The Ontario Psychiatric Association is the provincial voice of Ontario's Psychiatrists. The OPA serves to:
- Facilitate the exchange of scientific information
- Promote the optimal level of professional development and practice
- Advocate for the mentally ill and their families
- Represent members to governments, universities, and other medical associations
- Promote the prevention of mental disorders in the province of Ontario
CELEBRATING OUR PROFESSION
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.
Dr. Desi Brownstone