Mental Health

According to The Free Dictionary, mental illness is defined as, “Any of various psychiatric conditions, usually characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by physiological or psychosocial factors “(The Free Dictionary, 2007). Mental illness can certainly be a physical illness, but is not as easily diagnosed like a disease such as diabetes. In a disease like diabetes, physicians can run tests to look for certain indicators of the disease in the blood like the levels of blood glucose and hemoglobin A1C.

Sometimes physical conditions can cause mental illnesses. Unlike diseases like diabetes, mental health diagnoses’ often rely more on the patient relaying their symptoms to their physician or health care provider. This could not be as accurate because the patient may be unable to distinguish all of their symptoms or they may not think to tell the health care provider every symptom that they are suffering. According to John Grohol PsyD, “Treating mental illness rarely results in a “cure,” per se.

What it does result in is a person feeling better, getting better, and eventually no longer needing treatment (in most cases). But even then, rarely will a professional say, “Yes, you’re cured of your depression. ””(Grohol PsyD, 2009). The deinstitutionalization of the mentally ill began with the introduction of the use of psychotropic drugs for mental health treatment in the 1950’s. It was embraced as a way of saving money because the patients would be able to be treated on an outpatient basis and in theory also be able to function in the world while on medications.

This has not been as successful of a plan as originally intended. Crystal Riberio makes this point by stating, “The programs thought to replace care given in institutions were not nearly adequate. These programs, attempts to place the mentally ill back in society to be helped by the community members, day programs, and medications were not fully implemented to the full extent needed to replace institutions. This process led to an overwhelming number of mentally ill loose in society, becoming criminals due to lack of treatment” (Riberio, 2006).

It is important to acknowledge that mental health services are often administered by a patient’s primary care physician. The patient may make tell their primary physician about problems that they are suffering from in order to seek help there first. The primary physician can prescribe anti-depressants for a patient that is suffering from anxiety or depression. They can also run tests to make sure a problem is not organic in nature versus purely mental. If mental health and physical health care are kept separate, a physician could miss a medical diagnoses that could be causing a mental problem.

Some of the services that could be needed for the mentally ill are safe places for them to stay that will help protect mentally ill people from themselves if they are that unstable. There is also a need for therapy to help patients learn about their illnesses and how to cope with it. Managed Healthcare poses more challenges to the treatment of mental illness because they often impose more hoops to jump through in order for the patient to get approved coverage.

Managed care organizations reduce health care costs of mental health treatments by imposing limits on the amount of care a person can receive. They may also cover the treatments at a lower percentage, making the patient liable for a larger portion of the cost of care. In order to determine what kind of facility a mentally ill person should go to, one would have to be evaluated by a mental health professional. If the person is a danger to themselves or others, it would probably be best to have them admitted to a psychiatric hospital.

If they are simply depressed, they may be able to be treated with medicine and therapy. ? References The Free Dictionary . (2007). Medical Dictionary. Retrieved from http://medical-dictionary. thefreedictionary. com/mental+illness Grohol PsyD, J. M. (2009). Psych Central. Pysch Central. Retrieved from http://psychcentral. com/blog/archives/2009/05/22/how-do-you-cure-mental-illness/ Riberio, C. (2006). Deinstitutionalization of the Mentally Ill. Associated Content. Retrieved from http://www. associatedcontent. com/article/47201/deinstitutionalization_of_the_mentally_pg2. html? cat=17

The aim of this assignment is to citically examine the medical model in relation to a client that I am working with, for reasons of confidentiality I have used a pseudo name: The medical perspectives in Mental Health. Background Alan is a 42 yr old white british male, he was diagnosed with schitzophrenia at the age of 21yrs. He is the eldest of two children, his sister resides with her husband and children nearby. Alan resides at home with his parents, who are in their early seventies. Alan has always complied with medication, and agreed to hospitalization when necessary, compulsory admission has not been required. Scitzophrenia is a devastating mental illneess, and probably the most distressing and disabling of the severe mental disorders. The first signs of schizophrenia typically emerge in adolescence or young adult. The effects of the illness are confusing and often shocking to families and friends. ” http://www. psychiatry24x7. com. schizophrenia retreived 19/01/06. Alan is seen by his psychiatrist, every six months, unless he is unwell, when he will be seen more frequently. He is reviewed through the Care program approach at hospital out-patients.

His key worker is a community psychiatric nurse, (CPN). The psychiatrist plays a central role in the diagnosis of a mental disorder. Diagnosis is made after a mental health examination. The role of the psychiatrist in the mental state examination serves two purposes: “A detailed history is taken to identify change and characteristic clusters indicative of a specific psychiatric disorder. Secondly the psychiatrist has to make a comparison of change against a diagnostic criteria to establish presence or not of a specific psychiatric disorder. ” (Holland, 2003, p. 938) After illiminating organic cause, by physical examination, the psychiatrist makes a diagnosis by classification of the symptoms. In todays psychiatry there are two systems used to more reliably identify a mental disorder. The International Classification of Disease, 10th revision, (ICD10), and the American Classification Diagnostic and Statistical Manual, 4th revision, (DSMIV). European psychiatry are guided by the former. The ICD10 catogarises schizophrenia under, F. 20. using the description of Kurt Schieder’s first rank symptoms, (1959).

These are ranked as A – D, other symptoms E-I have also been added. (p. 49, ICD10, WHO 1992,). For a diagnosis of Schitzophrenia the person must show at least one of the first rank symptoms A- D and at least two of the symptoms, E- I. Alan experiences; – Thought withdrawal, insertion and broadcasting, he beleives that someone or something is responsible for this. (First Rank symptom A). – Auditory Hallucinations, he hears a running commentary about him. (First Rank symptom C). These are also known as the positive symptoms of schitzophrenia.

Alan also experiences more than two of the symptoms E –I, he has thought disorder, anxiety,depression and poor motivation, referred to as negative symptoms. (Kingdom, cited Bailey, 2000) The ICD10, goes on to provide subsections for types of schizophrena, and notes; not everyone agrees with the sub-sections, due to the overlapping symptoms that can be present from one type to another. According to Alan’s medical notes and on asking him, he does not appear to have been diagnosed with a specific type of schizophrenia. Given the clusters of symptoms that e has experienced, at various times, it would be difficult to place Alan into one of the sub- sections. The medical model excepts that the schizoprenic brain has increased ventricles, (spaces in the brain), which leads to an imbalance of chemicals in the brain. Using their main tool pshycopharmoglogy, they prescribe drugs to correct this imbalance. (Leonard,2003). The pathology of the illness considers that the chemical which is imbalanced is dopamine. Drugs used to treat mental disorders are known as; neoroleptics or psychotropics, they target the chemical dopamine by blocking the neuroreceptors.

The drugs effect behaviour, psychological cognitive function and/or the sensory experience. They also effect other neurotransmitters in the brain, such as serotonan, a chemical associated with affective disorders, therefore, the same drugs are used to treat different diagnosises. (Barry,2002). Alan has been prescribed various psychotropic drugs to try and control the positive and negative symptoms of schizophrenia. His medical notes demonstrate that drugs have been introduced, decreased and increased on a number of occassions, with little effect of relieving the symptoms substancially over a long period of time.

Over the years in psychiatry drugs have evolved, Alan has been prescribed some of the older drugs, Chlorpromazine and Haloperidol, these are referred to as ‘typical’drugs. These drugs cause side-effects such as; pseudoparkinsonism, (uncontrolable shaking of limbs), and Akathisia, (an uncomfortable internal restlessness and anxiety). (Barry 2002). Further medication was prescribed to combat these side- effects. Following this Alan’s psychiatrist changed his medication to the newer ‘atypical’drugs olanzipane and risperidone.

Alan did not respond to this medication and after a deteration in his mental health he was admitted to hospital and agreed to try another ‘atypical drug’clozaril thearapy. Given the toxicity of clozaril it is not used as freely as other psychtropic medication. A complication of clozaril is the effect that it has on the white blood cells, if the deficiency becomes to great the drug can kill. (Barry 2002). To reduce the possibility of this the white cells are monitered through regular blood testing.

The outcome of the long term effect of these drugs is not yet fully known. (Barry, 2002). Psychiatry does not go without critisim, Szass, (1997), best known as an anti – psychiatrist, challenges the concept of mental health as an illness. For an illness to be an illness it has to be classified as having three commonalities, cause – progression – and outcome. He argues that schizophrenia does not share any commonality, and that the reason a scitzophrenic patient becomes a patient is because those around him refuses to except a behaviour beyond the norm.

Laing, (1985), also supports this theory and informs the reader that psychiatry is the only medical model that does not have an exact pathology that is proven by labortory testing. Another school of thought suggests; individuals are treated for the side-effects of medication moreso than the original illness, (Illich, cited in Laing 1985). “They can end up fighting side effects …One drug to combat another…. Prehaps it is the medication that ends up disturbing mental behaviour, warping personalities or or conditions in to bigger problems. ( Hewitt, 2001, p. 72) Alan prosponed the decision to take clorazil due to the risk of toxicity. Since commencing treatment, the symptoms have reduced but not deminished, he still takes medication for side-effects, anxiety and depression. He continues to struggle with daily living. His anxiety levels are so intense, that this condition has preceeded the effects of schizophrenia, which has led to further isolation from society, he would like to engage in employment, paid or unpaid, however in his current frame of mind this is not a possibility.

Labour force 1995, reported that employment figures in mental health patients are much lower than any other disabled group. Only 21% of people with mental health problems are working or actively seeking work. (Webb&Tossell, 1999). Warnings on some medication advise that machinery must not be used, vechiles must not be driven, due to side-effects of drowsiness, alcohol should not be taken with a lot of psyhcotropic medication. All of these restrictions impact upon Alan’s ability to function in society. Secondry to this, Alan has to cope with the stigma attached to mental health disorders.

There is a stereo typical societal perception that individuals with mental health issues are more dangerous than others, regardless of research suggesting the opposite; Philo et al, (1993), published research to demonstrate that there is no evidence to suggest that a person with mental health issues is any more likely to harm than anyone else. Figures over the last 20 yrs demonstrate that there has been no increase in murder caused by someone with mental health problems,whilst the increase amongt the general polulation has more than doubled. Research shows that this discrimination within mental health does not stop with the lay person.

White, western people have better experience of the service than other ethnic groups. (Haddad & knapp, 2000). The Sainsbury Cenre for Mental Health, (SCMH), (2002), in it’s aim to influence national policy high lighted the inequalities experinced by Black and African Carribean communities. SCMH’s findings suggest that professional have a fear of some ethnic minority groups, due to individual size or skin colour. It is these stereotypical beliefs, cultural ignorance and racist views, that prejudice assessments and influences treatment, reponses therefore rely on heavy medication and restriction.

The consequences of which can be dentrimental, and have resulted in death, for people like David Bennett. In response to high profile cases, the Governement have produced various documentation to address issues of inequality. Delivering Race and Equality, (2003), set out to provide an action plan over 7yrs to improve mental health services for ethnic minority groups. The focus is on raising professional awarness around culture, ethnicity and racism. As the western world progresses towards a multi-cultural society, it is inevitable that more people from ethinic minorities will come in contact with mental health services.

Fernando, (1991), considers this to be of a special concern and warns that; “The white domination of black people promotes, and often imposes a cultural domination so that ways of thinking, family life patterns of mental health and mental health care that are identified as ‘European’in tradition ‘white’by racial origin, are seen as superior to others. ”(p. 198) Fernando, goes on to highlight the fact that many forms of human distress medicalised by western society are not medicalised by other societies, and notes that political forces dominates what is an illness and gives ultimate power to the psychiatry to treat.

Therefore suggesting that individual diagnosis can depend upon where you reside in the world. Rack, (1982), notes that western psychiatry has an important role in social control, whilst Asian psychiatry is largely concerned with spiritual development. Fenando states; “…medicine too is part of a culture and not a system with a life of its own outside the culture in which it lives. ” (P. 197) He advises that a reliable diagnosis is unlikely, unless the individual is interwiewed in their own language, as only a person with the same language knows what to look for.

If Racks theory is correct then services have a lot to achieve to gain full equality. According to research it is not only the diagnosis in mental health that globally differs, it is also the recovery rate. Research under taken by WHO, (1938, 1958, 1988, 1998), ## evidenced that only 33% of individuals diagnosed with schizoprenia in western soceity were successfully treated by drugs. A further pilot study by the same organisation, in the recovery of schizophrenia demonstrated that recovery rates in London and Washington, (33%, 34%), were immensly lower than in IBADIAN AND MAGA PERDESH, (86%,87%).

The variable out come appeared to be talking methods and a positve out look from the onset. People were advised that they would get better rather than being told there future would depend upon medication. Colman, (2004), suggests; “Most psychiatic doctors appear to be wedded to the idea that they must treat everyone with medication and that it is only through the use of medication that people recover. The evidence for ths view appears to be based on research carried out using moneys supplied by pharmacutical industry. ”(p. 4). Colman’s view does not stand alone, Klass, (1975), advises that drug treatment is encouraged by the profit they make for their producers, who also provide the drugs to treat the side-effects. Large profits from the industry is used to provide research and advertise what they view as successful intervention for mental disorders. (cited Pilgrim&Rogers, 1987). In relation to Alan’s drug therapy and the side-effects of anxiety, I have spoken to his treatment team regarding alternative therapy such as; Anxiety Management.

The response was that he had this previously and is unable to sustain self help techniques. My view was that this was a funding issue, psychosocial therapy costs more than drug therapy. (Pilgrim&Rogers, 1987). It appears to come secondary to drug therapy in the view of the medical model. “ Whilst it is generally conceded by most commenters on psychiatry that it is now electic… The bias towards physical treatment is still strong. ” (p. 121. Baruch&treacher,1978, Roman,1985, Bushfield 1986, cited Pilgrim&Rogers, 1987).

Alan has spoke with me regarding the conscequences of stopping treatment to combat the side-effects. Pilgrim & Rogers, (1987), amongst others acknowledge that individuals may stop complying with medication if the side effects from the drugs become intolerable and they are not listened to. “ treating psychiatrists do not take their complaints about ‘side-effects’, or their concerns about the debilitating effects of the drugs, seriously. Instead, doctors tend to be concerned only with the effectiveness of the drugs in symptom reduction (assessed by them, not the patients themselves)’. p. 125 ) If Alan chose not to comply to medication, experienced a deteriation in his mental health and refused voluntary admission to hospital he could be detained under the Mental Health Act 1983. (MHA). The mental state examination would be under took by a doctor who was not exculded under s12 of the act (MHA1983,cited Jones, 2004). In good practise Alan should be assessed by his psychiatrist and his own general Practitioner. Thus meeting the requirements of s 12 [2], (MHA1983). Both doctors must examine the patient within five days of each other (s12,[1],MHA1983).

As Alan is known to the clinical team, and has a specific diagnosis, admission for traetment (s3 MHA, 1983, cited Jones 2004), would possibly be the proposed section. (Code of Practise, 1999, ch5). Laing, (1985), Szass, (1997), claims that psychiatry is used to police society and not to treat the individual. Psychiatrists have been given the power to lock people up and treat them against their will, they have more power than a judge, and hospital wards provide a prison for the unconvicted individuals who do not meet societal norms.

The approved social worker,(ASW), also has a powerful role under the 1983 Act and does make the ultimate decision as to whether treatment in hospital is the most appropriate form of treatment. (s13[2],MHA1983). As a social worker under taking the duty of an ASW, (albiet as a shadow), I have been faced with dilema’s whereby the role and duty of an ASW conflict with my social work values, instead of promoting rights and autonomy I am restricting them. I am managing this by addressing the issues in debriefing following the ssessments, in supervision, and by challenging other professional’s practise when necessary. For example, on one assessment, nursing staff had observed a patient as being withdrawn because he chose not to watch television in the communial lounge. During interview, the patient advised that he was a Johava witness and was oppossed to violence which was all that was on the particular channel viewed in the lounge. On addressing this with staff, it was clear that cultural or religous needs this had not been taken in to consideration.

If Alan was formally admitted to hospital his psychiatrist does have the power to treat him against his wish. (part IV, MHA1983). This could include invasive treatment such as ECT, which Alan is oppossed to. I am therefore proposing Alan prepares an advanced directive, which will be incorporated in his careplan. Although, this does not over ride the clinical desicion his treatment team will need to take his views and wishes in to consideraton. MHA —————– Alan is supported by his family they have a good insight in to his illness, his father has recently been diagnosed with Alziemen’s disease.

My current concern is that his mother is a carer for two family members. The largest proportion of community care is carried out by unpaid family members, who often miss out on employment and become isloated. (Webb&Tossell, 1999). To ensure that Mrs A, is able to continue in her role, her needs also must be met. I have therefore requested an updated assessment under The Carer’s (recognition and service) Act 1995. Mrs. A’s wellbeing is paramount in preventing deteriation of the home situation which would inevitabley impact upon Alan’s mental health. Mrs.

A recognises the signs and symptoms when Alans mental health starts to deteriate, which in turn has historially prevented admission to hospital. Research from All Saints Hospital Birmingham evidenced that 59% of relatives recognise early warning signs one month before relapse and 75% two weeks before relapse. (cited Howe, 1998). Mrs. A feels that she is coping at present with the assistance of her support worker she is able to off load. She accesses carer’s groups which she finds helpful. If the situation becomes to much the family have agreed to access further support for Mr. A. nder The Community Care and National Health Service Act 1990. Alan receives support from the day centre where he is involved with Art therapy and other activities. He attends the Fountain club, (a mind project), where he has access to support through group therapy, and attends respite two days a month. Alan finds these resourses useful in helping him to live with not only schizophrena but also the side-effects of his medication. He is offered support and advise that is not from a medical perspective. The family also consider that alternative therapy is as important to them, as to Alan. Mrs.

A considers that Alan and the family’s needs have been better met since a holistic approach has been under taken, as social and pshcological factors are adressed, aswell as the pathology of the illness. Howe, ( 1998), acknowleges that this has been a general failure in the medical model. I have not progressed with my original task regarding accomodation because I feel that Alan has enough going on in his life at present, in coming to terms with his father’s illness. Although his CPN, considers that this would be in his best interest, the family do not want it and I am not convinced it is what Alan wants either.

Szass, (1997), refers to how the mentally ill pateint is considered to be incompetant where as the medically ill pateint is considered to be competant. If Alan did not have a mental disorder, residing at home would not be an issue for anyone, other than the family. I will continue to project my view wtih the CPN and in supervision. In conclusion to this assignment I would agree that all those who work with in this area have far to go in developing services. My role amongst this will be to challenge oppression, by raising awarness as I have done in practise, and to promote an holistic approach towards assessment.

I am of the view that medication does help certian individuals, and their life has improved with medication. However in my view this should be minimal to releive distress and enhanced with other socialogical and pyshcological intervention. Although relapse cannot be illiminated, research and literature referenced throughout this assignment suggests that there is a high colleration between staying well and receiving a combination of services. Drawing from my previous managerial experience I have know doubt that the constraints on budgets will effect resources, which will inevitable effect the services individauls receive.

Pilgrim&Rogers, (1987), acknowledge that the limitation of resourses and the cost to them, which is not measurable in comparison to physical treatment has been a factor that has prevented psychological and social models from competeing against the medical model. Undoubtabley this will need to change to allow individuals a successful chance of recovery. Authors referred to who opposs psychiatry and its role do have a fair arguement, in that drug treatment and legislation polices society, however no realistic alternative is provided.

In my view the way forward is through raising public and professional awareness and de-stigmatising mental disorder. Word count 3297 References Barry, P. (2003). Mental Health and Mental Illness. (7th ed). Philidelphia.. Lippincott. Colman, R. (2004). Recovery an Alien Concept. (2nd Ed). Fife. P. P press. Delivering Race and Equality, (2003) The Sainsbury Centre for Mental Health, breaking the Circles of Fear, breifing 17. A review of the relationship between mental health services and African Caribbean communities. London. Fernando, S. (1991). Menatal Health Race and Culture.

London. Mind publications in association with Macmillon. Hewitt, P. (2001). So You Think Your Mad, 7 Practical Steps to Mental Health. Ppppppppppp Handsell Publishing. Howe, G. (1998). Getting in to the System, Living with Severe Mental Illness. London. Jessica Kingsley publishers Ltd. Jones, R. (2004). Mental Health Act Mannual. (9th Ed). London. Sweet &Maxwell Ltd. Laing, R. D. , (1985). Wisdom, Madness and Folly. Making sense of psychiatry. Basingstoke. Paper Mac. Leonard, B. E. (2003). Fundementals of Psychopharmocology. (3rd ed). Wiley. Pilgrim, D. ,and Rogers, A. (1987). A sociology of Mental Health and Illness. (2nd Ed). Pppppppppppp. Open University Press. Professor, Kingdom, (2000). D. Edited by Bailey D. 2000, At the Core of Mnetal Health. Key issuese for practitioners managers and mental heealth managers, Rack, P. (1982). Race Culture and Mental Disorder. forwarded by G. Morris. London. Routledge. Szass, T. (1997). Insanity. The Idea and it’s Consequenses. Syrcuse. University Press. WHO, (1992). The ICD10, Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidlines. Geneva.

World Health Organisation. Webb. R. , & Tossell, D. , (1999). Social Issues for Carers Towards Posive Practice. (2nd ed) London. Arnold. Haddad, P. , & Knapp, M. , (2000). Health Professional’s views of services for schizophrenia – fragmentation and Inequality. Psychiatric Bulletin (24), p 47 – 50. http://www. psychiatry24x7. com. schizophrenia retreived 19/01/06. NICE, (2003). Recommends newer antipsychotic drugs as one of the first line options for schizophenia. Press release. retrieved 19/01/06. Webb site: http://www. nice. org. uk/page. aspx? 0=32928

Narcolepsy is a rare sleep disorder characterized by uncontrollable episodes of falling asleep at any place or time. After a 10 or 15 minute sleep attack, the person feels rested only brief period of time, then returns to an uncomfortable feeling of intense sleepiness. Many narcolepsy patients describe attempting to stay awake during the day like trying to stay awake after 3 days without sleep. Attacks may occur while driving, talking, or working. The central nervous system is involved. This disorder begins in adolescence or young adulthood and continues throughout life. Narcolepsy is a potentially disabling, life-long condition estimated to afflict about one in every one thousand people in the United States. Although it is not uncommon, narcolepsy is often misdiagnosed, or diagnosed years after symptoms first appear.

The four primary symptoms of narcolepsy are excessive daytime sleepiness (EDS) and cataplexy. People with narcolepsy are unable to resist the temptation of falling asleep and do so regardless of the number of hours slept the previous night. The excessive daytime sleepiness experienced by people with narcolepsy has been described as being like trying to stay awake after going several days without sleep. Frequently, people with narcolepsy fall asleep at inappropriate times, for example while eating or in the middle of a conversation. These moments often frequently occur during periods of intense emotion such as surprise, laughter, anger, or excitement (even in some of the most passionate situations).

Cataplexy is the sudden loss of strength in voluntary muscles triggered by these intense emotions. The cataplectic attack can range from partial muscle weakness in a few muscle joints to almost complete loss of muscle control and last for several minutes. Sleep paralysis and hypnagogic hallucinations are also extremely common among patients afflicted with narcolepsy. Although these four symptoms are considered the four key symptoms of narcolepsy, all four symptoms only occur in small portion of the patients most other patients experience some combination of the four symptoms.

A. Extensive Daytime Sleepiness (EDS)

This is probably one of the most persistent and disabling conditions that can be experienced by someone with narcoleopsy. This feeling typically lasts the entire day and occurs on a daily basis. When a patient with narcolepsy experiences a period where they do fall sleep it is more tan likely due to a failure to resist sleep instead of a sudden attack of sleepiness. Although this strong desire to sleep is constant, recent prior sleep does seem to relieve for momentary periods of time. Other factors that appear to prevent a sleep attack are physical activity and stimulants, but it also prolongs the period of feeling sleepiness.

EDS has had a rather significant negative affect on narcoleptics’ job performance at school and at the workplace. Narcoleptics experience severe problems with and are typically unable to work with automobiles and dangerous equipment. Narcoleptics are more impaired than epileptic patients in terms of job performance and how prone they are to accidents. Narcoleptics lack many physical, emotional, and family supportive needs, even when compared to patients with cerebral palsy and alcoholism.

Cataplexy is the condition in which the skeletal muscles experience extreme muscles. This can vary from paralysis in one limb or throughout the entire body. During an attack, the person is conscious and aware of the environment surrounding him or her and if the paralysis is only partial maybe capable of carrying on a conversation. After the attack, the patient is fully conscious and experiences no confusion. This nearly always triggered by some form of emotional stimulus. The occurrences of attacks vary from patient to patient; it can happen daily or happen only once in a patient’s life.

These are realistic dreamlike hallucinations that occur either from consciousness to sleep or sleep to consciousness. The hallucinations are typically visual with occasional auditory or other sensory components. It often occurs in conjunction with sleep paralysis (see below). One of the most common hallucinations is to get out of bed and moving about while simply lying in a bed and not even moving a leg. Other hallucinations are more threatening as if a possible attacker enters the room and the patient is unable to move.

This is form of paralysis that is the failure to move any skeletal muscle during the period from transition of consciousness to sleep or sleep to consciousness. This occurs frequently to narcoleptic patients. These experiences are extremely traumatizing to a patient and make it difficult for the patient to breathe. The attack usually lasts about 5 minutes but can be broke either by an extreme effort by the patient or external force such as being spoken to or touched.

The precise factor that causes of narcolepsy is not clearly understood. Narcolepsy seems to be a biological problem, possibly involving abnormalities of brain chemistry. Narcolepsy or a predisposition to it may run in families suggesting a genetic influence. However, the way the predisposition might be inherited remains unknown. There is no evidence for a psychological basis for the disorder.

The most accepted theory is that there is something disturbing REM sleep. The impaired REM system is the theory that explains EDS as well as cataplexy, hypnagogic hallucinations, and sleep paralysis. This was based upon the similarities between cataplexy and REM sleep. In both cases, skeletal muscles experience impairment, due to motor neuron blocking.

This blocking of motor neurons occurs along the spinal causing excitation of the neuron in the spinal cord.. Cataplexy occurs when this inhibition of mental neurons are blocked during consciousness. Sleep paralysis may occur when motor neuron occurs prior to actual sleep or extends beyond the waking up period. Hypnagogic hallucinations occur when shifting between REM and wakefulness, this results in the unusual hallucinations experienced during hypnagogic hallucinations. The precise neurological abnormality that causes the symptoms of narcolepsy.

The symptoms of narcolepsy are usually first noticed during teenage or young adult years although it can strike at any age. Most often the initial symptom to appear is excessive daytime sleepiness. Later, after several months or even years, cataplexy, hypnagogic hallucinations, or sleep paralysis typically develop. Different individuals experience wide variations in both the developments, the number and the severity of their symptoms. Family, friends, educators, employers and even those with narcolepsy often have a hard time understanding the problem and just what is happening.

There is no known cure for narcolepsy. Narcolepsy symptoms can be treated with varying degrees of success with medications and adjustments of life-style and educational. Treatment is primarily intended to cope with the symptoms of narcolepsy. Stimulants are often given to promote alertness and to cope with EDS. The two stimulants that are prescribed the most frequently are methyphenidate and pemoline. Dosage is usually scheduled to promote alertness at the most crucial times.

The one difficulty is that tolerance can rapidly develop to stimulants so it is recommended that stimulants be used only when truly needed. Adapting your work schedule to provide for naps at the time most crucial times of the most intense sleepiness can help prevent some of the affects of EDS. This also reduces the need and possible dependency upon medication. Funds for research are needed to advance knowledge about narcolepsy and test the effectiveness of methods of treatment and management.

Participants were randomly selected from an electronic version of the white pages and were sent informational letters regarding the study to their home. A total of 2790 participants were obtained; 1390 female and 1396 male, all over the age of 18 at time 1; 2009. Time 2 (2010) consisted of participants from Time 1 who agreed to a follow-up and there was a 74% response rate (N=2024; 927 female and 1147 male). All dependent variables were measured using accredited questionnaires. Depression was measured using the Patient Health Questionnaire 9 (PHQ-9).

This questionnaire is a nine item scale constructed from the DSM-lVs diagnostic past month, how often were you bothered by feeling down, depressed, or hopeless? ” Responses were measured with frequency ranging from O (not at all) and 3 (nearly every day) and severity O (no depression) and 27 (severe/clinical). Sickness absence and presenteeism were measured using the WHO Health and Work Performance Questionnaire. The questionnaires recorded the number of days that were missed due to being sick physically and or mentally and the employees weekly work hours.

Bullying was measured by having an operational definition provided for the participants and then being asked to report if they ever felt subjected to those behaviors. Job strain was measured using the Job Content Questionnaire asking on a four point Likert scale (1 ”strongly disagree to 4=strongly agree) inquiring about how taxing their Job was. Table 1 depicts that individuals with mild depression show a doubling in estimated productivity costs, 1040$, when it has to do with annual sickness absence. For sickness absence this number is tripled compared to the employee without depression at 1616$.

The annual costs for presenteeism followed similar trends showing that there is not much of an increase from moderately severe depressed employed and severe. The effects of depression on the individual ranges in the thousands of dollars annually compared to the employee who does not suffer from depression. Table 2 illustrates the costs that organizations face nationally. The majority of the costs can be traced back to the individuals who are suffering from mild depression despite severely depressed workers costing more individually.

The total costs of depression nationally are under 8 billion. Table 3 (PAR=Population Attributable Risk, OR”odd Ratios) shows that bullying is a significant predictor for depression (6% 0 2. 54 OR). Job strain without bullying had no significant effects. Regardless, the impact of the significant results of Job strain, Job strain and bullying, and bullying that is attributed to depression cost around 693 million. Lerner et al. (2010) also investigated the impact of depression on work performance and impact stressors. Like the previous study, Lerner et al. akes into consideration how stressful work place behaviors can either create or enhance depression. Much of this research is based on the Job demand-control-support framework which indicates that work involving high psychologic demands will be harmful to health, whereas work involving control and/or social support will be protective (Lerner et al. , 2010, p. 205). Using a longitudinal cohort study surveys were distributed at 6,12, and 18 months. There were a total of 14,268 participants between the ages of 18-62 years; 286 of them being depressed and 193 of them being controls.

My MBBS ( Bachelor of Medicine and Surgery ) course of study of Community Medicine gave me an chance to analyze the multidisciplinary Fieldss of Public Health.Moreover, I had the opportunity to expose to the wellness attention installation of our state through several Day Visit plans. My Day Visits to Institute of Public Health ( IPH ) Dhaka, International Centre for Diarrhoeal Disease Research, Bangladesh ( ICDDR, B ) , Expanded plan on Immunization ( EPI ) Centre, Dhaka etc. gave me a perfect range to detect the public wellness benefit in Bangladesh.Through these visits I become interested in this topic.

My involvement in Public Health was further stimulated by my field visit experience as a portion of RFST ( Residential Field Site Training Program ) at Sreepur upazilla. We performed a cross sectional survey on “ Psychosocial Assessment of Rural People of Bangladesh ” . That was for the first clip I was introduced to epidemiological study and worked utilizing SPSS to come in and analyse data.We were awarded the 2nd award for our distinguishable undertaking. During my arrangement, I had found that most of these rural people were incognizant of the basic wellness regulations and therefore easy infected by many catching diseases.We gave them wellness instruction about nutrition, sanitation and personal hygiene and distributed ORS ( Oral Rehydration Salt ) packages. I was really aroused when they showed self-concern for safe environmental pattern. With the aid of Upazilla Health Officer, we guided them to put in H2O seal latrines. The RFST experience aroused my involvement in the field of Environmental Health. Not merely were we able to make something new but we were besides able to assist the local population. By actuating and educating a group of people about wellness related jobs, we could finally diminish the disease load in the community. I realize the importance of hygiene instruction in our society.

In Ibrahim Medical College I managed to keep the top place in my category during the whole undergraduate plan. In the Final Professional MBBS ( Bachelor of Medicine and Surgery ) scrutiny, I stood foremost in the college. Besides academic surveies, I frequently volunteer to the BIRDEM General Hospital and Diabetic Association of Bangladesh ( DAB ) to take part in free wellness cantonments.

After my completion of 5 old ages of medical class, I have started one twelvemonth rotatory internship preparation at BIRDEM ( Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorder ) General Hospital. As an intern physician in third degree infirmary, I have the chance to pull off patients with wide scope of unwellness like hapless patients with diabetes complications, severe malnourished kids enfeebling from Kalazar, Tuberculosis and Helminthiasis, skin malignant neoplastic disease patient with arsenicosis and immature workers with assorted pneumonic complications. To battle the predominating environmental wellness jeopardies in Bangladesh I believe it is imperative to develop an effectual accomplishment in the field of Environmental Epidemiology. An MS grade in Environmental Health in the field of Environmental Epidemiology will supply me a alone chance to analyze the incidence of disease and diminish the impact of environmental wellness related jobs from our community.

During my internship in Gynaecology Department, I had made another field visit at Ramu Upazilla Health Complex, Cox ‘s Bazar.I was involved in supplying Essential Service Package ( ESP ) and Primary Health Care ( PHC ) to the local community.I organized a little group session with local people to discourse on issues like harmful consequence of chemical fertilisers, generative and child wellness attention and referral cognition for patients with cholera, diarrhea and pneumonia. I found this treatment really effectual as most of them were nescient about modern wellness attention. My community exposure and interaction with patients farther escalate my involvement in environmental wellness.

I will be take parting in a research undertaking on “ Identification and Magnitude of Antibiotic Prescription in Different Levels of Health Service Delivery Centres ” from November 2012.Under the supervising of Dept. of Microbiology, BIRDEM infirmary I will be working as a research assistant.I think it will be really effectual to better my accomplishments in the field of epidemiology and biometricss.

Bangladesh has made a sustained advancement in environmental wellness sector with precedence of issues like sanitation, planned urbanisation, forbiddance of plastic bag usage etc.By utilizing limited resources and wellness installations it has successfully promoted under five immunisation program.Working in both Upazilla and Tertiary degree infirmaries, I think environmental wellness demands more attending at primary level.Lack of sufficient figure of community doctors and unequal wellness installations fail to supply quality wellness service to the rural people. I am determined to function my community as a physician scientist every bit good as research worker to place community wellness job and create consciousness of wellness related jobs among them.After completion of Master ‘s plan I would wish to obtain a PhD grade in Environmental Health so that I can go on my research in the related field.

Analyzing Environmental Health at Boston University will be really esteemed and I am peculiarly excited by its accomplishment focused course of study, diverse expertness, outstanding module, multicultural environment in campus and extended practicum chances in this field.As a doctor I am in a alone place of steering the wellness attention squad. I am excited that if I get into the plan I would hold the chance to lend to the bequest of Boston University ‘s School of Public Health plan.

Finally, I believe that being an academician in a reputed university will function my ultimate calling dream as a research worker where I could be working towards the benefit of the society.The chance to prosecute my alumnus survey in Boston University will move as the origin of my dream towards a successful hereafter.

Most practicians rely on traditional methods ( antidepressants, CBT and reding ) to pull off mental wellness upsets and merely a minority have an consciousness, understanding or credence of the usage of art as a possible intercession. Critics of ‘art for mental wellness ‘ highlight the wealth of anecdotal and subjective grounds sing wellbeing and self-esteem betterments and the deficiency of quantitative, randomised controlled informations.

While the exact mechanism/s of ‘healing ‘ or wellness betterment is a topic for argument, surveies have shown quantitative wellness betterments through art engagement ( shorter infirmary corsets, reduced depression symptoms ) 1,2 These benefits have been recognised and encouraged by many authorities documents, enterprises and reappraisals. In recent old ages, nevertheless, their stated visions and hereafter purposes have produced small direct action and the exact function of art within the boundaries of modern medical specialty is ill defined.

Personal aim

To see my ain prepossessions of utilizing art as a direction scheme in mental wellness and to reflect on how my position has changed as a effect of a literature reappraisal and active engagement.

Preconceptions

To measure my ain acquisition and development, it seems appropriate to document my preconceived thoughts sing the engagement of art as a intervention for psychological conditions. Previous experience as an antidepressant representative for a pharmaceutical company taught me that art psychotherapeutics is a utile adjunct to medicines in ‘moderate ‘ disease and a utile standalone therapy for ‘mild ‘ depression and anxiousness. As a medical pupil, I instinctively grouped art-based therapy together with ‘alternative therapy ‘ and mentally stereotypic categories to doing clayware and picture flowers. While many of my co-workers view all alternate therapies as a ‘waste of resources ‘ or ‘placebo at best ‘ , I have ever kept an unfastened head, believing art likely can assist certain patients.

On contemplation, my premise is based upon my theory of causing ; industrialization and consumerism has created an environment, which for many of us is non contributing to mental well-being. From an evolutionary position we are societal animals, designed to be physically active, necessitating regular societal battle and submergence within the ‘natural ‘ environment. This provides creativeness, security, pleasance and support. Today, our inert and frequently stray concrete environment replacement ‘s creativeness for multimedia input. For many, particularly those with any susceptibleness, this being allows psychological jobs to boom.

Through take parting in originative activities, I believe that certain societal, environmental and cognitive demands are met. For some, the societal and synergistic facets of art therapy might let the look of suppressed feelings, doing this a signifier of indirect guidance. While my theory might be deemed nonsensical to some, or intuitive to others, the inquiry arises ; should this be funded on the NHS? While art intercessions will offer benefits to some, as a pupil of evidence-based pattern, I need converting. By its really nature, nevertheless, I expect to happen an inordinate sum of literature on instance surveies and descriptions of ‘improve-wellbeing ‘ . I am cognizant that GPs have been able to order art for a figure of old ages, doing me optimistic that robust quantitative grounds and cost-effectiveness analysis exists.

By carry oning a literature reappraisal and attention categories myself, I hope to go better informed, to acquire a clearer thought of what art intercession can offer. It would besides be good to reason whether in this clip of fiscal load, the grounds supports the usage of art for mental wellness on the NHS.

Literature reappraisal

The grounds for utilizing art to handle mental wellness day of the months back to the 1940 ‘s. Improved communicating was observed between psychopathology inmates and creative persons, the birth of art psychotherapeutics. Since so the literature contains a wealth of anecdotal benefits back uping humanistic disciplines engagement for mental wellness patients. There is a distinguishable deficiency, nevertheless, of unequivocal decisions or systematic reappraisals. This is highlighted by the first ‘art on prescription ‘ strategy ( 1991 ) , where Stockport GPs prescribed art based therapies to their mental wellness patients. Unfortunately quantitative informations collected was limited to a general wellness questionnaire, which merely noted a 5-point betterment in overall wellness over 15-weeks ( n=33 ) .3

In 2000, the Health Development Agency ( HDA ) reviewed the grounds of wellness benefits offered through community-based humanistic disciplines undertakings, included mental wellness projects.4 They concluded that although there was sufficient, albeit anecdotal, grounds for betterments in patient well-being and self-pride ;

‘Evaluation harmonizing to wellness standards is infrequent ‘ .

‘It is impossible to give precise inside informations of improved wellness, peculiarly in the visible radiation of the fact that so few undertakings straight provide information on wellness, or societal affairs related to wellness, which are based on formal instruments of measuring ‘ .

In 2002, the HDA commissioned the Centre for Arts and Humanities in Health and Medicine ( CAHHM ) to reexamine and measure community-based humanistic disciplines in wellness ‘ . While mental-health was non specifically addressed, the study criticised rating, quantitative evidence,5 sample sizes and highlighted disagreements between healer purposes and medical outlooks, proposing that in future undertakings ;

‘ … .all parties clarify their purposes, premises and demands ‘ .

It was non until 2004, when a study by Rosalia Staricoff mentioning 364 documents was published, that a specific literature reappraisal described how single modes of art can profit mental illness.6 She concluded that engagement with art improves self look, creativeness, self-esteem, stress degrees and communicating between service users, their households and the suppliers. It was besides fresh for this type of reappraisal that she offered some medical accounts for the betterments, largely in footings of physiological impact.

Sing the unfavorable judgments sing research methodological analysis discussed therefore far, it might be expected to happen a figure of randomized controlled, robust surveies published within the last five old ages. While this reappraisal found many little undertakings and mental wellness anecdotes in reappraisal documents, merely one quantitative survey, published in a scientific research diary was identified. In 2007, 30 patients having chemotherapy who were assigned to a H2O painting category, had significantly reduced ( p=0.021 ) depressive symptoms compared to those assigned to no activity.7

More late ( 2007 ) , the Humanistic disciplines Council produced an extended papers sing art for wellness, which included mental health.8 While it included elaborate information on instance surveies and good pattern, it was light on robust decisions of clinical and curative results, with one major exclusion. Singing for the encephalon demonstrated the important curative benefits singing has upon memory, depression and physical well-being in dementedness sufferers.9

In 2008, an 18-month rural undertaking placed creative persons in Cornish GP patterns to work with mental wellness patients ( Figure 1 ) . While the qualitative result steps were positive ( e.g. patient feedback ) , 10 it is interesting to observe how local consumption of this free enterprise ( 8.6 % ) reflects my planetary observations.

Figure 1: Users mosaic displayed in Falmouth surgery.

A recent survey ( 2010 ) investigated the significance of art to service users. It made the interesting remark that therapy creates distance from the ‘ … … .perceived subjugation of statutory service suppliers ‘ , 11 helping recovery.

While many of the publications discussed are promoting, when the grounds is scrutinised to the same grade as a scientific diary, the field is characterised by good recognised jobs ; subjective nature, little sample sizes, inconsistent or neglected validated rating methodologies.12

Personal Experience

In November 2010, Arts for Health Cornwall and Isle of Scilly ( AFHC ) commissioned four creative persons to run a 12-month undertaking, Arts response, with purposes to ;

‘ … supply meaningful originative activity chances in community scenes targeted at grownups with mental wellness jobs ‘ .

The group I attended consisted of one enthusiastic creative person and seven members who had attended similar strategies in recent old ages or were straight referred by their GP. In a really informal mode, we were encouraged to draw/etch our studies into froth to make printed cards ( Figure 2 ) . The general criterion was much higher than my personal creative activities below demonstrate!

Figure 2. My print and cards.

This was the 3rd of the group ‘s two-hour Sessionss and what first struck me was how good they had bonded. One lady, for illustration, was absent and they called to look into how she was. Another lady was late ; she had been sing a group member who was holding a ‘bipolar low ‘ , converting her to reach her GP. Finally, after the session they all went for a societal drink. While the benefits of socialization, communicating and originative battle were clear, the proviso of relationships appeared to even supply a potentially robust safety cyberspace.

One lady commented on how she had no avocations before go toing a similar group antecedently. From the experience art had grown into an of import portion of her life, she sold her foremost painting last hebdomad, hiking her assurance. Finding added intent and flight from hopelessness has frequently been reported from humanistic disciplines participation.13

The creative person commented that the group was diffident and loath to prosecute ab initio. During this session I could see how single assurance grew with each print success and group encouragement, taking to more proficient and luxuriant designs.

I needed to reflect upon how I might derive my coveted consistent, touchable consequences. One lady commented how leery she was that inside informations would be fed back to her surgery, taking me to reason that merely the creative person is in a place to justice consequences. This, nevertheless, would necessarily conflict with their purpose of making a relaxing, stress-free environment, be intrusive and impact their credibleness. From this I realised why so few undertakings offer inquirers during undertakings, allow entirely elaborate mental wellness evaluation graduated tables.

It was evident that this type of category succeeds or fails with the creative person. The undertakings must be designed to win with limited participant accomplishment, yet contain the flexibleness to stretch creativeness. By their dependance upon artist creativeness, it seems impossible that undertakings can of all time be standardised.

Concluding Contemplation and hereafter

So what have I learned from this experience? While my literature reappraisal highlighted promising grounds ( e.g. singing in dementedness ) , 9 it failed to supply the grounds necessary to convert me that art has a mainstream function in the intervention of mental wellness. Under certain fortunes, nevertheless, exposure to art is contributing to wellness and healing and hence decidedly has a healthcare function.

How to measure art strategies to a degree perceived as convincing to mainstream medical specialty is an country of much argument. From my experience, nevertheless, I believe we can ne’er standardize, randomize or placebo control this type of health care. As a effect I can non forsee a clip where we can robustly reply the inquiry, does art intercession work? My experience, nevertheless, allowed me to see the possible benefits, which as a GP I would enthusiastically back and use any local undertakings.

Engagement in the procedure has changed many of my preconceived positions. There will ever be a group of persons who ‘modern medical specialty ‘ fails to assist and I think mental wellness is one country which is typified by this thought. The art intercession I witnessed impressed upon me that complementary attacks to wellness can assist in domains frequently ill represented by traditional ‘medical ‘ theoretical accounts of health care ( assurance, self-esteem, communicating ) . Rather than beliing the medical theoretical account, such attacks compliment the thought of handling the emotional and religious demands of the individual holistically.

The literature reappraisal and personal contemplation besides highlighted the deficiency of apprehension of what art and wellness involves, particularly by clinicians who are frequently determination shapers and fund holders. In this epoch of asceticism undertakings will be expected to ‘deliver ‘ . With the benefit of experience I now judge an one-year strategy cost-efficient at & A ; lb ; 5,000 ( less than & A ; lb ; 60/hour ) , 14 nevertheless, I am concerned that many art-based undertakings will happen it impossible to make the sensed holy grail of supplying justifiable consequences and their support watercourses could easy be squeezed without an grasp of their benefit and an apprehension of the ‘results ‘ This hazards marginalizing vulnerable groups who are frequently ill represented by traditional medical specialty.

Citizens for mental health backgrounder

Scope of the issue

Our mental health is affected by many factors including where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family. Positive mental health is a cornerstone of our overall well-being. Mentally healthy people are able to cope with the inevitable stress and strain of daily life and have the resilience to rebound from life-changing events such as loss of a loved one, loss of a job, or marriage breakdown.

However, some leading health indicators show Canadians as a whole, and some groups in particular, are experiencing mental health problems in their lives. These problems exact a significant toll on individuals, their families, and society at large.

• Suicide accounts for 24% of all deaths among 15-24 year olds, and 16% among those from 25 to 44.
• More than half a million persons aged 15 and over (2. 2%) reported having activity limitations due to emotional, psychological or psychiatric conditions. An additional 1 % had activity limitations due to frequent memory problems or periods of confusion.
• Stress and mental health-related problems currently represent 40-50% of the short-term disability claims among employees of some of Canada’s largest corporations.
• The Canadian economy loses an estimated $30 billion a year in productivity due to mental illness and addiction problems.
• Social conditions such as poverty, income disparities, homelessness and housing instability, income insecurity, racism, sexism, homophobia negatively impact mental health.

Federal action

Health promotion seeks to develop strategies that increase individual and community control over the determinants of health to improve overall health and promote social justice and equity. Mental health promotion builds on the above principles. It entails enhancing people’s resiliency and coping skills, and above all, their capacity to take control over their lives, thereby improving their mental health. Mental health promotion is targeted at the population as a whole, including people with mental illness.

Policies and programs to promote mental health are pursued at every level of society, including the federal government. The Mental Health Promotion Unit (MHPU) was created in 1995 as the focal point of Health Canada’s efforts to maintain and improve positive mental health and well being for the Canadian population. The new MHPU addresses mental health promotion from a population health perspective that takes into account the broad range of determinants of mental health.

Its mandate is to promote and support mental health and reduce the burden of mental health problems and disorders by contributing to: the development, synthesis, dissemination and application of knowledge and the development, implementation and evaluation of policies, programs and activities designed to promote mental health and address the needs of people with mental health problems or disorders. In addition, Health Canada’s First Nations and Inuit Health Branch supports the delivery of public health and health promotion services on-reserve and in Inuit communities.

It provides drug, dental and ancillary health services to First Nations and Inuit people regardless of residence. The Branch also provides primary care services on-reserve in remote and isolated areas, where there are no provincial services readily available. Health Canada publications deal with issues such as helping children live with separation and divorce, coping with the stress of terrorism, and promoting mental health in First Nations and Inuit communities. Other federal departments also offer programs which promote mental health.

Federal programs related to, for example, income, employment, education, housing, or human rights all play a part in helping to promote the mental health of Canadians (see other “Citizens for Mental Health” Backgrounders).

Community response

Healthy public policy and, in particular, mentally healthy public policy is a responsibility of all levels of government across a wide range of departments. Policies in a range of areas from income security to reducing stress in the workplace or programs such as suicide prevention or youth counselling all constitute health promoting initiatives.

The following example related to health in the workplace could serve as a template for the development of mentally healthy policy in many areas of activity. Acting on the Ottawa Charter for Health Promotion’s call for “putting health on the agenda of policymakers in all sectors and at all levels” the authors of a recent report prepared for the Institute for Work and Health looked at the impact of information about the health consequences of unemployment and job insecurity. They evaluated the influence and potential of such information, and analysed barriers to utilizing it in employment policy-making.

The authors conclude with three recommendations aimed at combining greater awareness of employment-related health consequences with traditional employment policy-making:

• health policy-makers must act as the intellectual leaders in rephrasing health information in terms meaningful to employment policy-makers;
• both health and employment policy-makers must work toward an increase in cross-departmental and cross-governmental initiatives as well as toward greater awareness of and accountability for the health consequences of employment policy;
• these policy-makers should monitor support for initiatives that are proposed on the basis of health information and be prepared to offer this information when they encounter resistance from stakeholders, bureaucrats, the media, and the general public.

Sources

CMHA Ontario Division (www. ontario. cmha. ca/content/information_and_links/statistics. asp? cID=3296)

First Nations and Inuit Health Branch, Health Canada (www. hc-sc. gc. ca/fnihb/index. htm)

Global Business and Economic Roundtable on Addiction and Mental Health – see CMHA Ontario (www. ontario. cmha. ca/content/information_and_links/statistics. asp? cID=3296)

Mental Health Promotion Unit, Health Canada (www. hc-sc. gc. ca/hppb/mentalhealth/mhp)

Statistics Canada – Cat 89-577-XIE, A Profile of Disability in Canada, 2001. Citizens For Mental Health is a national project of the Canadian Mental Health Association April 2003