By Dr. Vicky Stergiopoulos, Physician-in-Chief at CAMH
One in 5 Canadians will have a mental illness in their lifetime and we know from clinical experience, research, and the experiences of patients and families, that we are not doing enough to meet the needs of those who are suffering.
With a problem this staggering there is a temptation to fall back on easy, simplified, or exaggerated analysis of what's wrong and what needs to be fixed. But instead, we need to lean into the complexity of this challenge with all of our resources, our shared expertise, and, yes, even our hearts. Because our patients and their families deserve nothing less.
As a psychiatrist for 20 years, and the chief at Canada’s largest mental health hospital, I know we can do better, do more, and do it together to respond to our country’s mental health crisis.
Today, the lived reality of those experiencing poor mental health or mental illness remains one of stigma, discrimination, and poor access to adequate care and supports. Many experiencing serious mental illness also face poverty, social exclusion and criminalization. In addition to access to high quality mental health care, adequate income support, housing, supported employment and social integration are instrumental for mental health recovery for our population.
Yet progress in improving access to care and addressing social determinants of mental health remains frustratingly slow. Despite the disabling nature of many mental disorders, investments in care and supports have not kept up with the needs of the population in Canada, and in countries around the world. Those of us working in mental health, see first-hand the health inequities faced by those experiencing mental illness compared to those seeking treatment for other health conditions.
The inequities within mental health care are also evident. Consider for example the experience of someone, who in addition to living with a mental illness, experiences stigma or discrimination and inequitable access to care because of their race, culture, socioeconomic status or sexual orientation. Given the impact of these social factors on heath equity, it is no surprise that leading universities and healthcare organizations have prioritized equity, diversity and inclusion, raising awareness of and attending to the needs of those experiencing multiple sources of social disadvantage.
Over the past 30 years, progress in neuroscience and the emergence of new effective treatments have advanced our understanding of how biological, psychological and social factors interact to precipitate or perpetuate mental illnesses, although there is much more yet to discover. Looking forward, advances in digital psychiatry and artificial intelligence can accelerate our understanding of mental health and mental illness and their determinants, and advance prevention, diagnosis, early intervention and personalized treatments for better outcomes in mental health. To realize such progress, robust investments in mental health research will be crucial.
At present, we train our future health professionals in the biopsychosocial model, teaching trainees to take into consideration the whole person, their biology, their social context, as well as their own personal feelings, reactions or beliefs, and how those influence their practice. We also train and support them to be good doctors, as defined by the Royal College of Physicians and Surgeons of Canada. That is, to be professional, communicate effectively, collaborate with others in inter-professional health teams, apply and advance new knowledge, lead effectively and importantly, to advocate for the needs of the patients and populations they serve. In other words, leveraging our humanity and as well as our expertise.
There is much to be proud of in our field when it comes to the wealth of talent, diversity of perspectives, and steadfast commitment to improving mental health outcomes for individuals and populations. These are key ingredients for progress, as are open minds and open hearts. I am hopeful for the future of psychiatry. In such a short time, I have witnessed the potential of neuroscience to revolutionize the field. I have also seen the impact of evidence-based interventions and supports and the growth in the number of psychiatrists embedded in community care, in boarding homes and rooming houses, in primary care, in shelters and ravines, and in remote communities in the north, working alongside other health professionals, seeing and treating patients in context, when and where they need it most.
There is much more to do. I remain hopeful that with the pool of talent that we have and that we grow, and the increasing number of advocates speaking up for mental health, the emerging mental health movement can help increase investments in mental health care and research, ignite discovery and innovation, reduce health inequities, and advance the rights of those living with mental illness. Let’s embrace the complexity of meeting these challenges, of meeting our patients where they are, ignore the noise, and keep working towards those goals.
I have spent most of my professional life working with adults experiencing homelessness and mental illness, in shelters, primary care, or the streets. This work has made me a better doctor. I had to look up what Chelsea boots are, but I’m proud to be fighting for social justice alongside those who wear them.