Tagde Jong

Reading of the Week: The Best of 2016 (and a Look Ahead to 2017)

From the Editor

It’s a Reading of the Week tradition that we end the year by considering the best of the previous 12 months.

And this year we have had great material to consider. Readings were drawn from diverse publications, including journals, but also newspapers and magazines; one Reading was a speech given by the Prime Minister of the United Kingdom. (On the rich diversity of material, I made a similar comment last year.)

If once no one seemed to discuss mental illness, today these issues are being talked about.

But instead of just looking back, let’s take a moment to look ahead.

For those of us concerned about mental health services, 2017 looks like it will be a great year.

Consider:

· Though the provinces and the federal government failed to make an historic deal in 2016 that would invest in mental health services, federal and provincial ministers of health all agree that mental health needs to be a priority, and some type of deal is likely to happen.

· In 2016, Starbucks Canada made headlines for its investment in mental health benefits for employees; it’s highly likely that other companies will follow this lead in the coming months.

· In the past year, more people spoke out about their mental health problems, including a famous singer and an Olympic swimmer; in 2017, more people will find their voice and share their stories.

So – Happy New Year.

Thanks to all those who made suggestions for Readings. And thanks to Dr. David Goldbloom for his three guest contributions, as well as to my father and to my wife for their editing.

There will be no Reading next week.

DG Continue reading

Reading of the Week: Guest Contribution – Dr. David Goldbloom on Involuntary Hospitalizations

From a Contributing Editor, Colleague and Friend of the Editor

All of us psychiatrists have exercised our responsibility for the involuntary admission of patients. Some patients (and many families) have expressed gratitude for this temporary but fundamental abrogation of civil freedoms – the freedom of movement – but for many patients it may be a source of fear and of loss of control and autonomy (even though the illnesses that they are experiencing also undermine control and autonomy). It may also reflect an upstream failure of less intrusive and earlier interventions to treat mental illness.

Involuntary admission: is there an alternative?

In an era of being patient-centred and recovery-focused, is a reduction in rates of involuntary hospitalization desirable? If you’re a human rights lawyer, the answer may be “well, yes, obviously”. If you’re a clinician, the answer may be “that depends on whether the patient ends up better or worse”. Nevertheless, there are a number of clinical initiatives in place whose goal would be to reduce the frequency of involuntary hospitalization (which does not preclude an increase in the rate of voluntary hospitalization).

So along comes a careful systematic review and meta-analysis of randomized trials to examine four categories of intervention that have, as their explicit primary or secondary outcome, a reduction in the rates of involuntary admission to psychiatric inpatient units. The interventions will seem familiar to any reader who has been involved in the care of people with severe and persistent mental illness. But the results are surprising.

– David Goldbloom, OC, MD, FRCP(C) Continue reading