Archive for October, 2017

How brain scans can tackle the stigma behind mental illness

How brain scans can tackle the stigma behind mental illness

New techniques may soon be able to identify children at increased genetic risk for psychiatric illnesses.
This article is published in collaboration with
The Conversation
25 Oct 2017
David Rosenberg
Professor, Psychiatry and Neuroscience, Wayne State University

As a psychiatrist, I find that one of the hardest parts of my job is telling

Parents and their children that they are not to blame for their illness.
Children with emotional and behavioral problems continue to

                                        suffer considerable stigma.

Many in the medical community refer to them as “diagnostic and  therapeutic orphans.”

Unfortunately, for many, access to high-quality mental health care remains elusive.

An accurate diagnosis is the best way to tell whether or not someone will respond well to treatment, though that can be far more complicated than it sounds.

I have written three textbooks about using medication in children and adolescents with emotional and behavioral problems. I know that this is never a decision to take lightly.

But there’s reason for hope. While not medically able to diagnose any psychiatric condition, dramatic advances in brain imaging, genetics and other technologies are helping us objectively identify mental illness.

Knowing the signs of sadness
All of us experience occasional sadness and anxiety, but persistent problems may be a sign of a deeper issue. Ongoing issues with sleeping, eating, weight, school and pathologic self-doubt may be signs of depression, anxiety or obsessive-compulsive disorder.

Separating out normal behavior from problematic behavior can be challenging. Emotional and behavior problems can also vary with age. For example, depression in pre-adolescent children occurs equally in boys and girls. During adolescence, however, depression rates increase much more dramatically in girls than in boys.

It can be very hard for people to accept that they – or their family member – are not to blame for their mental illness. That’s partly because there are no current objective markers of psychiatric illness, making it difficult to pin down. Imagine diagnosing and treating cancer based on history alone. Inconceivable! But that is exactly what mental health professionals do every day. This can make it harder for parents and their children to accept that they don’t have control over the situation.
Fortunately, there are now excellent online tools that can help parents and their children screen for common mental health issues such as depression, anxiety, panic disorder and more.
Most important of all is making sure your child is assessed by a licensed mental health professional experienced in diagnosing and treating children. This is particularly important when medications that affect the child’s brain are being considered.
Seeing the problem
Thanks to recent developments in genetics, neuroimaging and the science of mental health, it’s becoming easier to characterize patients. New technologies may also make it easier to predict who is more likely to respond to a particular treatment or experience side effects from medication.

Our laboratory has used brain MRI studies to help unlock the underlying anatomy, chemistry and physiology underlying OCD. This repetitive, ritualistic illness – while sometimes used among laypeople to describe someone who is uptight – is actually a serious and often devastating behavioral illness that can paralyze children and their families.

Image: The Conversation
Through sophisticated, high-field brain imaging techniques – such as fMRI and magnetic resonance spectroscopy – that have become available recently,

we can actually measure the child brain to see malfunctioning areas.

We have found, for example, that children 8 to 19 years old with OCD never get the “all clear signal” from a part of the brain called the anterior cingulate cortex. This signal is essential to feeling safe and secure. That’s why, for example, people with OCD may continue checking that the door is locked or repeatedly wash their hands. They have striking brain abnormalities that appear to normalize with effective treatment.
We have also begun a pilot study with a pair of identical twins. One has OCD and the other does not. We found brain abnormalities in the affected twin, but not in the unaffected twin. Further study is clearly warranted, but the results fit the pattern we have found in larger studies of children with OCD before and after treatment as compared to children without OCD.
Exciting brain MRI and genetic findings are also being reported in childhood depression, non-OCD anxiety, bipolar disorder, ADHD and schizophrenia, among others.

Meanwhile, the field of psychiatry continues to grow. For example, new techniques may soon be able to identify children at increased genetic risk for psychiatric illnesses such as bipolar disorder and schizophrenia.

New, more sophisticated brain imaging and genetics technology actually allows doctors and scientists to see what is going on in a child’s brain and genes. For example, by using MRI, our laboratory discovered that the brain chemical glutamate, which serves as the brain’s “light switch,” plays a critical role in childhood OCD.
What a scan means
When I show families their child’s MRI brain scans, they often tell me they are relieved and reassured to “be able to see it.”

Children with mental illness continue to face enormous stigma. Often when they are hospitalized, families are frightened that others may find out. They may hesitate to let schools, employers or coaches know about a child’s mental illness. They often fear that other parents will not want to let their children spend too much time with a child who has been labeled mentally ill. Terms like “psycho” or “going mental” remain part of our everyday language.
The example I like to give is epilepsy. Epilepsy once had all the stigma that mental illness today has. In the Middle Ages, one was considered to be possessed by the devil. Then, more advanced thinking said that people with epilepsy were crazy. Who else would shake all over their body or urinate and defecate on themselves but a crazy person? Many patients with epilepsy were locked in lunatic asylums.

Then in 1924, psychiatrist Hans Berger discovered something called the electroencephalogram (EEG). This showed that epilepsy was caused by electrical abnormalities in the brain. The specific location of these abnormalities dictated not only the diagnosis but the appropriate treatment.

That is the goal of modern biological psychiatry: to unlock the mysteries of the brain’s chemistry, physiology and structure. This can help better diagnose and precisely treat childhood onset mental illness. Knowledge heals, informs and defeats ignorance and stigma every time.


Please rescpect them in their own dramatic life!

Attorneys representing some 12,000 mentally ill inmates filed a motion Tuesday asking a federal judge to require Illinois Department of Corrections enforce a 2015 settlement agreement reached in the case of Rasho v. Baldwin. 


what-life-is-like-in-a-prison-camp-in-the-dnr-body-Image ©

Thousands of Illinois inmates are asking a federal judge to take action and help resolve a “human rights disaster” they say is taking place inside state prisons.
Attorneys representing some 12,000 mentally ill inmates filed a motion Tuesday asking a federal judge to require Illinois Department of Corrections enforce a 2015 settlement agreement reached in the case of Rasho v. Baldwin.
In their motion, attorneys from three legal organizations – Equip for Equality, Uptown People’s Law Center and Dentons – claim IDOC hasn’t held up its end of that agreement, which required it to establish “a mental health system to facilitate timely, consistent, and individualized treatment.”
The class-action suit began in 2007 after attorneys claimed treatment of mentally ill patients within Illinois’ correctional facilities had devolved to the level of “cruel and unusual punishment.” They say Ashoor Rasho, whose name appears on the lawsuit as its lead plaintiff, had been isolated and restrained inside the Pontiac Correctional Center instead of receiving the necessary treatment for his depression and auditory hallucinations.
“If we stopped right now then the case would have been 10 years of work down the drain, because we still don’t have a functional and meaningful mental health treatment system,” Equip for Equality attorney Andrea Antholt said. “These are human beings, these are fathers and brothers and mothers and sisters and they need help.
“We have people being physically injured, emotionally injured – real life harm to real life people – and that shouldn’t be acceptable to anyone.”

Read the full motion here.
Attorneys mention the case of one inmate, referred to only using the pseudonym “Henry,” who began suffering from depression and hearing voices while in isolation at another Illinois prison. Following a failed suicide attempt in June, Henry spent the next three months placed on “crisis watch” inside a stripped-down cell without his “clothes or property.”
“During that three-month crisis placement, his treatment plan was never updated,” attorneys in the motion state. “Other than seeing the psychiatrist once, Henry received no mental health treatment while on crisis watches. The only interaction he had was a daily check-in by a mental health professional for a few minutes at his cell door.”
The initial suit dragged on for nearly a decade before the sides reached an agreement in December 2015. While IDOC has since made some changes – such as expanding staff training and constructing new mental health facilities – this week’s motion claims the department hasn’t implemented several of the required remedies.
A federal-appointed compliance monitor wrote in a May 2017 report that IDOC had “considerably improved” the quality of its mental health services. But he also noted “tremendous problems” persisting within prison psychiatric services, and found the department was noncompliant in several areas, including treatment planning and suicide prevention.
In a follow-up memo published last week, the same monitor referenced IDOC’s “continuing emergency” caused by a lack of psychiatric services for mentally ill inmates.
“I must reiterate that IDOC is in a state of emergency regarding its provisions of psychiatric care,” the monitor wrote.
Antholt said some of the noncompliance issues are rooted in staff vacancy issues. The settlement itself didn’t require IDOC to budget out new positions, rather it asks the department to fill existing spots that have gone unfilled.
Alan Mills, executive director of the Uptown People’s Law Center, said the department has also fallen behind on basic medication management and has a standing backlog of more than 2,000 psychiatric appointments.
“This is not sort of a theoretical, constitutional thing that they ought to be doing,” he said. “People are desperately suffering in there … We have a human rights disaster inside of our prisons right now.”
IDOC has already outlined its plan to cut that backlog down significantly by the end of the year. It has also expanded the time available to hold psychiatric appointments, authorizing employee overtime and additional clinics to be run during second shifts and weekends……



“The agency,” she said, “stands by its record.”
Follow Matt Masterson on Twitter: @ByMattMasterson

Andrew Rawlins: Prison mental health care criticised after inmate suicide

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Andrew Rawlins had struggled with mental health problems from an early age, his family said
The sister of a prison inmate who took his own life just 48 hours after being remanded in HMP Bristol says she “has no faith in the system”.
Andrew Rawlins, a father-of-one from Clevedon, had struggled with mental health problems from an early age.
His sister Katrina said he should have been cared for in a mental health unit rather than remanded in custody.
Avon and Wiltshire Mental Health Partnership NHS Trust said it was to review the way inmates are monitored.
Mr Rawlins was on bail over an alleged assault when he was arrested for walking naked to a supermarket and sent to prison.
His sister had tried and failed to have him sectioned, and said of the prison service: “They don’t help people who are ill really.”
Anxiety and distress
The 26-year-old was one of five prison inmates who killed themselves at HMP Bristol last year – the second highest number of any prison in England and Wales.
A record number of inmates took their own lives in prisons in England and Wales in 2016, the Ministry of Justice recorded.
It said there were 119 self-inflicted deaths – 29 more than the previous year and the highest number since records began in 1978.
The Howard League for Penal Reform said prison suicides had reached “epidemic proportions”.
Mr Rawlins was living with his sister and her partner Tom Turner in May last year when the couple became alarmed at his behaviour.
Ms Rawlins told BBC Inside Out West: “He started sending threatening messages to me, Tom and a few other family members. Just sort of lashing out at us all the time really.”
She was also concerned because he was using cannabis and had threatened to kill himself several times.
The couple called a mental health helpline and were told the quickest way to get him sectioned was to call the police.
“Nothing whatsoever was being done for him,” said Mr Turner.

Image caption
Katrina Rawlins said people who are mentally ill should be in hospital, not prison
“We were being passed backwards and forwards from the police and the mental health service saying ‘well if he’s using cannabis we’re not going to go near him’.”
Then one morning in July, the couple said he smoked “a large amount” of the drug before undressing and walking naked to a local supermarket.
After failing to obtain any help from mental health services, the couple called the police and he was arrested.
Mr Turner said: “We didn’t want him arrested but we had to get something done and that was our only option.
“They say to trust the system, but I’m sorry to say after all this I have zero respect for the way things are working with the mental health side of things.”
The arrest put Mr Rawlins in breach of bail conditions and he was remanded in custody at HMP Bristol.
Within 48 hours he had hanged himself. The inquest into his death found he had taken his own life whilst suffering extreme anxiety and distress.
Ms Rawlins said: “I have no faith in the system. People who are mentally ill shouldn’t be in prison, they should be in hospital.”
In another high-profile case, Callum Smith, 27, from Cheltenham was found hanged in his cell at HMP Bristol in March 2016.

Image copyright
Cullum Smith Family
Image caption
Callum Smith, 27, from Cheltenham was found hanged in his cell at HMP Bristol last year
He had a history of mental illness and was “paranoid and delusional” when he was remanded after threatening to burn down his mother’s house.
An inquest found his suicide was contributed to by a number of inadequacies and failings by the prison service while he was in custody…..