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Proactive mental health care for children of parents with mental disorders called for

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A Queen’s University professor is the lead author of a new paper advocating for better mental health care for children of parents with severe mental illnesses.

Anne Duffy is a psychiatrist and professor in the university’s psychiatry department who has spent 25 years researching the genetic, biological, psychological and social factors involved with the link between children living with parents with mental illnesses such as depression, bipolar disorder and schizophrenia, and those children’s high risk for developing mental illness themselves.
Now, Duffy and her co-authors are using their latest published research, which points to decades of research data, to make recommendations on how to address what their paper describes as a “largely overlooked population” of children of parents with mental disorders who are “at high risk for reduced well-being and poor mental health.”
According to cited research, 55 per cent of youth whose parents suffer from a severe mental illness are at risk of developing a mental disorder before the age of 27, as well as facing “reduced well-being and increase psychosocial and academic problems.”

Duffy worked alongside scientists, clinicians and experts from 37 different countries to produce the paper, which was published on July 20 in the online journal Nature Mental Health.

“This is an international consortium of experts from complementary disciplines who got together, and we wrote this evidence-based review and call to action to advocate for proactive support and services for children at familial risk of severe mental illness,” Duffy told the Whig-Standard on Monday.

“One of the most robust risk factors for a mental disorder is having a family history, so having a parent with one of those disorders: major depression, bipolar disorder, schizophrenia,” Duffy said. “Currently, the way our system works is we take patients as individuals; we don’t base this on the family. If an adult comes in with schizophrenia, other than child-protection issues, we don’t ask routinely about the children and their mental health, and we don’t track them.”

Duffy said that currently in Canada and other places in the world, children would have to present as symptomatic themselves to access their own services.

“We’re sort of seeing this disconnect between the adult and the children services, and also, shouldn’t we be incorporating monitoring the mental health of these children at high risk as proactive prevention and health promotion, being mindful not to stigmatize or over-pathologize, because a lot of the kids are well?”

According to the paper, studies have been able to identify high-risk children of parents with severe mental illnesses who could benefit from proactive surveillance and early intervention efforts.

The many years of research that has led to Duffy and her co-authors’ paper has allowed them to formulate recommendations for policymakers, including Duffy’s 25-year-long Canadian Institutes of Health Research-funded study identified as Flourish, following children at risk of bipolar disorder due to having a parent with that disorder.

Duffy’s Canadian high-risk offspring bipolar study has worked to map biological and psychological risk factors and genetic determinants in the quest to understand the onset of bipolar disorder.

“It’s been a hugely successful study around the world,” Duffy said. “When I came to Queen’s, I was able to get a further grant, and we were able to improve individualized risk prediction looking at models of predicting for individuals based on their own family and personal history, what their risk wold be in the next one to five years. That wasn’t to scare anybody, but it was meant to empower families and patients, young people, so they can make good choices for themselves.”

Queen’s is launching a parallel research program for university students, looking at common mental disorders in post-secondary students.

That research and more has informed the recently published paper, as well as the recommendations that its authors are making to policymakers.

“We’ve reviewed the current evidence and we’ve distilled that into specific recommendations about a developmental approach,” Duffy said. “We advocated that the next steps would be through striking a working group, say through the (World Health Organization) or a similar organization, to organize a standard for supporting care for children at familial risk of severe mental illness. We’ve pretty much clarified from our perspective the next steps.”

The paper puts forward five recommendations, beginning with the creation of a task force of multidisciplinary experts, stakeholders and families on an international level to develop guidelines for supporting children’s well-being.

Further, the paper recommends that new training for psychiatrists and new mental health care pathways for children be developed, and then that academics, health-care providers, research communities, funding agencies and stakeholders be engaged to support both children and their parents through a number of initiatives and resources.

“If there was a recognized importance of asking about and tracking the mental health of children of these patients who are already identified in the adult psychiatric system, for example, that would be a really good starting place (and lead to) more collaborate work between adolescent and adult services in psychiatry (and) in community mental health,” Duffy said.

While faculty at universities like Queen’s have historically been well positioned to help inform the development of clinical practice, Duffy believes there is room for improvement.

“We certainly need to do more of that,” she said. “It’s getting the right people around the table. Hopefully, if this is an identified priority with those involved with planning out care, then hopefully they would invite us to the table. … We really do need to get back to the table. We’re currently not at the table, and I don’t know what’s happened. I think there was a different political philosophy in Ontario, and then there was COVID. We really need to have the experts around the table with the politicians in order to be pragmatic and translate the findings into evidence-based care, but also to show the cost-effectiveness of this to the taxpayer.”

Duffy said there are many things that can be done today to mitigate the risk for negative outcomes in young people.

“We’re negligent as a society if we continue to turn a blind eye to this,” she said.

After working with parents and their children for 25 years in her research, Duffy sees the need and the commitment to the issue on the part of families.

“What’s lacking is the commitment and willpower from the powers that be that organize care in this province and country,” she said.

“We arguably have the best data in the world … we’ve done really excellent work, like many Canadian research groups have, and sometimes these findings get more readily uptaken around the rest of the world than they do in Canada. I’m really passionate about this because I think we can make a difference in my own lifetime, and today, for young people.”

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

The Canadian Press. All rights reserved.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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