Sunday, June 8, 2014

CANADA by Aly Ladd

I. COUNTRY:
Canada

II. TOTAL POPULATION:
35,344,962 ("Home page — Statistics Canada")

III. POPULATION DEMOGRAPHICS: (men, women, kids, ethnicities):
(http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo10a-eng.htm)






IV. ESTIMATED NUMBER OF PEOPLE WITH MENTAL ILLNESS:
One in five adult Canadians (21.3 percent) will suffer a mental disorder in their lives. This figure translates into between 4.5-6 million people. ("Canadian Alliance on Mental Illness and Mental Health / Mental Illness Awareness Week | Quick Facts")
In 2012, approximately 2.8 million people, or 10.1% of Canadians aged 15 and older, reported symptoms consistent with at least one of six mental or substance use disorders in the past 12 months. ("Canadian Community Health Survey: Mental Health, 2012")
V. RELIGION / CULTURAL BELIEFS / SOCIAL CONTEXT:
IMPACT OF BELIEFS / SOCIAL CONTEXT ON PERCEPTION OF MENTAL ILLNESS AND PEOPLE WITH MENTAL ILLNESS:
It seems as though there is a sort of social stigma behind mental illness in Canada. People with mental illnesses are more often than not stereotyped. Some of the stereotypes include the mentally ill being violent, though they are much more likely to be victims of violence. There is also the idea that those who claim to have mental illness are just lazy or have lack of willpower. A lot of the stigma shows itself in the workplace where people with mental illness can lose jobs or credibility if they admit to having the illness. It becomes worse if they have been hospitalized. Apparently there’s also a bit of stigma in the Canadian medical community when it comes to mental illness. People with mental illnesses who go to the emergency room for help with suicidal thoughts have been made to wait as others were helped before them. (Whalen) It may be because of the stigmas that only one in three Canadians report that they have sought help and treatment for mental health problems. (“The Facts”).
The Aboriginal people of Canada also face a higher percentage of mental illness than the rest of the Canadian population. However, Aboriginal peoples are actually more likely to report their mental illness and seek help and treatment for them. 17% of Aboriginal people seek treatment, compared to the Canadian average of 8%. (Kahn, 2008). The Aboriginal traditional views of well being didn’t separate mental illness from other aspects of health. Their ideas of health, mental illness included, did not focus on the individual as much as it did connections with others and nature. (“Institutional Links”).

 VI. METHODS OF SUPPORT FOR PEOPLE WITH MENTAL ILLNESS:
            As it is a country that employs a universal health care system, mental health care in Canada can be treated through the government. However, the amount of treatment they can get through the government varies throughout the Canadian provinces. All Canadian citizens have access to physician and hospital services, but it’s up to each province to decide if it wants to cover supplementary care (ie. dental, prescriptions, vision, etc). (Kliff, 2012). The problem with this however, is that the mental health services that are part of Canadian health care are often overlooked or underfunded. As many as a third of the Canadians who look for mental health services through the Canadian health care system find that their needs are only partially met, and this number is even higher with children and young adults. ("For Reporters"). Many Canadians find themselves paying for things like psychiatric care and drugs out of pocket.
            However there are several programs that are working to bring the necessity of adding the the budget and availability of mental health care to light. The Mental Health Commission of Canada supports and works to increase collaboration between all sectors of Canadian health care, whether they be physical or mental. One of the ways the MHCC is doing this is by providing training to primary care doctors that increases their capacity to recognize and deal with mental health issues. (“Issue: Primary Care”). The Canadian Mental Health Association recognizes the importance of community care as well as formal treatment and works towards improving the universal access, terms and conditions, and public administration of mental health care available to the Canadian people. The CMAA also promotes insurance, both governmental and supplemental, to include prevention activities, supportive living and housing arrangements, and access to prescription drugs. (“Mental Health Services”).
            There are also multiple programs and websites, the MHCC and CMAA included, that are strongly fighting to minimize the stigma that surrounds mental illness. Almost every search that includes the phrases “mental health” or “mental illness” and “Canada” will have a link that leads to lists of facts about mental illness, what it is or how many Canadians have mental illness or the ways mental illness affects peoples lives. The sites more often than not mention common misconceptions about mental illnesses and people with mental illnesses and give examples of, or ways that, the stigmas surrounding mental health can be overcome.

VII. PERSONAL OBSERVATIONS
I find that it can be difficult to judge what other societies think about pretty much any topic, including mental illness, when one has not grown up in that society or even been immersed in the society for an extended period of time. That’s why I think I struggled a little with the section of this assignment that asked about how society and cultural beliefs affected views on mental illness. I found myself having to piece together what the overall Canadian beliefs on mental illness might be based on websites and articles that were set up mainly to fight stigmas. They seemed to fill in plenty of blanks, but I still feel like there are grey areas about how Canadian’s view mental health that I would only be able to fill in by visiting the country myself.
Also, I was rather surprised to find that Canadian health care system, which I had previously heard only positive reviews about, had so many problems supporting Canadian citizens with mental illnesses. I was shocked to find that Canadians with mental health problems can really only find support if they’re hospitalized. I always figured the Canadian health care system would obviously encourage community care and out patients. Though, even with these problems, it still seems to me that the Canadian health care system still does better helping citizens with mental health and making living mental health more affordable than the American system does.

VIII. REFERENCES: (APA FORMAT)


Canadian Community Health Survey: Mental Health, 2012. (n.d.). Government of Canada,
Statistics Canada.Retrieved June 3, 2014, from http://www.statcan.gc.ca/daily-quotidien/130918/dq130918a-eng.htm

For Reporters. (n.d.). CAMH: Statistics on Mental Illness and Addictions. Retrieved June 5, 2014,


Institutional links. (n.d.). The Human Face of Mental Health and Mental Illness in Canada 2006.
Retrieved June 6, 2014, from

Issue:Primary Care. (n.d.). Issue: Primary Care. Retrieved June 7, 2014, from

Kahn, S. (2008). Aboriginal Mental Health: The statistical reality. Visions Journal, 5(1),
6-7.

Kliff, S. (2012, July 1). Everything you ever wanted to know about Canadian health care in one
post.Washington Post. Retrieved June 7, 2014, from

Mental Health Services. (n.d.). Canadian Mental Health Association. Retrieved June 7, 2014, from

The Facts. (n.d.). Mental Health Strategy. Retrieved June 5, 2014, from

Whalen, David. B.A. “The Stigma Associated with Mental Illness.” Canadian Mental Health
Association. Retrieved June 5 2014, from http://www.cmhanl.ca/pdf/Stigma.pdf



NETHERLANDS by Bridgette Fortin

I. COUNTRY:  Netherlands

II. TOTAL POPULATION: 16.73 million (2013)

III. POPULATION DEMOGRAPHICS: (men, women, kids, ethnicities)

0-14 years: 17.1% (male 1,468,364/female 1,401,651)
15-24 years: 12.2% (male 1,041,181/female 1,002,125)
25-54 years: 40.8% (male 3,436,713/female 3,411,374)
55-64 years: 12.9% (male 1,083,095/female 1,085,929)
65 years and over: 17.1% (male 1,284,788/female 1,589,817) (2013 est.)

(World Population Review, 2014)


Ethnicities:
Dutch 79.3%
Europeans  5.7%
Turks 2.4%
Indo-Europeans  2.3%
Moroccans at 2.2%,
Surinamese  2.1%,
Caribbeans at 0.9%,
Poles at 0.6%,
Chinese at 0.3%,
Iraqis at 0.3%,
Other ethnic groups that comprise the remaining 3.9%.
(CIA World Factbook, 2013)

IV. ESTIMATED NUMBER OF PEOPLE WITH MENTAL ILLNESS:
3,000,000  per year
(Geneeskd, 1999)

V. RELIGION / CULTURAL BELIEFS / SOCIAL CONTEXT:
Religion:  According to CBS, in the year 2005/2006, 58% of Dutch people said they belonged to a religion or believed in a certain ideology. This is the equivalent of more than9 million people. Roman Catholics are the largest group with 29 percent. Nearly 20 percent are Protestant, and 5 percent are Muslims. The remaining 5 percent include Jews and Hindus, among other groups. Around 42 percent of the population says they do not belong to a religion.
(Statistics Netherlands, 2008)

Cultural Beliefs: Family is the key to social structure in Holland. The families are often small with only one or two children. Mothers tend to have no job outside of the family home as they are responsible for the upbringing of their children. This is unlike many other cultures.

Dutch people take great pride in appearances, they are known to be very disciplined, conservative and pay attention to all minor details. However they are all very private people and do not want attention upon themselves for any life successes. They do not like people who show and tell everyone how much money they have and the materialistic objects they may have.

Dutch people are highly tolerant of individual differences, and their children go through schooling without any gender bias. As the tax burden upon its workers is so high there is virtually no poverty at all in the whole country. Everyone is shown respect despite their differences.
(Every Culture, 2014)


IMPACT OF BELIEFS / SOCIAL CONTEXT ON PERCEPTION OF MENTAL ILLNESS AND PEOPLE WITH MENTAL ILLNESS:

Not much information is out there on how the Dutch perceive the mentally ill, but from what I could find they said that they don't see people different from one another despite problems they may have.
VI. METHODS OF SUPPORT FOR PEOPLE WITH MENTAL ILLNESS:

Since 2002 Euthanasia has been regulated in Holland and it is acceptable to assist the mentally ill with Euthanasia. In 2013, 13 psychiatric patients were euthanized which was a 500% increase since 2010.

The Netherlands have seen a steady increase in the euthanasia of mentally ill people since its regulation in 2002. There is also a movement within the mental health community professions to legitimize rational suicide.

(K House, 2013)
VII. PERSONAL OBSERVATIONS

The Netherlands seems like a great place to live that isn’t as judgmental as the United States, and what really stood out to me was that there is virtually no poverty at all in the whole country due to taxes, and that the Dutch are highly tolerant of individual differences.

VIII. REFERENCES: (APA FORMAT)



References
AdvamegInc (2014). Culture of The Netherlands - history, people, clothing, women, beliefs, food, customs, family, social. Retrieved June 6, 2014, from http://www.everyculture.com/Ma-Ni/The-Netherlands.html
Geneeskd, N. T. (1999). How much mental illness is there in the Netherlands? Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9763838
Koinonia House (2013, November 5). Euthanasia for the Mentally Disabled? - eNews for November 05, 2013. Retrieved June 6, 2014, from http://www.khouse.org/enews_article/2013/2159/print/
Statistics Netherlands (2008, June 12). CBS - Only few Dutch people go to church or mosque regularly - Web magazine. Retrieved June 5, 2014, from http://www.cbs.nl/en-GB/menu/themas/vrije-tijd-cultuur/publicaties/artikelen/archief/2008/2008-2476-wm.htm
World Fact Book (2013). Netherlands Demographics Profile 2013. Retrieved June 4, 2014, from http://www.indexmundi.com/netherlands/demographics_profile.html
Worlds Population Review (2014). Netherlands Population 2014 - World Population Review. Retrieved June 4, 2014, from http://worldpopulationreview.com/countries/netherlands-population/

ICELAND by Janice Grant

In the most recent national census, Iceland had a population of 329,279, with a nearly perfect ratio of 101 men for every 100 women (World Health Organization, 2011, 1). The population is also fairly young, with 25% under age 18 and only 12% above age 60 (World Health Organization, 2011, 1). Iceland is considered the least racially diverse country in the world, with 94% of the population being a native mix of Norse and Celts, and 6% being a “population of foreign origin” (Central Intelligence Agency, 2010).
            The overall picture that I got of Iceland’s treatment of mental illness is a curious blend of progressive philosophies and stigmatized neglect. From about 1400 – 1907, the mentally ill of Iceland were managed by local authorities, which often meant they were put in poor houses and made to do hard labor in primitive working conditions (Gudmundsson, 2012, 26). There were no treatment or alternative care options for those with mental illness until Kleppur Hospital for the mentally insane was opened in 1907 – about 100-150 years behind most of Europe (Gudmundsson, 2012, 25). Kleppur Hospital is most notable for the mental health policies and practices spearheaded by staff psychiatrist and physician-in-chief Helgi Tomasson, who chose to burn all straitjackets and restraints and prohibit any use of insulin shock, drug-induced convulsions, ECT, and surgical procedures like lobotomies in the entirety of Iceland (Gudmundsson, 2012, 28).
            Like many countries, after drugs like thorazine became widely used in the 1950’s, Iceland started moving patients out of Kleppur and into community treatment centers (Gudmundsson, 2012, 28-29). Unlike many countries, today Iceland no longer has any mental hospitals in the entire country, and involuntary commitment into general hospital psychiatric wards make up only 3.6% of all admissions – and restraints are still not used (Gudmundsson, 2012, 30).
            I could find no official sources that cited hard numbers on the number of people with mental illness, but the 2011 WHO census mentions that, “neuropsychiatric disorders are estimated to contribute to 32.5% of the […] burden of disease” (World Health Organization, 2011, 1). The only statistical information provided regarding mental health treatment were given in “rates per 100,000” (World Health Organization, 2011, 4), which I used to calculate the approximate number of people treated in:
Outpatient mental health facilities: 5,489
Mental health day treatment facilities: 635
Psychiatric ward of a general hospital: 2,647
Community residential facilities: 340
(World Health Organization, 2011, 2)
            Despite these apparently forward-thinking approaches to mental illness, Iceland has no official mental health policies or dedicated legislation protecting the rights of people with mental illness (World Health Organization, 2011, 1). WHO also reports that the majority of Iceland’s primary care providers had received no official in-service mental health training in the previous five years, and most primary care clinics had no official manuals on managing and treating mental disorders to guide said providers (World Health Organization, 2011, 1). To underscore this concerning information, a recent study of attitudes toward mental illness in Iceland found that they are most often presented by the media as a tragedy – “the person who is ‘wrestling’ or ‘battling’ disability” (Bjornsdottir and Johannesson, 2009, 440), as well as highlighting their need for family and community support as a “societal burden” (Bjornsdottir and Johannesson, 2009, 440).


References
Bjornsdottir, K., & Johannesson, I.A. (2009). People with intellectual disabilities in Iceland: A Bourdieuean interpretation of self-advocacy. Intellectual and Developmental Disabilities, 47(6), 436-446.
Central Intelligence Agency. (2010). The world factbook: Iceland. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/ic.html
Gudmundsson, O. (2012). History of Icelandic psychiatry. Nordic Journal of Psychiatry, 66(S1), 25-30.
World Health Organization. (2011). Iceland. Retrieved from http://www.who.int/mental_health/evidence/atlas/profiles/isl_mh_profile.pdf



GERMANY -- by Sabrina Penney

I. COUNTRY: Germany
II. TOTAL POPULATION: 80,800,000 (2014 est.)
III. POPULATION DEMOGRAPHICS: Age/Sex structure estimates for 2010=
     0–14 years: 13.7% (male 5,768,366/female 5,470,516)
   15–64 years: 66.1% (male 27,707,761/female 26,676,759)
   65 years and over: 20.3% (male 7,004,805/female 9,701,551)
Ethnicities- Stats for 2012
Europeans       94%     77,679,000
Americans       0.5%    418,000
Asians, Australians, and Oceania        2.5%    2,034,000
Africans (Including White Africans)   0.7%    577,000
Mixed or unspecified background       1.5%    1,208,000
Total population          100%               81,913,000
Information for this section retrieved from: http://en.wikipedia.org/wiki/Demographics_of_Germany
IV. ESTIMATED NUMBER OF PEOPLE WITH MENTAL ILLNESS: According to euro.who.net: 27% of the adult population (here defined as aged 18–65) have experienced at least one of a series of mental disorders in the past year. With an estimated 83 million people being affected by mental illness, and those over 65 are not even accounted for. Neuropsychiatric disorders are the second cause of disability-adjusted life years (DALYs) with the top four being: unipolar depressive disorder, alcohol use disorder, self-inflicted injuries, and Alzheimer’s and other dementias. Also according to the most recent available data 123,853 people commit suicide every year, out of which almost 80% are men.
V. RELIGION / CULTURAL BELIEFS / SOCIAL CONTEXT: 
Religion- Statistics from 2008: Christianity is the largest religion in Germany, with around 51.5 million adherents equaling 62.8%. Of those 30% are Catholics, 29.9% are Protestants, and the remaining 0.5% of the population belong to smaller denominations.
The second largest religion is Islam with an estimated 3.8 to 4.3 million adherents equaling 4.6% to 5.2%. Then Buddhism with 250,000 and Judaism with an estimated 0.3%. Hinduism has some 90,000 participants (0.1%). Germans with no stated religious adherence make up 34.1% of the population.
Cultural beliefs- Besides being a mecca for music, cuisine, art, architecture, literature, and philosophy Germany has also established a high level of gender equality, promotes disability rights, and is legally and socially tolerant towards homosexuals. Gays and lesbians can legally adopt their partner's biological children, and civil unions have been permitted since 2001.
Information for this section retrieved from http://en.wikipedia.org/wiki/Germany#Demographics.
Social Context- According to http://en.wikipedia.org/wiki/Demographics_of_Germany:
“Germany has one of the world's highest levels of education, technological development, and economic productivity. Since the end of World War II, the number of students entering universities has more than tripled, and the trade and technical schools are among the world's best. With a per capita income of about $41,370 Germany is a broadly middle class society.”
IMPACT OF BELIEFS / SOCIAL CONTEXT ON PERCEPTION OF MENTAL ILLNESS AND PEOPLE WITH MENTAL ILLNESS: 
Interestingly enough I could not find much information on mental illness in Germany and even less of the perception of those that are diagnosed with such.  I did discover though that there is an estimate of 10% of the population that is diagnosed with some form of mental illness. The negative attitudes and rejection by the public towards individuals with mental illness (particularly those diagnosed with Schizophrenia) are some of the main obstacles.  The most common consequence of discrimination for people with schizophrenia are social distance, exclusion, and discrimination in housing and employment. (Crisp et al., 2000; Link, 2000; World Psychiatric Association, 1998).
 VI. METHODS OF SUPPORT FOR PEOPLE WITH MENTAL ILLNESS: 
Hospitalization is common and under guardianship law, a patient can be hospitalized by his or her guardian against his or her will if there is a danger to his health that cannot otherwise be dealt with. Medication is still the go to therapeutic treatment with atypical antipsychotics being the most prescribed course of treatment. If a patient needs psychotherapy chances are he or she will have to wait longer than six months (Schulz, 117).
VII. PERSONAL OBSERVATIONS
I wanted to research Germany because of their history of eugenics. Although it surprised me that I could not find very much information on how the population of Germans view those with mental illness it became clear as to why when I realized the negative extent of their views. It appears to be one of those situations where it is not acknowledged and the information relative to the illness is not accurately understood by the people of Germany. There is a negative connotation by the public on those diagnosed. It is unfair and ignorant to assume that someone with a mental illness in either dangerous or unemployable. Their lack of knowledge and therapeutic processes is saddening.
VIII. REFERENCES: (APA FORMAT)
Crisp et al., 2000; Link, 2000; World Psychiatric Association, 1998
Schulz, Michael. (2004). Mental health services in Germany. Retrieved from https://www.radcliffehealth.com/sites/radcliffehealth.com/files/books/samplechapter/4369/Brimblecombe%20chpt%2004-636f9080rdz.pdf
Wikipedia., (2014). Demographics of Germany. Retrieved from http://en.wikipedia.org/wiki/Demographics_of_Germany.
World Health Organization Regional Office for Germany. (2014). Data and statistics. Retrieved from http://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/data-and-statistics.


Sunday, May 25, 2014

Medicalization, and the Importance of Etiological implications on diagnosis and treatment

There is a term in the recovery movement called "the medicalization of mental illness," which is known in disability studies as "the medical model." In this model, the doctor is the omniscient expert, the doctor identifies the pathology, the doctor prescribes medication for the illness, the patient does what the doctor says, and the patient is cured.

The problem here is that with mental illness, no one really knows definitively what its etiology is / what causes mental illness. The prevailing theory of etiology is that somehow the brain's chemistry has gone awry which informs our prevailing treatment these days --  correcting brain pathology chemically with medications.

However, there are 54 identified (so far) neurotransmitters in the brain. Think of the potential permutations and combinations of brain chemistry. Antidpressants supposedly act on neurotransmitters like serotonin or dopamine, yet the most prescribed antidepressants and their manufacturers admit...that the "method of action is unknown."  Even the pharmaceutical industry writes in the fine print "we don't know what these drugs do to the brain."

 Science is in its infancy in terms of our understanding of the brain, yet we proceed  to "cure" with relative certainty. We really have no idea how these medications work, if they will work, or what the long-term impact of medications are on the brain.

Etiology informs treatment. This is why I asked you to articulate what YOU think causes mental illness.

If we can't say for sure what causes mental illness, why are we looking to cure mental illness with medications -- despite not knowing how they act on the brain? If we think MI is caused by genetics, are we researching gene therapy? If it is caused by trauma, why aren't we focusing on love, support, and unconditional regard for people who have trauma in their backgrounds? If etiology is complex and multivariate, why aren't our approaches to diagnosis and treatment?

Questions for replies:

Why is there such certainty within the psychiatric community about medications as treatment? we know first and second generation neuroleptics CAUSE brain damage, and some research indicates that negative effects of newer meds are systematically downplayedn(perhaps due to profit motives). Why are clinicians so SURE of their diagnosis and medications for treatment? Walter Freeman was sure, too....and in hindsight...was his cure what was best for folks?






Research, Its Social Context, and the Impact of Profit on Findings

Whitaker writes "In short, in the 1950s, what American physicians and the general public learned about new drugs was molded, in large part, by the pharmaceutical industry's marketing machine..[which] played a critical role in the recasting of neuroleptics as safe, antischizophrenic drugs for the mentally ill." (p.150, kindle edition). His contention here is that the pursuit of profit by pharmaceutical companies skews their ability to do unbiased research and clinical trials on their products.

In an article published in the New England Journal of Medicine in 2008, researchers studied the clinical trials of 12 different antidepressants that were approved by the FDA (involving 12,564 participants).  Of all these studies conducted, 97% of the studies showing positive results were published, whereas only 12% of the negative studies were published.

Americans consume more prescription medications that all the world combined. Often we demand quick fixes of our "pathologies" -- a pill. It is easier to put a child on medications than to delve into deep family problems and issues and change them. 

The social context here is  twofold 1) Americans want medications to fix their problems, and 2) the pharmaceutical industry and it's marketing machine are driven by profit. It almost seems like the perfect storm, culminating in questionable clinical trials and findings that many feel are suspect.

Questions for consideration / posts / and replies:

1) How does social context impact research in general? what topics get researched and which ones do not?
 (for example, there is very little research on sex and sexuality for people with developmental disabilities, because social mores frown upon people with DD having sex)
2) How much of an impact does the current social context (profit and demand) have on clinical trials of medications for mental illness? what might be the incentive for downplaying negative effects of these new classes of drugs? 
3) The FDA is supposed to protect people from bad drugs coming to market. Is the organization successful in doing this? Why or why not? 


Reference: Turner, E., Matthews, A., Linardatos, E., Tell, R., & Rosenthal, R. (2008). Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy New England Journal of Medicine, 358 (3) 252-260Cited in Bojrab, 2014