Access to care is a hot topic, but is it the right topic when talking about accessing mental health care?
Scanning Canadian papers and magazines you are sure to find a mention of access to care for various physical conditions and procedures; hip replacements, knees, cancer care. Most of these discuss lengthy wait times, limited resources and few care locations. Very little discussion is given to what brought a person to seek help. Perhaps this is because it is intuitive to us that a person experiencing pain or difficulty managing their day to day life will seek out care in the first place.
The complexity of psychopathy was front and centre as Dr. Lisa Marshall presented during Grand Rounds at Ontario Shores Centre for Mental Health Sciences (OntarioShores) on Thursday, February 21.
In her presentation, Dr. Marshall, a forensic psychiatrist at Ontario Shores, provided greater insight into the term psychopathy and revealed some of the treatment challenges facing clinicians.
“The definition of psychopathy is much different than what is presented in the media,” noted Dr. Marshall.
While TV and film often depict psychopathy in the mold of the notorious movie character Hannibal Lector, it is extremely complex and doesn’t necessarily live up to common stereotypes.
A person who scores high in psychopathy lacks empathy and a sense of connection to other people. Other common traits of a psychopath can include glibness, a grandiose sense of self-worth, proneness to boredom, pathological lying, manipulative behaviour, impulsivity, irresponsibility and a failure to accept responsibility for own actions.
While more prevalent in the criminal justice system, psychopathy exists in other areas of our world.
“If you look at our society, some of the behaviours associated with a high scorer in psychopathy can also be traits or behaviours of people who have achieved great success in the business or political worlds,” noted Dr. Marshall.
Dr. Marshall pointed to research which suggests the difference between a high scorer in psychopathy who engages in criminal behavior and one who doesn’t is the person’s environment or upbringing.
While there is a belief that psychopathy is untreatable or that treatment attempts can make them worse, Dr. Marshall noted positive outcomes for high scorers in psychopathy have been achieved through a structured approach to treatment, which is also lengthy and intensive with a focus on reducing criminal behaviour along with other problem behaviours, thoughts and feelings.
Dating back to ancient Babylonian times, there has been recognition that persons should not be punished for criminal acts that they committed while severely mentally impaired. The details have changed over time, but the general concept remained.
Today, the law in Canada is derived from English law, and in particular the M’Naghten case. Under the current Criminal Code of Canada, a person is found not criminally responsible (NCR) for a criminal act if they suffered from a mental disorder that prevented them from understanding what they were doing, or alternatively, prevented them from knowing that what they were doing was wrong by the standards of society.