Dr Feelgood Saturday 18th January 2003

FORENSIC PSYCHIATRY

TREATING MENTAL ILLNESS ASSOCIATED WITH CRIME

This week the media has been buzzing with issues that are very difficult to discuss without emotions taking over. Discussions about mental illness and crime soon ignite debate about human rights and community safety.

Two cases are on everybody's tea break discussion list - and everybody's got an opinion ……..

One case revolves around reports of the release of a man from prison in Brisbane after serving nearly 15 years for the kidnapping and sexual assaulting 3 children. His release has raised heated discussion about risks of re-offending, community safety and attitude. It has sparked debate about effective treatment of offenders including psychotherapy and especially in this case, the value, or not, of castration. According to some newspaper reports this man refused to see the psychiatrists or take part in any treatment programs while in gaol.

The other story is about a Doctor who was evidently convicted of rape about a month ago but was still practicing medicine. While the Medical Board were adamant that due process takes time and they had to consider the case before a decision about registration status would be made on Thursday the electronic and print media called for action from the Medical Board saying it was taking too long!

According to reports yesterday morning this Doctor has now been suspended from practice, within 24 hours of the headlines were released. There are reports that this Doctor's psychologist has diagnosed a severe obsessive-compulsive disorder, which is now being treated.

The old "bad vs mad" labels have been dusted off and find their way into conversation, with people accusing offenders of hiding behind the diagnosis of mental illness. I found myself part of a heated debate about whether doctors "stick together to protect our colleagues" (which is about as archaic a notion as putting people with mental illness into lunatic asylums") and whether incarceration was more for the purpose of punishment or rehabilitation.

Hard topics to talk about because we all want to be safe but our society has evolved with agreed and specific protocols that govern the way we decide guilt or innocence and this gives all people rights. Without this system there would be anarchy - but it doesn't make it acceptable in all cases……..and to all people ……..hmmm Its getting harder to keep from contradicting myself here …..

I believe that the issue is about safety - obviously its ALL about the assessing risk of whether an released prsoner re-offend.

If a person has a mental illness they deserve to have it treated. How affective IS treatment of mental illness associated with Crime? What sorts of treatments are used? How reliable are predictions about re-offending? What safety nets are put in place to keep the community safe while recognising the rights of offenders who have served their sentence? Its here that there is always a huge outcry from the people living in next door to a former offender …."Who's rights are more important " ………………

Doctors don't make the laws ……like everyone else we try to uphold them and treat patients without prejudice .

Dr Michelle Perthe is a Forensic Psychiatrist and a specialist consultant in psychosexual treatment for the program at Victorian Institute of Forensic Mental Health - she will be joining me to help us understand forensic psychiatry and treatment of sexual offenders

On their website the VIFMH has its vision and mission as follows -

Vision - to become an international centre of excellence in understanding and treating mental disorders associated with criminal behaviour Mission - "to provide effective mental health services in a safe and secure environment to people who have both a mental disorder and a history of criminal offending or who present a serious risk of such behaviour." The delivery of forensic mental health services is a specialised and challenging area. It is an area that must address the special needs of mentally ill offenders, the justice sector and the community, while providing effective assessment, treatment and management of forensic patients in appropriately secure settings

Its all very well to have a trial by media, and although I would not feel comfortable living next door to a convicted paedophile, if we don't have a proper process to follow in the way these issues are handled

Click HERE to visit the Victorian Institute of Forensic Mental Health

Click HERE to visit the NSW Institute of Forensic Medicine

HEALTHY PASTIMES

SUCCESSFUL HERB GARDENS

Jennifer Wilkinson

"PLANTS OF PASSION"

I may know a few medical terms with long names and be able to apply my knowledge of medicine to assist humans when their body is wilting but don't let me loose with your plants. Gardening is an excellent activity for a healthy mind body and spirit and as long as you avoid being bitten by the 8 legged inhabitants and always do the manual things with your back and joints in mind of course.

I wonder if you are like me and tend to buy gardening books like I buy cookery books - maybe if I buy the right one it will automatically make me a success in the garden.

I love those gorgeous cottage gardens with their joyous colours and fragrances. I an also fascinated by the notion of planting certain items with purpose - whether to attract birds of bees into your garden or deter certain nasties. I dream of being able to pop out the back to pluck the perfect herb for medicinal or culinary pursuits

Jennifer Wilkinson is the author 'Plants of Passion' . With decades of growing and 16 years of writing and talking about gardening she has just released her latest fabulous book .

In Plants of Passion Jennifer has a comprehensive A-Z of herbs,plants and flowers for your cottage garden BUT more over a great section called "plants for a place and purpose" just look up your requirements and cross reference !

Jennifer will give us her tips on cultivating a herb garden with purpose !

Click HERE to find out more about Jennifer Wilkinson's book Plants of Passion

PREPARING AND STORING SUMMER FOOD SAFELY

Gastroenteritis due to contaminated food can happen to the nicest people, especially if you don't know some basic rules about food preparation, handling and storage. And it is NOT Something you want your party guests to remember about the time they spent at your place !

If food is your business then you cant afford to have customers get sick from your product. These days there are food safety and hygiene guidelines that need to be ingrained but they also apply at home.

Robert Dawson is a microbiologist and food and safety consultant with FoodSafe Risk Management. He is going to give us some tips on making sure your parties don't end up giving people a pain in the ……. !!

For more information on food safety training click HERE to visit Food Safe.

CELEBRITY CHECK UP

 DAME MARGARET SCOTT

This year Ballet is celebrating 75 years of London's Rambert Ballet Company in London . in 1947 the company toured Australia and we were fortunate enough that one ballerina didn't go back :

Dame Margaret Scott is our celebrity check up this week and she ,has been an integral part of The Art of Ballet in this country for over 50 of those years !.

Born in South Africa and now in her 81st year, and going strong Dame Margaret is an inspiration and a living icon for everyone who interested in the Ballet ,and moreover if you would like to look at her photo on my website - anyone interested in longevity.

Here in Australia she danced, choreographed and taught privately and in 1962 was part of the group who negotiated with the Elizabethan trust and formed the Australian Ballet.

In 1964 she was appointed the founding director of the Australian Ballet School and she was the guiding light for the next 27 years.

In 1990 Dame Margaret may have retired as Director of the Australian Ballet School but she was not retiring from Dance.

In 1992, like a ballerina's tutu, things came full circle when she was cast as Clara, the Elder, by Sydney Dance Director Graeme Murphy for his version of Nutcracker. The student teacher role was reversed because as Graeme was once her student at the Australian Ballet School.

Her most recent public performance was in 2000 at age 78!!

David McAllister,current director of the Australian Ballet is also a former protégé.

Dame Margaret Scott is yet another Australian treasure,a woman who has quietly made a huge difference - an inspirational role model.

Some of Dame Margaret's honours and achievements are listed below :

2001 Doctorate of Education Honoris Causa, RMIT University 1998 Doctorate of Law honoris causa, University of Melbourne 1998 Australian Dance Award for "Lifetime Achievement" 1998 Green Room Association "Lifetime Achievement Award" 1963-90 Founding Director of the Australian Ballet School 1988 Hon. Life Member of the Australian Ballet Foundation 1981 Awarded DBE 1977 Awarded OBE 1941-1953 Dancer in companies in Australia and England

Click HERE to visit the Australian Ballet

Click HERE to Visit the Australian Ballet School

SUPPORT GROUP OF THE WEEK

REFLEX SYMPATHETIC DYSTROPHY

Complex Regional Pain Syndrome ( type 1)

I received the following email from a listener last week

Dear Dr Feelgood,

My name is ****** & I suffer from RSD, which is now also called Complex Regional Pain Syndrome Type1 ( crps type1), or as I call it craps without an a in it. Most medical professionals, treat me as if it's all in my mind - even though I require an intrathecal infusion pump. Suffer severe muscle spasms, lower limbs black/purple colours, agitation, barely sleep average of 2 ( 3 : max); extreme hypersensitivity to touch, wind, air conditioning, all weather changes + fluctuations, even sound/vibrations eg. Fireworks, parties like neighbours, bumps in the road, just merely touching my wheelchair or my body & or bumping me. People unwittingly touch me or my wheelchair & can cause excruciating to agonising pain.

But they don't know because of lack of recognition for this condition - people/public think I'm mad, psychological, hysterical, drawing attention to myself - RSD has been around since the civil war but has only been recognised an international code in 1993 as complex regional pain syndrome type 1. I also suffer temperature changes, in several in one limb at a time for instance yesterday wasn't cold & yet my knee was icey cold, foot burning on fire etc.

Why is it never spoken about RSD / Complex Regional Pain Syndrome Type1 on tv / radio shows.So little information is given & yet prevention of RSD becoming permanent can reversed or even cured given early intervention. I have a carer that has to be with me 24 hrs daily for tasks such as dressing, showering, etc… & there isn't a lot of dignity left to salvage. Plus I require breakthrough pain relief after people smash my legs . Additional problems suffered as result of RSD ( CPRS1), lymphoedema, torn disc bulges in spine.

I would appreciate if would consider a session on cprs1 & complications.

He is quite accurate in his comments about people's attitudes to this condition and like many medical conditions this is often due the poor understanding of the disease its cause and treatment. It often seems to me that when we don't fully understand a condition, paradoxically, we tend to talk less about it which makes people with the problem feel isolated and afraid to speak up. In conditions like RSD this makes the whole thing worse!

CRP1 can be a debilitating condition made worse by lack of community and professional recognition of it. It can present in a variety of guises and there is much debate over the process of its development and so the best method of treatment.

Because if has both physical and psychological aspects, failure to diagnose it early can make treatment more difficult. The main stay of treatment is pain relief and support. The RSD support group has an excellent online resource at http://www.ozrsd.org/ where they explain the condition and treatment options as well as advice on coping with the condition and support .

RSD/CRP1 is more than a chronic pain condition -while there are several theories generally it is thought that it is due to a malfunction in the body's Autonomic Nervous system - this is the part of the brain and spine network that looks after such things as maintaining circulation and heat regulation. So it is involved in sweating, peripheral blood flow, hair growth etc.

It is thought that through some episode or episodes of trauma to an area that the message service to and from the brain and spinal cord gets damaged and the local autonomic responses become abnormal.

While the condition has had many names over the years currently the most internationally agreed title is Complex Regional Pain Syndrome (CRPS), agreed by the treating doctors, not necessarily by those who suffer from this condition. At last count I had found over 80 different names!!

The following is taken from the RSD website ( and there is much more there so please visit the site -

Some of the symptoms common to RSD sufferers include:

· Chronic pain after injury/surgery/trauma, pain that is out of proportion to the injury/surgery/trauma · Burning pain in the site of the RSD · Cold/Hot sensation(s) in the RSD site(s) · Discolouration of the RSD site(s) · Muscle spasm(s) · Limited range of movement · Extreme sensitivity to touch (even a slight breeze or soft clothing)

It is generally accepted that RSD will develop in 3 stages, although the time taken to "progress" to each stage will vary from person to person. While some sufferers will "progress" from stage 1 to Stage 2 in say 3 months, Stage 2 to Stage 3 in say 6 months, (9 months in total), others may have reached Stage 3 within weeks of onset of RSD, while others still may never "progress" past Stage 2. With those doctors who agree with the stages of RSD, it is believed that they are defined as:

1. "The Early 1st Stage - showing spontaneous and exaggerated pain and tenderness (allodynia), generalised swelling and temperature asymmetry (lower or higher) between normal and affected parts. 2. The Dystrophic 2nd Stage - with cold shiny skin, sweating, nail and hair changes. 3. The Atrophic 3rd Stage - with skin changes, osteoporosis, skeletal muscle atrophy and joint contractures, causing permanent severe restrictions of passive and active movement." (2)

To complicate matters RSD is a very individual condition, no two sufferers will have exactly the same symptoms, and treatment must be designed carefully for the individual, by a team of medical professionals.

RSD is usually caused by trauma/injury, and/or surgery, but in up to about 30% of cases the cause is unknown. Some cases have been linked to diseases such as Heart Attack, Stroke, Diabetes, Carpal Tunnel Syndrome, TMJ and some forms of Cancer. Although there is a debate about what came first, the disease or the RSD. The literature shows that the majority of RSD is caused by "minor" trauma, such as a pricked finger, a paper cut, a spider bite, an injection site, a simple fall or knock.

While it seems difficult to attribute a condition as severe as RSD with minor trauma another problem can be that the time between the trauma and the onset of symptoms can vary from instantaneous, up to 12 month later. Most of us can't remember how we got a bruise a couple of days ago, let alone 12 months ago!!

There is no one treatment and no known cure. Of course success depends how early it is diagnosed while there may still be a chance of minimizing the spiralling changes in skin and autonomic response, and response depends greatly how much support the sufferer received .

Joining us today to explain more is Tracy Pitman who is the driving force behind an Australian RSD support group . and also Dr Murray Taverner who is an anaesthetist and pain specialist . He is involved in treating patients with CRP1

Click HERE to visit the Australian RSD/ CRP1 support group home page

HEALTHY HOLIDAYS

Crusin' the Seas

Last week we were joined by Ted Hamilton in the studio. He played the Captain of a romantic Cruise Liner in the TV series THE LOVE BOAT - I think we all dream sometimes of indulging our fantasies and taking off on a South Pacific Cruise - so today on the show lets do it !

Gavin Smith is the Managing Director P&O Cruises and he's going to make us all sigh and wish we were cruising right now !

PROCEDURE OF THE WEEK

VARICOSE VEINS

Varicose veins are a common condition. For some they pose problems either because they don't like the appearance or for others they can result in medical complications like pain swelling and leg ulcers.

"Varicose Veins" is a term used to describe both the ropey blue vessels that many people have coursing down their legs or the small superficial networks of what are often referred to as "spider" veins.

The basic problems is blood flowing in the "wrong direction" in vessels not built to cope with the stress. Veins take blood back to the heart from the periphery. In the legs its an uphill battle ! There are big veins sitting deep inside muscles of the leg so that as you walk and move about the muscle contraction assists flow. The flow direction is maintained by a series of valves which close as the blood flows past preventing backlog. The trouble is that not all valves are equal ! Some of us inherit weak valves from our parents and hence the propensity for Varicose veins to run in families.

These days good diagnostic procedures and treatment options are s available . Dr Mark Mallouf is a surgeon who specialises in the treatment of varicose veins. He has the excellent title of being the President of the Australian and New Zealand Society of Phlebology ! He will be joining us to explain how to work through your options. His website is an excellent resource for information about Varicose Veins.

Click HERE to visit Varicose Veins Australia

ESTRANGED GRANDPARENTS AND VISITATION RIGHTS

 Family Law In Australia

A few weeks ago on the program we were discussing spending Christmas without family and a very important point was raised. A caller told us about her son who had separated from the mother of his children and he had since formed a new relationship. She told us that communication with his ex partner had broken down and he had found himself in a position where he it was becoming impossible for him to have the access he wanted to his children. The grandmother was telling us how much she missed seeing her grand children at this time of year and worried that the children were being influenced against wanting to make contact. She went on to say that she didn't want to upset her son by trying to make contact with the children. So where does that leave her ? What about the children surely they would benefit from contact with grandparents …… And so the question arose What are the Rights of Grandparents in Australian Family Law ? If you are a Grandparent, can you apply for custodial rights or access via the court ? Can children have independent representation in situations where the parents relationship has deteriorated to the point where they just don't communicate anymore but the child still wants to continue with family contact ?

Alistair Nicholson is the Chief Justice of the Family Court he will be joining us to explain this aspect of Family Law

Also Cathy Holmes is the manager of Child & Adolescent Services at the Family Mediation Centre in Victoria which is a member of Family Services Australia . She deals with situations like this every day and gives young people a voice in family breakdown. Cathy will join me in the studio to discuss solutions.

Click HERE to visit Family Services Australia - with links for services in each state.