Sep 6, 2016
This content contains explicit and sensitive information that may not be suitable for all ages.
Two mental health-related stories have hit the news recently that show a troubling trend in the way our mental healthcare system is working. A report released by the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES) showed that due to two major demographic changes in the past decade, demand for psychiatrists has outpaced supply by 17 per cent. On the other hand, mental health advocates have called for more funding for mental healthcare, as our nation now lags behind other OECD countries in that field. Canada is in for a big shift in mental health treatment, and we must be ready for radical change in order to positively impact our citizens.
The study released by CAMH and ICES focused on the demand for psychiatrists in Canada, and showed that there were two major demographic shifts that will require reform. One is that many rural psychiatrists are nearing retirement, and fewer younger ones are moving out of the city core. In Toronto’s Location Health Integration Network (LHIN), there are 61 psychiatrists for every 100,000 people. In rural areas that number might go down to just 4 psychiatrists per 100,000 people. The other shift showed that while there has been an increase in women in the field, female psychiatrists often saw fewer patients than their male counterparts. The study focused on the supply of Ontario psychiatrists and trends in practicing over time.
“What we do not have in the mental health system is a “system”-a way to ensure that the resources that exist in the province to provide mental health and addictions care to Ontarians goes to those with the greatest need,” said Dr. Paul Kurdyak, lead author on the study and psychiatrist and scientist with CAMH’s Institute for Mental Health Policy Research, and lead scientist for the Institute for Clinical Evaluative Sciences (ICES) Mental Health and Addictions Research Program. “Psychiatrists are one aspect of these resources, and need to be better integrated into the broader system so that the relatively few specialist psychiatrists are available to a larger number of patients who require specialist services.”
A psychiatrist is a licensed physician with extensive medical training that gives them more of an insight into the relationship between the physical, social, and psychological aspects of mental illnesses. There are also psychologists, who differ in that they focus more on how people think, feel and behave, rather than specifically on physiological aspects that lead to mental health issues. Social workers are other mental health professionals who work through systems of care to better give individual and family-based therapies.
Bev Gutray, CEO of the Canadian Mental Health Association (CMHA) British Columbia, referred to the need for better use of the stepped care model for patients accessing care.
“When we’re talking about the utilization of the most highly-trained professionals like psychiatrists, access to them is extremely limited,” Gutray said. “If you want to see a psychiatrist you will be waiting a long time. We’ve got to keep that resource serving people with the most complex and highest needs.”
CMHA BC offers a program called Bounce Back Today that offers telephone coaching at all times of the day throughout the entire week. The self-managed program means people can choose what to work on in with coaches. This sort of distance program allows people in rural communities access to care for low mood, stress, depression, and anxiety.
While access to psychiatrists can often take months after a physician referral, Bounce Back patients are served within five days. The program can help people experiencing mental illness early on, leaving psychiatrists free to help those in more extreme circumstances.
Another distance program that could have an effect on psychiatric care is Project ECHO, led by CAMH and the University of Toronto. Project ECHO is a virtual community that connects 18 rural “spoke” primary care sites with mental health and addictions specialists in a Toronto “hub”. The model, developed at the University of New Mexico School of Medicine, uses video conferencing to give professionals real-time consultation for cases they’re working on.
All of these changes and reform will depend on much-needed funding from the provinces and the federal government, as Canada now lags behind many other OECD countries, such as the United Kingdom and New Zealand. In a report released by the Canadian press, professionals from organizations such as the mental health commission of Canada and CMHA called for the percentage of funding to increase from 7 per cent to 9 per cent of the healthcare budget. Even with that increase, Canada would be behind many other developed nations, whose mental health funding is anywhere from 10 to 14 per cent.