TagGoldbloom

Reading of the Week: Rahael Gupta on Medical Students & Depression (& her Depression)

From the Editor

Once—and I have never shared this before—I stepped into the street on my walk home from the library. I knew that the bus hurtling through the night would not have time to stop before colliding with my darkly dressed frame, fracturing my bones and scattering my belongings. I imagined my head hitting the asphalt and my brain banging around inside of my skull, bruising irreparably with each impact. I imagined the bus driver’s horror as he turned off the ignition with shaking hands and leapt out of the vehicle to locate my body. It would be a catastrophe that the trauma surgeons could not salvage. I would die.

Rahael Gupta is many things. She’s a graduate of Stanford University, and also Columbia. She’s a medical student. She’s a self-described optimistic. She’s a marathon runner.

And she’s a person who has struggled with depression.

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In this week’s Reading, we consider her essay in JAMA. It’s moving and clever and important.

DG

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Reading of the Week: David Goldbloom on Research & Clinical Practice

 From a Contributing Editor, Colleague, and Friend of the Editor

This week’s selection is a brief paper with long implications. For all of us clinicians who turn to the peer-reviewed literature (either directly or through the filter of Reading of The Week) for guidance on how to help our patients, this paper is worth a read.

It is impossible to stay current on the treatment research results that emerge daily, and we look to those randomized controlled trials published in high-impact peer-reviewed journals for evidence of what works for people with the diagnoses that we find ourselves addressing in the office, the clinic, the ER or the inpatient unit. But who are those patients who sign consent forms to take part in these studies, and how much do they resemble the people sitting across from us?

Great clipboard but relevant to clinical work? 

– David Goldbloom, OC, MD, FRCP(C)
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Our Globe Essay: “For better mental-health care in Canada, look to Britain”

It may be the biggest change to mental-health-care services in five decades. Earlier this month, Quebec Minister of Health Gaétan Barrette announced that his province would publicly fund psychotherapy for people with depression and anxiety provided by psychologists, nurses and social workers. Ontario made a similar, if smaller, promise earlier this year and other provinces are considering similar initiatives. But how can we turn these big promises into big help for the hundreds of thousands of Canadians who could benefit? Two words of advice: go British.

So begins my new op ed, co-written with CAMH’s David Goldbloom, from Monday’s Globe and Mail.

The full piece can be found here:

https://www.theglobeandmail.com/opinion/for-better-mental-health-care-in-canada-look-to-britain/article37358415/

Canadian Journal of Psychiatry: “Telepsychiatry 2.0”

‘Closed-circuit television has been introduced into the field of mental hygiene as a medium for the administration of therapy to a mass audience. The present evidence indicates that that the use of this type of television may promote the development of new and more effective methods for the treatment of the mentally ill.’ This hopeful statement appeared at the beginning of a 1957 peer-reviewed paper. Four years later, the potential of telepsychiatry ‘as a means of extending mental health services to areas that are remote from psychiatric centers’ was described. Six decades later, where are we?

So begins an editorial in the current issue of The Canadian Journal of Psychiatry.  I’ve co-authored the paper; Dr. David Goldbloom is the first author.

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Drawing on the Serhal et al. paper on telepsychiatry in Ontario, we consider the current state:

Consider: of the more than 48,000 people in need of psychiatric care (defined by the authors as psychiatric or primary care within a year after a psychiatric hospitalisation), fewer than 1% saw a psychiatrist through telepsychiatry—and 39% saw no psychiatrist. We note the marked contrast with the United States, where telepsychiatry has been rapidly growing.

And we consider how to move forward. We propose a four-point plan, including “a province-wide strategy that has defined clinical priorities, geographic rationales, and measured outcomes.”

You can find our editorial here:

http://journals.sagepub.com/doi/full/10.1177/0706743717714469

Note: open access.

Reading of the Week: Physician, Heal Thyself? The Gold et al. Study on Docs and Disclosure (and Mental Illness)

From the Editor

If you had depression, would you tell people?

This week’s Reading is a paper from General Hospital Psychiatry that considers just this question. In it, the authors surveyed American female physicians, asking about mental disorders and why they would or wouldn’t choose to get help – and to tell people.

Would you share your mental health history?

This paper is paired with an essay written by Dr. Nathaniel P. Morris, a Stanford resident of psychiatry, who mulls mental illness and disclosure – and has a big disclosure of his own.

DG Continue reading

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: Remembering Dr. Elliot Goldner

From the Editor

I met him just once. Dr. Elliot Goldner was invited to give the Distinguished Member Lecture at the Canadian Psychiatric Association’s 2015 Annual Conference in Vancouver. Before a packed room, he gave a lucid speech on the state of the system – a speech peppered with insights and statistics, drawn from numerous papers; it was mesmerizing. After, he stayed to talk with people, and I joined the group that had gathered. Late for my own presentation, I received angry texts from my co-presenter. I couldn’t resist the opportunity to talk further about the access issues that he had so clearly discussed.

But if we met just once, over the years, I have read many of the papers that Dr. Goldner wrote and co-wrote. A Goldner paper – like a Goldner presentation – is impressive and memorable.

Dr. Goldner died in late November.

Dr. Elliot Goldner

In this Reading, we look at his life and career through the comments of some colleagues. We also consider his 2011 Canadian Journal of Psychiatry paper on access and psychiatry.

DG Continue reading

Reading of the Week: Guest Contribution – Dr. David Goldbloom on Locked Doors and Hospitalizations

From a Contributing Editor, Colleague and Friend of the Editor

This week’s reading is a provocative companion piece to the recent review of efforts to reduce involuntary admission to hospital. It is the environmental expression of the legal deprivation of freedom of movement: the locked door. Locked doors have a powerful symbolic meaning in psychiatry; outpatients coming for elective consultations sometimes tell me they are afraid if they “say the wrong thing” that I will “lock them up”. Asylum superintendents carried large rings of keys that embodied power and control.

Locked doors, better outcomes?

Having spent half my career working on inpatient units, I am, like almost all of you, familiar with the locked doors that distinguish our wards from all others found in a hospital. And I know the reasons for their justification: prevention of elopement by people at risk of harm to themselves and others. And that prevention is intended to serve not only the patient and family but also the clinicians and the institution in terms of risk management. And yet…people do elope. Sometimes they return and sometimes they do not. Sometimes they attempt or complete suicide and sometimes they do not.

There is, as always, a tension between safety and risk, between freedom and protection, between autonomy and control. Locks are ubiquitous but not universal on psychiatric wards. What do we know about whether they make a difference? And what would be the ethically acceptable methodology for determining it?

– David Goldbloom, OC, MD, FRCP(C) 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

Reading of the Week: Doing Things Differently – Clozapine and More

From the Editor

“When a Cape Breton cousin of mine was hospitalized at the main asylum for Nova Scotia in the 1940s with psychotic symptoms, his sister told me the family received a phone call from the treating physician telling them to give up all hope for their brother’s future.”

In his new book written with Dr. Pier Bryden, Dr. David Goldbloom – past Chair of the Mental Health Commission of Canada and Senior Medical Advisor of the Centre for Addiction and Mental Health – recalls the story.

Psychiatry is so much better today.

But there is room for much improvement. Uneven outcomes. Provider-focused care. Can we do things differently?

New approach, better results?

This week, we look at a blog published by HealthAffairs.org, considering the use of clozapine for people with schizophrenia. Dr. Adam Rose, drawing on the research, including his own research, wonders why we don’t use more of this effective treatment.

Then, turning to The Globe and Mail, we look at the life and death of Dr. Kate Granger – a physician who has challenged us health care providers to be more compassionate.

DG Continue reading