Day 61 of 99 Days to FASDay and we are looking at FASD, mental health and knowledge of professionals that most (if not all) people with FASD will come in contact with.
A study over 10 years ago in the United States revealed while over half of pediatricians felt prepared to identify and diagnose FASD only about a third felt prepared to manage and coordinate care. Now although this study is 10 years old, I suspect the numbers are still not a lot higher.
In fact, someone who was at the 8th International Conference on FASD in Vancouver, B.C. Canada reported during one presentation:
I find it hard to believe that not one person raised their hand, but obviously it was so few to make it noticeable for the person posting this.
However, from my own experience, the health care team the maiden sees, although knows about FASD, they don’t seem to have the capacity to properly manage her mental health. Even when the pediatrician she was seeing retired there was no doctor willing to take over her practice. And the Dual Diagnosis Clinic we’ve been to recently didn’t seem to truly understand FASD. In fact, the psychiatrist gave her an additional diagnosis rather than help create a plan to manage her current difficulties.
It would also appear it is the case for many mental health practitioners due to the continuing interest in an article by Jerrod Brown, published in 2017, in Counselling Today, FASD: A guide for mental health professionals. From the article:
Unfortunately, many of these providers and professionals lack the necessary training and expertise to accurately identify and effectively treat the unique and complex symptomatology of this population. The goal of this article is to provide a basic introduction of FASD to mental health professionals in six key areas: FASD symptoms, diagnostic comorbidity, memory impairments, tips for interacting with individuals who may have FASD, screening and assessment, and treatment
It is a great article and although just touches on the complex lives of this population, it is well-written and I encourage you to take some time to read it.
Since the original (2017) posts, there have been a couple new studies or reports, including a new study by Jerrod Brown and Diane Harr, and although limited in scope, does offer some hope that training and awareness is growing.
Perceptions of Fetal Alcohol Spectrum Disorder (FASD) at a Mental Health Outpatient Treatment Provider in Minnesota
This study, focused specifically on FASD, was developed to explore the generalizability of previous research and any changes over the last decade. Specifically, mental health outpatient treatment providers in a Midwestern state were surveyed about their training and knowledge of FASD.
This study sought to better understand how professionals understood and serve clients with FASD. This study has four key findings.
First, the majority of respondents (76%) had at least some FASD training within the last 5 years.
Second, the vast majority of respondents could demonstrate basic knowledge of FASD. For example, respondents were able to identify key symptoms of FASD including deficits in cognitive function (e.g., executive function and attention), social skills, and adaptive functioning.
Third, respondents typically recognized the impact of FASD of treatment length, effectiveness, and adherence.
Fourth, the majority of respondents recognized FASD’s impact on suggestibility and crime. Together, these findings suggest that mental health professionals may be better equipped to understand and treat FASD than professionals over a decade ago.
Nonetheless, future research is needed to better understand if and how these findings may generalize from the staff members of this facility to other settings across the United States.
Psychotropic Medication Algorithm for FASD
Dr. Mansfield Mela has been the lead researcher developing the first-ever psychotropic medication algorithm for FASD. According to the University of Saskatchewan, the expert panel is in the final phase of development for the algorithm and it will be widely available as soon as possible.
The maiden and I were able to be part of the trial for this, however the psychiatrist we saw didn’t seem to be interested in participating. So, yet again, we faced another barrier to receiving appropriate support.
Dr. Mela also participated in:
Tara Anderson, Mansfield Mela, (University of Saskatchewan) and Michelle Stewart (University of Regina)
It is the current authors’ perspective that the successful implementation of Changing Directions, Changing Lives, which seeks to improve mental health and well-being in Canada, cannot be realized effectively without considering FASD.
Given that 94% of individuals with FASD also have mental disorders, practitioners in the mental health system are encountering these individuals every day. Most mental health professionals have not been trained to identify or diagnose FASD, and therefore it goes largely “unseen,” and individual treatment plans lack efficacy.
Implementation of FASD-informed recommendations, such as those of the Truth and Reconciliation Commission of Canada (2015), can provide a more effective approach to mental health services and improve mental health outcomes.
Although the relationship between psychiatric risk and FASD is well established, the mental health system has generally not embraced the disorder. This has derailed the cohesive benefit expected to accrue from joint understandings of the relationship between mental illness and FASD.
The resulting, somewhat irrelevant, discussion focuses on whether the two are the same and demands a determination of the role of FASD in those who present with mental health challenges, or vice versa.
The difficulty of deciphering whether FASD is a risk factor, the major or a mild etiological factor, or a separate, unrelated disorder has created many challenges for how FASD fits into service delivery models. The significance of the relationship between FASD and mental health is therefore missed by many professionals (Fast & Conry, 2011).
The unsteady relationship the DSM has had with FASD over the years reflects the ambivalence that the psychiatric community has had to addressing FASD, specifically in its approach to intervening from a patient, service, epidemiological, or public policy perspective.
Current Canadian curriculums of medical school and psychiatric training programs are devoid of or contain inadequate content on FASD (Arnold et al., 2013). When considering diagnosing FASD and mental disorder, there are challenges associated with the implicit diagnostic processes when both are present.
McLennan (2015) emphasizes that “it is also critical to retain attention on the relative impacts of multiple etiological factors contributing to mental health and to be wary of approaches emphasizing single risk factor models” (McLennan, 2015, p. 589). The relationship between mental disorder and FASD is intricately complex and appears to be reciprocally linked.
The complexity of diagnosing a mental disorder in individuals prenatally exposed to alcohol can be compounded by existing cognitive and maladaptive behavioural difficulties.
The currently poorly understood interactions of genetic and environmental influences to the exposure of varying levels of alcohol exposure in utero can also confound the process for diagnosing mental disorders in this population.
Furthermore, when considering the process for FASD diagnosis in adults (in comparison to children and youth), diagnosis is multifaceted and may be impeded by the unavailability of the mother to confirm prenatal alcohol exposure, the absence of birth records, and indistinct facial features (Chudley, Kilgour, Cranston, & Edwards, 2007).
The takeaway from all this, is FASD and mental health is closely linked. Many practitioners are still not trained and aware. We’ve made some progress, but still have a long way to go.
The FASD Network of Saskatchewan created an infographic in 2019 to offer some tips for people with respect to FASD and Mental Health:
Come back tomorrow for Day 62 of 99 Days to FASDay.