Since 1973 the American Psychiatric Association have abided by the "Goldwater Rule", which states that it is unethical for psychiatrists to diagnose or offer a professional comment on a public figure's mental status when they have not personally evaluated the individual. The rule was created following the 1964 presidential election in which a magazine had published a survey in which thousands of psychiatrists commented on wether candidate Senator Barry Goldwater was psychologically fit for presidency. 

With the US election in full force and many individuals commenting on the presidential candidates, most notably Donald Trump, again the APA has reminded its members to keep the Goldwater Rule in mind. However, this year some psychiatrists and mental health experts are challenging the Goldwater Rule; some say its for the better good of the nation, while others report that having such in-depth access to candidates nowadays they have greater and stronger information with which to base their opinions on.

"Supporters of the Goldwater Rule have cited three main rationales for adhering to it: Most diagnoses made from a distance turn out to be wrong; the labels themselves can cause real harm to the person and family members; and the practice undermines the field’s credibility, particularly its commitment to confidentiality. Not to mention, others say, that it could expose a left-leaning bias in the field...

But those using clinical language to describe Mr. Trump’s behavior contend that this presidential election is vastly different, for a big reason: The proliferation of social media comments and video clips, which afford direct, unscripted access to candidates, was simply not available in previous races. The depth of that material creates a public persona complete enough to analyze on its own merits, they say."

What are your thoughts on the Goldwater Rule? How do you think mental health professionals should respond when asked their opinions on public figures or presidential candidates mental health?

For the full article, click here:
http://www.nytimes.com/2016/08/16/health/analyzing-donald-trump-psychology.html?emc=eta1&_r=1

"Imagine you are an ambitious new worker at a powerhouse institution. Your job performance is soaring, but you frankly work like a dog. Your weeks top out at 80 hours, you get maybe a single 24-hour block of time off every 7 days, you work weekends, and you often work up to 30 hours straight in one stint, sleep at work, and eat exclusively from food options in the building. You rarely see the sun, your mother currently has to take care of your cat for you, and you are home so infrequently you cancelled your Internet and cable."

Sound familiar? For many new physicians and residents, this is the road working in the medical profession can frequently take.  However, the problem of such a scenario is that it is the perfect environment to become overwhelmed, stressed, and eventually burnt out and becoming depressed, or even suicidal. 

On the bright side, many residency programs and medical facilities are working hard to focus on resident wellness and put in place services to support their learners and staff. However, as this article points out, often these supports tend to be offered at the resident's home school or hospital, leading to fears and worries related to confidentiality.  What is needed instead, as the physician who authored the article points out, are supports and mental health professionals to talk to who are not affiliated with their colleagues or place of employment.

Do you agree? Would you feel comfortable seeking mental health support at your place of employment?

For the full article, click here: http://www.kevinmd.com/blog/2015/12/dont-poop-eat-mental-health-services-young-physicians.html

A new journal article coming out from Western University has found that most ‪mental health‬ privacy policies in Canada and the US tend to exclude patients' families from receiving information about their loved one living with and being treated for a ‪‎mental illness‬.

The authors of the article go on to suggest that though mental health professionals may be restricted in sharing information with families due to a variety of reasons including provincial legislation (some of which enforce fines or penalties for failing to comply with the privacy regulations), physicians still have a duty to support the families of the patients they treat and provide important information regarding their family member's clinical status and treatment, particularly as many of these individuals stay with family following a visit to the ED or a hospital admission.

What do you think about these privacy legislations? Do you think that patients' families have a right to receive information about their loved one's well-being and care, and do physicians have a duty to keep families informed?

"The problem, according to the authors, is that because of the lack of availability of suitable supportive housing and psychiatric hospital beds, most seriously mentally ill people live with their families. Those families wind up taking on both therapeutic and supportive functions for their seriously ill relatives. Given this role and the fact that research has shown that involving families helps to improve treatment outcomes, it would be expected that the mental health system would make efforts to support those families -- but they rarely do."

For the full article, click here: http://www.huffingtonpost.ca/marvin-ross/mental-health-privacy-legislation-problems_b_8649276.html

As we posted about previously, there is a great deal of ongoing discussion surrounding the recent Supreme Court ruling that struck down the ban that prohibited physician-assisted death (PAD). At the Canadian Psychiatric Association, health reporter Andre Picard moderated a discussion among the psychiatry and palliative care communities and asked "Are We Ready?"

Key points of the talks included:

• 29% of Canadian doctors would participate in PAD.
• 50% of patients in palliative care have a mental health disorder
• Evidence showed that PAD actually leads to increased utilization of palliative care.
• Some argued that there is no slippery slope, and in countries/states already employing PAD, the right to dying with dignity has not been abused
• Many psychiatrists are concerned about finding the right balance between enabling death with dignity, while protecting patients from suicide and self-harm.
• Most palliative care physicians do not want to be involved in PAD.
• In Oregon, 1/3 of patients requesting PAD, never use the prescribed medication, but patients want to have the option of having control over their final days.
• Language is crucial, not only for setting guidelines or criteria for who has the right to die, but also in how we describe and refer to PAD as. Is a term such as "physician hastened death" preferable to "physician assisted suicide"?
  
  

What do you think about PAD? How do you think it will influence certain healthcare providers and their patients?

As you may remember, a few months ago, the Supreme Court of Canada made history when they unanimously struck down the ban that prohibited physician-assisted death for adults suffering "grievous" and "irremediable" conditions. While many applauded the decision in favour of personal autonomy and approved of Canadian citizens having the right to decide whether they wish to die with dignity or not, within the field of psychiatry hesitation and concern still lingers ...

Specifically, many psychiatrists are worried about how the new ruling will affect patients with mental health conditions, as they fear many would argue that certain mental illnesses cause "intolerable suffering" and treatments are often used for symptom control rather than a definite cure, making it fit under the "irremediable" criteria as well.

What's more is that some are arguing that psychiatric assessments should be performed for every person seeking assisted death, which could place psychiatrists in more of a "gatekeeper role" and in a immensely difficult position trying to balance between "enabling" suicide/death while still trying to protect patients, particularly those with mental illness‬.

To learn more about what psychiatrists from around the country are saying about this topic, check out the interesting article here: http://news.nationalpost.com/health/0914-na-suicide

"The ruling is creating deep discomfort in a field of medicine where “cures” are rare, and where many worry there is every possibility severe depression and other mental illnesses could meet the test for assisted suicide, or even euthanasia — death by lethal injection — as set out by the court, as long as the person is competent and can provide free and informed consent...

The big fear for psychiatrists is that they may be participating in physician-assisted death, when there is a chance for treatment."

Put your knowledge and skills to the test with the case of a 48 year old female, who was previously hospitalized for persistent auditory hallucinations, and who for the last 20 months has been sending a psychiatric resident letters and postcards that total over 3000 pages. 

Though the resident has never treated or even interacted with the patient, the patient believes he was her physician and prescribed her medications.  In her letters the patient expresses romantic feelings for the resident and "describes the resident's refusal to continue treating her as 'abandonment' and states she is contemplating self-harm because of his rejection."  She goes on to threaten to strangle the resident, and threatens the resident's female acquaintances and former romantic partners which she has garnered information about from the internet.  

Though the resident sends her multiple requests to cease contact, they are not acknowledged, and the patient goes on to call the resident's home over 100 times for another 2 months.

Can you think of how the resident can handle this situation safely and ethically?

"Stalked by a 'patient'" by Jacob Appel & Stuart Kleinman (Current Psychiatry)

Put your knowledge and skills to the test with the case of a 34 year old man, who was diagnosed with schizophrenia a year earlier, and is involuntarily admitted to a psychiatric hospital after assaulting both a family member and a police officer. He presents with auditory hallucinations, aggressive and threatening behaviour, and informs his healthcare team that he is a Christian Scientist and so his religion precludes him from taking any medications. The patient continues to refuse antipsychotic meds and believes his illness can be cured with prayer.

Can you come up with a treatment plan?

"Psychotic and needing prayer" by Alexander de Nesnera (Current Psychiatry)

A powerful story of a family who desperately want to help their loved one who has schizoaffective‬ disorder depressive type with persecutory delusions ‬, but are unable to because of the strict involuntary commitment laws in Maryland. 

"Because he does not think he is sick, voluntary treatment is not an option. Unless he threatens to harm himself or someone else, or is so sick he cannot keep himself alive, he cannot be deemed dangerous ..."

"Behind the yellow door, a man's mental illness worsens" by Stephanie Mccrummen (Washington Post)