Jehannine Austin explains the link between genetics and mental illness, and the important role genetic counsellors play in supporting individuals affected by mental illness.
What is the link between genetics and mental illness?
Genetic variations play an important role in the development of mental illness. There are a lot of different types of genetic variations that can contribute to whether or not a person develops a mental illness — from common, small variations that make very modest contributions to the likelihood of someone developing a psychiatric disorder, to rarer, larger variations that make a bigger difference.
But there is more than genetics at play when it comes to developing a mental illness — these conditions arise as a result of the combined effects of genetics and environmental factors acting together. And because our experience (or environment) plays an important role in the onset of these conditions, no genetic test will ever be able to tell us with absolute certainty who will, and who will not develop a mental illness. At the moment, there are no genetic tests that we can use to diagnose a psychiatric condition or confirm a diagnosis of a psychiatric condition.
In 10 years, how do you see advancements in genetics research transforming our understanding of and approach to treating psychiatric disorders?
Over the next 10 years, I would hope to see our developing understanding of how genetics contributes to mental illness leading to more targeted and effective treatments. At the moment, finding a psychiatric medication that works well with minimal side effects is often a really unpleasant process of trial and error — I think genetic research holds the potential to smooth this process for people.
How can genetic counselling be used to support individuals affected by psychiatric disorders, like bipolar, depression or schizophrenia?
As genetic counselors, our job is to provide support to people with lived experience of these conditions and their families using information, sharing what we know from our research on the causes of illnesses, like bipolar or depression.
Sharing what we know from research is really important because when someone develops a psychiatric disorder, one of the first things they and their loved ones wonder is: Did I cause this? Could I have prevented it? Is this somehow my fault?
Genetic counseling can help people to better understand what we know about the causes of mental illness from research, and — most importantly — can provide support for people as they process what this information means for them. This form of counselling can also be useful in addressing guilt, blame and stigma. We aim for our clients to leave their genetic counseling appointment feeling empowered and hopeful about their futures, and we have data to show we are successful in this!
When it comes to talking with clients about the chance that their child will develop a mental illness, we help them to understand what the chances are, and help them to figure out what that chance means to them and how that affects what they want to do. Genetic counselors do not advise you whether or not to have children; instead, they’ll support you in making an informed decision, and one that is the best for you.
In 2012, you established the world’s first psychiatric genetic counselling service of its kind. What was your motivation for launching this service?
My colleagues and I were motivated to launch this service because we recognized that people with mental illness and their family members have a need and desire to receive genetic counseling. Our research also supported the fact that genetic counseling can be helpful for this population.
Who can access this service?
Although the service is based in Vancouver, we offer genetic counseling for all residents of British Columbia — it doesn’t matter if you’re young or old, male or female, or based in Victoria or Vernon, you can access this service (either in person in Vancouver or at outreach clinics throughout the province, or by using telephone or telehealth).
We work with individuals who have either personally experienced a mental health problem, or who have a family member with a mental health problem. The genetic counselor will take a family history — often in advance of the genetic counseling appointment — and then provide genetic counseling. Appointments are usually 1-2 hours in length. One month later, the counselor will call to follow up and offer another appointment.
Two years on, what has been the impact of this service?
We have provided services to over 300 families — some of whom we saw through outreach clinics in Williams Lake, Kamloops, and Trail. We have also published a paper showing that people who received genetic counseling in the clinic are more empowered one month afterwards.
Over the course of the two years, we have also provided intensive training in psychiatric genetic counseling for nine students and didactic training for dozens of others.
Our work has also had impacts outside of B.C. In fact, our clinic has sparked the development of two others — one in the US and one in the UK.
You were recently elected to serve as the next president of the National Society of Genetic Counselors (NSGC). In your role as the next president — what are you setting out to achieve?
It is an opportunity to advocate for my profession — and for the patients that we serve as genetic counsellors — on a larger scale. I’d like to help find ways for increased professional growth and recognition for genetic counsellors, to increase awareness of the unique skill set of genetic counsellors among health care providers and the public at large, and to expand the genetic counsellor workforce and employment opportunities for genetic counsellors.
Mental Illness Awareness Week runs October 5-11, 2014.
Dr. Jehannine Austin is an Associate Professor in the Departments of Psychiatry and Medical Genetics. In addition to serving as Canada Research Chair in Translational Psychiatric Genomics and a Research Scientist at the BC Mental Health and Addictions Institute, Dr. Austin has been elected to serve as the next president of the National Society of Genetic Counselors (NSGC) – the largest professional organization for genetic counselors in the world. In 2012, she founded the world’s first specialist psychiatric genetic counselling service, housed at BC Women’s Hospital in Vancouver and funded by the BC Mental Health and Substance Use Services.