By Marvin Ross
My blood boils when people continually talk about mental health issues when in fact they are likely referring to mental illnesses and often specific mental illnesses. Consequently, I thought I would put this brief primer together hoping to possibly influence some that we need to be specific. Talking about issues diminishes the seriousness of some of these illnesses and the resolve of politicians and policy makers to take any action to improve services.
So, let me begin with defining Mental Health and Mental Health Issues
These terms mean nothing as we all have mental health and many of us have issues with our mental state. Some have actual illnesses and the more serious of them can cause significant morbidity for the sufferer and great stress for the family.
This is something that we all have at certain periods of our lives. When the spouse leaves, the dog dies and the bank is foreclosing on the mortgage, we get depressed. That depression is not pathological as we eventually get back to normal or near normal.
Some people, unfortunately, suffer from clinical depression. The definition given by the Mayo Clinic is “the more-severe form of depression, also known as major depression or major depressive disorder. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.”
“Clinical depression symptoms, even if severe, usually improve with psychological counseling, antidepressant medications or a combination of the two.” Intractable depression that does not improve with standard treatment may be helped by electroconvulsive treatment or ECT. Depression can lead to suicide.
According to the American Psychiatric Association (APA) “Anxiety is a normal reaction to stress. Mild levels of anxiety can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders. They affect nearly 30% of adults at some point in their lives. However, anxiety disorders are treatable with a number of psychotherapeutic treatments. Treatment helps most people lead normal productive lives.”
Obsessive Compulsive Disorder
According to the APA people experience “recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person’s daily activities and social interactions”.
People often have obsessive thoughts but for those with OCD, “thoughts are persistent and intrusive, and behaviors are rigid.” Two common treatments are a form of cognitive behaviour therapy (CBT) called exposure and response prevention and the same class of medications used with depression called selective serotonin reuptake inhibitors (SSRIs)
Bipolar Disorder (formerly Manic Depressive Disorder)
There are three types of Bipolar Disorder. Type I, Type II and Cyclothymic Disorder but all involve alternating bouts of extreme depression and extreme mania with periods of normal mood. It is estimated that 80-90% of those with this condition also have close family members with either bipolar or depression.
Bipolar disorder can and often does impact a persons work, family and social interactions and require hospitalization. Mood stabilizing drugs can help and, at times, ECT is also required. In some cases, people can develop psychotic symptoms usually seen in schizophrenia. These symptoms are disorganized thinking, false beliefs, and/or hallucinations. Frequently, patients will see a doctor for extreme depression and are treated for that when what they really have is bipolar disorder. Usually, people do not seek medical help for their mania even if it is harmful resulting in spending to the point of bankruptcy and dangerous behaviour. They will seek medical help when depressed but then the drugs used for depression can trigger mania. See https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders
Schizophrenia and Other Psychotic Orders
This impacts more than 1.5 million Canadians and is “among the world’s top 10 causes of disability-adjusted life-years”. In addition, “due to the potential severity of the illness and chronicity starting at an early age, schizophrenia and other psychotic disorders have significant direct and indirect costs not only in terms of treatment but also related to unemployment, suicide (5% rate), physical illnesses, and overall reduced life expectancy (in 2004 alone, 374 Canadians died prematurely from schizophrenia).”
Schizophrenia is estimated to cost Canada about $10 billion annually but research is minimal. Canada only spends about 1.54% of gross domestic spending on research and development compared to 4.8% spent by Israel or 2.8% in the US. The amount that goes to schizophrenia of that total is minuscule. Only 1.8% of the research dollars went to schizophrenia research while 16% went to cardiovascular illnesses. If Canada invested as much as International Standards consider appropriate, funding would increase 5 fold to $15 billion annually. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935527/
Help and treatment for those suffering is also deficient. As I pointed out in an earlier blog, Canada only has 13.1 psychiatrist/ 100,000 people and not all will see schizophrenia patients as a recent study found. This lags considerably from other countries like Switzerland (52), the UK (18) and Norway (25). When it comes to hospital beds, we rank 29th out of 35 countries. For all diseases, we have only 255 beds/100,000 when the recommended number for psychiatry is 50.
Since the vast majority of those with schizophrenia are unable to work, the disability allowances for disabled is about $1300 a month or, as some correctly describe it, legislated poverty. Imagine having to pay rent, food, clothing, etc on that amount which is about 40% below the poverty line.
People are suffering, homeless and going without treatment in a first world supposedly compassionate society.
Shame on our leaders.