Tuesday, February 21, 2012

Neglected Step-Child

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 "severe."

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. washdown@shaw.ca

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