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Workplace Alcohol Tests: Where Do We Draw the Line?

00Addiction, Alcoholism, Career, Featured news, Health, Law and Crime, Work February, 18

Source: Bousure at flickr, Creative Commons

Keeping our personal and professional lives separate is something many of us strive for. But, as Johnene Canfield recently discovered, we only have so much control over this process. In the spring of 2015, Canfield was fired from her six-figure position as a Minnesota Lottery official after a DUI conviction and a stint in rehab for alcohol abuse. The following October, she filed a lawsuit to reclaim her job.

Canfield’s former employers say the reason they dismissed her was to ensure the safety of other employees and clients, as well as to preserve employee productivity at the Minnesota Lottery. But these reasons reveal how problem drinkers are viewed as incapable of workplace competence.

According to Linda Horrocks, a former health care aide at Flin Flon’s Northern Lights Manor, a long-term care home for seniors, “Employers often act based on what they think they know about addiction and alcohol addicts”—but not necessarily on the reality of living with addiction. Horrocks, like Canfield, was fired for alcohol addiction.

She was eventually re-hired by the Northern Regional Health Authority, the health-governing body in northern Manitoba that oversees employment at Northern Lights Manor. But her employer required her to sign an agreement to abstain from drinking on and off the job, and to undergo random drug and alcohol testing.

In an interview with the Trauma and Mental Health Report, Horrocks said:

“I didn’t object to the testing, but I didn’t want to commit to never drink again on my own time. My union even advised me against signing this agreement, because I would just be setting myself up for failure—I hadn’t gone through treatment yet. And so, I was fired again.”

Horrocks maintains that the employers’ offer to help her abstain from alcohol completely was based on misconceptions about alcoholism and treatment.

“The managers knew a little bit about alcoholism, as family and acquaintances had gone through treatment. They just decided that the counselling that I was going through with Addictions Foundation of Manitoba was not enough because it is a harm-reduction program, not a direct path to complete abstinence.”

Horrocks understands why some may think that abstinence is the only way:

“After all, if you’re a recovering alcoholic, alcohol is deemed ‘your enemy.’”

Proponents for abstinence-based treatments argue that periods of abstinence can repair brain and central nervous system functions that were impaired. Having problem drinkers self-moderate alcohol intake has had variable success in the past. For some, the temptation of having “just one drink” can be a precursor to relapse. And for them, total abstinence may be a better approach.

But Horrocks explains, abstinence may not be the best approach for everyone. The harm reduction model accepts that some use of mind-altering substances is inevitable, and that a minimal level of drug use is normal. This approach also recognizes research showing experimental and controlled use to be the norm for most individuals who try any substance with abuse potential.

Harm reduction seeks to reduce the more immediate and tangible harms of substance use rather than embrace a vague, abstract goal, such as a substance-free society. During intervention talk sessions, therapists explore and attempt to modify drinking patterns or behaviours with the client. The clinicians support autonomous decision-making and independent goal setting related to drinking.

Evidence published in the Canadian Medical Association Journal shows that these programs aim to reduce the short- and long-term harm to substance users and improve the health and functioning of these individuals. There are also benefits to the entire community through reduced crime and public disorder, in addition to the benefits that accrue from the inclusion into mainstream life of those previously marginalized.

Benjamin Henwood and colleagues from the University of Southern California also show that those who work on the front-line of severe mental illness and addiction prefer the harm-reduction approach to complete abstinence. Yet few employers have taken this approach into account when deciding the fate of employees with proven substance abuse problems outside of the workplace.

Horrocks’s and Canfield’s experience begs the question, where do we draw the line? How much say do employers have over their employees’ personal lives? It may just be that employers need to better respect the privacy of workers, so long as workplace productivity is not affected. And if employers maintain substance abuse policies that bleed over into the personal lives of staff, consideration of a harm-reduction approach is key.

–Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller. 

This article was originally published on Psychology Today

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Stigma Surrounds HIV-Positive Children in China

30Bias, Featured news, Health, Law and Crime, Trauma February, 18

Source: quaerion at DeviantArt, Creative Commons

In 2014, a young boy (pseudonym ‘Kunkun’ for anonymity) was banished from his village in Sichuan, China after being diagnosed with AIDS. The villagers did not understand the disease, so feared for their safety. In a CNN article, resident He Jialing expressed his concerns for his daughter who went to school with Kunkun at the time:

“My daughter is around his age, and goes to a boarding school now. What happens if she gets bitten while playing with him here at home? That boy is too dangerous.”

There are roughly 740,000 active cases of HIV in China. Misinformation and intense stigma surrounding HIV and AIDS often result in tragic consequences for HIV-positive children. For example, infected children are frequently banned from their schools and abandoned by their loved ones.

Xu Wenqing, an HIV/AIDS specialist with UNICEF China, revealed to The World Post that HIV-positive children are often segregated from their peers in school:

“If their HIV status has been disclosed, it’s very common that parents of other children complain to the school and force the school to separate their children from HIV positive children.”

But a boarding school in China called the Green Harbor Red-Ribbon School was created in 2006 to house roughly 30 HIV-positive children between the ages of 6 and 19. The school is a refuge for those who have been ostracized by their communities because of their illness. Other organizations are intervening as well.

At an orphanage run by the non-government Fuyang AIDS Orphan Salvation Association, children receive food, housing, education, and the necessary medications to control the virus. The director, Zhang Ying, explained to Reuters that psychological improvements are seen in the children under their care:

“Our children have a healthier state of mind now. When I first started to get to know these children, they had low self-esteem and were afraid of being discriminated against by others. After these few years, by staging different kinds of activities for them, the children no longer feel inferior and are more confident about themselves.”

Although a source of refuge for children, boarding schools and orphanages are not a long-term solution. They cannot cope with the sheer number of children who have HIV. In the case of Green Harbor, the haven can only protect children to age 19, at which point they are expected to leave. Unfortunately, the stigma faced by HIV-positive adults is also problematic.

In 2010, a court in China ruled against a man who said that he was wrongfully denied a job after his prospective employer discovered he was HIV-positive. The judge’s ruling contradicted an earlier law that was meant to protect infected individuals from being discriminated against by employers. The law stated:

“No institution or individual shall discriminate against people living with H.I.V., AIDS patients and their relatives.”

Even with legal protection, those with HIV are still regularly banned from schools and jobs, perpetuating the ignorance and fear surrounding a positive status. And, although medical treatment of AIDS is becoming increasingly accessible in China, a 2009 United Nations report stated many infected people do not seek treatment due to lack of knowledge or to concern that their status will be exposed.

Lack of consistent medical care, or lack of any treatment for that matter, presents huge risks to those with HIV. Without medication, HIV can develop into AIDS and cause death. Nonadherence to medication can lead to the development of drug-resistant strains of HIV that may lower quality of life, since patients may require stronger medications with more serious side effects. All the more reason to reduce the stigma associated with positive-HIV status, and to support treatment for those battling the virus.

In an effort to combat these problems, China’s first lady Peng Liyuan appeared in public advertisements holding hands and playing with HIV-positive children at the Red-Ribbon School. Plus, in 2010, a law limiting HIV-positive individuals’ entrance into and movement within China was lifted, but more needs to be done.

People with HIV in China are still ostracized, and laws meant to protect them from discrimination are circumvented. Until awareness and access to disease education improve, cases of people being denied schooling and jobs due to HIV status are likely to continue. Furthermore, children who do not live in a protected environment or who are too old for an orphanage will be left fending for themselves.

–Abbiramy Sharvendiran, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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A Brain Stimulation Device May Power Healing

90Cognition, Cognitive Stimulation Therapy, Environment, Featured news, Health, Neuroscience February, 18

Source: UCI Research at flickr, Creative Commons

Promising new treatments for neurological disorders are aimed at transforming disease management through neuroplasticity—the brain’s ability to alter its structure and function to adapt to changes in the environment. Leading-edge research is investigating how technological solutions can enhance neuroplasticity, boosting recovery from neurological damage.

In September 2016, Helius Medical Technologies announced positive results for its pilot study using a brain stimulation device to treat pediatric Cerebral Palsy (CP). CP affects muscle control due to injury or malformation of the brain. For the study, some participants received standard physiotherapy, while others received standard physiotherapy along with 20 minutes of brain stimulation with Helius’s experimental device.

Those who received brain stimulation showed improvements in muscle spasms and gross lower limb motor function, over those who did not. And, there were improvements in quality of life, social status, and cognitive function. One explanation is that the brain stimulation device heightens the brain’s natural ability to heal, producing enhanced benefits from physiotherapy.

This new method of brain stimulation is termed cranial nerve non-invasive neuromodulation (CN-NINM). A successful feasibility study was done for the treatment of Multiple Sclerosis (MS), and studies are underway for Parkinson’s disease, brain injury, and stroke. Participants are reporting improvements in mental health and wellbeing, such as greater mental clarity and increased energy. And benefits may extend to other neurological conditions as well.

The brain stimulation device used in these studies comes from decades of work by researchers at the University of Wisconsin-Madison, in the Tactile Communication and Neurorehabilitation Laboratory (TCN Lab). The team named the device the Portable Neuromodulation Stimulator (PoNS). The PoNS consists of a small array of electrodes that transfer an electrical current to the patient’s tongue, activating areas of the brainstem and cerebellum. Researchers theorize that this activation induces a sequence of activity that spreads through the brain.

In his book, The Brain’s Way of Healing, researcher and psychiatrist Norman Doidge explains how brain stimulation enhances neuroplastic healing. Doidge says an underlying cause of symptoms in neurological disorders is a dysregulation of electrical activity in the brain. He explains the sequence of activity caused by the PoNS may help the brain balance the electrical activity in its networks of brain cells. Balancing promotes rest and relaxation of these cells, allowing further stimulation alongside appropriate rehabilitative therapy. Stimulation reactivates dormant or dysregulated brain cells, and reintegrates them into functioning networks. Taken together, these changes make an ideal state for neuroplastic healing to take place.

Doidge shares a story about Broadway singer Ron Husmann’s remarkable recovery, which Doidge attributes to neuroplastic healing. Multiple Sclerosis led Ron to lose control of his bladder, mobility, and singing voice. Devastated by the loss of his voice and feeling he had nothing to lose, Ron travelled to the TCN Lab. He spent two weeks in intensive speech therapy, accompanied by brain stimulation with the PoNS device. By the end of his stay, Ron was singing and dancing again.

Brain stimulation and modulation are not new. They are central to established, FDA-approved treatments, such as deep brain stimulation (DBS), for neurological disorders. But, an important difference between the PoNS device and deep brain stimulation is that DBS is a highly invasive treatment. It involves the insertion of an electrode into the patient’s brain, and introduces several possible risks, including infections and strokes. And so, DBS is only used as a last resort. But the PoNS is non-invasive and presents few risks. Plus, the effects of the PoNS appear to continue even after the stimulation ends, whereas the benefits of DBS tend to end when stimulation is turned off.

Reported side effects for treatment by the PoNS, though, include increased salivation, mild headaches, and jaw pain. To reduce side effects, researchers teach participants swallowing and relaxation techniques that manage saliva and tension in the jaw.

Although early evidence for the PoNS device is impressive, skeptics point out that the number of participants used in the studies is small, which reduces confidence in reported outcomes. And although the team at the TCN Lab has shown that the PoNS increases activity in key brain areas, theories on how, precisely, it contributes to healing are still unclear.

Still, the PoNS shows promise as an addition to rehabilitation programs, and as a way of promoting physical and mental health. This technology is one to watch.

–Stefano Costa, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Brain Stimulation Device Powers Healing

70Cognition, Cognitive Stimulation Therapy, Environment, Featured news, Health, Neuroscience February, 18

Source: UCI Research at flickr, Creative Commons

Promising new treatments for neurological disorders are looking to transform disease management through neuroplasticity—the brain’s ability to alter its structure and function to adapt to changes in the environment. Leading-edge research is investigating how technological solutions can enhance neuroplasticity, boosting recovery from neurological damage.

In September 2016, Helius Medical Technologies announced positive results for its pilot study using a brain stimulation device to treat pediatric Cerebral Palsy (CP). CP affects muscle control due to injury or malformation of the brain. For the study, some participants received standard physiotherapy, while others received standard physiotherapy along with 20 minutes of brain stimulation with Helius’s experimental device.

Those who received brain stimulation showed improvements in muscle spasms and gross lower limb motor function, over those who did not. And, there were improvements in quality of life, social status, and cognitive function. One explanation is that the brain stimulation device heightens the brain’s natural ability to heal, producing enhanced benefits from physiotherapy.

This new method of brain stimulation is termed cranial nerve non-invasive neuromodulation (CN-NINM). A successful feasibility study was done for the treatment of Multiple Sclerosis (MS), and studies are underway for Parkinson’s disease, brain injury, and stroke. Participants are reporting improvements in mental health and wellbeing, such as greater mental clarity and increased energy. And benefits may extend to other neurological conditions as well.

The brain stimulation device used in these studies comes from decades of work by researchers at the University of Wisconsin-Madison, in the Tactile Communication and Neurorehabilitation Laboratory (TCN Lab). The team named the device the Portable Neuromodulation Stimulator (PoNS). The PoNS consists of a small array of electrodes that transfer an electrical current to the patient’s tongue, activating areas of the brainstem and cerebellum. Researchers theorize that this activation induces a sequence of activity that spreads through the brain.

In his book, The Brain’s Way of Healing, researcher and psychiatrist Norman Doidge explains how brain stimulation enhances neuroplastic healing. Doidge says an underlying cause of symptoms in neurological disorders is a dysregulation of electrical activity in the brain. He explains the sequence of activity caused by the PoNS may help the brain balance the electrical activity in its networks of brain cells. Balancing promotes rest and relaxation of these cells, allowing further stimulation alongside appropriate rehabilitative therapy. Stimulation reactivates dormant or dysregulated brain cells, and reintegrates them into functioning networks. Taken together, these changes make an ideal state for neuroplastic healing to take place.

Doidge shares a story about Broadway singer Ron Husmann’s remarkable recovery, which Doidge attributes to neuroplastic healing. Multiple Sclerosis led Ron to lose control of his bladder, mobility, and singing voice. Devastated by the loss of his voice and feeling he had nothing to lose, Ron travelled to the TCN Lab. He spent two weeks in intensive speech therapy, accompanied by brain stimulation with the PoNS device. By the end of his stay, Ron was singing and dancing again.

Brain stimulation and modulation are not new. They are central to established, FDA-approved treatments, such as deep brain stimulation (DBS), for neurological disorders. But, an important difference between the PoNS device and deep brain stimulation is that DBS is a highly invasive treatment. It involves the insertion of an electrode into the patient’s brain, and introduces several possible risks, including infections and strokes. And so, DBS is only used as a last resort. But the PoNS is non-invasive and presents few risks. Plus, the effects of the PoNS appear to continue even after the stimulation ends, whereas the benefits of DBS tend to end when stimulation is turned off.

Reported side effects for treatment by the PoNS, though, include increased salivation, mild headaches, and jaw pain. To reduce side effects, researchers teach participants swallowing and relaxation techniques that manage saliva and tension in the jaw.

Although early evidence for the PoNS device is impressive, skeptics point out that the number of participants used in the studies is small, which reduces confidence in reported outcomes. And although the team at the TCN Lab has shown that the PoNS increases activity in key brain areas, theories on how, precisely, it contributes to healing are still unclear.

Still, the PoNS shows promise as an addition to rehabilitation programs, and as a way of promoting physical and mental health. This technology is one to watch.

–Stefano Costa, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Firefighters Fight Stress as First Responders

90Burnout, Featured news, Post-Traumatic Stress Disorder, Stress, Trauma, Work February, 18

We tend to think of firefighters saving lives as fires tear through homes or forest land. What many people don’t know is that firefighters are also first responders, arriving at crisis scenes even before paramedics or police officers.

Working in stressful and traumatic situations can take a toll on their mental health. Post Traumatic Stress Disorder (PTSD) and suicide rates are much higher in first responders than in most other professions. Canadian first responders experience twice the rate of PTSD compared to civilians.

Ongoing exposure to stress means that access to support is critical. But cultural and administrative barriers get in the way. Because firefighters are regarded as tough and invulnerable, many feel embarrassed to ask for help, and available programs can be difficult to navigate.

Brian (name changed for anonymity), a 30-year veteran of the fire service and a District Chief in Ontario, Canada has experienced the stressful effects of the job firsthand, and has witnessed the toll it takes on colleagues and family:

“You’re just supposed to deal with the effects of the job. The stigma is that, if you can’t handle it, you’re weak. This idea has been built into the profession.”

When Brian entered his new role as District Chief, he received very little training on how to support the well-being of those working under him. He received only a phone number to an Employee Assistance Program (EAP) to distribute to team members if they had an exceptionally stressful day. The call is left up to individual firefighters rather than to an outreach program that communicates to them directly.

Although Brian believes that firefighters can benefit from the EAP, he knows that stigma exists around making the call. So, the resource doesn’t get used.

“There have always been employee assistance programs. In all my thirty years, I’ve only seen the EAP used once or twice. For the program to work, the agency needs to call the firefighters, because firefighters don’t reach out.”

To fight this stigma, the province of Ontario has launched several initiatives, including a new radio and digital campaign created to raise awareness and reduce the hesitancy of first responders to seek support. A free online toolkit has also been developed that addresses how to cope with PTSD.

Social support is another essential component of first responders’ wellbeing. In a study published in the Journal of Occupational Health Psychology, Jasmine Huynh of Flinders University and colleagues found that support from family and friends was critical for protecting workers from burnout and for them to cope with the demands of frontline responsibilities.

Brian and his wife Sandra (name changed for anonymity) find support in each other and also through other firefighters and their families. Sandra explains that they often use humour to address the stress:

“When you go into the fire hall, there’s a lot of humour. I think we use humour to deal with the pressure, to keep going. That’s our coping mechanism. It’s also how we manage the stress as a family.”

While some programs exist to help firefighters work through their own issues, there is very little support for families of first responders. Having a loved one who is a firefighter can take a toll on the whole household.

In a study by social work professor Cheryl Regehr and a group of researchers at the University of Toronto, the authors explored how firefighters’ wives coped with the mental distress caused by their husbands’ emotionally taxing jobs. Wives handled partner stress by emotionally distancing themselves when necessary.

After thirty years, Sandra has learned to better read Brian’s emotional states, allowing her to recognize when he needs some space after a bad shift. She explains:

“If he comes home and is quiet, and not himself, I know that something is wrong. But I just let it go and let time pass, and then, eventually, I ask him about it. I can tell when it has been a rough shift. If he wants to be alone, I let him be.”

In an attempt to shield his children from the dangers of his job, Brian doesn’t discuss work much at home:

“When I was initially on the job, I talked to Sandra a lot about it, but when the kids came, I stopped. You don’t want to bring the experiences home; you don’t want the kids to worry. It’s bad enough that Sandra worries.”

Despite being proud of her husband, Sandra can’t help but feel constant fear in the back of her mind:

“I think about Brian’s safety all the time. The fear is always there. When he was first on the job, I tried not to think about it. I didn’t watch the news, and if I did, I prayed it wasn’t his fire truck at an emergency.”

To her relief, it has always been someone else’s fire truck. But that someone usually has a family at home, also worrying.

Brian and Sandra agree that more needs to be done to support frontline workers and families. At least initiatives like the media campaign and online toolkit serve as a starting point for an open dialogue surrounding the stigma of seeking help.

At the end of the day, Brian’s job is just that: a job. He says:

“People want to call us heroes. Most of the time, I don’t classify us as heroes. We do what we’re trained to do, and if we do it well, we all come home.”

–Alyssa Carvajal, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Models Face Routine Exploitation, Mental Health Problems

130Body Image, Career, Eating Disorders, Featured news, Health, Post-Traumatic Stress Disorder January, 18

Source: Richard George Davis, used with permission

Former model Nikki Dubose has graced the covers of fashion magazines from Maxim to Vogue to Vanity Fair. She’s modeled in Barcelona, Paris, London, and Tel Aviv, and has walked the runway for numerous fashion designers.

Despite the glamorous lifestyle, Dubose is also a sexual assault survivor, and has struggled with eating disorders and mental-health issues. The story is a common one for many in the modeling industry. In an article for the Huffington Post, Dubose describes her experience:

“There were regular pressures to sleep with the director of my agency, constant ‘model dinners’ he organized that involved the owner of the agency, the director and his friends, and select models. This led to [my] being drugged and raped. [I was] raped by a photographer at a lunch that was organized by the director of my agency. Later, when I confronted the director, I was shot down.”

A recent report from The Model Alliance shows that nearly thirty percent of models report being sexually harassed, while twenty-eight percent have been pressured into sex with someone in the industry. Most of the models surveyed said they never told anyone—over two-thirds of those who did report the harassment to their agents were essentially ignored.

In a 2014 Flare Magazine exposé, model Misty Fox also revealed being mistreated by a photographer. Fox said he took photos of her without consent as she was using the bathroom:

“He went to the next cubicle, leaned over like a kid in primary school and took my picture.”

When she asked for the film:

“He just sneered, ‘What are you going to do, tell your daddy?’”

When Fox reported this incident to her agent, the reply was:

“‘Honey, it’s [name redacted]; he’s a really big deal. You’re lucky to be there. Get some good shots. Gotta go.”

Stories of photographers preying on young models are commonplace, and there are few consequences. In an interview with the Trauma and Mental Health Report, Dubose said:

Education and legislation are critical here—talking about sexual abuse in workshops so that models can develop safety plans, know what organizations to reach out to, and who to call if something happens. Prevention is key. Plus, predators need to be held accountable. Adopting regulations is also important to change the way the industry currently runs.”

Recently, Dubose worked alongside California State assembly-member Marc Levine on Bill AB 2539, which addressed the need for “workplace protections and health standards in the modeling industry.” This proposal was based on the current French law that prohibits using models with a Body Mass Index (BMI) of 18 or lower. Disappointingly, the bill was not passed by the California state legislature. Dubose said:

“The government continues not to take the necessary measures to ensure the safety of models in an industry that puts them at risk.”

People often associate modeling with a luxurious lifestyle, but working in the industry can have an impact on mental health. Studies in the past decade have shown that models run a higher risk of developing psychological disorders and report lower life satisfaction compared to other occupations. The Model Alliance reports that sixty-eight percent of models surveyed suffer from anorexia, depression, or a combination of both.

Dubose recognizes how common mental health issues are in her industry. Her memoir “Washed Away: From Darkness to Light” recounts the painful struggles and abuses she suffered as a young, aspiring model. Success often comes at a great cost, with young hopefuls developing an array of dangerous disorders and unhealthy coping mechanisms in the pursuit of fame. She explains:

“Models are often forced into doing things that they don’t want to do, such as losing weight for jobs or sleeping with photographers and other people in the business, and are often victims of wage theft. Most of these girls and boys are minors. It is not acceptable for them to be subjected to abuse, rape, financial theft, and so on.”

A movement for change is emerging in response to these problems. Dubose and many others like her are fighting to create a future where young models perform their jobs in a safe environment without worrying about sexual and financial exploitation, eating disorders, and mental-health issues. Dubose concludes:

“It’s only a matter of time before we see major, positive change. I’m confident.”

–Ty LeBlanc, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Inadequate Training Leaves Workers Vulnerable to Compassion Fatigue

60Therapy News, Unclassified January, 18

Every afternoon, personal support worker Susan (name changed) struggled with administering medication to a particular elderly patient in the dementia ward where she worked. On one such occasion, fed up with the patient’s behaviour, Susan became so frustrated that she mumbled a profanity, reached over, and pinched the patient’s arm. With a sharp cry of pain, the patient quickly accepted the medication and Susan was able to move on.

Stories of malpractice or poor patient care like this are not as uncommon as one might imagine. Evident from media reports of negligence in hospital settings, such cases can ignite an outcry in the community and prompt questions about individuals’ suitability for caretaking roles. How could someone with a career revolving around caring for others lack empathy?

Grace, an Ontario care worker who witnessed Susan’s behavior firsthand, believes the demanding nature of the job took a physical and mental toll on her co-worker. Having worked for eight years at a residential center for dementia patients, Grace knows from experience just how mentally exhausting the work can be. In an interview with the Trauma and Mental Health Report, Grace explained:

“There’s so much to take care of with these particular patients. When it’s dinnertime, you have to make sure to clean the patient, take them to the dining room, prepare the area for them, feed them, etc. But the next thing you know, they may have soiled themselves or vomited and you have yet another thing to clean when you already have so much to do… There are times when you need to take dirty clothing or dishes from them and they refuse to give them to you or just start yelling at you.”

When faced with the same situation on a daily basis, Grace explains that it’s hard not to become exasperated:

“It can get annoying and even angering at times. It’s hard to control… I didn’t hear much from Susan when I first started working here, but then she began yelling at the patients. I do believe it’s because the stress finally got to her.”

Mental health professionals support Grace’s theory. Overworked employees who are plagued by such feelings of frustration are showing signs of Compassion Fatigue (CF).

Francoise Mathieu, CF specialist and founder of Compassion Fatigue Solutions in Kingston, Ontario, describes the condition on her organization’s website as a gradual emotional and physical exhaustion of helping professionals. While CF is sometimes used interchangeably with Vicarious Trauma (VT), there is a difference between the two. VT is a secondary form of post-traumatic stress disorder, where a worker becomes preoccupied with a specific event or patient problem. On the other hand, CF is an overall decline in the ability to empathize with others.

The American Institute of Stress also differentiates CF from ‘burnout’. With CF, the constant pressure to show compassion toward patients may wear on mental energy stores, leading workers to become emotionally blunted to people and events. Burnout is less dependent on this loss of compassion.

CF is not limited to mental health professionals. It has been shown to affect teachers, social workers, police officers, prison guards, and even lawyers who work with trauma victims. In Grace’s words:

“At first, the stories you hear and the things you see involving the patients really do follow you home. They used to make me feel depressed. Over time, that sensitivity does lessen. After being exposed to this type of thing day after day, you start to lose those feelings.”

According to CF expert Francois Mathieu, once workers begin to experience this emotional exhaustion, they may be prone to moodiness, irritability, difficulty concentrating, intrusive thoughts, feelings of hopelessness, and apathy in both workplace and personal relationships. Fran McHolm, Director of Continuing Education at the Nurses Christian Fellowship has written about how CF can lead to a decrease in general employee happiness, workplace satisfaction, and quality of patient care.

CF is not a rare condition. Results from a 2012 dissertation study by Shannon Abraham-Cook at Seton Hall University show that, out of 111 urban public school teachers in Newark, New Jersey, 90% were at high-risk for CF. In 2010, Crystal Hooper and colleagues from the AnMed Health Medical Center in South Carolina also found that 86% of emergency department nurses exhibited moderate to high levels of CF.

While CF is common in many workplaces, help for employees who are experiencing symptoms, is not readily available. In an interview with the Trauma and Mental Health Report, Isabella, an assistant teacher working with special needs children at a Toronto daycare, describes her experience:

“When we began training, the instructors only talked about how to care for the children and how to work with the different age groups. Management didn’t provide us with anything else. The only thing we can do when feeling overly stressed is go for a break.”

Grace adds that her center for dementia patients fails to directly address employee needs:

“Recently, they added cameras everywhere to prevent poor patient care, but it’s made things worse. Now we are forced to seem especially compassionate and the littlest mistake can lead to a suspension. The management doesn’t try to understand the worker’s view of things at all.”

Dan Swayze, vice president of the Center for Emergency Medicine of Western Pennsylvania, discusses several ways management can address employees’ personal needs pertaining to compassion fatigue. In an article in the Journal of Emergency Medical Services, Swayze writes about the importance of implementing policies and developing programs that can help ease the onset of CF. Teaching employees how to set professional boundaries with patients, conducting meetings to solve individual client issues as a team, and offering counselling services to stressed employees are just a few options administration can take.

And a 2015 study by researcher Patricia Potter and colleagues in the Journal of Continuing Education in Nursing argues for resilience training, a program designed to educate personnel about CF and its risk factors. Workers are taught how to employ relaxation techniques and build social support networks to cope with symptoms that arise from working with difficult populations. Staff members from a US medical center who participated in the training self-reported an increase in their empathy and overall emotional health.

Volunteer crisis hotline operator, Anabel, explains the benefits of these resources in her line of work:

“The staff at the distress center are really considerate of their volunteers. In the training they prepare you for compassion fatigue, encourage volunteers to take care of themselves, and to not take the calls home with you. They also make sure to be available to the volunteers 24/7 in case they need to debrief a call with someone. It really helps to know they’re there to talk to—often after a distressing call.”

Training and intervention programs can help safeguard against the development of compassion fatigue in care workers. But many people working in the field, like Grace and Isabella, have been thrown into care-taking roles with no consideration for the risks to their mental wellbeing. Both women have identified various ways of coping as a stopgap until they receive the assistance and support they need.

Isabella suggests taking full advantage of breaks every few hours:

“Whenever you feel overwhelmed, go for a break right away—even if it’s just to the washroom or for a coffee… When you leave and come back, you feel refreshed. I’m lucky that I live so close to my workplace that I can go home during lunch.”

Grace recommends taking a deep breath and focusing on any positive aspect of the job:

“I learn so much from the patients. Hearing their stories, you can end up getting really close to some of them. I try to listen to them when I can and when I see the positive effect that has on them, I feel very fulfilled.”

These coping mechanisms do not work for everyone, which is why early intervention is so important. While camera implementation has prevented some inappropriate conduct like Susan’s from continuing, it doesn’t address the root problem.

“There are times where I get angry,” Grace admits. “I can’t always entertain patients or be friendly. I try… but it’s so hard… I know a lot of people, like myself, are really sensitive, which is why we are so emotionally affected by this job. There’s no stress management or counselling here, but… these training programs could really help.”

For many helping professionals, compassion fatigue may be inevitable. Cases like Susan’s show that the wellbeing of individuals in caretaking roles directly influences the quality of care that patients will receive. Support in the form of training programs and other preventative measures can make a difference in the lives of these workers, and, improve patient care.

– Anjali Wisnarama, Contributing Writer

Image Credit
Feature: Pennsylvania National Guard at flickr, Creative Commons

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Police Lack Training to Deal with Mentally Ill People

100Therapy News January, 18

On March 4, 2016, Devon LaFleur, a 30-year-old struggling with bipolar disorder, went missing. His father contacted law enforcement to notify police of his son’s mental illness and tendency towards violence. After learning that LaFleur had allegedly robbed a bank and was on the run, Toronto police tracked down and fatally shot the young man during a confrontation.

In many instances where mental illness is concerned, police officers respond too quickly with force, sometimes without probable cause. In an analysis conducted by the Washington Post, American officers shot 124 people who showed some sign of mental or emotional distress in 2015.

The Post explains that, for the majority of these crimes, the police were not called for reports of criminal activity. As in LaFleur’s case, police were contacted by relatives, neighbors or other bystanders worried that a mentally fragile person was behaving erratically.”

An article by psychiatry professor Richard Lamb and colleagues at the University of Southern California reports that police officers are authorized to transport individuals with mental illness for psychiatric evaluation when there is reason to believe that they pose a danger or threat. But the researchers also state that this responsibility turns officers into ‘street-corner psychiatrists’ without giving them the training they need to make on-the-spot decisions about mentally ill people.

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An article published in Criminal Justice Review by Teresa LaGrange shows that “higher educated police officers recognize a broader range of disorders”, and they are more likely to “view the situation as requiring a professional intervention”.

However, LaGrange also recognizes that, instead of teaching practical skills like learning how to identify individuals with mental-health conditions, many educational workshops only consist of general descriptions about psychological terms and concepts.

Police officers need to know how to handle individuals who display different types of mental illnesses. The Washington Post analysis states that the most extreme cases of mentally ill people causing a disturbance were schizophrenic individuals, and those who displayed suicidal tendencies, or had some form of post-traumatic stress disorder (PTSD).

In some U.S. states, crisis intervention team training (CIT) is being implemented to help officers identify mental illness and determine the best course of action.

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CIT consists of a 40-hour training program for police forces that educates officers on mental-health issues and medications, and teaches about mental-health services in the local community. CIT also teaches methods that help de-escalate heated situations by encouraging officers to allow vulnerable individuals to vent their frustrations—methods that could have been useful in LaFleur’s case to reduce the risk of violence from both the police and offender.

So far, this program has been considered effective by the police departments using it.

Major Sam Cochran of the Memphis police department, a retired officer and a coordinator of the CIT program, emphasizes that law enforcement should partner with local mental-health agencies:

“If communities give attention only to law enforcement, you will fail as a training program. You cannot separate the two.”

Although the task of identifying mentally ill individuals can be daunting, these training programs are a step toward preventing injustices for individuals like LaFleur. Providing officers with appropriate training not only improves the ability to handle job stress, but may also provide the mentally ill with a chance to receive treatment.

– Afifa Mahboob, Contributing Writer

Image Credits
Feature: Free Images at Pixabay
First: Yannick Gingras at flickr, Creative Commons
Second: Alex Proimos at flickr, Creative Commons

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A Hands-On Approach to Psychotherapy?

70Therapy News January, 18

A friend of mine, Sigourney (name changed), once told me she would never see a therapist who wouldn’t hug her. Adamant that non-sexual touch in therapy helped her feel connected, she characterized a therapist who wouldn’t touch her as rejecting, cold, and untrustworthy.

The subject of non-sexual touch in therapy is controversial, and seems to vary depending on the professional training of the clinician. A study of clinical psychologists by Cheryl Stenzel and Patricia Rupert of Loyola University shows that many practitioners worry touch can be misinterpreted as erotic, or can damage a vulnerable client. There is also the risk of ethical complaints, so most psychologists refrain from touching clients under any circumstances.

In contrast, a summary of research by James Phelan of the American Psychoanalytic Association shows that, in surveys of psychotherapists and social workers, more than 80% touch their clients in non-erotic ways. This touch might include a pat on the arm or back, a side hug, or a full-on embrace.

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So, when is touch appropriate in a therapy session?

Little training or discussion exists on therapeutic touch. Students of psychotherapy are often left confused, unsure of how to proceed, and afraid to broach the topic with their supervisors. The ethics code of the American Psychological Association does not prohibit non-sexual touch, while sexual contact, of course, is forbidden. In an interview with the Trauma and Mental Health Report, social worker Cara Grosset, a 20-year practitioner of trauma counselling, says that touching a client depends on the context and the person.

“I work with children and adolescents who have experienced or witnessed severe traumas. They may have discovered a parent who died from suicide or seen their parent killed. If they are sobbing uncontrollably in a session when describing this experience, it seems almost inhuman to not reach out with a comforting and appropriate touch.”

Grosset sees many of her clients in group situations, such as summer camps for grieving youth. In this type of setting, a soothing side hug or pat on the back during a difficult discussion happens publicly, leaving little room for misinterpretation. She has found that these gestures help the healing process.

Another example of successful non-sexual touch happens when Grosset facilitates therapy with children and their parents. Some of her young clients run to her at the beginning of a session to hug her as their parents stand by. An affirming response from Grosset is important for the child to feel nurtured and valued.

But Grosset understands why some therapists are reluctant. Many clients don’t want to be touched, and it’s important to know each person’s boundaries. Touch must be for the client’s sake, not the therapist’s. And when touch helps build connection with the client, it can be a beneficial adjunct to talk therapy.

At the same time, touch can be difficult to navigate in private sessions due to ambiguous professional guidelines and taboos surrounding touch in this type of setting. Grosset’s viewpoints are substantiated by other therapists in qualitative research by Carmel Harrison and colleagues at Bangor University in Wales:

“The values of touch included the ideas that touch could offer clients support, acknowledgement and containment. Despite this, all therapists emphasised the rarity and cautious use of touch in their practice. They discussed touch as being outside the remit of clinicians, and considered how limited discussion and training perpetuated this belief.”

It’s easy to find opposing points of view. Some clients feel that a touch from their therapist increases their self-esteem and enables them to move past feelings of worthlessness. For example, a response to a blog on the website ‘Jung at Heart’ read:

“Twenty years ago, my therapy sessions were, after the first six months to a year, almost always punctuated at the end by a hug. Those hugs saved my young life.”

On the same website, others state that they would feel awkward and violated by a therapist’s touch:

“As a therapy client, I really don’t want my therapist touching me. Not a hug, or a pat of the shoulder, or even a handshake.”

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In a 2015 New York Times blog, psychotherapist Hilary Jacobs Hendel explains how she spontaneously hugged a client, but still feels uncomfortable about integrating touch into her practice. Instead, she uses imaginary touch, asking her clients to visualize hugs: “Even when I think a physical hug would be therapeutic, I continue to rely on fantasy.”This unique workaround ties back to concerns of actually touching clients.

The benefit of non-sexual touch in therapy is still open to interpretation. Even though research shows that human touch is important to wellbeing, individual clients and therapists differ greatly in their beliefs on the subject, and risk-management leans toward using it sparingly if at all.

– Lysianne Buie, Contributing Writer

Image Credits
Feature: stux at Pixabay, Creative Commons
First: Matthew G at flickr, Creative Commons
Second: Amy Wharton at flickr, Creative Commons

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Let’s Eliminate Physical Restraints in Group Homes

20Therapy News January, 18

In April 2015, Justin Sangiuliano, a seventeen-year-old diagnosed with Autism, was physically restrained at his group home in Oshawa, Canada. To control an aggressive outburst, two staff members grabbed his arms and placed him on the floor as he kicked and screamed. Staff released him once he stopped struggling, but Justin never got up. He was rushed to the hospital without a heartbeat and died five days later.

Justin’s death, and the deaths of other children in Ontario group homes, raises questions about the provincial child protection system and the efficacy of using force to restrain vulnerable populations.

The Canadian Institute for Health Information defines physical restraint as when “a person is physically held to restrict his or her movement for a brief period of time in order to restore calm to the individual.”

Ontario regulations state that physical restraints can be used to prevent group home residents from injuring themselves, injuring others, or causing significant property damage. Restraints should only be used after less intrusive methods have been applied and deemed ineffective.

But a Toronto Star investigation found that physical intervention is being used as a frequent form of discipline in these homes. The report documented that, between 2010 and 2015, some 45,000 restraints were used in Ontario residential programs to discipline vulnerable children and youth. Restraints were used in more than one third of the 1,200 serious occurrence reports filed in 2013 by group homes in Toronto.

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While there may be some benefits to using physical restraint in controlling violent children, inappropriate use of these practices suggests a power and control issue among some group home staff.

The Toronto Star investigation reported an instance of a child begging to be released: “I’m going to pee myself.” The staff members refused to let go of the child until he urinated on himself.

In another study by social work professors Laura Steckley and Andrew Kendrick at the University of Strathclyde in Glasgow, Scotland, children spoke to the injuries they incurred as a result of forcible restraint:

Half the time when residential staff restrain you they just purely hurt you. I get hurt most of the time. I had a mark from a carpet burn, hurting on my shoulder, and marks on my chest.”

Additionally, preventable deaths and high rates of physical intervention on children with developmental disabilities demonstrate inadequate training of residential staff.

In an interview with the Toronto Star, Kim Snow, an associate professor at Ryerson University’s School of Child and Youth Care, speaks to the dangers of restraining children with developmental disabilities without safe and adequate staff training:

“Although the provincial government lists six approved training programs in the use of physical restraints, no one has looked at which techniques are best. Is one safer than the other? Should one be used in certain situations and not others? Sometimes staff can’t contain kids using a restraint. So what happens when those situations occur? Until we can answer those questions, the risk of harm as a result of restraints is quite high for both staff and kids.”

As an advocate for child safety within the Ontario residential system for over three decades, Snow wants the province to track the use of restraints more closely.

“It takes highly skilled staff to work with children with histories of trauma and accompanying rage to be able to contain them without physically intervening. When people lack those skills they become frightened and they intervene much too quickly. When that happens, the child or youth’s physical and psychological safety is at risk.”

Research by the Residential Child Care Project at Cornell University addresses the physical and psychological harm that can result from restraint use on a vulnerable population. The 2008 study found restraints to be “a considerable risk to vulnerable youth, are intrusive, have a negative effect on the treatment environment, and have a profound effect on those youth who have experienced trauma in their lives.”

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And a 2013 report by Youth Leaving Care, a working group created by the Ontario government to investigate the quality of care vulnerable youth receive in group homes, identified high frequency of restraint use to be a major problem, and recommended the government “works with group home providers to clarify and reinforce policies and best practices to make sure they are followed.”

So, what is being done to improve the care of children with disabilities in Ontario residential homes?

Irwin Elman, the Provincial Advocate for Children and Youth, leads a group called Youth Leaving Care that caters to young people who grew up in Ontario’s group homes.

While certain advocates of children and youth in residential homes call for improved training to properly implement restraints, Elman believes these homes should eliminate restraint altogether to limit preventable deaths.

“These are children who often come with experiences of violence or serious mental health challenges. How in hell do we expect them to achieve to their full potential, to heal, to find supportive relationships in those kinds of environments?”

– Lauren Goldberg, Contributing Writer

Image Credits
Feature: Valentine Svensson at flickr, Creative Commons
First: William Gantz at flickr, Creative Commons
Second: Paul Townsend at flickr, Creative Commons