Archive for the ‘Education’ Category
Mental Illness and the Family: Recognizing Signals and How To Cope
April 7th, 2011 | 
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Most people believe that mental disorders are rare and “happen to someone else.” In fact, mental disorders are common and widespread. An estimated 54 million Americans suffer from some form of mental disorder in a given year.
Most families are not prepared to cope with learning their loved one has a mental illness. It can be physically and emotionally trying, and can make us feel vulnerable to the opinions and judgments of others.
If you think you or someone you know may have a mental or emotional problem, it is important to remember there is hope and help.
Accept your feelings
Despite the different symptoms and types of mental illnesses, many families who have a loved one with mental illness, share similar experiences. You may find yourself denying the warning signs, worrying what other people will think because of the stigma, or wondering what caused your loved one to become ill. Accept that these feelings are normal and common among families going through similar situations. Find out all you can about your loved one’s illness by reading and talking with mental health professionals. Share what you have learned with others.
Handling unusual behavior
The outward signs of a mental illness are often behavioral. Individuals may be extremely quiet or withdrawn. Conversely, he or she may burst into tears or have outbursts of anger. Even after treatment has started, individuals with a mental illness can exhibit anti-social behaviors.
When in public, these behaviors can be disruptive and difficult to accept.
The next time you and your family member visit your doctor or mental health professional, discuss these behaviors and develop a strategy for coping.
Establishing a support network
Whenever possible, seek support from friends and family members. If you feel you cannot discuss your situation with friends or other family members, find a self-help or support group. These groups provide an opportunity for you to talk to other people who are experiencing the same type of problems. They can listen and offer valuable advice.
Seeking counseling
Therapy can be beneficial for both the individual with mental illness and other family members. A mental health professional can suggest ways to cope and better understand your loved one’s illness.
When looking for a therapist, be patient and talk to a few professionals so you can choose the person that is right for you and your family. It may take time until you are comfortable, but in the long run you will be glad you sought help.
Taking time out
It is common for the person with the mental illness to become the focus of family life. When this happens, other members of the family may feel ignored or resentful. Some may find it difficult to pursue their own interests.
If you are the caregiver, you need some time for yourself. Schedule time away to prevent becoming frustrated or angry. If you schedule time for yourself it will help you to keep things in perspective and you may have more patience and compassion for coping or helping your loved one. Only when you are physically and emotionally healthy can you help others.
“Many families who have a loved one with mental illness share similar experiences”
It is important to remember that there is hope for recovery and that with treatment many people with mental illness return to a productive and fulfilling life.
Warning Signs and Symptoms
To learn more about symptoms that are specific to a particular mental illness, refer to the Mental Health America brochure on that illness. The following are signs that your loved one may want to speak to a medical or mental health professional.
In adults:
▪ Confused thinking
▪ Prolonged depression (sadness or irritability)
▪ Feelings of extreme highs and lows
▪ Excessive fears, worries and anxieties
▪ Social withdrawal
▪ Dramatic changes in eating or sleeping habits
▪ Strong feelings of anger
▪ Delusions or hallucinations
▪ Growing inability to cope with daily problems and activities
▪ Suicidal thoughts
▪ Denial of obvious problems
▪ Numerous unexplained physical ailments
▪ Substance abuse
In older children and pre-adolescents:
▪ Substance abuse
▪ Inability to cope with problems and daily activities
▪ Changes in sleeping and/or eating habits
▪ Excessive complaints of physical ailments
▪ Defiance of authority, truancy, theft, and/or vandalism
▪ Intense fear of weight gain
▪ Prolonged negative mood, often accompanied by poor appetite or thoughts of death
▪ Frequent outbursts of anger
In younger children:
▪ Changes in school performance
▪ Poor grades despite strong efforts
▪ Excessive worry or anxiety (i.e. refusing to go to bed or school)
▪ Hyperactivity
▪ Persistent nightmares
▪ Persistent disobedience or aggression
▪ Frequent temper tantrums
Source: Mental Health America
Protect Your Teen’s Mental Health
By Ann Guerrisi-Hawn, Penn State
Being a teen and being a parent have never been more complicated. Along with the usual risks and temptations, today’s families face an uncertain economy and unpredictable job market. On top of that, there are ever-growing opportunities for adolescent mischief via social networking sites, text messages, YouTube, and Twitter. While the challenges are different for this generation, the solutions remain very much the same. You have to stay close, continue to listen, and seek help when a problem arises.
Stay in Touch
There’s no substitute for spending time with your teen. Keeping the lines of communication open is one of the most important things a parent can do. When children reach 12, 13, or 14 — just when they need help the most — many adolescents start to withdraw from Mom and Dad. Knowing this can help you make the extra effort to connect with them. If you suspect a problem, ask your teen what’s bothering him or her. Don’t ignore warning signs and hope the problem will go away.
Mental Disorders
In any given year, one in 10 U.S. children and adolescents suffers serious mental disorders that cause significant problems at home and in school. Yet, just one in five of those youths is diagnosed and treated appropriately.
Like adults, teens can suffer from mental health problems caused by biology and environment. Biological factors include imbalances in brain chemistry, developmental changes, hormonal imbalances, and inherited risks for certain conditions, such as depression or other mental health disorders in other family members. “Having certain other medical conditions like asthma, cystic fibrosis, thyroid disorders, pain disorders, or chronic medical disorders can predispose the teens to develop mental health disorders,” stated Fauzia Mahr, medical doctor at Penn State Hershey Children’s Hospital. Environmental factors include substance abuse and being the victim of sexual assault, emotional abuse, physical abuse, or violence. “Even events like parental separation or divorce or being bullied by peers can have tremendous effects on the teen’s mental health,” Mahr said.
Despite parents’ best efforts, teens will make mistakes because at this developmental stage in their life they are exploring themselves and the environment to develop their own sense of identity. Their behavior is more likely to be impulsive during adolescence.
Warning Signs
A teen with a mental disorder may have a variety of symptoms. Depression often manifests itself as irritability in teenagers; therefore, persistent irritability should be taken seriously and must be evaluated by a health care professional to avoid any negative outcomes later on.
Symptoms of depression include:
– Chronic sadness or hopelessness
– Persistent nightmares
– Declining interest and performance in school
– Alcohol or drug use
– Loss of interest in things they once enjoyed
– An unbalanced relationship with food
– Crying spells
– Decreased need for sleep
– Anxiety
– Poor appetite
– Irritability
– Thoughts of death or dying
– Self-injurious behaviors like cutting themselves
– Feelings of guilt
– Anger/agitation
Act on these signs quickly by getting your child to a mental health professional. Untreated mental disorders can lead to serious outcomes, including but not limited to, school failure, family conflicts, drug abuse and even suicide.
Most importantly, if there is any risk of harm to self or others, please take your teen to the nearest emergency room to be evaluated.
ADHD, conduct disorder and smoking most strongly related to dropping out of high school
Teens with attention-deficit/hyperactivity disorder (ADHD) — the most common childhood psychiatric condition in the United States — are less likely to finish high school on time than students with other mental-health disorders that often are considered more serious, a large national study by researchers at the UC Davis School of Medicine has found.
There are three types of ADHD: the hyperactive type, the inattentive type and the combined type. Symptoms include not being able to pay attention, daydreaming, being easily distracted and being in constant motion or unable to remain seated.
“Most people think that the student who is acting out, who is lying and stealing, is most likely to drop out of school. But we found that students with the combined type of ADHD — the most common type — have a higher likelihood of dropping out than students with disciplinary problems,” said Julie Schweitzer, an expert on ADHD at the UC Davis MIND Institute, an associate professor of psychiatry and behavioral sciences and the study’s senior author. “This study shows that ADHD is a serious disorder that affects a child’s ability to be successful in school and subsequently in a way that can limit success in life.”
Published online in July in the Journal of Psychiatric Research, the study “Childhood and Adolescent-onset Psychiatric Disorders, Substance Use, and Failure to Graduate High School on Time” found that 32.3 percent of students with the combined type of ADHD — which incorporates hyperactive and inattentive symptoms — drop out ofhigh school. Fifteen percent of teens with no psychiatric disorder drop out.
“Understanding the factors that contribute to dropping out of high school has major public-health implications, given that a third of youth in this country do not complete high school on time. Supporting mental-health interventions for students may have a significant impact on reducing high school dropout,” said study author Elizabeth Miller, an assistant professor of pediatrics and an adolescent medicine specialist at UC Davis Children’s Hospital.
In 2006 an estimated 4.5 million children in the United States between 5 and 17 years of age were diagnosed with attention-deficit/hyperactivity disorder , according to the Centers for Disease Control and Prevention. An estimated 9.5 percent of boys and 5.9 percent of girls are diagnosed with the condition.
The next most at-risk teens are students with conduct disorder, whose symptoms include aggression, lying, stealing, truancy, vandalism and a general pattern of rule-breaking. Thirty-one percent of students with conductdisorder drop out, said Joshua Breslau, associate professor of internal medicine and the study’s lead author. Breslau said the research shows there are different pathways to poorhigh school performance.
“This study identifies multiple ways in which mental-health problems can affect education at the high school level. Attention-deficit/hyperactivity disorder impacts achievement because it affects how well students are able to perform basic classroom tasks from paying attention to turning in their homework,” said Breslau. “Students with conductdisorder are able to do just as well as everyone else academically but disciplinary issues and dealing with the routines of school life may cause them to drop out.”
For the study, the researchers examined the joint, predictive effects of childhood- and adolescent-onset psychiatric and substance-use disorders on failure to graduate high school on time, using data collected during 2001 and 2002 from the National Epidemiological Survey of Alcohol and Related Conditions. A total of approximately 43,000 racially diverse male and female participants over 18 from throughout the United States were interviewed by U.S. Census Bureau representatives about the age of onset of psychiatric diagnoses, substance use and high school graduation. Respondents were excluded if they had less than eight years of education or arrived in the U.S. after age 13. A total of 29,662 of the respondents were included in the UC Davis study.
Among childhood and adolescent psychiatric disorders, diagnosis with either the combined type of ADHD or the inattentive type — at 28.6 percent — resulted in the highest dropout rates. Students with mania, a mooddisorder, and panic disorder dropped out at 26.6 and 24.9 percent respectively. Students with other mental-health disorders had dropout rates in the high teen- to low 20-percent range. The disorders included specific phobias (like fear of water), social phobia (fear of people), post-traumatic stress disorder, generalized anxiety disorder and depression.
But more predictive of dropping out than all other mental-health disorders except ADHD and conduct disorder was tobacco use. The study found that 29 percent of students who used tobacco failed to complete high school on time. Only 20 percent of teens who used alcohol and 24.6 percent of teens who used drugs dropped out. However, when the three substances were examined together, the effect of drinking and using drugs was no longer significant, Breslau said.
“Kids who smoke had a much higher risk of dropping out than kids who drink alcohol or use other drugs. When we looked at smoking in combination with other substances, drinking and using drugs did not increase one’s risk of not completing high school on time. There’s no additional increment of risk of dropping out once you account for smoking,” Breslau said.
The reasons why this is the case merits further investigation, he said. However, existing literature suggests that poor educational performance contributes to smoking. If this is true, then breaking the connection between smoking and education may be essential to further reduction in the prevalence of smoking, Breslau said.
The implication of the findings, according to Breslau, is that the impact of mental health on education is likely to arise from a small set of conditions.
“This study suggests that focusing on a relatively narrow and hopefully more manageable range of mental-health conditions may have a consequential impact on improving school performance in secondary education.”
Schweitzer said that devising effective interventions to help students with ADHD graduate high school would have important long-term societal consequences.
“If you don’t have your high school degree, you’re going to have less income. You can’t buy houses and cars. People who drop out of high school are more likely to be reliant on public assistance. This is a disorder that has serious long-term impacts on your ability to be successful and contribute to society, not just in school, but for the rest of your life,” she said.
The UC Davis School of Medicine is among the nation’s leading medical schools, recognized for its research and primary-care programs. The school offers fully accredited master’s degree programs in public health and in informatics, and its combined M.D.-Ph.D. program is training the next generation of physician-scientists to conduct high-impact research and translate discoveries into better clinical care. Along with being a recognized leader in medical research, the school is committed to serving underserved communities and advancing rural health. For more information, visit UC Davis School of Medicine at www.ucdmc.ucdavis.edu/medschool/.Cyberbullying Linked to Mental Health
A new study from Finland has determined that teens who “cyberbully” others via the Internet or cell phones are more likely to suffer from mental health issues. In addition, the victims also suffer from mental and physical issues.
Cyberbullying is defined by the researchers as an aggressive, intentional and repeated use of mobile phones, computers and other electronic equipment to harass victims who cannot easily defend themselves.
Dr. Andre Sourander of Turku University in Finland and colleagues had 2,438 Finnish adolescents in seventh- and ninth-grade complete questionnaires and found six months prior to the survey, 4.8 percent of the participants were only victims of cyberbullying, 7.4 percent were cyberbullies only and 5.4 percent were both victims and perpetrators of cyberbullying.
Other than being questioned about cyberbullying, they were also asked about substance use, traditional bullying behavior and psychosomatic symptoms, including headaches and abdominal pain.
The researchers discovered that victims of cyberbullying reported living in a house with less than two biological parents; perceived emotional, concentration and behavior difficulties; having trouble getting along with others; headaches and abdominal pain
.
The researchers further found that cyberbullies reported emotional problems, concentration and behavior difficulties; trouble getting along with others, hyperactivity; conduct problems; infrequent helping behaviors, frequent smoking and drinking; headaches and not feeling safe in schools.
“The feeling of being unsafe is probably worse in cyberbullying compared with traditional bullying,” Dr. Andre Sourander of Turku University and co-authors wrote. “Traditional bullying typically occurs on school grounds, so victims are safe at least within their homes. With cyberbullying, victims are accessible 24 hours a day, seven days a week.”
“There is a need to create cyberenvironments and supervision that provide clear and consistent norms for healthy cyberbehavior. Clinicians working in child and adolescent health services should be aware that cyberbullying is potentially traumatizing,” stated Sourander.
“Policy makers, educators, parents, and adolescents themselves should be aware of the potentially harmful effects of cyberbullying. Future research is needed on whether antibullying policies, materials, interventions, and mobile telephone and internet user guidelines are effective for reducing cyberbullying,” Sourander said.
Cyberbullying Workshop Highlights Prevalent Issues
The ever-growing issue of cyberbullying has hit children at all age levels. Bullying is not designated for the classroom, lunchroom or playground anymore. It reaches into the living room, bedroom and kitchen of bullied children.
Severe cases of cyberbullying have occurred in school districts across Long Island, some of which have resulted in death-threats, fights and suicide.
“We’ve heard terrible stories from kids who were bullied online,” one Long Island school administrator said. “Parents have heard their children contemplate suicide and horrible, horrible things when it comes to being cyberbullied, but got them help. It’s sad and [New York] state should do something about it.”
According to Dr. Victor Fonari, director of the Division of Child and Adolescent Psychiatry at North Shore University Hospital, the definition of bullying over the last ten years has changed drastically.Fonari was a professor at the NYU School of Medicine and has been appointed to the United States Department’s National Crisis Response Team. He will be a professor of psychiatry at the Hofstra University School of Medicine in July 2011.
Fonari said bullying used to be confined to aggressive behavior of individuals toward others such as verbal threats, bodily injury, sexual harassment and emotional and psychological disruption.
However, now bullying has reached into the “information superhighway” and attacks people and children’s psyche more than ever. The harm that comes to a young child’s mind can shape how they develop as an individual.
Children’s Mental Health – Resource List
Here is a short list of resources for those of you who are seeking information on children’s mental health issues. During their formative years it is important to understand what’s going on, what’s normal, and what isn’t. These resources will help guide your instincts about your child’s behavior.
- AD/HD and Kids
- Antidepressant Medication and Children
- Anxiety Disorders and Kids
- Autism
- Autism in Children
- Back to School
- Back to School: Parent-Child Communication
- Back to School: Tips for Parents
- Back to School: Your Child’s Mental Health
- Bipolar Disorder in Children
- Boot Camps – Juvenile
- Bullying and Gay Youth
- Bullying: What to Do About It
- Child and Adolescent Fast Facts
- Child and Adolescent Suicide
- Children’s Depression Checklist
- Conduct Disorder
- Co-occurring Disorders and Youth
- Coping with Separation and Divorce
- Depression in Children
- Depression in Teens
- Helping Children Cope with Loss Resulting from War or Terrorism
- Helping Children Deal With War
- Helping Children Grow Up Healthy—Mind and Body
- Improving the Mental Health and Well-being of America’s Children
- Learning Disabilities
- Recognizing Mental Health Problems in Children
- Returning from War: Reconnecting with Your Children
- Schizophrenia in Children
- Talking to Kids about Fear and Violence
- Talking to Kids about School Safety
- What Does Gay Mean?
- What Every Child Needs for Good Mental Health
Source: Mental Health America
Why Most People Are Refusing To Seek Help
Psychological wellness іѕ tο bе taken very seriously, аnԁ quite arguably іt’s much more іmрοrtаnt thаn ουr physical well-being. Simply bесаυѕе іf уου аrе nοt mentally stable, chances аrе уου won’t bе аbƖе tο deal wіth thе countless challenges whісh аrе раrt οf life. Lеt’s face іt, wе аƖƖ encounter periods whеn wе feel depressed, frustrated, annoyed аnԁ јυѕt wish tο isolate ourselves. In such periods, wе mау handle іt bу going tο sleep οr finding a corner аnԁ јυѕt сrу away thе misery. Fοr mοѕt οf υѕ thіѕ work, аѕ thе period wіƖƖ pass аnԁ thеn wе саn resume ουr normal life. On thе οthеr hand, ѕοmе individuals wіƖƖ undergo lengthy periods οf depression whісh demands immediate medical attention. A lack οf healthcare care сουƖԁ result within thе condition getting worse.
Whеn wе аrе mentally healthy, wе аrе аbƖе tο face thе challenges οf life аnԁ find solutions tο thеm without losing ουr minds. In turn, іf wе hаνе аn inability tο handle life’s pressures аnԁ challenges Ɩіkе losing a job, having a tragic death іn уουr family, failing аn exam οr a having a prolonged period οf illness, thеn іt сουƖԁ bе caused bу a hereditary element, genetic element, οr аn injury tο уουr brain.
Anybody suffering frοm a psychological disorder such аѕ depression, anxiety, οr panic attacks, ought tο receive immediate medical care. Thеу ought tο nοt bе left οn thеіr οwn tο resolve thеіr difficulties, simply bесаυѕе thеу wіƖƖ probably bе unable tο hеƖр themselves. Whаt thеѕе persons wіƖƖ require іѕ a medical specialist whο іѕ a expert іn thе field οf psychological health tο hеƖр thеm recover frοm thеіr psychological sickness. Psychological illness іѕ very similar tο physical sickness іn thаt thе persons whο аrе physically sick саn’t аѕѕіѕt themselves аnԁ іt’s nο fault οf thеіr οwn.
In cases whеrе people fall ill mentally, thеу′ll need lots οf emotional comfort аnԁ support, аѕ well аѕ effective counseling tο resolve аƖƖ underlying difficulties, ѕο thаt thеу саn return tο thеіr regular existence. If a doctor assess thеm аnԁ discovers thе root cause οf thе depression аnԁ mood swings, thеn hе mау recommend ѕοmе form οf treatment fοr thеm οr prescribe ѕοmе anti-depressants tο аѕѕіѕt thеm recover.
One οf thе major difficulties wіth mental health illnesses іѕ thаt mοѕt people whο аrе affected bу psychological difficulties аrе refusing tο talk аbουt thе issue аnԁ occasionally refusing tο seek expert healthcare аѕѕіѕt due tο thе ɡrοѕѕ misunderstandings аnԁ misconceptions frοm thе general society concerning mental wellness difficulties. Although wе аrе living іn a extremely technological era filled wіth innovative аnԁ modern іԁеаѕ, thе attitude аnԁ behaviors frοm thе public towards people troubled bу mental wellness issues hаѕ nοt changed, mainly bесаυѕе mοѕt individuals refuse tο see even a psychiatrist fοr аѕѕіѕt οr even ɡеt treatment simply bесаυѕе οf fеаr οf whаt someone mау ѕау аbουt thеm.
Thе ɡοοԁ thing іѕ thаt social, healthcare аnԁ Governmental organizations hаνе now mаԁе іt thеіr point οf duty tο educate thе general public concerning psychological wellness problems tο ensure thаt anybody experiencing psychological wellness problems wіƖƖ bе аt liberty tο consult wіth a medical professional tο resolve thе problem.
Abουt thе Author:
Brent McNutt enjoys working wіth healthcare professionals. Hе іѕ аn avid writer fοr UniformHaven.com, whісh offers Landau Scrubs аnԁ Landau Shoes.
Schools warned over how they handle mental health problems – News – East Anglian Daily Times
EXCLUSIVE – By Anthony Bond Wednesday, 9 June, 2010
SCHOOLS in the county have been warned over the way they handle pupils with mental health problems after a court found that Suffolk County Council discriminated against a boy with a ‘school phobia’.
At the end of last year, the Special Educational Needs and Disability Tribunal found that the county council and the governing body of the east Suffolk secondary school unlawfully discriminated against the boy, now 16, on four separate claims.
It followed an unsuccessful prosecution by the county council and the school against the boy’s parents for failing to ensure their son attended school regularly. The boy and the school involved cannot be identified for legal reasons.
Following the tribunal decision, the county council and school appealed against two of the four claims of discrimination which related to the prosecution against the boy’s parents.
But, despite the school winning its appeal, the tribunal judge rejected the council’s.
In his judgement, Upper Tribunal Judge Ward blasted the authority, saying it “proceeded obdurately” with the prosecution against the boy’s parents – despite being provided with medical evidence from the youngster’s GP and a child psychologist showing that he was suffering from mental health problems which affected his attendance at school.
Judge Ward said the council “closed its mind” by continuing with the prosecution.
Last night, the boy’s father, who can’t be identified, told the EADT: “This decision means that after all the heartache we have gone through, it might change the county council and the schools and the way that people like our son are dealt with from now on.
“Hopefully the council will have been shaken up so that it will not keep prosecuting parents of children with these sorts of disabilities.
“We have a son who needed help and all they could do was go through their silly procedures and instead of giving us help they made our lives very difficult.”
Judge Ward also warned that this case should cause the council to “revisit its approach to such prosecutions” and said that schools in similar situations in the future should “carefully consider” how it deals with such cases.
As a result of the appeal decision, the judge has ordered that Suffolk County Council send written apologies to the boy and his parents by June 18 which are to be signed by Eddy Alcock, the chairman of the council.
Despite winning this appeal, which found that the school could not have influenced the council to stop the prosecution, the school did not appeal against the earlier tribunal decision which found that it unlawfully discriminated against the boy by failing to make reasonable adjustments to his education.
As a result of this, the governing body of the school must also ensure that written apologies are sent to the youngster and his parents by June 18.
A spokesman for Suffolk County Council said: “Naturally the council was disappointed not to be successful in the appeal in this case. We have accepted the outcome of the Tribunal and will comply with its decision.”
THE boy involved developed chronic anxiety following time-off due to a viral illness when he first joined the secondary school.
He was diagnosed by a clinical psycholgist as suffering from a school phobia.
His parents always maintained that the school and the county council failed to offer their son the support that he needed because they never understood his mental health problems.
In June last year, the council took the parents to court for failing to ensure their son attended school reguarly.
If found guilty, they could have been sent to prison for three months and fined up to £2,500.
The council continued with the prosecution despite the child psychologist, to whom the boy was referred, saying it was worsening his mental health.
Despite this, and the fact that the couple have other children who successfully attended the same school, the decision was taken to prosecute the parents.
But following a one-day trial at South East Suffolk Magistrates’ Court in Ipswich, the parents were found not guilty.
At the same time, they took the council and school to the Special Educational Needs and Disability Tribunal for unlawfully discriminating against their son’s mental health by failing to make reasonable adjustments to the way in which he attends school.
via Schools warned over how they handle mental health problems – News – East Anglian Daily Times.
Posted in Education, Mental Health News | 
Tags: children's needs, Education, mental health | 
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Mental health group has a lot of education work ahead, survey shows – Winnipeg Free Press
A survey of Winnipeggers by the Canadian Mental Health Association found many believe the organization should work hard to reduce the public’s stigma and discrimination towards mental illness.
Nicole Chammartin, executive director of the CMHA’s Winnipeg region, said it’s that stigma which has raised its head in recent days with the negative reaction by the public and provincial government to a Criminal Code Review Board ruling last week that would see Vince Li get two brief supervised outdoor passes a day.
Chammartin said 555 people responded to the survey during the last few months and of them, about 25 per cent said the CMHA should work hard at reducing the stigma of mental illness.
The comments received on the issue included “sometimes it (stigma) is worse than the mental illness itself”.
“I think that number says a lot,” Chammartin said on Wednesday after the CMHA released the survey’s results.
via Mental health group has a lot of education work ahead, survey shows – Winnipeg Free Press.
