WEBVTT - Break from Reality: Psychosis + Violence 0:00:05.510 --> 0:00:08.639 My brother took his life. He was 24 years old. 0:00:08.660 --> 0:00:11.930 I was 23 years old. I remember it like it 0:00:11.930 --> 0:00:15.680 was yesterday. Has it changed everything in the trajectory of 0:00:15.680 --> 0:00:19.700 my life and our family's life? Of course. Years ago, 0:00:19.700 --> 0:00:22.550 when I was sure I was in another psychotic break 0:00:22.550 --> 0:00:25.400 and I ended up running naked in the area here, 0:00:25.700 --> 0:00:28.760 doing all these weird sorts of things. And the cops 0:00:28.760 --> 0:00:31.270 came and got me and they're like, What's going on? 0:00:31.280 --> 0:00:33.470 And I couldn't speak to them. I just said, having 0:00:33.500 --> 0:00:36.199 trouble to verbalize. And they came and got me. And 0:00:36.200 --> 0:00:39.980 when I got into psych, the psychiatrist was like, This 0:00:39.979 --> 0:00:44.449 is an example of a happy psychotic, right? So psychosis 0:00:44.659 --> 0:00:47.960 can be a happy type of psychosis. That's how I 0:00:47.960 --> 0:00:52.370 present sometimes. So it's not always violent, it's not always scary. 0:00:52.580 --> 0:00:55.760 It's doing things that are embarrassing and hard to deal with. 0:00:56.570 --> 0:01:00.200 I've experienced a lot of different trauma caused by myself 0:01:00.200 --> 0:01:02.900 and caused by others, too. But the times that I've 0:01:02.900 --> 0:01:06.410 done things to others in my psychotic state, I don't 0:01:06.410 --> 0:01:09.619 have a filter. The filter gets turned off and suddenly 0:01:09.620 --> 0:01:12.679 I'm doing whatever the voice commands me to do. I've 0:01:12.680 --> 0:01:15.979 hurt myself and I've hurt others and had major jaw 0:01:15.980 --> 0:01:20.839 surgery in 2012 because of an accident. Listening to the voices. 0:01:21.140 --> 0:01:24.650 It's a struggle because when I'm mentally unwell, those would 0:01:24.660 --> 0:01:26.720 be things that I would normally do if I'd been 0:01:26.720 --> 0:01:30.710 medicated and stable. I'm completely a different person in my 0:01:30.709 --> 0:01:32.780 psychotic state, completely different. 0:01:40.510 --> 0:01:42.460 Well, there's no way to predict whether a person with 0:01:42.459 --> 0:01:45.160 a mental illness will become violent. There's still a common 0:01:45.160 --> 0:01:48.700 understanding that those diagnosed with a serious mental illness like 0:01:48.700 --> 0:01:54.490 schizophrenia are unpredictably aggressive. It's no surprise we see mental illness, 0:01:54.490 --> 0:01:57.490 substance use and violence connected in the news, on TV 0:01:57.490 --> 0:02:01.780 shows and in movies. But unfortunately, this can create fear, 0:02:02.320 --> 0:02:04.810 and this fear can be a driving force for negative 0:02:04.810 --> 0:02:09.370 attitudes towards people living with a serious mental illness. Before 0:02:09.370 --> 0:02:12.580 we get into today's episode, here's a couple facts for 0:02:12.580 --> 0:02:16.960 us to think about. People who experience psychosis are five 0:02:16.960 --> 0:02:20.320 times more likely to be violent than the general population. 0:02:20.710 --> 0:02:25.600 But an individual experiencing psychosis is three times more likely 0:02:25.840 --> 0:02:29.860 to take their own life than another person's life. My 0:02:29.860 --> 0:02:32.620 name is Faydra Aldridge, the host of Look Again: Mental 0:02:32.620 --> 0:02:36.070 Illness Re-Examined a podcast about mental illness brought to you 0:02:36.070 --> 0:02:41.380 by the B.C. Schizophrenia Society and other partner organizations. Today 0:02:41.440 --> 0:02:45.609 we get to speak with Dr. Rakesh Lamba. Dr. Lamba 0:02:45.639 --> 0:02:49.480 is the medical director with BC Mental Health and Substance 0:02:49.480 --> 0:02:52.960 Use Services. He is also a clinical assistant professor of 0:02:52.960 --> 0:02:56.320 psychiatry at the University of British Columbia and has a 0:02:56.320 --> 0:03:00.579 ton of experience doing risk assessments with Correctional Services Canada 0:03:00.970 --> 0:03:04.690 and with the Parole Board of Canada. Dr. Lamba, welcome 0:03:04.690 --> 0:03:05.650 to the podcast. 0:03:05.740 --> 0:03:08.950 Thank you. Happy to be here and thanks for having me. 0:03:10.120 --> 0:03:12.640 Thanks for taking the time. So before we jump in 0:03:12.639 --> 0:03:14.620 to the questions today, I just want to take a 0:03:14.620 --> 0:03:18.610 minute to hear some clips from people who have or 0:03:18.639 --> 0:03:22.030 are experiencing psychosis. Let's take a listen now. 0:03:23.830 --> 0:03:28.989 He did exhibit some violence that was quite scary. He 0:03:28.990 --> 0:03:33.790 took a sledgehammer through the TV and he did take 0:03:33.790 --> 0:03:36.310 some violence to my mum at the time. It was very, 0:03:36.310 --> 0:03:39.580 very difficult. But as I know and what I've learnt, 0:03:39.790 --> 0:03:42.940 that was not him. That was the illness when he 0:03:42.940 --> 0:03:48.250 wasn't taking care of himself. I don't know if that 0:03:48.250 --> 0:03:50.590 was really her when she was that ill. And that's 0:03:50.590 --> 0:03:52.390 what I try to see. I try to think that 0:03:52.570 --> 0:03:55.450 she didn't know that her brain was hijacked at the time. 0:03:55.630 --> 0:03:58.540 That's how it helps me get through, like knowing that 0:03:58.540 --> 0:04:01.210 my mom's brain was hijacked and that was really her 0:04:01.210 --> 0:04:03.430 when she did pull a knife on people and on 0:04:03.430 --> 0:04:04.930 the paramedics that time. 0:04:07.950 --> 0:04:10.680 So, Dr. Lamba, what is psychosis? 0:04:10.710 --> 0:04:16.290 Psychosis is best understood as a break from reality. Essentially, 0:04:16.290 --> 0:04:21.180 the highly confused state of mind, which has an alternative 0:04:21.180 --> 0:04:26.549 reality or a misperception of the environment that they are in. 0:04:26.940 --> 0:04:31.230 As one can imagine, such experiences can generate strong emotions 0:04:31.230 --> 0:04:36.390 in a person like fear, anger, agitation, and sometimes, unfortunately, 0:04:36.390 --> 0:04:41.130 aggression in responding to these experiences. And the individual involves 0:04:41.130 --> 0:04:47.520 experiencing delusions and hallucinations, feelings and those experiences to be 0:04:47.520 --> 0:04:51.720 as real as you and me would consider normal experiences. 0:04:51.870 --> 0:04:56.730 They lose that insight, that ability to pause and think 0:04:56.910 --> 0:05:00.210 and consider the reality of these experiences. 0:05:01.080 --> 0:05:05.610 Dr. Lamba We talked earlier about the association between mental 0:05:05.610 --> 0:05:11.969 illness and violence. How do you explain the relationship between 0:05:12.120 --> 0:05:16.890 psychosis and potential violence to your patients and the families 0:05:16.890 --> 0:05:17.760 that you work with? 0:05:18.029 --> 0:05:23.280 The association between psychosis, particularly as a symptom of mental 0:05:23.279 --> 0:05:27.239 illness and violence, appears to have two common beliefs. I 0:05:27.240 --> 0:05:30.630 think it's very important to have a very balanced and 0:05:30.630 --> 0:05:35.490 nuanced view of the relationship between psychosis and violence. As 0:05:35.490 --> 0:05:39.090 you can imagine, any exaggerated concerns of this violence are 0:05:39.089 --> 0:05:43.950 indeed stigmatising and further marginalising to a population that is 0:05:43.950 --> 0:05:46.979 very vulnerable. On the other hand, if you deny this 0:05:46.980 --> 0:05:51.719 relationship that leads to missed opportunities to treat individuals, to 0:05:51.720 --> 0:05:54.089 provide them with the help and support that they need, 0:05:54.240 --> 0:05:58.080 and may then in some instances lead to more violent 0:05:58.080 --> 0:06:01.740 incidents that only further stigmatize the group as a whole. 0:06:01.990 --> 0:06:05.730 That also has not been very clear in defining this relationship. 0:06:05.850 --> 0:06:10.410 Remote Studies first said that there is the record relationship 0:06:10.410 --> 0:06:15.420 between psychosis, schizophrenia and violence. The latter studies were somewhat 0:06:15.420 --> 0:06:19.919 more economical, but more recent studies that use good methodology 0:06:19.920 --> 0:06:24.060 have in fact shown a consistent but modest relationship between 0:06:24.060 --> 0:06:28.559 schizophrenia and violence or the risk of individuals with psychosis. 0:06:28.830 --> 0:06:32.760 Perpetrating violence is a relative risk to the general population. 0:06:33.180 --> 0:06:36.060 But it's equally true that very few individuals who suffer 0:06:36.060 --> 0:06:40.049 from psychosis or schizophrenia actually commit violence. And when you 0:06:40.050 --> 0:06:43.230 look at the total burden of violence in society, only 0:06:43.230 --> 0:06:46.740 about 10% of the violence is accounted for by individuals 0:06:46.740 --> 0:06:50.400 who are psychotic. Another important aspect to consider about this 0:06:50.400 --> 0:06:55.500 relationship is that violence committed by individuals who suffer from 0:06:55.500 --> 0:07:00.000 psychosis occurs most commonly during acute stages of the illness 0:07:00.330 --> 0:07:03.870 when they are untreated, in fact, even when they are undiagnosed. 0:07:04.110 --> 0:07:08.070 So a substantial portion of patients with schizophrenia who commit 0:07:08.220 --> 0:07:12.660 acts of violence do so before they have presented for treatment. 0:07:12.960 --> 0:07:15.450 And it is not uncommon for it to come to 0:07:15.450 --> 0:07:19.110 light that a person suffers from schizophrenia only due to 0:07:19.110 --> 0:07:22.560 this serious violent incident. The most extreme example of this 0:07:22.560 --> 0:07:26.340 is if you consider all homicides, but if untreated by 0:07:26.340 --> 0:07:30.780 individuals with schizophrenia, 40% of them were committed by patients 0:07:30.780 --> 0:07:33.750 in their first episode, they had not yet been diagnosed 0:07:33.840 --> 0:07:36.660 as suffering from the illness and hence they were untreated. 0:07:37.680 --> 0:07:41.250 So based on what you said there, it sounds as 0:07:41.250 --> 0:07:46.710 though the key is the untreated mental illness. That seems 0:07:46.710 --> 0:07:52.410 to be the connection between psychosis and violence. Would you 0:07:52.410 --> 0:07:53.070 agree with that? 0:07:53.280 --> 0:07:57.150 Yes, I would agree with that. And those are important factors. 0:07:57.210 --> 0:08:00.300 There are some other general factors as well amongst individuals 0:08:00.300 --> 0:08:04.260 who suffer from schizophrenia that may help assess the occurrence 0:08:04.260 --> 0:08:08.220 of violence. But very important features are the untreated symptoms. 0:08:09.100 --> 0:08:11.910 Now, Dr. Lamba, is there any way to predict whether 0:08:12.150 --> 0:08:17.580 a person with schizophrenia or an individual experiencing psychosis will 0:08:17.580 --> 0:08:19.530 in fact become violent? 0:08:19.710 --> 0:08:22.860 The short answer is no. And to help understand that, 0:08:22.860 --> 0:08:28.110 you have to understand the difficulties in predicting violence in general. Firstly, 0:08:28.110 --> 0:08:32.189 if you consider the word predicting, predicting simply refers to 0:08:32.190 --> 0:08:35.969 that binary decision of yes or no. Will the person 0:08:35.970 --> 0:08:39.480 be violent or will a person not be violent? Violence 0:08:39.480 --> 0:08:43.230 itself is very uncommon. Generally speaking, when you are trying 0:08:43.230 --> 0:08:48.209 to predict yes or no for an event that is uncommon, 0:08:48.210 --> 0:08:52.170 that becomes all the more difficult. And so that's no 0:08:52.170 --> 0:08:55.770 different for individuals who suffer from schizophrenia. The other thing 0:08:55.770 --> 0:09:00.450 to consider is that violence is a complex outcome. There 0:09:00.450 --> 0:09:04.260 are many factors that account for violence, many of which 0:09:04.260 --> 0:09:08.460 we don't understand. There are some factors that contribute to 0:09:08.460 --> 0:09:10.590 violence that we still don't know, and that is true 0:09:10.590 --> 0:09:14.610 for general population as well as individuals who suffer from schizophrenia. 0:09:14.760 --> 0:09:17.790 And so that's why it's very difficult to, quote unquote, 0:09:17.790 --> 0:09:22.830 predict violence in the individual who suffers from psychosis or schizophrenia. 0:09:23.800 --> 0:09:27.910 So, Dr. Lamba, what are some signs that could indicate 0:09:28.270 --> 0:09:31.750 that a person living with schizophrenia may be at risk 0:09:31.750 --> 0:09:32.470 for violence? 0:09:32.590 --> 0:09:36.040 What helps us assess the risk to say that at 0:09:36.040 --> 0:09:39.460 this particular point a person might be more likely, not 0:09:39.460 --> 0:09:43.660 necessarily will, but just more likely to go on to 0:09:43.660 --> 0:09:48.610 be violent is a constellation of symptoms. As a single factor, 0:09:48.700 --> 0:09:51.790 person who has a history of violence is more likely 0:09:51.790 --> 0:09:53.859 to be violent in the future as a single stand 0:09:53.860 --> 0:09:57.460 alone factor. That's the strongest factor. And that's true for 0:09:57.460 --> 0:10:01.090 individuals who do not suffer from any illness as well 0:10:01.090 --> 0:10:05.229 as individuals who suffer from schizophrenia. So keeping that in mind, 0:10:05.260 --> 0:10:08.290 it's easier to assess the risk of violence in a 0:10:08.290 --> 0:10:11.530 person who we know has some predisposition to violence and 0:10:11.530 --> 0:10:15.490 has previously been violent, as opposed to somebody who has 0:10:15.490 --> 0:10:18.340 never been violent. When we are just trying to predict 0:10:18.550 --> 0:10:20.589 out of the blue that whether or not this person's 0:10:20.590 --> 0:10:24.220 going to be violent. I think what's important to consider 0:10:24.220 --> 0:10:27.340 is that person who is, for example, in the throes 0:10:27.340 --> 0:10:33.130 of acute psychosis and experiencing delusions and hallucinations very acutely, 0:10:33.280 --> 0:10:36.490 a person who is under the influence of substances or 0:10:36.490 --> 0:10:40.270 in the middle of the run of use of drugs, 0:10:40.270 --> 0:10:46.360 particularly stimulant drugs, a person who has complete absence of insight, 0:10:46.510 --> 0:10:51.310 person who has violent fantasies or ideas as part of 0:10:51.309 --> 0:10:56.380 their illness or delusions. Those factors will add up to 0:10:56.410 --> 0:11:01.450 a period of heightened risk to that assessment that this 0:11:01.450 --> 0:11:03.819 is a time period where the individual is at a 0:11:03.820 --> 0:11:05.650 heightened risk for violence. 0:11:06.580 --> 0:11:10.090 And Dr. Lamba, you talked about this earlier. It must 0:11:10.090 --> 0:11:16.090 be so incredibly awful for an individual experiencing psychosis because, 0:11:16.360 --> 0:11:19.900 as you said, they believe it. They are living it. 0:11:20.530 --> 0:11:23.949 So based on all your years of experience working with 0:11:23.950 --> 0:11:28.450 people experiencing psychosis and their families, what do you hear 0:11:28.450 --> 0:11:31.350 from them about what it's like to live with psychosis? 0:11:31.370 --> 0:11:35.770 So that reaction to an incident that the person has 0:11:35.770 --> 0:11:39.850 perpetrated in the midst of a psychotic state varies. They 0:11:39.850 --> 0:11:43.510 look back at how they behaved in that particular incident 0:11:43.780 --> 0:11:48.460 and they are absolutely overcome with remorse, shame, guilt. One 0:11:48.460 --> 0:11:51.460 of those feelings. And then there are other individuals who 0:11:51.460 --> 0:11:56.920 unfortunately have ongoing persistent psychosis where they are in a 0:11:56.920 --> 0:11:59.559 mental state where it briefly, if at all, they can 0:11:59.559 --> 0:12:02.920 actually reflect on their behaviors in their past. So the 0:12:02.920 --> 0:12:06.370 severity of the illness and the course of the illness varies. 0:12:06.580 --> 0:12:10.660 But certainly I have seen many patients who later on 0:12:10.660 --> 0:12:15.100 in periods of remission, quite horrified about their own behaviour 0:12:15.100 --> 0:12:16.900 committed while they were psychotic. 0:12:18.630 --> 0:12:22.650 You're listening to Look Again. Mental Illness re-examined a podcast 0:12:22.650 --> 0:12:27.030 brought to you by the Schizophrenia Society and by partner organizations. 0:12:27.660 --> 0:12:31.380 I'm your host, Ada Aldridge. This podcast would not be 0:12:31.380 --> 0:12:34.890 possible without the support of the community. From the bottom 0:12:34.890 --> 0:12:37.319 of our hearts, we want to thank you for caring 0:12:37.320 --> 0:12:41.940 about serious mental illness and everything that's around it. Together, 0:12:41.940 --> 0:12:46.670 we truly can make a difference. Welcome back to Look Again. 0:12:46.700 --> 0:12:53.750 Mental illness re-examined. We're back with forensic psychiatrist Dr. Rakeysh Lamba. Okay, Dr. Lamba, 0:12:53.870 --> 0:12:57.770 based on your work with the Correctional Services Canada and 0:12:57.770 --> 0:13:02.540 Forensic Psychiatric Services, I'm curious about what typically happens to 0:13:02.540 --> 0:13:06.740 a person with a serious mental illness like schizophrenia if 0:13:06.740 --> 0:13:09.380 they are arrested for committing a crime. 0:13:09.500 --> 0:13:13.220 So when a person is detained, they go to a 0:13:13.220 --> 0:13:16.460 remand centre or a jail and they are held in custody. 0:13:16.580 --> 0:13:20.240 What happens in British Columbia, in the provincial correctional system 0:13:20.240 --> 0:13:25.189 is that all individuals undergo a physical and mental health 0:13:25.190 --> 0:13:30.350 screening within 24 hours of being detained. And within 24 0:13:30.350 --> 0:13:33.410 hours of admission to a correctional centre. The mental health 0:13:33.410 --> 0:13:38.059 screening includes things like screening for the presence of symptoms 0:13:38.059 --> 0:13:43.010 of mental illness, including psychotic symptoms like delusions, hallucinations, residents 0:13:43.010 --> 0:13:48.679 of mood disorders, symptoms like depression, mania, suicidal ideas, intent 0:13:48.679 --> 0:13:53.179 or planning for suicide. Screening is also very important for 0:13:53.270 --> 0:13:56.750 substance use. So they were screened for whether or not 0:13:56.750 --> 0:13:59.809 a person appears to be under the influence of substances 0:13:59.809 --> 0:14:02.660 having come recently off the street or whether they are 0:14:02.660 --> 0:14:06.710 suffering from withdrawal symptoms. The screening process is actually quite detailed. 0:14:06.980 --> 0:14:10.640 Upon admission to the correctional centres and it runs to 0:14:10.640 --> 0:14:13.610 achieve two things. The first thing is does this person 0:14:13.610 --> 0:14:18.050 need any kind of special observation or special placement within 0:14:18.050 --> 0:14:21.200 the facility? The second thing that it determines is what 0:14:21.200 --> 0:14:25.040 sorts of services this person needs to be referred to. 0:14:25.100 --> 0:14:28.190 Do they need to see a psychologist, a psychiatrist, a 0:14:28.190 --> 0:14:32.300 general practitioner right away? There's also a process of what 0:14:32.300 --> 0:14:35.690 we refer to as medication reconciliation. They try to obtain 0:14:35.690 --> 0:14:38.060 a bit of a medication history for the person so 0:14:38.060 --> 0:14:41.330 that there is no break, and that is continuity in 0:14:41.330 --> 0:14:45.230 giving individuals their medications, whatever conditions that they had been 0:14:45.230 --> 0:14:48.840 taking medications out in the community once they are detained. 0:14:48.860 --> 0:14:51.950 Depending on how they present and as they move from 0:14:51.950 --> 0:14:55.640 that court process, the courts have an ability to refer 0:14:55.640 --> 0:15:00.230 these individuals for assessment, for fitness to stand trial. So 0:15:00.260 --> 0:15:02.780 the court or the lawyers and more with the patient 0:15:03.080 --> 0:15:07.130 can become interested to know whether this person is fit 0:15:07.130 --> 0:15:09.950 to stand trial, which essentially means do they understand the 0:15:09.950 --> 0:15:13.070 nature of the charges against them? Do they understand the 0:15:13.070 --> 0:15:17.630 consequences of a guilty finding or a guilty plea? Are 0:15:17.630 --> 0:15:21.020 they able to enter a plea or answer to those charges? 0:15:21.230 --> 0:15:24.620 Are they able to participate meaningfully in the court process? 0:15:24.750 --> 0:15:29.180 So that's all under the assessment of fitness to stand trial. 0:15:29.930 --> 0:15:32.060 How long does that process typically take? 0:15:32.090 --> 0:15:34.970 Dr. Lamba So that's a good question. It can take 0:15:34.970 --> 0:15:38.810 some time. At the first appearance or in subsequent appearances 0:15:38.810 --> 0:15:42.109 in court, when such a concern may arise, a court 0:15:42.110 --> 0:15:44.630 may order such an assessment to be done either in 0:15:44.630 --> 0:15:47.810 custody or out of custody. There is a bit of 0:15:47.810 --> 0:15:50.900 a wait for these individuals to be admitted to the 0:15:50.900 --> 0:15:55.610 forensic psychiatric hospital where these assessments are conducted in custody. 0:15:56.390 --> 0:15:59.660 All in all, the courts have the ability to order 0:15:59.660 --> 0:16:03.620 these assessments for 30 days with one extension of another 0:16:03.620 --> 0:16:06.950 30 days. So there is some wait for admission to 0:16:06.950 --> 0:16:09.980 the forensic psychiatric hospital. Once they get to the hospital, 0:16:09.980 --> 0:16:12.830 depending on their condition and depending on whether or not 0:16:12.830 --> 0:16:16.040 they need treatment for any acute symptoms that are present, 0:16:16.520 --> 0:16:19.550 it can take some time. The other consideration that may 0:16:19.550 --> 0:16:22.310 come up during the court process is the court may 0:16:22.310 --> 0:16:26.330 become concerned about what the mental state of this person 0:16:26.330 --> 0:16:29.730 was when they committed the act that led to the charges. 0:16:30.350 --> 0:16:34.790 And that assessment is referred to as criminal responsibility or 0:16:34.790 --> 0:16:39.980 whether a finding of and see are maybe not criminally 0:16:39.980 --> 0:16:43.850 responsible due to a mental disorder is warranted in this case. 0:16:44.300 --> 0:16:47.930 And those assessments also, when ordered in custody, take place 0:16:47.930 --> 0:16:49.700 at the forensic psychiatric hospital. 0:16:50.680 --> 0:16:56.530 Now going through this process and the assessments, we have 0:16:56.530 --> 0:16:59.560 talked a lot about the impact on family, and I 0:16:59.560 --> 0:17:02.530 don't think the impact on families can be emphasized enough. 0:17:02.890 --> 0:17:06.010 So why do options two families have to keep their 0:17:06.010 --> 0:17:09.520 loved one protected and ensure that they get the proper 0:17:09.520 --> 0:17:12.280 support while they're going through these assessments? 0:17:12.310 --> 0:17:17.379 So unfortunately, there is not much that families are able 0:17:17.380 --> 0:17:20.320 to do while the person is going through the assessments. 0:17:20.500 --> 0:17:24.970 The forensic psychiatric hospital is not like your regular hospital. 0:17:25.150 --> 0:17:28.300 There are things like visitation, but because these individuals are 0:17:28.300 --> 0:17:32.050 considered to be in their custodial phase of the treatment phase, 0:17:32.140 --> 0:17:36.850 there are special rules that apply around visitation. I'm sure 0:17:36.850 --> 0:17:41.140 that families feel a bit disconnected at this stage of 0:17:41.140 --> 0:17:45.100 the process. The patients, of course, can contact their families 0:17:45.100 --> 0:17:48.100 by phone and be in touch with their lawyer, their families, 0:17:48.100 --> 0:17:50.740 their friends, whether they are at the correctional center or 0:17:50.740 --> 0:17:55.330 at the forensic psychiatric hospital. But unfortunately that seems to 0:17:55.330 --> 0:17:58.660 be the extent of their direct support and contact at 0:17:58.660 --> 0:18:03.490 that stage. And while it's difficult to say a lot 0:18:03.490 --> 0:18:06.730 about what the families can do while the loved ones 0:18:06.730 --> 0:18:10.180 are going through assessment, I think in general, the families 0:18:10.210 --> 0:18:13.300 have a big role to play in their journey by 0:18:13.300 --> 0:18:18.310 emotionally supporting their loved ones, by encouraging them, monitoring their 0:18:18.310 --> 0:18:23.230 mental state, monitoring their compliance to medications, watching for signs 0:18:23.230 --> 0:18:27.399 of acute relapse, helping them through difficult phases of their lives, 0:18:27.400 --> 0:18:30.850 helping them deal with stressors. Because we know that stress 0:18:30.850 --> 0:18:35.109 is an important precipitant of an acute episode. So just 0:18:35.109 --> 0:18:39.460 that kind of support, helping their loved ones abstain from 0:18:39.460 --> 0:18:43.390 drugs and alcohol, helping them access treatment. And then, of course, 0:18:43.390 --> 0:18:47.109 advocacy within the system to help support their loved ones. 0:18:48.040 --> 0:18:49.990 And Dr. Lamba, I know this is a big question, 0:18:49.990 --> 0:18:55.629 but I'm curious, what changes would you as a forensic psychiatrist, 0:18:55.810 --> 0:18:59.290 like to see within the criminal justice system in terms 0:18:59.290 --> 0:19:02.619 of how people with a mental illness are viewed and treated? 0:19:02.740 --> 0:19:06.700 That is a big question. I mean, we speak about 0:19:06.910 --> 0:19:10.900 the criminalization of the mentally ill. That's essentially what's happened 0:19:11.109 --> 0:19:15.939 over the last two or three decades with the deinstitutionalization 0:19:15.940 --> 0:19:20.350 movement when the big psychiatric institutions closed down and no 0:19:20.350 --> 0:19:25.270 services or resources were added to address the needs of 0:19:25.270 --> 0:19:29.770 the ill population. What we saw is a few negative outcomes, 0:19:30.310 --> 0:19:33.399 and the biggest one of them was the criminalization of 0:19:33.400 --> 0:19:37.330 the mentally ill. Jails and forensic psychiatric facilities became the 0:19:37.330 --> 0:19:42.520 default mental institutions. That's been the unfortunate experience, of course, 0:19:42.520 --> 0:19:46.390 over the last couple of decades. Criminalization of the mentally ill. 0:19:46.480 --> 0:19:49.960 The reverse of this process will take some time, obviously, 0:19:49.960 --> 0:19:54.070 and a lot of coordinated effort and resources it will 0:19:54.070 --> 0:19:55.359 take to reverse the trend. 0:19:56.260 --> 0:19:59.320 Thank you. And I have one final question, Dr. Lamba. 0:19:59.619 --> 0:20:04.930 And as we said earlier, we know through media that 0:20:04.930 --> 0:20:08.050 there is that fueling a fear when it comes to 0:20:08.050 --> 0:20:12.820 the connection between people experiencing psychosis and violence and the 0:20:12.820 --> 0:20:18.970 widespread public perception that everyone who has schizophrenia is going 0:20:18.970 --> 0:20:22.600 to be violent. How do we address that and how 0:20:22.600 --> 0:20:27.850 do we combat that automatic connection that seems to be 0:20:27.850 --> 0:20:29.170 in our society today? 0:20:29.200 --> 0:20:33.229 That's a difficult one. How to combat this widespread perception. 0:20:33.250 --> 0:20:35.470 I think everybody has a role that the mental health 0:20:35.470 --> 0:20:39.910 professionals role is to keep highlighting at every available opportunity 0:20:39.910 --> 0:20:43.690 that this relationship is not automatic. Keeping in mind that 0:20:43.780 --> 0:20:47.830 while there is a correlation as a group, individuals with 0:20:47.830 --> 0:20:51.160 schizophrenia may be at more risk for violence as compared 0:20:51.160 --> 0:20:55.090 to the general population. Only few of the individuals who 0:20:55.090 --> 0:20:58.570 suffer from schizophrenia are actually violent. And looking at the 0:20:58.570 --> 0:21:01.690 broader picture, you look at all of the violence, the 0:21:01.690 --> 0:21:04.840 load of the burden of violence in society. Only a 0:21:04.840 --> 0:21:08.170 small amount of that is accounted for by individuals who 0:21:08.170 --> 0:21:11.229 suffer from schizophrenia. And I think that puts it best 0:21:11.230 --> 0:21:11.950 in perspective. 0:21:12.640 --> 0:21:16.900 Yeah, I think it's important to emphasize that there's not 0:21:16.900 --> 0:21:22.150 an automatic connection between violence and somebody experiencing psychosis. But 0:21:22.150 --> 0:21:25.360 we also have to be very real and very cognizant 0:21:25.359 --> 0:21:28.180 of the fact that there is a connection and people 0:21:28.180 --> 0:21:31.810 who are untreated can be violent. And that's why I 0:21:31.810 --> 0:21:35.139 am so happy we are having this conversation today. Dr. Lamba, 0:21:35.170 --> 0:21:35.710 I would agree. 0:21:35.740 --> 0:21:36.190 Thank you. 0:21:37.619 --> 0:21:39.990 And a huge thank you to you, our audience, for 0:21:39.990 --> 0:21:42.959 joining us for this episode. Together, we can change the 0:21:42.960 --> 0:21:46.740 narrative around mental illnesses like schizophrenia and put an end 0:21:46.859 --> 0:21:50.070 to the many myths and stereotypes that we were talking 0:21:50.070 --> 0:21:53.490 about today. If you have any questions or comments, tweet 0:21:53.490 --> 0:21:57.210 us at b c schizophrenia. Get our latest episode. 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