Mental Health: the status quo is unacceptable
David Goldbloom, OC, MD, FRCPC (Nova Scotia & Exeter 1975) is a Professor in the Department of Psychiatry at the University of Toronto. He recently retired from clinical practice at the Centre for Addiction and Mental Health, where he was inaugural Physician-in-Chief and subsequently Senior Medical Advisor. He is a former Chair of the Mental Health Commission of Canada and is an Officer of the Order of Canada. He co-authored How Can I Help? A Week in My Life as a Psychiatrist (2016) and more recently authored We Can Do Better: Urgent Innovations to Improve Mental Health Access and Care (2021).
I began to write We Can Do Better: Urgent Innovations to Improve Mental Health Access and Care just prior to the onset of the pandemic. It was squeezed into weekends and evenings after full days at the hospital, seeing patients and training senior residents in psychiatry. Like most of my colleagues, I suddenly found myself working remotely, except for weekly shifts jabbing people at a vaccination clinic, seeing patients on video connections from my home to theirs – or sometimes to their cars, open fields, and other novel settings where they could maintain needed privacy. The world of mental health adapted rapidly to the necessary shift – a clinical imperative for patients and an economic imperative for providers – and suddenly we all learned that our traditional ways of doing things were not necessarily the best, or the most convenient for people in need.
It took a pandemic to scale up a technology for assessing people at a distance that was first reported in the psychiatric literature in 1957. But Covid did other things that accelerated innovation. It set a new world record for the development of vaccines, a process that traditionally had taken many years and instead was achieved in a matter of months. This has raised public and professional expectations around innovation. Finally, the pandemic placed a spotlight on the mental health sequelae of both the infection and the constraints it placed on our emotional, social, educational, and vocational lives. Contrary to initial fears and quick national surveys, the pandemic did not cause a tsunami of mental illness and suicide. Indeed, suicide rates cross-nationally declined during the pandemic. Sober scholarly analysis, rather than newspaper hyperbole, suggests rates of mental illness did not increase significantly.
But public awareness of mental health, which was growing prior to the pandemic, appears to have been further heightened – to the extent that improving mental health now often figures in the platforms of political parties of all stripes, something that was unimaginable two decades ago.
Prior to the pandemic, every health professional – as well as individuals struggling with mental illness and their families – knew that access to care was a problem, even in relatively highly resourced countries, and that treatments were good but not great, with no major paradigm-shifting advances. I am one of those health professionals. But I am also an optimist by nature, and one of the advantages of working in a teaching hospital of a university is the opportunity to learn about innovations that could make a difference.
All too often, the government response to unmet health need is to offer funding for more of the same – more of the traditional clinicians, more hospitals, more beds. There is a need to think differently about how services are provided and to consider new approaches, mindful of the need to gauge outcomes (a need that is often ignored with our existing approaches that have been sanctified as traditions).
In my book, I describe just some of the innovations happening now and awaiting scaling up; some have already been implemented and evaluated outside of Canada, while others have been created and tested within Canada. They include integrated services for youth that are community-based, accessible rapidly without appointment, and committed to outcome measurement; pharmacogenetics to help minimize the current trial-and-error approach to antidepressant selection; advances in the app world and artificial intelligence; rapid transcranial magnetic stimulation; and scientifically evaluated solutions to homelessness.
All of these are evidence-based contributions toward providing that essential component of all healthcare: hope.