Already in 2014 there have been a number of suicides around the world.  A handful of these suicides have received extra attention though, as those who passed away all worked within the financial industry.  Though there is some controversy about the relationship between work in the financial sector and mental health/suicide (as some of the articles below discuss further), the point that is made clear is that both employers and health professionals alike need to be made more aware of this association and better support those who may be at increased risk for suicide (whether because of one's high-stress job, isolation, or their demographics or previous medical/psychological history).

"Bankers' Deaths Shine Light on Stress in Industry, Tunnel Vision" by Ben Moshinsky (Bloomberg)
"What's Behind Epidemic of Financial Industry Deaths" by Michael Gray (NY Post)
"Is There A Suicide Contagion on Wall Street?" by Jen Wieczner (CNN Money)
"Wall Street Suicides Related to Demographics, Not to Work" by Sally Satel (Clinton Herald)
"Why Wall  Street Bankers Commit Suicide" by Linette Lopez (Business Insider)

World Bipolar Day (WBD) is celebrating it's inaugural year today, on March 30th, which also happens to be the birthdate of artist Vincent Van Gogh, who was believed to have experienced bipolar disorder.

The idea behind WBD is to "bring world awareness to bipolar disorders and eliminate social stigma. Through international collaboration the goal of World Bipolar Day is to bring the world population information about bipolar disorders that will educate and improve sensitivity towards the illness" (International Society for Bipolar Disorders).  

In honour of WBD, take a few minutes today to learn more about Bipolar Disorder and help spread awareness about this medical condition.  

"I'm Breaking Up With the Word 'Addict' and I Hope You'll Do the Same" by Meghan Ralston is a must-read article that discusses why we need to stop using the word "addict" and reminds us to use more patient-centered language instead as one's health or medical diagnoses, whether physical, emotional, or mental, does not define who they are as a person. 

"We don't say, "my mother, the blind," or "my brother, the bipolar." We don't say, "my best friend, the epileptic," or "my nephew, the leukemia." We don't do that because we intuitively understand how odd it would sound, and how disrespectful and insensitive it would be. We don't ascribe a difficult state as the full sum of a person's identity and humanity ... My days of chaotic substance abuse are long behind me. I am not "an addict" now, and I wasn't "an addict" then. I'm just a person, who had a period of difficulty, pain and challenge. I battled, I failed, I tried again -- just like most people."

Courageous journalist and news anchor, Mark Joyella, shares his compelling story about his experience with mental illness and discusses the importance of being open and talking about mental health. As Joyella explains, too many people hide their mental health issues, largely because of stigma. However, as Joyella quotes the executive director of the National Alliance on Mental Illness of Minnesota, “the best way to change peoples’ attitudes about mental illnesses is for people to share their personal stories.”

In his article, Joyella also talks about how mental health issues can affect employment and is one of many factors that keep people with psychiatric disorders quiet, isolated, and avoiding help and support. Most interesting of all though is that he delves deep into the issue of the media, including the role they play in perpetuating stereotypes and stigma, and the select ways in which they choose to report about mental health and those with psychiatric diagnoses.  An important read for all!

"Screw Stigma: I'm Coming Out" by Mark Joyella (Medium)

Vancouver, British Columbia is well-known for their pioneering of harm reduction strategies. Not only do they have Insite (North America's only legal supervised injection site), mobile vans distributing clean needles, and new crack pipe vending machines, but they also have a clinic that through two studies (NAOMI and SALOME) was able to provider users with pharmaceutical heroin.  The basis providing this prescription heroin, is similar to that for methadone, in that it helps to reduce illicit drug use, reduce the harms associated with addiction, and helps these individuals have a chance at recovery.

You can find out more about the two studies mentioned above and the efficacy and impact of heroin-assisted therapy by checking out this fantastic article: "Vancouver - Giving Junkies A Fix To Keep Them Off The Streets" by Travis Lupick.

For more information on Vancouver's harm reduction tactics and news on how Providence Health Care and participants in this program have gone to the Supreme Court to fight for the right to continuing prescribing heroin, see some of the articles below:

• "There's A Crack Pipe Vending Machine In Vancouver" by Garth Mullins (VICE)
• "Prescription Heroin Case Going to Supreme Court" by Andrea Woo (Globe and Mail)
• "Federal Heroin Prohibitions Violate BC Patients' Charter Rights, Lawyer Argues" by Andrea Woo (Globe and Mail)
• "Canada's Health Minister Fails to Explain Ottawa's Policies on Harm Reduction" by Travis Lupick (Straight.com)
• "Photos: Portland Hotel Society's Mobile Needle Exchange" (Globe and Mail)

"Anorexic woman saved by strangers at Green Hills YMCA" by Tom Wilemon, is a heartwarming and inspiring story of how a young woman battling with anorexia, was saved by the love and concern of strangers. The "strangers" were 9 individuals who had taken note of Lauryn Lax and her deteriorating health at the Green Hills Family YMCA, which they all used to work out. The group staged an intervention, contacted Lauryn's parents, and brought her to hospital where she received much-needed treatment and began her road to recovery. 
Would you have done the same?

In follow-up to the "Doctors Miss Suicide Warning Signs" post which provided resources to help become familiar with suicide warning signs and suicide risk assessment, the resources below will provide further information in regards to how to manage these patients.

As one of the resources describes, determining how to treat or support a patient who is suicidal is based upon the physician's initial psychiatric assessment of the patient, the patient's physical health status and wishes, how "at risk" they are deemed to be by the healthcare team, and after consideration of the patient's protective factors.  While in some cases the treatment may seem somewhat clear, such as a patient who has overdosed on medication and requires medical treatment, or the patient who is experiencing substance-induced psychosis and requires being kept in hospital for further evaluation, there will be times when making a decision surrounding a patient who is suicidal is more challenging.  

While, most hospitals or medical facilities have a crisis team or mental health professionals on call, those in rural or remote areas may lack access to psychiatrists or other mental health facilities and be faced with greater responsibility in managing these patients.  In any case, clinicians should conduct thorough assessments, try to collaborate with the patient and come up with a plan of action together, and involve family members and mental health professionals (ex. social worker) if possible to together ensure the patient's continued safety.   

For those in rural or remote communities, telepsychiatry is a growing area of medicine and psychiatry, and will likely be a viable and very useful option in the future.  Already certain areas in the US and Canada are implementing telepsychiatry programs, which not only allow healthcare professionals to consult with one another, but allow patients in areas without adequate resources to speak to/be assessed by a psychiatrist or mental health professional.  More information about telepsychiatry, including some preliminary research on it's utility and cost-effectiveness are also included below.

"Evaluations and Treatment of Patients with Suicidal Ideation" by Michael Gliatto and Anil Ray (American Family Physician)

• Provides basic information on the assessment of patients who are suicidal, a simple algorithm for treatment, and information on hospitalizing, prescribing medications and discharging/referring to outpatient programs

"Mental Health for Emergency Departments" (Australia - NSW Health Department)

• A very detailed resource for emergency room clinicians that provides information on triaging and assessing patients with mental health complaints, managing these patients (including those who are suicidal and other topics such as when to sedate or use restraints)

"Working With A Client Who Is Suicidal" (Simon Fraser University and BC Ministry of Health)

"Suicide Prevention Strategies" by J. John Mann, Alan Apter, Jose Bertolote, Annette Beautrais, Dianne Currier, Ann Haas, Ulrich Hegerl, Jouko Lonnqvist, Kevin Malone, Andrej Marusic, Lars Mehlum, George Patton, Michael Phillips, Wolfgang Rutz, Zoltan Rihmer, Armin Schmidtke, David Shaffer, Morton Silverman,  Yoshitomo Takahashi, Airi Varnik, Danuta Wasserman, Paul Yip, Herbert Hendin (JAMA)

"Emergency Telepsychiatry" by P Yellowlees, MM Burke, SL Marks, DM Hilty, JH Shore.
"Managing Suicides Via Videoconferencing in a Remote Northern Community in Canada" by Michael Jong
"Telepsychiatry: Getting Help to Kids Where They Live" by Mary Sheppard 

Mental illness is not restricted to North America. While prevalence of and perspectives on psychiatric disorders may vary from place to place, it is something that can and does affect people around the world.  

In India for example, there are estimated to be around 4 million people with schizophrenia (Centre for Global Mental Health).  As a result, there has been increasing focus and research on those with schizophrenia in India to better understand the experience of having a mental health condition like schizophrenia in a country outside North America and Europe, to identify the nation-specific barriers to care, and see what programs or services this region needs and how effective new implemented programs are at reducing stigma and treating or supporting these patients.

To give you an idea of how schizophrenia affects those in India and their families, check out some of these resources and documentaries below.  They not only describe how features of schizophrenia such as the content of one's hallucinations varies between two regions like India and the US, but also highlight current issues limiting diagnosis and treatment such as too few psychiatrists, lack of community support services, medications that are either too expensive or not available, and a lack of awareness or education about mental health among the general population.  More so, the resources and documentaries also highlight some of the current work being done in India to improve the diagnosis and care of those with schizophrenia, in addition to helping family members and those in the community better understand this condition.

• "Living With Schizophrenia in India" by Santosh Loganathan & Srinivasa Murthy (Transcultural Psychiatry)
  
• "Schizophrenics and Home Care" by Donald G. McNeil (NY Times)
• "The Violence In Our Heads" by TM Luhrmann (NY Times)
• "This is One Happy Moment For Me: Stories of Resilience and Recovery By People With Schizophrenia and Their Family Members in India" (Community Care for People With Schizophrenia in India)