Breaking Down the Breakdown
As a mental health writer from Canada I’d be remiss if I didn’t link to The Globe and Mail’s feature series Breakdown: Canada’s Mental Health Crisis. They present over a dozen articles and videos on stigma, workplace issues, information on some disorders, and the newspaper is also publishing many reader stories (which they are still welcoming). During the weeklong series, there are also online Q&A sessions with a handful of experts.
The series began with an interview and Q&A with Dr. David Goldbloom, a Professor of Psychiatry at the University of Toronto with an active Physician-in-Chief clinical practice, serving as a director on the year-old Mental Health Commission of Canada. Its mandate is to advise government on forming a national mental health care strategy, to address stigma, and to share information. The Globe series would seem to be one result, as most of the articles address social and employer stigma, and the final Q&A on June 30th is with the Commission’s Chair, Michael Kirby. Former Senator Kirby spent years investigating the Canadian mental health system (or lack thereof) and authored the key report Out of the Shadows at Last – Transforming Mental Health, Mental Illness and Addiction Services in Canada.
Some of the articles in Breakdown, like The Orphans of Medicare, do address issues of underfunding, lack of treatment options and scarce hospital beds. Among all the appeals to readers to drop prejudices against people with mental illnesses, however, there are few mentions of the more serious problems underlying the system. For example:
- inconsistent availability of mental health services across the country, especially in rural areas
- shortage of nurses, including psychiatric nurses and mental health nurses, and burnout from being overburdened by workloads
- shortage of psychiatrists, especially child psychiatrists, and the lack of organized recruitment of younger doctors as a generation retires
- lack of funding for psychologists and psychotherapists
- severe shortage of licensed long-term tertiary care facilities, post-deinstitutionalization
- shortages of supportive community housing at all levels
- overburdened community mental health teams providing inadequate services and even then only to a small minority of patients
- more and more patients with addictions and co-occurring disorders, without a rise in programs to treat both
- lack of detox beds (especially for crystal meth), rehab facilities, and post-rehab housing
- dramatically rising costs for provincial prescription drug programs, due to more expensive medications
- looming crisis as baby boomers age and acquire dementias, with few seniors’ mental health care facilities or geriatric psychiatry services
- lack of 24 hour crisis services beyond expensive ERs
- revolving door acute hospital care, with mental patients accounting for a third of all hospital admissions
- an almost total lack of home care assistance, no respite care for families, and the problem of parents caring for adult children becoming elderly and unable to continue providing home care
I know, I know, I’m too gloomy, but there it is. Few Canadians are willing to say it aloud, and most health care bureaucrats are too invested in their own jobs and rhetoric to listen. As a longstanding volunteer involved with two mental health organizations, as well as a writer who’s consulted a huge amount of research literature over the years, I’ve noticed these problems and noticed that oftentimes even the other volunteers refuse to acknowledge them. You might think Canada is a great place to live for health care, but we just pretend. Politely.
Congratulations to the Globe and Mail on their nice anti-stigma feature. They have published articles on some of the above issues in the past, to their credit.
Know what would be good to help fight stigma? Recovery, which is terribly difficult for people to achieve under these conditions.
Kiume, S. (2018). Breaking Down the Breakdown. Psych Central. Retrieved on April 9, 2020, from https://psychcentral.com/blog/breaking-down-the-breakdown/