Arbab headed the program from 1974-1978. Farzam Arbab was a member of the NSA of Colombia from 1970 – 1980. Dr. Arbab holds a BA from Amherst College, Massachusetts (1964), a doctorate in elementary particle physics from the University of California, Berkeley (1968), and an honorary doctorate in science from Amherst College (1989). Farzam Arbab served as president of Fundacion para la Aplicacion de las Ciencias (FUNDAEC), a nongovernmental development agency in Colombia, from 1974 to 1988, and continues to serve on its board of directors. “Farzam Arbab’s doctorate in theoretical particle physics (1968) led him to Colombia to work with the University Development Program of the Rockefeller Foundation to strengthen the Department of Physics at the Universidad del Valle. While there he began to study the relationship between science, technology, and educational policy and their effects on development, which led him and a group of colleagues to form the Fundación para la Aplicación y Enseñanza de las Ciencias (Foundation for the Application and Teaching of Science).”

1974-75 Budd Hall was a visiting fellow at the Institute of Development Studies at the University of Sussex from 1974 – 1975. While at Sussex he met international researchers like Francisco Vio Grossi from Chile and Rajesh Tandon from India, who shared his research interests. (Hall, Budd 1997) 

1975 While at Sussex Budd Hall compiled a special issue of the journal Convergence on the theme of what he labelled ‘Participatory Research’. Hall chose the term ‘participatory research’ to encompass the collection of varied research approaches, including Swantz’ ‘Partipant Research’ and the European ‘Action Research’ which ‘shared a participatory ethos.’ (Hall, Budd 1997) 

1976 First World Assembly of the International Council for Adult Education which took place in Dar es Salaam in 1976. 

1970s “La critique la plus tranchée est intervenue dans les années ’70 et vient des universitaires engagés du Sud s’insurgeant contre l’aspect élitiste, importé, ethnocentrique du savoir occidental. D’autres épistémologies furent proposées, notamment par Orlando Fals-Borda (Colombien), Mohammed Anisur Rahman (Bangladeshi) et Budd Hall (Canadien travaillant en Tanzanie). (Se référer à Fals-Borda et Rahman Action and knowledge. Breaking the monopoly with P.A.R., Apex Press, N.Y. 1991). C’est Budd Hall qui lanca le vocable Participatory Action-Research (P.A.R.) ou RAP : “recherche-action-participative” au cours de son travail visant à associer les villageois ujamaa de Tanzanie à sa recherche-action.” Network Cultures 

1977 the International Council of Adult Education supported the initiation of a global network in Participatory Research that brought together the work of a growing number of practitioners/scholars already engaged participatory research practices in different parts of the world. Budd Hall, Edward Jackson, dian marino and Deborah Barndt. This included Orlando Fals-Borda and colleagues in Colombia, Francisco Vio Grossi in Chile, Rahman in Bangladesh and Hall in Tanzania. (Hall, Budd 1997) (Fischer 1996)  

1977 In the early stages of participatory action research many academics left their institutional posts to engage in more militant activism. Inspiration was garnered from humanist philosophies, from the writings of Ghandhi and in the contemporary version of Marxist thought. Orlando describes this stage as iconoclastic where no established institutions were trusted. (Orlando 1992:15) 

1977 World Symposium on Action-Research and Scientific Analysis was held in Cartagena, Columbia. This event was organised by Orlando Fals-Borda and Columbian institutions along with other national and international bodies. The theories of Antonio Gramsci offered new insights into participation. (Orlando 1992:15) Hall asserts that Fals-Borda originated the term “Participatory Action Research.” Budd Hall recalled that this Symposium “totally and efficiently dismissed for once and for all the pretention of detached positivist science.” (Hall, Budd 1997) 

1977 A follow-up meeting was held in Aurora, Ontario with Budd Hall, dian marino, Edward Jackson, Yusuf Kassam (Tanzania), Abdelwahid Yousif (Sudan), Per Stensland (USA), Helen Callaway (UK), Greg Conchelos, Paz Buttedahl, Francisco Vio Grossi, a colleague from India. The participants at that meeting produced a working definition of Participatory Research. 1. PR involves a whole range of powerless groups of people–exploited, the poor, the oppressed, the marginal. 2. It involves the full and active participation of the community in the entire research process. 3. The subject of the research originates in the community itself and the problem is defined, analyzed and solved by the community. 4. The ultimate goal is the radical transformation of social reality and the improvement of the lives of the people themselves. The beneficiaries of the research are the members of the community. 5. the process of participatory research can create a greater awareness in the people of their own resources and mobilize them for self-reliant development. 6.It is a more scientific method or research in that the participation of the community in the research process facilitates a more accurate and authentic analysis of social reality. 7. The researcher is a committed participant and learner in the process of research, i.e. a militant rather than a detached observer.(Hall, 1978:5) (Hall, Budd 1997)

1978 There were five nodes in the Participatory Action network: Toronto; New Delhi-Rajesh Tandon, coordinator; Dar es Salaam, Tanzania – Yusuf Kassam, coordinator; Netherlands – Jan de Vries, coordinator; Caracas, Venezuela – Francisco Vio Grossi, Coordinator.(Hall, Budd 1997) 

1979 There were meetings in New Delhi organized by Rajesh Tandon, at Highlander Research and Education Centre hosted by John Gaventa.(Hall, Budd 1997) 

VOICES OF CHANGE: Aboriginal-centred and Inuit-centred participatory action research projects:

PHASE I Aboriginal PAR: Land Use and Occupation

 

c.1965 Community self-surveys (CENTRAD 1973; Ponting and Gibbons 1980 cited in Jackson 1993:49.) 

1968 – discovery of oil and gas, Prudhoe Bay, Alaska 

1968 – Inter-departmental Task Force on Northern Oil development 

C.1970′s Land Use and Occupancy Studies (Jackson 1993:50) 

1970 – Imperial Oil discovery of oil and gas in the Mackenzie Delta 

1970 – General guidelines for the construction and operation of oil and gas pipelines in the Mackenzie Valley and Northern Yukon 

1971 – Environmental Social Program 

1972 – Expanded Guidelines for Northern Pipelines 

1974 – Canadian Arctic Gas Application 

1974 – Government creates the Pipeline Application Assessment Group 

1974 – Environmental Protection Board 

1974 – Independent Mackenzie Valley Pipeline Inquiry 

1974 British Columbia Nazko-Kluskus Land Use (cited in Jackson 1993:50)

1974 – 1977: Mr. Justice Thomas Berger’s enquiry was established on March 21, 1974. “Northern Frontier – Northern Homeland: The Report of the Mackenzie Valley Pipeline
Inquiry.”

1976 The Alcan Project proposed to carry natural gas by pipeline from Prudhoe Bay to the continental United States. It was put forward by a consortium of companies but it would have been Foothills Pipelines (Yukon) that would be building the Yukon portion of the pipeline. http://www.economicdevelopment.yk.ca/industry/OilAndGas/businessdevelopment/Lysyk%20Inquiry.htm

1977 Dene land use and occupancy study led to claims made by Dene Nation. Nahanni Butte is one of the Deh Cho’ communities. Nahanni Dene speak Slavey. (Nahanni 1977 cited in Jackson 1993:50) 

1978 Mackenzie Valley proposed pipeline was prevented due to the inquiry into Dene Land Use (Jackson 1978) 

1977 Eastern Arctic Inuit land use led to claims made by Inuit Tapirisat (Brice-Bennett 1977 cited in Jackson 1993:51) 

1977 Northern Ontario Nishnawbe-Aski Land Use (Sieciechowicz 1977 cited in Jackson 1993:50) 

Freeman, M. 1976. Inuit Land Use and Occupancy Project, Vol. 3: Land Use Atlas. Ottawa: Dept. of Indian and Northern Affairs. 

1970s Other Land Use and Occupation Studies led to Committee for Original People’s Entitlement (The Inuit of the Western Arctic) (Jackson 1993:51) PHASE II Aboriginal PAR: Water, Sanitation, Health, Housing, Social Services

 Late 1970′s Aboriginal-initiated, community-directed research on water, sanitation, health, housing, social services. (Jackson 1993:50) These studies used qualitative methodologies. (Jackson 1993:53)

1977 Trout Lake Band Council This PAR Cree-centred project (1977 – early 1980s) used local research committees, community seminars, study trips and local training along with reports in Cree syllabics. The research was designed to select a water and sewage system for the community. The choice was between a costly sewer line to service a small minority of non-Aboriginal houses (termed ‘technical apartheid’) vs a trucked water and waste system that would serve all the community. The more democratic second system was chosen. The project received international attention. (Jackson 1993:52) 

© Maureen Flynn-Burhoe 2002. Uploaded to aflicktion March 2009.

“The first thing to note is that the concept of ‘duty of care’ is spelled out from the outset. This includes a reference to a moral obligation on behalf of those working in the University: The University must exercise a “duty of care” to employees and to those under supervision and this duty is recognised in both criminal and civil law. There is also a moral duty that the teacher has towards the pupil. (University ‘A’ Occupational Safety, Health and Environment Unit 2004: 4) It is then explained that it is through a system of ‘line management’ that the University’s statutory requirements are expected to be met. In University ‘A’ formal responsibilities for issues of fieldworker safety are delegated to Heads of Departments. It is therefore for the Head of Department to ensure that the risk assessment for the fieldwork is made and to ensure that safe systems of work have been established for all staff and students. Frequently the Head of Department will delegate this duty to a particular member of staff as Departmental Safety Officer, or to different research managers – PhD supervisors and Principal Investigators (Bloor, Fincham and Sampson 2007-06).”

A number of authors have stated that researchers can be negatively affected emotionally and physically by research on sensitive issues (Alexander et al. 1989; Burr 1995; Cowles 1988; Dunn 1991; Gregory, Russell and Phillips 1997; Lee 1995; McCosker, Barnard and Gerber 2001). Some of the possible negative outcomes include gastrointestinal problems (Dunn 1991), insomnia and nightmares (Cowles 1988; Dunn 1991; Etherington 1996), headaches (Dunn 1991), exhaustion and depression (Ridge, Hee and Aroni 1999) and threats to physical safety (Langford 2000; Lee 1995). (Dickson-Swift et al. 2006: 857) (Bloor, Fincham and Sampson 2007-06).”

“There are two manifestations of resistance to researchers documented in the literature. One relates to unwillingness on the part of potential research participants to cooperate, and to be obstructive, and the other relates to unco-operativeness on the part of those connected with research participants – for example ‘gate keepers’. For anthropologists the separation of these two sites of resistance is often complicated, as in a study of a particular community there might be no distinction between a participant and a gate keeper (Bloor, Fincham and Sampson 2007-06:32).”

The process of ‘pain by proxy’ described by Moran-Ellis (Moran-Ellis 1997: 181) appears to have resonance for many researchers. The emotional strain of having to deal with distressing situations or narratives can be acute. It should be noted that there is also a literature concerned with the emotional impact of disturbing data on those not directly involved with the gathering of the data. Transcribers and PIs have been singled out as particularly vulnerable to this effect (McCosker et al. 2001). Hochschild’s description of ‘deep acting’ (Hochschild 1983: 42-3), may mask levels of upset or even trauma suffered by researchers who feel their professional integrity would be brought into question if such upset were acknowledged. However, increasingly there is recognition that the issue of emotional well-being is of great importance to researchers, research institutions and the integrity of qualitative research itself (Bloor, Fincham and Sampson 2007-06:34).

“With regard to PhD students, several contributions highlighted the ambiguous position of research students when it comes to the requirements of PhD research and risk to well-being. It is often the case that a precondition of PhD funding in the social sciences is that it is original research. In some instances this means that the specific research arena has not been previously entered. Therefore the potential risks in such research arenas are, to certain extent, untested. In these circumstances it is inevitable that PhD students become their own risk assessors and the least experienced in research can find themselves in the most exposed positions when it comes to potential harm (Bloor, Fincham and Sampson 2007-06:34).”

“There was discussion of what one contributor called ‘re-entry shock’. This was described in relation to both returning to a research site, but also adjusting back to a ‘normal’ life after extended periods of field research. One researcher reported the isolation they felt when trying to readjust to their life after particularly intense fieldwork. The final area of discussion in the emotional impact involved the possible damage done by the misrepresentation of results, particularly in popular media. Once again the need for specialist training and awareness programmes to be provided through institutions was highlighted (Bloor, Fincham and Sampson 2007-06:45).”

Sampson, Helen; Bloor, Michael; Fincham, Ben. “A Price Worth Paying? Considering the `Cost’ of Reflexive Research Methods and the Influence of Feminist Ways of `Doing.’ Sociology, 42:5:919-933 (2008) DOI: 10.1177/0038038508094570.

Abstract: “Drawing on analysis of relevant literature, focus groups, and web-based discussion board postings, assembled as part of an inquiry into risks to the well-being of qualitative researchers, it is argued that emotional harm is more prevalent than physical harm and may be particularly associated with reflexivity and the important influence of feminist research methods. The particular concern of feminist researchers with reflexivity, with research relationships and with the interests of research participants may make them especially vulnerable to emotional harm.”

Bloor, Michael; Fincham, Ben; Sampson, Helen. 2007-06. Qualiti (NCRM) Commissioned Inquiry into the Risk to Well-Being of Researchers in Qualitative Research.

Risk to emotional well-being of researchers involved in qualitative research, Role conflict, Anxiety, Isolation, Resistance, Unanticipated long term impact of research, Staying emotionally/psychologically safe

 

• “In Ontario, an estimated 530,000 children and adolescents have treatable mental illnesses, but only 150,000 are getting care.
• The youth suicide rate — 18 deaths per 100,000 — actually understates the loss of life because many kids overdose on drugs or die in violence. It also masks the staggeringly high rate — 108 per 100,000 — among aboriginal youth.
• Children wait one third longer than adults for psychiatric care in Ontario. They wait seven times as long as patients needing MRI or CT scans.
• Canada produces just 10 child psychiatrists a year (Goar 2005-02-11).”

Timeline

1958 The Canadian federal government started funding hospitals but excluded asylums (Bacic 2008-08).

1970s Canadian Federal Policies of “deinstitutionalization forced patients out of [mental health] care with no investment in community supports for [mental health] sufferers (Bacic 2008-08). Dr. Donald Milliken, president of the Canadian Psychiatric Association and a practitioner with nearly 40 years of experience, recalls his experience as a medical resident in 1970: “They gave me the keys to a ward and said, ‘There are 100 patients in there. Discharge 50.’ G&M“

2005-02-11 Senator Michael Kirby, head of the committee examining Canada’s mental health system met with “30 child psychiatrists, medical researchers, mental health advocates and parents at a
roundtable on kids and mental health, organized by business leaders and hosted by Scotiabank. [. . . ] Canada has the “worst adolescent suicide rate among the world’s leading industrial powers. Every year, 300 kids between the ages of 10 and 19 kill themselves [C]anada is doing an abysmal job — worse than the United States, Japan, Israel, Bulgaria, Belarus or Ukraine — of addressing the root causes of teen suicide (Goar 2005-02-11).”

2006-05 Senators Michael Kirby and Wilbert Joseph Keon tabled the Canadian Standing Senate Committee on Social Affairs, Science and Technology report entitled “Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada.”

2006-12-28 “In the United States, suicide is the third-leading cause of death among persons 15 to 19 years of age. In 2005 alone, according to the Centers for Disease Control and Prevention, 16.9% of U.S. high school students seriously considered suicide, and 8.4% had attempted suicide at least once during the preceding year (Friedman 2006-12-28).”

2008 The Globe and Mail printed a week-long series entitled “Breakdown: Canada’s mental health crisis.” “Columnists André Picard, Dawn Walton and Elizabeth Renzetti examined critical aspects of Canada’s mental health crisis, including how one-third of general hospital beds are filled with mentally ill patients, how 70 per cent of people with severe mental illness are working despite their illness, and how jails and penitentiaries have become warehouses for the mentally ill [. . . ] “Canada still doesn’t have a coherent strategy for treating the mentally ill,” says Ed Greenspon, The Globe and Mail’s editor-in-chief.” (Bacic 2008-08)

Who’s Who

Jennifer Chambers, co-ordinator of the Empowerment Council, an advocacy group for Canadian Association of Mental Health patients.

Anita Szigeti, lawyer for the Empowerment Council, an advocacy group for Canadian Association of Mental Health patients.

Vahe Kehyayan, director of the Psychiatric Patient Advocacy Office.

Simon Davidson, chief of psychiatry at the Children’s Hospital of Eastern Ontario.

Senator Michael Kirby, heads of the committee examining Canada’s mental health system.

Donald Milliken, past-president of the Canadian Psychiatric Association.

Richard Guscott, a Hamilton psychiatrist who specializes in treating children with mood disorders.

Jean Wittenberg heads the infant psychiatry program at Toronto’s Hospital for Sick Children.

Peter Szatmari, a specialist in autism who heads the psychiatry division at McMaster University.

Nasreen Roberts, director of adolescent in-patient and emergency services at Queen’s University.

Webliography and Bibliography

Bacic, Jadranka. 2008-08. “Landmark series on Canada’s mental health crisis gets people talking.” Canadian Psychiatric Aujourd’hui.

CPA. 2008-10. “Youth and Mental Illness.” Canadian Psychiatric Association.

Goar, Carol. 2005-02-11. “Tackling the issue of teen suicide.” TheStar.com

Friedman, Richard A. 2006-12-28. “Uncovering an Epidemic — Screening for Mental Illness in Teens.” New England Journal of Medicine. 355:26:2717-1719

Kirby, Michael J. L.; Keon, Wilbert Joseph. 2006-05. “Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada.” The Standing Senate Committee on Social Affairs, Science and Technology.

“The purpose of a Consensus Development Conference is to evaluate available scientific evidence on a health issue and develop a statement that answers a number of predetermined questions. A group of experts present the evidence to a panel, or “jury”, which is an independent, broad-based, non-government, non-advocacy group. The jury listens to and questions the experts. The audience is also given the opportunity to pose questions to the experts. The jury convenes and develops the consensus statement, which is read to the experts and the audience on the morning of the final day. The statement is widely distributed in the Canadian health care system (BUKSA Final Program 2008-10).”

…..

“According to most recent estimates, nearly 1.2 million Canadians aged 15 and older suffer from depression.[1] With approximately 4% of Canadians reporting having had a major depressive episode within the past 12 months,[2] depression is the most prevalent mental health condition in Canada, and is projected to be the leading cause of burden of disease in high-income countries by the year 2030.[3]“

Bibliography and Webliography

1. Canadian Council on Social Development. A Profile of Health in Canada. Retrieved June 10, 2008, from http://www.ccsd.ca/factsheets/health/.
2 Gilmour. H., Patten, S. (2007). Depression at work. StatsCan Perspectives, November, 19-33.
3 Mathers, C.D., & Loncar, D. (2006). Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLoS Medicine, 3(11), e442.
4 Beaudet, M.P., & Diverty, B. (1997). Depression an undertreated disorder? StatsCan Health Reports, 8(4), 9-18.
5 Wang, J.L. (2007). Depression Literacy in Alberta: Findings From a General Population Sample. The Canadian Journal of Psychiatry, 52(7), 442-9.

Objectives
• To develop a consensus statement on how to improve prevention, diagnosis, and treatment of depression in adults.
Participants will be able to:
• Describe the various types of depression and prevalence in Canada and Alberta
• Outline the key impacts of depression on individuals, families and society (including workplace)
• Outline the risk factors of depression including genetics, childhood experiences and relation to substance abuse
• Outline the most appropriate ways of diagnosing depression
• Describe the current treatments for depression and what evidence is available for their safety and effectiveness
• Describe the obstacles for effective management of depression
• Identify key research gaps in the field of depression

Maintenance of Certification (MOC)

Conference Organizing Committee

Dr. Egon Jonsson – Chair, Organizing Committee, Executive Director and CEO, Institute of Health Economics; Hon. Michael Kirby – Jury Chair, Chair, Mental Health Commission of Canada; Dr. Scott Patten – Scientific Chair, Professor, Depts of Community Health Sciences and Psychiatry, University of Calgary; Dr. Ray Block, Former President and CEO, Alberta Health Services/Alberta Mental Health Board; Mr. John Warrington, Manager, External Affairs, West, Wyeth Canada; Dr. Roger Bland, Executive Medical Director, Alberta Health Services/Alberta Mental Health Board; Dr. Steve Newman Professor of Psychiatry, University of Alberta,

Conference Communications Committee
Ms. Rhonda Lothammer, Communications Manager, Institute of Health Economics; Mr. Mike Pietrus
Communications Director, Mental Health Commission of Canada

Partners
Ms. Lisa Bergerman Research Coordinator, Alberta Health Services/Alberta Mental Health Board; Mr. Steve Clelland Director of Research, Alberta Health Services/Alberta Mental Health Board; Mr. Steve Long
Executive Director, Pharmaceuticals and Life Sciences,
Alberta Health and Wellness;
Dr. Craig Mitton
Assistant Professor, Health Studies, University
of British Columbia;
Mr. John Sproule
Senior Policy Director, Institute of Health Economics;
Ms. Rhonda Lothammer
Communications Manager, Institute of Health Economics;
Ms. Judy Wry
Project Manager, BUKSA Associates Inc.;
Ms. Josephine Lamy
Communications Coordinator, Alberta Health Services/
Alberta Mental Health Board;

Partners
Institute of Health Economics
Alberta Health Services
Mental Health Commission of Canada
Alberta Depression Initiative

Jury Members
Hon. Michael Kirby, Jury Chair;
Dr. Roger Bland;
Dr. Carolyn Dewa;
Ms. Madeleine Dion Stout;
Dr. Elliot Goldner;
Dr. Nancy Hall;
Dr. Alain Lesage;
Dr. Glenda MacQueen;
Dr. Ian Manion;
Dr. Garey Mazowita;
Mr. Rod Phillips;
Ms. Shelagh Rogers;
Mr. Phil Upshall;

Expert Speakers
Dr. Scott B. Patten, Scientific Chair;
Dr. Glen Baker;
Mr. Leonard Bastien;
Ms. Mary Ann Baynton;
Dr. June Bergman;
Dr. Dan Bilsker;
Ms. Lauren Brown;
Dr. Patrick Corrigan;
Dr. Janet M. de Groot;
Dr. Keith Dobson;
Dr. David J. A. Dozois;
Dr. Nady el-Guebaly;
Dr. Vincent Felitti;
Ms. Zorianna Hyworon;
Dr. Philip Jacobs;
Dr. Sidney H. Kennedy;
Dr. Raymond W. Lam;
Dr. Sonia Lupien;
Dr. A. Donald Milliken;
Ms. Shelagh Rogers;
Dr. Harold A. Sackeim;
Dr. Eldon R. Smith;
Dr. David L. Streiner;
Dr. Angus H. Thompson;
Dr. Thomas Ungar;
Dr. Patrick J. White;

Questions
1 What is depression and
how common is it?
2 What are the effects of
depression for the individual,
family, and society?
3 What are the risk factors
for depression, and how
can prevention of these
be improved?
4 What are the most
appropriate ways for
diagnosing depression?
5 What are current treatments
for depression and what
evidence is available for their
safety and effectiveness?
6 What are the obstacles to
effective management of
depression and strategies
to overcome them?
7 What further research is
needed in the field?

Wednesda y, October 15, 2008
7:00 – 8:15 am Breakfast and Registration – Bonavista/Lakeview Endrooms
8:15 – 8:30 am Opening Remarks – Britannia/Belaire/Mayfair
8:30 – 9:00 am Question 1: What is depression and how common is it?
• Depressive disorders, symptoms, prevalence, and incidence
Scott B. Patten MD FRCPC PhD, Professor, Faculty of Medicine, Departments
of Community Health Sciences and Psychiatry, University of Calgary
Panel Question and Answer
9:00 – 10:20 am Question 2: What are the effects of depression for the individual,
family, and society?
• The perspective of the individual and families
Shelagh Rogers, Broadcast Journalist, CBC Radio
• Impact on mortality and morbidity including other diseases
Eldon R. Smith OC MD FRCPC, Emeritus Professor, University of Calgary;
Chair, Canadian Heart Health Strategy and Action Plan
Lauren Brown BScPharm MSc ACPR, PhD Candidate, School of Public Health,
University of Alberta
• Impact on the workplace and society
Zorianna Hyworon, Chief Executive Officer, InfoTech Inc.
• Economic impact and utilization of health services
Philip Jacobs DPhil CMA, Director, Research Collaborations, Institute of Health
Economics; Professor, Health Economics, Faculty of Medicine, University of Alberta
Panel Question and Answer
10:20 – 10:45 am Break – South Foyer
10:45 am – 12:20 pm Question 3: What are the risk factors for depression,
and how can prevention of these be improved?
• Age, sex, race, and genetics
Sidney H. Kennedy MD, Professor of Psychiatry and Psychiatrist-in-Chief,
University Health Network, University of Toronto; Founding Chair, Canadian
Network for Mood and Anxiety Treatments (CANMAT)
• Adverse childhood experiences in relation to depression in adult ages
Vincent Felitti MD, Clinical Professor of Medicine, University of California;
Founding Chair of Preventative Medicine, Kaiser Permanente, San Diego
• Factors that cause different forms of stress and its relation to depression
Sonia Lupien PhD, Scientific Director, Mental Health Research Centre, Fernand
Sequin Hopital Louis-H Lafontaine, Université de Montréal
• The abuse of alcohol and other substances
Nady el-Guebaly MD DPsych DPH FRCPC, Professor and Head, Addiction Division,
Department of Psychiatry, University of Calgary; Medical Director, Addiction Program
& Centre, Alberta Health Services/Calgary Health Region

Wednesda y, October 15, 2008 (continued)
• Work related risk factors
Mary Ann Baynton MSW RSW, Director, Mental Health Works, Canadian Mental
Health Association; Ontario Program Director, Great-West Life Centre for Mental
Health in the Workplace
Panel Question and Answer
12:20 – 1:30 pm Lunch – Bonavista/Lakeview Endrooms
1:30 – 2:15 pm Question 4: What are the most appropriate ways for
diagnosing depression?
• Early detection, screening and other diagnostic methods
David L. Streiner PhD CPsych, Professor, Department of Psychiatry, University
of Toronto; Assistant Vice President, Research Director, Kunin-Lunenfeld Applied
Research Unit, Baycrest
• Diagnosis and follow up from a family practitioner’s perspective
June Bergman MD CCFP FCFP, Associate Professor, Department of Family
Medicine, University of Calgary
Panel Question and Answer
2:15 – 3:25 pm Question 5: What are current treatments for depression and what
evidence is available for their safety and effectiveness?
• Pharmaceutical treatment: Benefits and risks
Raymond W. Lam MD FRCPC, Professor and Head of the Division of Clinical
Neuroscience, Department of Psychiatry, University of British Columbia;
Director, Mood Disorders Centre of Excellence, University of British Columbia
Hospital, Vancouver
Panel Question and Answer
• Cognitive Behavioral Therapy
Keith Dobson PhD, Professor and Head of the Department of Psychology,
University of Calgary; Executive Director, Council of Canadian Departments
of Psychology; President-Elect, Academy of Cognitive Therapy; President-Elect,
International Association of Cognitive Psychotherapy
Panel Question and Answer
3:25 – 3:55 pm Break – South Foyer
3:55 – 4:50 pm Question 5: What are current treatments for depression and what
evidence is available for their safety and effectiveness? (continued)
• Psychotherapy
Janet M. de Groot BMedSc MD FRCPC, Associate Professor, Departments of
Psychiatry and Oncology and Associate Dean, Equity and Teacher-Learner Relations,
University of Calgary
• Self-management
Dan Bilsker PhD, Adjunct Professor, Faculty of Health Sciences,
Simon Fraser University; Clinical Assistant Professor, Faculty of Medicine,
University of British Columbia
Panel Question and Answer
Conference Program
7
Thursda y, October 16, 2008
7:15 – 8:30 am Breakfast and Registration – Bonavista/Lakeview Endrooms
8:30 – 9:45 am Question 5: What are current treatments for depression and what
evidence is available for their safety and effectiveness? (continued)
• Electroconvulsive therapy
Harold A. Sackeim PhD, Professor, Departments of Psychiatry and Radiology,
College of Physicians and Surgeons of Columbia University; Emeritus Chief,
Department of Biological Psychiatry, New York State Psychiatric Institute
• Non-traditional forms of treatment of depression
Raymond W. Lam MD FRCPC, Professor and Head of the Division of Clinical
Neuroscience, Department of Psychiatry, University of British Columbia;
Director, Mood Disorders Centre of Excellence, University of British Columbia
Hospital, Vancouver
• Healing practices in the Aboriginal community
Leonard Bastien, Elder and Consultant, Native Multi Service Team, Calgary and Area
Child and Family Services Authority
Panel Question and Answer
9:45 – 10:05 am Question 6: What are the obstacles to effective management
of depression and strategies to overcome them?
• Stigma
Patrick Corrigan PsyD, Professor and Associate Dean for Research, Institute
of Psychology, Illinois Institute of Technology
10:05 – 10:35 am Break – South Foyer
10:35 am – 12:30 pm Question 6: What are the obstacles to effective management
of depression and strategies to overcome them? (continued)
• Health care structure, financing and reimbursement systems
A. Donald Milliken MB MSHA FRCPC, Advocacy Committee Chair and Past-President,
Canadian Psychiatric Association; Affective Disorders Clinic, Victoria
• Mental health literacy: Tools for individuals and family
Thomas Ungar MD MEd CCFP FCFP FRCPC DABPN, Chief of Psychiatry,
North York General Hospital
• Access to health care for people with depression
David J. A. Dozois PhD CPsych, Associate Professor, Department of Psychology,
Faculty of Social Science, University of Western Ontario
• Waiting times and shortage of personnel
Patrick J. White PhD, Clinical Professor and Chair, Department of Psychiatry,
University of Alberta; Regional Clinical Program Director, Mental Health,
Alberta Health Services/Capital Health
Panel Question and Answer
12:30 – 2:00 pm Lunch – Bonavista/Lakeview Endrooms
8
Thursda y, October 16, 2008 (continued)
2:00 – 3:15 pm Question 7: What further research is needed in the field?
• Biomedical
Glen Baker PhD DSc, Professor and Vice-Chair (Research) and Director,
Neurochemical Research Unit, Department of Psychiatry, University of Alberta
• Clinical
Sidney H. Kennedy MD, Professor of Psychiatry and Psychiatrist-in-Chief,
University Health Network, University of Toronto; Founding Chair, Canadian
Network for Mood and Anxiety Treatments (CANMAT)
• Population Health
Scott B. Patten MD FRCPC PhD, Professor, Faculty of Medicine, Departments
of Community Health Sciences and Psychiatry, University of Calgary
• Economics
Philip Jacobs DPhil CMA, Director, Research Collaborations, Institute of Health
Economics; Professor, Health Economics, Faculty of Medicine, University of Alberta
• Policy
Angus H. Thompson PhD, Department of Psychiatry and Alberta Centre for
Injury Control & Research, University of Alberta; Research Associate, Institute
of Health Economics
Panel Question and Answer
3:15 – 4:00 pm Open discussion on all conference topics
Frida y, October 17, 2008
7:45 – 9:00 am Breakfast – Bonavista/Lakeview Endrooms
9:00 – 9:30 am Reading of the Consensus Statement
Consensus Panel Chair:
• Honourable Michael Kirby, Chair, Mental Health Commission of Canada
9:30 – 10:30 am Open Discussion
10:30 – 11:00 am Closing Remarks
• Honourable Michael Kirby, Chair, Mental Health Commission of Canada
• Egon Jonsson PhD, Executive Director and CEO, Institute of Health Economics
• Scott B. Patten MD FRCPC PhD, Professor, Faculty of Medicine, Departments
of Community Health Sciences and Psychiatry, University of Calgary
11:00 – 11:30 am Media Conference – Britannia/Belaire/Mayfair
Conference Program
9
Jury Members
JURY CHAIR
Michael Kirby
Mental Health Commission of Canada
The Honourable Michael Kirby was Secretary to the
Cabinet for Federal-Provincial Relations and Deputy Clerk
of the Privy Council from 1980 to 1983. In this capacity,
he was deeply involved in the negotiations which led
to the patriation of the Canadian Constitution and the
inclusion of the Charter of Rights in the Constitution. He
was summoned to the Senate on January 13, 1984. From
1999 to 2006, Senator Kirby was the Chairman of the
Standing Senate Committee on Social Affairs, Science
and Technology which resulted in a major two year study
of the health system in Canada. He retired from the Senate
on October 31, 2006. In May 2006, under Senator Kirby’s
chairmanship the Committee completed a study of Mental
Health, Mental Illness and Addiction. The first three reports
were released in November 2004, the final report, Out
of the Shadows at Last was released on May 9, 2006.
In March 2007, Michael Kirby was appointed Chair of the
Mental Health Commission of Canada.
Roger Bland
MB ChB, FRCPC, FRCPsych
Executive Medical Director, Alberta Health Services/Alberta
Mental Health Board; Professor Emeritus, Department of
Psychiatry, University of Alberta
Dr. Bland obtained his medical degree from Liverpool
University and after a period in general practice, trained in
Psychiatry at the University of Alberta. He has held academic
appointments at the University of Alberta, Department
of Psychiatry for over 30 years. He was Chair of the
Department of Psychiatry from 1990 to 2000 and currently
holds an appointment as Professor Emeritus. Dr. Bland
currently works as Executive Medical Director with Alberta
Health Services/Alberta Mental Health Board and was a
former Director and Assistant Deputy Minister for Mental
Health for Alberta.
He has had appointments in a variety of settings including
Alberta Hospital Edmonton, Alberta Hospital Ponoka,
community clinics of the mental health service, general hospital
inpatient and outpatient services, and providing mental health
services in a primary care clinic.
Dr. Bland has been involved in research in psychiatry
epidemiology and the cause and outcome of psychiatric
disorders for many years. He is currently a member for the
CPA of the Shared Care Working Group and collaborated
with Dr. Marilyn Craven in the publication of a bibliography
on shared care.
He has received the Alberta Medical Association’s Medal of
Distinguished Service, the Alexander Leighton Award from
the Canadian Academy of Psychiatric Epidemiology and
Canadian Psychiatric Association, and the Michael Smith
Award from the Schizophrenia Society in 2000. He was
awarded Honourary Life Membership of the Schizophrenia
Society of Alberta, and received the Canadian Medical
Association’s Senior Member Award.
Carolyn Dewa
MPH PhD
Program Head, Work and Well-Being Research and
Evaluation Program, Centre for Addiction and Mental Health;
Associate Professor, Department of Psychiatry, Department
of Health Policy, Management and Evaluation, University of
Toronto; CIHR/PHAC Applied Public Health Chair
Carolyn S. Dewa is an Associate Professor in the
Departments of Psychiatry and Health Policy, Management
and Evaluation at the University of Toronto. She is also
the Program Head of the Centre for Addiction and Mental
Health’s Work and Well-being Research and Evaluation
Program and is a Senior Scientist/Health Economist in the
Centre’s Health Systems Research and Consulting Unit
(HSRCU). She currently holds a Canadian Institutes of
Health Research IPPH/PHAC Applied Public Health Chair.
She received her doctoral degree in health economics from
Johns Hopkins University School of Hygiene and Public
Health and her MPH in health services administration from
San Diego State University School of Public Health. She
did a fellowship at the Harvard Medical School Department
of Health Policy and Management. Since joining the Centre
for Addiction and Mental Health in 1998, she has become
a national leader in workplace mental health research,
particularly in disability related to mental illness among
workers, the effects of mental illness on productivity and
interventions to improve disability outcomes.
10
Madeleine Dion Stout
President, Dion Stout Reflections; Inaugural and Vice-chair,
Board of Directors, Mental Health Commission of Canada
Madeleine Dion Stout, a Cree speaker, was born and raised
on the Kehewin First Nation in Alberta. After graduating
from the Edmonton General Hospital as a Registered
Nurse, she earned a Bachelor’s Degree in Nursing, with
Distinction, from the University of Lethbridge and a Masters
Degree in International Affairs from the Norman Paterson
School of International Affairs at Carleton University. She
serves on several Aboriginal and non-Aboriginal boards and
committees including the B.C. Women’s Health Research
Institute, the StreettoHome Vancouver Foundation and the
Aboriginal Women’s Health Program and was President
of the Aboriginal Nurses Association of Canada and
member of the National Forum on Health. In August 2007,
Madeleine was appointed to the Mental Health Commission
of Canada as an inaugural member and Vice-chair of the
Board of Directors. Madeleine was a Professor in Canadian
Studies and founding Director of the Centre for Aboriginal
Education, Research and Culture at Carleton University
in Ottawa. Now self employed, she continues to work as
a researcher, writer and lecturer and is currently affiliated
with three CIHR research grants. She has received the
Assiniwkamik Award from the Aboriginal Nurses Association
of Canada twice; a Distinguished Alumnus Award from
the University of Lethbridge; and an Honorary Doctor of
Laws by the University of British Columbia. The Canadian
Nurses Association of Canada has selected Madeleine for
the Centennial Award to be awarded to 100 outstanding
Canadian nurses later this year.
Elliot Goldner
MD MHSc FRCPC
Professor, Faculty of Health Sciences, CARMHA, Simon
Fraser University; Chair, Advisory Committee on Science,
Mental Health Commission of Canada
Dr. Goldner is a Professor at Simon Fraser University’s
Faculty of Health Sciences where he founded the Centre for
Applied Research in Mental Health & Addiction (CARMHA),
a research unit designed to provide research support to
government ministries, health authorities and community
agencies in their efforts to advance the quality of mental
health and addiction services.
Before joining the Faculty of Health Sciences at Simon
Fraser University, Dr. Goldner was on faculty at the University
of British Columbia’s Faculty of Medicine for 20 years, where
he was an active teacher, researcher and psychiatrist, and
was Head of the Division of Mental Health Policy & Services.
For many years, he cared for patients with mental health and
substance use problems at St. Paul’s Hospital in downtown
Vancouver and also provided mental health care in the
city’s Downtown Eastside. Dr. Goldner developed and
led a number of highly regarded treatment programs and
was the first provincial director of eating disorder services
in British Columbia.
Currently, Dr. Goldner directs a national Research Training
Program, entitled ‘Research in Addiction & Mental Health
Policy & Services’, funded by the Canadian Institutes of Health
Research in order to train scientists to conduct research to
advance the healthcare system’s approach to mental illness
and addiction. He also directs the Investigative Team of
the Michael Smith Foundation for Health Research, Health
Services Research & Policy Network, addressing Mental
Health & Addiction. Dr. Goldner has received awards for
his scholarly work and he has served on various Boards
of Directors. Currently he is a Director on the Board of the
Centre for Addiction Research, at the University of Victoria,
and also serves on the Board of the Coast Foundation
Society, a non-profit society that provides services to people
with severe mental illnesses. Dr. Goldner has recently been
appointed the Chair of the Advisory Committee on Science,
in Canada’s National Mental Health Commission.
Nancy Hall
PhD
Policy and Community Based Research Consultant,
Canadian Mental Health Association BC Division; Member,
BC Mental Health Review Board; Former Mental Health
Advocate of BC
From 1998-2001 Nancy Hall served as BC’s first
Mental Health Advocate. Her job was to comment on the
implementation of the province’s Mental Health Plan and
provide systemic policy advice. Since that time, Nancy
continues to work at the interface between policy, practice
and self care especially related to community mental health
services for individuals with serious and persistent mental
illness and or severe addiction. Her current project portfolio
includes: the BC Campus project which is a community of
practice to support improved evidence based approaches to
mental health and addiction on BC post secondary campuses;
the Mental Health Diversion project which is a province
wide consultation to develop best practices; and a service
framework to address system wide strategies to keep people
with mental disorders out of difficulty with the criminal justice
system and a housing policy review with CMHA’s 20 branches
located throughout BC.
Currently Nancy serves as a special advisor to the newly
formed StreetoHome Foundation which is mounting a new
approach towards ending homelessness in Vancouver.
Jury Members
11
Nancy is appointed to the BC Mental Health Board and
serves as a volunteer on the Vancouver Foundation’s
Community based Research Ethics Review Board.
Alain Lesage
MD FRCPC MPhil DFAPA FCPA
Professor, Department of Psychiatry, University
of Montréal and Fernand-Seguin Research Centre,
L-H Lafontaine Hospital
Dr. Lesage is currently a Professor in the Department of
Psychiatry, Faculty of Medicine, University of Montreal. He
has been at the Fernand-Seguin Research Centre, L-H
Lafontaine Hospital, Montreal, since 1987. He obtained
his medical degree from Sherbrooke University (Quebec,
Canada) and completed his psychiatric training within the
University of Montreal Hospitals network. He trained between
1983-1987 in epidemiologic and evaluative research at the
Institute of Psychiatry and Maudsley Hospital (UK) and at the
Verona’s Psychiatric Institute (Italy). He was invited research
fellow at the Health Systems Research Unit of the Clarke
(Toronto, Canada) in 1994-1995 and Visiting Scientist at the
Harvard School of Public Health 2003-2005. He participated
in the development of Best Practice in Reforming Mental
Health Services. He concentrates his work on the needs of
severely mentally ill persons using evaluative, epidemiological
and health services approaches. At L-H Lafontaine Hospital
and the University of Montreal he heads a unit to support,
through evaluation, the development of innovative treatments
and programs. He is associate editor for the Canadian
Journal of Psychiatry and was editor-in-chief of Santé
Mentale au Québec. He is past president of the Canadian
Academy of Psychiatric Epidemiology. He was the vice-chair
of the Advisory Board of the Institute of Neurosciences,
Mental Health and Addiction of the Canadian Institutes of
Health Research 2001-2006 and keeps the mandate of
fostering the CIHR mental health in the workplace long-term
research agenda. In November 2007, he received the Alex
Leighton Award from the Canadian Academy of Psychiatric
Epidemiology. He was the vice-chair of the Advisory Board
of the Institute of Neurosciences, Mental Health and
Addiction of the Canadian Institutes of Health Research
2001-2006 and keeps the mandate of fostering the CIHR
mental health in the workplace long-term research agenda. In
November 2007, he received the Alex Leighton Award from
the Canadian Academy of Psychiatric Epidemiology and the
Canadian Psychiatric Association. He pursues the training
of the next generation of researchers in mental health and
addiction services and policies research in collaboration with
colleagues Elliot Goldner, Carol Adair, and Paula Goering
from British Columbia, Alberta and Ontario.
Glenda MacQueen
MD FRCPC PhD
Professor and Head, Department of Psychiatry, University of
Calgary and Alberta Health Services/Calgary Health Region
Dr. MacQueen assumed the position of Professor and
Head of the Department of Psychiatry at the University
of Calgary in September 2008. Prior to this she was
the Academic Head of the Mood Disorders Program at
McMaster University where she was also an associate
member of the Intestinal Diseases Research Group and
Director of the Clinician Investigator Program for the
Department of Psychiatry and Behavioral Neurosciences.
She was a founding member of the Brain Body Institute, a
multidisciplinary institute focused on understanding the role
of the brain in the onset and progression of psychiatric and
somatic diseases. She completed her PhD in experimental
psychology with a focus on psychoneuroimmunology at
McMaster University where she also completed her MD
and residency training in psychiatry.
Dr. MacQueen is a clinical editor of the Current Medical
Literature Psychiatry series and is on the editorial board of
the Canadian Journal of Psychiatry. She is now serving as the
Scientific Officer for the Behavioral Sciences B Committee
of the Canadian Institutes for Health Research. She is on
the executive board of the Canadian Network for Mood and
Anxiety Treatment. Working with colleagues from a number of
disciplines she has been funded by the Canadian Institutes
of Health Research, the Ontario Mental Health Foundation,
the Canadian Psychiatric Research Institute, the National
Alliance for Research in Schizophrenia and Depression, the
Stanley Medical Research Institute, the National Institutes
of Health, the Scottish Rite Foundation, the NCE Allergen
Inc and Physicians’ Services Incorporated. She received
the 2008 Innovations Award from the Canadian College
of Neuropsychopharmacology. She is very involved in
training of students in medical and graduate programs
and recently received an award for Excellence in Research
Mentorship from the Department of Psychiatry and Behavioral
Neurosciences at McMaster University.
Ian Manion
PhD CPsych
Executive Director, Provincial Centre of Excellence for Child
and Youth Mental Health at CHEO
Dr. Manion is a clinical psychologist and scientist-practitioner
who has worked with children, youth and families presenting
with a variety of social, emotional, and behavioural problems.
12
Dr. Manion is a Clinical Professor in the School of Psychology
at the University of Ottawa, and a Visiting Professor at the
University of Northumbria (UK). He is the Executive Director
for the Provincial (Ontario) Centre of Excellence for Child and
Youth Mental Health at the Children’s Hospital of Eastern
Ontario (CHEO). He is actively involved in research in the
areas of parent/child interactions, community mental health
promotion, youth and parent depression as well as youth
suicide. He is a committed advocate for child and youth mental
health sitting on a number of local, provincial, national and
international boards and committees.
Dr. Manion is co-founder of Youth Net/ Réseau Ado,
an innovative, bilingual community-based mental health
promotion program with satellites across Canada and in
Europe. This program strives to understand the mental health
issues facing youth and to better address these issues with
sensitivity to gender, age, culture, and geography.
Garey Mazowita
MD CCFP FCFP
Chair, Department of Family and Community Medicine,
Providence Health Care; Clinical Associate Professor,
University of British Columbia
Dr. Garey Mazowita received his MD from University of
Manitoba in 1979, his CCFP in 1990 and his FCFP in
2000. He was in full-service private practice in Winnipeg
for many years, and then joined the Department of Family
Medicine at University of Manitoba where he became
a full-time preceptor. Prior to assuming his position as
Chair, Department of Family and Community Medicine
at Providence Healthcare in Vancouver, he was Medical
Director of Community and Long Term Care for the Winnipeg
Regional Health Authority. He has participated on, or
chaired numerous committees for the University of Manitoba,
including several years as a member of the Research Ethics
Board; Manitoba College of Physicians and Surgeons; and
the Manitoba College of Family Physicians where he was
President in 1998. He is currently a Clinical Professor,
Faculty of Medicine, University of British Columbia, and
remains active in research and clinical practice.
Rod Phillips
President and CEO, Shepell·fgi
Rod Phillips is President and CEO of Shepell·fgi, one of
North America’s leading providers of health and productivity
solutions for employees and organizations. Under his
leadership, Shepell·fgi offers integrated services that improve
the health and productivity of eight million employees and
their families from over 7,000 organizations in Canada,
and 64 other countries around the world.
In 2000, Rod was selected as one of Canada’s Top 40
Under 40 by the Caldwell Partners and the Globe and Mail’s
Report on Business. In 2005, he was selected as one of
the “Best of the Best” on the 10th Anniversary of the Top
40 Under 40 program. Rod is currently the Vice-chair of the
Global Business and Economic Roundtable on Addiction and
Mental Health, a member of the Canadian Institutes of Health
Research Workplace Mental Health Task Force and the U.S.
Centre for Employee Assistance Quality Advancement. Rod
is also a member of the board of Nexient Learning Inc. and
the Canadian Psychiatric Research Foundation and a past
member of the Council of The College of Physicians and
Surgeons of Ontario and past-President of the Canadian
Club of Toronto.
Rod is a graduate of the MBA program at Wilfrid Laurier
University in Waterloo and has an Honours BA in Political
Science and Literature from the University of Western
Ontario in London.
Shelagh Rogers
Broadcast Journalist, CBC Radio
Shelagh Rogers grew up in a home where every radio was
tuned to CBC. She dreamed of one day working with the
legendary broadcaster Peter Gzowski. When she landed her
first job in radio, it was at a country station in 1976. Ten years
later, she joined Peter Gzowski on air to read listener letters
and later he appointed her Deputy Host of Morningside. For
the past decade, Shelagh has hosted national current affairs
programs and traveled the land collecting stories. Shelagh
Rogers is currently the host of “The Next Chapter”, a program
devoted to Canadian books, writers and readers of all kinds.
It airs every Saturday at 3 pm, 3:30 in Newfoundland.
She has always been passionate about exploring issues
through the lives of people. Last year, she presented a
week-long series about the impact of mental illness on
family, friends and co-workers and hosted a year long series
examining the lives of aboriginal people called “Our Home
and Native Land”. For twenty-two years she has been a
literacy volunteer and her Bonspiel for Literacy has raised
more than $500,000.
A published writer, Shelagh is the winner of the 2008 Special
Women’s Health Journalism Award from the Canadian
Foundation for Women’s Health. She holds an Honourary
Doctorate from the University of Western Ontario and is a
proud recipient of a CAMH Transforming Lives Award 2008.
Jury Members
13
EXPERT CHAIR
Scott B. Patten
MD FRCPC PhD
Professor, Faculty of Medicine, Departments of Community
Health Sciences and Psychiatry, University of Calgary
Dr. Scott Patten is a Professor at the University of Calgary
in the Departments of Community Health Sciences and
Psychiatry and a Health Scholar with the Alberta Heritage
Foundation for Medical Research. His research focuses
on depressive disorders with an emphasis on those
epidemiological perspectives most relevant to population
health. Dr. Patten obtained his Medical Doctorate from the
University of Alberta (1986), and subsequently completed
a Residency in Psychiatry (1991) and PhD in Epidemiology
(1994) at the University of Calgary. He practices psychiatry
through the Consultation-Liaison Service located at the Peter
Lougheed Centre in Calgary.
Abstract 1
Depressive Disorders, Symptoms, Prevalence,
and Incidence
Nested within the broader category of Mood Disorders,
Depressive Disorders are characterized by a lowering of
mood, diminished interest or pleasure and diminished energy.
Associated features include disturbances of sleep, appetite
and cognition, altered thinking style, psychomotor changes and
thoughts of death or suicide. The most significant category
of Depressive Disorder is Major Depressive Disorder. In
order to qualify for this diagnosis, symptoms must be present
(during the same 2-week period) most of the time, nearly every
day. Furthermore, the disturbance must be associated with
distress, dysfunction or danger. The history of these disorders
is long, dating back at least to Hippocrates’ Aphorisms, in
which reference is made to persistent “melancholic affection.”
In the 1970s, empirical diagnostic criteria began to emerge,
greatly facilitating subsequent research. These criteria allowed
reliable identification of depressive disorders in community
studies. Early epidemiologic studies confirmed that depressive
disorders, particularly Major Depressive Disorder, have a very
high prevalence in the general population. At any point in time,
major depressive episodes afflict 2% of the Canadian adult
population. Approximately 5% will have an episode during
Speakers and Abstracts
Phil Upshall
National Executive Director, Mood Disorders Society
of Canada; Special Advisor on Stakeholder Relations,
Mental Health Commission of Canada; Adjunct
Professor, Dept of Psychiatry, Dalhousie University,
Past Executive Director, Canadian Alliance on Mental
Illness and Mental Health; Project Director, Mental
Illness Awareness Week 2008
Phil was educated at Dalhousie University, Halifax,
(B.Com. 1965) and the University of Toronto
(LLB 1967). He was called to the Bar of Ontario
in 1969. Currently, Phil is the National Executive
Director of the Mood Disorders Society of Canada
(MDSC), a virtual national NGO with a mandate to
represent the interests of consumers and families
dealing with depression, bipolar interest and other
related mood disorders. MDSC has led research
into the relationship between problem gambling
and bipolar illness; has held workshops dealing
with the stigma of mental illness; has led the way in
developing collaborative working relationships with
the First Nations, Inuit and Métis mental wellness
communities and has developed background research
for and hosted a workshop dealing with wait times
in emergency rooms for patients presenting with
psychiatric issues.
Phil was a member of the Institute Advisory Board
of the Institute of Neurosciences, Mental Health
and Addiction and has been a member of a number
of expert panels for Stats Canada, Health Canada,
CIHI and others. He is the immediate past National
Executive Director of the Canadian Alliance on Mental
Illness and Mental Health (CAMIMH).
Phil is the Special Advisor, Stakeholder Relations, to
the Mental Health Commission of Canada; an adjunct
Professor in the Department of Psychiatry, Dalhousie
University; the Managing Director of Mental Illness
Awareness Week in Canada and the project manager
for the Canadian Collaborative Mental Health Initiative,
Phase 2. He is one of the first Board Members
appointed to the Canada Post Foundation on Mental
Illness and Mental Health, is a member of the Advisory
Board to the Canada Research Chair, National Core
for Neuroethics, University of British Columbia.
14
Speakers and Abstracts
any given year. Most epidemiologic studies have placed the
lifetime prevalence of Major Depressive Disorder at between
8% and 17%, but for methodological reasons the true value
is almost certainly higher.
Despite these remarkably high prevalence figures,
depression’s population health impact has remained
under-appreciated for many years, probably because of
the importance traditionally ascribed to mortality indicators
in public health. Since 1990, the Global Burden of Disease
Project has sought to examine the impact of various health
conditions in terms both of premature death and years lived
with disability. By this standard, Major Depressive Disorder
is among the world’s most burdensome health problems.
According to some projections, Major Depression will be
the leading cause of disease burden in high income
countries by 2030. Recent research has documented
substantial increases in the frequency of depression
treatment. However, health systems have been more
effective in providing pharmacologic than non-pharmacologic
treatments. Also, the current orientation of health systems
tends to be with acute management and they may not
deliver adequate long-term management. Suboptimal
clinical interventions may contribute to poor outcomes,
especially in terms of chronicity and comorbidity.
Abstract 2
Future Population Health Research
In the area of population health, early psychiatric
epidemiologic studies yielded dramatic results. They
demonstrated high prevalence and extensive undertreatment.
These dramatic results emerged at a time of
therapeutic optimism both in terms of pharmacologic and
non-pharmacologic treatments. Perhaps as a result of this
confluence, the population-health literature moved quickly
towards a focus on health services research and specifically
towards an emphasis on access to treatment. Evidence of
high prevalence led to an assumption that the primary care
medical system should be the focus of new initiatives. A
number of basic epidemiological issues have been largely
overlooked. For example, factors related to the longitudinal
course of these disorders in the population remain ill-defined.
Because of this omission, the heterogeneity of depressive
disorders has been under-appreciated, so useful options for
health service delivery may have been overlooked. Dramatic
evidence of under-treatment in early epidemiologic studies
may also have encouraged the acceptance of simplistic
procedures for assessing treatment access. Evidence now
suggests that these approaches are biased. A systemic issue
relates to the expensive nature of large scale epidemiologic
studies. Most of the emerging data derive from large national
and international initiatives that are of unprecedented
quality, but which have the potential to suppress innovation.
Population health research across its entire spectrum from
epidemiology to health policy research is needed, but
simplistic assumptions and conventional methodologies of
past research will need to be abandoned if this enterprise
is to be successful.
Glen Baker
PhD DSc
Professor and Vice-Chair (Research) and Director
Neurochemical Research Unit, Department of Psychiatry,
University of Alberta
Dr. Baker is a Tier I Canada Research Chair and a former
Chair of the Department of Psychiatry at the University of
Alberta. His research deals primarily with the neurochemistry
of psychiatric disorders and the mechanisms of drugs
used to treat them; drug development, with a focus on
neuroprotective agents and drug metabolism; and drugdrug
interactions. He has been involved extensively in
supervision of research trainees, editorial work and service
to the scientific community. Dr. Baker was President of
the Canadian College of Neuropsychopharmacology
(CCNP) from 1992 to 1994 and is currently an Associate
Editor for the Journal of Psychiatry & Neuroscience and a
member of the editorial boards of several other journals. He
has published 270 peer-reviewed papers and numerous
book chapters, editorials, conference proceedings and
abstracts and has co-edited over 30 books. During his
academic career he has supervised or co-supervised
33 graduate students and 18 postdoctoral fellows and
served on review panels for MRC/CIHR, AHFMR, Health
and Welfare Canada, the Canadian Psychiatric Research
Foundation and the Canada Foundation for Innovation. His
honors and awards include the CCNP medal, McCalla and
Killam Professorships, the University of Alberta Excellence
in Mentoring Award, a DSc and an Alumni Award of
Achievement from the University of Saskatchewan, and
the CCNP Innovations in Neuropsychopharmacology
Award. In 2007, he was selected as one of the University of
Saskatchewan’s 100 Alumni of Influence recipients as part
of the University’s Centennial celebration.
15
Abstract
Future Directions in the Biomedical Treatment
of Depression
Most currently available prescription antidepressant
drugs have known effects on 5-hydroxytryptamine (5-HT,
serotonin) and/or noradrenaline (NA). While these drugs
are used widely and have increased our knowledge of brain
function, they are associated with response and remission
rates lower than desired, excessive adverse effects and
prolonged periods before clinical improvement occurs.
Recently, with the applications of elegant neuroimaging,
molecular biological, neurochemical and pharmacological
techniques, several exciting new possible targets have been
identified for the development of novel antidepressants.
Targets include dopamine (drugs that affect 5-HT, NA and
DA simultaneously are also under investigation), GABA and
glutamate, neuroactive steroids (act as allosteric modulators at
GABA and/or glutamate receptors), corticotrophin releasing
factor (CRF), substance P, cytokines and the immune
system, melatonin and intracellular signaling cascades and
neurotrophic factors. The systems mentioned above do
not operate in isolation, and there is an increasing trend to
study multiple systems in drug development. Although rapid
clinical response still remains elusive, recent studies with the
NMDA glutamate receptor antagonist ketamine are promising
(although ketamine has adverse effects). Neuroimaging
studies (MRI, MRS, fMRI) have provided useful tools for
understanding structural and functional changes in brain areas
and, when combined with studies on some of the systems
mentioned above, should lead to more effective diagnosis
and tracking of improvement in depression. Other factors to
consider in future biomedical studies in depression include:
deep brain stimulation; herbal products and nutraceuticals;
epigenetic regulation in depression; metabolomic approaches
to define biomarkers; the use of endophenotypes to describe
depression; and the need for better animal models. (Funding
provided by CIHR and AHFMR).
Leonard Bastien
Elder and Consultant, Native Multi Service Team; Calgary
and Area Child and Family Services Authority; Government
of Alberta, Children and Youth Services
Mr. Leonard Bastien was the Head Chief of the Piikani
Nation for 3 years, and was Minor Chief for 6 terms. He
also served as Chair for the Alberta Chiefs Summit for 7
years, was the Elder Advisor for the Calgary Chamber of
Commerce and is currently the Elder/Consultant Region
3, Calgary and Area, Child and Family Services Authority,
Native Multi-Service Team in Calgary, Alberta.
Mr. Bastien has been an Instructor/Researcher at the
Blackfeet Community College in Browning, Montana,
and has provided Cross Cultural Education for the U.S.
Administration dealing with North American Indian Tribes.
At the Blackfeet Community College in Montana, Mr.
Bastien has presented the methodology of incorporating
the Blackfoot Way of Life into Western World Values,
Beliefs and Philosophies and the difference it establishes
to the American Colleges and University faculties of various
disciplines in Washington D.C. He has also served as Faculty
Chair for Aboriginal Health Symposium, Banff
School of Management, Aboriginal Leadership Program
in Banff, Alberta.
Mr. Bastien is a Traditional Elder, Ceremonialist, and Political
Advisor for the Blackfoot Confederacy (Blood Tribe, Siksika
Nation, Piikani Nation, the Blackfeet of Montana, U.S.A.)
Married to Audrey, together they have five beautiful
daughters and five wonderful grandchildren.
Abstract
Healing Practices in the Aboriginal Community
Establishing a trust factor with the client is the first and
foremost requirement. The next process is assessing the root
of the depression, developing a course of action to deal with
the matter and deciding on the appropriate treatment plan
for the client. We the “Blackfoot” have several ceremonies
and methods that assist and in many instances resolve the
matter at hand. An understanding of the ceremonies, ritual,
and treatment plan are all a part of the healing practice.
The methodology of the healing practitioner will not be
standard and systematic for all healers. Each healer would
have their own unique way of practice. It must be clearly
understood and respected that traditional orthodox Blackfoot
culture stands on its own and is in no way parallel to other
cultures. Most universities teach Pan Indianism and believe
all Indian tribes in North America are the same. Details of
methodologies for healing practices can be disclosed at the
practitioner and client level. On a personal note, the root of
a majority of depression factors in the aboriginal community
can be attributed to the “Residential School Factor”. Poverty
as a violence is another major contributor and the systematic
“Manifest Destiny of Assimilation”.
16
Speakers and Abstracts
Mary Ann Baynton
MSW RSW
Director, Mental Health Works Canadian Mental Health
Association; Ontario Program Director, Great-West Life
Centre for Mental Health in the Workplace
Mary Ann is the director of Mental Health Works, which is a
multiple award-winning initiative of the Canadian Mental Health
Association of Ontario. Mental Health Works addresses
the management of workplace mental health issues from a
practical approach that is grounded in Mary Ann’s firsthand
experience as a business owner and manager. Her work
has included energy, communication, and industrial sectors,
federal, provincial, and municipal governments, healthcare,
education, and finance sectors. Mary Ann also serves as the
Project Director for the Great-West Life Centre for Mental
Health in the Workplace which is a corporate social initiative of
the Great-West Life Insurance Company that seeks to provide
knowledge and resources to employers who are interested in
improving workplace mental health and effectively addressing
employee mental health issues.
Mary Ann holds a Master’s degree in Social Policy and did
her research on innovation and empowerment in policy
implementation. In other words, her research was on why
the best laid plans don’t always work out and how to
change those results. She has 8 years experience as a
nationally certified coach and feels many of the skills used
in sports can be useful in business as well.
Currently, Mary Ann is a member of the Mental Health
Commission of Canada’s Workforce Advisory Committee
and is on the Accessibility for Ontarian’s with Disabilities
Employment Standards Committee.
Her background includes 15 years in the corporate world
and 5 years in the non-profit sector. Today she speaks about
managing mental health issues in the workplace, acts as a
consultant in returning people to work where mental health
issues or a history of workplace conflict is presenting an
obstacle to success, and helps workplaces find solutions
unique to their particular dynamic and reality. Mary Ann also
both creates and delivers workshops which provide awareness
and practical solutions to what are often complex issues.
Abstract
Work Related Risk Factors
The majority of supervisors and managers in the workplace
have neither the time nor the interest in doing a thorough
review of the literature in the area of mental health risk factors.
What they want and need is a practical approach that answers
the questions, “Why is this my concern?” and “What exactly do
you want me to do about it?”. For this reason, we distill much
of the literature down into three main themes: 1) Recognize
when an employee may be struggling with mental health
issues. (Notice) 2) Approach management of all employees
from the standpoint of helping them be successful at work.
This item includes looking at organizational or systemic
issues, management effectiveness, co-worker interactions and
individual well-being at work. (Focus on solutions rather than
problems) 3) Engage employees in determining the solutions
that allow them to be successful. (Get commitment instead
of compliance – this also adds to the sense of control for the
employee) This approach has the ability to prevent, manage
and address mental health concerns for people ranging from
very healthy to those who are experiencing serious levels of
illness. The beauty of it all is that we are not asking those in the
workplace to diagnose, treat or counsel their employees. We
are giving them concrete, practical advice about doing what
they are paid to do – support employees to be productive.
References:
Mental Health Works, an initiative of the Canadian Mental
Health Association – www.mentalhealthworks.ca
Great-West Life Centre for Mental Health in the Workplace
www.greatwestlife.com/centreformentalhealth
June Bergman
MD CCFP FCFP
Associate Professor, Department of Family Medicine,
University of Calgary
Dr. June Bergman has been a full service family physician
for over 35 years in Ontario and Alberta. She believes that
Primary Care involves caring for the whole person from a
biopsychosocial perspective. She states that as primary care
17
physicians, the care of individuals must include physical
and mental illness as well as their roots in their family
and community.
She has been involved for the past 15 years in program
development with mental health. Initially she helped develop
a shared mental health care program aimed at providing
mental health resources in family physician offices. Mental
health clinicians are partnered with family physicians and
see patients together to establish diagnosis, care pathways
and counseling. Psychiatric expertise is available on an asneeded
basis and in a variety of forms, including telephone
calls, educational sessions and the typical consultation. Her
program has been fully evaluated and found to be successful.
Primary Care Networks have now arrived in Alberta and
through the Foothills primary care network she has helped add
additional resources to community family physicians. They now
have access to a behavioural health professional in their office
for just in time management of acute problems. Telepsychiatry
is also available with psychiatrists to discuss selected patient
problems. Evaluation of these services is in place. Currently,
she is an Associate Professor with the Department of Family
Medicine at the University of Calgary.
Abstract
Depression in Primary Care
Depression is a very common diagnosis in primary care.
People accessing primary care have equal presentation
of physical and mental health issues.
Primary care is based on personal relationship between a
patient and the caregiver and is rooted in the community.
Family physicians follow a biopsychosocial model and are
well trained to manage most mental illness. If supports are
put in place to adapt for the main barriers to managing
mental health issues, primary care clinics can do exemplary
work. Our personal relationship with our patient is a long
time relationship and can be transferred to other health
care professionals.
Many models of care have been developed to support
primary care of mental health issues. This discussion will
review some of these and their strengths and weaknesses.
Integration of care with secondary and tertiary care is
essential to support needs of the patient and the work of
primary care physicians. Integration at the primary care
level of caregivers with other defined skills supports timely
diagnosis, appropriate intervention and maintenance of the
individual in his or her community.
As we further develop primary care with multi disciplinary
teams, IT support and networks of physicians we can expect
more capacity for mental illness care. Primary care also has
a major role to play in prevention of illness and promotion of
mental health through timely education, anticipatory counseling
and early identification of illness.
Evidence based interventions are now included in our
primary care quality improvement indicators as defined
through the national evaluation project.
Dan Bilsker
PhD
Adjunct Professor, Faculty of Health Sciences, Simon Fraser
University; Clinical Assistant Professor, Faculty of Medicine,
University of British Columbia
Dr. Bilsker is a psychologist who consults to a mental
health services research group (CARMHA) at Simon Fraser
University and works in an emergency psychiatric unit at
Vancouver General Hospital. His academic appointments
are Adjunct Professor, Faculty of Health Sciences, Simon
Fraser University and Clinical Assistant Professor, Faculty
of Medicine, University of British Columbia. He has been
overseeing an ongoing project to enhance the system of
mental health care in British Columbia by disseminating
brief behavioural interventions for mood disorders in primary
care. He has led projects to produce several depression
self-management tools:
• A self-care manual focused on mood problems associated
with chronic illness, Positive Coping with Health
Conditions (to be released in late 2008).
• A self-care manual focused on depression in work settings,
Antidepressant Skills at Work (2007).
• A self-care manual for depressed individuals,
Antidepressant Skills Workbook (2005), available in
French, Chinese and Punjabi translation.
• A self-care manual for depressed teenagers, Dealing
with Depression (2005).
Abstract
Self-management
Supported Self-management, a novel intervention for
depressive disorders, will be reviewed in terms of key
quality of care dimensions: 1. Definition and examples
of this intervention, including a self-management tool
developed at Simon Fraser University; 2. Relevance
to needs of the Canadian health system, focused on
its potential to increase capacity for comprehensive
18
Speakers and Abstracts
depression management; 3. Effectiveness in the
management of depression, focused on the results of
randomized controlled trials, and the contribution of
provider support for self-management; 4. Appropriateness
with regard to its suitability for different severity levels,
applicability to primary care settings and potential for
addressing the problem of medication overuse in mild
cases. 5. Feasibility of introducing this intervention as
a standard component of depression care, focused on
its compatibility with primary care practice, cost relative
to standard depression treatment and acceptability to
primary care providers as well as to depressed patients
(as measured by behavioural uptake of the intervention
under realistic conditions). Overall, the data presented here
indicate that supported self-management is an intervention
with considerable potential to enhance the quality of
depression care in Canada. It is no panacea, but does
represent an underutilized technology which should be
introduced nationally while being carefully evaluated with
regard to its optimal dissemination, cost-effectiveness,
adaptation to provincial health systems and sustainability.
Lauren Brown
BScPharm MSc ACPR
PhD Candidate, School of Public Health, University
of Alberta
Lauren Brown obtained her Bachelor of Science in Pharmacy
in 2001 at the University of Alberta, and completed a
hospital pharmacy residency in the Capital Health Authority
in 2002. She completed a Master of Science in Medical
Sciences-Public Health Sciences in 2004.
Her MSc thesis topic was the temporal relationship
between depression and diabetes. Lauren has also looked
at the relationship between antidepressant medications
and depression. Lauren is now working towards her PhD,
investigating access to care in people with schizophrenia,
specifically focused on prevention and treatment of
cardiovascular disease.
Abstract
The Impact of Depression on Diabetes
Depression is a common illness that has a substantial impact
on daily functioning, and increases the risk of mortality. Not
only is depression debilitating due to its related symptoms,
research has demonstrated that depression is associated
with a number of chronic medical conditions. Diabetes is
among many chronic diseases that appear to be related to
depression. Diabetes is also a serious health problem, and
is associated with a number of complications including heart
attack and stroke (cardiovascular disease), limb amputation,
kidney disease, and eye disease. The lifespan for someone
with diabetes is 13 years shorter than someone without
diabetes, and cardiovascular disease is the most common
reason for death.
Depression is approximately two times more common in
people with diabetes compared to people without diabetes.
Research has demonstrated an increased risk of diabetes in
people with a history of depression; however, having diabetes
does not seem to increase the risk of developing depression.
Also, people with diabetes and comorbid depression are less
likely to take their medications, test their blood sugar, and
adhere to a proper diet. Not surprisingly, having depression
increases the risk of developing complications associated with
diabetes, including cardiovascular disease and eye disease.
Given that depression appears to be a risk factor for diabetes,
and people with comorbid depression and diabetes are at a
higher risk of cardiovascular disease, eye disease, and kidney
disease compared to people with diabetes only, it is likely
important to regularly screen for diabetes in people diagnosed
with depression.
Patrick Corrigan
PsyD
Professor and Associate Dean for Research Institute of
Psychology, Illinois Institute of Technology
Patrick Corrigan is Professor and Associate Dean for
Research in the Institute of Psychology at the Illinois Institute
of Technology. He came to IIT after more than a dozen years
19
at the University of Chicago where he directed the Center for
Psychiatric Rehabilitation. Corrigan is also Chief of the Joint
Research Programs in Psychiatric Rehabilitation at IIT. The
Programs are research and training efforts dedicated to the
needs of people with psychiatric disability and their families.
Seven years ago, Corrigan became principal investigator of
the Chicago Consortium for Stigma Research (CCSR), the
only NIMH-funded research center examining the stigma of
mental illness. CCSR comprises more than a dozen basic
behavioral and mental health services researchers from
seven Chicago area universities and currently has more than
ten active investigations in this arena. Corrigan’s current
research includes an employer survey about health condition
stigma in Hong Kong, Beijing, and Chicago and a survey
on the ADA with a nationwide sample. Corrigan is a prolific
researcher having authored ten books and more than 200
papers. He is also editor-in-chief of the American Journal of
Psychiatric Rehabilitation.
Abstract
Stigma: If We Build It Will They Come?
Many people who might benefit from treatments fail to
seek them out or to fully adhere to them. Epidemiological
surveys showed as many at 40 to 65% opt not to pursue
it. One might hypothesize that these ratios represent the
worried well, people who adjust to their disorder, and do
not need services. But these same studies show that people
with serious mental illness including depression and other
affective disorder, have equally low care-seeking rates.
Additional research on adherence showed at least half of
people involved in treatment drop out prematurely or fail
follow-up treatment as prescribed. Most of this work has
examined care-seeking and adherence to pharmacological
treatments. Participation in psychosocial interventions like
cognitive therapy show even worse ratios.
Stigma has been shown to be a barrier to care-seeking and
adherence in two ways. (1) People do not seek treatments
in order to avoid the labels often associated with stigma.
The stereotypes and prejudice elicited by stigma common
to Canadians include blame and incompetence. (2) People
curtail or otherwise minimize participation because of selfstigma
and loss of empowerment.
Preliminary research on label avoidance suggests some mix
of social education and contact may be effective. Social
education involves contrasting the myths of depression with
the facts. Contact with people with mental illness is essential
for stigma change. These strategies are most effective when
targeting groups; e.g., crafting programs for young adults in
college. Self-stigma is challenged by enhancing the person’s
empowerment over life decisions and the treatments meant
to enhance associated goals.
Janet M. de Groot
BMedSc MD RCPC
Associate Professor, Departments of Psychiatry and
Oncology and Associate Dean, Equity and Teacher-Learner
Relations, University of Calgary
Dr. Janet de Groot is an Associate Professor at the University
of Calgary in the Departments of Psychiatry and Oncology.
A psychiatrist with demonstrated expertise in educational
administration and leadership, her clinical and academic
focus has been psychotherapy, women’s mental health
and psychosocial oncology. Since joining the University
of Calgary’s department of psychiatry in 2006, she has
been committed to strengthening psychotherapy training
in her recent role as chair of its active and dedicated
psychotherapy subcommittee (2006-8). Janet obtained her
MD at the University of Alberta, and then completed her
psychiatry residency and subsequent sub-specialty research
training in eating disorders and female psychology at the
University of Toronto, where she was a faculty member for
over a decade. As the new Associate Dean, Equity and
Teacher-Learner Relations reporting to the Dean, Janet
will continue to address issues affecting the educational
environment, as well as promote and facilitate equity at the
Faculty of Medicine, University of Calgary.
Abstract
Psychotherapy and the Treatment of Depression
Evidence-based practice in the psychotherapy of depression
requires consideration of the best available research for each
treatment model, clinical experience and the preferences and
characteristics of the person with the illness. Psychotherapy
interventions are potentially valuable when antidepressant
medications are ineffective or inadvisable due to adverse
effects and when patients show a clear preference and
motivation for psychotherapy. In addition to cognitive
behavioural therapy (CBT) which will be discussed by Dr. K
Dobson, interpersonal psychotherapy (IPT), psychodynamic
psychotherapy and integrative interventions that combine
elements of various psychotherapeutic modalities have been
shown to be valuable in both individual and group formats
in the treatment of depression. Therapist experience with
a therapeutic modality and a strong therapeutic alliance
20
Speakers and Abstracts
between therapist and patient/client enhance psychotherapy
outcomes. Therapeutic mechanisms of action are being more
carefully delineated and vary by psychotherapeutic modality.
Supervised provision of psychotherapy is considered the
gold standard for training of psychotherapists and thus,
included in the clinical training of mental health professionals.
To ensure that future psychiatrists have proficiency in
several psychotherapeutic modalities, the specialty training
requirements in psychiatry have recently been revised to
enhance the amount of longitudinal supervised training in
the psychotherapies. Psychotherapy use for mood disorders
is increasing and elements of supportive therapy are often
provided in conjunction with antidepressants. Psychotherapy
treatment for depression considers a broad range of
outcomes, in addition to symptoms of the illness, as well
as subsequent social functioning and relapse rates.
Keith Dobson
PhD
Professor and Head of the Department of Psychology,
University of Calgary; Executive Director, Council of
Canadian Departments of Psychology; President-Elect,
Academy of Cognitive Therapy; President-Elect, International
Association of Cognitive Psychotherapy
Dr. Dobson completed his PhD in 1980 and has been
a Professor in the Clinical Psychology training program
at the University of Calgary since 1989. During his time
there he has served in various roles, including Director of
Clinical Psychology and Head of Psychology. His research
has focused on both cognitive models and mechanisms in
depression, and the treatment of depression, particularly using
cognitive-behavioral therapies. Dr. Dobson’s research has
resulted in over 150 published articles and chapters, 7 books,
and numerous conference and workshop presentations in
many countries. In addition to his research in depression, he
has written about developments in professional psychology
and ethics, and has been actively involved in organized
psychology in Canada, including a term as President of the
Canadian Psychological Association. He was a member of the
University of Calgary Research Ethics Board for many years,
and is President-Elect of the Academy of Cognitive Therapy,
as well as the President-Elect of the International Association
for Cognitive Psychotherapy. With Dr. Scott Patten, he is
also a co-leader of the Hotchkiss Brain Institute Depression
Research Program. Among other awards, he was given the
Canadian Psychological Association’s Award for Distinguished
Contributions to the Profession of Psychology.
Abstract
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is increasingly
recognized as an efficacious and cost-effective treatment
for depression. This presentation reviews some of the
recent evidence that relates to this recognition. The efficacy
of CBT is reviewed relative to two other psychological
treatments for depression (Interpersonal Therapy and
Behavioral Activation), but the focus of the presentation is
on the relative efficacy of CBT and pharmacotherapy for
depression. It is argued that when consideration is made
of such issues as side-effects, drop-out, and relapse, CBT
significantly outperforms pharmacotherapy. Further, data
from two recent trials suggests that the long-term costs
associated with pharmacotherapy outweigh those for
CBT. Recent developments in the treatment of depression
using CBT in the United Kingdom are reviewed. Policy
implications of the evidence for Canada are suggested.
David J. A. Dozois
PhD CPsych
Associate Professor, Department of Psychology, Faculty
of Social Science, University of Western Ontario
David J. A. Dozois received his PhD from the University of
Calgary in 1999 and is now an Associate Professor in the
Department of Psychology at the University of Western
Ontario. Dr. Dozois’ research focuses on the role of cognition
in depression and anxiety and cognitive-behavioural theories/
therapy. Dr. Dozois has published over 70 peer-reviewed
articles and book chapters, and has three edited books. He has
also presented numerous papers at national and international
conferences. Dr. Dozois received early career awards from
the Canadian Psychological Association (CPA), the Canadian
Institutes of Health Research, the National Alliance for Research
on Schizophrenia and Depression, and the Ontario Mental
Health Foundation. He has been on the Board of Directors
(Director-Scientist) for the Canadian Psychological Association
since 2005. He also maintains a small private practice.
21
Abstract
Access to Health Care for People with Depression
Depression is an extremely debilitating mental health
problem, affecting approximately 4% of Canadians in a given
year. This disorder is associated with significant cognitive,
emotional, behavioural, somatic, and social impairment.
Depression impacts not only the individual sufferer, but
also has formidable economic and social consequences.
Researchers have, in fact, predicted that by the year 2020
depression will be second only to ischemic heart disease
in terms of cost to society. For the vast majority of persons
who experience major depressive episodes, the disorder
is also highly recurrent. Notwithstanding its tremendous
burden, delays in help-seeking and limited access to care
are common and exacerbate the personal and societal
burden associated with this disorder. Although estimates
vary widely, approximately half of individuals with depression
never see a clinician and many of those who do seek help
fail to receive evidence-based care. Treatment-seeking
appears to have increased recently, but there is considerable
room for improvement in access to care, particularly for
empirically-supported psychological interventions (e.g.,
cognitive-behavioural therapy, interpersonal psychotherapy).
In this presentation, I will outline some of the individual (e.g.,
fear of stigma), provider (e.g., underdetection) and systemic
(e.g., limited availability of effective treatments) barriers to
adequate treatment delivery. Following this overview, I will
suggest strategies for overcoming each of these three
main obstacles.
Nady el-Guebaly
MD DPsych DPH FRCPC
Professor and Head, Division of Addiction, Department
of Psychiatry, University of Calgary; Medical Director,
Addiction Program & Centre, Alberta Health Services/
Calgary Health Region
Dr. el-Guebaly is Professor and Head, Division of Addiction,
Department of Psychiatry at the University of Calgary and
past Chair of the Department. He is the Founding Medical
Director of the Alberta Health Services/Calgary Health
Region’s Addiction Centre and Program.
He is also Board Chair of the Alberta Gaming Research
Institute; Third term Chair, Addiction Psychiatry Section of
the World Psychiatric Association; and Executive Medical
Director and Past-Founding President of the International
Society of Addiction Medicine.
He holds recognition awards from the American Society of
Addiction Medicine, the Mexican Psychiatric Association,
The Italian Society of Addiction Psychiatry, the University
of Calgary’s Guenther Distinguished Achievement Award
in International Health, a Queen Elizabeth II Golden Jubilee
medal and an Alberta Centennial medal.
Major research interests have resulted in 200 peer-reviewed
papers and chapters, 450 abstracts, and 60 past and current
research grants.
Abstract
The Abuse of Alcohol and Other Substances
Both substance abuse (SUD) and depressive disorders are
common in the general population. There are several ways
SUDs and depression may interact:
• Depression may be a risk factor for SUDs – “the selfmedication
hypothesis”.
• Depression may result from chronic intoxication –
symptoms disappear within weeks.
• Depression and SUDs may modify each other’s course
in terms of symptomatology, rapidity of onset and
treatment response; a long comorbid history may
be difficult to disentangle.
• The presence of both disorders does not always imply
a causal link.
Individuals suffering from depression should all be screened
for substance abuse, substance abusers should be screened
for suicidality. The levels of non-risk drinking for depressed
individuals are lower.
Differentiating between both disorders must take into
account their relative onset, persistence of symptoms after
detoxification or in past experience being “clean and sober”,
the relative expectations from type, amount and duration
of substance use as well as family history. The presence
of chronic dysthymia or personality disorder may further
complicate the diagnostic process.
When both disorders occur, an integrated treatment
approach is recommended. In general, the prescription of
antidepressants alone modestly decreases substance use
and the symptoms of depression. The goal is to abstain from
intoxicants to allow for mood stabilization. This is achieved with
psychosocial strategies including motivational interviewing,
cognitive-behavioral therapy, relapse prevention, contingency
management or 12-Step facilitation. Participation in informed
mutual help groups can be a major factor in recovery.
22
Speakers and Abstracts
Vincent Felitti
MD
Clinical Professor of Medicine, University of California;
Founding Chairman, Department of Preventive Medicine, Kaiser
Permanente Medical Care Program, San Diego, California
Vincent J. Felitti is a Co-Principal Investigator of the
Adverse Childhood Experiences (ACE) Study, ongoing
collaborative research between Kaiser Permanente and the
Centers for Disease Control. A 1962 graduate of Johns
Hopkins Medical School, Dr. Felitti is an internist who
founded the Department of Preventive Medicine for Kaiser
Permanente in San Diego, California in 1975. He served as
Chief of Preventive Medicine until 2001. Under Dr. Felitti’s
leadership, the Health Appraisal Division of the department
became the largest single-site medical evaluation facility
in the world, providing comprehensive, biopsychosocial
medical evaluation to a total of 1.3 million individual adults.
During his career, he developed major health-risk abatement
programs for obesity, smoking cessation, the genetic
disease Hemochromatosis, and somatization disorders.
These programs are provided to over 1,000 patients per
month in San Diego. Dr. Felitti is a Clinical Professor of
Medicine at the University of California and a Fellow of
The American College of Physicians.
Abstract
The Adverse Childhood Experiences Study
The Adverse Childhood Experiences (ACE) Study is a
long term, in-depth analysis of over 17,000 middle-aged,
middle-class Americans, matching their current health status
against 10 categories of adverse childhood experiences that
occurred on average a half-century earlier. This collaborative
effort by Kaiser Permanente and the CDC found that:
• adverse childhood experiences are surprisingly common
although typically concealed and unrecognized;
• they still have a profound effect 50 years later, although
now transformed from psychosocial experience into
organic disease and mental illness;
• and that adverse childhood experiences are the main
determinant of the health and social well-being of the nation.
We will present the full range of our findings and discuss
their implications for diagnosis, treatment, and prevention.
It should be possible for participants to come away with an
understanding of the need to routinely screen for adverse
childhood experiences in all patients, have an awareness of
their relevance to chronic conditions and ‘problem patients’,
and have a sense of appropriate approaches to treatment
that will need to be devised for each case. The implications
for medical practice of this comprehensive biopsychosocial
approach are profound and have the potential to provide a
new platform upon which to base primary care medicine.
The Adverse Childhood Experiences Study thus has direct and
important relevance to the practice of medicine and to the field
of social planning. Its findings indicate that many of our more
common public health and adult medical problems are the
result of events and experiences present but not recognized
in childhood. The ACE Study challenges, as needlessly
superficial, the current conceptions of depression and
addiction, showing them to have a very strong dose response
relationship to antecedent life experiences. Further information
about the ACE Study is available at www.ACEStudy.org and

http://www.cdc.gov/NCCDPHP/ACE/

Ms. Zorianna Hyworon
CEO
Info Tech Inc.
Zorianna Hyworon is the CEO of InfoTech Inc., providers of
an online health risk assessment to employers since 1990.
Working globally, she has supported Global Fortune 500
& FT500 corporations in applying data and information
gained through integrating health risk assessment with
organizational, mental health and productivity measures to
support informed business decisions. For the past three
years, she has performed benchmark analysis covering
over 200,000 employees by country, region and industry
to provide a base of comparative data related to health,
productivity and organizational factors. Benchmark results
also track change over time, comparing risk flow against the
natural flow of risk. A key element of this benchmark analysis
is to place the data from depression screening in the context
of lifestyle, work/life and organizational factors.
23
Prior to founding InfoTech Inc., Zorianna was Assistant Deputy
Minister in the Manitoba Departments of Industry, Trade &
Technology and previously Finance, with an 18 year career
in the public and corporate sectors in Canada, providing
operational, strategic and policy direction in the application of
information technology to support the decision making needs
at the consumer, management and executive levels.
Abstract
Impact on the Workplace and Society
Drawing on a global benchmark, this presentation will highlight
the results of depression self-screening within the context of an
online health risk assessment completed by employees in major
Canadian and global corporations. Prevalence and severity
of depression symptoms as measured by the PHQ-9 will be
correlated to age, gender, known heart disease and diabetes,
clinical predictors of heart disease and diabetes, lifestyle
factors. The impact of depression on productivity loss through
presenteeism and absenteeism, as measured by the Work
Limitations Questionnaire (WLQ), will be presented in a broader
context of health, lifestyle, organizational stressors, work/life
and job factors. The financial impact of productivity loss as
linked to severity of reported symptoms will be compared at
individual and employee population levels for the Canadian and
the global benchmark groups. Examples of practical workplace
initiatives for supporting individuals suffering from depression
through workplace-centered productivity-focused protocols
delivered through enhanced EAP services will be presented for
consideration for use in Canadian workplaces.
Philip Jacobs
DPhil CMA
Director, Research Collaborations, Institute of Health
Economics; Professor, Health Economics, Faculty of
Medicine, University of Alberta
Philip Jacobs is Director of Collaborations at the Institute of
Health Economics and Professor of Health Economics at the
University of Alberta, Department of Medicine. His research
areas are economic evaluation and health finance. He was
the project director for the IHE booklet, Mental Health
Economic Statistics in your pocket, and has conducted
several studies on the cost of mental health services in
Canada. He is currently working with Drs. Kim Lim and
Carolyn Dewa on a booklet entitled, How much should we
spend on mental health? which will be published later this
year by the IHE. He has worked with co-investigators at the
IHE and Alberta Mental Health Board in the development of
a provincial database for mental health services utilization.
Abstract
Economic Impact and Utilization of Health Services
This talk will present the economic concepts and data
which can help the jury incorporate economic issues in their
deliberations about depression. The basic components of
cost which use up resources are: treatment costs, social
service costs, workplace costs (regarding absenteeism and
presenteeism). Other costs include “human costs” (loss of
quality of life), government and private disability payments,
and external costs (e.g., crime). Basic treatment costs for
depression for Canada are not known. In Alberta in 2006
the costs were $81 million, excluding costs of community
mental health centres. Work loss costs are roughly 2 times
this amount, human costs approximately 4 – 6 times, and
government social assistance payments about one-half.
Canadian research indicates that about one-half of the
persons with depression are not diagnosed or treated.
Research from Australia indicates that optimal care will
reduce the costs of those who are currently treated by about
30%, and extending treatment to the currently untreated will
increase those costs by 10%. There are no Canadian data.
Sidney H. Kennedy
MD FRCPC
Professor of Psychiatry and Psychiatrist-in-Chief, University
Health Network, University of Toronto; Founding Chair,
Canadian Network for Mood and Anxiety Treatments
(CANMAT)
Sidney H. Kennedy is Professor of Psychiatry and
Psychiatrist-in-Chief at University Health Network, University
of Toronto. He obtained his medical degree from Queen’s
University, Belfast, Northern Ireland and trained in Psychiatry
in the United Kingdom and in Canada.
Dr. Kennedy has been a clinician, researcher and educator at
the University of Toronto for two decades. He held the inaugural
24
Speakers and Abstracts
Cameron Wilson research chair in Depression Studies at
the University of Toronto. Dr. Kennedy is a former President
of the Canadian College of Neuropsychopharmacology and
was the founding Chair of the Canadian Network for Mood
and Anxiety Treatments (CANMAT). He is a Distinguished
Fellow of the American Psychiatric Association and a member
of the American College of Neuropsychopharmacology.
He was awarded the JM Cleghorn Award for excellence
and leadership in clinical research by the Canadian
Psychiatric Association in 2004 and the Canadian College
of Neuropsychopharmacology Gold Medal in 2006 for his
contribution to neuropsychopharmacology in Canada.
He has explored the neural circuitry of depression using PET
and fMRI during the past decade, publishing on effects of
antidepressants, cognitive behavioral therapy and deep brain
stimulation on regional brain activity.
He has championed the development and dissemination
of Clinical Guidelines for the treatment of Mood Disorders
(Depression and Bipolar Disorder) through CANMAT and
is the primary author of “Treating Depression Effectively:
Applying Clinical Guidelines” with Drs. Raymond Lam, David
Nutt and Michael Thase, now in its second edition. He also
co-authored “Depression and Personality: Conceptual and
Clinical Challenges” with Drs. Michael Rosenbluth and
Michael Bagby in 2005. He has over 250 peer-reviewed
publications and participates in numerous international
societies and conferences.
Abstract 1
Risk Factors for Major Depressive Disorder:
Age, Sex, Genetics, Culture and the Environment
Relatively consistent findings about risk factors for depression
have emerged across international epidemiological studies.
While individual risk factors are important, recent evidence
suggests that interactions among factors may be even more
important in understanding vulnerability and prevention
strategies. Taken together, age and sex have a strong influence
on depression risk. Before age 14, boys and girls are equally
at risk; in midlife women are twice as likely to experience
depression as men, while older men and women are equally at
risk. Social/environmental, biological/hormonal and ‘willingness
to report’ differences have all been considered in explanatory
models. There is also an interaction between sex, marital and
economic status. Work by Kendler and associates identifies
three ‘risk pathways’ to depression involving antecedent a)
anxiety symptoms, b) conduct disorder and substance use,
and c) multiple economic and psychosocial disadvantage.
Increasing demands for work output in the presence of
minimal job flexibility are also risk factors. Racial/ethnic factors
influence genetic risk as well as symptom reporting and
misdiagnosis. The interaction between genes and environment
is well illustrated in studies of the serotonin transporter where
the short allele conveys an increased risk of depression
following adverse life events and influences treatment
response. Screening for high-risk groups (e.g. post-partum
mothers with prior history of depression) and applying early
intervention strategies for diagnosis and treatment as well as
emphasis on relapse prevention through cognitive behaviour
therapy, pharmacotherapy and other maintenance strategies
should form the basis of prevention planning. Future research
to identify biologically distinct subpopulations and match
personalized treatments offers the best option for prevention.
References:
1. Kendler KS. Hierarchy and heritability: the role of
diagnosis and modeling in psychiatric genetics. Am J
Psychiatry 2002;159:515-8.
2. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW,
Harrington H, McClay J, Mill J, Martin J, Braithwaite A,
Poulton R. Influence of life stress on depression:
moderation by a polymorphism in the 5-HTT gene.
Science 2003;301:386-9.
Abstract 2
Future Clinical Research
The current diagnostic classification of major depressive
disorder is devoid of implications about cause and effect.
By requiring 5 out of 9 symptoms, with at least one being
depressed mood or lack of interest, the end result is clinical
heterogeneity and an inability to accurately match treatment
to symptom profile. Future clinical research should be
considered under two main themes: (1) assessing and
refining current practices (2) adopting paradigm shifts.
Early detection and treatment improves long-term outcomes,
yet treatment seeking in Canada is associated with greater
severity and longer duration of episode (Mojtabai & Olofson,
2006). What are the least resource intense first-line strategies
to treat depression? If CBT or other psychotherapies are
first-line interventions, what are the guidelines for their use
according to symptom profiles, severity, episode duration and
number of prior episodes? If pharmacotherapies are first-line
treatments, what algorithm can be developed to enhance
current rates of remission? Given the disappointing results
from the largest effectiveness trial of antidepressant therapies
(STAR*D), how can trials with enough power to detect clinically
meaningful differences between treatments or between
subpopulations of depressed patients be carried out?
Real paradigm shifts will occur when distinct neurobiological
markers are identified in subgroups of depressed people and
targeted treatments are matched to patient profiles. There
are numerous examples of abnormal biological findings in
depressed patients. These range from alterations in: various
hormonal axes, circadian rhythms, inflammatory mechanisms,
neurotransmitter-receptor sequences, brain structure
and function. Two examples of targeted therapies are the
development of melatonin-receptor acting agents that reset
aberrant circadian rhythms and deep brain stimulation to
25
specific brain regions identified as abnormal using functional
brain imaging techniques. Melatonin agents may be useful
early in the course of a recurrent depressive illness while
deep brain stimulation would be reserved for otherwise
treatment resistant patients.
References:
1. Mojtabai R, Olfson M.Treatment seeking for depression in
Canada and the United States. Psychiatr Serv 2006;57:631-9.
2. Warden D, Rush AJ, Trivedi MH, Fava M, Wisniewski SR.
The STAR*D Project results: a comprehensive review of
findings. Curr Psychiatry Rep. 2007;9:449-59.
Raymond W. Lam
MD FRCPC
Professor and Head of the Department of Psychology,
University of Calgary; Executive Director, Council of
Canadian Departments of Psychology; President-Elect,
Academy of Cognitive Therapy; President-Elect, International
Association of Cognitive Psychotherapy
Dr. Raymond W. Lam is Professor and Head of the Division
of Clinical Neuroscience in the Department of Psychiatry,
University of British Columbia, and Director of the Mood
Disorders Centre of Excellence at UBC Hospital within the
Vancouver Coastal Health Research Institute. His research
examines clinical and neurobiological factors in seasonal,
atypical, difficult-to-treat and workplace depression, biological
effects of light, clinical trials and treatment programs for
depression. This work has been supported by many agencies
including the Canadian Institutes of Health Research and
industry research grants. Dr. Lam has published over 270
scientific articles and book chapters, and edited or authored
six books on depression. He also sits on the editorial boards
of six international journals, including the Journal of Affective
Disorders and the Cochrane Collaboration, and reviews for
numerous journals and funding agencies.
Dr. Lam has received many awards for his research and
teaching, including the R.O. Jones Memorial Award
(Canadian Psychiatric Association, 2007), Silver Anniversary
Leadership Award (UBC Medical Alumni, 2006), the Scientific
Achievement Award (Vancouver Coastal Health, 2003), the
Douglas Utting Prize and Medal for Depression Research
(SMBD-JGH/McGill University, 2001), the Nancy Roeske
Award for Excellence in Medical Student Education (American
Psychiatric Association, 1998), and a Special Recognition
Award (Canadian Mental Health Association, 1999).
Abstract 1
Pharmaceutical Treatment: Benefits and Risks
Recent media attention has raised controversy about the
safety and efficacy of antidepressants, but the reality is that
there is more evidence for the usefulness of medications than
for any other treatment in psychiatry. The problem, however, is
that despite the recent focus on evidence-based approaches,
there is simply too little available evidence for many of the
important clinical decisions that must be made with individual
patients. Randomized clinical trials (RCTs) with placebo
controls are the gold standard for demonstrating efficacy and
safety, but there are many limitations to the RCTs conducted
for approval by regulatory agencies and none are designed
with safety as a primary outcome. Therefore, results from metaanalyses
of RCTs must be supplemented by information from
pharmacoepidemiological studies, large naturalistic database
studies, and forensic studies in order to come to reasonable
conclusions about safety and efficacy. Overall, there is
clear evidence that antidepressants are safe and effective
treatments for moderate to severe depression, although any
use of medications for depression (as for any other condition
in medicine) requires careful monitoring of patients.
Abstract 2
Non-Traditional Forms of Treatment of Depression:
Benefits and Risks
There are several evidence-based treatments for depression
that are considered “non-traditional” as well as numerous
approaches that do not as yet have quality evidence to
support their use. Randomized clinical trials (RCTs) with
placebo controls are the gold standard for demonstrating
efficacy and safety, but adequate placebo conditions for
non-pharmacological treatments are challenging to design.
In addition, there is much less funding available for RCTs
of non-traditional treatments because these treatments are
usually not patentable. Consequently, the quality and quantity
of evidence for non-traditional treatments lags behind that
of pharmaceutical treatments. Some of the evidence-based
non-traditional approaches include somatic treatments such
as bright light therapy (primarily for winter depression),
transcranial magnetic stimulation, and St. John’s wort. Other
approaches with less quality evidence include exercise,
acupuncture, omega-3 fatty acids, S-adenosyl-methionine
(SAMe), and other herbal therapies and neutraceuticals. While
some of the latter approaches are unlikely to be associated
with serious risks, the limited evidence makes it difficult to
recommend them for any but the mildest forms of depression.
26
Speakers and Abstracts
Sonia J. Lupien
PhD
Scientific Director, Mental Health Research Centre, Fernand
Sequin Hopital Louis-H Lafontaine, Université de Montréal,
Faculty of Medicine
Dr. Sonia Lupien is Scientific Director of the Mental Health
Research Centre Fernand Seguin at Hospital Louis H
Lafontaine, and is an Associate Professor with the Department
of Psychiatry at Université de Montréal. Dr. Lupien is also the
Founder and Director of the Centre for Studies on Human
Stress (www.hlhl.qc.ca/stress). After completing her PhD in
Neuroscience at Université de Montréal, Dr. Lupien received
postdoctoral research training at the University of California
in San Diego and at Rockefeller University in New York. Dr.
Lupien’s research interests focus on the effects of stress over
the human lifespan. Early in her career, she showed that high
levels of stress hormones in older adults are linked to both
memory impairment and smaller volume of the hippocampus,
a brain structure involved in learning and memory. Two years
later, she showed that children from low socioeconomic status
present higher levels of stress hormones when compared
to children from high socioeconomic status. Importantly, Dr.
Lupien’s research has demonstrated that stress may have a
negative impact on humans at any age, be it young or old. Her
future projects include a research program on the detection
and intervention for stress in the workplace, as well as the
development of the DeStress for Success Program that aims
at educating children and teenagers on stress and its impact
on learning and memory.
Abstract
Factors That Cause Different Forms of Stress and its
Relation to Depression
The popular definition of stress is time pressure. Indeed, we
usually feel stressed when we do not have the time to perform
all the tasks we would like to do in the allocated period of time.
However, what most scientific studies tell us is that stress
is not caused by time pressure. Rather, it is caused by the
combination of four characteristics of a situation that when
detected by the brain, can cause a profound stress response.
Chronic activation of the stress response can lead to stressrelated
disorders such as burnout or depression. This happens
because the same stress hormones that the body produces in
order to deal with the stressor can easily and rapidly cross the
blood brain barrier and access the brain. When these stress
hormones access the brain, they have significant impact on
learning and memory, as well as on regulation of emotion. With
this set of knowledge in mind, it is now easier to analyze both
personal and organizational factors that could cause chronic
stress in Canadian workers. Consequently, understanding
the characteristics of a situation that induce a stress
response in humans can help both individuals and industry
at deconstructing the causes of stress, in order to organize
behavior and/or work environment that will prevent the chronic
activation of a stress response and the negative effects that
accompany it.
A. Donald Milliken
MB MSHA FRCPC
Advocacy Committee Chair and Past-President, Canadian
Psychiatric Association; Affective Disorders Clinic, Victoria
Dr. Milliken has practiced both clinical and administrative
psychiatry for almost forty years. He trained in psychiatry
at the University of Alberta and has an additional degree in
health administration from the University of Colorado. He
was the Chief of Psychiatry for the Misericordia Hospital,
Edmonton, then the Clinical Director of Forensic Services,
Alberta Hospital, Edmonton and taught at the University
of Alberta with the rank of Clinical Professor. In 1993, he
relocated to Victoria, British Columbia, where he was the
Chief of Psychiatry for seven years. During this time, he
developed a catchment-area model of services, integrating
in-patient and out-patient systems with the belief that care
must go to those most in need; that the system must provide
continuity of care and support in a simple yet seamless
manner, and that the organization of care must be seen as
being clinically sensible by practitioners and recipients alike.
Dr. Milliken has received a Special Award for Outstanding
Service from the Alberta Board of Review, and an “Exemplary
Psychiatrist” Award from the US National Alliance for the
Mentally Ill.
27
A Past-President of the Canadian Psychiatric Association
(CPA), he is a signatory to the Canadian Collaborative
Mental Health Initiative’s “Charter for Mental Health Care”,
and co-chaired the first CPA / Global Business and
Economic Roundtable on Addiction and Mental Health forum
on “Mental Health and the Workplace”.
A principal author of the CPA Policy Papers “Wait-Time
Benchmarks for Patients with Serious Psychiatric Illnesses”
and the draft “Standards for Public Services of Psychiatric
Care” (in press), he sits on the CPA Board of Directors
representing British Columbia and currently chairs the CPA
Advocacy Committee. Dr. Milliken advocates about the need
to have levels of care for patients with psychiatric illnesses
that are equal to those provided to patients with other
illnesses of equivalent disability.
Abstract
Health Care Structure, Financing, and Reimbursement
Systems
Major depression has been described as the “single most
expensive” disorder facing Western societies. The mortality
and morbidity associated with this illness is significant, yet too
often, the care offered is ad-hoc, relatively unplanned, does
not address the needs of the patient with the disability, and is
unsupportive of the practitioner charged with that care.
If the goal is to restore the patient with varying levels of
disability and vulnerability to a symptom-free state, and to
minimize the risk of recurrence, there is no single “onesize-
fits-all” system for care. The treatment needs will vary
with the acuity of the symptoms, the level of disability
experienced, and, within limits, the personal preferences
of the patient. For a recurrent and disabling condition that
incapacitates a variety of mental functions, a purely demanddriven
model of care may not be appropriate.
The interests, skills and level of comfort of the primary
physician must also be considered and supported. The
ubiquitousness of depression as a co-morbid condition must
be recognized and addressed. Ease of access to and from
higher levels of stepped care is essential.
As for any chronic or relapsing illness, educational programs
addressing the needs of both patients and families to
understand the illness, to address behavioural changes
to reduce future vulnerabilities and to promote relapse
prevention have to be made available in a manner that is
evidence-based, effective and yet cost efficient.
It is against this background that the underlying paradigms
of the planning process must be identified and carefully
examined.
Shelagh Rogers
Broadcast Journalist, CBC Radio
Shelagh Rogers grew up in a home where every radio was
tuned to CBC. She dreamed of one day working with the
legendary broadcaster Peter Gzowski. When she landed her
first job in radio, it was at a country station in 1976. Ten years
later, she joined Peter Gzowski on air to read listener letters
and later he appointed her Deputy Host of Morningside. For
the past decade, Shelagh has hosted national current affairs
programs and traveled the land collecting stories. Shelagh
Rogers is currently the host of “The Next Chapter”, a program
devoted to Canadian books, writers and readers of all kinds.
It airs every Saturday at 3 pm, 3:30 in Newfoundland.
She has always been passionate about exploring issues
through the lives of people. Last year, she presented a weeklong
series about the impact of mental illness on family, friends
and co-workers and hosted a year long series examining the
lives of aboriginal people called “Our Home and Native Land”.
For twenty-two years she has been a literacy volunteer and her
Bonspiel for Literacy has raised more than $500,000.
A published writer, Shelagh is the winner of the 2008 Special
Women’s Health Journalism Award from the Canadian
Foundation for Women’s Health. She holds an Honourary
Doctorate from the University of Western Ontario and is a
proud recipient of a CAMH Transforming Lives Award 2008.
Abstract
The Perspective of the Individual and Families
Canada is so often cited as the best country in the world
in which to live. How can it be that this great country is the
only country in the G8 that does not have a national strategy
to deal with mental illness? My presentation will begin at
home. As someone with unipolar depression, I know about
the high personal stakes that come with that diagnosis from
exclusion to rejection, from low self esteem to downright
shame. Feeling this way puts stress on families who may
themselves become more predisposed to depression. My
address will be personal and anecdotal with thoughts on
recommendations for both the depressive and their families,
such as the top ten things a depressed person hates to hear.
It will also suggest ways in which families can and do help,
through care, comfort and concern. Perhaps it’s time for us
as families to bring depression forward as families of gays
and lesbians did, to help normalize public thinking and feeling
about mental illness in general and depression in particular.
We need to reduce the charge this issue has, to bring the
temperature back to normal. And a good place to start is in
the home.
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Speakers and Abstracts
Harold A. Sackeim
PhD
Professor, Departments of Psychiatry and Radiology, College
of Physicians and Surgeons of Columbia University; Emeritus
Chief, Department of Biological Psychiatry, New York State
Psychiatric Institute
Dr. Harold A. Sackeim served as Chief of the Department
of Biological Psychiatry at the New York State Psychiatric
Institute, for 25 years. He is currently Professor of Clinical
Psychology in Psychiatry and Radiology, College of
Physicians and Surgeons, Columbia University and Professor
in the Department of Psychiatry, Weill Medical College of
Cornell University. He is also the founding Editor of the new
journal, Brain Stimulation. He received his first B.A. from
Columbia College, another B.A. and a M.A. from Magdalen
College, Oxford University and his Ph.D. from the University
of Pennsylvania, where he also completed his clinical training
in the Department of Psychiatry.
His research has concentrated on the neurobiology and
treatment of mood disorders. He has made numerous
contributions to the understanding of pathophysiology of
major depression and mania through use of brain imaging
techniques and by examining the role of lateralization of
brain function in normal emotion, neurological disorders, and
psychiatric illness. For the past 27 years, he has led the clinical
research on electroconvulsive therapy (ECT) at Columbia
University and the New York State Psychiatric Institute. This
work has identified fundamental factors in this treatment
that are responsible for its efficacy and side effects, and
has radically altered understanding of both therapeutics and
mechanisms of action. This research program has provided
compelling evidence regarding the localization of the brain
circuits involved in antidepressant effects, and has revamped
understanding of the underpinnings of ECT’s effects on mood,
behavior, and cognition. Dr. Sackeim is widely credited with
transforming the use of this treatment worldwide.
Dr. Sackeim has directed programs at the New York State
Psychiatric Institute and New York Presbyterian Hospital in the
pharmacological treatment of late-life depression, and in the
use of Transcranial Magnetic Stimulation (TMS), Vagus Nerve
Stimulation (VNS), Deep Brain Stimulation (DBS) and other
forms of focal brain stimulation. Dr. Sackeim is the originator
of Magnetic Seizure Therapy (MST), now undergoing clinical
trials in the US and Europe, and has recently developed FEAST
(Focal Electrically-Administered Seizure Therapy) and FEAT
(Focal Electrically-Administered Therapy), new forms of brain
stimulation undergoing evaluation as therapeutic modalities
in neurological and psychiatric conditions. Dr. Sackeim
introduced functional brain imaging to the medical center at
Columbia in 1980, and directed a large group using Positron
Emission Tomography (PET) and Magnetic Resonance Imaging
(MRI) to study pathophysiology and treatment effects in mood
disorders, anxiety disorders, Lyme disease, substance abuse,
Alzheimer’s disease, and normal aging. Other recent work
directed by Dr. Sackeim involved preclinical, primate research
on the functional significance of structural brain changes
induced by different forms of brain stimulation.
Dr. Sackeim is a member of the editorial board of several
other journals, chairs the Task Force on ECT for the World
Federation of Societies of Biological Psychiatry, and has
received many national and international awards for his
research contributions. These include three Distinguished
Investigator Awards from the National Association for
Research in Schizophrenia and Depression, a MERIT
Award from the National Institute of Mental Health, the Joel
Elkes International Award from the American College of
Neuropsychopharmacology, election as Honorary Fellow of the
American Psychiatric Association, and the Award for Research
Excellence from the New York State Office of Mental Hygiene,
Edward Smith Lectureship, National Institute of Psychobiology,
Israel, the lifetime achievement award form the EEG and
CNS Society, and the NARSAD Maddox Falcone Prize, for
lifetime achievement in research on affective disorders. He is
past President of the Society of Biological Psychiatry and the
Association for Research in Nervous and Mental Disease. He
has authored more than 350 publications.
Abstract
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is the biological intervention
with longest continuous use in the treatment of major
depression. Its strengths and limitations have been well
characterized. Epidemiological studies in the US indicate
that utilization of ECT, after a period of decline in the 70’s
and 80’s, has stabilized or is somewhat increased. The most
common indication for use is resistance to pharmacological
treatments for major depression, but first-line use of ECT is
not uncommon. ECT is the most effective short-term treatment
for major depression. No alternative intervention has reliably
shown equivalent, let alone, superior efficacy. The efficacy
of ECT has been established in sham-controlled trials,
comparative trials with respect to pharmacological strategies,
and in studies manipulating ECT treatment parameters. It is
established that the efficacy and cognitive effects of ECT are
highly contingent on the parameters of electrical stimulation,
specifically the anatomic positioning of electrodes, electrical
dosage, and electrical waveform. The key limitations of ECT
concern durability of benefit and cognitive side effects. Relapse
29
is common after achieving remission, and may be reduced by
use of specific pharmacological strategies or continuation ECT.
Amnesia for events in the recent past is the most profound
deficit, and the severity and persistence of the amnesia is
strongly determined by choice of treatment parameters.
Eldon R. Smith
OC MD FRCPC
Emeritus Professor of Medicine, University of Calgary; Chair,
Canadian Heart Health Strategy and Action Plan
Dr. Smith was born and educated in Nova Scotia, receiving
his medical degree cum laude from Dalhousie in 1967.
Following Internal Medicine and Cardiology training in
Canada, UK, and the USA, Dr. Smith joined the Faculty
of Medicine at Dalhousie in 1973. In 1980, he moved to
Calgary to become Professor and Head of the Cardiology
Division at Foothills Hospital and the University of Calgary.
He became Head of the Department of Medicine in 1985
and Associate Dean (Clinical Affairs) in 1990. From 1992
to 1997, Dr. Smith was Dean of the Faculty of Medicine at
the University of Calgary. In 1997, he was appointed Editorin-
Chief of the Canadian Journal of Cardiology.
Dr. Smith’s research interests include circulatory mechanics,
exercise physiology and echocardiography. He has published
more than 250 papers and book chapters and has been a
contributor to many national and international organizations; he
has been President of the Canadian Cardiovascular Society
and the Association of Canadian Medical Colleges and
Vice President of the Inter-American Society of Cardiology.
He has served on a number of public boards including the
Alberta Heritage Foundation for Medical Research, the
Alberta Health Professions Advisory Board, and the Premier’s
Advisory Council on Health in Alberta. He founded and served
as President and Director of the Peter Lougheed Medical
Research Foundation, a national initiative to support excellence
in health research in Canada. He is chair of the Advisory Board
of the Libin Cardiovascular Institute of Alberta and recently was
appointed by the federal government to Chair the development
of a National Strategy for Cardiovascular Health and Disease.
Dr. Smith has received a number of honors/awards including
the Young Investigator’s Award of the Canadian Cardiovascular
Society, the Keon Achievement Award of the University of
Ottawa, 125th Anniversary of Canada Commemorative Medal
for Contributions to the Citizens of Canada, The Achievement
Award of the Canadian Cardiovascular Society, Alumnus of
the Year, Dalhousie University, Dedicated Service Award of
the Heart and Stroke Foundations of Canada, Certificate of
Meritorious Service of the Alberta College of Physicians and
Surgeons, Beamish Award for Leadership in Cardiovascular
Science and Education from the University of Manitoba,
Certificate of Recognition from the Royal College of Physicians
and Surgeons of Canada, Order of the University of Calgary, a
citation from the Senate of the Philippines for aid in developing
medical education in that country and the 2005 medal of
Service from the Canadian Medical Association. In 2005,
he was named an Officer of the Order of Canada. He is the
2007 recipient of the Graham Medal from the Royal College of
Physicians and Surgeons of Canada and an AsTECH award
from the province of Alberta for outstanding contribution to the
research and development community.
David L. Streiner
PhD CPsych
Professor, Department of Psychiatry, University of Toronto;
Assistant Vice-President, Research Director, Kunin-Lunenfeld
Applied Research Unit, Baycrest
David Streiner attended the City College of New York, and
then did his graduate work in clinical psychology at Syracuse
University. In 1968, he joined the newly-formed Department
of Psychiatry at McMaster University, and became the Chief
Psychologist at the McMaster University Medical Centre.
In 1980, he also became a member of the Department of
Clinical Epidemiology and Biostatistics at McMaster, and
was the Deputy Chair of CE&B for two years.
He retired from McMaster in 1998, and began the next day
as Director of the Kunin-Lunenfeld Applied Research Unit
and as VP, Research, at the Baycrest Centre for Geriatric
Care; and as a Professor in the Department of Psychiatry
at the University of Toronto.
30
Speakers and Abstracts
With his colleague, Dr. Geoff Norman, Dr. Streiner has
published four books (PDQ Statistics; PDQ Epidemiology;
Biostatistics: The Bare Essentials; and Health Measurement
Scales: A Practical Guide to Their Development and Use); and
is the co-editor (with J. C. Verster and S. R. Pandi-Perumal) of
Sleep and Quality of Life in Clinical Medicine. He is currently
editing two other books: Psychiatric Epidemiology in Canada
(with John Cairney); and When Research Goes Off the Rails
(with Souraya Sidani). He has published over 260 articles,
including a series, “Research Methods in Psychiatry,” in the
Canadian Journal of Psychiatry, that now consists of 27
articles. He was one of the founding editors of Evidence-
Based Mental Health; is currently editor of the Statistical
Developments and Applications section of the Journal of
Personality Assessment; and is on the editorial board of
Perceptual & Motor Skills, Evidence-Based Medicine, Brief
Psychotherapy and Crisis Intervention, Archives of Women’s
Mental Health, Physiotherapy Canada, Perceptual and Motor
Skills, ACP Journal Club, and Revista Brasileira de Psiquiatria.
In 2004, Dr. Streiner received the first Graduate Course
Coordinator’s award from the Institute of Medical Sciences
at the University of Toronto for running the most acclaimed
graduate course. In the same year, he was given the
Alexander Leighton award by the Canadian Academy of
Psychiatric Epidemiology and the Canadian Psychiatric
Association, “for his continuous, innovative and inspirational
teaching of methods relevant to psychiatric epidemiology,
clinical epidemiology, clinical research and knowledge
transfer.” He is a Fellow of the Canadian Psychological
Association and of the Society for Personality Assessment.
His main interests are woodworking, scale development,
woodworking, long-term outcomes of extremely low birth
weight children, woodworking, quality of life in children
with epilepsy, woodworking, the epidemiology of affective
disturbances in the elderly, and woodworking.
Abstract
Testing for Depression
It is widely accepted that a significant proportion of people
who are depressed are not recognized as such by their family
physicians or others within the health care system. Over the
years, it has been proposed that there be better detection
of people with depression, mainly by having them complete
depression screening inventories in their doctors’ offices,
which could alert the physician to the presence of a problem.
However, an inescapable fact of life is that no test is perfect.
Screening tests can make two types of errors: false positives,
in which people are erroneously labeled as depressed
when they are not; and false negative, in which depressed
people are missed. Moreover, there is a trade-off between
these two types of errors: in order to miss as few people
as possible, more false positive mistakes will be made;
conversely, to avoid the economic and psychological costs
of falsely labeling a person as depressed, more real cases
will be missed. This talk will discuss how tests can be used
sequentially to optimize detecting people with depression;
and the various groups to whom tests can be administered
– the general public, those who visit family physicians, and
those whom the physician feels are at greatest risk – and
address the advantages and disadvantages of each.
Angus H. Thompson
Department of Psychiatry and Alberta Centre for Injury
Control & Research, University of Alberta; Research
Associate, Institute of Health Economics
Dr. Thompson has contributed over 30 years as a clinical
psychologist, research scientist, senior administrator, and
university professor concerned with health and mental health
issues in Alberta, nationally, and internationally. His key
areas of interest are suicide prevention, prevention of stigma
against those with mental health problems, early childhood
development, and systemic and economic issues related
to health and mental health. He completed his doctorate
in psychology at the Institute of Psychiatry in the University
of London. Employment history includes affiliations with
the Alberta Department of Health, the University of Alberta,
Flinders University in Australia, and currently, the Institute of
Health Economics.
Abstract
Future Policy Research
Policy research can be distinguished from other forms of
health research in that it is designed to support decisions
about health services delivery rather than about the factors
that might be related to health, per se. Thus policy makers
will want to know (often on an ongoing basis) the answers
to the following questions:
• Are depression treatments effective?
• Is it true that depression often goes untreated?
• Would services for these currently untreated be accepted?
Effective?
• Can we prevent depression? How?
31
• What is the cost for depression treatment? For prevention?
• What is the societal economic burden of depression?
• What is the ratio of intervention cost to economic burden?
• What other things will be changed by effective interventions
for depression?
• How can we tell when things get better?
Although these questions are relevant to most jurisdictions, the
ultimate version of this presentation will be refashioned and
updated in line with the findings presented at this conference.
Thomas Ungar
MD MEd CCFP FCFP FRCPC DABPN
Chief of Psychiatry, North York General Hospital
Dr. Ungar is an award winning educator and one of Canada’s
leading voices of mental health care. He is a clinician and
Chief of Psychiatry and Medical Director Mental Health
Program at North York General Hospital, and Associate
Professor of Psychiatry at the University of Toronto.
With special expertise in primary care, mental health care
and subspecialist certification in psychosomatic medicine
Dr. Ungar collaborates on numerous projects, including
the Canadian Psychiatric Association task force on clinical
practice guidelines, the anxiety review panel for the Ontario
Guidelines for the management of anxiety disorders in
primary care, the Canadian Collaborative Mental Health
Initiative, and the Canadian review panel for the World
Health Organization Management of Mental Disorders
in Primary Care.
Trained at the University of Toronto in both Psychiatry and
Family Medicine, Dr. Ungar has clinical experience as both a
community family physician and psychiatrist. His academic
training includes two years of fellowship and subspecialty
certification in psychosomatic medicine, a Master’s Degree
in Education, and a senior fellow of the Educating Future
Physicians for Ontario project. Dr. Ungar has several
awards for innovative design and delivery of national
continuing education programs including the Mood Disorder
Management Workshop on Depression, ACCESS, a national
program on psychosis management, and Reality GP, a
national program on depression and anxiety disorders.
He is currently developing The Mental Health Minute, a
consumer friendly evidence-based public mental health
education service consisting of brief audio and video
minutes, podcasts, consumer friendly treatment guidelines,
and website www.mentahealthminute.com.
Abstract
Mental Health Literacy: Tools for Individuals and Family
Successful examples and tools for depression prevention,
diagnosis and treatment will be reviewed, including text
based, audio, video, and e-learning.
This presentation will provide a brief overview and synthesis
of the field of Health Literacy for Canadians. Mental
Health as subject matter presents unique challenges of
philosophical stigma and hidden bias. Due to the nature
of mental illness patient-clients may suffer unique literacy
skill challenges. Opportunities for improving mental health
literacy will be highlighted including design skills and themes
for the design of effective, user-friendly knowledge transfer,
knowledge translation and knowledge exchange with the
less traditional design example of The Mental Health Minute,
a consumer friendly infotainment approach to improving
depression and mental health literacy.
Patrick J. White
PhD
Clinical Professor and Chair, Department of Psychiatry,
University of Alberta
Dr. White was born in Ireland and came to Canada in 1989.
Dr. White obtained his MB, BCh, BAO degree in 1976
from the National University of Ireland and then received his
MRCPsych from the Royal College of Surgeons of Ireland
in 1986. Upon arriving in Canada, Dr. White initially worked
as a psychiatrist at Alberta Hospital Edmonton. He currently
is Regional Program Director for Mental Health with Alberta
Health Services/Capital Health and Clinical Professor and
Chair of the Department of Psychiatry, University of Alberta.
Dr. White sits on various committees and is quite active in
teaching psychiatry residents. He is also President-Elect of
the Canadian Psychiatric Association and Deputy Speaker
of the Alberta Medical Association–Representative Forum.
For More Information
Consensus Development Conference Secretariat
BUKSA Conference Management
and Program Development
Suite 307, 10328

Consensus Development Conference Secretariat
BUKSA Conference Management
and Program Development
Suite 307, 10328 – 81 Avenue NW
Edmonton, AB T6E 1X2
Phone: (780) 436-0983 x 226
Fax: (780) 437-5984
Email: consensus@buksa.com
www.buksa.com

While she sat there alongside the others a woman stopped and tried to give her money too. She didn’t feel insulted. She just felt she was supposed to hear this man’s story. He was a veteran from the war in Iraq and he was suffering from PTSD [1]. It somehow made those stories we read about “out there” seem closer to “here and now” in Calgary.

Suicide prevention is a primary concern for Bostonian Jonathan Shay, M.D., Ph.D., staff psychiatrist for Veterans Affairs in Boston in his work with Viet Nam war veterans. The suicide statistics among Vietnam war veterans are higher than American soldiers who died in Vietnam (MHAT). While their names do not appear on the Memorial Wall, their faces are reflected on its surface.

The numbers of suicides among veteran-soldiers of the Irag OIF (Operation Iraqi Freedom) and Afghanistan theaters have reached epidemic proportions. In 2003 the US military engaged a team of mental health experts to investigate unprecedented numbers of psychiatric casualties.

“It is baffling, if not astonishing, that these military psychiatrists, supposed experts in combat-related stress, have so normalized war that it is overlooked as the source of the disease they have been sent to diagnose, that its horror can be thus discounted and its psychic effects rendered invisible (Shay 2006:2).”

Shay argues that wars have provided scientists and doctors with an ongoing supply of combat-traumatized soldiers including material to enhance understanding of the etiology of soldier-veteran suicides. He claims that war itself is a disease that kills and maims bodies, and ravages the minds of those who engage in it. In the 20th century US (and Canadian?) soldiers were at a much higher risk of becoming a psychiatric casualty (and death by their own hands) than death by enemy fire (Shay 2006:2). And the psychological ravages of war are not restricted to veteran-soldiers. The mental wounds are not restricted to those directly involved but also are inflicted upon civilians and society at large. In fact, Shay argues forcefully that Herman’s groundbreaking work on trauma and recovery (1992, 1997) can be applied to societies as well.

Shay claimed that the “structure, organization and fundamental culture” of 20th century US military ventures contributed to the trauma suffered by soldiers. He challenges distorted histories about why the Viet Nam war ended. He asked a question he cannot answer but felt compelled to raise:

“[Did] and in what ways, [US Vietnam War soldier's] resistance or refusal in the face of moral outrage serve[...] to protect an individual psyche from the effects of an overwhelming traumatic experience[?] (Shay 2006:2).”

The human practice of war, a state-sponsored activity which causes lethal physical, emotional , spiritual and psychological trauma, can be ended. An end to war is an intergenerational project similar to ending the human practice of slavery. “It has been with us since time began.” “It is part of human nature.” “It is part of every culture and found in every part of the world (Shay 2006:xii).”

The end the human practice of war involves “creating trustworthy structures of collective security, within which citizens of every state would have a well-founded confidence in their security from attack by another country [or from within as in the case of genocide perpetrated on a targeted population within the borders of a nation-state]- backed up be reliable expectation of prompt, effective and massively multilateral armed intervention (Shay 2006:xii-xiii).”

Shay refers to Emmanuel Kant’s essay “Perpetual Peace: A Philosophical Sketch” [4] in which Kant argued that even in a peaceful world where ruinous wars have passed away, police-like soldiers, would be necessary. Shay is not calling for peace through war, but peace from ruinous wars (2006:xiii).

Notes

1. During the American Civil War the disorder was called “irritable heart;” in WWI it was called “shell shock,” in WWII it was “battle fatigue” and now it is called Post traumatic Stress Disorder (PTSD) (Shay 2006:2-3).

2. The suicide of her husband, a Vietnam veteran, provided the impetus for Penny Coleman to research the “why question” and the result is the book entitled Flashback.

3. Judith Herman (1992, 1997) described responses of intrusions or flashbacks as a reflex in which the mind attempts to integrate [explain, contextualize, make tolerable?] an intolerable memory. When the “intolerable memory” fails to be integrated, wounds remain open and healing cannot take place. This may provoke a contradictory reflex where the mind protects itself by numbing, “forgetting” or avoiding the intolerable memory. Intolerable memories can be triggered automatically and repeatedly. Defense mechanisms of avoidance and numbing create their own problems and make the sufferer even more vulnerable. Herman called this self-perpetuating cycle, an “oscillating rhythm” between two intolerable states of being (intrusion and constriction) where healing and equilibrium remain elusive, a dialectic of trauma.

“The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner that undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy. When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom (Herman 1997:Introduction).”

4. Kant also included notions of “hospitality” providing all with the freedom to emigrate with an anticipation of hospitality from the nation-state to which they were immigrating. He imagined a world of nation-states governed by republican governments and a global body of governance, a league of nations. His ‘conversation’ on world peace is ongoing.

Meanwhile, convoluted arguments are offered by political science professor, Erik Gartzke, who warns of the “possible pitfalls of a capitalist peace” (Perpetuating Peace forthcoming). Gartzke has used the Fraser Institute Economic Freedom Index to argue that ensuring economic freedom (including the freedom of the military industries) is more effective than forms of governance in the reduction of violent conflict.

US military professionals themselves are not militarists. Militarists who argue against an end to war include U.S. military industries and their most enthusiastic allies in politics and the media, many of whom seem to imagine that war exists to provide them with an income and/or an adrenalin rush (Shay 2006:xi).

Webliography and Bibliography

Coleman, Penny. 2006. Flashback: Post traumatic Stress Disorder: Suicide and the Lessons of War. Boston: Beacon Press.

Durkheim, Emile. Suicide.

Herman, Judith Lewis. 1992 [1997]. Trauma and Recovery: the aftermath of violence- from domestic abuse to political terror. New York: Basic Books.

Hopper, Jim. Excerpts from Trauma and Recovery.

Shay, Jonathan. 2006. “Foreword.” in Coleman, Penny. 2006. Flashback: Post traumatic Stress Disorder: Suicide and the Lessons of War. Boston: Beacon Press.

Mental Health Assessment Team (MHAT)