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." In lieu of World Suicide Prevention Day, this video of a police officer reaching out to an individual who was dangling over a bridge railing and contemplating jumping, reminds us of how powerful and beneficial recognizing and reaching out to someone in need of emotional support and mental health services can be. As the International Association for Suicide Prevention has written on their website, "the act of showing care and concern to someone who may be vulnerable to suicide can be a game-changer. Asking them whether they are OK, listening to what they have to say in a non-judgmental way, and letting them know you care, can all have a significant impact. Isolation increases the risk of suicide, and, conversely, having strong social connections is protective against it, so being there for someone who has become disconnected can be life-saving." In Chicago, Illinois, the Cooks County Jail has been undergoing an overhaul in an effort to improve conditions at the jail, as well as improve the overall well-being of the inmates. To lead these changes, the jail took a unique approach and selected a clinical psychologist to act as warden, something no other correctional institution has done before, but could perhaps be the way of the future ... Dr. Jones Tapia, knows all too well how prevalent mental illness is among those incarcerated and how frequently it goes ignored in jails and prisons, often leading to increased maltreatment and increased difficulties and multiple re-incarcerations when individuals are later released. With her background in mental health, Dr. Jones Tapia is hoping to change this current culture and has already been working to implement changes to better address mental well-being. "The program she is most proud of — and the centerpiece of efforts to overhaul the jail — is the mental health transition center... Five days a week, a group of about 15 inmates with mental illnesses like depression, bipolardisorder and schizophrenia, receive cognitive behavioral therapy, job readiness skills and extra recreation. The warden said such inmates who were released without such services were often back within weeks as they amassed dozens, even hundreds, of arrests for petty crimes like shoplifting and drug possession because they were unable to obtain the prescription drugs needed to treat their condition. Many are rearrested just to receive treatment, so upon their release, inmates are now given a two weeks’ supply of medication. “If somebody doesn’t have access to the basic tools to survive, they’re more likely to recommit a crime and come back,” Dr. Jones Tapia said. “So we know it’s not just a mental health problem. It’s more of a well-being problem.”" You can read more about the health services offered at Cooks County and the other changes in the works by checking out the article here: http://www.nytimes.com/2015/07/31/us/a-psychologist-as-warden-jail-and-mental-illness-intersect-in-chicago.html?_r=1 According to a recent survey of medical students, 30% report having experienced or received treatment for a mental health condition while in medical school. More startlingly, 1 in 7 have contemplated suicide at some point during their studies. The study, "More than 80% of medical students with mental health issues feel under-supported", published in the Student BMJ this month, while identifying some shocking statistics regarding med student mental health, highlights an even bigger issue ... over 80 percent who have experienced mental distress have found the support they received only moderate or they received none at all. "And it’s not just the intensity of the course. Stigmatizing attitudes to mental health problems are passed down from senior doctors, making it difficult for students to step forward when they need support. A second respondent said, “The stigma with mental health issues especially comes into focus when exposed to consultants and tutors who refer to it as a weakness.” The same respondent had worked with several consultants who had stated that depression “isn’t a real illness.” These attitudes seem to contradict some of the efforts being made by some medical schools in stamping out stigma. The second respondent also added: “When this is rhetoric we are exposed to from senior consultants on the wards—many of whom we look up to and aspire to be—is it any wonder that students struggle to come forward?”" In the controversial and powerful article, "Freedom, Finally, After A Life in Prison", we learn about Paula Cooper, a woman who was charged with murder in her adolescence and initially was sentenced to die in the electric chair had a family member of the individual she killed not campaigned to have her sentence changed. During her decades in prison Cooper seemed to have transformed her life and she was finally released in 2013, years early due to good behaviour. Though it took some getting used to the world outside of prison, from the outside looking in Cooper seemed to be doing well and worked hard to make a new life for herself. However, deep down she still struggled with overwhelming guilt from the incident that landed her in prison and depression that had stemmed from a traumatic and troublesome childhood. Eventually, it all became too much and in May of this year, Cooper took her own life. More than anything, this article points out the flaws in our mental healthcare system, particularly with respect to the lack of psychiatric treatment and support in prison and especially when individuals are released, which for any individual is a difficult adjustment, but can be heightened for those with a history filled with trauma, torment and mental health issues. "Mental health care in prison is mostly a pill in a paper cup. Ms. Cooper herself was briefly on antidepressants, she told her sister. No one mandated follow-up treatment for “re-entry,” an apt term considering how much it must feel like dropping from outer space. “Nobody helps because people don’t see us as human beings,” Ms. Cooper said... We need to provide mental health assessments; adequate counseling and treatment programs; rehabilitation; and appropriate medication, as opposed to just sedatives. We should make outpatient treatment a condition of parole, and expand the use of specialized mental health “re-entry courts,” which offer intensive guidance and support." |
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Supporting and enhancing students' and health professionals' knowledge and understanding of mental health and psychiatry
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