Sunday, September 27, 2009

Drugs or Time?

Mental illness is an issue that hits close to home for me. My mother is bi-polar. My son, ex-husband, and son-in-law all show signs of schizophrenia. I've seen the devastation of these diseases up close and personal. We depend on our minds to self-assess our condition; to let us know when we are not well. Mental illness strips us of even this basic freedom and family, friends, or the state must intervene. In a delusional state, the mentally ill may blame family members for the indignity of forced care. The only comfort I get is to see them recovered, back home, and able to smile again.

Don't get me wrong; psychiactric medications have changed the face of care for the mentally ill. Gone (or nearly gone) are the ice baths, restraints, incarceration, and shock treatments. The attached article provides an extensive list of past treatments. I don't buy in to this author's assertion that true cure is blocked by the drug companies. We use drugs because they are the best solution yet available. We also still have short term incarceration when a person is so far gone they are a danger to themselves or others. And a very few are too dangerous to ever have in the population at large. But for the most part, these medications help people live out in the community and relatively independent lives.

I've often wondered, however, in the aggressive pursuit of lower costs, or by simple ignorance or neglect, if we do the mentally ill a disservice by characterizing their disease as only a drug problem. Bipolar Disorder responds beautifully to medication. There's a specific deficit in the brain, and medication replaces it. Schizophrenia, however, does not respond as well. All the medications do right now is to keep the worst symptoms in check. I suspect that Schizophrenia is really a bundle of brain flaws all of which present similar symptoms (delusions, paranoia) if left unmanaged long enough. Even my bipolar mother presented delusions and paranoia when she was very far gone.

From "The economic burden of mental health problems in Canada": By Stephens T, Joubert N.

"This study provides a comprehensive estimate of the economic burden of mental health problems in Canada in 1998. In particular, it estimates the cost of non-medical services that have not been previously published and the value of short-term disability associated with mental health problems that were previously underestimated according to the definitions used here. The costs of consultations with psychologists and social workers not covered by public health insurance was $278 million, while the value of reduced productivity associated with depression and distress over the short term was $6 billion. Several data limitations suggest that these are underestimates. The estimated total burden of $14.4 billion places mental health problems among the costliest conditions in Canada."

There are precious few classes and counselling sessions freely available to the mentally ill. There are clubs and group sessions. My son visits his support worker as often as once a week. But those sessions are primarily a check-in, to monitor if my son is better or worse. There's a wonderful program at Ponoka that helps people with combined mental health and drug issues. But it lasts only six weeks. Follow-up is minimal.

WHO Optimal Mix for Mental Health Care
Here in Canada, the burden of care falls on the family doctor, who spends up to half their time taking care of mentally ill patients. I suspect most are patients suffering from various depressive disorders. Why? Because psychiactric counselling is not fully covered by our health care system. Drugs are.

Mental illness in itself is a socially isolating disease. Treating the illness with drugs alone does not resolve the isolation. Some of my family members carry the burden of their illness, fears and anxieties unresolved, weighted down. My psychologist friend describes a day in the life of a person in depression as wading through jell-o. The effort to dress, to go to the store, to walk down the hall, takes all they have. Imagine for the schizophrenic getting through a normal conversation while ignoring the dozen other conversations or so competing in his head.

It seems to me that it could be possible that many mentally ill could experience greater empowerment over their disease, and less medication. The mentally ill might be coached through new coping techniques that would help them reduce their dependence on medication.

There's Cognitive Behavioral Therapy, for instance, that takes less time than the old psychotherapy. Greater community supports are needed as well, and supports for the families with mentally ill members.

The World Health Organization recognizes the need for better care for the mentally ill. Governments across the world need to see mental health as a vital component of primary health care. We need to change policy and practice. Only then can we get the essential mental health services to the tens of millions in need”, said Dr Margaret Chan, Director-General of the World Health Organization.

The world health report 2001 - Mental Health: New Understanding, New Hope

I'll stop now. My researcher's gene has been activated and I'm having trouble putting this article to bed. To answer the title of this blog, I think we need drugs and time...much more time. We need to think about and talk about these issues openly. We need to be there for family members who are mentally ill. Help them out of the confusing maze of their illness. Help them find greater fulfillment and happiness from living.