What do we really need to improve mental health services?

More psychiatrists not needed, but funding, co-ordination

Recently the results of a study commissioned and conducted by the Coalition of Ontario Psychiatrists was published.

The study found that the existing 1,900 practising psychiatrists are not enough to meet the escalating demand on their services. In apparent agreement with this finding, the previous Liberal government earmarked $2.1 billion over four years and the current Progressive Conservative government a scaled back $1.9 billion over 10 years to address this “shortage problem.”

In Ontario there are more than 20,000 registered social workers and social service workers; many providing front-line counselling services in agencies and in private practice. Of registered psychologists there are approximately 4,200; many providing therapy and counselling in various settings. Then there is the newly formed College of Registered Psychotherapists of Ontario whose members come from different disciplines and whose primary function is face-to-face counselling.

Each year the 14 universities in Ontario that have social work programs each graduate several hundred professionals many of whom will provide counselling services in various settings. Similarly, while fewer in number, each year several hundred registered psychologists with doctoral degrees start providing counselling services.

There are several points to be made based on these metrics approximations and some elephant in the room ignored facts. A significant contingent of scholars have and continue to question the efficacy of psychiatry and the profession’s primary tool, psychopharmacological intervention. Many have gone as far as to say psychiatry does more harm than good and that the drugs prescribed create problems instead of solving them. Before we jump on some out of tune bandwagon in their parade and ignore some serious allegations, at the very least, there needs to be a very public examination of what we get for our tax dollars from psychiatric services. Let us examine the serious concerns about this specialties efficacy before we go any further.

We also don’t need more social work counsellors, psychotherapists, family or couples counsellors or clinically trained psychologists until we figure out how better to employ the various skills they possess. The figuring out needs to include proper funding of qualified counsellors which would entail first examining and then addressing the unwarranted monopoly status currently enjoyed by psychiatry in Ontario and Canada.

The figuring out also needs to include examining the benefits derived from medicalizing maladaptive behaviour. Of the some 300 Diagnostic Statistical Manual 5 (DSM5) disorders only a handful have a definable organic basis. The remaining

290 disorders are reactions to life’s vagaries which can take a myriad of forms. Chemically altering with prescription drugs the minds of troubled people is a questionable practice — albeit clearly preferable to addressing the psychosocial factors precipitating these problems.

Last but not least, figuring out needs to include the language we use. Language does matter. Although health is defined as a state of well-being in body and mind, when the word is used, it almost always has a physical connotation. Even in psychiatry’s DSM5 the concept of mental health is avoided, and rightfully so, given that only a handful of disorders have a physical marker.

Let us all also strive for clarity in language which in turn will produce relevant strategies to address and/or prevent behavioural, cognitive or emotional disorders. Instead of allocating funds to “mental health” and perpetuating a significant distortion of reality, we would all be better served if the government funds co-ordinated relevant services to address and prevent the exponentially increasing instances of maladaptive behaviours from occurring.