John Haggarty

Wait Time Impact of Co-Located Primary Care Mental Health Services: The Effect of Adding Collaborative Care in Northern Ontario

Objectives: In the shared care model, psychiatrists and physicians work in the same office areas, write their notes in the same casebooks, and can more rapidly exchange information about referrals and health conditions of their patients. We evaluated the impact of the introduction of a shared mental health care service, co-located with a primary care site, on wait times for mental health services in a northern Ontario city. Method: Chart reviews were conducted to examine a total of 3589 referrals for 5 mental health outpatient services (1 shared care and 4 existing services) from January 2001 to the end of June 2004. The shared mental health care service site was started in July 2001. Wait time was measured 6 months prior to and up to 3 years after the introduction of the shared care service. Results: The shared care site offered services more than 40 days sooner and also helped to reduce wait time on the nonshared care sites. After shared care began, the pre-existing, nonshared care services had wait times of about 13 days shorter during the 3 subsequent years. Conclusions: The shared care service maintained the lowest overall wait times, compared with the existing nonshared care services. The existing services experienced a decrease in the number of days waiting when the baseline wait time was compared with that of the following year.

Suicide among Inuit: results from a large, epidemiologically representative follow-back study in Nunavut

Objective: The Inuit population in Canadas North has suffered from high rates of death by suicide. We report on the first large-scale, controlled, epidemiologically representative study of deaths by suicide in an Indigenous population, which investigates risk factors for suicide among all Inuit across Nunavut who died by suicide during a 4-year period. Methods: We identified all suicides by Inuit (n = 120) that occurred between January 1, 2003, and December 31, 2006, in Nunavut. For each subject, we selected a community-matched control subject. We used proxy-based procedures and conducted structured interviews with informants to obtain life histories, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II diagnoses, and measures of impulsive and (or) aggressive traits. Results: Compared with control subjects, subjects who died by suicide were more likely to have experienced childhood abuse (OR 2.38; 95% CI 1.39 to 4.08), have family histories of major depressive disorder (P = 0.002) and suicide completion (P = 0.02), and have been affected by major depressive disorder (OR 13.00; 95% CI 6.20 to 27.25), alcohol dependence (OR 2.90; 95% CI 1.59 to 5.24), or cannabis dependence (OR 3.96; 95% CI 2.29 to 6.8) in the last 6 months. In addition, subjects who died by suicide were more likely to have been affected with cluster B personality disorders (OR 10.18; 95% CI 3.34 to 30.80) and had higher scores of impulsive and aggressive traits (P < 0.001). Conclusions: At the individual level, clinical risk factors for suicide among Inuit are similar to those observed in studies with the general population, and indicate a need for improved access to mental health services. The high rate of mental health problems among control subjects suggests the need for population-level mental health promotion.

Suicidality in a sample of arctic households

We investigated the association of suicidal ideation and behavior with depression, anxiety, and alcohol abuse in a Canadian Arctic Inuit community. Inuit (N = 111) from a random sample of households completed assessments of anxiety and depression, alcohol abuse, and suicidality. High rates of suicidal ideation within the past week (43.6%), and suicide attempts within last 6 months (30%), were reported. Ideation was more frequent among younger persons, whereas those favoring local native language were less likely to report a wish to die. Higher overall suicidality scores were associated with higher anxiety, and alcohol abuse, but not with depression or gender. Implications for future research are discussed.

Kurdish Refugees’ View of Politically Motivated Self-Immolation

Self-immolation has been used as a political tool by various oppressed groups, including Kurdish refugees. To examine sociodemographic correlates of the views on self-immolation, we carried out semi-structured interviews with 54 Kurdish refugees (18 women, 36 men). The majority of these refugees (74.1%) indicated that they did not expect self-immolations to help in obtaining freedom for Kurdistan. Their opinions on this issue were uniform across educational and occupational levels, gender, number of years since escape, and other socio-demographic variables, except age. Younger refugees were less likely to see self-immolation as politically effective. The belief in self-immolation was uncorrelated with the frequency of post-traumatic nightmares dealing with the escape from or persecution in Kurdistan.

Single-session therapy in outpatient mental health services: Examining the effect on mental health symptoms and functioning

ABSTRACT Single-session therapy is being implemented in a number of mental health settings to increase the accessibility and efficiency of services, despite limited evidence supporting its utility. This study evaluated a new single-session therapy program offered to adults at an outpatient community mental health clinic in Northwestern Ontario, Canada. The purpose of the study was to determine if clients’ satisfaction with the service and outcomes after attendance supported continued implementation of single-session therapy We hypothesized that after attending the session, clients would (1) be satisfied with the service, (2) experience a decrease in their symptom severity, (3) experience less impairment related to their symptoms, and (4) report improvements in their ability to manage their presenting problem. Participants (n = 109, 63% women, Mage = 38.95, SD = 13.96) completed measures related to their satisfaction with the service, symptom severity, impairment, and their ability to manage their presenting problem before the session, after the session, and at one-month follow-up. The majority of participants rated the session favourably, and experienced a decrease in their symptom severity and associated impairment after attending the session. Moreover, they reported improvements in their ability to manage their presenting problem in terms of the stress it has caused them, their understanding of the cause, their ability to cope, and their knowledge of supporting resources. The single-session therapy service also provided access to services sooner than traditional individual therapy within the clinic. The current findings support continued implementation of single-session therapy.

Disability and Psychiatric Symptoms in Men Referred for Treatment with Work-Related Problems to Primary Mental Health Care

The relationship between male sex and employment as barriers to accessing mental health care is unclear. The aim of this research was to examine (1) whether the clinical features of men referred to a shared mental health care (SMHC) service through primary care differed when symptoms were affecting them in the work domain; and (2) empirically re-evaluate the effectiveness of a SMHC model for work-related disability using a pre-post chart review of N = 3960 referrals to SMHC. ANOVA and logistic regression were performed to examine symptoms (Patient Health Questionnaire, PHQ) and disability (World Health Organization Disability Assessment Schedule, WHODAS 2) at entry and discharge. Men were RR (relative risk) = 1.8 (95% C.I.: 1.60–2.05) times more likely to be referred to SMHC with work problems than women. Having greater disability and more severe somatic symptoms increased the likelihood of a work-related referral. There were no significant differences after treatment. Problems in the work domain may play an important role in men’s treatment seeking and clinicians’ recognition of a mental health care need. This study is relevant because men are underrepresented in mental health (MH) treatment and primary care is the main gateway to accessing MH care. Asking men about functioning in the work domain may increase access to helpful psychiatric services.

Severe anorexia in an Amish Mennonite teenager.

the same pe riod, ir ri ta bil ity, hy per ac tiv ity, and dis trac ti bil ity gradu ally ap peared and wors ened, with out marked im pair ment of func tion ing. This pa tient had no his tory of a simi lar pe riod. Af ter 1 week of to tal in som nia, queti apine was dis con tin ued, and chlor pro maz ine 100 mg daily was re started. All symp toms dis ap peared in 1 week and did not re ap pear in the fol low ing weeks.