Planning Mental Health Services Rationally

By Dr David Laing Dawson

Over the years I have been several times involved in planning mental health services, sometimes in a general and wide sense, sometimes specific programs. In each case I usually ask, “How much money do we have to spend? What is the budget?” And usually there is no answer to this question. The game is not played that way. First the proposal to compete with other proposals and then, within a highly politicized process, the allocation of funds.

This means of course, that the words are being sold, promoted. Not the actual evidence based possibility of major effectiveness with consideration of budget. But rather the most pleasing, hopeful, expansive words of promise (with fewest political complications) are being sold and often funded. This may be a good way to fund an arts program, but for health, we really should turn to science.

If we say, instead, “We have 10 million dollars to spend to prevent suicide in a particular state or province; how should we spend it for best results?” then our thinking might be clarified for us. What do we actually know about suicide and suicide prevention? What do studies from various parts of the world show? Where are the high risk populations? Which ones can we actually target?

Then we might look at the large range of social and economic factors that comprise risk factors that indirectly, or at a distance, contribute to a high suicide rate, and pass on these. They are usually broad conditions that can be gradually improved, and should be gradually improved through political action and do require political will and good economic times. (housing, minimum wage, employment, social programs, education)

Then we could look at specific high-risk populations and figure how we could spend that 10 million effectively to measurably reduce the suicide rate.

Then we might notice that a very high risk group for completed suicide comprises people too-late identified as suffering from severe mental illness, recently discharged psychiatric patients, and especially those suffering from a severe and chronic mental illness who drop out of treatment and/or stop their medications.

And then we can ask if there is a way of spending that 10 million dollars to improve and repair the services offered this group of people. They are identifiable. They are at high risk. And it is possible with limited money to enhance the programs that serve them. Especially during visits to emergency, drop-in clinics, and family doctors, and then in the years following diagnosis and/or discharge from hospital.

Of course we need to improve the resilience and mental health of our children, if we can. But not as a means to reduce the suicide rate, but rather for overall success of our children as adults. And this means, not a suicide prevention program, but rather more money and support for the educational system and improvements in this system utilizing all we know about learning, nutrition, physical health, exercise, social growth, stress management, disability accommodation, ensuring each child has some success and a chance to belong.

When it comes to suicide then, we don’t need a “national strategy”. We need to continue to improve all our services and our lives, with improvements in our educational systems, income support and equality, a healthy economy and good jobs, improved general health care systems and easy access to same, addictions programs, income and social support for the elderly, affordable housing…… And we need to turn our attention to those people we know to be at especially high risk for suicide (sufferers of severe mental illness, recently discharged patients) and improve our services and access to services for these people.

 

 

 

 

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5 thoughts on “Planning Mental Health Services Rationally

  1. As usual Dr Dawson writes a very much to the point column. I agree with every word in the article

    ” Fine words do not butter parsnips ” . Neither does a silly national suicide strategy do anything to really prevent suicide. Of course it does and will give many make work projects for many who would not otherwise be employed.

    To quote Dawson”Then we might notice that a very high risk group for completed suicide comprises people too-late identified as suffering from severe mental illness, recently discharged psychiatric patients, and especially those suffering from a severe and chronic mental illness who drop out of treatment and/or stop their medications”
    This is where the money ( action ) should be applied. Access to proper treatment and professionally trained people. Then there will have more “sunny days ” for people who are tortured by miserable symptoms Rational policies and not silly inflated talk is needed.

    Liked by 1 person

  2. Correction . There will be more sunny days…See above !..

    Many of us have said the same things for thirty years and so many planners such as those at the LHINS former DHC, Queen’s Park committees the current “National” Commission on mental health continue to trot out silliness and spend money wildly. If the new president “Wilson” has any sense he will scuttle some of the nonsense and urge that money be put into direct services as well as heed serious biological science. Patricia Forsdyke.

    Liked by 1 person

  3. The reason why we have not found any way to successfully ameliorate or cure mental illnesses is that we still have no idea how to do this. We missed the boat about the biological nature of mental illnesses.

    This was because early microscopes were not strong enough to see the infecting microbes. So with no ready answer we attributed social concepts as the cause of madness, as sociology ruled at the time. We didn’t even know of the existence of viruses until improved magnification But we continued to believe that only bacteria could cause infections in humans.

    Added to this, microbes did not incubate for years and show the results of viral infections. We knew that with bacteria, the resulting illness came close to the time of the original infection.

    This is what science expected of any infections. But with parasites and viruses the symptoms of any brain infections they created did not appear for years-often into old age.(think Alzheimer’s disease, the age of onset of schizophrenia, autism’s infant brain infection.)

    (Multiple Sclerosis occurs in Middle Age. Another incurable disease.)

    I wish scientists would retrace their steps, like this. Maybe there is a clue here)

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  4. It looks like families know more about serious mental illness and the services necessary to truly care for the chronic brain diseases they endure, than those who care for their schizophrenic loved ones.

    A recent media article decrying current “professional” services was inundated by comments that agreed with the criticisms and added many more.

    It will be a challenge and expensive but we can no longer ignore urgent scientific brain research to find root causes of these diseases. Funds spent on science could be found if we stopped the pointless faux services in the interest of scientific brain research to eradicate these age-old curses of humankind.

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