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The concept of schizophrenia is coming to an end, here’s why

Aug. 2017

The concept of schizophrenia is dying. Harried for decades by psychology, it now appears to have been fatally wounded by psychiatry, the very profession that once sustained it. Its passing will not be mourned.

Today, having a diagnosis of schizophrenia is associated with a life-expectancy reduction of nearly two decades. By some criteria, only one in seven people recover. Despite heralded advances in treatments, staggeringly, the proportion of people who recover hasn’t increased over time. Something is profoundly wrong.

Part of the problem turns out to be the concept of schizophrenia itself.

Arguments that schizophrenia is a distinct disease have been “fatally undermined”. Just as we now have the concept of autism spectrum disorder, psychosis (typically characterised by distressing hallucinations, delusions, and confused thoughts) is also argued to exist along a continuum and in degrees. Schizophrenia is the severe end of a spectrum or continuum of experiences.

Jim van Os, a professor of psychiatry at Maastricht University, has argued that we cannot shift to this new way of thinking without changing our language. As such, he proposes the term schizophrenia “should be abolished”. In its place, he suggests the concept of a psychosis spectrum disorder.

Another problem is that schizophrenia is portrayed as a “hopeless chronic brain disease”. As a result, some people given this diagnosis, and some parents, have been told cancer would have been preferable, as it would be easier to cure. Yet this view of schizophrenia is only possible by excluding people who do have positive outcomes. For example, some who recover are effectively told that “it mustn’t have been schizophrenia after all”.

Schizophrenia, when understood as a discrete, hopeless and deteriorating brain disease, argues van Os, “does not exist”.

Click link to read full article

Single phone number to access support services

29 June 2017

Health Minister Jonathan Coleman says from today a new free 24/7 four digit phone and text number will make it easier for people to connect with mental health and addictions professionals.

“It’s important that we talk about our mental health and wellbeing with our friends and family, but it’s equally as important that there is professional support available when we need it,” says Dr Coleman.

“Need to talk? 1737 is free to call or text from any landline or mobile phone, 24 hours a day, 7 days a week."

It’s a new and easy way to access the existing National Telehealth Services provided through the Alcohol and Drug, Depression, and Gambling Helplines. These helplines will still be accessible through the same phone numbers, but 1737 creates a new front door.

“Research shows that four digit numbers are easier to remember, and that they can attract a wider range of people who may feel other specific lines are not suited to their needs."

“The same trained mental health professionals who currently respond to calls, texts, webchat and emails across the existing National Telehealth Service mental health and addiction helplines will be on hand to support people who call or text 1737.

“In line with international trends, here in New Zealand we’ve also seen an increase in demand for mental health and addiction services in recent years."

“We know that around 47 per cent of New Zealanders will experience a mental health issue during their lifetime – and one in five will meet the criteria for a mental health diagnosis in any given year."

“To help address this, the phased implementation of the Early Mental Health Response service continues."

“Once it is fully implemented across the country the Early Mental Health Response service will give NZ Police and Ambulance staff the option to transfer 111 callers who need non-urgent social or psychological support to a 24/7 mental health nursing team for assistance."

“Budget 2016 invested $12 million over four years into the initiative which is currently operating with Police north of Waikato and will be fully implemented by the end of 2017.”

The new 1737 number and the Early Mental Health Response service are part of a much larger work programme focused on modernising our mental health and addiction services. Budget 2017 committed an extra $224 million over four years into this area, including $124 million in new innovative approaches. Cabinet will soon consider a new mental health strategy, which will further outline the Government’s new approach.

Sweet Charity Op Shop Opening 12th May 2017

Two non-government organisations have banded together to take funding into their own hands, as the pool of money from Government and philanthropists dwindles.

The Grief Centre and Supporting Families in Mental Illness and have banded together to create a third charity to generate income.

Supporting Families in Mental Illness general manager Emma Dore said the charity she manages works with families of people affected by mental illness.

While the Grief Centre provides support, counselling, advice and resources to those affected by loss or grief. Together, they've created Sweet Charity.

Access to nature reduces depression and obesity, finds European study

Trees and green spaces are unrecognised healers offering benefits from increases in mental wellbeing to allergy reductions, says report.

People living close to trees and green spaces are less likely to be obese, inactive, or dependent on anti-depressants, according to a new report.

Middle-aged Scottish men with homes in deprived but verdant areas were found to have a death rate 16% lower than their more urban counterparts. Pregnant women also received a health boost from a greener environment, recording lower blood pressures and giving birth to larger babies, research in Bradford found.

Court of Appeal Upholds DHB's Smoking Ban

Last week the Court of Appeal dismissed a challenge to Waitemata District Health Board's (WDHB's) smoke-free policy.  The policy prohibits smoking on any WDHB premises, including in mental health intensive care units (MHICUs) where patients are unable to leave the premises and smoke off-site.
The policy was challenged by a former psychiatric patient who argued that the policy was unlawful as it was inconsistent with the New Zealand Public Health and Disability Act, and that it breached his (and other patients') rights under the New Zealand Bill of Rights Act (NZBORA).
The Court of Appeal disagreed, finding that the total smoking ban imposed by WDHB on all hospital sites was lawful, represented a reasonable response to a pressing social need to reduce the incidence of smoking and second-hand smoke, and was consistent with the requirements of good medical practice.  It also found that the policy did not breach the rights and freedoms provided for in the NZBORA. Read Update.

The Problem Gambling Appeal - the Court of Appeal's turn

2016 will see the Ministry of Health challenge the High Court's ruling against the Ministry's decision in respect of its procurement of problem gambling services. The Ministry filed a Notice of Appeal in the Court of Appeal in August last year, following the Problem Gambling Foundation's successful judicial review of the Ministry's decision to award the major problem gambling services contracts to providers other than the Foundation.  The case is important because it demonstrates that the courts will enforce the Government Rules of Sourcing and any rules that are contained in an agency's Request for Proposal document.  If a government agency fails to comply with the requirements set out in the Rules of Sourcing and its own procurement documents, it runs the risk of its procurement decisions being successfully judicially reviewed.  For further coverage of the High Court decision see our legal update.

Better protection of our vulnerable children

The various changes and initiatives introduced by the Children's Action Plan and the Vulnerable Children Act will continue to be phased in during 2016.  For many health and disability providers, the most significant change is the new requirement to carry out safety checks on staff who work with children.  The requirement to safety check new "core children's workers" came into force in July last year and the requirement will extend to encompass all new "children's workers" in July this year.

Changes to the Coroners Act - a new and improved system

Following an extensive review process, the Coroners Amendment Bill has now had its second reading and is due to come into force in July 2016.  The proposed changes are wide ranging, but from a health provider perspective, a key change will be the new qualification on the requirement to notify when a death occurs while a patient is undergoing medical or surgical treatment.  Under the amended Act, notification will only be required when the death is also "medically unexpected".  Other significant changes include reduced restrictions on suicide reporting, requirements for organisations to provide written responses to Coroner's recommendations (see the supplementary order papers), and a new ability to direct a preliminary (non-invasive) inspection of a body before a full post mortem. 

Fifty years in the making - a new compulsory treatment regime for substance addiction

Following a Law Commission Report and extensive consultation, the new Substance Addiction (Compulsory Assessment and Treatment) Bill was introduced into Parliament in December 2015.  The Bill is intended to replace the Alcohol and Drug Addiction Act 1966 and provides a new regime for the compulsory assessment and treatment of people with substance addiction.  Notably, in order to impose compulsory treatment under the Bill a person must not only be considered to have "severe substance addiction" but their capacity to make informed decisions about treatment must also be "severely impaired".  The Bill also expressly recognises that compulsory treatment must be a last resort, only to be used when voluntary treatment is unlikely to be effective.  Indications are that the Bill will proceed through its first reading and on to Select Committee in early 2016.

Vitamin D status linked to severity of schizophrenia

Recent research shows that schizophrenia is caused by a neurodevelopmental defect that disrupts early brain formation. Vitamin D possesses neuroprotective properties, with some research indicating that healthy vitamin D levels may be an essential component for healthy neural development and function. Due to the presence of vitamin D receptors and the enzyme required to activate vitamin D (1-alpha hydroxylase) in the brain, researchers hypothesize that vitamin D may work locally in the brain to influence proper development.

The research on this topic has only just begun. Current research indicates that low vitamin D levels during the prenatal period and early childhood are significantly linked to schizophrenia. One small study found vitamin D status is significantly associated with schizophrenia. Since the study consisted of such a small sample size, researchers wanted to know if they could replicate these results in a larger sample, further illustrating the potential role of vitamin D in schizophrenia.