Fighting for a Future-2004 and Are we still fighting for a future-2019
The first ‘Fighting for a Future’ Symposium held in 2004 identified six areas that needed action for change and needed further research and support for individuals with FASD. They were: 1) Homelessness, 2) Finances,  3) Physical and Mental Health, 4) Education, Programming and Employment, 5) Legal Actions and Addictions and 6) Family Support.¹ During the 8th International Conference on FASD held in Vancouver early this year, CanFASD presented the progress of these six areas over the last 15 years, asking the question ‘Are we still fighting for a future?’.² Shana Mohr, a training coordinator with the FASD Network of Saskatchewan who is also a parent and a member of the CanFASD Family Advisory Committee, presented an overview of the progress made in terms of Mental Health for individuals with FASD. In this blog post, we summarize the contents of the Mental Health section of the Are we still fighting for a future? presentation.

Recommendations made in 2004
The following recommendations were made regarding the mental health needs of individuals with FASD in the 2004 Fighting for the Future symposium.¹

• The development and funding of targeted health care delivery and mental health treatment should be considered as a primary risk management tool for working with adolescents and adults with FASD.
• The provision of long-term mental health care for parents and other family members should be available, funded and encouraged as a risk reducing tool in maintaining essential supports for individuals with FASD.

Research Developments – 15 years
They identified that it is vital to develop a comprehensive system of mental health care to meet the needs of individuals with FASD as well as their parents, families and caregivers.¹ In response to these needs, over the last 15 years, significant progress has been made. Key research developments related to mental health for FASD include:

• Cook, 2016: Development of new FASD diagnostic criteria identifying FASD as a full body disorder and thereby including mental health assessment as a significant part of the diagnostic process.³
• Popova, 2016: A systematic review that identified mental health conditions as comorbid with FASD. ⁴
• Anderson 2017: A study that discusses how mental health needs of individuals with FASD can be met according to the Mental Health Strategy for Canada.⁵
• Mela 2018: A systematic review of clinical evidence regarding the use of psychopharmacological interventions such as the use of psychotropic drugs to treat individuals with FASD⁶
• Mela 2018: The first psychotropic medication algorithm for FASD by Dr. Mela’s research group⁷

Additionally, the work done by CanFASD to support individuals with FASD and their families was also highlighted as a significant development of mental health in the FASD sector.

Gaps and Needs
Regardless of the tremendous progress made in meeting the mental health needs of individuals with FASD, the ‘Still Fighting for the Future’ research group identified that there are still many gaps that need to be filled.² These include:

• More funding and supports are required for mental health services that are specifically designed for individuals with FASD
• Mental health systems in Canada need to recognize FASD as a condition with significant mental health needs and make accommodations
• Sufficient training should be provided for health care/mental health care professionals regarding FASD
• There is a great deal of stigma associated with FASD that needs to be addressed

Considering the progress, gaps and needs, the two recommendations made at the 2004 Fighting for a Future Symposium regarding mental health for FASD still appear to be valid. In other words, we are still fighting for a future and together all of us can make a difference.

References

1          Lutke, J. & Antrobus, T. Fighting for a Future: FASD and ‘the system’: adolescents, adults and their families and the state of affairs. (FASD Support and Resources in Alberta, Surrey, BC, 2004). https://fasd.typepad.com/fasd_support_in_alberta/2008/02/post-1.html.

2          Harding, K., Reid, D., Mohr, S., Lutke, J., Wilson, M. & Liyanage-Zachariah, V. Still Fighting for a Future: Where We Were and Where We Are Now. Exploring 15 Years of Progress on FASD in Canada. 8th International Conference on FASD doi:https://interprofessional.ubc.ca/files/2019/03/A9_Harding.pdf (2019).

3          Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M., Baldwin, M. E., Chudley, A. E., Conry, J. L., LeBlanc, N., Loock, C. A. & Lutke, J. Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan. Cmaj 188, 191-197 (2016).

4          Popova, S., Lange, S., Shield, K., Mihic, A., Chudley, A. E., Mukherjee, R. A. S., Bekmuradov, D. & Rehm, J. Comorbidity of fetal alcohol spectrum disorder: A systematic review and meta-analysis. The Lancet 387, 978-987, doi:https://doi.org/10.1016/S0140-6736(15)01345-8 (2016).

5          Anderson, T., Mela, M. & Stewart, M. The Implementation of the 2012 Mental Health Strategy for Canada Through the Lens of FASD. Canadian Journal of Community Mental Health 36, 69-81 (2018).

6          Mela, M., Okpalauwaekwe, U., Anderson, T., Eng, J., Nomani, S., Ahmed, A. & Barr, A. M. The utility of psychotropic drugs on patients with Fetal Alcohol Spectrum Disorder (FASD): a systematic review. Psychiatry Clinical Psychopharmacology 28, 436-445 (2018).

7          Mela, M., Hanlon-Dearman, A., Densmore, R. & Reid, D. Psychotropic Medication Algorithm for FASD. (2018). https://research-groups.usask.ca/psycholegal-fasd/psychotropic-medication-algorithm-for-fasd.php.