Privatizing Canadian Healthcare is not an option.

By Marvin Ross

Covid and staff shortages in healthcare has led the right wing Ontario government to hint that drastic innovations like privatizing may be required to give health care a new life. Sadly, they are blinded by their own ideology and a lack of understanding of the issues. That may sway some to agree with them.

I for one am impressed with how well the system actually works despite the problems but more of that in a minute. Ontario already has parts of its health system privatized and it is a disaster. Since the election of an earlier right wing government under Mike Harris and his Common Sense Revolution, long term care has allowed for profit homes. Harris would become chair of the Chartwell Chain of residences and Wikipedia estimates he received $3.5 million for his services.

During Covid, it was discovered that the private long term care homes had the worst outcomes with far more elderly dying in their care than in the not for profit or municipal homes. The situation was so dire that the military was called in to help and the troops were shocked at what they found.

In October, I wrote about a private chain that provides so called supportive housing to adults with disabilities and the conditions were barbaric. The Global TV news has just done a multi -part expose on a private chain that provides housing and supports for vulnerable kids. The series outlines the findings of possible human trafficking and mistreatment, over medication, and possible deaths which the government has ignored. In fact, the office that provided oversight was disbanded in 2018 as a cost saving measure by the incoming Ford government. The report on the chain was never completed as a result.

I cannot imagine anyone wanting that type of care throughout the rest of the health system. If we consider what is often put forth for a dual system, that makes no sense. The argument is to allow private care for those who can afford it and keep the public system. The problem is that we only have a limited number of doctors, nurses and other professionals. With a private system, many would migrate to there where they could earn a lot more money leaving very few staff for a public system.

As it is now, nurses are fleeing hospitals because they are overworked and undervalued. The government has capped their salaries to no more than a 1% increase. In order to fill in for vacancies, hospitals and long term care facilities are forced to bring in nurses from agencies at $120 an hour. Why not pay nurses what they are worth. The government categorically refuses to rescind the bill that restricts their pay.

The biggest problem with health care in Ontario is the stupidity of how it is run. As I explained in one of my op eds in the local paper, the problem is a rapidly expanding bureaucracy which has no value added component. Today, the Ministry of Health and Long-Term Care has two ministers and an associate minister devoted to mental health and addictions. In 2005, there was just one minister. All those chiefs need staff so that today we have one deputy minister assisted by three associate deputy ministers. In 2005, it was one deputy and one associate deputy.

Each of the above needs a fairly large staff to report to them to rationalize their existence. The more senior staff you have, the more juniors are needed. Going down one level we have the assistant deputy ministers who, today, number 14. Again, an entire bureaucracy is required beneath them to justify their existence. In 2005, there were only seven assistant deputies or one half as many as today. Has there been any improvement in care and delivery between 2005 and today as the result of this growth in bureaucracy?

No but there is a new organization called Ontario Health which has, I’m told, 30 Vice Presidents.

The provincial premiers are all demanding that Ottawa fork over more money but Ottawa rightly refuses unless their is accountability from the provinces on how the money is to be spent and how it was spent. Ottawa did give Ontario $450 million to improve the wait list for kids seeking mental health care. As a result, the wait list went from 18 months to 40 months and the money was used to develop a Centre of Excellence for mental health – more bureaucrats.

Despite this mess in health care and the delayed surgeries and long wait times, the system is working thanks to the dedication of the staff. At the height of covid, someone with Alzheimers in a good care facility for whom I was power of attorney, wound up in hospital. He was found one morning sitting on the floor at the foot of his bed and staff sent him to the ER at the University Health Network in Toronto.

He was suffering delirium from extreme constipation and was kept for months as he recovered. By this point, he needed long term care but his dementia had deteriorated to violent outbursts and he had to be watched by a staff person all the time. Staff were excellent, caring and compassionate and finally decided to refer him to the Toronto Rehab Hospital across the street where the psychogeriatric unit might have some success with his aggression. That would have made it easier to find him a placement.

Regrettably, he managed to escape from his wheelchair restraint, fall and fracture his hip. He was then moved next door to the ER at the Mt Sinai Hospital where the fracture was repaired. Sadly, and not unusual, he developed a pulmonary embolism and was moved into palliative care. Staff were kind, attentive and kept me updated on a regular basis so I could provide reports to his family in the US, the UK and Australia.

His passing was a tragedy but the care he received and the human contact and consideration was what we would all like. And this was at the height of the pandemic when staff were overworked and stressed.

I have other stories in a similar vein but it all illustrates how well served we are by a very dedicated, compassionate group of professionals.

They and the rest of us do not deserve the idiocy we see from our ideologue politicians.

Chronic Homelessness – A Trip to Finland for Trudeau

By Marvin Ross

Most of us, on our regular ramblings around whatever city we live in, can’t help noticing the increase in panhandling and tents pitched discretely in public parks. Signs of increasing homelessness are everywhere. Most readers of this blog also know that one significant reason for that homelessness is untreated mental illness. The solution is pretty straight forward.

Thanks to the Auditor General of Canada in her latest report, government efforts in this area have been an expensive waste.

Infrastructure Canada spent a total of $1.36 Billion between 2019 and 2021 on preventing and reducing homelessness without ever knowing if the money had any impact. That sum accounted for 40% of all the money spent on the housing initiative. Canada Mortgage and Housing spent an additional $4.5 billion without knowing who actually benefited from that spending. Rental housing units under the National Housing Co-Investment Fund was to be for affordable rental properties for low-income people but, in fact, many of the homes were not affordable.

Very disappointing but frankly not surprising. Governments give money for projects and groups not with the hope that some good will come of it but to be able to say “we’ve funded that project” now go away and leave us alone. If they truly cared about change, they would give more rationally and they would evaluate the outcomes of what they are doing. Instead, as the Toronto Star asked in its editorial, who is in charge? And then concluded no one!

Contrast what our government has not done with Scandinavia and, in particular, Finland where homelessness is declining. The Finnish solution is simple – give people housing. Not only do they give people homes but they provide services. “Services have been crucial,” says Jan Vapaavuori, who was housing minister when the original scheme was launched. “Many long-term homeless people have addictions, mental health issues, medical conditions that need ongoing care. The support has to be there.”

In one housing building as an example, the 21 residents are supported by 7 staff. That’s a strategy that is not cheap but it pays all sorts of dividends in cost savings and in generating improvements in human dignity. Finland spent 250 million Euros developing housing and hiring 300 support staff but saved an annual 15,000 Euros per homeless persons in emergency medical care, social services and the justice system.

I would like to make a suggestion for Mr Trudeau. I’ve lost track of just how much travel he’s done in the past few months between the Queen’s funeral in England, NATO, the G20 and a few other conferences in places like Thailand and Cambodia but winter is a lovely time to visit Finland. He could relax in a sauna while discussing how to move our Canadian homeless out of parks, ravines and from under bridges and over sidewalk grates into properly supported homes.

How about it Justin? And, before you go, take a look at this one hour long documentary on the absurdity of what is happening in BC. Treatment is ignored in favour of harm reduction in the case of addictions – a government sponsored drug distribution program. Well worth the time spent watching it despite the ads interspersed throughout.

Depression and Repressed Memory

By Dr David Laing Dawson

I recently had a request from a woman suffering from depression who is seeing both a psychiatrist and a psychologist. The psychologist is focusing on the woman’s relationship with her mother when she was a young girl and I was asked what I thought of cognitive behavioural therapy. This is my reply:

Dear

We are complicated creatures and I don’t have a simple answer to your question.

Depression, serious depression, something we used to call “clinical depression”, meaning beyond simple sadness or grief, and usually involving physiological dampening (energy, appetite, sleep, slowed speech and thinking) and even cognitive changes (I described those in a recent blog) is an illness.

The first and most important treatment is medication. We have many of these now to choose from and the choice can be guided a little by science and mostly by clinical experience. If the depression is accompanied by high anxiety (we used to call this agitated depression) then the SSRI meds work well: Cipralex, Zoloft etc. If the depression is more of a flat, can’t get up kind of depression, then the medications with some stimulant quality may work better: effexor, wellbutrin (buproprion). Sometimes a combination works best.

It has long been known that depression can follow a serious viral or bacterial illness, and now it appears this may be because of the bacteria and the antibiotics used changing the gut flora and eliminating all the good serotonin producing bacteria. And it is much more likely this or current events in life trigger a depression than something from distant childhood.

In a state of depression though, our brains dredge up all the things that we have felt guilty about, or angry or aggrieved. These are not necessarily causative, but merely associative, something like thinking about all the previous good times in a current good time, and thinking about all the previous bad times in a current bad time.

But certainly a professional counselor – supportive, non-judgmental and wise – is an important part of treatment and recovery. The actual conceptual foundation for that therapy is not important, providing it does no harm.

Now one of the ways therapy can do harm is to “create memories”. There is no such thing as a “repressed or blocked” memory of significant events. That is not how memory works. We may choose to never think about, dwell upon, or address or talk about something significant but we don’t “forget” it. We may retain accurate memories of a few words, an emotion, the outline of an event, but all the rest is re-created, and re-invented as we talk about it. It is very easy for a therapist knowingly or unknowingly to create false memories in a patient. Surprisingly easy. And very easy to shape a memory into something far more significant than it really is.

Now basic CBT is okay and merely a complex version of “thinking positively” or as the AA people call it, getting rid of the “stinking thinking”. And it is based on the notion that our ways of thinking and the words we use affect the ways we feel. A crisis can be an overwhelming problem and hopeless, or an opportunity.

So give yourself time. If you like your therapist and she or he is not rigid in their philosophies and techniques, stay with it. But mostly talk about people and events in your life in this decade.

Work to find the right medication. Keep balance in your life, adequate good sleep, good diet (there may be a role here for probiotics), exercise, music, routine; maintain all your important and good relationships. You will get well.

Guest Blog – My son’s death revealed the connection between mental illness and addiction

By Sandra Ingram

I am a retired professor and up until 20 months ago, I was the mother of a young man who has since taught me life lessons that I never thought were mine to learn.

Devin, our only child and the centre of our lives, passed away at age 22 on Feb. 7, 2021, from what was later found to be an accidental overdose involving opioids.

While he had been under psychiatric care for the last few years of his life and hospitalized twice, there was nothing that could have prepared my husband or me for this unimaginable loss. 

Devin was a sweet, affectionate and loving child. In adolescence he transformed, becoming increasingly isolated and inward focused, with a developing addiction to video games.

By age 14, he had begun to experiment with marijuana, and while we as parents did not condone it, he secretly continued to use more potent drugs — we now know — to calm the turmoil that was taking root in his brain.

Severe psychiatric diseases often emerge at this age and take years to be fully diagnosed due to their complexity — not to mention the potential medical, legal and social implications of some diagnoses.

By Grade 11, he was being treated for anxiety and depression. By the time of his high school graduation, Devin was so anxious he was unable to attend.

The fact that he achieved that milestone is something we now regard as astounding. 

Shortly after graduation, Devin was admitted to hospital for a psychotic episode. He had lost touch with reality and was hearing voices.

Because drug use can interfere with severe mental illness diagnosis, we were not told at this stage that he had a definitive illness. It was not until the post-psychosis treatment that I heard schizophrenia might be a possibility, but we needed to wait to see how recovery would unfold.

The word terrified me so much that I decided I would not read about it or learn more until, or unless, I had to. In the meantime, I would push on and do my best to help my son rebound from this crisis with the multitude of drugs required for his recovery. 

As a mother, I was worried sick about his developing medical condition. In terms of his drug use, I was angry, guilt-ridden and even ashamed. How could this be happening to him and us?

As a teen, when Devin was becoming more socially withdrawn, we encouraged him to consider volunteering. Despite his pain, he embraced the idea.

He put in more than 600 hours of service — mostly with an organization devoted to increasing the quality of life for individuals with severe developmental disabilities, to help them live their best lives with dignity and respect.

Upon his death, they planted a tree and dedicated a physical space to his memory. They have even created an annual award in his name.

Devin’s condition was moving closer to a schizophrenia diagnosis in the few months before his death, when he went into hospital for a second time. We now know that Devin suffered from two potentially fatal diseases: schizophrenia and addiction. Both of these robbed him of the ability to live out his life. 

And while you may recognize schizophrenia as a disease, I suspect there are many out there who question whether addiction deserves that label. Until this tragic outcome, I was one of them, having had no prior exposure to it and a lot of bias. I thought it was a choice.

Now I know better and see addiction for what it is: a chemical, brain-based compulsive disease. My son did not choose the path to addiction any more than he chose to become mentally ill.

What’s more, there is a grim connection between the two. According to the Centre for Addiction and Mental Health, “people with a mental illness are twice as likely to have a substance use disorder compared to the general population. At least 20 per cent of people with a mental illness have a co-occurring substance use disorder. For people with schizophrenia, the number may be as high as 50 per cent.”

Regardless of education, social status or racial/cultural background, mental illness has the potential to destroy lives and families. It contributes to a vulnerable population who do not necessarily look different from anyone else and are capable of giving extraordinary gifts to society.

Unfortunately, many are also at tremendous risk of being harmed by the ravages of a toxic drug supply and those involved in the trafficking of opioids.

While I am not naive enough to believe that my son’s troubles would have disappeared if he did not have access to opioids, I want people to see the inherent dangers, particularly to those with mental illness, that these drugs pose. 

After all, their lives matter. Don’t they?   

Sandra Ingram is a retired university professor and published author who lives in Winnipeg. This article first appeared on October 8 on the Canadian Broadcasting Corporation First Person Series

Aspergers, for Better or for Worse

By Dr David Laing Dawson

Greta Thunberg has called it her super power. And indeed, her blindness and deafness to the non-verbal nuances of human communication, and lacking the caution that that creates in most of us, allows her to barge ahead confronting world leaders advocating for a change in all human behaviour, though she is but a teenager.

A couple of times, talking with boys on the ASD spectrum, I have quipped that, “I was as smart as you are when I was 14. But then I discovered girls, and sports, and hanging out, and parties, and music, and clubs, and girls.”

It does appear that for most of us, a large portion of our brain is utilized to receive, interpret, and respond to pre-textual and contextual components of language. This includes body language, facial expression, context, assumed role relationship, eye movements, and the prosody and cadence of the text being exchanged. It has been said that up to 80% of the meaning of the words we use in speaking to one another can be found in the non-textual components of language. And it is in the non-textual components of language that we discern the nature of our current relationship and what we can expect in the near future. Just think of the thousand ways one can say, “Hello.”

The neuro-diversity that is Aspergers has benefited humankind in many ways, from the breaking of the Enigma Code, to the development of computer sciences, the understanding of gravity, alternating electrical current, the theory of relativity, and the theory of evolution.

But quite suddenly we live in a world with technology that allows us to forgo that most complex and nuanced world of face to face communication. Emojis help but they cannot replace the raised eyebrow, the constricting of pupils, the tonal change at the end of a phrase, the tiny hesitation before a word is used, the forced laugh, the genuine smile…

I suspect Facebook was originally created to help certain young men acquire girlfriends without the trouble of venturing outside their dorms and actually talking with women face to face. Now Mark Zuckerberg wants us all, or at least our Avatars, to join him in the metaverse, to work and play in a virtual world, where eyes resemble the headlights of an ambulance transporting a talkative Alzheimers patient from the hospital to a long term care facility on a Sunday afternoon.

And Elon Musk.

I have wondered if this particular neurological organization, this particular diversity we call Aspergers, is actually an evolutionary step. What was once a small but useful group who were able to forgo the pleasures and anxiety of always trying to fit in, enabling them to pursue a single mathematical puzzle for days and years, could now become dominant as we merge with machines.

Who else might be content and even happy living with a family of robots in a geodesic dome on Mars?

“I don’t get poetry.” One of my Asperger patients once told me. “If you want to say that you enjoy walking in the woods after the first snow fall, why not just say it?”