OPA President's Report 2021
June 14, 2021
The OPA has been very grateful for your support this past year. It has enabled us to engage in our core advocacy initiatives: Psychotherapy (led by myself), Access to Care (led by Dr. Ho), and Indigenous Health (led in the interim by Dr. Whitney). We are continuing to develop how we can serve you better by strengthening the diversity, the equity, and the inclusion within our organization. We have used our weekly newsletters/social media platforms to keep you up-to-date on these pieces and on our associated educational offerings. Over the last several weeks, messaging was sent in support of LGBTQ+, Indigenous, and other racialized communities in response to recent events that have come to the forefront in the news. On that note, I would like to highlight that the OPA is thinking of our Muslim colleagues who were touched by tragedy last week. We will have a more detailed statement coming out during tonight’s anti-racism presentation.
Since 2020, we have been focusing on a virtual approach due to the pandemic and that has offered us greater flexibility during this intense time. We successfully wrapped up our centennial year via Zoom in April 2021. The event video is available on our Web site. We are looking forward to upcoming events such as the Advocacy in Action presentation next month, which will allow for a deeper dive into the OPA’s work, will give us a chance to hear from the CPA President, and will help us honor our award winners from the past 2 years.
My goal is to continue building on our strengths in my final year as President. I look forward to the road ahead.
Dr. Renata M. Villela, MD, FRCPC
President, Ontario Psychiatric Association
Letter from OPA President, Dr. Renata Villela
I am excited to be taking on the role of President in the context of the OPA's centennial anniversary. Our original plans were to offer you a thought-provoking celebration of this milestone via our annual conference and the new art exhibit entitled "In Their Shoes: Sharing Psychotherapy Stories." The COVID-19 pandemic, however, changed our plans. Our goal is to still provide that high caliber content to you, hopefully in person during the spring of 2021 as circumstances permit. Virtual options could alternatively be made available. We will keep you informed as more details emerge.
We plan to further gain momentum in all three key OPA Initiatives (Access to Care, Indigenous Health, and Psychotherapy), which are in the capable hands of our leads. We also continue to build our social media presence, having launched our Instagram account (@ontpsychassociation) last year.
It is during these especially unexpected times that I have been grateful to have such a fabulous team here at the OPA that is passionate about advocacy. This dynamic group has made it a joy to come to the table and exchange ideas for improving mental health care in Ontario. I would like to especially thank: Dr. Dufour for his vision with the OPA Initiatives and his encouragement of my early participation in them and Dr. Sukhera for his excellent leadership, as highlighted by our transition during the pandemic. I welcome our new council members and look forward to working with the entire group to address member needs because our longevity as an organization is about you.
My presidential theme will be rooted in diversity and its applications across the board. As a physician, as a patient, and as a woman, I am aware that we are more than the sum of the parts of our identity. Yet these facets can be picked apart and weaponized against us, be it in obvious or subtle ways.
We hear those who feel fortunate to live in a country that has a rich, multicultural fabric. It does not, however, mean that our society is immune to the implicit and the explicit prejudice and racism that prevents underrepresented groups from receiving access to adequate care and which adds to the collective trauma of their experiences. This issue has been highlighted in recent media stories about Asian, Black, and Indigenous communities having been especially affected. I hope that you have all had a chance to read the OPA's strong statement on this issue that was released on June 8, 2020. I am personally disturbed by the atrocities that have come to light and I encourage us to engage in the key discussions about doing better. We cannot afford to meet this suffering with silence―equality should not still have to feel like a dream in the 21st century.
The diversity theme also feels particularly relevant during the pandemic as we have been dealing with the psychiatric wave. In our current provincial infrastructure, there has been an opportunity for enhanced collaboration between all levels of mental health care and the government. Rather than cutting back, it is a chance for expansion. The pandemic has fast-tracked greater access in the form of remote clinical encounters. This shift has helped reduce infection transmission rates and has broken down barriers to those with geographic restrictions and to those with disabilities that would have otherwise prevented them from attending an appointment. We see community psychiatrists helping keep patients stable through the full spectrum of biopsychosocial treatments such as intensive psychotherapy and medication management. We see psychiatrists in acute care centers focusing on the emergent situations. There is also the important interplay with academic settings, which continue to engage in innovative research and teaching.
In reflecting on our history, it becomes apparent that, while time does not heal all wounds, it is a key ingredient for our understanding of experiences of distress that can then guide us toward the best path forward. Let us use this time, therefore, to improve and to build upon our foundation, which includes taking care of ourselves and of each other.
Dr. Renata M. Villela, MD, FRCPC
President, Ontario Psychiatric Association
Farewell Letter from OPA President, Dr. Javeed Sukhera
June 9, 2020
This year has been a rollercoaster. I did not anticipate that I would be addressing you virtually in the midst of an unprecedented pandemic. I did not anticipate that our entire paradigm of delivering psychiatric care would change in the ways that it has.
We have also watched as our Black, Asian, and Indigenous colleagues continue to experience atrocious and unacceptable acts of violence that must be condemned in the strongest possible terms. Yesterday we sent out our message on the issue of systemic racism. Psychiatrists have an important role to play in addressing the disproportionate impact of violence and coercion on patients of colour. We must not only acknowledge and reckon with the impact of systemic racism on our most vulnerable and marginalized patients, but we must also rise up and do our part to dismantle oppressive structures and work towards a more just and equitable healthcare system.
In the midst of everything that surrounds us, I want to share some gratitude. Thank you to all of you for the work you do. Even though sometimes it feels like your work is in the shadows, we as an organization see you and hear you. We know the emotional work involved with helping others through the most challenging and painful moments of their lives. We know the challenge of adapting our care delivery models and balancing our personal and professional lives. Psychiatrists across Ontario have been rising up in unprecedented ways. I thank you for your service. I thank you for your sacrifice.
My Presidential theme entitled “Stigma in the Mirror” reflected the importance of self-care and activism among our profession. I have enjoyed traveling the Province and meeting so many of you. Psychiatry is definitely at a crossroads. I am proud to be part of a profession that consistently seeks to elevate the dignity of those who we serve. Although there has been passionate debate and discussion this year about our professional identity as psychiatrists, I will maintain that our diversity is our strength. I know that Ontario Psychiatrists are committed to improving the unjust system that limits access to medically necessary care for those who need it.
I would like to recognize our OPA Council members. These include Drs. Anees Bahji, Angela Ho, Desi Brownstone, Diana Kljenak, Jon Davine, Joy Albuquerque, Karen Shin, Ken Fung, Mathieu Dufour, Melissa Andrew, Natasha Snelgrove, Renata Villela, Valerie Primeau, and Wiplove Lamba. I would also like to thank OPA Staff, particularly Halyna Troian who has been such a privilege to work with.
In particular, outgoing Council members Drs. Dufour, Snelgrove and Bahji will be leaving Council this year. I want to thank them for their service and for their contributions to the OPA.
I would like to acknowledge some of the work of our Council this past year:
Dr. Wiplove Lamba and Dr. Angela Ho as Co-Chairs of the Education Committee have been involved in planning and organizing several events in the fall and had an incredible conference planned for you that we sadly had to postpone. In the meantime the Education Committee has set up a series of webinars on relevant and timely topics of interest.
Dr. Valerie Primeau has been hard at work exploring new and innovative ways of expanding and enhancing our membership base.
Dr. Anees Bahji has led efforts on improving our member in training engagement and recruitment efforts.
Dr. Angela Ho led our initiative collaborating with the MTO on addressing concerns regarding reporting requirements. Due to the OPA’s advocacy and ongoing collaboration with the MTO, we are exploring revisions to the legal language of the regulation, and the MTO has drafted an interpretative guide to assist in understanding the Regulation.
Dr. Karen Shin has led work on mental health act reform. She has assembled a working group including patient partners to dig deeper into how we can work with patients to address some of the challenges with mental health legislation.
Dr. Renata Villela has been remarkable in her leadership and diligence on the psychotherapy file. She has led OPA’s work as a member of the leadership team that has been advocating to save OHIP funded psychotherapy.
Dr. Angela Ho and her team including Dr. Natasha Snelgrove, and Dr. Desi Brownstone worked to engage with Ontario Psychiatrists and wrote a paper on Improving Access to Care which we released in January. This paper reflects our ongoing advocacy as an Association. We as psychiatrists know that access to timely and appropriate mental health and addictions care is a significant challenge for Ontarians. The latest measures of access and quality demonstrate an abysmal track record. We know that individuals with mental health or addiction needs deserve better in our province.
Since the Provincial Government released their new Mental Health Strategy a few months ago, the OPA has been working hard to ensure that psychiatry is represented and that our voice is heard.
This year also represented a turning point for organized psychiatry in Ontario. With dwindling membership revenue, we have come together with the OMA Section to discuss future governance models that may align the work of both organizations while building a strong and sustainable voice for Ontario Psychiatrists. This is a crucial conversation for our profession. We cannot sustain an organization without rethinking how we do business.
As we move into the centennial year of the OPA and honour our history, and our future, I hope that we do so with pride and humility. We must celebrate the work we do. Our value is immeasurable to the health care system. Now more than ever, psychiatry has something to bring.
I am honoured to be passing the baton to Dr. Renata Villela who is a principled leader and will bring fresh, dynamic, and enthusiastic ideas to the organization. Through her leadership in the area of psychotherapy and advocacy she has already made a significant impact. I am so excited for her presidency.
So with this I bid you farewell as OPA President. Serving our profession in this capacity has been an honour I will never forget. I look forward to the future and am excited for what psychiatry will continue to contribute in the year ahead.
OPA President, March 2019 - June 2020
Letter from OPA President, Javeed Sukhera
Stigma in the Mirror: Breaking Stigma without Breaking Ourselves
This theme reflects the role of psychiatrists as health advocates, while recognizing the need for self-care, self-compassion, and stigma reduction towards self and others.
As psychiatrists, we bear witness to a broken system. Our system is prejudicially underfunded and hyper fragmented. As psychiatrists, we are persistently undervalued and stigmatized.
I often say that psychiatrists face a double-edged sword of stigma. Within the house of medicine, we are at the bottom of the hierarchy. Within the mental health community, we are often stigmatized as out of touch and privileged.
It does not have to be this way.
Ask yourself, why did you choose psychiatry?
I chose psychiatry because I thrived on connection. Psychiatry was the first rotation I felt truly human. Psychiatry was the only place I felt I was given the time, and afforded the opportunity to be my authentic self.
By the time I started practice, I was working in a busy inpatient service. I slowly began to feel like I was a hamster on a spinning wheel, running on a cycle of admission and discharge. Something was just not right.
In the context of our dysfunctional system I was tireless in my advocacy. The only way I knew how to reconcile the moral strain of psychiatric practice was to run faster, and work harder.
All I knew was how to keep disconnecting myself from what made me human. Before long I no longer felt human.
I know I am not alone.
And I am here today to let you know, that you are not alone.
My presidential theme: Stigma in the Mirror: Breaking Stigma without Breaking Ourselves reflects an important message.
In these deeply challenging times, our profession is under great strain. In this context, we remain steadfast in our advocacy. We are the fighters; the stigma-busters. When the system gets tough, we fight tougher. We work harder.
But we are at risk of losing ourselves.
We can be the change we seek; but change starts by looking in the mirror.
We can aspire to be the most compassionate version of ourselves while accepting our imperfections and vulnerabilities.
We can break the cycle of stigma without breaking ourselves.
I look forward to visiting you this year and sharing my message of advocacy, self-care, recovery, and compassion.
OPA President, March 2019 - June 2020
Letter from OPA President, Mathieu Dufour
It is with great privilege that I will be your President for this year.
This presidency will be under the theme of Quality. Quality has become the buzz word in health care. But in my humble opinion, Ontario psychiatrists are already providing high quality of care, and have been for many years.
What is different now however is that we need to measure quality. There is a push for clinicians to prove, with outcomes measures, that what we are doing, really make a change in the lives of our patients. And there are many other aspects of quality other than pure outcomes, what we called effectiveness. We need to think also of timely access, equity, safety, efficiencies and patient-centered care. The public and by extension the governments will want us to show that the care we provide meets these quality expectations.
Mental health has been and will continue to be in the forefront in health care for many years. Last year, the federal government transferred to provinces 5 billions over 10 years only for mental health. In Ontario, the government just announced 2.1 billions in mental health with a special focus on psychotherapy and access.
The OPA is the voice of the Ontario psychiatrists and we need to have a say on how this new money should be spent. My hope is that, this year, the OPA will continue to advocate for our patients and to be a leader on this quality agenda, because if it does not come from us, it will likely be imposed on us.
The quality agenda can be also applied to the OPA itself. I have been on the OPA Council for the past 3 years and I can confirm that your OPA Council members had been working very hard to represent your interests and the wellbeing of our patients. However, I am not certain if we measured the outcomes and show enough to our members all the work we did. My hope is that we focus on a handful of issues that are important to our members like access, quality standards, shortage of psychiatrists and to measure and show the results of our work so that the OPA can remain a key player in Mental Health in Ontario.
I am very proud to be in the OPA, which is slightly older than me as the OPA is preparing for his 100th anniversary in two years.
OPA President, 2018
Letter from OPA President, Desi Brownstone
Shortly after being asked to be President-Elect for this year I was asked what theme I would choose for my year. I looked back at the recent themes chosen by my predecessors. Their themes all expand on our roles as psychiatrists. But they triggered a question: What about our primary function? Psychiatrists treat people suffering from emotional problems. These problems can have a profound effect on the person’s functioning and on their families. Sometimes I think that in the press of our ongoing work we forget how important and how complex what we are doing is both for our patients, their families and for our society. When we take a close look into our activities, as the Canadian Psychiatric Association Practice Profile study did in 2003, we can see this. The study was conducted by Dr. Blake Woodside, a previous President of the OPA, and his group. They surveyed psychiatrists across Canada. The diagnoses as well as measures of distress and disability were sought using a designated hour chosen at random on a given day. The details regarding the most ill patient seen that day were also sought. They found that we work in a variety of settings, mostly hospitals and private offices. More than half of us work in more than one setting. Our patients have significant rates of medical and psychiatric comorbidities. Our patients have significant rates of disability and of suicide attempts and self-harm. Many have been a risk to others. A variety of studies have shown these characteristics to be true not only of patients seen in hospitals but also of patients seen in private offices. These details and characteristics are not visible in our billing data and are not currently captured in any other way.
It would be useful to repeat the Practice Profile Survey. In Ontario, the Health Services Restructuring Commission did its work after the survey was completed. The HSRC recommendations resulted in the closure of many psychiatric beds and the amalgamation of schedule 1 psychiatric units. In my city, London, we went from 3 hospital units with large outpatient departments to one. The HSRC and politicians repeatedly committed to no bed closures prior to services and programs being transferred into the community. The beds have closed and we are still waiting for the programs and services.
Also since the PPS was conducted, there have been many programs cut. As an example, St. Joseph’s Hospital in London had a program called the Outpatient Psychotherapy Service (OPPS). Nowadays we would describe OPPS as a specialty multi-disciplinary team comprising psychiatrists, psychologists, social workers, nurses and other therapists. Following the closure of OPPS the waiting list in my private practice went from 4 to 6 months to over a year and it has rarely been shorter. One wonders if the administrators responsible for the closure of OPPS considered the impact on the population served by OPPS.
Since these events London has had a burgeoning problem with homelessness and addiction. One of the routes to addiction is being unable to get the necessary treatment for emotional problems and subsequently turning to drugs and alcohol.
Also, since these events, hospitals across Ontario have struggled with large numbers of patients presenting to emergency departments for emergency treatment and management. The London Free Press just reported that the psychiatric emergency of London Health Sciences Centre was at 140% occupancy. They have been dealing with 20 or more patients awaiting a hospital bed.
We are practicing our profession in a time of significant change. Governments are finally beginning to respond to the problems and gaps in our mental health system. There will be many opportunities for us to improve the provision of psychiatric care in our communities. But whenever we are asked to change our practices we must consider the impact of transferring care from the patients that we currently serve, and not only possible improvements for others who will now receive care.
The work that we do helping our patients is important, and to be celebrated.
OPA President, 2017
Letter from OPA President, Diana Kljenak
"To affect the quality of the day, that is the highest of arts"
Henry David Thoreau
Many of us have entered medicine and psychiatry to positively affect the days and lives of our individual patients. In “The Physician as Health Advocate: Translating the Quest for Social Responsibility Into Medical Education and Practice” Dharamsi et al. eloquently argue that “Medical systems that tend to focus largely on the individual relationship between the physician and the patient, with little attention to the doctor’s role and responsibility to society, will face difficulty serving vulnerable groups”. Therefore, in addition to being devoted to the best interests of each individual patient, it is our professional responsibility to respond to the mental health care needs of society, especially the needs of our most vulnerable and underserved population. It is our responsibility to be socially engaged and accountable.
We need to champion social justice efforts aimed at addressing social determinants of health. As the healthy communities are the foundation of a healthy society, we need to strive to be involved in public advocacy efforts directed at improving conditions that positively impact the well-being of our patients. Our patients and the people of Ontario need affordable housing, income security, and supported employment opportunities. They need to live in an environment free of neglect, abuse, violence and discrimination based on race, gender, and sex orientation. They need to be able to live in an environment that is supportive and does not stigmatize them because of their illness. They need equitable access to high quality mental health care regardless of their diagnosis and regardless of whether they live in an affluent part of Toronto or in one of Ontario’s rural communities or remote First Nations communities or whether they are in a correctional facility.
We need to practice culturally competent and evidence-based psychiatry, commit to address the needs of the most disadvantaged and ensure that limited health care resources are put to their best use. Our focus needs to be not only on decreasing the burden of mental illness but also on enabling the future where the most disadvantaged and vulnerable groups will be served and have equitable access to services and where the mental health of the population will be a priority. I am convinced that a health care system that is proactive in supporting wellness and building or strengthening resilience is more equitable and sustainable then the one focusing solely on alleviation of illness.
Self-awareness, mindfulness and the reflective capacity that we harness as psychiatrists will give us the necessary ability to widen the lens and broaden our field of vision. This vision will include both equitable care of the mentally ill and promotion of mental health for all. It will include not only care and advocacy for the individual patient, but also care and advocacy for vulnerable communities.
To bring this vision to reality, we need to continue listening to our patients as well as our partners in the health care sector. We need to strengthen existing partnerships and look for and embrace new partnerships outside of the health care sector.
We need to dance the collaborative dance that also includes asking to be listened to so that we could provide the best access and care for our most vulnerable population and work towards mental health for all.
This is how we can enlarge our impact.
Dr. Diana Kljenak
OPA President, 2015-2016
Letter from OPA President, Gary Chaimowitz
FROM INTEGRATION TO COLLABORATION
Last year, Dr. A. Marin, as part of her presidential theme “Preparing the Future”, focused on considering the role of psychiatrists as clinicians, educators and researchers within an evolving health care system.
There has been significant change within Ontario with respect to the perception of mental illness, and the increasing openness with which people discuss their experiences with mental illness and treatment providers. At the same time as people are increasingly and actively seeking help for mental illness, we psychiatrists are increasingly aware of the lengthening waitlists for those seeking psychiatric consultation and treatment. Given limited resources and increasing shortages of psychiatrists in many areas of the province, it has become imperative that we provide care not in isolation, but as part of a health care team that can address holistically the needs of Ontarians seeking assistance for their mental health concerns. Many of us already practice using a more integrated approach to care, through being part of a multidisciplinary team, by providing a shared care approach to a family health team or by meeting regularly with a patient’s family or caregiver. We see and treat patients not in isolation, but as people who are part of families, who work, and who contribute to their communities. We take an integrated approach to care to address not just the biological but the psychosocial aspects of mental illness.
This year’s theme will build on the issues addressed by Dr. Marin. “From Integration to Collaboration” highlights our evolution as health care providers working within a system of care increasingly dependent on the expertise and commitment of many partners, all working to their full scope of practice to cope with the increasing complexities of mental illness. Best care for patients requires us to consider physical health issues, as we increasingly use a more varied and complicated regime of medications in a population with epidemic rates of metabolic illness and obesity. We need the collaboration of our primary care and specialist colleagues to effect improvement in our patients with these issues. We also need to be knowledgeable about the impact of social determinants of health on risk and prognosis of mental illness. Poverty, homelessness, addiction and lack of education can have an incredibly detrimental impact on expression of mental illness, and without collaboration with case managers, social workers, and housing operators, treatment plans to address our patients needs will remain suboptimal. Finally, as patients transition from inpatients to outpatients , or from child and youth mental health services to adult services, collaboration across health care sectors is essential for patients to experience a seamless transfer of care and to ensure the best outcome for them with respect to their psychiatric illness.
Collaboration is an essential aspect of psychiatric assessment, treatment and recovery. It is necessary both for the patient, but also for psychiatrists. Collaboration is talking to, listening to and working with patients and our healthcare partners. It is more than working alongside other healthcare professionals. This year I plan to meet with you and with those partners necessary for effective collaboration. We will better understand our individual roles within the context of high functioning health care teams, operating within a health care system that allows prompt access and ensures the best care for our patients. I look forward to meeting you over the course of the next year, and hear your ideas and thoughts about mental health integration and collaboration in Ontario.
Dr. Gary Chaimowitz
OPA President, 2014