World first trial of cannabis to treat epilepsy

Associate Professor Udaya Seneviratne

Monash researchers are studying the effects of cannabis on epilepsy patients in a world-first international clinical trial.

Monash Medical Centre is among other Victorian hospitals to participate in the large-scale, multicentre study. 

A common medical condition, epilepsy affects around 1 per cent of the population. 20-30 per cent of epilepsy patients continue to have seizures despite taking current antiepileptic medications, and ongoing seizures carry a risk of serious injuries, psycho-social and mental health problems and sudden death.

“Many centuries ago in China, cannabis was used as a medicinal agent to treat several ailments and in the early 1800s, western medicine started using it as a painkiller,” said Monash University’s Associate Professor Udaya Seneviratne.

“More recently, there has been resurgence in interest of the use of cannabis to treat epilepsy, chronic pain, spasticity, and nausea.”

“Some studies have highlighted dramatic improvement in seizure control with cannabis, in patients with uncontrolled epilepsy,” said Associate Professor Seneviratne, who is also Monash Health’s leading epileptologist.

Cannabis contains over 80 chemical compounds known as cannabinoids. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the most studied chemicals.

“THC has psychoactive properties producing a “high”, a property sought by recreational users, however, CBD has medicinal properties, and unlike THC, does not cause addiction,” said Associate Professor Seneviratne.

CBD has potent antiepileptic properties demonstrated in animal studies. Its value as an antiepileptic drug to control seizures has been shown in small studies in humans.

Associate Professor Seneviratne said patients with focal epilepsy who are still having seizures despite taking standard antiepileptic drugs are being selected to take part in the trial.  

“At the moment, we do not have sufficient evidence on efficacy and safety of cannabis to recommend it as an antiepileptic agent to treat epilepsy.”

“Both the medical community and patients are eagerly waiting for the results of this trial—it will be an important milestone in establishing the place of CBD as an antiepileptic drug, bringing hope to those living with epilepsy.”

In Victoria, Monash Medical Centre, Austin Hospital, Royal Melbourne Hospital and St. Vincent’s Hospital are involved in this clinical trial.

Award to aid diabetes research

Monash Health’s Head of Diabetes and Vascular Disease Research, Professor Sophia Zoungas, has been awarded the inaugural Australian Diabetes Society Ranji and Amara Wikramanayake Clinical Diabetes Research Award. 

This award recognises the career of a leading clinical diabetes researcher and was made possible by the generosity of Dr Ranji Wikramanayake, a long-standing member of the Australian Diabetes Society.

The award will support Professor Zoungas’ research on the prevention and management of type 2 diabetes and its complications.

Professor Zoungas says she is “looking forward to leading the organisation during this period of escalating diabetes prevalence and considerable need for greater efforts to prevent and manage the disease”.

The award will assist Professor Zoungas in enhancing the welfare of individuals with diabetes through improving knowledge and understanding, producing management guidelines, training of health professionals and supporting diabetes research. 

Monash research to improve cognitive and psychological recovery for patients with stroke

Associate Professor Cadilhac

Improving cognitive difficulties for patients with stroke is the aim of two collaborative research studies at Monash University, funded by the Victorian Stroke Clinical Network (VSCN).

It is estimated that approximately one third of stroke survivors will develop memory problems, yet stroke rehabilitation centres tend to focus on physical rehabilitation rather than cognitive difficulties and psychological recovery.

Associate Professor Dominique Cadilhac from the School of Clinical Sciences at Monash Health (SCS) with Dr Rene Stolwyk and Dr Dana Wong of the Monash Institute of Cognitive and Clinical Neurosciences will undertake two projects relating to the subacute care of patients with stroke.

Associate Professor Cadilhac, Head of Translational Public Health and Evaluation (Stroke and Ageing Research), and her team will conduct program sustainability and feasibility evaluations for both projects.

“The ultimate goal is to provide evidence from these projects that will support further expanding of the availability of these neuropsychological services to patients with stroke throughout Australia,” said Associate Professor Cadilhac.

The first project, led by neuropsychologist Dr Wong, focuses on increasing access to a group rehabilitation program for patients with stroke who have memory problems.

“In collaboration with Monash Health and Austin Health, we will roll out and evaluate the effectiveness of the Monash Memory Skills Group, which has helped improve everyday memory functioning for patients with stroke,” said Associate Professor Cadilhac.

Barry Moore, a stroke survivor who has participated in the Monash Memory Skills Group, said

“With physical issues from a stroke you have access to the support of physiotherapists.  For the mental stuff, however, I really did not know where to go. The Memory Skills Group at Monash was wonderful for me; my brain suffered fairly badly in my stroke and this was the first time anyone had addressed it. The course had many practical aspects relating to memory but also treated how the mind could work better. It was terrific for us to have those discussions with experts."

Developing and evaluating a new teleneuropsychology rehabilitation service for Echuca Regional Health, a collaborating partner organisation, is the aim of the second project led by Dr Stolwyk.

“The hospital’s stroke survivors have not previously had access to such a service, which will provide assessment and treatment for stroke-related cognitive, behavioural and mood impairments,” said Dr Stolwyk.

Echuca Regional Health’s Stroke Coordinator Lauren Arthurson said the VSCN-funded research grants will enable Echuca Health to collaborate with Monash’s leading researchers to provide the necessary support to their stroke patients.

“These grants acknowledge the collaboration between the School of Clinical Sciences at Monash Health and the Monash Institute of Cognitive and Clinical Neurosciences and enable translational research with health and industry partners,” said Associate Professor Cadilhac.

“Together we are making a difference to the health of Victorians through the provision of access to cognitive assessment and rehabilitation for people living with stroke.”

Douglas Blank takes out People's Choice Award

Congratulations to Douglas Blank, PhD student in the Ritchie Centre, who won the People's Choice Award at Monash University's Three Minute Thesis Competition University Final last month.

Women in STEM and Entrepreneurship

The Australian Government Department of Industry, Innovation and Science (DIIS) is currently calling for applications for the Women in STEM (Science, Technology, Engineering, and Mathematics) and Entrepreneurship programme.

Background
The programme provides funding to support women in STEM, to eliminate barriers for women’s participation in STEM education and careers, including entrepreneurship. The programme supports outreach programmes targeting girls and women to foster interest in entrepreneurship, to develop innovation and entrepreneurial skills, and to build professional networks. The programme also provides funding to identify and celebrate STEM role models in science and research, entrepreneurship and corporate leadership to inspire school-age girls.

The funds available for a grant are between $5,000 and $250,000 for a maximum duration of 24 months. Full applications are submitted electronically and due externally to Business.gov by 5pm AEST 6 October 2016.


Please refer to the DIIS website for a complete list of eligibility criteria, Factsheet, Application Form and Scheme Guidelines

SCS Women in Medicine & Science Workshop Develop a Brilliant CV, 11 October

Bookings link:

https://my.monash.edu.au/news-and-events/bookings/mmcbs/view/175978/

Enquiries:  jinleng.graham@monash.edu

CiiiD seminar "Structure-function of the type I interferon ligand-receptor interactions" 4 October: Dr Nicole de Weerd

This week's CiiiD Tuesday seminar, 4th October, will feature Dr Nicole de Weerd from the Hertzog Lab.

Natalie Bitto will chair the seminar, which will be held 1-2pm in the TRF Seminar Room 1.

The CID seminar will be held from 12-1pm in the same room. More information about the CID seminar series can be found here:http://www.med.monash.edu.au/scs/medicine/cid/seminar-series.html

A light lunch is served at 11.45am in the TRF Level 2 foyer area.

CID weekly seminar: Dissecting the evolution of immune responses to infection in lymphoid organs, 11 October

Tuesday 11 October, 12-1pm, Seminar Room 1, TRF
Presented by Associate Professor Scott Mueller, ARC Future Fellow

Lab Head in the Department of Microbiology and Immunology at the University of Melbourne, located in the Peter Doherty Institute for Infection and Immunity.

The initiation of immune responses to pathogens involves a complex series of interactions between lymphocytes and dendritic cell (DC) subsets. These events occur within the lymphoid tissues, which are highly structurally and functionally organised to support the orchestration of adaptive immunity. Subsets of stromal cells provide critical signals for immune cell migration and homeostasis, as well as controlling the hypertrophy of lymphoid tissues in response to inflammation. Using advanced imaging, transgenic and molecular tools we are dissecting the generation of T cell responses to virus infection and the roles of stromal cells in lymph nodes and spleen.

Associate Professor Scott Mueller is an ARC Future Fellow and Lab head in the Department of Microbiology and Immunology at the University of Melbourne, located in the Peter Doherty Institute for Infection and Immunity. He completed his PhD at the University of Melbourne, before working as a post-doc in the USA with Prof. Rafi Ahmed, and then Dr Ronald Germain, before returning to start his own group. He has contributed fundamental insight into the dynamics of T cell activation and the roles of dendritic cell subsets, the generation and functions of tissue-resident memory T cells, and the roles of stromal cells in lymphoid organs. His laboratory is continuing work on these areas, as well as examining neural regulation of T cell responses and developing new methods for the imaging and quantification.

Please contact Andrea Johannessen (andrea.johannessen@monash.edu) if you would like to meet with A/Prof Mueller after the seminar.

A light lunch is served prior to the seminar at 11:45am in the seminar room foyer, level 2, TRF Building.
Further information available from CID Weekly Seminar Series website [http://www.med.monash.edu.au/scs/medicine/cid/seminar-series.html]

The CiiiD Tuesday Meeting is held directly after at 1:00pm.  Hugh Gao and Jesse Balic will be presenting on Tuesday 11 October.

Grand Round Presentation - Lung & Sleep state of the art lecture - 05/10/2016

Unit: Lung & Sleep      

Presenters: Dr Barton Jennings

Topic:  “Bronchoscopy, EBUS and new lung procedures”

Date: Wednesday 5 October 2016

Time: 12.30pm to 1.30pm

Venue: Main Lecture Theatre, Monash Medical Centre, Clayton.

“TLR-mediated degradation of cIAP1 triggers cell death and inflammasome activation in the absence of XIAP." Thursday 6 October

This week's  Hudson Seminar will be held Thursday 6 Oct, 12-1 pm, Lecture Theatre 1, Monash Medical Centre.

The speaker will be Dr Kate Lawlor, Senior Postdoctoral Fellow, Vince Laboratory, Inflammation Division, Walter and Eliza Hall Institute of Medical Research.

Light refreshments to follow presentation outside the Lecture Theatre.

Dr Kate completed her PhD at the Walter and Eliza Hall Institute of Medical Research in 2004, where she discovered a pathogenic role for G-CSF in rheumatoid arthritis (phase 1 clinical trials underway, CSL). After being awarded a CJ Martin training Fellowship she completed a postdoctoral position at the Cambridge Institute for Medical Research (2005-2008, Prof K. Smith) examining the effects of innate inhibitory receptors on autoimmune and infectious diseases. Upon her return to WEHI, Kate has focused her research on the role of cell death regulators in inflammation. Her work has defined the role of Inhibitor of Apoptosis Proteins (IAPs), particularly XIAP, in repressing ripoptosome-mediated cell death and inflammasome activation.

Recently, Kate and her research team has uncovered that Toll-like receptors (TLR) utilising the adaptor Myd88 induce the degradation of cIAP1, and its binding partner TRAF2. Conversely, a TRIF-type 1 IFN signal blocks cIAP1 degradation. Notably, in the absence of XIAP, TLR-induced cIAP1 degradation activates the NLRP3 inflammasome. These results may explain why in response to pathogen infection, XIAP mutant patients may develop severe autoinflammatory symptoms characterised by enhanced inflammasome activity.

HealthPEER Seminar 21 October - The days of the manikin are numbered?

Presenter: Professor Jean Ker (University of Dundee, UK) 

Date: Friday 21st October 2016 

Time: 1:00-2.30 pm 

Location: Clayton Campus 43 Rainforest Walk Meeting Room 1 

RSVP and videoconference requests to: healthpeer.courses@monash.edu by noon Thursday 20th October

Flyer with more details HERE.

Genomics and personalised medicine: Have we arrived at our destination - BioBreakfast - 7th November 2016

The personalisation of healthcare is one of the biggest global drivers of innovation in medical technology and pharmaceuticals today. Advances in genomics have created opportunities to deliver patient specific information to tailor treatments to the individual in a way never before possible.

The new ‘omics revolution is set to empower clinicians and patients to make informed decisions on care pathways – but how far have we progressed in terms of delivering on the promises of precise and personalised medicine?

Date:Monday 7th November, 2016
Time: 7:30am for a networking breakfast followed by presentations at until 9.00am
Venue: The Royal Society of Victoria, 8 La Trobe St, Melbourne VIC 3000
Cost: $50 for Members and Non-Members
Register HERE.

All proceeds from this event go directly to fund Innovation Week 2016
About Innovation Week

Innovation Week is an annual celebration of innovation in science, technology, engineering, mathematics and medicine (STEMM) in Australia led by the Australian Science and Innovation Forum (ASIF) in partnership with the Australian Academy of Technological Sciences and Engineering (ATSE).

The goal of the week is to foster an innovation culture that values basic research, features the translation of discoveries, celebrates successful teams as well as emerging entrepreneurs and start-ups.

Faculty Roadshow for Monash Health Translational Precinct (MHTP) - How to Manage Unsatisfactory Progress

Please Note: Attendance to this Roadshow will be credited towards Level 2 Supervisor Accreditation

The Faculty is committed to providing support to supervisors of graduate research students and improving candidature completions.  One of the challenges for supervisors is managing students who show unsatisfactory progress. 

This roadshow is designed to highlight various options available to supervisors to assist them in this process.   The following topics will be covered:

• How to manage a student who is showing unsatisfactory progress, both within and outside the milestone framework
• Administrative support available for managing unsatisfactory progress
• Case study examples of academic issues relating to unsatisfactory progress 

Date: Thursday 6th October 2016
·         Time: 3.30 - 4.30 pm (approx 1 hour duration) 
·         Venue: Hudson Institute, Level 3 Boardrooms, 27 - 31  Wright St Clayton
·         Location: Monash Medical Centre

Please register your attendance via the Booking System online via the following link:

https://my.monash.edu.au/news-and-events/bookings/fmnhsrdo/view/175505/

Food, Fertility and Pregnancy: Monash University leads the way with on-line training for health professionals

Most Australian women’s diets before and during pregnancy do not meet nutrition recommendations.  This issue is further compounded by confusing dietary advice conveyed in the media, on the Internet, and by families regarding what women should and shouldn’t be eating. This advice can be confusing and costly (at best) or dangerous for the health of mother and child (at worst). 

The Department of Nutrition and Dietetics at Monash University has developed a flexible on-line course entitled Food, Fertility and Pregnancy for all health professionals in antenatal care.  The course has been designed to equip health professionals to answer their patient’s food and nutrition related questions regarding fertility and pregnancy.

• Is there a special fertility diet?

• Can foods determine the sex of a baby?

• Is folate the only nutrient I need to worry about during pregnancy?

• What foods can I eat when I am pregnant?

Women want confident, consistent and personalised advice regarding fertility and pregnancy.  Australian research has found that doctors, midwives and other health professionals are trusted sources of fertility and pregnancy advice.  Health professionals face many challenges when providing food and nutrition advice.  Such challenges include misinformation in the public, minimal training to provide nutrition advice, and a lack of confidence.  

The Food, Fertility and Pregnancy course aims to address these issues and to help health professionals identify when they should refer women for more specialised dietary advice.    

Information about the two week Food, Fertility and Pregnancy course is HERE.

Can a seaweed supplement reduce your risk of diabetes?

We are looking for people to participate in a study to find out if eating a seaweed supplement can reduce your risk of diabetes.

· Are you between the ages of 18 and 65?
· Do you have a BMI less than 30 kg/m2?
· Are you interested in finding out about how your body handles sugar?

Then contact Margaret to find out more information.
Email: margaret.murray@monash.edu  Phone: 9902 4199

This study takes place at the BASE Facility in Notting Hill.  The ethics approval number is CF16/53 - 2016000019.

Diversity and Inclusion Week , 3-7 October 2016

Details here: www.monash.edu/diversity-inclusion-week

Windermere Foundation- 2017 Doctoral Scholarships in Health

The Windermere Foundation will award three 20 17 Doctoral Scholarships to support the professional development of Victorian health practitioners who will become future leaders in their profession .A scholarship of $40,000, payable over two years, will be awardedfor eachof the following disciplines:

•    Allied Health

•     Medicine

•     Nursing

Guidelines and Applications Instructions, as well as a downloadable editable application form, canbe found on the Foundation's website at:  windermerefoundation.com.au

Applications close on Monday 31 October 2016 at 5.00 pm

GRADUATE EDUCATION SUPERVISOR DEVELOPMENT GRANTS 2017

The Office of the Vice-Provost (Graduate Education) is calling for seed funding applications to support projects aimed exclusively at the professional development of graduate research supervisors.

Eligibility

Associate Deans, Graduate Research are encouraged to contact senior research leaders in their respective departments, schools or institutes and discuss initiatives for supervisor development. Supervisors completing proposals must be primary or associate supervisors of Monash graduate research students.

Grant categories and funds

Grants will be allocated to successful proposals within the following categories:

·        Social Impact &/or Industry – grants of up to $15,000

·        Cross-faculty/interdisciplinary – grants of up to $10,000

·        Single focus initiatives – grants of up to $5000

More information HERE.

Monash Warwick Alliance Seed Fund 2016 - APPLICATIONS NOW OPEN

The Monash Warwick Alliance Seed Fund 2016 scheme is open for applications, and the submission closing date is 13 November 2016.

Alliance Seed Fund

·     Purpose: Incubation of new initiatives with high potential via supported workshops/visits. Team Based.

·        Selection Criteria: Based on technical and strategic merit & joint capacity.

·        Value: Up to AUD$30,000 plus GBP£15,000.

·        Next Collection Date: 13 November 2016

Any proposed collaborative activities which fall outside the scope of the Seed Fund or Student-led Initiatives Scheme should be discussed directly with the Alliance Project Team.

Please refer to the web site for more information at: http://intranet.monash.edu.au/monash-warwick/funding-schemes/seed-fund.html

Queries should be directed to the Monash Warwick Alliance Project Coordinator, Mr Allan Mahler (allan.mahler@monash.edu).

How Disease Models Strangle Science

In some quarters substance abuse is rigidly defined as a "disease". Professionals trained from that perspective, as well as many addicts who recovered through 12-step groups, often hold onto this point of view very firmly. Explorations into other perspectives, and their resulting approaches to intervention, are often seen as heresy within those communities. I am personally aware of one facility which only allows medical protocols due to its fidelity to this paradigm. When one whispers "What about harm reduction?" this is met with gasps and even shaming, which is odd given the role of shame in substance abuse.

While disease models do allow sufferers to be unburdened by needless shame, and may help some on the higher end of the abuse spectrum, they cannot help the other 80-90% of those affected. Substance abuse is well-known as a stubborn, intractable problem for many people. For this reason alone we ought to creatively explore as many options as possible for investigating and helping.

Some are proposing that addiction is not a disease at all. They point to a consistent lack of supportive data (except for brain changes that may result from addiction), and argue for approaches focusing on skills like mindfulness and understanding the role of history in the development of abuse behaviours. Others believe that addiction is actually a method of disconnecting from relationships since, by definition, one is not functioning in reality when one escapes it. So, some people turn toward escape as a means of coping with problematic interpersonal patterns. This approach offers many possibilities in terms of program and service development. It is even easy to see how 12-step programs such as AA address addictions through the development of community.

Every field has its sacrosanct positions, sometimes borne of economic or political motives. That rigidity is dangerous in that it may stifle thought, investigation, and creativity. Of all fields one would think that mental health needs this degree of openness most of all.

Mental Health Movements

Slowly (sometimes not so slowly) and surely, a movement is taking hold which questions traditional views of mental health treatment, if not the concept of mental health itself. Many professionals and consumers alike are questioning systems which focus on disease models and the research, or lack thereof, which under-girds them. In the United Kingdom the movement is fairly advanced, as evidenced by publications in professional societies and various communications from humanistic psychology leaders.

While there has long existed serious criticism of psychiatry in particular, it has risen to higher levels since the advent of the DSM5 which many believe has significant conceptual problems and poor support in research. As noted elsewhere, the NIMH has abandoned it as a requirement in its research protocols. Questions are being posed about long-held notions of illness itself, an example being the addictions as some are viewing it as a social issue more than a brain issue. A recent review of 29 studies also posits that depression is much more than just a mental disorder. Perhaps most prevalent in recent years has been serious criticisms concerning the relationship between Big Pharma and medicine, with hundreds of articles available about this topic. But there's more; research is also demonstrating actual harms associated with psychiatric medications including antidepressants.

More importantly, the concepts of mental health and mental illness are getting another look. In particular some see these concepts as more complex than binary; that it is possible to have some measure of both in the same individual. Keyes (2002) proposes that each of us manifest aspects of both flourishing and languishing, both at once and at different times. In this view it is possible to view folks as a combination of both adjusted and impaired, which permits more sophisticated approaches to human problems as opposed to nailing down symptoms with a hammer.

These really could be exciting times as we rethink old or worn out professional chestnuts. We might be living in a time preceding major paradigmatic changes in mental health service delivery.

Keyes, CL (2002). The Mental Health Continuum: From Languishing to Flourishing in Life.
Journal of Health and Social Behavior, Vol. 43, No. 2, pp. 207-222

Behind the Magnifying Glass: Categorizing Vast Human Experience

Current models of diagnostic systems are woefully imprecise. But their use continues and is embedded in the economics of mental health care. One is not paid or reimbursed for the cost of services by an insurance company without a DSM-5 diagnosis, even though there is wide acknowledgement of its shortcomings. The coin of the realm is depending on runes. Even the NIMH has changed its reliance on the DSM-5 in funded research projects, and has begun looking elsewhere for diagnostic constructs. Incidentally, as of this writing the United States is the only country not mainly relying on the ICD-10 for its diagnostic rubrics, though that may change soon. One wonders what this says about America.

This has thrust the discipline of psychiatry into some disarray; it is after all the author of the DSM-5. But it is not alone. All mental health professionals are flummoxed when they try to reconcile the height, width, and depth of human problems with rigid, confining, and just plain silly diagnostic tools. The situation results in working with folks who technically "meet criteria" for a disorder but don't have it, and vice versa. It also means that some folks have a disorder but do not resemble each other in the least, except for a handful of "criteria".

It is even the case that many who "have" common disorders such as depression, anxiety, and substance abuse, may need no "treatment" at all. A great many such persons have issues which remit on their own, and to a greater degree than those who were in treatment! This must partly be because we may not know what we're aiming at as we shoehorn complex human beings into simplistic pigeon holes. This phenomena comports with my own clinical experience. Most of those I work with might have intense periods of distress or crisis, but these are essentially transient as they are borne of developmentally- or contextually-based predicaments in their lives. And most of the time, a few sessions focused on understanding these predicaments plus some problem-solving results in demonstrably positive outcomes. This takes profound listening and respect on the part of the helper, not one who is guided by a manual.

Think about it. Remember how you felt on your worst days, and those parts of your past and present which were the ingredients for such times. Remember if you ever felt understood, and if you did, by whom. It might have been a therapist who did. I hope it was, because I know there are many of us who can. But it might have been a minister, a friend, a family member, or a stranger on the street. And chances are good they didn't follow a manual.  

Privileged Communication, Respect of Persons, and Informed Consent

As medicine has adopted electronic records systems and pushed for integrated health care operations (the actual working definition of which varies widely), concerns about privacy and oversharing records have arisen. A recent Google search for this erosion of privacy resulted in 97,600,000 hits. In 2015 an estimated 100 million health care records were stolen, affecting approximately one out of every three Americans, an increase of 11,000 percent over the previous year. Clearly security has not kept pace with developments in the technology involved. This situation is ripe for lawsuits.

Some have warned that such records systems can lead to other types of damages, pointing to 147 such adverse events in 2013 alone, and have clearly advised for the separation of physical and mental health records. There has also been a successful movement in Minnesota which is using legislation to challenge forced shared records adoption by psychologists in health care settings. Its leaders cite two main motivations: potential for harm, and the right of psychologists to govern their own practices.

As if this was not of enough concern, some of these operational models, which may include mental health services, also build in compulsory "consent" to share records with unnamed "healthcare professionals". I say compulsory because this consent is required in order to receive services. This consent process occurs when one is under the duress of suffering, and before one can know what exactly is in the record, the purpose of the sharing, and who specifically will receive it. This means that such a process fails to secure informed consent, part of the ethical bedrock of the mental health professions, something we learn almost from the moment we set foot in training programs.

In all 50 states clients of a variety of mental health professionals are granted the right of privileged communication in therapy. Aside from exceptions having to do with harm to self or others this right is absolute; no third party has an entitlement to this information. Compulsory consent processes force therapy clients to waive the right of privilege in toto; once it is waived there is no longer any privilege. No other professional services for which persons may claim privilege (clergy, attorneys) engage in compulsory consent in order to receive their assistance.

This is so because it is ethically and morally wrong.

In addition to the violation of informed consent and right of privilege, these practices fail to respect the autonomy of persons, their right to self-determination and choice. They also fail to act with integrity, beneficence and non-maleficence in carrying out professional services. These duties are spelled out in the ethical codes of all mental health professions in one way or another.

Compulsory and total consent processes are sought after presumably for two reasons: perceived ease of communication, and the convenience of business procedures including billing (in all honesty I think the latter is the real motivation). It is claimed that such conveniences result in improved outcomes, but research support for that is mixed. Where support exists it regards those who cannot speak for themselves, such as the very young, the very old, and those who have been deemed incompetent. It is an injustice to treat all persons in this same manner. Further, an informed consent process at the point information is needed has always been available. In 25 years of practice I have never known this to not work well.

Combine lack of security with totally open mental health records and you have an enormous problem. Oversharing and failure to respect persons will lead to injury and therefore litigation. That is one way to resolve these predicaments. The media will also get involved, and that is another potential pathway to resolution. Or we could all just go ahead and do the right thing.

Expectations and Mental Health

Mental health issues are best viewed in their entire context. Claims of increasing mental illness among our youth are overwrought in large part because these fail consider context. One important aspect of context involves the expectations of students, as well as those around them.

As noted previously, learning and growth is supposed to be uncomfortable. Refining one's approach to thought and decision-making is difficult business, as we must separate bias from rationality and objectivity, the dross and gold of education. Costa (2016) sees this as a process of unlearning, to which recent cohorts of students are reacting poorly to as a result of their expectations for their college experience. In particular she sees this as a clash between the inherent stresses of learning and a mindset which over-values performance ratings, preconceived notions of success, discomfort with ambivalence and doubt, and a hyper-focus on outcome rather than process.

This is a view which deserves more consideration. It could help explain, for example, high rates of self-reported distress in the absence of true or moderate to severe mental illness. It is consistent with observations concerning modern parenting practices, the coping skills repertoire of adolescents and young adults, and data which support rapid positive changes in these dynamics with just a modicum of support or counseling.

In the popular press we often see polarizing comments about higher education, parents, and students, and this is not useful. It is the interaction of all three, mediated by the expectations of each, which deserves our attention and investigation.

Mental Health and Politics

Does mental health and politics mix? Yes and no. The type of politics represented by consensus-building grassroots efforts, informed by solid data, to advocate for better policy and services definitely has a role to play in improving mental health care. Barbara Mikulski's work to improve parity in mental health is a prime example of this.

There is another kind of politics which has no place in mental health communities or movements. This type of politics seeks to gain attention primarily for its sponsors, tends to rely on spin or distortions of data which capture attention and followers, and avoids building consensus or involving stakeholders in any genuine sense. Such attempts are often short-lived because its true motives are shallow, which means true advocates will not stay on long. In reality, these methods result in harm for mental health and those who are in the trenches fighting for its advocacy. If they do produce a policy or service these will be faulty since the data they are built on are faulty as well, likely causing conflict or confusion among stakeholders. The sponsors of these movements tend to move on to other projects rather quickly, and qualified others do not step in their place to sustain what they started. Sometimes a group of vendors will develop related products, but their main goal is financial and has little to do with improving mental health care. Various attempts in support of conversion therapy for homosexuality, which has resoundingly been condemned in nearly all professional circles, are perhaps good examples of this type of politics. But many other, smaller movements are more mundane and numerous than this.

We have a short supply of the type of work Mikulski has carried out. But we have an abundance of the other. Those working in mental health professions are always looking, if not starving, for help. When approached by marketers or politicians there can be a real temptation to take the bait. The switch comes later of course, and by then there will disappointment that one's expertise or carefully maintained information drew no attention in the development of the product or cause. A far worse outcome may involve a cheap and immature denigration of your work in order to falsely contrast it with what is being sold.

So, here are some tips in managing these contacts:

• Do thorough research on the individual or cause before you meet with them
• Involve other stakeholders and witnesses to the discussions and agreements
• Put any agreements in writing with signatures of all concerned
• Consider contacting the media with your perspectives on project development
• Push out content broadly on social media
• Maintain fidelity to your philosophy and work throughout the process

College Students and the Severity of their Concerns

Much has been written concerning recent cohorts of college students and their reported difficulties. See a prior post concerning one debate on this issue. These students are called, by various authors, slackers, socially inept, narcissistic, poorly equipped to cope, entitled and demanding, and perhaps most frequently, more mentally ill than previous generations.

But none of this squares with my direct experience. Large-scale epidemiological studies in America and Canada refute the claim regarding mental illness. The most recent annual report of the Center for Collegiate Mental Health notes that various indices of mental health have remained "generally flat" for the last five years. The authors hypothesize that noted increases, such as demand for services, are best thought of as "expected outcomes", that is, the result of increased attention and dollars devoted to mental health in higher education. It is puzzling that many continue to make contrary statements, including mental health professionals in my own field. Puzzling until one considers who or what may benefit from such reports: the profession itself. More specifically, the part of the profession oriented to the medical paradigm and the swift "delivery" of interventions such as medication.

There is little doubt that the current generation of students have distinctive attributes and challenges. But so did mine, and so did the one before mine. Many generational distinctions also happen to be positive, but one does need read much about that. Like so many things in life at present, one is more likely to read spin or distortions of data.

So where and how does the mental illness distortion originate? This is probably something that is over-determined, but one way this starts is via survey data. Two oft-reported data points come to mind. ACHA's "40% of college students report having been so depressed that it is hard for them to function", and AUCCCD's "85% of counseling center directors believe student's issues are more severe". Both are misleading. What is not reported in the first example is the meaning behind "depressed" and "function". Do 40% of students not get out of bed? Not sleep? Not eat? Not go to class? Higher education would collapse overnight if this were true. Regarding the AUCCCD survey item, I can testify as one who completes and submits it every year. The response options we are provided on the severity item include "increased", "decreased", and "unsure". "Remained the same" is not provided as an option. This would be my choice if it was. I believe this forced-choice results in a distortion, in this case an inflation concerning severity.

The data does say something, however it is not possible to say exactly what. One hypothesis is that both data points reflect a subjective sense of discomfort, and are mirror images of each other. Students are in fact uncomfortable and they readily admit to high levels of distress. Some of this is due to the stress and strain of growth and development. Some is due to changes in parenting patterns (about which I wrote previously). Some is due to global issues in politics, conflict, and economics. Many students have little faith that the degree they are working hard to earn will translate to a secure livelihood. In short, they are supposed to feel uncomfortable. I would too if I was them.

As for college counseling center directors, our discomfort is about meeting the needs of these students who are knocking on our doors with rising frequency. This is occurring in the context of a nationwide and chronic problem with under-funding and inadequate resources in many centers. Our subjective emotional state often involves something like panic and fatigue as we attempt to address the needs of the masses coming to us. We are supposed to feel uncomfortable too.

It's all about context. And context is missing from key surveys and thus the national discussion.