Over the last few years, I’ve written several opinion pieces regarding the abysmal state of mental-health care in British Columbia. While some of these issues are not B.C.-specific, I have been a psychiatrist in this province for nearly 15 years, so I am reflecting a depth of clinical experience treating British Columbians suffering from severe mental illnesses. The abysmal state I speak of is rooted in several serious systemic problems, including the lack of timely access to high-quality psychiatric care, the abusive treatment some mentally ill patients are subjected to within our health system, poor access to new, better tolerated psychiatric treatments and the lack of acceptance of mental illnesses that have an abundance of science supporting their existence.
Psychiatric stigma is truly alive in our society, even within the medical profession. This is why psychiatric care has always been woefully underfunded. Yet in response to these serious issues, my colleagues have mostly been silent. Some have written or spoken to me quietly, thanking me for speaking out. Yet, they do not stand with me publicly, demanding that we do better.
It’s possible that most of my colleagues are happy with our mental health system and I am one of a disgruntled few. If it’s true that most are satisfied, it would mean that they are oblivious to the suffering of thousands of patients. I say this because I have met only a handful of patients who had anything positive to say about their mental-health care. If you think our system is fantastic, or even passable, you’re a psychiatrist who doesn’t see patients, or you have not been listening.
Some colleagues might fear that their job at a hospital, mental-health team or as an administrator will be in jeopardy if they speak up. To that I say, as the leader of any medical team, the physician is the individual who is ultimately responsible for a patient’s medical care. We are held to account for that care by our patients, their families and our professional college. That role comes with a responsibility to speak up when we know patients are being failed, even if it’s uncomfortable. Yet, too many of us say nothing.
A few B.C. psychiatrists probably believe they have access to all the medications they need to adequately treat their patients. Some might view new medications as simply expensive replicas of older ones that offer no additional benefit. There might even be a few who don’t believe medications are necessary at all, and that all psychiatric illness can be managed with talk therapy, exercise or a healthy diet. Those psychiatrists are in the wrong profession.
While there is clear research evidence supporting the value of talk therapy, exercise and a healthy diet for those suffering from a mental illness, for severely ill patients it is not possible to yoga your illness away. Medications are essential tools of our trade and patients and their loved ones depend on psychiatrists to know how they work, how to use them safely and appropriately, and to help them to choose the safest, most-effective, best-tolerated option. Every patient is an individual, with unique treatment requirements, and I need every possible tool in my medication toolkit to offer each patient the treatment that is best suited to their needs.
To those psychiatrists who are comfortable to offer their patients the older drugs they know well, without considering that there are likely safer, more tolerable alternatives, I ask them to ask themselves, “Would I want my loved one to take that drug?” If not, why would that be acceptable for your patient? I have cared for many medical colleagues and their loved ones in my practice and I have never had one ask me to prescribe them “whatever costs the least.”
Any psychiatrist who doesn’t believe psychiatric medications improve and often save lives hasn’t been doing their job. Sadly, many people who have a serious mental illness and view medications as ineffective have been failed by my profession. No one wants to take medication, but for serious mental illnesses there are few other options, and access to them is severely and inappropriately limited. Finding the right treatment takes time, patience and support. For those who want a psychiatrist’s help, there is always a path ahead.
Finally, B.C. psychiatrists — all physicians, actually — must denounce what is happening at B.C. Pharmacare under Health Minister Adrian Dix. B.C. has the lowest drug expenditures and public expenditures on drugs per capita in Canada. New, safer treatments that are Pharmacare benefits in every other province are not covered in B.C. While not paying for medications might be cheered as fiscally responsible, the science is clear: un- and under-treated mental illness massively increases the financial burden for society. Consider that one day in hospital can cost $1,500. When you add the costs of absenteeism, presenteeism (not being effective at work), as well as human suffering, suicide and the financial burden of poorly resourced mental-health care is manifest. This demonstrates the short-sighted vision of the Therapeutics Initiative: avoiding one day in hospital would treat one patient with an appropriate, tolerable medication for an entire year.
Dix has actively engaged and richly funded the Therapeutics Initiative, a group of “health professionals” that spreads misleading or false information about psychiatric and other medical illnesses and treatments without clinical experience, under the guise of “University of B.C. experts.” Their ignorance extends beyond the clinical, cherry-picking, poor-quality data, excluding widely accepted research and falsely characterizing the author’s conclusions. Interestingly, their most recent newsletter highlighted issues of antidepressant discontinuation, which is extremely rare with newer treatments that Pharmacare refuses to cover.
The Therapeutics Initiative has no psychiatrists, yet they send newsletters to doctors concluding that antidepressants are addictive, antipsychotics are ineffective, and ADHD is caused by starting school too soon. The arrogance required to speak with authority about a subject for which you have no training is monumental. Imagine if a group of psychiatrists sent out a newsletter claiming, “All cancer treatments are entirely useless,” or if a group of pharmacists sent out misleading and misquoted research entitled, “Neurosurgeons are quacks.” That seems ridiculous, yet that is what the Therapeutics Initiative has been doing related to psychiatric disorders.
The Initiative counts on my colleagues to remain silent as they work to dismantle what little our system has to offer our patients. If they are to have any role in determining what constitutes safe and appropriate psychiatric care, the Initiative must include several practicing psychiatrists to scrutinize the newsletter’s research and conclusions.
I urge patients and their families to write to Dix or their MLA to demand improved mental-health funding. To my fellow health professionals, please speak up. B.C. needs your leadership, and your patients desperately need your advocacy.
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