Dr. Mansfield Mela, MBBS, FWACP, MRC (Psych), MSc, FRCPCDr.
Mansfield Mela is an Associate Professor of Psychiatry at the University of Saskatchewan. His clinical practice is out of the Forensic Outpatient Clinic at University of Saskatchewan and the Forensic Inpatients Services at Regional Psychiatric Center, Saskatoon. Dr. Mela’s recent research studies include psychiatric drug use in sex offenders, FASD in forensic populations, neurotoxic metals in aggressive patients, spirituality and religiosity in forensic psychiatric patients.
“Physician, heal thyself” is an expression that is relevant to my initiation to clinical research in FASD. Before learning about the clinical symptoms of FASD, I had been frustrated by the lack of clinical improvement among the offenders with mental disorders who formed my patient caseload. Many of my patients did not complete homework assignments. My repeated instructions appeared to have little or no tangible effect on those I counseled. Individuals described to me their difficulties with an apparent lack of recall for our previous sessions, and follow-up counseling visits seemed to be new visits. My frustration was growing until I spoke to another psychologist. This experienced clinician had completed training in the diagnosis of FASD, and encouraged me to check it out myself. I then participated in training through the Lakeland Center for FASD, which set the different trajectory for my clinical and research work.
I was initially drawn to the field of FASD research by my knowledge of the neuroscience behind the effects of FASD, as well as effective approaches in managing individuals with the related symptoms. One reason that I was attracted to this area of research was the widespread lack of identification of individuals affected by FASD. This was the case in my earlier years of clinical practice. On a large scale, this trend contributes to the overrepresentation of individuals with FASD in the mental and criminal justice systems.
For the past fifteen years, my research interests have resulted in collaborations directed at understanding ways to help patients. The results of our research have included strategies to address deficits in individuals with FASD. When I applied these evidence-based strategies to my clinical work, it greatly relieved my frustrations—“physician heal thyself,” really. However, my motivation for working in this area continues to be to help individuals, and therefore to benefit society, by reducing victimization. My patients have taught me by the way they live their lives and by the exquisite resilience they display.
The primary areas of my research activities include identifying those with mental diagnoses who also manifest the cognitive and psychosocial symptoms of prenatal alcohol exposure. I am particularly interested in populations within the mental and criminal justice systems. Below is a list of just a few of the research projects on which I am currently working, or plan to complete in the near future.
Currently I am working with a panel of experts to evaluate the medication algorithm we designed to guide prescriptions for individuals with FASD. Additionally, I plan to continue to address a significant need for education training and skills acquisition on FASD for professionals and clinicians. This training should be targeted towards professionals who come in contact with individuals with FASD and other comorbid disorders. The need for professional training in FASD is informed by previous research that identified stigma from professionals as a barrier to care for affected individuals and their caregivers.
Another area of future research of mine is using different models to test out how to effectively reduce stigma. Additionally, I recently collaborated with physicians on a project looking at how to address dental and emergency room needs in individuals with FASD.
Finally, I am interested in researching how to prevent individuals with FASD from getting involved with the criminal justice system. Similarly, I plan to investigate how to prevent individuals with FASD who have significant legal risks from encountering additional negative legal consequences.
Research efforts to study effective approaches to treat and manage FASD are certainly needed at this time. For the best outcomes, researchers should collaborate with individuals with FASD and their caregivers. Additionally, effective and transformational clinical research should investigate how governments can influence professionals to adopt best practices for working with individuals with FASD. Future research will take advantage of new technologies including neuroimaging and artificial intelligence on data.
The research by the CanFASD Research Leads has notable benefits. Implementation of our research findings have the potential to reduce the rates of disability from prenatal alcohol exposure and its enormous economic burden. Additional direct benefits of our research includes improving the quality of life of individuals, their caregivers, and professionals. Further, research in FASD has the potential to positively influence mental health, child welfare, and corrections; and to reduce correctional and medical costs. Therefore, addressing the needs of one of the most stigmatized and vulnerable populations has important economic, moral, and social justice benefits which cannot be easily quantified. This research is therefore good for the society at large.
I continue to wonder about the word stigma. I understand the term related to biological mothers, but not to those with an FASD. Do we really mean stigma or discrimination? I am of the mind that the continued use of stigma marginalizes all individuals who are different than we expect they “should” be. That is, it reinforces the idea that we should “stigmatize.”