Improve access to psychiatric care

Posted on February 14, 2008 in Health Debates – EditorialOpinion – Improve access to psychiatric care
February 14, 2008
Zahinoor Ismail

As Canadians, and as citizens from all over the world, we are certain to share one common bond – someone we know or love suffers with a mental or psychiatric illness. Cases of psychiatric illnesses continue to be diagnosed in increasing numbers. For example, it is estimated that one person in every 100, or 300 000 Canadians, will be diagnosed with schizophrenia in their lifetime. This places the economic cost of schizophrenia at over $4 billion per year.

The recently announced National Physician Survey, Canada’s largest survey of nearly 20,000 practicing and in-training physicians, reinforced one of the most prevalent issues in the management of psychiatric illnesses – access to psychiatric care. The survey reported that 64 per cent of family doctors rate access to such care for their patients as fair to poor. As a consequence of this limited access to specialist psychiatric opinions, these patients can end up in the Emergency Room in crisis. They wait longer than medically ill patients in the ER and add to the overcrowding there. Or they can remain untreated for extended periods.

Recently in Ontario there has been a growing awareness of the need to improve mental health and psychiatric care. Prior to the Ontario election, a joint effort by the Schizophrenia Society of Ontario and the Ontario Psychiatric Association called for action to improve wait times for access to treatment for patients with schizophrenia. Most provincial parties responded with their own recognition of the need for greater funding and access to mental health and psychiatric care.

We know that earlier clinical intervention increases the odds of treatment success. Untreated depression is associated with structural brain changes and untreated psychosis results in longer episode duration and poorer response to medications. So in a broader sense, increased wait times results in sicker patients who need more care. But it is this early care that is essential to improving the world of a patient who is often suffering from social isolation, poor quality of life and an increased risk of mortality.

We are not fortunate enough to have a “one size fits all” approach for patients suffering from mental illness. Mental illness is complex, and a multidisciplinary approach is often required in its management. In addition to the professional care of psychiatrists and access to the most advanced medications, these patients also need access to other mental health professionals to fully meet their needs.

For patients with mental illness, finding the appropriate treatment is often a challenging and difficult task for family physicians and psychiatrists alike. What may work for one patient may not work at all for another due to the great complexity of illness. Some patients may respond well to the first treatment option, whereas others may require a half dozen or more different options or even a combination of treatments before arriving at one that is successful for them.

Having access to the right treatment option can mean the difference between a life of despair and isolation for a patient, versus one that holds new promise and hope for greater independence and self-management. This will result in reduced office visits, reduced need for additional care and fewer hospitalizations. And, it might just free-up enough human resources to reduce the time some patients are waiting to see me, or one of my colleagues.

I am encouraged that we are beginning to close the gaps between access to treatments and the burden that access barriers place on the system as a whole. If psychiatric care is to become more accessible over the long term, then access to all treatments– from new counselling interventions to medicines to community support services– must be recognized as critical to building a truly integrated and accessible system.

The National Physician Survey highlights clearly the lack of access to psychiatric care. Now is a time of positive change in the management of mental and psychiatric health care, and the survey should be heeded. This involves a comprehensive approach to ensure that the appropriate care is both available and accessible. Our governments have an opportunity to ensure the accessibility of mental health treatment to increase the odds that more patients can return to more productive lives, easing the burden on a system that has been stretched to capacity.

As health-care professionals we have an opportunity and an obligation to ensure we advocate strongly for the needs of our patients. We owe this not only to them, but to those who are waiting as well.

Dr. Zahinoor Ismail heads the Multilingual Memory Clinic at the Centre for Addiction and Mental Health and is an assistant professor at the University of Toronto

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