How's my mental health today?
Better than my physical health. Seems I have come down with a nasty stomach flu. I'll let a former colleague speak in my place today.
Mental health care treated like neglected stepchild
William Ashdown -
February 15 2012 01:00 AM -0600
Mental health experts from across Canada are converging on Winnipeg
today for a rare two-day summit on mental health issues, particularly as
they affect children.
Traditionally, mental health has been the neglected stepchild of the
health-care system -- the last service to be improved and the first to
be shortchanged. It has few champions.
Mental health funding is easiest to squeeze, with the least amount
of political consequence. After all, these are not prominent illnesses,
such as cancer or heart disease, nor are they "niche" maladies with
strong public support, such as breast cancer. Nor do they pull on the
heartstrings the way that children's diseases do.
It is easier to underfund services in mental health and few are
willing to complain, either because they are ill or because of stigma.
This is typical worldwide.
And, no wonder! The usual picture of the adult mentally ill is
vastly different from the reality. Media cover only the most unnerving
examples of the illnesses -- slumped figures on street corners, begging
for coins, or raging at shadows. Manitoba's "Bus Killer."
The vast majority of people with mental illness, however, are
invisible -- teachers, nurses, bus drivers, pilots, policemen,
professors, radio hosts, politicians, priests and rabbis.
The only thing they have in common is a category of illness that
affects the way they feel and sometimes clouds the way they think. Only
in the rarest of cases are they problematic to anyone but themselves and
their loved ones.
Crime stats clearly demonstrate the mentally ill are vastly more often the victim than the villain.
Within medicine itself, mental illness has always been treated as
second-rate. Ask any medical school administrator what are the popular
specialities, and rarely will psychiatry be mentioned. Residency
positions for psychiatry are usually easier to acquire than others.
As a result, Canada faces a critical shortage of psychiatrists, at
exactly the time when we need to be bolstering the numbers. More than
half of all psychiatrists in Canada are within five years of retirement,
with nowhere near enough replacements being trained.
In other specialities, this would be a national crisis. In mental health, it barely raises an eyebrow.
Psychiatry as a speciality also ranks among the lowest-paid, far
below most other specialists. Yet psychiatrists have the challenge of
dealing, not just with a patient's mental health, but also carefully
monitoring the larger picture.
For instance, many illnesses, heart disease, for example, show up
with initial symptoms that mirror mental illnesses. Failure to recognize
these for what they are can lead to disaster.
Psychiatry also ranks well down on the "social scale" of medicine. Other specialities often denigrate them.
A surgeon I knew referred frequently to psychiatrists with contempt
as being "doctors who refused to practice medicine" and who took the
"easy way out." He had nothing but scorn for psychiatry, until his own
family needed help.
Yet doctors themselves are especially vulnerable to mental illness.
One doctor in three will have a significant mental illness during his
practice years, affecting his practice, his patients and his health.
This is an extraordinarily high rate of illness.
Until the last few decades, medical authorities treated mentally ill
doctors with a brutality sometimes reserved for criminals. Most were
struck off, or driven from their positions, and forced to take lesser
roles. Often decisions were based on little evidence and concrete proof.
No wonder that doctors are among the most reticent to ask for help when
they need it.
Several times in my career as an advocate for the mentally ill,
doctors came to see me for advice and aid rather than reveal their
symptoms to a colleague. Often they would sneak in after hours, through
the back door, so as to not be recognized.
With that picture in mind, and given that many with mental illness
refuse to seek help, it is understandable psychiatric disorders might
not be easy to accurately estimate. Making it worse is the fact many
will be misdiagnosed, or will refuse to accept their diagnoses.
No one wants mental illnesses (and sometimes doctors are reluctant
to diagnose them) due to stigma, the pervasiveness of which is clear
from the constant use of euphemisms -- breakdown, exhaustion, stress
leave, needing a break. The English language abounds with innocuous
words disguising symptoms of mental illness.
Another complication is that not everyone agrees as to what is what.
But generally, the gold standard is set by the World Health
Organization and the U.S. National Institute for Mental Health.
In 1990, the WHO listed five psychiatric disorders among the 10 most
disabling in the world. These are not the deadliest illnesses, just the
ones that create the most disability.
Depression tops the list at No. 1, followed by alcohol abuse at No.
4, bipolar disorder at No. 6, schizophrenia at No. 9, and
obsessive-compulsive disorders at No. 10. Five of the 10 most disabling
illnesses on the planet are illnesses of the function of the brain.
In more local terms, NIMH (National Institute for Mental Health)data indicate 9.5 per cent of Manitobans
annually suffer from a mood disorder, half of which will be classified
That means at least 114,000 Manitoba men, women and children will
have a mood disorder this year and 51,600 will be severely ill, which
means sick enough so that their lives, jobs and relationships are
damaged or destroyed. About 160 will kill themselves.
As to how many get help, in 2010 about 70,000 Manitobans were
treated and, depending on the severity of the illness and the skill of
the physician, about half received adequate treatment.
William Ashdown is vice-president of the Mood Disorders Society of Canada. firstname.lastname@example.org