Dr. Mansfield Mela – Psychiatrist

Dr. Mansfield Mela is a psychiatrist and associate professor at the University of Saskatchewan. In addition to providing FASD assessments on those suspected of the disability, much of his current research is focused on FASD in forensic populations.

The importance of FASD to the field of psychiatry and to society in general
Dr. Mela explains that without a diagnosis, individuals living with FASD experience life with a significant amount of “frustration” – something that extends to those working in support capacities. As a psychiatrist, once a diagnosis is confirmed, he and an affected individual can work through challenges much more effectively.

Citing his own research, Dr. Mela highlights the cost savings by removing individuals with FASD from various institutions, allowing them to live more productive and independent lives within the community.

The most intriguing aspect of his profession with regards to FASD?

“To see people succeed when they are mostly written off,” Dr. Mela says.

“On the level of an individual suffering with FASD, I am usually intrigued by the strengths and abilities that are not immediately acknowledged or recognized. They face a lot of challenges in life and failures, but their core strength is quite remarkable.”

The biggest risks associated with FASD

Dr. Mela says there needs to be greater specialization within the field of psychiatry and medicine in treating individuals with FASD. He would ideally like to see FASD managed more cohesively as the medical condition it is – similar to when someone is sent to the hospital suffering from a broken leg, he or she is looked after by a specialist team. As such, Dr. Mela strongly advocates for greater dialogue between those in psychiatry and the medical fields – in particular obstetrics and gynecology. There should also be less of a gap between the spheres of mental health and FASD, he argues, as many individuals impacted with the disability also experience coexisting mental illnesses.

He adds that a lack of awareness by a significant portion of society is still one of the greatest risks to individuals with FASD. With greater information sharing and collaboration, Dr. Mela is confident better interventions will result, thereby heightening affected individuals’ overall quality of life.

The most effective supports and services

Through Dr. Mela’s research and firsthand experience, he has found that having strong personal relationships, stable housing, modified forms of education and a “treatment team” are the best supports an individual affected by prenatal alcohol exposure can obtain. He adds that a diagnosis itself can provide its own form of support.

FASD diagnosis rates

It’s been long estimated that the number of people living with FASD in Canada is approximately one per cent, according to the Public Health Agency of Canada. However, some recent studies have pegged that number to be as high as five per cent due to lack of diagnosis or misdiagnosis. Additionally, some individuals and their families simply don’t want to admit to the disability due to the stigma surrounding it.

Dr. Mela says his office specifically has seen a rise in patients receiving FASD diagnoses. However, he attributes the rising numbers at his clinic to heightened awareness of his specialty, which has resulted in an increasing number of referrals sent to him.

“Because of my practice and teaching, more people are coming to me by the day, but I can’t comment on the overall numbers in Canada,” he says.

Potential of tenth domain

As explained in the FASD Diagnosis Introduction, currently multidisciplinary assessment teams examine nine areas of the brain, or domains, to determine FASD – with medical doctors being the only professionals permitted to officially confirm diagnoses. Pending guideline updates – being undertaken by the Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) – include adding a tenth domain called “Affect Regulation,” or more commonly referred to as “mental health.”

The new domain is promising, says Dr. Mela, however, with a “caveat.” He feels that greater research is necessary to determine the appropriate definition of an “affect regulation” domain. As it stands, the experienced psychiatrist says the definition is too wide-ranging and open to interpretation.

One solution the doctor proposes is calling it a “research domain.” He suggests that the tenth domain could also come into play when someone is being screened for a mental illness. For example, if an individual is being examined for schizophrenia, he feels it would make sense for that person to also be given an Asante Centre screen for FASD. By doing so, he feels a more accurate picture of FASD rates in Canada would be realized.

“If it comes out positive, you could compile the maternal history and confirm a diagnosis of FASD,” he explains, adding that in such cases a psychiatrist’s input (which examines the physical traits associated with the disability) would give the new domain more validity.