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Solitary Confinement Is Torture

00Ethics and Morality, Featured news, Health, Politics, Psychopathy, Punishment, Suicide May, 18

Source: The Euskadi 11 at flickr, Creative Commons

Sixteen-year-old Kalief Browder spent three years in New York’s notorious Rikers Island prison, awaiting trial for robbery. Two of those years were spent in solitary confinement. Browder’s case was eventually dismissed and, after surviving four suicide attempts during incarceration, he was released. Suffering from depression and paranoia from his years in isolation, Browder died by suicide in June of 2015.

Former U.S. President Barack Obama referenced Browder’s story in an opinion piece he wrote for the Washington Post, explaining his decision to ban solitary confinement for juveniles in all federal prisons, and calling for greater restrictions on its use as a punitive measure. New York had already ended the use of isolation for prisoners 16 and 17 years old, but in October 2016, the age restriction was extended to age 21 and younger.

In 2015, Canada’s Prime Minister Justin Trudeau moved to ban the use of long-term solitary confinement by placing a 15 consecutive-day limit on its use—as of writing, this ban had not come into effect. His decision was motivated in part by the death of Ashley Smith, a young offender who had spent more than 1,000 days in isolation. At the age of 19, while being held in solitary, Smith died by hanging herself. A coroner’s inquest ruled her death a homicide, indicating that other people’s actions were factors in her death.

Reforms are moving in the right direction, but results of a 2011 United Nations (UN) report raise the question—should isolation be permitted under any circumstances? UN Special Rapporteur Juan E. Mendez said in this report:

“Solitary confinement, [as a punishment] cannot be justified for any reason, precisely because it imposes severe mental pain and suffering beyond any reasonable retribution for criminal behaviour and thus constitutes an act defined [as] … torture.”

Nevertheless, according to the National Conference of State Legislatures, many American states impose no restrictions on the use of solitary confinement, even for juveniles. In Canada, there is currently no limit on how much time a prisoner can spend in solitary confinement. And, if adopted, the limits proposed by Trudeau will only affect federal prisons.

According to an American National Survey by the Association of State Correctional Administrators at Yale, “between 80,000 and 100,000 people were in isolation in prisons as of the fall of 2014.” In Canada, The Globe and Mail reports, “1,800 Canadian inmates are held in segregation on any given day.”

According to Mendez, the adverse health effects of this type of imprisonment are numerous, and include ‘prison psychosis,’ which can lead to anxiety, depression, irritability, cognitive disorders, hallucinations, paranoia, and self-inflicted injuries. Mendez concluded that “solitary confinement for more than 15 days…constitutes cruel and inhuman, or degrading treatment, or even torture”—well below the time Browder and Smith spent in isolation.

The adverse effects of solitary confinement on mental health have a long history of documentation. David H. Cloud, head of the Vera Institute of Justice’s Reform for Healthy Communities Initiative, stated:

“Nearly every scientific inquiry into the effects of solitary confinement over the past 150 years has concluded that subjecting an individual to more than 10 days of involuntary segregation results in a distinct set of emotional, cognitive, social, and physical pathologies.”

These findings prompted Kenneth Appelbaum from the Center for Health Policy and Research at the University of Massachusetts Medical School to write an article calling for American psychiatry to join the fight against the use of solitary confinement.

Many prison administrators disagree. In an interview with the Boston Globe, the Massachusetts Commissioner of Correction defended the use of solitary, explaining:

“We have to be realistic when we’re running these prisons. Segregation is a necessary tool in a prison environment.”

An article by Corrections One, an online news outlet for the correctional field, explains that segregation keeps jails safer by removing violent and dangerous inmates from the prison population, in the same way that imprisonment removes dangerous people from society. Segregation, the article states, is primarily used on prisoners that pose a risk of harm to themselves or others.

Speaking with the Canadian Broadcasting Company (CBC), Lisa Kerr, law professor at Queen’s University in Southern Ontario, reported that:

“Prison administrators have long been convinced that they cannot manage their institutions without easy, limitless recourse to segregation.”

Watch-dog groups point out that other countries apply the use of solitary confinement more selectively and with greater oversight than is used in North American prisons. In the U.K., while solitary is still in practice, the number of prisoners subjected to this form of punishment is much lower. Even more progressive are correctional institutions in Norway, where prison reform has moved away from punitive approaches and has placed rehabilitation and reintegration as a key focus during incarceration.

Eliminating the use of solitary confinement for juveniles is a promising first step towards abolishing the practice entirely. While supporters of solitary may not feel there are effective alternative punishments, human rights advocates continue to fight for prison reform. Looking at solutions used in other countries, perhaps more effective and humane incarceration methods can be realized, and the current paradigm of punishment may shift.

–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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Man to Monster

00Therapy News May, 18

Anatomy of Violence, a film directed by Deepa Mehta, takes viewers on an emotional journey, illustrating how we create perpetrators of violence against women.

Mehta made the film after hearing about the gang rape of Jyoti Singh in Delhi, India. The BBC news reported that an off-duty driver took his bus for a joyride with five friends. When Jyoti boarded the bus, believing it was on-duty public transportation, the men raped her and beat her with iron bars. She died of the injuries.

According to the BBC, a rape victim cannot be publicly named under Indian law to protect the family from shame. In defiance, Jyoti’s mother Asha Singh stated in a public gathering after the attack:

“I say this in front of you all that her name was Jyoti Singh.”

The significance of her actions cannot be overstated. Jyoti’s mother said she had no shame in being known as the mother of a rape victim—it was the perpetrators who should feel shame.

Jyoti’s death sparked outrage across India, and brought public attention to the false belief that women are to blame when assaulted. Although media coverage focused on the victim, filmmaker Mehta decided to analyse what led the men to do what they did.

In an interview with The Reel, Mehta explains:

“I was in Delhi when this horrific incident [the rape of Jyoti] took place, and since then, I have been curious about what made or turned these men into brutal animals.”

Film Director Deepa Mehta

Mehta thinks the rapists were not born monsters, but became that way. In the film, she explores factors contributing to their violent behaviour. She also humanizes the men by portraying their day-to-day lives, similar to the lives of other Indian men. They worked, they cooked, they had families.

This approach was highlighted when she spoke to the CBC about the film:

“I really wanted to humanize [the rapists]. [It] doesn’t excuse what they did, but it helps start a conversation about why these things happen.”

Early in the film, Vikas, one of the perpetrators, is shown hiding under the bed when his uncle enters his room and sexually assaults him. By age eight, Vikas is homeless.

Another character Dinesh grew up in a family where women were treated badly. He always received what he wanted, while his sisters were forced to take care of him and do household chores. In one scene, Dinesh’s sister is reading a book. Dinesh yells that he wants the book. His sister is then threatened by their father with violence if she denies her brother’s request.

Researchers at Georgia State University found similar themes in the backgrounds of men who were self-confessed rapists. The researchers analysed an “ask a rapist” thread on Reddit that posed the question: Reddit’s had a few threads about sexual assault victims, but are there any redditors from the other side of the story? What were your motivations? Do you regret it?”

Someone responded with:

“I was an extremely isolated youth who came from a broken home, and my escape was the Internet… Most of the material [internet pornography] was very sexually aggressive towards women.”

Much like the characters in the film, this individual sees his environment as contributing to his violent behavior.

The responses to the Reddit thread also showed themes of: blaming the victim or their biology, expressing hostility toward women, and objectifying women. More than one motivation was typically found to underlie a single rapist’s actions.

Similar themes are apparent in Anatomy of Violence, with some dramatic examples of victim blaming. The defense lawyer stated explicitly:

“The girl is to blame as much as the guys. Why was she roaming outside? If my daughter did this, I would burn her alive.”

Not only was Mehta’s focus on the rapists unconventional, so was her decision to film the documentary in an amateurish style. In a conversation with the Trauma and Mental Health Report, the film’s cinematographer Maithili Venkataraman said that the low-budget feel of the film was deliberate. They did not want to distract from the deeper social issues the film was emphasizing.

When speaking with Refinery 29, Mehta emphasizes:

“I wanted it to look very raw. I felt it doesn’t need distractions… it just needed to hit you in the gut.”

-Anika Rak, Contributing Writer

Image Credits
Feature: intographics at pixabay, Creative Commons
First: Donostia Kultura at flickr, Creative Commons
Second: Hamilton-Mehta Productions, Movie Poster

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Unforeseen Stress When a Child Receives a Transplant

00Featured news, Guilt, Health, Post-Traumatic Stress Disorder, Stress, Trauma April, 18

Source: debowscyfoto at pixabay, Creative Commons

On April 13, 2016, Bill and Lindsay Brent received the phone call they were desperate for. Their youngest child Nathan would get the liver transplant he urgently needed. Within hours, the family from Barrie, Ontario was heading to The Hospital for Sick Children in Toronto.

By 8:00 the next morning, Nathan’s life-saving surgery was underway. Twelve hours after surgery began, the Brents’ feisty toddler emerged from surgery sedated, but holding his own, and began his road to recovery.

Twenty months earlier, Nathan was diagnosed with Alagille Syndrome, a genetic disorder affecting his liver, and severe enough that his only hope for survival was a liver transplant. But as the months passed, the situation began to look bleak. Nathan’s rare AB negative blood type greatly decreased his chances of finding a donor match.

Complicating matters further, Nathan was ineligible for the program; he required a liver from a deceased donor rather than from someone who was living. In his case, a pediatric donor would increase the odds of success, meaning that another child would have to die for Nathan to live.

And yet, despite insurmountable odds, thanks to the decision of one family, a liver was donated and Nathan survived.

Raelynn Maloney, a clinical psychologist and co-author of the book Caring for Donor Families: Before, During and After, says that the donor waiting period can be extremely stressful for families.

“Many traumas can occur during the ‘waiting period’; seeing a loved one suffer from illness without a clear outcome in sight, financial stress as families juggle care demands with work schedules, and, of course, the fear of running out of time.”

For the Brents, though, the psychological impact of their son’s traumatic journey started to surface only after the transplant was completed. Bill explains:

“Even though you are devastated when you receive the news that your child has a life-threatening illness, your need to remain focused on the outcome and to stay positive takes over. What has been shocking is the magnitude of post-transplant emotions that we’ve had to face. You’ve received a miracle, and yet, somehow, you are gripped with guilt and sorrow for the donor’s family, and an anxiety about the future that is so strong, it hinders your ability to feel good about life.”

For the couple, while they shared the same concerns for Nathan, their struggles with anxiety manifested in different ways. While Lindsay tended to ruminate and panic about the risks to Nathan post-transplant, such as illness, injury, and organ rejection, Bill reported an increase in social anxiety and was gripped with survivor’s guilt and depression. He says:

“It is very difficult for me to accept that my son needed someone to die for him to live. The donor family is in our thoughts constantly, and words cannot describe how thankful we are to them. They are our heroes.”

Maloney explains that recipient families can have a delayed reaction to the distress they experience while their loved one is on the donor list, and they are often unprepared for the rush of emotions that come after transplant.

While remaining focused on a solution, recipient families often do not allow themselves the space to grieve setbacks as they occur. Rather, they strive to maintain hopefulness while supressing the pain of the situation.

Maloney emphasizes that it may only be during recovery, when these families finally have a chance to process what they have gone through, that the traumatic grief hits.

The Brents recognized that, post-transplant, there was much more time to reflect on the enormity of what they had been through. Although grateful for Nathan’s outcome and the support of their family and friends, the Brents still faced ongoing emotional issues, all while trying to build normalcy back into their lives. Lindsay explains:

“Since Nathan has received his new liver, we no longer have access to the transplant support team that was available to us before the surgery. The medical team has moved on, the social support from the families at the hospital has been less frequent since we have returned home. In a way, Bill and I feel like we’ve lost family members, people that up until the transplant were a part of our innermost circle. In some ways, we feel left to navigate this post-transplant terrain on our own.”

Maloney acknowledges that there is an illusion held by the public that, after a transplant, all is well and life returns to normal. In reality, this is a time when transplant recipients and their families may need even more support as they try to reconcile the trauma of the illness with a hopeful and optimistic view of the future.

Now at home, Nathan continues to improve. Bill and Lindsay look forward to the time when this difficult journey will be surpassed by many happier, hopeful moments.

–Kimberley Moore, 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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“Unfair and Lovely” Campaign Raises Shadeism Awareness

10Adolescence, Beauty, Featured news, Media, Race and Ethnicity, Self-Esteem April, 18

Source: Glenn Robinson at Flickr, Creative Commons

“Cover up your arms before you leave.”

Growing up, I heard this refrain a lot. But not out of fear of harmful sun, or out of concern that my clothes were too revealing. Rather, my parents were trying to prevent me from getting darker.

I am a second generation Canadian. My parents were born in Jaffna, Sri Lanka, and immigrated to Canada over 30 years ago. Almost immediately we were subject to a hierarchy of skin tone, a hierarchy rooted in colonialism that links whiteness to power and serves as a breeding ground for something called shadeism.

Shadeism is prejudice based on skin colour; it is predominantly seen as an intra-racial (within race) issue, based on one’s degree of skin tone or shade, rather than categories like “black” or “white.”

The issue has been in the news recently with the launch of a social media campaign called “Unfair and Lovely,” a photo series featuring images of two South Asian sisters named Mirusha and Yanusha Yogarajah.

In an interview with the BBC, Unfair and Lovely creator Pax Jones—a black student from the University of Texas—explains that the driving force behind the movement is to challenge shadeist beliefs:

“Our goal was to combat colourism and the under-representation of people of colour in the media. We were trying to challenge the way colourism permeates our lives.”

The name “Unfair and Lovely” is a take on the popular skin lightening cream Fair and Lovely. The movement calls on darker-skinned individuals to post images of themselves on social media using the hashtag #unfairandlovely. There are nearly 13,000 posts on Instagram citing the hashtag, and users have been sharing images along with descriptions of their personal experiences confronting shadeism.

During an interview with the BBC, one of the sisters Mirusha from the original photo series discussed her experiences with shadeism:

“In college, I was abused by a South Asian person who had lighter skin. And someone once threw a bleach balloon at me. At the time, it was really hard for me to see myself as valuable. It is difficult to understand why people will dehumanise you for the way you look. I felt very vulnerable.”

As a person of colour, it can be psychologically damaging to live with social stigma around having a darker complexion. The idea of darker skin being considered less beautiful and linked to lower status can result in lower self-esteem and feelings of inferiority.

Research by Maxine Thompson at North Carolina State University and Verna Keith at Arizona State University shows that dark-skinned Black women face issues of low self-worth and confidence as a result of shadeism.

Their data indicate that self-esteem increases as skin colour becomes lighter in African-American women judged as having “low and average levels of attractiveness.” Women who were “highly attractive” showed no correlation between self-esteem and skin colour. Black women also preferred lighter skin tones and believed lighter complexions were more attractive compared to Black males.

In my life, the influence of shadeism has not been limited to preventing dark skin. When I was younger, I also tried lightening my skin. With creams like Fair and Lovely, or home remedies like rubbing lime juice on my arms and face, I was in a constant battle with my skin.

When I was introduced to Tamil movies in my preteens, I was confused by the depictions of so-called Sri Lankan, Tamil-speaking women. Expecting to finally see people who looked like me, I saw only light-skinned women.

Often these films cast women of different backgrounds with lighter complexions to play the part of Sri Lankan women. Casting individuals of darker complexion is often restricted to those playing the role of villain. I grew to idealize those with lighter complexions, seeing them as more attractive and desirable.

The lack of dark-skinned representation is not limited to film and television. It also has a place in activist communities addressing race issues. Yogarajah explained how she and her sister decided to participate in the Unfair and Lovely campaign because of a lack of representation in advocacy circles:

“Pax asked us to take part after noticing that even many of the advocates/activists addressing racism in the black community who had a large following had light skin. We discussed it, and I noticed the same thing in the South Asian community: activists and advocates with a large audience against racism, sexism, fat-phobia, etc., usually were lighter skinned. So this photo shoot occurred, and then we created a hashtag.”

Experiences with shadeism are wide-ranging from micro-aggressions and subtle jokes among family, to incidents like the abuse faced by Mirusha in college. Campaigns like Unfair and Lovely raise awareness.

–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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For Those With Schizophrenia, Writing Can Help

30Creativity, Featured news, Health, Integrative Medicine, Psychopathy, Self-Help, Therapy March, 18

Source: Joe Skinner Photography at flickr, Creative Commons

A myth in popular culture: Mental illness leads to creativity. The idea is bolstered by successful movies like Total Recall, Minority Report, and Blade Runner, based on the work of author Philip K. Dick, who struggled with schizophrenia. Other notable artists, like singer-songwriter Brian Wilson from The Beach Boys, also showed schizophrenic symptoms.

These links have led scientists to question the relationship between schizophrenia and creative expression. While a connection appears to exist, the assumption that schizophrenia can cause creativity (or vice versa) doesn’t hold up, not in any simple or direct way. Often, these assumptions overlook other risk factors, such as family history, that contribute to the disorder.

And a report on brain illness and creativity by Alice Flaherty, associate professor of neurobiology at Harvard Medical School, paints a more complicated picture. While schizophrenia is not necessarily associated with creativity, one specific traitopenness to unusual ideas—relates to creativity and is prevalent among schizophrenic patients. This trait is common in many writers, as their work is a product of their imagination.

Mental health professionals have observed the therapeutic effects of writing on patients with schizophrenia—finding that the creative process assists these individuals with managing their symptoms.

Laurie Arney, who has schizophrenia, is a case in point. Arney’s therapist Christopher Austin from the Calgary Health Region in Alberta applied an approach called Narrative Therapy to help her cope with the illness. As part of the approach, Arney wrote about her thoughts, feelings, and hallucinations in an open journal to Austin, who would then write back, asking questions about her experiences and helping her process them. He found:

“Writing helped the client to express her experience of living with a mental illness, to describe her years of mental health treatment, and to find her own path toward wellness.”

As an adjunct to other therapies, the approach was helpful for Arney. She explained:

“When I am writing, I do not censor myself the same way as when I am talking. When something stressful happens to me, I can just go to my computer. As I write to Chris about the incident, I am already starting to go through the process of dealing with it. I do not have to save up all my concerns until my next [therapy] appointment.”

Writing therapy is also supported by research from Simon Mcardle at the University of Greenwich in the United Kingdom and colleagues. Certain creative or expressive writing exercises, such as poetry and story-writing, help schizophrenic patients express themselves, and control their thoughts and hallucinations.

According to Noel Shafi, a poet and neuroscience researcher, poetry can be used as a communicative tool for schizophrenic patients to share their emotions and disturbed thoughts. Shafi explains:

“The client externalized his negative beliefs in the form of a Haiku, using poetic expression for personal awareness and growth. The client had lost his sense of self-worth through his experience with psychosis and was now using poetry to validate his existence.”

But there are some risks associated with writing therapy, as these narrative exercises can elicit negative or disturbing expressions. According to Shaun Gallagher of the University of Memphis and colleagues, when using self-narratives, such as journal accounts or stories, patients can get confused between the story and real life. One patient’s narrative account reads:

“I get all mixed up so that I don’t know myself. I feel like more than one person when this happens. I’m falling apart into bits.”

Without regular monitoring, there may be difficulties, especially if patients struggle to distinguish between their thoughts and reality. Still, as a tool in the therapist’s kit, therapeutic writing does offer some help to a number of high-risk patients with serious mental-health problems.

–Afifa Mahboob, 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 Increases Risk of Compassion Fatigue

70Burnout, Caregiving, Featured news, Health, Stress, Trauma, Work March, 18

Source: Pennsylvania National Guard at flickr, Creative Commons

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, 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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For Mentally Ill, Jail Diversion Program Gives Second Chance

30Featured news, Health, Law and Crime, Loneliness, Politics, Psychiatry, Psychopathy March, 18

Source: octopusdevon at flickr, Creative Commons

On February 8, 2015, Natasha McKenna—a 37-year-old who suffered from mental illness—died following an incident in which she was tasered four times by law enforcement.

After a week-long delay in transporting her to a county jail in Virginia, where she would be provided with mental-health resources, she became agitated. In an effort to regain control, officers used a stun gun on her multiple times. Despite CPR to revive her, McKenna passed away shortly after.

McKenna had been diagnosed with schizophrenia, bi-polar disorder, and depression when she was just fourteen. Her case highlights a growing issue in county jails and prisons across America: resources are scarce for offenders with mental illness.

In 1992, the National Alliance for the Mentally Ill (NAMI) and Public Citizen’s Health Research Group released a report revealing alarmingly high numbers of people with serious mental illness incarcerated in the United States. The subsequent 2002 report showed that little had changed in the preceding ten years.

But shortly after McKenna’s death in 2015, Fairfax County Jail—where she had been held—created a Jail Diversion Program (JDP). The objective of this program is to divert low-risk offenders in mental-health crises to treatment rather than send them to a prison setting that exacerbates their symptoms.

JDPs are designed so that authorities, alongside certified crisis clinicians, have the capacity to decide whether a non-violent offender who suffers from a mental disorder is directed to a JDP where they can receive treatment, or is arrested. JDPs give offenders the opportunity to work with a trained mental-health clinician, ultimately transforming how resources are provided.

Sarah Abbot, the program director of Advocates—a JDP in Massachusetts that works with the Framingham Police Department—believes that JDPs are crucial in early intervention for mentally ill offenders.

During an interview with the Trauma and Mental Health Report, Abbot explained:

“JDP’s effectively divert people with mental illness from the criminal justice system, and have been shown to be successful in the prevention of unnecessary arrests for those who suffer with a mental illness. Police choose to transfer offenders to JDPs 75% of the time.”

Abbot believes that early intervention via JDPs is key to preventing those with a mental illness from reoffending. In 12 years of operation, Advocates has successfully diverted 15,000 individuals from the criminal justice system into treatment.

During calls related to misdemeanors, police respond to the scene with a JDP clinician. After consulting the clinician, the officers use their discretion, along with information from victims and bystanders, to decide whether or not to press charges. Alternatively, the officer can choose to secure treatment for the offending individual at a JDP.

In the latter case, the clinician performs an assessment to determine if the offender meets the criteria for inpatient care. If so, they are diverted from arrest and placed in a local mental-health facility where they receive intensive treatment through the support of counsellors, social workers, psychologists, and psychiatrists.

The purpose of JDPs is to de-escalate encounters with mentally ill offenders and create a cooperative environment for assessing the situation. Abbot views their contribution as a form of compassionate justice:

“If we can keep mentally ill individuals out of the criminal justice system, their lives will ultimately be better by default. How much better depends on the quality of the treatment they receive and the individual’s commitment to success.”

The literature on JDPs suggests that placing these individuals in treatment programs within their community, where they have the support of family and friends, inevitably results in lower rates of relapse in comparison to incarceration.

Abbot believes that JDPs are vital in keeping individuals away from the isolation of a jail cell:

“My hope is that we divert people like Natasha McKenna into proper treatment, because once they are in a cell, things can escalate quite quickly.”

If somebody with a mental illness has an arrest on their record, JDPs keep doors open to them for education, employment, and housing. JDPs have the potential to protect individuals like McKenna, and provide offenders suffering from mental illness with a second chance at living stable lives post-arrest.

–Nonna Khakpour, 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

Robert T Muller - Toronto Psychologist

Mental-Health Stigma All Too Common in Iran

70Depression, Featured news, Health, Psychopathy, Stress, Trauma March, 18

Source: PakPolaris at Deviant Art, Creative Commons

A Minor Leap Down, an Iranian film featured at international film festivals in Berlin and Toronto, illustrates the struggle of a 30-year-old Iranian woman named Nahal, whose deteriorating mental health is undermined by her family.

When Nahal is told she’s had a miscarriage, instead of seeking support from her family—who have, in the past, refused to recognize her struggle with depression—she keeps the news to herself, leading to desperation.

Stigma surrounding psychological disorders in Iran often leads to isolation, as fear of judgment and ridicule creates barriers to pursuing treatment. Some reports show that 26.5 percent of Iranian women and 20.8 percent of Iranian men have mental-health difficulties.

In an interview with the Trauma and Mental Health Report (translated, Farsi to English), Hamed Rajabi, director of A Minor Leap Down, explains:

“This social system is only concerned with how people work and perform, and when that performance is lowered, their behavior is instantly condemned.”

Research by Ahmad Ali Noorbala and colleagues from Tehran University of Medical Sciences shows women in Iran have a greater incidence of mental disorders than women in Western cultures. One contributing factor may be that women in Iran are often confined to the home, leading to isolation and poor domestic conditions.

After the loss of her unborn child, Nahal spirals into deep depression, deciding not to remove dead fetal tissue from her womb. When she tries to address the issue with her mother and husband, she’s turned away.

Familial relationships and reputation are important aspects of Iranian culture. Mental illness in a family member is viewed as a familial flaw.

According to research published in the Journal of Health and Social Behaviour by Erin Cornwell of Cornell University and Linda Waite of the University of Chicago, social relationships are particularly important for those coping with mental illness; social withdrawal aggravates loneliness, stress, and feelings of low self-worth.

Nahal’s silence about her mental illness also relates to a worry that she’ll be forced to resume antidepressant medication, which she took prior to pregnancy. Medications like these are seen as first-line treatment in Iran.

In A Minor Leap Down, filmmaker Rajabi addresses the over-prescription of psychotropic medication in Iran, explaining:

“Depression signifies that a part of our lives hurt—and taking pills won’t solve anything until we distinguish which part of our life is causing the problem.”

Although recognition of mental-health problems in Iran has arguably increased over the past few years, considerable stigma still exists.

Awareness can translate to an enhanced understanding of the complexity of mental-health problems in a culture that holds rigid attitudes about mental health and illness.

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

Robert T Muller - Toronto Psychologist

For Those With Schizophrenia, Writing Can Help

80Therapy News February, 18

A myth in popular culture: Mental illness leads to creativity. The idea is bolstered by successful movies like Total Recall, Minority Report, and Blade Runner, based on the work of author Philip K. Dick, who struggled with schizophrenia. Other notable artists, like singer-songwriter Brian Wilson from The Beach Boys, also showed schizophrenic symptoms.

These links have led scientists to question the relationship between schizophrenia and creative expression. While a connection appears to exist, the assumption that schizophrenia can cause creativity (or vice versa) doesn’t hold up, not in any simple or direct way. Often, these assumptions overlook other risk factors, such as family history, that contribute to the disorder.

And a report on brain illness and creativity by Alice Flaherty, associate professor of neurobiology at Harvard Medical School, paints a more complicated picture. While schizophrenia is not necessarily associated with creativity, one specific trait—openness to unusual ideas—relates to creativity and is prevalent among schizophrenic patients. This trait is common in many writers, as their work is a product of their imagination.

Mental health professionals have observed the therapeutic effects of writing on patients with schizophrenia—finding that the creative process assists these individuals with managing their symptoms.

Laurie Arney, who has schizophrenia, is a case in point. Arney’s therapist Christopher Austin from the Calgary Health Region in Alberta applied an approach called Narrative Therapy to help her cope with the illness. As part of the approach, Arney wrote about her thoughts, feelings, and hallucinations in an open journal to Austin, who would then write back, asking questions about her experiences and helping her process them. He found:

“Writing helped the client to express her experience of living with a mental illness, to describe her years of mental health treatment, and to find her own path toward wellness.”

As an adjunct to other therapies, the approach was helpful for Arney. She explained:

“When I am writing, I do not censor myself the same way as when I am talking. When something stressful happens to me, I can just go to my computer. As I write to Chris about the incident, I am already starting to go through the process of dealing with it. I do not have to save up all my concerns until my next [therapy] appointment.”

Writing therapy is also supported by research from Simon Mcardle at the University of Greenwich in the United Kingdom and colleagues. Certain creative or expressive writing exercises, such as poetry and story-writing, help schizophrenic patients express themselves, and control their thoughts and hallucinations.

According to Noel Shafi, a poet and neuroscience researcher, poetry can be used as a communicative tool for schizophrenic patients to share their emotions and disturbed thoughts. Shafi explains:

“The client externalized his negative beliefs in the form of a Haiku, using poetic expression for personal awareness and growth. The client had lost his sense of self-worth through his experience with psychosis and was now using poetry to validate his existence.”

But there are some risks associated with writing therapy, as these narrative exercises can elicit negative or disturbing expressions. According to Shaun Gallagher of the University of Memphis and colleagues, when using self-narratives, such as journal accounts or stories, patients can get confused between the story and real life. One patient’s narrative account reads:

“I get all mixed up so that I don’t know myself. I feel like more than one person when this happens. I’m falling apart into bits.”

Without regular monitoring, there may be difficulties, especially if patients struggle to distinguish between their thoughts and reality. Still, as a tool in the therapist’s kit, therapeutic writing does offer some help to a number of high-risk patients with serious mental-health problems.

– Afifa Mahboob, Contributing Writer

Image Credits
Feature: Joe Skinner Photography at flickr, Creative Commons
First: Calum MacAuley at unsplash, Creative Commons
Second: Wellcome Library at Wikimedia, Creative Commons

Robert T Muller - Toronto Psychologist

Workplace Alcohol Tests: Where Do We Draw the Line?

40Addiction, 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