Schizophrenia Daily News Blog

How Mentally Ill in Norway are Treated

An excerpt from a column written by Steve Lopez, of the Los Angeles Times:

"The timing was perfect. I had just asked a Yale professor why there are no mentally ill people living on the streets of Norway, where he helped design some of the most progressive mental health treatment in the world. Then a colleague mentioned she was working on a story about Los Angeles County sheriff's deputies dumping a mentally ill man on skid row in downtown Los Angeles, where thousands of chronically ill people sleep on filthy, rat-infested streets. ...

I have to say I don't quite follow the logic. You take a man who can't fend for himself and dump him in one of the most dangerous corners of the city? Only after an LAPD captain confronted the deputies was the man taken in for psychiatric evaluation.

The fiasco serves as a snapshot of a shamefully inept system beset by
lack of coordination and resources and made worse by a societal penchant for treating mental illness as if it were a bad lifestyle choice. But the good news is that for the first time in decades, there's a chance for Los Angeles and all of California to pay penance by building a national mental health care model that eases suffering for thousands. ...

Southard meets regularly with researchers at USC, UCLA and other
schools to stay abreast of the latest mental health developments from around he world, in part so that he can take full advantage of the nearly $200 million a year that will eventually flow into the county from Proposition 63. It was Southard who referred me to a UCLA psychiatrist named Tyrone Cannon, whose specialties are the genetics and neuroscience of mental illness. His research is aimed at predicting serious brain disorders so they can be treated before they're full-blown.

... Cannon told me the reason he's focusing on early intervention is that the treatment of chronic patients .. so difficult.

"We just don't have the cures for these illnesses once they've fully
taken hold," he said.

The reason schizophrenia first strikes in adolescence and early adulthood, Cannon said, is that a pruning process takes place at that time, as the brain disposes of unused tissue between cells in an attempt to make the brain more efficient.

In young people with a genetic predisposition — roughly 1 person in 100 develops schizophrenia — there's an over-pruning, so that fewer brain cells are left that function normally.

"In the earliest phases … you get the classic picture of someone who
goes from an A and B student — plays with peers and plays in the school band — to a kid who is holed up in his room, not responding to friends or social activities," Cannon said.

"What the patients themselves tell us is that they're attending to some very low-level auditory phenomena you'd call hallucinations, but
they're not full-blown. There's a voice calling their name, but at that point they understand the voice is coming from inside their own head."

Cannon and others are trying to ensure that Proposition 63 funding
takes this line of research into consideration so that money goes to
programs for early identification and treatment of high-risk patients through counseling, family education and medication.

Such intervention is no panacea, Cannon admitted.

"But it helps immediate functioning, so you find that people are able
to go back to school or engage in social network…. I think what we're
doing is giving people the skills to cope with these problems and giving them internal models of what the symptoms mean, so that they don't have to go at such a right angle to the rest of society."

The Yale professor I mentioned at the top of the column, Thomas
McGlashan, is a friend of Cannon's, and he is leading similar research in Connecticut and Norway. That country has a destigmatization program unlike anything in the United States, he said, so that people know what warning signs to look for and exactly where to get immediate help.

When I asked if the mentally ill populate skid rows in Norway,
McGlashan said it was unheard of.

"There is no homelessness," he said. "It's banned."

Then what happens to the Nathaniels of Norway?

"They would have him connected with an outpatient clinic," McGlashan
said. He'd have a regular doctor, a nurse who visited him at home and a day-care worker who checked to see if he needed help managing his life.

With a national healthcare system in Norway, McGlashan said, there are no questions about who is covered and for what. Another key difference, the professor added, is a Norwegian philosophy that favors involuntary treatment rather than protecting the civil rights of patients who aren't well enough to know how sick they are.

None of this makes all suffering disappear for patients or their loved ones, McGlashan said, calling schizophrenia "one of the worst disorders known to man." But it's a far cry from a set of handcuffs and a ride to skid row."