Screen Teens for Most Extreme Consequence of Psychiatric Illness: Suicide

The most extreme consequence of mental illness is suicide. Acute psychiatric emergency utterly changes people, especially youth, causing extreme social isolation. Yet in 2008 mental illness remained ” a public health crisis [. . .] shrouded in misconceptions and misunderstandings. [. . .] These illnesses are serious, disabling, sometimes crippling, and all too often fatal. They deserve to be treated with respect, and those who suffer from them should not experience prejudice,” says Dr. Milliken. “If we treat both the illness and the individual with respect, without fear and in a straightforward manner, then we will legitimately look at trying to provide a range of options to help those individuals recover and resume their place in our families, our friendships, and our society, just as we do for other medical conditions.”

  • “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.

Expert Jury on Public Policy by Consensus: Institute of Health Economics

The Institute of Health Economics partnered with … to host a Consensus Development Conference in Calgary on October 9-10, 2008 on diagnosis and treatment of depression.

“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
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