Newsletter No. 49

Is there an ‘Ice’ epidemic?
A recent article by Dr Brendan Quinn in IMPACT, newsletter of the Burnet Institute, Autumn 2015 posed the question, “Is Victoria facing an ‘Ice’ epidemic? Media reporting seems to suggest this but investigation shows otherwise.
‘Ice’, or crystal methamphetamine is an illicit, synthetically-produced stimulant. It acts on the body’s central nervous system, causing the release of monoamine neurotransmitters including norepinephrine, dopamine and serotonin. It is such a powerful influence on the neurophysiological ‘reward’ system that it becomes more important than the normal rewards of social life. The desired benefits of methamphetamine use include enhanced feelings of euphoria, wellbeing, self-esteem, alertness/wakefulness, increased libido and reduced appetite. However, adverse consequences of methamphetamine use include increased blood pressure, bruxism (teeth clenching, grinding), cardiac
arrhythmia, stroke and numerous psychological outcomes.
The enhanced purity of crystal amphetamine is associated with an increased likelihood of experiencing the myriad harms that can result from methamphetamine consumption in general (particularly as a result of more frequent and heavy use patterns), including:
 physical impairment such as acute injury/trauma, significant weight loss and malnutrition, dependence, and cardiovascular and cerebrovascular complications
 psychological co-morbidity such as anxiety depression, psychosis, insomnia and suicidality
 the transmission of blood-borne virus and sexually transmitted infections, including hepatitis C and HIV
 involvement in criminal behaviours.
However, the triennial National Drug Strategy Household Survey reported that during 2007- 2013, the percentage of people who had used any methamphetamine in the previous 12 months remained stable, accounting for around two per cent of all Australians. About 50 per cent of these individuals reported that ice was the main form of methamphetamine they had used in 2013, versus 22 per cent in 2010. The Illicit Drug Reporting System (IDRS) found that among Australians who inject drugs (PWID), recent ice use remained stable during 2012-2013 at around 55 per cent. Use of other methamphetamine forms (speed and base) decreased in this group. Lastly, among Australian ecstasy and related drug users surveyed for the Ecstasy and related Drugs Reporting System (EDRS), recent use of any form of methamphetamine dropped from 61 per cent to 50 per cent during 2012-2013. Recent ice use fell from 29 per cent to 23 per cent among this group.
Importantly, these findings suggest that there has not been a considerable uptake in ice use by non-methamphetamine users. Rather, it is likely that those already using other methamphetamine forms are shifting to ice. Such evidence of stable or declining patterns of methamphetamine use contradicts the media’s depictions of an Australian ‘ice epidemic’. Nevertheless, we are seeing indications of more prevalent methamphetamine-related harms in Australia, including increased numbers of ambulance call-outs and people presenting for treatment.
What is the best response to these changes?
Costly, stigmatising and ineffective population-wide approaches (e.g., the well- known ‘US Faces of Meth’ campaign) should be avoided. Rather, to adopt an evidence- based and non-sensationalistic approach, the following measures are needed :
 improving treatment pathways to address barriers to service utilisation for people who use methamphetamine.
 A focus on key populations (e.g., young people, people who inject drugs, men who have sex with men) for tailored treatment and harm reduction education.
 Improving access to sterile injecting equipment by expanding needle/syringe program opening hours, implementing vending machines in high-use areas, and distributing clean smoking paraphernalia through existing services (noting that selling and possessing ice pipes is illegal in some Australian states and territories, including Victoria). This will cater to the differing schedules and sleep-wake cycles of methamphetamine users and aid in preventing the spread of blood-borne virus infections.
 Continue education of frontline workers such as police and ambulance paramedics about methamphetamine use (eg., use contexts, patterns and related harms) and how to adequately address users’ needs.
The recent redevelopment of the Victorian drug treatment sector provides an opportunity to be more responsive to the needs of clients, including those who use methamphetamine. We must avoid inaccurate, stigmatising and scare-mongering depictions of drug use in the community, and focus on implementing evidence-based treatment and harm reduction initiatives.
Annual General Meeting
The AGM will be held on Wednesday 26th August 2015 at Pacific Rim restaurant in Albert Park. Pacific Rim is a Thai restaurant in Bridport Street at the corner of Ferrars Street, Albert Park. It serves excellent food at very reasonable prices.
The meeting will begin with a short business component at 7.00pm, prior to which the dinner orders will be taken. Dinner will be served at about 7.45pm, after-which Anne McLeish will describe developments that have occurred over the last two decades in out-of- home care for children in need of care and protection.
Although the restaurant does not require pre- payment or pre-ordering of food, it does wish to know how many people will be attending. If you are intending to come, please let me know by an email to
mawdsley@melbpc.org.au
PREVENTION OF MENTAL DISORDERS (Project 5)
MHYFVic advocates support for preventive mental health, particularly at the universal level because of its potentially greater public health benefit. Five approaches to mental disorder prevention for children and families are being researched in this MHYFVic Project. These are : (1) General health and welfare; (2) Promoting family functioning; (3) Enhancing pro-social participation; (4) Promoting realisation of potential; (5) Dealing with toxic events.
Task Five of this project targets the fifth of these issues. Other tasks will target the other four issues.
The MHYFVic approach was based upon the World Health Organization literature on prevention of mental health disorders. Another survey was described in the 2001 report of the USA Surgeon General on mental health which devoted a chapter to risk factors and prevention. It referred to many biological factors, psychological factors and the interaction between these that we would refer to as social factors.
The biological factors included not only the genetic and chromosomal disorders but exogenous causes such as very low birth weight, poor nutrition, lead and similar poisonings, brain injuries from trauma and infections like measles, rubella, syphilis and HIV, and pre-natal toxicity such as foetal alcohol syndrome and effects of other drugs including cigarette smoke. Many of these are avoidable and preventive measures are included in earlier tasks of the MHYFVic policies about general health and welfare (Prevention Project Task 1 on our website).
The psychological and social factors were in two broad groups – dysfunctional family life with its attendant attachment difficulties, and stressful life events. The dysfunctional family factors included discord, parenting deficiencies and antisocial conduct. Particular note was made of maternal depressive disorders and parental substance abuse. Preventive measures about these are included in earlier tasks of MHYFVic policies about promoting family functioning and pro-social behaviour (Prevention Project Tasks 2&3 on our website). Stressful life events included bereavements and separation losses, and maltreatment including physical, psychological and sexual abuse and peer pressures such as stigma and bullying. In the Australian context we could also add refugee detention. These are the main topics for Prevention Project Task 5.
Separation and loss The deleterious effects of separation and loss on children’s development is nicely summed up by Susan Hols on the pcavt.org website. The essence is that the risk to mental health should be recognized and appropriate counselling provided. In Victoria the issue is addressed by the Australian Association for Loss and Grief.
Suicide of loved ones. This is a special case of separation and loss combining not only the grief of the loss but also the potential guilt relating to fantasies of failure to prevent the death and stigma relating to the mental disorder.
Physical abuse The deleterious effects of physical abuse on children’s development vary greatly with the age of the child and the severity of the assaults, ranging from relatively minor injuries through to broken bones, hearing and eyesight damage, brain damage and permanent incapacity. In addition there may be significant personality, attachment, anxiety and depressive disorders including Post- traumatic Stress Disorder.
Child Protection Services are mandated to respond to identified abuse and neglect but in recent decades confine themselves to statutory legal processes and referrals, no longer undertaking therapeutic roles which are delegated to outside agencies. Client resentment of statutory intervention almost inevitably results in splitting of the “good guy” and “bad guy” roles, but this is now made concrete by organisational arrangements; the “bad guy” removing the children from the family is not the same person as the “good guy” offering counselling. However, even the acceptance of the latter may be rejected because of anger with the former, rendering the protective intervention relatively ineffective. Supervision and decision-making are separated from progress towards ‘good enough’ family functioning. Reintegration is more difficult to achieve and more difficult to monitor.
Sexual abuse Sexual abuse, like physical abuse, is seriously disturbing to children’s healthy development. It, too, has the Child Protection service mandated to respond to suspected cases of abuse. The processes of assessment and treatment are even more difficult and specialised. The prevention of sexual abuse is described in a program on the pcavt.org website. The essence is the provision of a family support system to promote positive parenting and a climate of open discussion that can safely explore sexual issues. The responsibility of adults in ensuring the safety of children remains paramount.
Psychological abuse Whilst psychological abuse is also included in the mandate of Child Protection Services, this
form of abuse is rarely the subject of intervention orders because of the difficulty in providing substantiating evidence. The exemplar of this abuse is bullying.
Stigma The damaging psychological effects of stigma on mental health, and possible ways of counteracting these effects, are considered in the MHYFVic Project “Impact of Stigma”. In strengthening our belonging to the “In-group” we reject the “Out-groups”. The essence of dealing with stigma is to reappraise the In- group to include some characteristics previously rejected. Education and self- awareness are key components.
Bullying Bullying may be one of the harmful components associated with stigma but is a toxic influence on mental health regardless of who is the victim. An excellent summary has been published by Essays, UK. (November 2013). Treatment Interventions For The Victim Of Bullying Psychology Essay. Retrieved from http://www.ukessays.com/essays/psychology /treatment-interventions-for-the-victim-of- bullying-psychology-essay.php?cref=1
Children of Parents with Mental Illness (COPMI) The COPMI website says that the risk of development of mental disorders in children of parents with mental illness ranges from 41 to 77% and that family interventions have the potential to reduce this risk by about a half.
Inappropriate detention of children The serious impact of detention on asylum- seeking children has been well documented. Professor Louise Newman’s 2014 Winston Rickards Memorial Oration (see MHYFVic website) dramatically highlights this. Australia has not needed to lock up previous waves of asylum seekers such as Vietnamese and Croatians, who were more than willing to await processing whilst accommodated in the community. The only difference today is in the mindset of the Government, and it is totally unnecessary and harmful. Community based assessment should be re-instituted as a humanitarian matter of urgency.
Conclusion The identification and early intervention into potentially damaging psychological stressors is a key factor in prevention of mental disorders in young people. Although Child Protection Services are mandated to respond to identified abuse and neglect, there are other unidentified barriers to overcome. Proposing appropriate mechanisms to identify and respond to such events will be among the tasks of this MHYFVic Project.
The process will be to gather information about best practice models, and publish this progressively on our website until it can be formulated into an advocacy policy for MHYFVic to lobby the authorities. The material for this project is still being accumulated. If you have any ideas to contribute or if you want to help to develop the project, please call me.
Project Coordinator : Dr Allan Mawdsley Contact on 0419 77 00 66 or
mawdsley@melbpc.org.au
References :
“US Surgeon General report on mental health : culture, race and ethnicity” Public Health Rep. (2001) Jul-Aug, 116(4): 376. PMC1497348.
Susan Hols “Effects of Separation and Loss on Children’s Development” accessed on pcavt.org 2015.
COPMI http://www.copmi.net.au/images/pdf/Resear ch/gems-edition-13-sept-2012.pdf
HISTORY CORNER,
1901 and 1917
I would like to propose a special series of events to commemorate the establishment in 1917 of the Demonstration Projects of the American Child Guidance movement. This philanthropically funded program is the cornerstone of the practices of all mental health professionals interested in working with families. I would like Victorian services to host local teleconferences with each of the American clinics as they currently exist, by presenting both current practice and on the history of the original clinic.
Clinics anywhere around the world could join as observers as say, practitioners of the Judge Baker clinic in Boston, exchange with Austin CAMHS, or the Jewish Board of Deputies clinic in New York interact with Members of Melbourne’s Jewish Taskforce against Domestic Violence, or Bouverie Family Therapists exchange with the Philadelphia Child Guidance clinic staff, recalling the days of Haley and Minuchin!
This may seem far fetched, but I think if we get working early, we can coordinate a very interesting international, yet local program, of learning and exchange. We owe a lot to the Harkness Foundation for funding these first clinics. The Harkness family was the far-less- well-known partner to the Rockefeller Foundation and Texas oil. The Harknesses funded the development of Child Guidance through their Commonwealth Fund.
The man who got the Harkness family involved was psychiatry pioneer from Johns Hopkins University, Dr Adolph Meyer. Dr Meyer and premier American psychologist of the time, William James, supported the formation of the Mental Hygiene Movement by the much forgotten Clifford Beers. From the formation of the movement, Meyer and James were able to influence the establishment of the First Presidential Conference on Childhood in 1909. That conference resolved to have social research on the question of whether delinquency was caused by social or biological factors. Healy’s research through the Illinois Institute of Psychopathic Research established the social origins of delinquency. By 1913, this had evolved into the establishment of the Child Welfare Association and the advocacy of Meyer for an intervention program (James died in 1910, having just completed his manifesto on American achievement: American pragmatism).
Meyer approached the Harkness family and received funding for the Demonstration programs of six Child Guidance clinics. The staffing of these clinics was based on the unit of research established by Healy: a medical doctor as diagnostician and treater, a psychologist as educational assessor and school liaison, and social worker as intake director, community liaison, and parent consultant. Of course, nobody knew what was really involved in any of these roles, but this was how Meyer implemented the dream of Beers for the Mental Hygiene movement: this was a great distortion.
In 1901, Beers was admitted to a mental asylum following the terrible loss by suicide of his brother. He found the conditions so inadequate and demoralizing that he felt moved to start a crusade against the inhuman treatment of such places. He reasoned that great changes had been made to physical health around the world by the Hygiene movement that saw broad scale implementation of sanitation systems. He felt that there needed to be a similar program for Mental Hygiene; whatever that might be! He wrote his story in The mind that found itself which was published with the launch in 1907 of the movement.
Beers engaged the leading psychiatrist and leading psychologist in his advocacy, but Meyer’s view of how to achieve mental hygiene through the eradication of delinquency removed most of what Beers had intended for his program.
So, in 2017, I would like to see Beers honoured and Child Guidance honoured. I hope the Victorian community of professionals can join in this project. Please contact me. MHYF Vic will write to the various services to request participation, but this provides an early warning for everybody.
Jo Grimwade
Mental Health for all! A report of the WFMH conference held in Lille, France, 28-30 April, 2015
The World Federation for Mental Health, founded in 1948, held the first International Mental Health Congress at the Lille Grand Palais. There were papers presented from over forty countries over the course of three full days.
We went with expectations that the conference would be focussed on illness prevention in family contexts, but actually it was mostly about the provision of services to groups more usually outside the reach of services and on provision of services earlier and in a more client inclusive way. Of course, early intervention and respectful inclusion of marginal groups helps prevent illness, but few papers focussed on programs that were only concerned with prevention.
The published aims of the congress were:
 To support an integrated approach to mental health globally
 To support the up skilling of primary care and promote the notion of “skill mix” in the delivery of mental health interventions
 To support joint psychiatric and primary care dialogue and training, and
 To support the implementation of the WHO Global Mental Health action plan. The first day introduced themes that were prevalent throughout: reduction of stigma, dual diagnoses (mental health and another; for example, children with brain trauma), and collaboration with carers and service consumers. The second day began with a special focus on stigma prevention and community education; as the day unfolded a large number of innovative approaches to particular syndromes or needs, across the world, were presented. The third day was a blend of many these issues with sessions focussed on brief presentations. We present below a sample of the sessions attended (a full list of abstracts was provided in USB form and this will be accessible through the MHYF Vic website).
Jo Grimwade presented a paper entitled; Behold, the four-headed professional! I outlined the mindsets of the mental health professional and how these get in the way of thinking about an active role in mental health promotion and mental illness prevention (this constitutes the fourth “head”; the others are Treatment, Education, and Research). Jo spoke a little of the work of MHYF Vic (Mental Health for the Young and their Families, Victorian Group) and of programs being conducted at the Cairnmillar Institute. The paper was well received: the reproduction of the PowerPoint slides can guide appreciation of the content.
One important paper on the topic of mental health promotion and governmental level advocacy for prevention came from Singapore. Porsche Poh, who was a WFMH Vice-President for SE Asia, presented the work of her agency: Silver Ribbon Singapore. Silver Ribbon began in the USA in 1993 as an initiative of jurist, Jean Singleton Leichty and
has been established in a number of US states and in countries across the world. The Singapore program is privately funded, but was launched by the President, S. R. Nathan, in 2006. The aim is to “stamp out stigma” involving collaboration partner James Cook University. The substance of the paper was to advocate for investment in mental health advocacy.
Dr Tine van Bertel, a Dutchwoman now at University of Cambridge, presented on the engagement of media in reducing stigma through the Anti-Stigma Program European Network (ASPEN). She aimed to
 Provide an overview of the role that traditional and new social media play in reinforcing or tackling stigma of mental ill health,
 Highlight the difficulties, complexities and challenges surrounding media reporting as well as personal, communal and corporate values and responsibilities in reporting and sharing messages on mental health, and
 Explore how media can positivity contribute towards destigmatizing mental- ill health, promoting metal health and social inclusion, and empowering and connecting people and communities.
Dr Bertel’s conclusion had ten premises about the use of media in mental health advocacy:
1. Targeted and tailored intervention for school groups, work groups, etc.
2. Intervene through all inclusive activities such as theatre, art, and sport
3. Openly talking about mental health: “dare to share, dare to care”
4. Direct contact between those of influence and those with diagnoses
5. Champions
6. Positive language usage
7. Use media to build capacity (Twitter and
Facebook can engage others in activities)
8. Ban insensitive and incriminating reportage
9. Invest in communities (so communities support those with mental health problems)
10. Endorse ethical frameworks with a rights- based approach: focus on “what unites us , not what divides us”
A follow-up paper by Dr Patt Franciosi reviewed the world-wide activities provided by affiliates in a variety of countries associated with World mental Health Day (10 October). During the course of the presentation, a Portuguese psychiatrist, received a WFMH award for the successful program entitled En CONTRAR+SE which used young people and music to encourage change in attitudes.
A paper of somewhat different focus was provided in a plenary by Bostonian, Professor Jeffrey Geller, who was one of the chairs of the congress’ scientific committee. The paper was entitled; Mental Health for All: an American view, but actually it was an exercise in affirming the knowledge base of mental health practitioners in the nineteenth century. Systematically, Professor Geller demonstrated that many of the current givens about psychiatric illness were well-known in the mid to late 19th century. As an amateur historian of mental health practices, I was particularly pleased to hear articulated basic understandings that might have directed our discipline’s development have been ignored and then rediscovered over one hundred years later.
Professor Geller commented that armed with these particular 19thC understandings:
 Living in society has stresses
 Organized psychiatry is need to
ameliorate symptoms and provide
rehabilitation
 War causes psychiatric casualties
 Those with mental health conditions have
shorter life spans
 Families can exacerbate to ameliorate symptoms
 Leisure and recreation is associated with good mental health
 National governments can support or defeat mental health reform
 Peers can provide valuable services With the addition of client inclusive practice, Geller asserted “we can change people’s lives”. Not rocket science, just an understanding of what history has told us!
A paper on eating disorders by American Family Therapist and Social Worker, Rebecca Cooper, built around her book, Diets don’t work, was encouraging as it supported an approach to these disorders that was not dominated by the Maudsley Model approach. Part of her argument was about the physical changes induced by the starvation routine of the sufferers. The US army, under Keys in the 1950s, undertook a study of healthy recruits and noted the effects on eating habits of semi- starved soldiers. The other important comment was that whatever therapy, eating disorders probably require nine months of treatment, while much funding was for twelve week programs.
A Portuguese psychiatrist presented on an outreach maternal mental health program. A Brazilian psychiatrist presented her work with family caregivers to mitigate the effects of mental illness and associated problems, including family violence. From Africa came reports of emergency room and suicide in Mozambique and mental health prevention and mitigation attempts in the prisons of Madagascar and Togo. Most commonly topics for childhood programs concerned autism or trauma. In all these papers, there was comment about unmet need, innovation, and under-resourcing.
An innovation to a Clubhouse International program involving inclusion of children and families (Child and Family Connections) in
Philadelphia, was very interesting. Clubhouses exist across the USA for people with mental health problems who want to find work and housing. These are locally funded, largely through community donations and most often are job-finding services with a social environment. This particular program has gone further by providing services to families with a job-seeking mentally ill person, to prevent the consequences of the illness causing disruption to the lives of the children and of the partners.
Amid the wide variety of papers, one further paper deserves special comment: a presentation by London-based Greek architect, Dr Evangelia Chrysikou. Dr Chrysikou has become a specialist in the design and renovation of psychiatric inpatient facilities. She spoke of the connection between building design and mental health that was noted by the ancient Greeks and then proceeded to present design principles for the modern building.
One always picks and chooses papers based on one’s interests and the reader of this report may infer interests in public education, advocacy, eating disorders, maternal health, early intervention, homelessness and unemployment among the mentally ill, children of parents with mental illness, and architecture. There were no reports on children in out of home care, except in the context of parental mental illness, or childhood trauma of another sort.
We were greeted warmly with Australian accents and found the whole event rather encouraging. Sadly, one of the real heroes of the field of mental illness prevention, Clifford Beers, was unknown to anyone. He started the Mental Hygiene movement in 1907, which was the precursor of the WFMH and of Child Guidance. We hope to change this lack of appreciation of this man’s work in coming years!
Merci beaucoup, WFMH!
Jo Grimwade(The Cairnmillar Institute) and Marell Lynch (Take Two, Berrystreet)
OUR UPDATED WEBSITE
After much thought our website has been significantly revised to give casual visitors immediate information about what we do and what we stand for, whilst at the same time allowing members to go straight to specific sections such as Projects or Newsletters or Events, without having to navigate past reams of information.
Now that the main revision has been implemented we are working on tasks of development of Projects to give us the evidence base for our advocacy. There are quite a few items under development at the present time which are not yet reflected in the website but over the next few months we expect to see a burgeoning of activity.
Visit us on mhyfvic.org
2014 MHYF Vic Committee
* President : Jo Grimwade * Vice-President : Jenny Luntz * Past President: Allan Mawdsley * Secretary : Celia Godfrey * Treasurer : Anne Booth * Membership Secretary:Kaye Geoghegan * Projects Coordinator, Kylie Cassar * WebMaster, Ron Ingram * Newsletter Editor, Allan Mawdsley * Youth Consumer Representative, vacant * Members without portfolio:
Suzie Dean, Miriam Tisher, Zoe Vinen, Sarina Smale