Friday, 27 December 2013

Penny Wise and Pound Foolish

Mayor Gregor Robertson and the Vancouver Police Department have appealed to the Provincial Government for help to deal with a mental health crisis overwhelming the city’s resources.  Robertson wants 300 new hospital beds to accommodate the growing street population of mentally ill individuals who are also addicted to drugs and/or alcohol.

Health Minister Terry Lake recently announced that his Ministry would be adding a nine-to-12 bed psychiatric assessment and stabilization unit at St. Paul's, plus two more Assertive Community Treatment teams (ACT teams), which include social workers, psychiatrists, nurses, addiction counsellors, police and outreach workers to help people discharged from emergency.

Everyone concerned who is attempting to deal with the crisis is missing one critical piece; The best time to avert a crisis is before it becomes a crisis.

The problem is that in North American, what is commonly called a “health care system” is in practice a disease management system.  With one in three Canadians experiencing a mental health disorder at some point in their lives and 21% of youth between the ages of one and 15 currently having a mental health disorder, the current mental health crisis is only going to get worse unless we change how we think about mental health care delivery in our nation.

We can start by including all qualified mental health practitioners in our medical services plans so people can access counselling and therapy before it leads to greater problems like self-medicating through drug or alcohol abuse, criminality, or suicide.  Too costly you say?  Here are some real numbers;

Statistics from the World Health Organization and the Canadian Institute for Health information tell the same story; Canada spends $50 billion annually managing mental health problems.  That amounts to almost 25% of the $207 billion we spend on health care across Canada.

Hospital stays for a mental health crisis do not come cheap; A person admitted to hospital for depression costs on average $17,081 per day; an eating disorder averages $16,831 per day; and obsessive compulsive disorder comes in at $8,384 per day.

Treatment for these disorders cost far less and allows the patient to remain in their community and often at work.

Let’s take one disorder that I am very familiar with and help people overcome it on a daily basis; Obsessive Compulsive Disorder (OCD);

According to 12 different studies conducted by the American Psychological Association, 83% of clients undergoing therapy for OCD were improved after an average of 15 sessions with a counsellor.  At $85 per session, that comes to $1,275.  Yet left untreated, our health care system shells out an average of $8,384 for each OCD hospital stay.  So even if treatment for OCD only reduced emergency hospital visits by one per person affected, that still reduces our health care costs for OCD by 84%.

By “opening the books” and allowing mental health appointement coverage through our medical plans, we can vastly reduce that $50 billion we spend each year on crisis management.  To ensure there is no abuse of  the system, we can stipulate that a patient is required to have a referral from their physician to be covered under their health plan.

Keep in mind that the cost savings wouldn’t be limited to the health care budget alone.  According to B.C. Deputy Justice Minister, Brent Merchant, people suffering from a mental health disorder account for 56% of the Canadian prison population.  Therefore, more than half of the $30+ billion spent in Canada for police, courts, and prisons is spent as a direct result of untreated mental health problems.

As a tax payer, if you truly want value for your tax dollar and want to free up resources that may impact you directly, get involved;
Doubting that the voices of a few people can bring about change?  Let me leave you with this;

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." ~ Margaret Mead

Aaron D. McClelland, RPC –

Thursday, 28 November 2013

The Good Monsters Revisited

Tap and Mercy are members of the

Bikers Against Child Abuse motorcycle group

in Saskatoon, Saskatchewan.

Photograph by: Gord Waldner , The StarPhoenix

I discovered today that the story link in my original post back in May about Bikers Against Child Abuse (B.A.C.A.) no longer worked.  I do think, however, that their story has to be told and retold because it says so much about child abuse, safety, healing, and caring.

B.A.C.A. was formed in 1995, spearheaded and founded by Chief (all B.A.C.A. members go by their road names) in response to hearing about an eight year old boy who was so frightened of his abuser that he refused to leave his home.  Chief recruited his biker buddies and befriended the boy.  Within weeks, the boy was again venturing out, riding his bike and playing with his friends.

B.A.C.A. has grown worldwide since then, including a Canadian chapter in Saskatoon, where Tap (seen above on the left) is the Chapter President.

B.A.C.A. members are real bikers, and some have a criminal past, but to become a member they have to pass a criminal record check and anyone with a history of child abuse or domestic violence is refused.  B.A.C.A. also has a strict rule that at least one of the members present with a child has to be the same sex, so B.A.C.A. has both male and female members.

B.A.C.A. prospects have to take training from approved child mental health professionals as part of their year-long indoctrination into the club.

When a child has been abused and is frightened, family members or guardians can call their local B.A.C.A. chapter who will then verify the abuse through the court system, police department, or social services agencies.  Once a child is accepted into the B.A.C.A. program, the chapter organizes a ride with all members rolling out to the child's home.

The child is introduced to the B.A.C.A. members and told who they are and what they do.  B.A.C.A. then gives the child their own kutte - a vest with a B.A.C.A. patch on the back and the child's new road name embroidered on the front - they are then patched in as a member of the club.  Unlike most motorcycle clubs that require members to wear their kuttes with pride, child members can choose to wear them or not - some not wanting to due to the stigma of having been abused.

In Saskatoon at the membership ceremony, B.A.C.A. members each hug a teddy bear and it is given to the child who is told that the bikers have put their love and caring into the bear, and when they're scared, they can hug the bear and feel that love and caring and know that their biker brothers and sisters are there for them.

But it doesn't stop there.

The child is then given two bikers as their own and is given their cell phone numbers and told they can call on them any time, day or night.  Those bikers belong to that child for as long as the child wants.

Assigned B.A.C.A. members are called upon to fill many roles; sometimes it's simply a matter of riding their bikes past the child's home at bedtime - their Harley's thundering past, letting the child know that they are there for them always.

B.A.C.A. members have been called by children to spend time with them when they are home alone while their parents are at work; to walk them to school and home again; even to escort their school bus on their Harleys.  At times B.A.C.A. members will stand on guard outside a child's home all night to help them feel safe.

But perhaps the most important duty B.A.C.A. members have is to be with the child for any court appearances.  If a child has to testify against their abuser, B.A.C.A. members form a protective circle around the child and escort them to the witness stand.  They will then fill the front row of the courtroom and tell the child to look at them, not at their abuser when they testify.  Once the child is finished testifying, B.A.C.A. again forms a circle around the child and escorts him or her home.

"When a child is in a courtroom, their monster is in there with them." Tap told a reporter outside the Saskatoon courthouse in May, 2013, "But with us there, the child thinks 'I have my own monsters and mine are bigger and meaner than you are'."

If an abuser continues to harass or intimidate a child, B.A.C.A. members will organize a ride to the abuser's neighbourhood where they will post flyers and visit all the abuser's neighbours, explaining who they are, what they do, and why they are there.

Despite the biker stereotype, B.A.C.A. has a strict non-violence policy.  If an abuser ever confronts a B.A.C.A. member, their policy is to walk away.  That is of course, so long as the abuser doesn't try to hurt the child.

"We're kind of like barbed wire around the child." Tap said, "And if you try to get to that child ... well, you figure it out."

One of the most important things an abuser steals from a child victim is their sense of safety.  B.A.C.A. gives that safety back.  But B.A.C.A. gives more; acceptance of the child as a valued person; validation that what happened to them WAS a big deal and; that it wasn't their fault.

For more information on Bikers Against Child Abuse, drop by their website at Bikers Against Child Abuse International - Breaking the Chains of Abuse.

And next time you pass a biker, flash him wave - he (or she) might just be one of the good monsters.

Aaron D. McClelland, RPC -

Tuesday, 12 November 2013

Who Are The Stigma Villains?

This one is mostly for my colleagues – and yes, I’ll be pointing some fingers.

There is an international movement afoot to reduce the stigma surrounding mental health issues with the endgame being that people who are facing mental health problems can seek help without fear of being judged, marginalized, or vilified.  One such movement in Canada is Partners For Mental Health of which I am a member.

A recent exchange on a forum for mental health practitioners illustrated for me that one of the largest and most powerful populations perpetuating the stigma around mental health issues are counsellors and therapists themselves.  That’s right, I’m looking at you Counsellor.

Here’s the breakdown of the problem;

Far too many mental health professionals oppose the use (even the existence) of the Diagnostic and Statistical Manual of Mental Disorders which is now in it’s fifth edition (DSM-V).  They rail against it, claiming it labels people, transforms psychiatrists into shills for the large pharmaceutical companies, etc.

A few years ago I was diagnosed with Type II Diabetes after my physician compared the list of my symptoms and the results of blood tests with the diagnostic criteria for Type II Diabetes.  I was then gradually prescribed various medications and dosages plus a change in diet until my Diabetes became manageable.

Was I “labeled”?  Some people try to when they say; “Oh, you’re a diabetic.”  And when they do, I am quick to correct them; “No, I have Type II Diabetes.”  Just like a person with a mental health disorder such as schizophrenia isn’t a “schizophrenic”, they are a person who has schizophrenia.

Mental Health practitioners who vilify the DSM-V and the diagnosing of mental disorders are responsible for intensifying the stigma of mental health problems.  By protesting against the DSM-V and against diagnoses, they are saying that a mental health diagnosis is a bad thing – that it labels a person and makes them a social pariah; someone to be shunned.  That a diagnosis is something to be avoided at all cost.

I have a very dear friend who spent most of her early teen years deeply depressed, barely surviving three serious suicide attempts, and withdrawing completely from society.  She believed that she was flawed, that she couldn’t ever be like other people, that there was no hope for her.  She was finally (and properly) diagnosed with Complex Post-Traumatic Stress Disorder, and when she learned what it was and how it happened to her, AND that it was treatable, she was profoundly relieved.   These symptoms that had driven her to want to die weren’t her – they were the result of something that had been done to her.  By being diagnosed and beginning treatment, she could separate who she was from what the CPTSD was trying to turn her into.

The DSM-V is a tool, nothing more.  Like any tool, its value lies in how it is used.  I can use a wrench to fix your car or to damage it.  If someone misuses a tool and causes damage, it isn’t the tool’s fault.

The DSM-V is used to diagnose mental health disorders for a number of reasons;
  • To create a starting point for effective treatment by educating practitioners on the nature of any particular disorder
  • To allow individual practitioners to determine if they have the skills to treat this person or refer them on to someone with specific expertise in that area
  • To allow extended health plan administrators to justify authorizing the adequate number of sessions to treat the disorder

So, to my colleagues who continue to vilify the DSM-V and diagnoses in general; apply some critical thinking to what the end result of your ranting will be.  It just might convince someone like my cherished friend that getting diagnosed is a bad thing and could result in them ending their life.

And that would be a tragedy.

Aaron D. McClelland, RPC –

Sunday, 27 October 2013

The Walking Dead

A Tale for Hallowe'en ...

A young man sat patiently in a South African clinic awaiting his turn to see a doctor.  His mother had brought him to the clinic after he began to act strangely during a vacation away from their home in Scotland.  The young man was recovering from a motorcycle accident and his mother thought a vacation in a dry climate would do him a world of good.

When his name was called, the young Scotsman wearily rose and shambled slowly into the exam room and stood listlessly, his eyes dull, his hands limp at his sides.  When the Doctor entered and asked the young man what the problem was, he lifted his vacant eyes and without expression met the Doctor's gaze.

"I'm dead." the young man proclaimed with as much sincerity he could muster with his monotone voice, "I died of septicaemia after my accident and now I am in hell." 

"How do you know you're in hell?" asked the puzzled Doctor.

The young man looked out the window at the sunbaked landscape, "The unbearable heat." he said, "And it looks like hell."

"But your mother brought you here today.  Does that mean she is dead and in hell as well?''  the Doctor asked.

"No." said the young man, "I borrowed her spirit to show me around hell.  She is really at home in Scotland, asleep in bed."

The young man believed he had become one of the walking dead.


Yes, and what's more; it is a true story, embellished to be sure, (I'm only guessing at the actual conversation), but true none-the-less.

In January of 1990, that young Scotsman did travel to South Africa with his mother while recovering from a motorcycle accident and had become convinced that he had died and was now in hell.  And he was not the only one to ever have the syndrome.

It's called Cotard's Delusion, Cotard's Syndrome, or sometimes Walking Corpse Syndrome.

In 1880, during a lecture in Paris, a French neurologist named Jules Cotard first described the syndrome, calling it déliire de négation (negation delirium).  It is a rare condition and people who experience it hold the delusional belief that they are indeed dead, do not exist, or are putrefying.

Cotard's Syndrome is thought to result from a disconnection between the fusiform part of  the brain (the region that allows us to recognize faces) and the limbic system (the cluster of brain organs where emotions arise).  If these two regions are disconnected, when the patient looks at themselves in the mirror they do not recognize themselves, nor do they experience any emotions when viewing their own or any other person's face.  With that lack of recognition and emotion, the patient concludes that they are no longer alive.

Treatment for Cotard's Symptom includes medications (antidepressants & antipsychotics) that are sometimes administered along with electroconvulsive therapy.

Developing Cotard's Syndrome would truly be a nightmare, and a real one.

Aaron D. McClelland, RPC -

Wednesday, 2 October 2013

A Surprising Little Grief

I discovered the television series Breaking Bad a few months ago and spent the summer catching up on the first four and a half seasons in preparation of watching the last episodes as the story drew to a close.  Like millions, I became a fan of the main character Walter White - the meek Nobel Prize winning high school chemistry teacher who, when diagnosed with stage three lung cancer, begins to cook methamphetamine to make enough money in the time he has left to provide for his family.  Walter “breaks bad”, but for a good cause; he has a wife to support and two children to put through college.

Spoiler Alert:
Early on, as Walter discovers that with his knowledge of chemistry and his meticulous nature, he and one of his ex-students, Jessie Pinkman, cook a type of meth that has a purity of over 96% - a feat unheard of in the drug world.  In addition to the purity and potency, his unique formula produces a clear product with a blue tint that sets it apart from all other meth and makes him and his recipe a hot commodity.  However, as Walter is drawn into the drug trade, he finds himself repeatedly being used as a pawn.  Walter comes to the realization that he has to take the initiative to guide the course of his own life.

We know from the outset of the series that the treatment Walter undergoes for his cancer will at best only prolong the inevitable. Even when he goes into remission, we know that his cancer will one day return and he will eventually die.  And Walter knows it as well.

As Walter journeys deeper into the crime world he creates the persona “Heisenberg” (named after a German physicist) and takes charge of his destiny.  Along the way, as Heisenberg, Walter lies to his family, betrays and manipulates his partner, causes literally hundreds of deaths, and commits some gruesome crimes.  But through it all, along with millions, I found myself cheering for Walter; for the first time in his life he was taking risks and was succeeding.  For the first time - ironically as a dying man - Walter felt truly alive.

In the final season his cancer came back as predicted, his web of lies collapsed and his crimes impacted everyone around him.  Yet still we cheered for him, right to the bitter end.

When it came at the end of the final episode, Walter’s death was a poetic one - he had come to grips with his own reality after almost a year of soul-searching while hiding out under an assumed name.  His final act was to set things as right as he could; he took his revenge on people who had wronged him, provided for his family, and freed his ex-partner Jessie from a life of living hell.

Walter’s death came peacefully in the end, to the strains of Badfinger’s 1972 hit “Baby Blue” - originally a love song written for a girl named Dixie, but now forever etched into the minds of Breaking Bad fans as Walter’s swan song.  For Walter, “Baby Blue”, was the blue meth he created and made world famous - the accomplishment he loved simply for the pure chemistry.

The final scene of Breaking Bad and Badfinger’s song were ever present in my mind for days after watching the finalé.  I repeatedly asked friends and colleagues if they were Breaking Bad fans and if they’d watched the final episode.  I spent three fruitless days trying to find someone to talk to about it.  No one I met had.

I began to question why it was important for me to find another fan and talk about Walter’s death and the answer I arrived at surprised me.

I was grieving.

I suppose I still am, and this column is my way of eulogizing Walter White.  To pay tribute to a man who touched my heart.  It doesn’t matter that he was a fictional character and his story was a make-believe crime drama; on an emotional level, Walter was real.

I miss Walter.  I miss cheering him on through his seemingly insurmountable struggles.  I miss the passion he gained for life through the knowledge of his impending death.  I miss him as though he were a dear friend now lost to me, and my search for someone to talk to about it was a desire to grieve openly, to talk about the emotions the song “Baby Blue” now elicit, and to hear someone say; “I miss him too.”

Grief can find us on any level.  From the death of a loved one, to the loss of a treasured memento, and even in the death of a fictional character.  And no matter how small that grief may be, it’s an important process for us; it reminds us we are human and we make connections that enrich our lives and the loss of those connections make us sad.  Yet at the same time, grieving renews hope and appreciation of what remains to us.

When we experience a loss, we must grieve, we must hurt, and we must say goodbye - each of us in our own time and in our own way.

Goodbye, Walter.  I miss you.

Aaron D. McClelland, RPC -

Sunday, 4 August 2013

It Begins With The Breath

To understand the importance of breath in recovering from anxiety, one first has to understand the brain and the function of its parts.

Anxiety, or fear, originates in two areas of the brain.

The first is the Limbic system where, in addition to helping store emotional memories, the amygdala - (about the same size and shape as an almond) - is constantly on the lookout for danger.  Working with the hippocampus, the amygdala compares everything we see, hear, smell, taste, and feel with significant memories of everything we’ve ever experienced.  When it finds a match and the match is labeled as a danger, the amygdala triggers a fear response, preparing the body for flight or fight by activating the release of epinephrine (adrenaline), cortisol, and other chemicals into our system.

And the thing about the amygdala is, it has no cognitive ability, meaning it can’t think and has no sense of time, and being so, it can’t tell the difference between a real current threat or an old memory or nightmare.  That’s why telling yourself you shouldn’t be anxious rarely works.

The second area that fear originates from was discovered by research conducted at the University of Iowa; Fear and panic in humans with bilateral amygdala damage  (2013 - Feinstein, et al).  Their investigation indicated that fear could be induced in persons whose amygdalae were damaged by having them breath an air mixture with low oxygen and high carbon dioxide – and it worked by producing intense fear in people who had never felt fear before.  As one test subject said of the experience; “it was the number one, worst feeling ever.”  This fear reaction takes place in the brainstem, and is a response to a lack of oxygen within the complex Autonomic Nervous System (ANS).  Basically, the ANS detects a lack of oxygen in the bloodstream and sends the fear message that the body is dying.

By looking at these two systems and the body’s reaction to anxiety/fear, one can see how low grade anxiety, originating in the amygdala, can trigger a full out panic attack, launched by the ANS; As we begin to feel anxious, our breathing becomes more rapid and shallow.  Less oxygen reaches the lower part of our lungs and the bloodstream becomes starved for oxygen and polluted with carbon dioxide.  Muscle cells in our body send signals to our ANS and the ANS escalates the moderate anxiety to a full panic attack.  It becomes a cycle of fear that is overwhelming.

Pretty scary stuff.

Through two complimentary systems; the Sympathetic Nervous System (SNS), which is responsible for the fear response, and; the Parasympathetic Nervous System (PNS), which calms things down, the ANS controls respiration, heart rate, blood pressure, blood flow, body temperature, et cetera.  Of all the functions the SNS and PNS control, that control can only be overridden consciously in one area: respiration.  We can control our breathing to speed up or slow down, to be shallow or deep.

And this is where breathing comes in as part of treatment for anxiety and anxiety disorders.

While the SNS might be gearing up for a knee-shaking panic attack, we can counter its effects by practicing measured diaphragmatic breathing, also known as “belly breathing”.  Instead of drawing air into the lungs by expanding the chest, we draw air deep into the lungs by pushing the belly out and pulling down on the diaphragm.  The technique I teach my clients is to breathe in through the nose to a slow count of five seconds while expanding the belly, hold for one second, then blow it out through the mouth as though they were trying to blow the seeds off a dandelion – again, for about five seconds.  The reason for this is twofold; Not only does it draw oxygen rich air deep into the lungs, it also pushes out the carbon dioxide that has pooled in the bottom of the lungs.

In addition to feeding the body the oxygen it needs, it also activates the PNS which reacts to the slower breathing rate and starts to calm other things down by lowering the heart rate and blood pressure, dilating blood vessels, et cetera.

You can try it right now by repeating this measured diaphragmatic breathing method three times. By the end of the third slow, measured, deep breath, you should start to feel it in your body – often as a warming sensation in the large muscles.

In my practice as a Multimodal Therapist, I can employ a wide range of therapeutic approaches so long as they have proven efficacy, and given the positive research into breathing, Mindfulness, and Yoga, I integrate one or more of these when treating clients with anxiety issues to address their symptoms.

Of course, therapy doesn’t end there; once a client has their anxiety under some level of conscious control, we can then begin to explore where the anxiety originates from and choose a treatment plan to address those origins.

Aaron D. McClelland, RPC –