40 is Too Young to Die

Here is an electronic version of a new report that was officially launched yesterday. The report was developed by the Early Onset Illness and Mortality Working Group, partly in response to the alarming number of  premature deaths we have experienced here at Houselink.

Please share this document far and wide with your networks.

The good news is that the Toronto Central LHIN has recognized this issue as a funding priority  a year from now, and  the working  group work will continue to organize a think tank in the New Year. The report can also be found on Houselink’s website under Programs and Services, at www.houselink.on.ca

To download this article, please click here.

Table of Contents:

1. The Perfect Storm
2. The Hurdles to a Long and Healthy Life
Hurdle 1: No Money, Bad Food, No Exercise, No Information
Hurdle 2: “Our Meds Make Us Sick”
Hurdle 3: Seeking Help
Hurdle 4: The Doctor’s Visit
Hurdle 5: The Emergeny Room Experience
Hurdle 6: The Hospital and Discharge Experience
3. The Way Forward
4 Being Part of the Solution


Do Mental Health Patients Fall Through the Cracks?

The Canadian Mental Health Association says 20% of Canadians will experience a mental health illness at least once in their lifetime.  Eight percent of Canadians will have major depression.  When necessary, we hope that patients with depression and other psychiatric illnesses receive good care while they’re hospitalized. However, according to a new study, once they’re discharged from hospital, it’s a different story.

Researchers at the Centre for Addiction and Mental Health looked at more than 13,000 Ontario patients who were admitted to hospital for treatment of depression and then discharged from hospital when they no longer needed to be admitted.  Within 30 days of discharge, one in four patients hospitalized for depression had either visited an ER or was readmitted to hospital for depression.

The study found that men, older patients, and those who live in rural communities (where there’s a chronic lack of mental health services) were more likely to need readmission to hospital or treatment in the ER.

More important, it turns out that the overwhelming majority of the patients who required further treatment in the ER or hospital readmission were those who did not receive appropriate follow up care from a mental health professional or family doctor.

You might be amazed just how many patients with depression do not get follow up care.  Of the 13,000 patients studied by researchers at the Centre for Addiction and Mental Health, nearly 5,000 did not receive appropriate follow up care with a family doctor, psychiatrist or community worker.

For context, the researchers also looked at patients from Ontario who had been hospitalized for a heart attack or heart failure.  The study found that 99% – in other words, virtually every patient with heart attack or heart failure – had a follow-up visit to a doctor within 30 days of leaving the hospital. That compares to just 62% of the patients admitted with depression.  That tells me there’s a yawning gap in the care received by mental health patients.

It’s a gap I see in the ER.  Just about every shift, I see patients recently discharged from hospital for depression who need to be readmitted.  As well, I see lots of patients with other mental health diseases who also tend to fall through the cracks.  In particular, patients with borderline personality disorder tend to go through phases when they’re in and out of hospital.  I would also put people who have both depression and alcohol and drug abuse in that category too.  Patients who are both homeless and have mental health issues are also at high risk of needed to be readmitted.  So too are patients with schizophrenia and other forms of psychosis.

The mental health patients I see from the vantage point of a big city teaching hospital have a fair number of outpatient community resources that can provide some level of after care.  Patients with mental health problems who are discharged from rural hospitals have it much worse.

Hospital readmission is not simply the price of doing business.  It’s a benchmark of failure that is expensive for a health care system trying to save its pennies.  It’s also quite deleterious to the health and wellbeing of patients.

The take home message is that hospitals, family doctors and others who provide community health services need to communicate better with one another so that community services can step in the moment a patient is discharged.  Electronic health records would help with that.

More than that, a generation ago, when ‘deinstitutionalization’ of psychiatric services was in vogue, mental health treatment was supposed to move from hospitals to the community.  Beds were closed.  Community mental health services were supposed to be built up, but in many cases, they weren’t.  Some have suggested that deinstitutionalization has been a failure.  And now, we’re paying the price.

I say it’s time for governments to pony up with increased services and better coordination of available resources – especially in rural and other underserviced areas.  Meanwhile, mental health patients need to be watched carefully in the hours and days following discharge because that’s when they’re at high risk of relapse and suicide attempts.

And, while we’re at it, how about putting a bit of accountability into psychiatric hospitals that discharge patients without adequate follow up?  It would be easy to track and penalize hospitals with high readmission rates.  In the ER, I have to see and take care of patients within a prescribed period of time or we get penalized.  The people who work in psychiatric hospitals should be accountable too.

Original article can be found at CBC.ca

New guidelines on mental health are welcome

Please see original article at the Guelph Mercury

It took nine years of pleading, lobbying and negotiating. But the breakthrough finally came. This week the Ontario Association of Chiefs of Police unveiled provincewide guidelines on the disclosure of sensitive information about a person’s mental health.

Police information checks, routinely required by employers and voluntary agencies, will no longer include any reference to an incident involving mental health that did not result in criminal charges.

Since the millennium, thousands of Ontarians have lost jobs, promotions and chances to serve their community because of a past mental health crisis. A family member might have phoned 911 during a suicide attempt. A doctor might have called for a police escort to the hospital after an adverse drug reaction. An individual with a mental disorder might have sought help during an emergency.

It all ends up in the police data bank.

That was where it remained until 1999. Then the Ontario government decreed that all new teachers must undergo police checks. The directive was well-intentioned — no parent wants his or her child exposed to a pedophile or predator — but it was devastating for job applicants who had experienced an episode of mental illness.

Other organizations quickly followed the schools. Day-care centres, nursing and retirement homes, sports leagues, community agencies and some businesses began requiring police checks.

(These are not criminal record checks. They are police information checks that include all contact between an individual and the police, regardless of the reason.)

Alarm bells soon started ringing at the Ontario Psychiatric Patient Advocate Office. David Simpson, who headed the independent government agency at the time, remembers fielding calls from dozens of people who had learned, to their horror, that they had police records. They were being barred from jobs and voluntary positions because of illnesses that had been successfully treated.

“It can stop people dead in their tracks,” he said. “For those who are on the road to recovery, it can be a devastating setback.”

Simpson heard from students who were afraid of failing their courses because they couldn’t get a voluntary placement; public servants who dared not seek promotions because of what might turn up in their police record; parents who couldn’t coach their kids’ soccer teams; retirees who couldn’t give back to their community.

In 2002, Simpson contacted Keith Norton, who was then the province’s human rights commissioner. He agreed the practice of releasing police information indiscriminately was a problem and took it up with Bob Runciman, the public safety minister of the day. Runciman said the issue was beyond his control. The Ontario Association of Police Chiefs was responsible for the use and disclosure of information collected by its members.

Fortunately, Norton’s successor, Barbara Hall, was more insistent. She wrote to every police chief in the province pointing out that the practice of releasing information about a person’s mental health was “potentially discriminatory.”

A handful of police forces, including Toronto’s, responded. It developed a sophisticated risk assessment tool to determine whether to release information about a person’s mental health. But most local forces continued to red-flag individuals who posed no threat.

The Ontario Psychiatric Patient Advocate Office still gets daily calls from people who want to apply for a job or become a volunteer, but fear they’ll be stigmatized and rejected.

The new guidelines won’t solve everything. They’re not binding; each police force will set its own policies. Nor do they seal all mental health records. Organizations with vulnerable clients will still have access to relevant mental health information.

Most stakeholders, however, consider them a fair compromise.

It shouldn’t have taken this long to get the balance between privacy and public safety right.

But in the mental health sector, where no victory comes easily, this is a moment to celebrate.

Carol Goar writes for Record news services.

Free Ebook – Managing Severe Depression

This free ebook can be found here, at Chipmunka Publishing.



This book has been written out of the recent experience of two and a half years of severe depression. The author had herself been a social worker with counsellor training.

Depression is a serious illness or mental condition which crushes your capacity to help yourself.

The majority of self-help books, and even counselling itself, seem geared to mild or moderate depression. That is the kind of the depression which will respond to “think positive” ideas, a walk in the park, a talk with a friend.

Getting a reliable diagnosis is difficult. But a diagnosis is important. Treatments for mild depression don’t help if you have severe depression.

But the symptoms can be easily mis-read and the severity of a condition underestimated. It can then be a struggle to get the support you need.

In fact, the most important message might be to encourage you to believe that you will get through it in spite of everything. But you won’t believe that whilst you are in the firmest grip of the depression.

Severely depressed, it is as if you are in a parallel universe.

This kind of depression is not the result of any lack of ‘positive thinking’; it is not a failure to deal with the ups and downs of life, nor a depressive attitude towards life, as some have called it. It is not any kind of failure. No one is yet absolutely certain how it comes about – but a genetic predisposition and the trigger of overwhelming stress is a likely explanation.

Many caring, competent, intelligent and courageous people – have spent time, sometimes years, in their own private mental dungeon of depression. Those individuals who are insensitive, who think mainly about themselves and don’t really care much about others may be less likely to fall ill in this way!

Only those who have been severely depressed can really understand it. It includes at various times an overpowering sadness, desolation, intense anger, fear of other people, withdrawal, a hunted feeling, impatience, forgetfulness, self-neglect, a strong and persistent, automatic death wish, exhaustion and panic.

On the other hand, you may not feel or display any emotion at all with an almost catatonic immobility. Whatever the emotion, it is a desperately lonely state.

This book will help you to feel less alone, get to know yourself, suggest ideas to build resistance to depression and also to recognise and take notice of the warning signs.

About the Author

Jan Winster grew up in the North West. After graduating from University she worked as a social worker for a number of years, in child care and with young people.

Later, she began a new career teaching adults, coaching and freelance writing and She has also spent some time as a carer.

A series of losses and other trauma was followed by a depression which lasted for over two years.

The experience of seeking help lead Jan to take an interest in the issue of relieving and preventing a recurrence of this disorienting condition.

She has tried to discover “what works” with severe depression informed by her own experiences and those of others and also by extensive reading – testing out a range of ideas to discover what actually works.

Book Extract


Severe depression is thought to almost always be preceded by a loss of some kind – a grief. It may be a death or other kind of loss. This is the trigger. Grief is not thought to be the actual ‘cause’. This comes from a chemical imbalance which is described later.

Triggers can be the repeated onslaughts of distressing events, or a continuous chronic and stressful situation. Chronic situations can be as bad, or even worse, in their impact as a one-off trauma. It is when you have no means of escape and a feeling that whatever you do will make no difference that stress becomes overwhelming and prepares the way for depression.

It is remarkable that we risk our own survival like this. If you just happen to be downhill ski-ing and find you are going too fast, the solution is to throw yourself into a deliberate fall, to get out of the danger before it is too late…! Life’s pressures are a bit like that, too. Very often – whether through inertia, curiosity, exhaustion or fear we fail to say: “that’s it”, and jump ship before all of our strength has totally gone.

Of course, we don’t actually know what our limits are until it is too late.

We may have a genetic disposition to depression; or we may have been brought up in a certain way to serve other people’s needs before our own. It may be both.

The writer, Charlotte Wolfe, described the ‘sin’ of not being oneself. She feels this sin is due to ‘false attention and ingratiating behaviour’. In other words, we may be trying to please others and losing ourselves in the process.

We may lose sight of who we are, of our own being. In a sense, we allow our inner selves to die. Depression is the hollow, frightened shell which is left.

Being unable to love ourselves, we go out of ourselves to love and to be loved; we go out too much and too far, she says. There is nothing to come back to when we have to return to ourselves.

Certain people can become exhausted by giving, adjusting themselves to the needs of other people. And the emotionally needy will home in – with relief but no concern, or even acknowledgement – towards the giver.

This book helps you to get back into the driving seat of your own life.

Ontario takes a backward step on mental health

Original article can be found here.

Goar: Ontario takes a backward step on mental health
Published On Tue Jul 12 2011


By Carol Goar Editorial Board

Shortly after the provincial Legislature adjourned for the summer, the Ministry of Health began negotiating the hand-off of Ontario’s Psychiatric Patient Advocate Office, an independent provincial agency, to the Canadian Mental Health Association.

There was no public announcement. A memo was sent to “stakeholders” (employees of the agency and hospitals providing psychiatric care) from Assistant Deputy Minister Patricia Li. “I am writing to advise you of a change being planned that will improve the lives of people living with mental illness,” she said. “Integrating the Psychiatric Patient Advocate Office’s rights advice and advocacy services with the Canadian Mental Health Association’s community-based mental health services will result in a more coordinated, patient-centred continuum of care.”

The reaction from mental health activists was swift and negative.

The Psychiatric Patient Advocate Office was their watchdog, their voice, their first line of defence against being involuntarily drugged, restrained and subjected to excessive force by the police.

But their concern went deeper than that. By embedding the Psychiatric Patience Advocate Office in the Canadian Mental Health Association — the main provider of outpatient services for people with mental disorders — the province was creating a serious conflict of interest. How could a patients’ advocate criticize the organization to which it belonged? How could it speak out when it was part of the health-care delivery system?

The employees of the Psychiatric Patient Advocate Office are upset, too. They’ve been sending distress signals through their union.

Most Ontarians don’t know the Psychiatric Patient Advocate Office exists. But to people with mental disabilities and their families, it is as important as the Ontario Human Rights Commission or the provincial ombudsman.

It was created 28 years ago by former health minister Larry Grossman following a series of deaths at the Queen Street Mental Health Centre. The Star investigated and found prison-like conditions, involuntary drug treatment and unconsenting electroshock therapy in many of the province’s 10 psychiatric hospitals.

Grossman placed watchdogs in all 10 psychiatric hospitals and had them report to an arm’s-length government agency called the Psychiatric Patient Advocate Office.

Initially, the move was controversial. Hospital administrators regarded the patient advocates as spies and mental health activists weren’t sure whose side they were on.

But over time, the agency earned the respect of both sides. It won access to legal services for psychiatric patients, persuaded public authorities that police should not release information about an individual’s mental health without a risk assessment, ensured that individuals in psychiatric care received the social benefits to which they were entitled and spoke out on issues ranging from regulation of retirement homes to the stigma of mental illness.

Against all odds, the Psychiatric Patient Advocate Office survived 28 years of budget cuts, hospital closings and health-care reforms under six different governments.

It is ironic that it could now be felled — or downgraded into a branch of a charity — by a simple administrative procedure.

But it won’t happen without a fight. David Simpson, former director of the agency, has requested an urgent meeting with Health Minister Deb Matthews. Mental health advocates are organizing, blogging, reaching out and mobilizing. They have sent around an electronic petition and posted a position paper online.

It angers them that the province is doing this in midsummer when Queen’s Park is empty and Ontarians are not paying attention. It upsets them that there was no public consultation. And it worries them that the ministry is chipping away at the rights of one of the most vulnerable groups in society under the guise of “integrating” health services.

But their biggest concern is that the government is poised to walk away from its role as the guardian of Ontarians with mental disabilities.

Carol Goar’s column appears Monday, Wednesday and Friday.

Free E-Book – Stigma: Worse than Psychosis By Jason Tune

Free e-book available here, from Chipmunka.


Synonymously Jason has activated a dissent into the reduction of stigma regarding mental illness. His first book ‘Sex, Drugs and Northern Soul’ outlined his own recovery from his own demons and experiences as a ‘service user’ in the 1980’s. Jason’s second book ‘Stigma worse than the illness’, is an uplifting if not empowering story into the reduction of stigma into mental illness. No one is exempt from mental ill health vulnerabilities or immune to its susceptibilities. However Jason has become an advocate into ensuring the recovery model is perpetuated nationally, if not internationally to its maximum extent by his biography, presentation and networking.

About the Author

In Rotherham, Yorkshire, 45 years ago my son, Jason Tune, a healthy 10 lb baby was born. It was a normal birth without complications. I watched him grow from a happy boy into a bright teenager. As he was approaching his 16th birthday, his behaviour started to change dramatically and he became restless and withdrawn. After seeking medical advice, I was told he was suffering a mental breakdown. He spent quite a long time in an out of hospital. Despite all the trauma and stigma he encountered he never once gave up fighting to regain his identity. Through his self belief and determination he is now able to lead a normal meaningful life. So much so, that he is now employed by a NHS Mental Health Trust helping a ‘new generation’ with a similar disposition.

Patrick Tune

Book Extract

Stigma comes in many different forms and my first memory of it was back in 1969 at Kimberworth School Infants in Rotherham aged 4 going on 5 when I had squinty eyes and needed glasses, I was on free school meals and had to queue in a separate queue from the other kids. At this point in my life I obviously had little appreciation of the complexities of the emotions induced by rejection, but for the first time ever I became angry as a result of it and this anger was to be a driving force in my life for some years to come. The big kids, on the same road, who went to the comprehensive school were calling me “Clarence the crossed eyed lion”, “Bozz eyed bastard” and other derogative terms associated with my lazy eye. One day I looked over the infant school playground wall into the adjacent comprehensive school yard and promised myself that one day I’m going to be the biggest, toughest guy there and nobody is ever going to bully me again.

As I wrote in my first book that when I went to jumble sales with my Grandma, whom I loved dearly and who left me with memories that I would not sacrifice for all the tea in China, I was often seen by older kids who verbally expressed their depreciation of my attire. I preferred to run these evening sorties during winter for the protection of the cover of darkness. However, the love of my Gran outweighed the pain of my ignorant persecutors. Although there wasn’t much money around at that time in my neck of the woods I was fetched up with a word called “respect” and amongst my peers respect was paramount.

Throughout my primary school days I started going to Sunday school, the Salvation Army and Pentecostal Church, although I wasn’t sure about all the things I was being taught in these places I learned enough respect and decent values to feel I had gained something that outweighed the labelling of “Bible basher” and other such derision directed at me by my peers. Nobody likes to be shown up but I recall as a child in the mid seventies being publicly denounced in the swimming baths upon being caught trying to smuggle my verruca into the water. It was always better if one had the chance to share their verrucca with other children as the blame would be diluted and one would not stand alone “a problem shared being a problem halved” and all that.

One memory of my childhood concerns parents not allowing their children to mix because of their backgrounds. A particular painful instance of where I fell foul of this concerned a young lady who had captivated my heart in the last year of primary school yet it could not be due to the non-acceptance of her higher socioeconomic status family who did not approve of the families on my estate. We were disempowered from being able to make our own decisions, the consequences not quite leading to the tragedy of Romeo and Juliet but none-the-less people underestimate the pain that young hearts can feel.

Into my comprehensive school days, I hadn’t realised I had been marked with a reputation that went before me and I feel this reputation did not truly represent who I was. I was the young guy that helped the elderly cross the road, helped his family for love rather than reward, wished to succeed at schoolwork and even did bits of charity work. My misleading reputation and false friends, that clung to me because they enjoyed trouble, brought stigma upon me. I ran into this trap through simply trying to survive.

Book Recommendation


Sidetracked by Schizophrenia
A Mother and Son’s Struggles and Victories

In Sidetracked by Schizophrenia, Charlotte documents her son’s encounters with the many medications and difficult life situations that come as part of living with this disease. It covers the trials and errors, the failures, the partial successes, the side effects, the exciting movement toward more and more effective treatments, and the hope for living a normal life medication free. The book speaks to family members who are, or have been there and to professionals who are called on to make judgments about what regimen may be most effective for their patients. It encourages the reader to keep an open mind about the body’s capacity to heal itself when given the right balance.