Paul Kurdyak MD, PhD, FRCPC
Medical Director, Performance Improvement, CAMH
David S. Goldbloom, OC, MD, FRCPC
Senior Medical Advisor, CAMH
Benoit H. Mulsant, MD, MS, FRCPC
Clinician Scientist, CAMH
As Budget Day in Ontario approaches, we have an opportunity to reflect on how our health care system is meeting the needs of Ontarians. Despite increased awareness and declining stigma, people of all ages with mental illness or substance use disorders are still unable to access effective and integrated care.
In Ontario, between 2006 and 2011, the rate of Emergency Department (ED) visits for mental health increased by 33%, and half the children and youth who visited the ED for the first time had not received mental health outpatient care. The ED should not have to be the first stop for children and youth with mental health problems.
Ontarians who live in rural or remote communities, and those who are marginalized, have an even more difficult time accessing care. Family doctors, who provide the bulk of front-line mental health care, face great difficulty referring patients for psychiatric consultation and treatment.
In a study exploring the impact of financial incentives to improve access to psychiatrists, 60% of individuals had no access to a psychiatrist within 6 months after a suicide attempt, and incentives did not change this rate.
There are just over 2,000 psychiatrists in Ontario. Toronto and Ottawa have more psychiatrists per capita than anywhere else in Ontario. Psychiatrists in all areas outside of Toronto and Ottawa are in short supply and, in several regions, the majority of psychiatrists who are working there are nearing retirement.
Effort should be focused on figuring out how to best use the highly specialized expertise of these 2,000 psychiatrists to serve a greater number of Ontarians in need. There needs to be less focus on what type of treatment modality should or should not be funded, and more focus on how services should be organized to address the existing need.
For example, we need to ensure that high intensity services are available for those with the highest need. This alignment of need with treatment intensity occurs in other areas of the health care system through systematic measurement of need and treatment outcomes. Provincial data agree with what we see in the CAMH ED: there are far more individuals with no access to mental health care than there are individuals receiving care.
The needs of Ontarians would be best met if our psychiatrists more meaningfully collaborated with family physicians, nurses, and other mental health professionals to offer both short-term and long-term evidence-based treatment.
We sincerely hope that psychiatrists, policymakers, and, most importantly, the people they serve, can work together to build a mental health system that uses the best evidence to respond to the mental health needs of Ontarians.