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The longer we allow tradition to guide our practices, the more serious the mental health crisis will become.
The longer we allow tradition to guide our practices, the more serious the mental health crisis will become.

The longer we allow tradition to guide our practices, the more serious the mental health crisis will become.

By Daniel Derkach, Jack.org Network Liaison. 
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On the staggering gaps in services.
When compared with other realms of our healthcare system, psychiatry and related forms of mental health care are still incredibly undervalued in Canada. Some might argue that the demand for improved mental health care is unfounded and that we simply need to better prepare young people for the harsh realities of life. But that perspective ignores the stark reality facing youth in this country; suicide remains the leading health-related cause of death for youth, and increasing numbers of young people report struggles with depression, anxiety, and addiction. What’s promising is that my peers are getting better at speaking up about their mental health, and reaching out for help when they need it. What’s worrying is that too few of them actually get appropriate support in time for it to make a difference. 

It’s absolutely essential that robust mental health systems are in place to turn the tide. But unfortunately, our mental health care is often not accessible, affordable, or effectively administered to a staggering number of people in Canada. As a recent article in the Globe and Mail highlights, psychiatrists in Canada are, on average, the oldest and lowest-paid medical professionals in Canada. And while pay incentives and training more psychiatrists could help, the issue isn’t always about a lack of resources, but how those resources are used. As the article points out, the ratio of psychiatrists per person is almost 10 times lower in the city of Brampton than in Toronto — a pattern that exists in regions all over the country. Rural regions sometimes must rely on psychiatrists who live in other cities to make trips in to help — in Kenora, for example, psychiatric help had to travel in from Thunder Bay, over 500 kilometres away. 

Even in cities where there are enough psychiatrics to serve the population, significant problems persist, namely due to the fact that psychiatrists are largely free to choose which patients they treat, and for how long. This leaves room for “complicated” patients to be turned away. The Globe article reports on a study published last year that found that “40 per cent of Ontario youth discharged after an emergency department visit for their first psychotic episode received no outpatient mental health care for 30 days,” while a 2017 paper found that “the majority of people treated in an Ontario emergency department after a suicide attempt were not seen by a psychiatrist within six months.” 

And while some receive little to no psychiatric care at all, others receive it in abundance, even when it’s possible they could be served just as well by health professionals who are less scarce than psychiatrists. The article draws attention to a number of studies co-authored by Dr. Paul Kurdyak, an emergency department psychiatrist at Toronto’s Centre for Addiction and Mental Health and board member for Jack.org, which found that “in Toronto and Ottawa, 40 percent of full-time clinicians saw fewer than 100 patients a year” and that those smaller-volume clinics tend to treat patients from wealthier neighbourhoods, and with fewer histories of hospitalization for psychiatric issues. 

Dr. Kurdyak goes on to provide several recommendations, including the potential for centralized registries to connect patients with psychiatrists, and establishing collaborative care teams, which would include psychiatric nurses, psychologists, and social workers, as well as improved monitoring of patient progress. Developing teams of mental health professionals would allow more psychiatrists to be able to administer more care. Other innovations, including group treatment, have shown incredible promise but have not been widely implemented across the psychiatric practice. 

The psychiatric profession, like most of our mental health care systems, must adapt significantly if it is to keep up with the level of demand for services. We need to build a psychiatric system where collaboration between mental health professionals thrive, technology is embraced, and psychiatrists are incentivized to treat the “complicated” patients. In order for these changes to occur, Canadians must advocate for decision-makers to take these issues seriously: both our elected leaders and our healthcare practitioners must be willing to work together to change our fractured healthcare system. Ideally, this collaboration includes youth voices to ensure the crisis is being met head-on. Over 3,000 young leaders with Jack.org are working on the ground, twelve months a year, to identify barriers and innovate better solutions in every region of Canada. Let’s talk. Because the longer we allow tradition to guide our practices, the more serious the mental health crisis will become.

Daniel Derkach is a former Network Representative with Jack.org, and a current Network Liaison.