Schizophrenia

Schizophrenia is generally regarded as one of the most significant illnesses treated by mental health services. Its significance lies in the profound impact of the illness on sufferers and their families and friends. The illness is long term and treatment is usually ongoing. The person with schizophrenia may suffer relapses in the condition if medication is not continued.

What is Schizophrenia?
Schizophrenia is a disorder of the brain that interferes with thinking and judgement of reality, and may also affect a person’s mood, motivation and ability to relate to others. The causes are not fully understood but there are clear genetic factors coupled with triggers in the person’s environment such as personal stress or substance abuse. These circumstances can produce changes in brain chemistry, which give rise to the symptoms. The effectiveness of treatment varies from person to person. There is no “cure” as such, but medication and therapy aim to control or reduce symptoms. For about 50% of sufferers, they can, with support, maintain relatively normal lives in the community and have productive working careers and family lives. Others may experience episodes of relapse where severe symptoms re-emerge and may require periods of hospitalisation for a few weeks, disrupting their community adjustment.

Schizophrenia is a true illness with biochemical roots. There is no evidence that it results from poor parenting as was once believed.

Who can suffer from schizophrenia?
Schizophrenia typically first emerges in young adults. Both males and females are affected equally. Schizophrenia is diagnosed all over the world in all cultures and races. It is also present in all social class categories but there is some evidence that the inner-city poor are more vulnerable. The world incidence has been stable at about 1 in 100 for the past several decades. From the available data it is concluded that the Bermuda incidence rate is similar (1%). The risk is higher if others in the same family have had the illness.

Symptoms of schizophrenia
Schizophrenia can present with a wide variety of symptoms, not all of which are experienced by every individual. The first of three clusters of symptoms are the “psychotic” symptoms including delusions (false beliefs) and hallucinations (usually voices). These symptoms typically cause the greatest distress to the patient, who may feel threatened by people he believes are plotting against him. There are sometimes feelings of being controlled by others or of being capable of controlling other’s thoughts. The ”disorganised” symptoms include confused thinking and odd speech. Thoughts tend to be jumbled and people have difficultly in understanding the patient. The “negative” symptoms include lack of emotional expression, loss of interest or pleasure, and apathy. The loss of self-care skills and social withdrawal also fall in this category. This rather passive profile is much more common in our clients than the misleading Hollywood depiction of violence in people with schizophrenia.

Treatment
Antipsychotic medications form the first line of treatment. Significant improvements have been witnessed in recent years and modern (“atypical”) antipsychotics produce fewer and less severe side effects than traditional medications. This improvement in side effects has promoted greater adherence to prescriptions.

Psychosocial treatments assist in reinstating life skills. Emphasis is placed on social skills, activities of daily living, and vocational skills. A core goal of rehabilitation services is engagement of clients in meaningful activity such as “sheltered work” placements.

Individual and group psychological therapies are also employed to aid in symptom control, assist adjustment to novel circumstances, and helping the patient to identify and avoid relapse triggers.

Success in treatment depends on a supportive network of family, employer, friends, and clinical staff assisting the individual to achieve the greatest independence possible.

Met and unmet needs
People with schizophrenia in Bermuda are fortunate in having access to the full range of clinical services and professionals found elsewhere. More challenging is their access to affordable housing and suitable employment.

In cases where significant family support is not available, they often have difficulty in maintaining themselves. Recent changes in Financial Assistance regulations and reduced availability of Salvation Army Shelter beds pose further threats to them. These limitations in community resources contribute directly to patterns of homelessness, substance misuse, and petty crime for a subgroup of people with schizophrenia. This group then contribute to keeping our Courts, Prisons and hospital beds occupied on a rotating basis in a cycle, which is detrimental to the community and the individual.

In the past there has been active support from the Bermuda Schizophrenia Society and the Bermuda Mental Health Foundation and other charities. In recent years, this group of clients has lacked a vocal community advocate to press for better conditions. The professionals involved have restrictions on their ability to comment on politically sensitive issues. The need for revitalised advocacy support from the community is apparent.

How to get help
The first source of assistance for emerging symptoms of mental illness is usually the family doctor. After a screening assessment for other (physical) causes for the symptoms, the GP will normally refer to the Acute Community Health Clinic for psychiatric assessment and treatment. Once a diagnosis is made, the patient and his family will be offered further education on the nature of the illness and its treatments.

Family members and carers often benefit from the mutual support provided in the weekly Family Support Group. If a wider range of services is required, the patient may be referred on to the Community Rehabilitation services.

For further information on the illness or services available contact the Community Mental Health Clinic on 239-2261 or 236-5208.

Jeremy Lodge completed his postgraduate training in Britain and has been with Bermuda Hospitals Board for 26 years. He is employed as a clinical psychologist working with adults in both the Acute Mental Health Programme and the Rehabilitation Programme at St. Brendan´s Hospital.

8 October 2004 News

Substance Use

Human beings have used brain and mental state altering substances from the beginning of civilization. Alcohol was probably the earliest drug used, from accidentally consuming fermenting fruit and grain. There is archaeological evidence to indicate the early use of substances like cannabis, opiates and cocaine too. The consequences and costs of alcohol must have become apparent very early, as there is evidence of severe strictures against the use of such drugs in early human societies. The popular belief continues to hold that these substances provide joy and enhance one’s brain and mental functions, but scientific evidence has yet to indicate any substance which enhances our thinking, emotion, memory, perception, consciousness or behavior. All these substances alter our mental functions, but there is little evidence to suggest that they enhance such functions.

The most dangerous drug people use is tobacco. An estimated 1.1 billion out of six billion people in the world use tobacco, causing over 4.2 million deaths an year. Approximately 11, 000 die every day from disorders related to tobacco use. We have heard about the HIV/AIDS epidemic, the SARS epidemic but not about the tobacco epidemic. The World Health Organization estimates that every year tobacco use kills more than AIDS, tuberculosis, maternal deaths, accidents, homicides and suicides put together. It is the most dangerous consumer product ever produced.

Alcohol, the second most commonly used and abused drug, is freely available in almost all countries. A third of the entire world health care cost is spent to treat disorders arising from alcohol and tobacco use. However, unlike tobacco (even one cigarette is harmful), there is no evidence to suggest that drinking within sensible and safe limits poses a health threat. The World Health Organization and the Royal College of Psychiatrists (U.K.) suggest that a person should drink no more than one or two drinks (a glass of wine, a measure of spirits, half a pint of beer) in any day and to include a few days of abstinence each week. Pregnant women should not drink at all as there is considerable evidence that drinking alcohol during pregnancy harms the fetus.

Caffeine, the mild stimulant in tea, coffee and other cola drinks, is perhaps the only drug we consume with little or no adverse health and social consequences. However, if the consumption is high enough a person could become addicted to caffeine and often anxiety symptoms stem from excessive caffeine.

Cannabis (marijuana) is the most commonly used illegal drug and world wide there are about 140 million users of this drug.

The use of heroin is estimated to have doubled or tripled since 1985. The risk of death, particularly among users who inject the drug, is about 20 to 30 times higher than non-drug users in the same age group.

Cocaine and its derivative “crack” cocaine has seen a global increase. Traditionally, people in Andean countries in South America chewed the coca leaves for thousands of years. It was relatively recently in 1860 when the main chemical, cocaine was isolated and became more widely available. In earlier times it was used mainly as a painkiller, but in the 1970s and 1980s it became very popular with young people in western European and North American countries.

It is perhaps more relevant and useful to look at these drugs through their action on the brain and the nervous system rather than in terms of legal or illegality of use. The objective evidence is that all these drugs tend to affect the brain and consequent behavior in an adverse manner. The responsibility of parents and educational institutions in particular, and society in general, is to give the skill to its young people to decide on the most healthy course of action in regard to use of substances of dependence. People need accurate objective information about drugs and society has a responsibility to protect children from exposure to drugs before they gain the skill and knowledge to make an informed choice. Research has revealed that educational programs focusing on learning how to manage emotions do better in persuading young people from using (no ‘of’ here) drugs, rather than direct programs focusing exclusively on drugs.

Promotion of healthy life styles should be given priority both for young and adult populations. These will include eating balanced meals, regular exercise, regular sleep, being engaged in a range of recreational and relaxation activities, being part of a supportive and affectionate social network, gaining abilities to solve routine life problems and to plan one’s life goals.

Every government has a responsibility to formulate and implement a national alcohol and drug policy to ensure a reduction in both supply and demand of drugs in a given country. Policies must work towards reducing availability of drugs, both legal and illegal, while health and educational policies must promote a reduction in demand for drugs. Research has again shown such preventive measures tend to give better value for money than money spent on treatment. This is so because treatment of the drug and alcohol dependent person is very challenging and the results are often disappointing.

In Bermuda a range of treatment services are available for persons having drug use related problems through a service known as Turning Point based at St Brendan’s Hospital. These include both in-and outpatient services provided by a multi disciplinary team of therapists. Outpatient services are available on all weekdays during working hours. In-patient treatment is provided by a detoxification unit, which helps patients withdraw from a drug under safe conditions. A team of therapists provides both psychological and pharmacological interventions and assists clients with their social problems. Turning Point encourages and welcomes the involvement of family and friends in the recovery programs of its clients.

In addition to the services provided by St Brendan’s Hospital, some non-governmental organizations also provide residential care. Alcoholics Anonymous and Narcotics Anonymous are the other therapeutic agencies, which help people with drug dependencies.

The availability of a range of therapies for alcohol, tobacco and other drug use related disorders needs to be emphasized and with good engagement in a therapy program many can look forward to a drug free life. Whether your addiction is tobacco, alcohol, heroin, cocaine or cannabis (marijuana) one can quit using their drug of dependence. A person may need to attempt several times before succeeding quitting and hence the phrase “DO NOT QUIT QUITING”.

Dr. Edirimuni Rodrigo completed his training in Sri Lanka and England, and is now a consultant psychiatrist at St. Brendan’s Hospital.

8 October 2004 News

Learning Disability

The term ‘learning disability’ refers to a condition characterized by significant impairment in intellectual functioning. Individuals with a learning disability have difficulty understanding and learning new information, and generalising information to new situations. They also have limitations in two or more areas of adaptive skills, which may include communication, self-care, home living, social skills, self-direction, health and safety, basic schooling and work. These impairments and difficulties are present from childhood, and not the result of a head injury or accident.

Causes of learning disability include genetic factors, infection prior to birth, brain injury at birth, brain infections or brain damage after birth. Examples include Down’s Syndrome, Fragile X syndrome and cerebral palsy. However, in nearly one-half of people with learning disabilities the cause of the disability is unknown. A person’s deficits will vary depending on the nature and severity of their learning disability. Some people are able to lead independent lives with minimal support, while others are unable to look after themselves.

Learning disability used to be known as ‘mental retardation’ or ‘mental handicap’ in Bermuda and Britain, but is still referred to as ‘mental retardation’ in North America.

Mental health problems for people with a learning disability
A learning disability is not a mental illness. However, people with learning disabilities can experience the full range of mental health problems. In fact, mental health problems are more common among people with learning disabilities than in the general population.

Depression, manic-depressive illness and related conditions are the most common mental health problems experienced by people with learning disabilities, but psychotic disorders such as schizophrenia are also more likely in this population.

The degree to which individuals are disadvantaged or ‘handicapped’ by a learning disability is largely dependent on social and cultural factors. Historically, people with learning disabilities have been devalued and misunderstood. They commonly experience prejudice and stigma, repeated experiences of failure, and are often labelled or treated like children. All of these factors may contribute to psychological problems. Social consequences of the learning disability, such as having less control over their lives compared to their peers, and having difficulty finding socially valued employment, may lower self-esteem and contribute to the increased risk of experiencing psychological problems.

Identification and assessment of mental health problems
Identifying mental health problems in people with learning disabilities can be difficult. People with learning disabilities may not recognise their ´symptoms´ as a problem they should see a doctor about. In addition, depending on the severity of the disability, a person’s verbal skills may be limited or absent, making it difficult to communicate how they are feeling to family, friends, caregivers and/or doctors.

Family and caregivers play an important role in the assessment process by providing important background information and observations of changes in the individual’s behaviour and mental state. However, caregivers may not realise the significance of symptoms, or may not think the symptoms are severe enough to warrant medical attention. Some useful indicators are disturbances in appetite; sleep patterns, level of arousal, sexual behaviour, and interest in pleasurable activities.

Getting help
Treatment approaches with books, photographs, pictures or drawings may help individuals with learning disabilities recognize, understand and express their feelings better than words alone. For some individuals, treatment may need to concentrate on the quality of a person’s environment and their ability to interact with that environment.

Medical treatment may also be necessary, depending on the nature and severity of the problem. The prescribing doctor, usually the general practitioner (GP), will monitor the treatment’s effectiveness with regular appointments and will advise when to stop the medication.

If people with a learning disability (or their family members or caregivers) have concerns about their mental health, they can contact their GP, who may refer them to the Learning Disability Service at St Brendan’s Hospital (236-3770, ext. 3296) for specialist advice and help.

Robyn Montarsolo completed her postgraduate training in Australia and has been with Bermuda Hospitals Board for one year. She is employed as a clinical psychologist working with adult clients in both the Learning Disability and Turning Point Programmes at St. Brendan´s Hospital.

7 October 2004 News

CHILD AND ADOLESCENT MENTAL HEALTH

Children and adolescents, like adults, can have mental health concerns that interfere with the way they think, feel, and act. A person’s mental health influences their self-image, self-esteem, mood, energy, attention, and their interactions with the outside world. Mental health, like physical health, is important at every stage of life. When untreated, mental health concerns can lead to school failure, family conflicts, sexual promiscuity, drug abuse, violence, and even suicide.

Mental Health Disorders Are More Common in Young People than You Realize
When mental health concerns interfere with one’s daily functioning, impairing one’s ability to adequately work, socialize, or even meet their basic needs, then the concerns become a mental health disorder. Studies in the United States show that at least one in five children and adolescents have a mental health disorder. At least one in 10, or about 6 million people, have a serious emotional disturbance. A serious emotional disturbance refers to a mental health disorder that severely disrupts daily functioning in home, school, or in the community.

The Causes

Mental health disorders in children and adolescents are caused by a combination of biology and environment. Examples of biological causes are genetics, chemical imbalances in the body, damage to the central nervous system, such as a head injury, and the development of the child and adolescent’s brain. Research on teen brain development indicates that although teens feel ready to take risks, they are still learning how to think before they act.

Many environmental factors also put young people at risk for developing mental health disorders. Examples include:

– Exposure to violence, such as witnessing or being the victim of physical or sexual abuse;
– Exposure to emotional abuse and/or neglect;
– Stress related to chronic poverty and inadequate housing;
– Stress related to having a chronic illness;
– The loss of important people through death, divorce, or broken relationships and/or
– Exposure to environmental toxins, such as high levels of lead.

Signs of Mental Health Disorders Can Signal a Need for Help

Children and adolescents with mental health concerns need help. A variety of signs may point to mental health disorders or serious emotional disturbances in children or adolescents. Pay attention if a child or adolescent you know has any of these warning signs:

A child or adolescent often feels:

– Sad and hopeless for no reason, and these feelings do not go away,
– Very angry most of the time and crying a lot or overreacting to things,
– Worthless or guilty,
– Anxious or worried,
– Unable to cope with a loss or death of someone important over a prolonged period of time,
– Extremely fearful or having unexplained fears,
– Significant difficulty concentrating and unable to sit still for even short periods of time,
– Constantly over-concerned about physical problems or physical appearance, or
– Frightened that his or her mind either is controlled or is out of control.

A child or adolescent experiences big changes, such as:

– Showing declining performance in school,
– Losing interest in things once enjoyed,
– Experiencing unexplained changes in sleeping or eating patterns,
– Avoiding friends or family and wanting to be alone all the time,
– Feeling life is too hard to handle, or
– Experiencing suicidal thoughts.

A child or adolescent behaves in ways that cause problems, such as:

– Using alcohol or other drugs,
– Dieting and/or exercising obsessively,
– Sexually promiscuous behavior,
– Violating the rights of others or constantly breaking the law without regard for other people, or
– Doing things that can be life threatening or threatening to others.

Finding the Right Services Is Critical

To find the right services for their children, families are encouraged to seek information about treatments and services and obtain referrals from professionals such as general practitioners, pediatricians, school counselors and/or teachers. The “Helping Services” section of the blue pages in the phone book is also a helpful resource to find the appropriate service to meet your child’s needs. It is also a good idea to talk to other families, and do some research on family network organizations in your community, church and/or as advertised in the media.

We must remember that every child’s mental health is important. Mental health problems at any age are real, painful, and can be severe. The good news is that these problems can be recognized and treated, and that caring families and communities can work together to help.

For further information, please call Child and Adolescent Services at 239-6344.

Dr. Sandy De Silva is employed as a clinical psychologist working with young people between the ages of 4 and 18 years old at Child and Adolescent Services. She has been with Bermuda Hospitals Board for 2 years.

6 October 2004 News

CHILD AND ADOLESCENT DEPRESSION

What is Sadness versus Depression?

It’s not unusual for young people to experience “the blues” occasionally. Adolescence is always an unsettling time, with the many physical, emotional, psychological and social changes that accompany this stage of life. When a young person feels that he or she cannot meet the academic, social, or family expectations of others, they may feel rejected and disappointed. Many young people feel that life is not fair or that things “never go their way.” They feel “stressed out” and confused.

Depression is more than just “feeling blue.” Depression is also different from feelings of grief. It does not mean that one is weak. Children and teens with clinical depression cannot simply “snap out of it.” Depression is a health problem that impacts feelings, thoughts, and behaviors, and can appear as physical symptoms. Risk-taking behaviors, such as sexual promiscuity, aggressive behaviors, and substance use may occur to avoid feelings of depression.

What Does Depression Look Like?

Warning signs of depression in a child or adolescent include the following. These signs are often present for more than two weeks.

– Persistent sadness and/or anger.
– Feeling worthless.
– Falling behind in school.
– Withdrawing from friends or activities usually enjoyed.
– Low level of energy and fatigue all of the time.
– Talking about self-harm or suicide.
– Overly aggressive behavior.
– Substance abuse.
– Eating and sleeping patterns are disturbed.
– May have physical complaints, but there is no medical reason for the complaints.

How Young People Can Help Themselves

– Try to make new friends. Healthy relationships with peers are central to ones’ self-esteem and provide an important social outlet.
– Participate in sports, job, school activities or hobbies. Staying busy helps one to focus on positive activities rather than negative feelings or behaviors.
– Join organizations that offer programs for young people. Special programs geared to the needs of children and adolescents help develop additional interests.
– Ask a trusted adult for help. When problems are too much to handle alone, children and teens should not be afraid to ask a parent, family member, responsible friend, school teacher, or school counselor for help.

What Parents and Others Can do to Help

– Offer help and listen. Encourage children and teens to talk about their thoughts and feelings. Listen, don’t lecture.
– Trust your instincts. If it seems that the situation may be serious, seek prompt help.
– Pay attention to talk about suicide. Ask direct questions and don’t be afraid of frank discussions. Silence can be deadly! If you have serious concerns about this, call Child and Adolescent Services at 239-6344 during working hours or take your child to the Emergency Ward at King Edward Memorial Hospital after-hours.
– Seek professional help. Alert key adults in the child’s or teen’s life — family, friends, teachers, school counselors, and pediatricians or family doctors. These individuals can help to determine if the child or teen requires assessment and treatment by a mental health professional.

Dr. Sandy De Silva completed her postgraduate training in the U.S.A. and has been with Bermuda Hospitals Board for 2 years. She is employed as a clinical psychologist working with young people between the ages of 4 and 18 years old at Child and Adolescent Services.

6 October 2004 News

Bermuda’s Mental Health Awareness Week

Today is the first day of Bermuda’s Mental Health Awareness Week, an initiative to boost understanding of the prevalence of mental illness and to combat the stigma associated with it, particularly among the 16 to 24 year-old age group. Recent research has shown that there is a lack of understanding and awareness of mental illness in Bermuda, underscoring the importance of community education.

As the only psychiatric facility in Bermuda, St Brendan’s Hospital provides a full range of mental health care and services and serves approximately 600 outpatients per year. St Brendan’s covers all areas of psychiatry including acute general adult psychiatry, child and adolescence, rehabilitation, community care, extended care and the psychiatric sub-specialties of learning disability and substance misuse.

This article, the first of a week-long series, will illustrate the core services offered at St. Brendan’s. Subsequent articles will focus on specific mental health issues.

St. Brendan’s Hospital, part of Bermuda Hospitals Board, provides the following services:

Child and Adolescent Services
Child and Adolescent Services is a community mental health service for young people (4-18 years old) and their families. We provide interdisciplinary mental health assessments and treatment to young persons who are generally identified as having problems with psychiatric, emotional, behavioral, family, and developmental issues. Our clients are referred by parents, school counselors, physicians, and other community agencies.

Acute Mental Health Programme and Rehabilitation Programme
The Acute Community Mental Health Programme provides interdisciplinary mental health assessments and treatment to adult persons with mental health problems. Our clients are referred by physicians and other community agencies or may refer themselves. Clients requiring in-patient services are accommodated in wards in St. Brendan’s Hospital. For clients with severe and enduring mental health problems, the Community Rehabilitation Service can provide an ongoing programme of treatment and work experience.

Learning Disability
The Learning Disability Service is a hospital and community based service for adults (18 years +) who have a learning disability. Individuals with a learning disability have a significant impairment in their intellectual functioning in addition to deficits in two or more areas of adaptive/social functioning, which are present from childhood and are not the result of a head injury/accident, or following the onset of an illness in adulthood.

This service is a team of professionals who provide care and support for people with a learning disability. This involves conducting assessments to identify a persons strengths and needs, and implementing individualized plans to increase the autonomy and quality of life of people with a learning disability. We work closely with families and carers to help support them in their provision of care. Our clients are referred by family members, carers, schools, GP’s and other organizations within the community.

Turning Point
The Substance Abuse and Problem Gambling Service provides assessment and intervention for adults (18 years +) who have substance abuse or problem gambling issues. We also have a Detoxification unit providing in-patient detox treatment for drugs and alcohol. The service conducts assessments to identify a persons needs and implement individualized treatment plans. We work closely with families and other agencies to ensure each client is receiving the maximum support necessary to facilitate the treatment process. Our clients are self-referred, or referred by family members, GP’s and other agencies within the community.

All of the services described above are operated by multidisciplinary teams including psychiatrists, psychiatric nurses, clinical psychologists, social workers, family therapists, counsellors, occupational therapists, physiotherapists, and others.

When you contact the relevant service for your needs an intake worker will complete an initial referral. You or the person that you are referring will be assigned to the appropriate worker who makes a comprehensive assessment, which will determine your or his/her treatment needs.

For anyone receiving services at St. Brendan’s Hospital their insurance company is charged and there is no co-payment charged to the client. For clients without insurance, there is government subsidy for services incurred.

For more information or to make a referral, please call St. Brendan’s Hospital at 236-3770 for the appropriate services during normal office hours. For emergencies only, there is a helpline after-hours and on weekends, please call 236-3770.

Dr. Sandy De Silva completed her postgraduate training in the U.S.A. and has been with Bermuda Hospitals Board for 2 years. She is employed as a clinical psychologist working with young people between the ages of 4 and 18 years old at Child and Adolescent Services.

Dr. Maggie Cormack completed her postgraduate training in Britain and has been with Bermuda Hospitals Board for 3 years. She is employed as a clinical psychologist working with adults in the Acute Mental Health Programme at St. Brendan´s Hospital.

Robyn Montarsolo completed her postgraduate training in Australia and has been with Bermuda Hospitals Board for 1 year. She is employed as a clinical psychologist working with adult clients in both the Learning Disability and Turning Point Programmes at St. Brendan´s Hospital.

Jeremy Lodge completed his postgraduate training in Britain and has been with Bermuda Hospitals Board for 26 years. He is employed as a clinical psychologist working with adults in both the Acute Mental Health Programme and the Rehabilitation Programme at St. Brendan´s Hospital.

5 October 2004 News

STIGMA AND MENTAL HEALTH

In ancient Greece bodily signs or stigmata were cut or burned onto people’s bodies to mark them as different. Today we use the word stigma to refer to the attitude people often have about others who suffer from mental health problems. How often does the assumption we make about people change when we find out that they have schizophrenia, depression, mania or anxiety? We view people with mental disorders in a less favourable regard and negative fashion.

HOW CAN STIGMA ARISE?

Stigma arises in many ways. Sometimes people with mental disorders can behave differently or come to one’s attention more easily because of their manner and demeanor. Sometimes the effect of medication can be seen in their posture or by way of a noticeable tremor in their hands or fingers. Sometimes they may dress in an unkempt or bizarre fashion.

When we observe that people are different we often make judgments and these judgments can be negative and prejudiced. These attitudes about people with mental illness occur because we lack knowledge or education about these disorders. We hear our family and friends criticizing such people. We read negative and biased reports about mental health issues on the television news or in newspapers, and we watch people with supposed mental illness in television dramas or films being portrayed as dangerous, violent or “psychopathic.” This often leads us to develop assumptions about people with a psychiatric diagnosis, which are inaccurate and not based on fact.

For instance, many people believe that mental illness is a sign of weakness in an individual or as a result of laziness or a lack of will power. Some people think that sufferers should be able to just “snap out of it” and that it occurs because they don’t try hard enough.

Mental illness is not a sign of weakness; even the most robust and strongest of individuals have a 1 in 4 chance at some point in their life of developing a mental disorder. Other popular misconceptions are that people with mental health concerns are dangerous and out of control and are likely to attack. In fact they are more likely themselves to suffer from violence and assault because of their own vulnerability.

A person with a mental health disorder may be you, a family member, a friend, a neighbor or the person standing next to you in line at the grocery store. Mental illness does not choose whom to strike, but rather we are all vulnerable to endure mental health concerns due to a combination of the stress in our environments and our biological make-up. If your mental health concerns impair your ability to maintain daily functioning, then you need to ask for help. This is not a matter of shame or pride, but rather of quality of life.

Research around the world has shown that there are many myths and misapprehensions that develop in society about mental illness. As a result of this, those with mental health problems are frequently discriminated against. They are less likely to have employment or access to education, good housing, proper representation in the justice system, contentment, happiness, fulfilled and enriched lives, and so much more.

REDUCING STIGMA

So what can be done to reduce and eliminate the stigma that so many people with mental illness suffer from? Government, health care professionals and advocates of the sufferers around the world have begun to work to eliminate and change people’s attitudes.

Successful anti-stigma campaigns are ongoing in countries such as the United States, Canada, Britain and Australia. Educational sessions are held at schools, colleges, societies and clubs. Promotional fun days and rallies help the message to get across. Leaflets and educational materials are made freely available and distributed so that all members of society have access to information about mental illness. The media are encouraged to report and reflect on people with mental health issues without sensationalizing, over-exaggerating or stereotyping their stories.

In television, film producers, writers and actors are urged to show positive portrayals of characters with mental disorders. Indeed, story lines involving characters with mental health problems in two popular soap operas in Britain and Australia did much to change the view of the community in the late 1990’s in those countries.

So what can be done in Bermuda? It is true to say that stigma and prejudice continue to occur. Over the years, Mental Health Awareness Week has aimed to promote, inform and educate the public about mental disorders. This year the campaign is targeting young people. Young people are often most at risk of developing mental health problems, and are least likely to seek help or support when it is required. Young people are also likely to suffer the most from the stigma of mental illness.

We must all work hard to make stigma a thing of the past – the ancient past. It falls on all members of society to question prejudice, develop an open mind and to at least ensure that their actions do not hinder someone’s else’s attempt to lead their lives in a fulfilled, enriched and meaningful way.

Dr. David Price completed his training in England and has been with the Bermuda Hospitals Board for three years. He is a consultant adult psychiatrist at St. Brendan’s Hospital.

4 October 2004 News

St. Brendan’s Hospital Announces Mental Health Awareness Week ‘Changing Minds’ Campaign Encourages Residents of Bermuda to Examine Their Attitudes

St. Brendan’s Hospital today announced its Mental Health Awareness Week, which will run from October 4 to 9 in Bermuda under the banner of ‘Changing Minds’. The aim of this year’s campaign is to reduce the stigma that surrounds mental health, particularly among the 16 to 24 year-old demographic. An important component of the campaign will be the renaming of St. Brendan’s Hospital to reflect the entry in to a new period of increased understanding and acceptance of mental health issues in Bermuda.

Results of a recent public perception study indicate that Bermuda residents may not be adequately familiar with mental health issues, pointing to a need to boost understanding about the prevalence of mental illness and to remove the stigma associated with it.

“The sense of embarrassment and stigma associated with mental illness is a significant barrier to people seeking the help they need,” said Patrice Dill, director of St. Brendan’s Hospital. “Our goal is to help the community understand that mental illness is not a weakness, and that it can affect anyone, from any walk of life. We also want to let residents of Bermuda know that help is available.”

This year’s campaign will include presentations at Bermuda College; a book club lunch; a ‘day at the movies’ open house featuring films that deal with mental health issues; a series of articles by clinical psychologists appearing in various media publications and a careers fair at St. Brendan’s Hospital. For more information about specific events, please contact the Changing Minds hotline at 236-3770.

Changing Names
St. Brendan’s Hospital today renaming competition is open to members of the public aged 16 and over. Prizes will be awarded to the winner and two runners-up. For more information and entry guidelines, please call 236-3770 or visit www.bermudahospitals.bm. Deadline for submissions is October 15, 2004.

The name St. Brendan’s has been associated with psychiatric care in Bermuda since the 1800s. Care for people with mental health disorders, learning disabilities and substance abuse problems has improved dramatically over this period as a result of increased knowledge, well-trained staff, a move towards community care and new medicines.

“Mental health is an important issue in Bermuda. We encourage the community to take advantage of this opportunity to educate themselves about the various issues surrounding mental health,” said Joan Dillas-Wright, chief executive officer at the Bermuda Hospitals Board.

About St. Brendan’s Hospital
As the only psychiatric facility in Bermuda, St Brendan’s Hospital provides a high standard of comprehensive mental health care and services. St Brendan’s covers all areas of psychiatry, including acute general adult psychiatry, child and adolescence, rehabilitation, community care, extended care, plus the distinct services of learning disability and substance abuse. Forensic psychiatric services are provided to the prisons and consult liaison services are provided to the general hospital and social service agencies. Care and services are provided by an interdisciplinary, multi-cultural team of professionals.

St. Brendan’s Hospital has 130 inpatient beds, several community group homes and serves approximately 1200 outpatients per year. The hospital has been accredited for the past 25 years by the Canadian Council on Health Services Administration, and is recognized by the Royal College of Psychiatry as a training site for psychiatric resident doctors.

Supporters of this year’s Mental Health Awareness Week are Project 100, St. Brendan’s Hospital Amenities Committee, Bermuda College, Mental Health Foundation, Barritts, Butterfield and Vallis, Bookmart, Power 95, Hott 1075 and Mix 106.

30 September 2004 News

Bermuda Hospitals Board and Butterfield Bank Encourage Community to Take Advantage of Health Awareness Service

The Bermuda Hospitals Board (BHB), in conjunction with the Butterfield Bank Employee Shared Trust (BEST), is offering an awareness programme to educate the community about prevalent health conditions in Bermuda. Healthcare professionals from the BHB and community support organizations are available to give one-hour presentations to businesses, schools, church groups, parent-teacher associations or any group with 20 or more people. Interested parties are encouraged to contact the BHB’s Education Services Department at 236-2345, ext. 1569 to book a presentation.

“Awareness is key to disease prevention and treatment. We strongly encourage businesses, schools and other groups in the community to take advantage of this free service that offers information about prevalent health conditions in Bermuda,” said Bradlyn Deshields, Manager of Education Services at the Bermuda Hospitals Board.

BEST provided start-up funding to facilitate the presentations and to produce a community health education directory. The directory outlines prevalent health conditions and lists organizations that provide support and information for those living with the disease and their loved ones. This resource is widely distributed throughout Bermuda in health clubs, post offices, doctors’ offices, gas stations, etc.

“BEST is pleased to support this important initiative, and we hope that companies and community groups will take the opportunity to increase their health awareness,” said Butterfield Bank employee Daniel Cooke, Chairman of BEST. Butterfield Bank has taken advantage of the programme by holding a series of popular ´Wellness Lunch & Learn´ seminars for employees, covering topics such as diabetes, heart disease and asthma.

Experts are available to deliver presentations about Alzheimer’s disease, asthma, breast cancer, depression, diabetes, kidney disease, heart disease, HIV/AIDS, osteoporosis, prostate cancer, stroke or substance abuse. The following questions will be addressed in each presentation: What is this disease? How do you get it? How is it diagnosed? How is it treated? How can you maintain optimal health?

Several community support organizations are also involved in this initiative; namely: Allan Vincent Smith Foundation, Alzheimer’s Support Group, Family Support for Mental Health, Just Between Us/Reach to Recovery, Neverland Foundation, Open Airways, P.A.L.S and Star/Lighthouse.

Key Facts About 12 Prevalent Health Conditions in Bermuda

– Alzheimer’s disease is the leading cause of dementia in people over the age of 65. It is estimated that approximately five per cent of people in Bermuda over this age, and 20 per cent over the age of 85, are living with Alzheimer’s disease.
– Asthma is one of the leading medical conditions facing Bermuda residents. In 2002, 12 per cent of the population was diagnosed with asthma symptoms. Of these, 2,350 were under the age of 14.
– Improved screening practices are leading to earlier detection of breast cancer .
– Depression is a serious medical illness that negatively affects how one feels, thinks and acts. This condition affects approximately 6,500 Bermudians each year.
– HIV and AIDS are the third leading cause of death in Bermuda after cancer and heart disease.
– As kidney disease becomes more progressive, kidneys lose their normal function of cleansing the blood of waste products and extra fluids. If this goes untreated, end stage kidney disease and/or death can result.
– Osteoporosis is a silent, progressive disease in which bones become fragile and brittle and sometimes break with trauma. This disease is best treated if diagnosed early to prevent such fractures.
– Prostate cancer is the most common cancer in men. Its incidence rises with increasing age. It is more common in black males.
– In Bermuda, stroke is one of the major causes of long-term disability in the elderly. High blood pressure, diabetes and smoking all increase the risk of stroke.
– Substance abuse is a serious problem. A 2000-2001 survey by the Bermuda National Drug Commission found that, on average, drug use starts at age 14.

“The Bermuda Hospitals Board is proud to play a key role in this initiative. We are here to provide care to the community, and outreach programmes such as this one can go a long way toward raising awareness of diseases that affect many residents of Bermuda either directly or indirectly,” said Joan Dillas-Wright, Chief Executive Officer of the Bermuda Hospitals Board.

26 August 2004 News

BERMUDIAN PATIENT URGENTLY IN NEED OF MARROW DONOR Recruitment Drive at King Edward VII Memorial Hospital on October 1 and 2

Every day, 3,000 patients around the world search for potential bone marrow donors to become their “miracle match.” These patients (both adults and children) suffer from life-threatening diseases, and a bone marrow or blood stem cell transplant is their best chance for a cure.

Because marrow and stem cell transplants require matching certain tissue traits of the donor and patient, and because tissue type is inherited, a patient´s best chance of finding a matched donor is from his or her own racial or ethnic group. “Seventy percent of these children and adults will not find a match within their family,” says Elise Collins, Donor Center Coordinator at the Dana-Farber Cancer Institute. “These patients must turn to the unrelated donor registries to search for their miracle match.”

Diane Dismont, a patient from Bermuda, is one of many patients looking for their marrow match.

The members of Diane’s family were tested, but none was a perfect match for Diane. The family has initiated a search of the National Marrow Donor Program’s (NMDP) Registry of volunteer marrow donors.

In order to increase her chances of finding a lifesaving bone marrow donor, the National Marrow Donor Program at the Dana-Farber Cancer Institute in Boston, in association with King Edward VII Memorial Hospital (KEMH) and with funding provided by The Marrow Foundation, has initiated a recruitment campaign that targets the residents of Bermuda, especially those of African descent. Recruitment drives will take place on Friday, October 1 (12:30 pm to 6 pm) and Saturday, October 2 (9 am to 4 pm) in the lobby of KEMH. No appointments are necessary. Potential donors who register at this drive will also be joining the Registry in honor of Debria Evans– another Bermudian patient who, sadly, passed away recently before her matching donor could be found. These donors will have the opportunity not only to help Diane, but anyone in the world who identifies them as a match.

“We strongly encourage residents of Bermuda to volunteer as potential donors for this drive,” said Joan Dillas-Wright, chief executive officer of the Bermuda Hospitals Board. “This is a wonderful opportunity for the community to come together for an important cause.”

Volunteers must be eligible blood donors between the ages of 18 and 59, in good general health, free of all chronic diseases, and not excessively overweight. To join the NMDP Registry, volunteers will sign a consent form agreeing to enroll on behalf of a stranger, and have a small sample of blood drawn for testing. If you have previously enrolled at another drive, you do not need to reregister. Cash donations will also be accepted to offset the $65 per person cost of typing potential donors.

The NMDP is committed to its global mission to extend and improve life through innovative stem cell therapies. Through its extensive U.S. and international network, the NMDP maintains the world’s largest and most diverse Registry of more than 5 million potential volunteer marrow and blood stem cell donors, including more than 28,000 cord blood units. The NMDP also provides resources for patients and physicians, and conducts research to improve the outcomes of stem cell

transplantation. The NMDP has facilitated more than 16,000 transplants throughout the world for patients with life-threatening diseases such as leukemia and aplastic anemia, as well as certain immune system and genetic disorders. The NMDP offers searching patients who do not have suitable family donors a single point of access for all three types of stem cells used in transplantation: marrow, peripheral blood stem cells and umbilical cord blood.

For more information on marrow donation, please visit www.marrow.org.

Contact:

Kathleen Whalen
National Marrow Donor Program
Dana-Farber Cancer Institute
kathleen_whalen@dfci.harvard.edu
(617) 632-2571
www.marrow.org

23 August 2004 News