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Earlier discussion

Dr. Donald Milliken and hospitals

Continued from Page 1

Dr. Donald Milliken: The only way that I can approach your question is as a clinician. The needs of persons with depression, schizophrenia, OCD, anxiety disorders etc. do not vary from one province to another. As a clinician, I am very comfortable in saying that a person suffering with a moderate-to-severe depressive illness needs a combination of support at home and at the work place, proper medication management playing careful attention to doses, benefits and side effects, as well as the necessary education and rehabilitative psychotherapy to understand the illness and prevent relapses.

The needs of the patient do not differ from one part of the country to another. The local system, therefore, must be organized to address these needs. The tremendous contribution both of this Globe series, as well as the Senate report "Out of The Shadows" is that both are focused on clearly discussing the needs of the persons who suffer. By keeping these needs at the forefront of the discussion, I believe that we can, over time, bring order out of chaos.

Too often, however, I have sat in meetings when services are being planned or reorganized and I have been the only one there with recent clinical experience. My own belief is that this is part of what is wrong -- the system goes awry when we lose contact with those whom we are supposed to serve.

Mary Mary from toronto Canada writes: Being someone who has been through the system on a few occasions, I have encountered significant differences in my treatment level. Because of stigma that still surrounds mental illness, the highest priority in treatment should be health care professionals' ability to treat the patients as human beings that deserve respect. Personal interaction is important and probably the most difficult when dealing with the mentally ill. Is the system changing to a focus on qualitative education and aiding the transistion of the mentally ill back to society and prevention of future episodes, or are they still in the primitive quantitative approach? What changes are being made???

Dr. Donald Milliken: Mary, thank you for putting your finger on what is, to me, a really important point that must never be lost as we discuss system change. We must always remember that "the system" is there to serve people in pain and in distress. One of the mantras that I keep repeating both to the students I teach and to the patients whom I see is that we must cheat ourselves with "grace and dignity". Indeed, challenging the patient to treat himself or herself with grace and dignity is sometimes difficult, as they try to deal with their own personal feelings of stigma and shame.

Over the almost four decades that I have been in practice, I have seen many swings in the approaches used in this system. Certainly, for a while the drug companies would have had us believe that the only thing we had to do to help people with serious illnesses was to prescribe them the correct drug in the correct amount. While, for the patients whom I see, this is an important part of their care, nevertheless to help them lead in the most fulfilled and complete life that they can, I -- and other members of the treatment team -- needs to pay close attention to their own knowledge of the illness, their own aspirations, and help them as much as we can with counsel l ing and rehabilitative psychotherapy to lead full lives as parents, spouses, siblings, workers and community members. We can only do that by working with the individual in question, not by seeing them as someone who is easily labelled.

ZAKSTER from Canada writes: After 40 years of clinical practice, I would be very interest ed in hearing about Dr. Milliken's experience with patients who recover from clinical depression. I am not referrign to bi-polar, or schizophrenia, but unipolar and severe depression (not necessarily with delusions or voices).

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