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

As part of the Choosing Wisely Canada campaign, in June, 13 recommendations were made by the Canadian Psychiatric Association and its working group partners, the @Canadian Academy of Child and Adolescent Psychiatry (CACAP) and the Canadian Academy of Geriatric Psychiatry (CAGP) for the field of ‪‎psychiatry‬.

One of the main recommendations included how first-line treatments for ‪‎insomnia‬ should not include routine use of antipsychotics, and rather should be focused on non-pharmacological options including sleep hygiene and behavioural techniques.

Other recommendations also comment on treatments for ‪ADHD‬, ‪depression‬, and ‪‎dementia‬, as well as on using benzodiazepines in acute care, and ordering toxicology screens on psychiatric patients. For the full list check out the link here: http://www.cpa-apc.org/media.php?mid=2240

The Mental Status Examination is a vital part of any psychiatric assessment or encounter with patients with possible ‪mental health‬ concerns. To brush-up on your observation skills and the components of an MSE, check out these short and helpful videos that walk you through formulating a MSE during three different patient encounters!

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."