Category: Suicide

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The Hidden Struggles of Animal Rescue Workers

00Animal Behavior, Depression, Featured news, Resilience, Suicide, Trauma September, 19

Source: 12019 at Pixabay, Creative Commons

During the civil war in Syria, veterinary surgeon Amir Khalil from the charity organization Four Paws International, travelled to Aleppo to rescue surviving zoo animals. Before the war began, the zoo was home to around 300 animals, yet by July 2017 only 13 remained. After months of intense negotiations with the Syrian and Turkish governments, local factions and warlords, and two dangerous rescue missions later, Khalil managed to save all 13 animals. Prior to this rescue, Khalil had rescued animals from conflict zones in Libya, Gaza and Iraq. 

When tragedy strikes, most people think about the potential harm done to human lives. However, many care deeply about animals and are willing to put their lives at risk to save them. In fact, during Hurricane Katrina, of those who did not evacuate their homes, 44% did so because they did not want to abandon their pets.  

Research has even shown that there are some circumstances in which people chose to save pets over humans. One study showed that 40% of people chose to save their own pet over a foreign tourist. Another study showed that when presented with a fictional news story, people cared more about crimes involving dogs and children than adults. A possible reason for this surprising finding was likely due to the vulnerable nature of animals. In fact Khalil felt compelled to rescue many animals in the past simply because the zoo animals were dependent on humans. In an interview with The Telegraph, he explained: 

“Humans have the option to escape, but animals caged in a zoo don’t have this option. It was humans who brought animals to these places. They cannot speak, they have no political agenda, but they are messengers from the darkness, they bring hope.”

Other animal rescue workers express similar sentiments. Darren Grandel, Deputy Chief of the investigations department at the Ontario Society for the Prevention of Cruelty to Animals, explained in an interview with the Trauma and Mental Health Report (TMHR) that the most difficult part of his enforcement work is witnessing innocents being harmed: 

“The animals, all the time, are the innocents. It’s not that they’ve chosen to engage in a type of activity that can harm them. The humans have done it to them. So a lot of the time you’re seeing innocent animals being harmed, sometimes in very horrific ways, in ways that you couldn’t imagine someone hurting another living thing. It can be very, very traumatic.”

When working on rescuing  animals such as in the wake of a natural disaster, a similar type of trauma can be experienced.  In a TMHR interview, Miranda Spindel, a veterinarian with 19 years of experience, including a decade with the American Society for the Prevention of Cruelty to Animals explained:

“On deployment, you are typically away from home and often working in conditions that are less than ideal. Sometimes, there are animal owners as well as animals involved, who may have experienced very stressful and emotionally challenging situations and require skilled and compassionate care, too. Often the work is physically as well as mentally challenging.”

Animal rescue work, though important, severely affects the mental health of these individuals. Humanitarian aid workers and first responders report high rates of depression, anxiety and PTSD. Animal rescue workers occupy similar roles, rescuing and proving aid to animals in distress and likely experience similar mental health problems. And, according to a study in the American Journal of Preventative Medicine, those in protective service occupations, including animal control workers, have the highest rate of suicide, at 5.3 per million workers. 

Veterinarians and others individuals who work with animals also experience high rates of compassion fatigue. Compassion fatigue, also known as vicarious traumatization, refers to stress symptoms that result from providing care and empathy to humans or animals in distress. 

Janice Hannah, Campaign Manager of the International Fund for Animal Welfare’s Northern Dog Project described one such experience in a TMHR interview:

“I remember visiting a rural shelter. The dogs were literally stuck in a poop filled fence, cold, wet and hungry. That was the end of shelter work for me – I had been to so many similar shelters around the world and am reminded of the sadness felt in those situations. Though those feelings dissipate over time, it never goes fully away. You end up building up more and more sadness and discomfort around all the animals that you see but can’t make a tangible difference about the circumstance. 

There are some programs in place, such as support groups and internal services within organizations to help animal rescue workers recover from trauma. Yet, more needs to be done to better help individuals who have dedicated their lives to helping animals. Increased peer support and open communication without fear of stigma are required to better help individuals with mental health problems. Spindel emphasizes that preventative measures are equally important:  

“Whether or not workers are suffering from mental health issues, the circumstances are generally enough, in my opinion, that mental health services and resources should be made available as a matter of routine. Trained support during the deployment – or even before – not just debriefing afterward – seems critical to building resiliency for this type of work.”

From enforcement officers to veterinarians, many different professionals work selflessly to rescue innocent animals from harm. With greater support services, these individuals will be better able to cope with the stresses of their job, enabling them to better help animals in need.  

-Roselyn Gishen, 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

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When a subway passenger dies by suicide, workers suffer too

00Featured news, Health, Post-Traumatic Stress Disorder, Suicide, Trauma, Work August, 19

Source: Lily Banse at Unsplash, Creative Commons

In an article in a Canadian daily, The Globe and Mail, Oliver Moore reported that during 2016, 21 suicide attempts occurred on Toronto’s subway system. In fact, a study published by the Journal of Urban Health considers suicide on subway platforms to be a public health issue.

Subway delays by attempted suicide not only affect passengers, the victims and their families, but drivers as well. Subway workers and drivers who have witnessed a suicide have been reported to have Post-Traumatic Stress Disorder (PTSD). Research suggests that those exposed to human-generated traumatic events have a greater chance of developing PTSD.   In an interview with Vice Magazine, psychologist Wilfried Echterhoff discussed the long-lasting psychological trauma workers face when confronted with a death on the worksite:

“Some people have never been confronted with death before…To suddenly be confronted with it in such a violent way can lead to PTSD or a serious depression.”

In an interview with the Trauma and Mental Health Report, Robert (name changed), a retired subway worker with over 30 years of experience, described an incident he faced while working: 

“One Saturday afternoon maybe around 11:00 a.m. or 12:00 p.m., I witnessed a lady jump off the subway platform. I needed to go upstairs and tell my supervisor and my supervisor told me that my face was all white. They kicked everyone out and only the police and ambulance were allowed to come in.” 

Nik Douglas, a train driver who worked for the Northallerton subway station in the UK, noted in an interview with The Independent:   

“When I was on my own I’d burst into tears for no reason, I found sleep hard and I’d have flashbacks during the night and day. I could be in a room full of people with a really good party atmosphere but feel alone and isolated. That’s one of the biggest things I remember, feeling alone… It changed my life instantly from who I was to what I have become. Some people aren’t affected, but two years after it happened I’m still not the same person.”

In deciding what was best for his mental health, Nik took six months off work to deal with his PTSD. Recent studies suggest that in Canada, 6.5% of subway workers have been absent from work due to witnessing suicides while working. Last November, this rate was at its highest with 7.44% of employees absent. Some employees are unable to return to work altogether and opt to receive compensation from their employers.

Nik experienced intrusive distress and feelings of isolation. Kevin, a 39-year-old subway driver expressed his feeling of being responsible for the suicide of a man:

“When he looked at me and our eyes met, time just stood still. It felt like driving your car over railroad tracks, that rumbling feeling you get … I realized then that I just killed somebody.”  

In his years of working at the subway, Robert explained the brief protocol subway workers go through once they have witnessed a suicide:

“The subway drivers have to talk to the police after that happens. They always have to stay and give a statement. Then they’re taken off duty for that day. Then they get sent home or to counselling. It depends on what the driver wants to do. It just started recently in the last five or six years.  The company asks if the drivers want to speak to someone.”

Effective suicide preventions have been created to decrease the suicide rate in subway stations and increase safety. Subway stations in Tokyo have implemented glass doors that open for passengers to board the subway only once it has arrived in the station. Other preventions put in place are blue lights and mirrors set up to discourage suicide attempts. In London and Paris, these forms of preventions have been effective too. 

In addition, intervention programs, including the Gatekeeper Program, exist for those who are feeling suicidal.  However, interventions put in place for subway workers who experience suicides are rare. Most workers deal with the effect of these experiences on their own. In Robert’s words:

“If something is going to happen, it’s going to happen.  There’s nothing you can do. They don’t tell you this can happen or that can happen.  They won’t tell you what can happen when you sign up for this job.  They don’t tell you that workers deal with this.  They don’t train you how to deal with it.  They won’t ever tell you what to expect even when training people.”

Social support is argued to be one of the most powerful factors in recovering from PTSD and is known to decrease risk for depression, foster resilience, and reduce stress in those who have experienced traumatic events.  Mindfulness-based stress reduction therapy has shown to reduce stress and increase recovery in those with PTSD.  

Lucia Chiara Limanni, 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

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When Bipolar Disorder Brings Marital Distress

00Bipolar Disorder, Depression, Featured news, Marriage, Stress, Suicide July, 19

Source: Cristina Jiménez Ledesma at Flickr, some rights reserved

In a busy urban community church, Reverend John Tahir, a parish minister, enjoys many moments helping and advising members of his congregation. One of his more meaningful responsibilities is counselling young couples, providing marriage education to them with the hopes of preparing them for this new chapter in their lives. The importance of this task is not lost on Tahir, as he knows far too well that significant issues such as money, boundaries, and lack of communication to name a few, can result in marital challenges. The reality is that marriage can be a rather difficult journey. 

Dr. Gary Chapman’s book, The Five Love Languages, examines marital discord resulting from a lack of effective communication. The premise is that every person enters a marriage with their own definition of what love means. As a result of these inevitable differences, people have distinctive love languages. According to Chapman, problems in marriage arise primarily because people often expect their spouse to demonstrate love in a way that is compatible with their own love language.  

It is not hard to imagine that living with a spouse struggling with a mental health disorder only adds to the complexities of marriage. The divorce rate varies among mental health disabilities because each condition presents its own unique challenges. For example, those who have phobias and obsessive compulsive disorders have a much lower divorce rate than affective disorders such as bipolar disorder and depression. Though there are four different types, bipolar disorder is characterized by drastic mood shifts with either manic or depressive episodes. Those with this affective disorder can experience high, elated, and energized moods while experiencing hopeless and depressive ones at other times. It is interesting to note that the divorce rate of those with bipolar disorder is very high—approximately double the rate of the general population.

In an interview with the Trauma and Mental Health Report, Brian (name changed for anonymity) shares his experience of having bipolar disorder: 

“It’s been hell struggling with suicidal thoughts every day. I’ve lost a sense of joy and optimism.  I find it difficult to complete even regular daily activities.”

Brian’s struggles have taken a great toll on Christina, his wife. Spouses of individuals with bipolar disorder, like Christina, may be at increased risk of stigma, stress, depression, psychiatric symptoms and a decreased quality of life:

“My life revolves around my husband. I’ve taken on a lot of additional responsibilities and it has affected my physical and mental wellbeing.” 

Christina recalls being late for a recent meeting because she was afraid that her husband was going to kill himself: 

“I didn’t feel comfortable leaving him at home that day. I had my mother-in-law come over so that I could attend my meeting.”

The relational interaction between spouses, where one is a patient and the other a caregiver, can contribute to additional marital challenges. Research suggests that neither patients with bipolar disorder, nor their spouses were accurate in describing each other’s experiences and concerns when it came to the impact of the disorder on their lives. These differing perspectives can lead to marital difficulties because each partner’s thoughts and feelings are misunderstood and challenged. The issue speaks to a lack of effective communication, which Chapman believes can contribute to the breakdown of the relationship.  

Brian and Christina both emphasized certain themes that were important to themselves while neglecting other aspects that were important to the other. When asked to reflect on a specific experience related to Brian’s psychiatric treatment, the couple highlights different concerns:

Christina: “I feel frustrated and helpless due to the lack of support and guidance from medical professionals. I have to constantly fight for Brian to receive proper treatment.”

Brian: “I have first-hand experience as a patient. When I’m in the hospital, I feel like I lose my identity as an individual. I am treated as just one among many other patients with a mental illness.”   

Lack of effective communication appears to be a common theme in all marital problems, which becomes further impaired when coping with the difficult challenges associated with bipolar disorder.  

In his book, Chapman asks:

“Could it be that deep inside hurting couples exists an invisible ‘emotional love tank’ with its gauge on empty?…If we could find a way to fill it, could the marriage be reborn? With a full tank, would couples be able to create an emotional climate where it is possible to discuss differences and resolve conflicts? Could that tank be the key that makes marriage work?

—Young Cho, 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

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When Doctors Are At-Risk for Suicide

00Burnout, Depression, Embarrassment, Emotion Regulation, Featured news, Health, Suicide May, 19

Source: Feature: skeeze at Pixabay, Creative Commons

They had known each other well enough in the early days of medical school, when they were students studying well into the night. After graduation, they went their separate ways, each assuming the other was doing well.

“I wanted you to hear it from me,” a colleague sadly said on the phone. Dr. Ranjana Srivastava nearly fell to the pavement when she was told that her long-time friend and colleague—a clinician, wife, and devoted mother—had died by suicide.

Unfortunately, this is not the first that time Dr. Srivastava had to face the suicide of a colleague. In a piece she wrote for The Guardian, Srivastava explains:

“Forced smiles and tough hides abound in the workplace, where always being ‘fine’ is a badge of honour. This is why it can be so difficult to distinguish doctors who will indeed be fine from those who need help.”

Research shows a higher rate of mental health problems among physicians. A 2013 report estimates over 25% of doctors in Australia having at least a minor psychiatric disorder, with 10% reporting suicidal thoughts in the past year. A survey of 2000 U.S. physicians showed that roughly half believed they met criteria for a mental illness in the past, but had not sought treatment. And in Canada, recent research estimates over 26% of Canadian doctors suffer professionally due to poor mental health, with 20% of them reporting they had been depressed in the last 12 months. Overall, roughly 30% of physicians worldwide have depression or symptoms of it, according to an extensive review published in the Journal of the American Medical Association (JAMA).

Why is this the case? The answer isn’t all that clear, but according to physician and social worker Katharine Gold and colleagues, stigma is to blame. Their research looked at survey responses of over 2000 female physicians, and it showed that stigma attached to mental illness is greater among medical trainees and physicians than in the general population. According to one respondent:

“I have been discriminated against in a department after disclosing my history of well-treated depression to my department chief.”

And this is not an isolated incident. Studies show that 50% of doctors are less likely to work with a colleague who has a history of depression or anxiety disorder, with four in ten admitting to thinking less of such a colleague. And throughout the years, healthcare organizations have favoured a punitive approach when addressing the issue of physician mental illness, rather than a supportive one. So disclosing mental health issues by a medical doctor can pose a real threat to licensing, career, and reputation, leading to reluctance to seek help.

In an interview with the Trauma & Mental Health Report, medical student Jamie Katuna explains the predicament physicians face:

“Getting care could mean problems for doctors. If they seek help for mental health issues and if someone decides they are ‘unstable’ and shouldn’t be seeing patients, that physician is out of a job and would have a really hard time finding another one. So instead, doctors suffer in silence.”

When deteriorating mental health makes it difficult to work, many physicians ignore their symptoms and continue to work anyway, often self-medicating with drugs or alcohol to avoid the perceived embarrassment of having a psychological disorder.

Steps are being taken to bring awareness. Many universities and medical organizations are starting conversations about physician wellness and stigma reduction. Physicians and medical students who have lived through suicide attempts, depression, and other mental health issues are standing up for themselves and each other. Likewise, organizations such as the American Foundation for Suicide Prevention and the American Medical Association have recommended reforming medical licensing questions to make it clear that physicians may get help without fear of negative consequences. Despite the growing support, Thomas Schwenk of the University of Nevada School of Medicine noted that change isn’t happening fast enough:

“A lot of [conversations about mental health stigma are] very difficult and very slow to happen, and unfortunately tragic incidents like the two suicides in Quebec and other suicides across the country are still occurring because it’s taking time to change that culture.”

There are some resources available. In Canada, organizations like Physician Health Program and the Canadian Medical Association provide a range of direct services for physicians and medical students at risk of, or suffering from, substance use, psychiatric disorders, or occupational stress. The interventions offered can include awareness workshops, referral to treatment, and monitoring, all while maintaining confidentiality. Also, online resources such as ePhysicianHealth and Combating Stigma are available.

Most solutions exist at a personal or program level, but the problems are pervasive and affect the entire structure of healthcare education. According to Katuna:

“The culture of medicine should undergo amazing and radical transformations. We need to redesign how we implement medical education.”

Systematic problems require systematic solutions and until then, medical professionals remain at risk.

— Ilia Azari, 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

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Pressures to Breastfeed Can Harm Maternal Mental Health

00Child Development, Decision-Making, Embarrassment, Featured news, Guilt, Health, Parenting, Postpartum, Stress, Suicide January, 19

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Florence Leung of British Columbia, Canada went missing on October 25, 2016 while struggling with post-partum depression. Less than a month later, her family discovered that she had taken her own life, leaving behind a husband and infant son.

In an emotional public letter, Leung’s husband Kim Chen wrote an impassioned plea to new mothers asking them to seek help if they felt anxiety or depression. He also revealed that his wife’s difficulties with breastfeeding, and the resulting feelings of inadequacy, likely contributed to her condition. Urging women not to criticize themselves about an inability to breastfeed or a decision not to breastfeed, Chen wrote:

“Do not ever feel bad or guilty about not being able to exclusively breastfeed, even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes, and teachings at breastfeeding classes.”

Speaking with the Trauma and Mental Health Report, Melissa (name changed) said that she was struck by Chen’s words, and recalled the scrutiny around breastfeeding she experienced with her first child:

“I was tired, sore, and the baby was cranky and constantly wanting to feed. It surprised me that, despite my vocal frustration and obvious difficulty breastfeeding, the nursing staff and lactation consultants were adamant that I continue to breastfeed exclusively.”

The frustration worsened once the couple returned home. The week that followed was exhausting, spent trying to calm a screaming newborn who constantly wanted to feed. The couple attended several breastfeeding clinics that reiterated the same message: breast is best. Melissa and her husband felt confused and defeated.

Shortly thereafter Melissa became completely overwhelmed:

“I began to get scared, and not trust myself. My inability to easily nurse and soothe my baby without intense discomfort led to feelings of failure. My emotions were overwhelming. I wasn’t sleeping because I was constantly pumping breastmilk or nursing.”

Within a week after giving birth, Melissa’s infant was suddenly much quieter and less agitated. Upon closer examination, she noticed that the baby looked pale, and was lethargic and dehydrated. A frantic trip to the emergency room (ER) revealed the newborn was not getting enough liquids and nourishment—despite the many scheduled feedings. Melissa said:

“When the ER doctor apologized for the miscommunication and advised us that supplementing with formula is not only okay, but sometimes necessary, I felt a mixture of relief and betrayal. Relief because I knew we would be okay, yet betrayed by some health professionals who put their personal agendas above our health and well-being.”

In an interview with the Trauma and Mental Health Report, Diane Philipp, a Child and Adolescent Psychiatrist at SickKids Centre for Community Mental Health in Toronto, shared that she meets many mothers suffering from stress, shame, and guilt associated with breastfeeding. Philipp explained that the judgements of others place unnecessary pressure on mothers:

“It’s important for mothers to have access to frank and open discussions that are safe and non-judgemental where they can seek out information and make the most knowledgeable decision that is best for their child and for themselves in terms of breastfeeding.”

Every woman’s situation is unique. Lifestyle habits, medication use, and medical and psychological history can complicate the post-partum experience. With this context in mind, the healthcare team should provide a comfortable environment—free of judgement—when discussing post-partum issues, including how to provide an infant’s nourishment.

For mothers who are unable to nurse, be it for medical, physical, or personal reasons, their decision can be supported and honoured in a way that promotes emotional well-being and encourages healthy parent-child bonding. Philipp said:

“For parents who can’t breastfeed for whatever reason, wonderful attachment bonds can still be made. Breast milk is not the only ingredient in a valuable, long-lasting relationship.”

Melissa, now a mother of two healthy school-age children, remains sensitive to others’ assumptions of breastfeeding:

“I felt so pressured to get it right, and so judged when I couldn’t provide for my child. Even when you come to terms with your decision not to breastfeed, people question your choice. Looking at my children today, I know I did the right thing.”

– Kimberley Moore, 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

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Ketamine Depression Treatment Poses Unknown Risks

00Decision-Making, Depression, Education, Featured news, Health, Psychopharmacology, Suicide November, 18

Source: SnaPsi at flickr, Creative Commons

New evidence that ketamine, an anesthetic medication, might be effective in treating depression is leading to increased research on the drug. What’s significant is the rapid relief in symptoms seen in some patients. After just one dose of ketamine, their depression can decline within three days, much quicker than with conventional anti-depressants.

This finding is particularly meaningful for people at risk for suicide. Ketamine may provide an option for physicians to quickly treat acutely suicidal patients by creating a window of opportunity to begin long-term behavioral and pharmacological therapies. If a patient’s symptoms are relieved even for a short time, it may be long enough to intervene.

Recent excitement also surfaced when researchers from New York’s Mount Sinai School of Medicine demonstrated the drug’s ability to alleviate treatment resistant depression (TRD). TRD occurs when feelings of intense sadness, loss of energy, and inability to experience pleasure persist even after multiple attempts at treatment. In the study, a shocking nine out of 10 patients with TRD experienced significantly reduced symptoms after their first dose of ketamine.

Despite this finding, questions remain about the drug’s long-term efficacy, as well as its side effects.

Anthony (name changed) has first-hand experience with ketamine to treat TRD. In a Reddit thread and interview with the Trauma and Mental Health Report, he explained that, prior to receiving ketamine treatment, he had tried numerous anti-depressants. After spending weeks or months on each drug to no avail, his doctor would switch him to a new drug in hopes of finding one that worked, but nothing did. Anthony began researching alternative treatments himself. He explained:

“When you try so many drugs—SSRIs, SNRIs, TCAS, antipsychotics, lithium, depakote—you are pretty open to anything that will help.”

He discovered ketamine and was enticed by the prospect of its therapeutic benefits:

“Before ketamine, I was in a hole. This was as depressed as I had ever been. I was suicidal. I called my mom and dad. They rescued me, letting me live in their basement. There, I began researching ketamine until I knew almost every study. I convinced my doctor to let me try it.”

But ketamine is only approved for use as an anesthetic by the U.S. Food and Drug Administration (FDA). This provision means that any patient who receives ketamine treatment for depression must have it prescribed as an “off-label” treatment. In other words, the doctor prescribes the drug for a non-FDA-approved use.

Choosing to participate in an unapproved treatment may expose a patient to more risks than they are aware of. FDA approval for ketamine use in anesthesia indicates that one time treatments are not harmful, but it is uncertain whether repeated treatments are safe. And, the long-term effects are not known.

Not surprisingly, the off-label prescription of ketamine has been criticized. A study by Melvyn Zhang at the Institute of Mental Health in Singapore and colleagues cited multiple problems with ketamine treatment for depression. A major criticism was that current information is based on inadequately short periods of observation. These observations indicate depression relapse rates as high as 73% one month after treatment ends.

Nevertheless, after deciding he was scared, but prepared to do anything to overcome his depression, Anthony began intravenous (IV) ketamine treatment in his doctor’s office:

“[When taking the drug] I feel completely disconnected from my body. I cannot move. I feel partly elated, and partly terrified. Reality becomes distant. I have no awareness of my body; only my mind exists. In this space, I can see my own struggle with depression. I recognize in this strange way that the depression isn’t real, not a part of me. I realize that I am surrounded by people who love me. Slowly, I come back to the chair I’m in, back to the doctor’s office. Somehow, I already feel better.”

After his initial treatment, Anthony said that his thoughts of suicide disappeared. He remembers feeling clear-headed, not high or euphoric. He felt normal again. This realization was so profound, he was moved to tears:

“After the initial five treatments, I was having moments when it felt like all my symptoms of depression were gone. But they would always eventually return. I was prescribed a nasal spray about a month after my last IV treatment. That worked for a while.”

Unfortunately, these benefits had serious contraindications. Anthony experienced lingering feelings of being disconnected from his body and from reality. Another study investigating ketamine use for TRD found that three out of 10 participants experienced dissociative symptoms from the drug.

These side effects have yet to be fully understood. Although Anthony believes that the treatment saved him, it also opened the door for other mental-health problems:

“Looking back, I would do it over again, as ketamine literally pulled me from suicidal thoughts. But, in my opinion, ketamine opened the door for the feelings of disconnection. And they are a huge struggle for me every day now.”

With alarmingly high post-treatment relapse rates, little knowledge of long-term safety, and worrisome side effects, ketamine has yet to be proven as a lasting treatment for depression.

– Stefano Costa, 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

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Should Those with Mental Illness Have the Right to Die?

00Chronic Pain, Decision-Making, Featured news, Health, Resilience, Suicide September, 18

Source: KingaBritschgi at DeviantArt/Creative Commons

On June 17, 2016, Canada joined a handful of countries and several U.S. states in enacting assisted suicide legislation. Medical Assistance in Dying (MAID), also known as euthanasia, was passed into Canadian law as Bill C-14 in an effort to provide relief from unbearable suffering to those whose death is reasonably foreseeable.

Although having the choice to die brings relief to many individuals and their families, Bill C-14 does not cover those who wish to end their life due to an unendurable mental illness.

Being denied a legal right to assisted death for significant mental illness was the plight of 27-year-old Adam Maier-Clayton. Since childhood, Maier-Clayton suffered from unrelenting psychological disorders that robbed him of sustaining a reasonable quality of life. In an essay published in The Globe and Mail, he detailed the unrelenting pain his psychological disorder caused him:

“I’m not suicidal in the sense that I hate myself and I want to leave. I think this world is beautiful, but this amount of pain is intolerable… Some people are confined to lives of truly horrifying amounts of suffering that no amount of treatment can stop.”

Maier-Clayton lobbied the Canadian federal government to change the criteria that would allow people with severe mental illness to qualify for medical assistance in dying. His bid was not successful. Sadly, in April 2017, he took his own life.

Currently, the law in Canada excludes access to MAID for people suffering from psychological issues alone. For right-to-die supporter, author, and journalist Sandra Martin, this position is disrespectful to the severely mentally ill. In an article written for The Globe and Mail, Martin argued for what she believes is the best interest of the patient:

“We can’t leave it to vote-wary politicians and risk-averse medical associations to campaign for an equitable MAID law….We can’t wait for another constitutional challenge to recognize that not all suffering is physical. That struggle is Maier-Clayton’s legacy—and fighting for it might make a difference to you or somebody you love.”

Not having an available, safe, and medically supervised solution to dying does not prevent death. According to Dying With Dignity Canada, the absence of a legal and feasible option pushes individuals into making agonizing and expensive decisions. They must either take their own life or travel abroad to countries where assisted suicide is legal.

Despite the pressure to change MAID, lawmakers are taking a cautious approach to considering future regulation on right-to-die policies involving psychological disorders. Many mental health professionals and organizations meet this unhurried approach favourably, as they feel it is necessary to protect potentially vulnerable members of society who may recover.

The Centre for Addiction and Mental Health (CAMH) supports the Canadian government’s decision to painstakingly consider the implications of MAID for psychiatric patients. CAMH stated:

“CAMH recognizes that people with mental illness can experience intolerable psychological suffering as a result of their illness, but there is always the hope of recovery. In those rare cases where a mental illness may be determined to be irremediable, safeguards must be in place to make sure that an individual truly has the capacity to consent to MAID.”

On February 8, 2017, in a panel discussion jointly hosted by the University of Toronto Faculty of Law and CAMH, mental health professionals converged to dissect this multifaceted debate. In addition to the vast legal issues, they discussed the enormous ethical dilemmas inherent in right-to-die policies. Panel member Scott Kim, Senior Investigator at the National Institute of Health, summarized some of the ethical, moral, and legal issues at play, and cautioned against enacting policy without the appropriate research on euthanasia available. Kim emphasized the risk of human error in the medical profession in making this type of decision:

“Euthanasia is permanent….Even the most sophisticated psychiatrist does not have too much data to go on except their own experience and impressions to make these prognostic determinations.”

Kim goes on to point out that wanting to die is often part of the mental illness manifestation itself, and with correct and consistent treatment, the desire to end one’s life may abate.

MAID currently requires a medical practitioner to support a patient’s resolve to die. The magnitude of such a permanent decision lies not only with the patient, but also with the medical professional. In an occupation that is obligated to ‘do no harm’, supporting the death of someone with a non-terminal illness, despite an intolerable life, appears contradictory.

Tarek Rajii, panel member and Chief of Geriatric Psychiatry at CAMH, has worked with patients that he knows may never recover. However, based on the current research available, Rajii remains hesitant about MAID for mental illness:

“We don’t know who will die suffering. We don’t know how to identify that person….If we are considering MAID as a form of treatment intervention, when there is very limited evidence, as a medical profession, do we introduce an intervention without enough evidence, that we don’t [fully] understand?”

With making the decision to end a life of psychological suffering, mistakes are not an option. There is no room for error; there is no reversal. And yet, how much suffering can one person endure? Ultimately, we are left with the realization that, despite the pain from devastating mental illness, hope for recovery cannot be ruled out.

– Kimberley Moore, 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

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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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Online Programs Confront Suicide in Indigenous Communities

30Depression, Featured news, Health, Resilience, Suicide, Therapy December, 17

Source: Nicole Mason at unsplash, Creative Commons

In 2016, a wave of suicides occurred in Canada’s indigenous populations. Communities in northern Saskatchewan particularly witnessed several youth suicides. In October of that year, five girls between 10 and 14 died by suicide in the span of a few weeks. The situation intensified when news broke later that month that a 13-year-old girl was the latest to take her life: a total of six young girls in the province.

Indigenous communities have a long and painful history of mental health issues. Persistent poverty, discrimination, and systemic racism have been cited as key factors in the growing mental health crisis these people face today. Indigenous communities are found in remote, less populated areas, making it difficult for them to get adequate care.

Suicide is the leading cause of death for indigenous peoples—indigenous youth being an acutely vulnerable population. Unsurprisingly, there has been a public outcry for intervention. To reach these remote areas, both activists and researchers are turning to technology to alleviate the growing suicide epidemic.

The We Matter Campaign, an initiative by brother-sister duo Kelvin and Tunchai Redvers, began in October 2016. The campaign consists of videos from members of the indigenous community sharing personal stories of survival and hope. The Redvers’ website hosts a variety of work from indigenous youth—visual art and poetry, in addition to the videos, which are the main focus. Individuals with diverse experiences have shared their stories, from high school students, to residential school survivors, to members of parliament.

One especially moving story comes from comedian Don Burnstick, who discloses:

“I ended up on a chair with a rope around my neck, and I was going to hang myself. …I imagine if I would have done that, I would have ended up another statistic; a cross on the ground in my res. None of this life would have happened for me. I was very grateful that I got off that chair, took the rope off and looked at suicide and said ‘I’m not going to do it. I don’t care how much pain I’m in. I’m not going to do it. You’re not going to get me.’”

By hosting a multi-media campaign on platforms like Facebook and Twitter, as well as their own website, the Redvers harness technology and social media to reach otherwise isolated populations.

Kelvin and Tunchai Redvers spoke to the Trauma and Mental Health Report about their initiative. When asked how it started, Kelvin emphasizes the role of the internet:

“It seemed like something so simple, yet we hadn’t seen anyone do it yet. 3AM is when life seems so bleak and you feel most alone. Since our campaign is online and available at all hours, it could really help during those dark moments.”

Tunchai further highlights the important role technology plays in their approach:

“Our campaign is online, and it lives online—to all remote corners, to those who might not reach out for help. It’s less overwhelming that way, less intimidating.”

Researchers, too, are harnessing the power of technology to help indigenous youth populations. Sally Merry and colleagues at Auckland University have developed a video game called SPARX (Smart, Positive, Active, Realistic, X-Factor thoughts). Referred to as the first “scientifically-proven ‘gamified’ online therapy for depressed people,”SPARX is a fantasy role-playing game designed to teach coping skills based on the principles of cognitive behavioural therapy. SPARX teaches five behaviours to help young people address stress or depression: problem solving; being active; dealing with negative thoughts; improving social skills; and learning relaxation techniques.

Anecdotal findings of SPARX in Auckland show that adolescents using it report feeling happy that their peers don’t know they are depressed, and that they can deal with their mental health concerns on their own. That same study found youth reporting decreased feelings of hopelessness and better emotion regulation. One user explains:

“It gives you the courage to sort out your problems, face your problems, and may even enable you to take another step and talk to someone.”

SPARX has been used to treat depressed youth in a variety of cultural contexts, including indigenous youth. After successful results with the New Zealand Māori population, the approach is being tried in Canada. Given that individuals of the Inuit community in Nunavut are 11 times more likely than the national average to commit suicide, researchers from York University are working to adapt SPARX for the Inuit context (SPARX-N).

This technology is enabling new routes to helping marginalized, indigenous populations that live in inaccessible areas. Although tangible outcomes remain to be seen, technology-based solutions offer hope toward helping heal a long history of trauma. Above all, the founders of the We Matter Campaign emphasize the strength and resilience of indigenous communities. Tunchai says:

“There are a lot of issues out there, but also so much creativity, love, and hope.”

–Fernanda de la Mora, 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

fd-_-article-1-_-feature-1-470x260-1.jpg

Online Programs Confront Suicide in Indigenous Communities

00Depression, Featured news, Health, Resilience, Suicide, Therapy December, 17

Source: Nicole Mason at unsplash, Creative Commons

In 2016, a wave of suicides occurred in Canada’s indigenous populations. Communities in northern Saskatchewan, in particular, witnessed several youth suicides. In October of that year, five girls between 10 and 14 died by suicide in the span of a few weeks. The situation intensified when news broke later that month that a 13-year-old girl was the latest to take her life: a total of six young girls in the province.

Indigenous communities have a long and painful history of mental health issues. Persistent poverty, discrimination, and systemic racism have been cited as key factors in the growing mental health crisis these people face today. Indigenous communities are found in remote, less populated areas, making it difficult for them to get adequate care.

Suicide is the leading cause of death for indigenous peoples—indigenous youth being an acutely vulnerable population. Unsurprisingly, there has been a public outcry for intervention. To reach these remote areas, both activists and researchers are turning to technology to alleviate the growing suicide epidemic.

The We Matter Campaign, an initiative by brother-sister duo Kelvin and Tunchai Redvers, began in October 2016. The campaign consists of videos from members of the indigenous community sharing personal stories of survival and hope. The Redvers’ website hosts a variety of work from indigenous youth—visual art and poetry, in addition to the videos, which are the main focus. Individuals with diverse experiences have shared their stories, from high school students to residential school survivors to members of parliament.

One especially moving story comes from comedian Don Burnstick, who discloses:

“I ended up on a chair with a rope around my neck, and I was going to hang myself. …I imagine if I would have done that, I would have ended up another statistic; a cross on the ground in my res. None of this life would have happened for me. I was very grateful that I got off that chair, took the rope off and looked at suicide and said ‘I’m not going to do it. I don’t care how much pain I’m in. I’m not going to do it. You’re not going to get me.’”

By hosting a multi-media campaign on platforms like Facebook and Twitter, as well as their own website, the Redvers harness technology and social media to reach otherwise isolated populations.

Kelvin and Tunchai Redvers spoke to the Trauma and Mental Health Report about their initiative. When asked how it started, Kelvin emphasizes the role of the internet: “It seemed like something so simple, yet we hadn’t seen anyone do it yet… 3 a.m. is when life seems so bleak and you feel most alone. Since our campaign is online and available at all hours, it could really help during those dark moments.”

Tunchai further highlights the important role technology plays in their approach: “Our campaign is online, and it lives online—to all remote corners, to those who might not reach out for help. It’s less overwhelming that way, less intimidating.”

Researchers, too, are harnessing the power of technology to help indigenous youth populations. Sally Merry and colleagues at Auckland University have developed a video game called SPARX (Smart, Positive, Active, Realistic, X-Factor thoughts). SPARX is a fantasy role-playing game designed to teach coping skills based on the principles of cognitive behavioural therapy. SPARX teaches five behaviours to help young people address stress or depression: problem solving; being active; dealing with negative thoughts; improving social skills; and learning relaxation techniques.

Anecdotal findings in Auckland show that adolescents using SPARX report feeling happy that their peers don’t know they are depressed, and that they can deal with their mental health concerns on their own. That same study found youth reporting decreased feelings of hopelessness and better emotion regulation. One user explains, “It gives you the courage to sort out your problems, face your problems, and may even enable you to take another step and talk to someone.”

SPARX has been used to treat depressed youth in a variety of cultural contexts, including indigenous youth. After successful results with the New Zealand Māori population, the approach is being tried in Canada. Given that individuals of the Inuit community in Nunavut are 11 times more likely than the national average to commit suicide, researchers from York University are working to adapt SPARX for the Inuit context (SPARX-N).

This technology is enabling new routes to helping marginalized, indigenous populations that live in inaccessible areas. Although tangible outcomes remain to be seen, technology-based solutions offer hope toward helping heal a long history of trauma. Above all, the founders of the We Matter Campaign emphasize the strength and resilience of indigenous communities. Tunchai says: “There are a lot of issues out there, but also so much creativity, love, and hope.”

–Fernanda de la Mora, 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