By Marvin Ross
The Canadian province of Ontario has just had an election for a new government in which all four parties running put forth their ideas on how we could improve services for the mentally ill. Unfortunately, most talk about mental health rather than illness and put forth strategies to increase the use of psychotherapy for essentially the worried well.
What appears below is my post election op ed critiquing the party platforms. The lesson for advocates is to reject the term mental health and to focus on illness. And while psychotherapy may be appropriate in some circumstances, it is not appropriate for illnesses. Medicine is based on the concept of triage where the most seriously ill or injured go first. In our world, the most seriously ill – those with schizophrenia bipolar, etc – are ignored
The election is over and the biggest losers are the mentally ill. The sad reality is that it did not matter who won as none of the parties offered a realistic solution.
Mental illnesses (unlike the vague mental health referred to by politicians) like schizophrenia, bipolar disorder, anxiety, severe depression are medical problems requiring prescribed medications, often hospitalizations and life long care. As explained by my fellow blogger, Dr. David Laing Dawson, “calling severe mental illness a “mental-health issue,” and addiction an “issue with substances” is ridiculous.
These “issues” become a new reality, he says, that allows us “to ignore the real reality of the jails and prisons filling with the mentally ill, the burgeoning homeless population, and the horrific struggle families go through trying to get psychiatric treatment for a family member who is mentally ill.”
In an op ed in here last year, I pointed out that Premier Doug Ford made no progress in mental illness services other than a report called Road Map to Wellness which has not accomplished much because of COVID-19, as explained by the minister responsible last year and confirmed recently by a staff member. The wait time for children’s services went from 18 months in 2018 to 40 months today.
Ford did establish a new bureaucracy called the Centre of Excellence for Mental Health and Addictions “as a central engine to design, manage, and co-ordinate the mental-health and addictions system.” Most of what they have done is to arrange for psychotherapy sessions for people, including internet sessions and supports for stressed health-care workers.
I don’t want to knock psychotherapy, but serious mental illnesses require much more than talk therapy. The Polish psychologist and critic of psychotherapy, Tomasz Witkowski, in his forthcoming book, “Fads, Fakes, and Frauds,”points out that there are 45 theoretical schools explaining the functioning of our psyche and that in psychotherapy there are over 600 different (often conflicting) modalities. So, when politicians push psychotherapy, which school and which modalities do they favour? I suspect they have no idea.
To be fair, the Tories did set up four new mobile clinics in hard to reach communities and they are working on the establishment of early psychosis programs.
The Liberal platform we can discount. In 2010, they released the results of an all-party committee consultation on improving mental health and addictions based on extensive consultations and expert submissions from across the entire province and then failed to act on almost all of them.
The NDP wanted to make mental health part of OHIP (Ontario’s public health plan), which it already is. Mental illnesses are covered by OHIP as treatment is provided by medical doctors and hospital stays. Andrea Horwath focused most of her efforts on counselling in order to help people stressed by the COVID pandemic when the main problem is the lack of timely services for illnesses.
The Greens were a little more realistic in advocating for supportive housing with extensive supports, reducing wait times and increasing spending on mental illnesses from seven per cent of the health budget to 10 per cent. According to the Canadian Institute for Health Information, we spend less than most countries in the OECD with France at 15 per cent and the UK at 13 per cent. They, too, pushed for more psychotherapy but the bottom line is no one had any realistic strategies to improve services.
We will all continue to suffer as a result.