Tag Archives: mental health

Getting our daily dose of “Vitamin G”

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Last September, over 200 participants took part in a unique forum in Vancouver to discuss nature and health – more specifically, the impact of spending time in nature on health, and the contribution of parks and protected areas to healthy communities. The forum sought to share knowledge, foster linkages between diverse sectors, and to identify best practices, strategies, and tools.

One of the things discussed by presenters and attendees was how people intuitively know that being in nature, simply put, makes them feel good. Whether getting a dose of ‘Vitamin Green’ helps to relieve stress, lift the spirit, or provide a bit of perspective on life, getting out into nature seems to contribute to enhanced wellbeing. While everyone intuitively understands this, our reductionist North American tendencies have had us questioning how and in what ways nature has this effect on health for the past decade or so. Well, good news for those of you scientific folk out there (you know who you are!) – the quantitative evidence supports a nature-health link. Our intuitive selves have been right all along! As discussed by keynote speaker Dr. Frances Kuo, research has linked healthy urban ecosystems to stronger, safer neighbourhoods, lower crime, reduced AD/HD symptoms, and reduced aggression, with benefits still being found even when income and other factors that could explain a nature-health link are taken into account. Additional quantitative evidence exists at the physiological level as well, with benefits having been measured objectively through such indicators as blood pressure and immune system functioning. For a comprehensive review of the literature, check out this National Recreation and Park Association report written by Dr. Kuo.

So now the evidence is there to prove what we kinda knew all along. What’s next? Well, at an individual level, we can all get outside more. If you’re like the bulk of urbanites, you may not be close to mountains, lakes, and forests (although a shocking number of us here in B.C. actually are – not to rub it in, Toronto). Forum presenters actually addressed this, and made it clear that nature can be found anywhere – a nearby park or stream by your house, a patch of trees outside your work – and even the smallest exposure to nature has been found to be beneficial.  In addition, urban planners and health professionals have been starting to act based on this ever-growing body of evidence. For example, some physicians are now prescribing time in nature to their patients.

Getting past the urban/nature divide may take some work ... but it can be done

It’s clear that to address this at a population level, an interdisciplinary approach is needed, with health professionals, urban planners, and environmental specialists being just a few of the disciplines who need to be at the table to ensure that all Canadians have access to diverse and regular sources of nature. If this forum is any indication, these various disciplines are ready and willing to come together to focus on this in creative and holistic ways.

 

 

Rendezvous with Madness

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Last night I attended the Rendezvous with Madness film festival. I was invited by a friend in the final year of her psychiatry residency that was on the panel following the film screening.  It is the second time in a couple of weeks that I was at an event that had a focus on mental health. The other was at the Excellence Canada Performance Summit that I attended on behalf of a colleague. It had a session on mental health at work. These types of events and discussions are part of a longer-term trend of better understanding mental health and how to integrate dialogue about it into our community rather than hiding it away, sometimes literally (see this great Active History paper on how the stories of those in Toronto’s insane asylums, who used to be hidden behind walls they help build).

The session at Excellence Canada offered examples of how workplaces across the country are taking steps to better address metal health as part of their workplace health and wellness programs that have more traditionally focused on physical health. The activities and topics covered were broad reaching during the discussion, including identifying risk factors in organizations, employee access to benefits when experiencing mental illness, and approaches for how organizations can help their employees cope with challenges and stress in the workplace. The Bell Mental Health Initiatives was one of the projects covered. It is a $50 million commitment to enhancing the lives of Canadians by increasing awareness, understanding and treatment of mental illness across the country by focusing on anti-stigma, care and access, workplace and research. When large corporations like Bell are undergoing a paradigm shift with mental illness (or at least want to brand themselves as having done so), it is a good indicator of how far we’ve come.

The Rendezvous with Madness Film Festival is another indicator. The festival has been around for 19 years. The film I saw was “People in White” and told the stories of psychiatric patients through reenactment with other patients (and a handful of actors representing the stories of real patients. It showed the complexity of the doctor-patient relationship and raised questions about power dynamics and treatment method. It opened a discussion about how realistic these relationships were depicted and how dramatically things have changed in the couple of decades since the festival started, including that such a film that focuses on the stories of patients never would have been told until recently. The venue for the film screening was Workman Arts, an organization dedicated to working with artists with mental illness and promoting art that creates greater understanding of mental illness. It was inspiring to hear how far this project has come and how they have observed and reflected the changing perceptions of mental illness.

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Masthead photo courtesy of floodllama

Mandatory Fortification: the good, the bad and the scary

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In 1998, the Canadian government mandated folic acid fortification of certain food products in Canada – namely, all white flour and enriched grain products. This, in theory, is fantastic. Folic acid (a synthetic form of the B-vitamin folate) is necessary for proper neural tube development, which occurs early after coFolic-cereal-boxnception when most women are still unaware they’re pregnant. Subsequent data, 11 years onwards, shows seemingly successful results: since fortification became mandatory, neural tube defects (such as spinal bifida) have declined in Canada by approximately 50% (Canadian Journal of Public Health, 2009).

Now, one would think that when introducing such a large-scale, population level intervention, one would do their homework. Such questions as, ‘Is there a risk if one has too much folic acid? How will folic acid quantities be regulated once in the food supply? Who will be responsible for such regulation?’ come to mind. What is fairly disturbing is that, until recently, the actual amount of folate in Canadian food has been unknown. A recent report (Shakur et al, 2009) published in the Canadian Journal of Public Health is, as far as the researchers are aware, the first direct assessment of actual folate amounts in the Canadian food supply. It found that label values did not accurately reflect actual amounts of folate in foods – and were on average 50% higher than the stated value. This wouldn’t be such a concern if having too much folic acid didn’t pose a health risk. Problem is – a growing body of literature seems to suggest it may. Consuming high levels of folic acid has been found to mask Vitamin B12 deficiency, increase cognitive impairment in seniors, and increase insulin resistance in unborn children. A recent report in the Globe and Mail cited some new research suggesting high levels of folic acid may accelerate cancer growth in at-risk individuals.

As concerning as these findings are, what’s even more troubling is the current call in Canada to increase the level of folic acid fortification, with the aim of reducing neural tube defects a further 25%, without any further research into potential health risks.

Compare the Canadian government’s approach to fortification with that of England’s, who currently do not mandate folic acid fortification: recently confronted with calls to institute mandatory fortification, England’s Chief Medical Officer has delayed making a final decision until the risks and the benefits have been carefully researched and weighed.

Undeniably, folic acid is incredibly important for proper neural tube development in unborn children. And, as this occurs very early in pregnancy, it does make sense to fortify the general food supply with it in order to ensure women who may not be taking supplements or getting adequate amounts do. However, the Canadian government has the responsibility to research and weigh all of the risks and benefits of instituting such a large-scale intervention before it is introduced, and properly monitor levels in a timely, scheduled, and scientifically sound manner.

In Health,
Michelle Amy Burtnyk

Expanding the Grey

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Diversity is underappreciated.

What’s that you say, but we love diversity. Heck, we’re lowermainlanders, (those of us not off plundering the rich bounty of the sea anyway) we’re all about that stuff.

On the surface that may be true, we celebrate lunar New Year alongside Robbie Burns day. We appreciate the different smells, flavours, and the rich patina of a multicultural landscape. What we don’t seem to truly appreciate is mental diversity.

It’s not that we don’t recognize the breadth in our varying capacity to learn, cope, empathize, love, and generally thrive amongst our peers. The issue is that we have created a divisive atmosphere focused on the extreme. We built a black and white landscape where we’re either gifted or handicapped, and thus celebrated or medicated.

I’ve been thinking about this a lot recently, partially because of the rough waters in the k-12 community.

The B.C. Labour Relations Board has ruled that not administering FSA tests amounts to illegal job action, yet a substantial number of parents and teachers oppose the tests. Part of the problem is the tests don’t properly account for diversity in the classroom.

We’re not just talking social diversity here, but the breadth in maturity and capacity to thrive in a traditional learning environment.

There’s a whole grey area that comes into play between gifted learners and those with significant challenges. Our resources go to coping as best we can with those on either end of the spectrum, while to a great extent those in the great gray are ignored.

This mirrors life outside the k-12 community as well. In order to get support people are pushed to align themselves with one extreme or another.

There aren’t a lot of groups or programs dedicated to helping average people succeed, which is leading to the diagnosis and treatment (which all too often means medication) of ever slighter variances from the norm.

Feel awkward in social settings?
It’s not that while being told you were a unique snowflake during your formative years you found yourself amid a sea of indistinguishable yet equally unique snowflakes. Find the right diagnosis and you can be medicated for your pervasive developmental disorders.

Worried to the point of exhaustion?
That’s not because your education and upbringing didn’t equip you with adequate coping mechanisms for the realities of an uncertain future. It’s an anxiety disorder and you need TCAs and SSRI

I’m not trying to say that we shouldn’t strive to recognize and address mental illness. I’m sure each and every one of us has seen or felt the effects of mental illness at some point in our lives. I’m saying we should appreciate mental diversity as we appreciate physical and social diversity.

Those of us that are awkward, nervous, or prone to worries need patients, caring, and appreciation for what we bring to the table.

A complex grisaille.

So expand the grey. Find beauty in its complexity, and opportunities to help all of us who exist within its gauzy borders to thrive. After all, grey is a common companion to us landlubbing lowermainlanders for the better part of the year.

-mikeB

Mental Health and Community

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It’s an ongoing struggle trying to figure out how we, as a community, can take care of our most vulnerable citizens. For a while, those with disorders and addictions were sheltered in among their relatives. Then we institutionalized it all and put the onus on governments. Nowadays, neither the institutions nor, often people’s relatives, seem to be capable of taking care of folks.

That has left a gap, which has spawned the Downtown Eastside and all its sad consequences.

One of the best ways of helping people to become more healthy is to connect them to healthy role models, neighbours, services, and community. Despite NIMBY protests that are sure to arise, its important to ensure folks who need help are integrated into healthy communities. That’s right Kerrisdale and Dunbar.

Only once we start accepting our most vulnerable (and often most difficult to handle) neighbours back into our community can we really build a place that’s a real model on “diversity”.