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Irene Jansen

CHSRF - The Sources of Attitudes on the Canadian Healthcare System - 1 views

  • factors that explain Canadians’ attitudes toward healthcare
  • four topics: healthcare issue salience (or the prominence of healthcare issues), spending on healthcare, support for private hospitals and support for paying to obtain quicker access
  • Women are more likely than men to consider healthcare important, to want to augment health spending and to oppose a two-tier system.
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  • Quebecers and Westerners tolerate privatization to a greater extent.
  • Wealthier individuals are more supportive of privatized healthcare.
  • In years when health is more prevalent in the media, issue salience is more widespread, there is more support for healthcare spending, private hospitals are less accepted and paying to jump the queue is less endorsed.
  • Hospitalization is linked to increases in positive ratings.
  • people treated for life-threatening ailments such as cancer and heart disease, often requiring hospitalization, tend to demonstrate more confidence in healthcare than people who are treated for conditions such as asthma and chronic pain
Irene Jansen

Drummond austerity cure: bad medicine for ailing economy < Government, Ontario | CUPE - 0 views

  • The report, which contains some 400 recommendations, is part of an austerity agenda that, if implemented, will gut public services such as child care, health care and education.
  • CUPE Ontario's submission to Drummond detailed new revenue sources including increased taxes on banks and corporations and new tax surcharges on individual incomes over $300,000 and $500,000 annually. Recent Angus-Reid polling shows Ontarians overwhelmingly support such measures.
  • CUPE Ontario says its proposed changes would increase revenue by more than $9 billion a year, reducing the current provincial deficit by more than 50 percent.
Irene Jansen

The patient comes first - 0 views

  • there's a tremendous groundswell of support for transforming health care to make it focused on the needs of patients.
  • Over the last year, Canada's doctors and nurses have criss-crossed the country to hear directly from Canadians about what they want from their health-care system. We have heard two inseparable yet paradoxical truths: there is an abiding allegiance to our system of medicare, but also a deep belief that it needs to be modernized to meet 21st century needs.
  • A CMA poll released today shows that more than 90% of Canadians said that we need national standards for health care, and an overwhelming 97% continue to believe the federal government's responsibility for the Canada Health Act is important.
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  • provincial and territorial leaders should take the opportunity in Victoria to adopt principles to guide the way in the years ahead. Innovative solutions are welcome, but they need to be based on a pan-Canadian approach that ensures that no matter what province or community you're in, you'll have comparable access to quality health care.
  • Endorsed by more than 70 medical, health and patient organizations, and counting, these principals can also inform the innovation needed to renew our health-care system. They call for:- Patient-centred care, with seamless access to the continuum of care based on patient needs;- Quality care, with services that are appropriate, respectful of individual choice and delivered in a manner that is timely, safe, effective and based on the latest evidence;- Equitable access to such care;- Health promotion and illness prevention, with attention paid to the social determinants of health;- Sustainable health care; and- A system in which the public, patients, families, providers and funders all have a responsibility for ensuring the system is effective and accountable.
Irene Jansen

Cdn health system more efficient than US: Study canada.com August 5 2011 - 0 views

  • The study from the University of Toronto and New York's Cornell University says U.S. doctors pay an average of nearly $83,000 each for administrative costs associated with insurance documents. In Canada, for doctors based in Ontario that cost is significantly less at just over $22,200.
  • In addition, nurses, medical assistants and other hospital staff dedicate nearly 21 hours per week to filing insurance papers and other duties required to push insurance claims through. For the same duties in Ontario, just 2.5 hours are spent each week.
  • published in the August edition of the journal Health Affairs
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  • if U.S. doctors were able to reel in the administrative costs to a level on par with those polled in Ontario, it would result in an annual savings of more than $27 billion for the American health-care system.
Irene Jansen

Health Council of Canada / Conseil canadien de la santé - Canadian Perceptions of the Health Care System - 0 views

  • This report presents a synthesis of the last four years of public opinion polling data (2002 – 2006) on the Canadian health care system. These data are used to understand how Canadian perceptions have changed since the Romanow Commission – including whether Canadians see the system as improving or deteriorating, and how they view governments’ performance on health care issues. In addition, the report examines the state of Canadian opinion on issues such as government spending, private health care, problems with the current system, and priorities for future policy developments, including home care and pharmacare. This overview – Canadian Perceptions of the Health Care System by Professor Stuart Soroka – was released as a companion document to the Council’s report, Health Care Renewal in Canada: Measuring Up?
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    February 2007
Irene Jansen

We need a Grand Bargain to save our public services - The Globe and Mail - 0 views

  • But Canada doesn’t simply need “protection” of current transfers. It needs a Grand Bargain, where greater, more transparent and more reliable federal funding is combined with a realignment of the way the provinces deliver those services, and of the whole fiscal relationship between the provinces and the federal government.
  • Without more federal support – now stuck at 20 per cent of total provincial spending – current reforms could stall. New ones will not get off the ground.
  • The provinces and the federal government should take a hard look at options such as European-style social insurance, in which health and welfare spending are funded by payroll deductions that are split off from the regular income tax stream.
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  • Tax swaps, whereby the federal government takes over corporate income tax and the provinces take in all sales tax revenue, are another alternative worthy of consideration.
  • Australia does all-in transfers, bundling federal health and social payments into a single funding package, that are then equalized according to each state’s need.
  • An opinion poll commissioned by the Mowat Centre for Policy Innovation shows that, in every province except Quebec (where sentiment is almost evenly split), people feel they’re not getting fair treatment when it comes to federal transfers.
  • Mowat Centre for Policy Innovation
Irene Jansen

Health care: 94% of Canadians - including Conservatives - choose public over for-profit solutions < Health care, Privatization | CUPE - 0 views

  • Nov 24, 2011
  • An overwhelming 94-percent of Canadians support public - not private, for-profit - solutions to making the country's healthcare system stronger - with an equal number of Conservatives flying the banner for public health care.
Irene Jansen

Public's appetite for efficient health care only goes so far - The Globe and Mail - 0 views

  • By the account of a new Environics poll, a majority of Canadians now believe inefficiency, rather than underfunding, is the biggest threat to health care. Perhaps all those dire warnings from politicians and think-tanks and media outlets about costs growing unsustainably are starting to penetrate.
  • Among the most inescapably necessary reforms is hospital restructuring. In Ontario, governments dating back to Bob Rae’s New Democrats have recognized that it’s no longer practical for hospitals, particularly in rural areas, to function as one-stop shops. Much more cost-efficient, and often better for patient outcomes, is to centralize difficult and expensive procedures in fewer places.
  • for policy-makers, a certain cold-bloodedness is required
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  • The hard truth about health policy, acknowledged by anyone who works in the field, is that it’s largely about rationing care.
  • To spend on a rare procedure that could save a single life, for instance, might mean quietly not spending on something else that could spare a dozen.
Govind Rao

Five Southern Ontario hospitals to be closed; replaced with acute-care centre - The Globe and Mail - 1 views

  • ive Southern Ontario hospitals to be closed; replaced with acute-care centre Add to ... KAREN HOWLETT AND ADRIAN MORROW The Globe and Mail Published Monday, Jan. 13 2014,
  • The Ontario government has given the green light to a long-awaited new hospital near Niagara Falls – one month before voters in the region go to the polls in a by-election.Health Minister Deb Matthews announced on Monday that five hospitals in Southern Ontario will permanently close their doors and be replaced with a new acute-care centre, as part of a massive overhaul of the troubled Niagara Health System. The province is providing funding of $26.2-million to help develop plans for the new hospital plus two urgent-care centres, or walk-in clinics.
Govind Rao

Medicare Is On the Road to Oblivion | National Newswatch - 0 views

  • Mar 12 2014
  • During the 2011 federal election, the federal Liberals ran a poll on their website asking Canadians to choose their favourite anti-medicare quote from Prime Minister Stephen Harper.
  • Although it’s the social program most cherished by Canadians, universal health care has been under attack from both Liberal and Conservative governments almost from its inception.
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  • In its 2012 budget, the Harper Conservatives made significant cuts to health care. Health Canada faced reductions of $200.6 million;&nbsp; the Public Health Agency of Canada planned cuts of $68 million, a reduction of almost 11 per cent;&nbsp; and the Canadian Institutes of Health Research faced a budget decrease of $45 million
  • The 2014 federal budget takes yet another run at Medicare. The Harper government is eliminating the equalization portion of the Canada Health Transfer (CHT) and replacing it with an equal per capita transfer.
  • “This means that less populous provinces with relatively larger and more isolated populations will have more and more difficulty delivering more expensive universal services,” McBane wrote in an article published in The Hill Times in February.
Govind Rao

Today on the Hill: health and homes | Metro - 0 views

  • April 8, 2014
  • OTTAWA – Health care and homelessness top the parliamentary agenda today in Ottawa. The Mental Health Commission of Canada is releasing its final study that shows the effectiveness of federal investments in ensuring homeless Canadians get off the streets. The commission says as many as 30,000 Canadians are homeless on any given night, with many facing mental health or addiction issues. Other events happening on and around Parliament Hill include: — The Canadian Medical Association and Nik Nanos reveal new polling results on what kind of care seniors and baby boomers want from their federal government;
Govind Rao

Canadians spend more on drugs than on doctors - Infomart - 0 views

  • The Collingwood Enterprise-Bulletin Fri Jun 20 2014
  • (NC) Canada's healthcare system has been a source of national pride for decades with citizens benefitting from universal and accessible care. But sadly, with the current spending trajectory, the future of the system as we know it is unsustainable. Our cherished healthcare system is being challenged by demographic shifts, increasingly high prevalence of chronic disease and the advent of very expensive specialty and targ eted therapies. We are now spending $23 billion dollars on drugs, significantly more than on the physicians who treat us. Simple chang es to our healthcare choices will ensure a sustained system for future generations. And these chang es will actually have no impact on Canadians at all -except for keeping more money in our wallets and more money available to be reallocated into other important health innovations.
  • The results of a poll conducted by Leger, the Research Intelligence Group, on behalf of Teva Canada indicates that at minimum 78 per cent of Canadians already know that generic medicines have the same effectiveness as brand-name medicines, contain the same amount of the active ing redient and must abide by the same quality standards as brand-name manufacturers.
Govind Rao

We'Ve Got It Good Canada's health-care system may not be; Perfect, but as David Sherman discovers, we're luckier than we think we are - Infomart - 0 views

  • Ottawa Citizen Sat Sep 27 2014
  • Her tax dollars hadn't earned him a room fast enough for her, but had paid for this: his third stay in neuro-recovery, after three brain operations, countless weeks of tests in hospital and out, pre-and post-op consultations, social work and psychologists and therapy. She had been too stressed to think about that.
  • In fact, health outcomes in the U.S., where about 45,000 people a year die for lack of proper health care, are not better than Canada's. And according to the Canadian Institute for Health Information, Canada performs better than average in nearly all categories when compared to the other 33 Organization for Economic Co-operation and Development or OECD countries. According to them, Canada spent about $211 billion on health care in 2013, which breaks down to about $6,000 per patient. We invested more of our economic growth since 2005 in health care than the OECD average, which might explain why our outcomes are better. An American ex-pat was complaining over dinner about our health-care system. He insisted profit is the necessary incentive to make health care work. Public financed medical system doesn't cut it. A friend across the table, a nurse, said, "You just had eye surgery. For free. You had no complications and you hardly waited at all." He had no answer for that.
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  • Insurance companies would like us to believe private health care is preferable. They would like a bigger chunk of the action Ă  la Obamacare in the U.S., where tax dollars flow to health-insurance companies. Private health companies would like us to believe profit pays. And, of course, some wealthy individuals would like to buy their way into first-class care without the annoying wait times and the indignity of being treated like everyone else. The woman with a coffee jones and high anxiety over her husband's stay in post-op was mollified quickly enough. They found him a bed at the Civic campus in a few hours.
  • Had she been in the U.S. her husband's surgeries could have cost her as much as $500,000 - brain surgery runs anywhere from $75,000 to $125,000 not counting the extras like doctors' fees and hospital stays and convalescence. If she had insurance, there's a good chance a U.S. health-insurance provider would have dropped her long ago. Most of us have had friends or family that have been through the heart bypass or hip-replacement mill. They have survived. They have better lives. They waited, sometimes painfully long, but came out the other end without declaring bankruptcy or selling their homes.
  • Polls show Prime Minister Stephen Harper's popularity circling the drain as he talks about pipelines and the economy and getting tough on crime. Voters are thinking the crime is his lack of interest in their health and well-being. No, our system is not perfect. Wait times can be long if you're not knocking on heaven's door. The Fraser Institute wants us to know we pay too much - according to their figures a family of four earning about $110,000 pays about $11,000 of their taxes toward health care. If there's an underlying problem, it's our taking this massive system for granted and seeing only the faults. Canada's health care saves and improves lives without the attendant anxiety of how we will afford it. Yes, it can be better. It can use more money. It can be more efficient. But ask the people who have survived a crisis and were treated with dignity regardless of their bank balance, and they'll undoubtedly tell you it works pretty damned well. David Sherman is a Montreal writer and musician.
  • Although many Canadians complain about the cost of health care, it works much better than they think it does.
Govind Rao

Manitoba budget leads to deeper digs into rainy-day fund - Infomart - 0 views

  • The Globe and Mail Fri May 1 2015
  • Smokers and banks will pay more to help finance Manitoba's infrastructure spending in a deficit budget that comes close to draining its rainy-day fund. The governing NDP tabled a $15-billion budget Thursday that boosts tobacco taxes by $1 on a carton of cigarettes that costs $128. It also increases the capital tax on financial institutions to 6 per cent from 5 per cent. The budget - which includes a $422-million deficit - also increases tax credits for caregivers of vulnerable relatives at home and boosts rental assistance for welfare recipients by up to $271 a household. "We made a decision to invest in infrastructure. We made a decision to invest in health care. We made a decision to invest in education," Finance Minister Greg Dewar said Thursday. "Other provinces have taken a different route." The budget draws $105-million from Manitoba's rainy-day fund to pay down debt and support infrastructure spending. That leaves $115-million in a bank account that boasted $864-million in 2009.
  • That will be replenished at some point "as the economy grows," said Mr. Dewar, a longtime backbencher who took over the portfolio last fall after a partial caucus revolt against Premier Greg Selinger. The fiscal blueprint promises $1-billion in infrastructure spending as part of a five-year stimulus plan that was announced when the government raised the provincial sales tax in 2013. The budget also includes modest spending increases in health care and education. It records the latest in a string of deficits as the province delays balancing the books until 2019 - four years later than originally promised. Mr. Dewar disagreed with Statistics Canada's assessment that Manitoba's economy grew by 1.1 per cent last year. He suggested the province is "on track to have the strongest economy in Canada." But that's not enough to balance the books in the near future, he said. "We're starting to see good numbers now and we're anticipating that we shall return to surplus as long as we continue to spend less than we have coming in."
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  • That did little to quell critics who said the NDP has given up even the pretense of trying to rein in spending. Progressive Conservative Leader Brian Pallister said the government could have balanced the books this year if it had "just held the line on spending." "They are making promises with money they are taking from our children and grandchildren here," the Opposition leader said. "It took 109 years for us as a province to get about $18-billion into debt. It's taken six for the premier and the NDP to double that debt. Somebody's got to pay that back." Todd MacKay, prairie director of the Canadian Taxpayers Federation, said the "overwhelmingly irresponsible budget" shows the New Democrats have a spending problem. "They promised to have this budget balanced. Instead, the deficit is going up," he said.
  • "Future generations are going to pay for this budget. It's completely irresponsible." The infrastructure spending wasn't enough to win over others. Winnipeg Mayor Brian Bowman said it will do little to help the province's largest city. "We need new money. The model is ... fundamentally broken in terms of how we fund our cities," he said. "We have an obligation to fix it." The NDP tries to leave behind internal turmoil that led to a leadership race in March which Mr. Selinger won by 33 votes. The Premier's top five cabinet ministers resigned last year after calling for him to step down in light of plummeting opinion polls following the provincial sales-tax increase. "The government has obviously been preoccupied with something else over the past eight months and has not been focused on governing," said Chuck Davidson, president of the Manitoba Chamber of Commerce. "This was a great opportunity to at least get us on a path ... to getting our economic house in order. They missed the mark."
Govind Rao

Pro and con experiences with our health-care system | Toronto & GTA | News | Tor - 0 views

  • May 03, 2015
  • A Nanos research poll released last week found 73% of Canadians are concerned or somewhat concerned that they would not be provided with a desired level of comfort and support if they or loved ones faced a life-threatening experience or were nearing death. We asked two GTA-area residents about their recent experiences with the quality of care provided in hospital.
Govind Rao

'We have the evidence ... Why aren't we providing evidence-based care?'; Mental illness affects one in five Canadians and costs us nearly $50-billion a year. So why aren't we treating it like any other health-care crisis? Erin Anderssen explores the case - 0 views

  • The Globe and Mail Sat May 23 2015
  • It's 4:30 on a Friday afternoon at her Sherbrooke, Que., clinic and Marie Hayes takes a deep breath before opening the door to her final patient of the day, who has arrived without an appointment. The 32-year-old mother immediately lists her complaints: She feels dizzy. She has abdominal pain. "It is always physical and always catastrophic," Dr. Hayes will later tell me. In the exam room, she runs through the standard checkup, pressing on the patient's abdomen, recording her symptoms, just as she has done almost every week for months. "There's something wrong with me," the patient says, with a look of panic. Dr. Hayes tries to reassure her, to no avail. In any case, the doctor has already reached her diagnosis: severe anxiety. Dr. Hayes prescribed medication during a previous visit, but the woman stopped taking it after two days because it made her nauseated and dizzy. She needs structured psychotherapy - a licensed therapist trained to bring her anxiety under control. But the wait list for public care is about a year, says Dr. Hayes, and the patient can't afford the cost of private sessions.
  • Meanwhile, the woman is paying a steep personal price: At home, she says, she spends most days in bed. She is managing to care for her two young children - for now - but her husband also suffers from anxiety, and the situation is far from ideal. Dr. Hayes does her best, spending a full hour trying to calm her down, and the woman is less agitated when she leaves. But the doctor knows she will be back next week. And that their meeting will go much the same as it did today. In its broad strokes, this is a scene that repeats itself in thousands of doctors' offices every day, right across the country. It is part and parcel of a system that denies patients the best scientific-based care, and comes with a massive price tag, to the economy, families and the health care system. Canadian physicians bill provincial governments $1-billion a year for "counselling and psychotherapy" - one third of which goes to family doctors - a service many of them acknowledge they are not best suited to provide, and that doesn't come close to covering patient need. Meanwhile, psychologists and social workers are largely left out of the publicly funded health-care system, their expertise available only to Canadians with the resources to pay for them.
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  • Imagine if a Canadian diagnosed with cancer were told she could receive chemotherapy paid for by the health-care system, but would have to cough up the cash herself if she needed radiation. Or that she could have a few weeks of treatment, and then be sent home even if she needed more. That would never fly. If doctors, say, find a tumour in a patient's colon, the government kicks in and offers the mainstream treatment that is most effective. But for many Canadians diagnosed with a mental illness, the prescription is very different. The treatment they receive, and how much of it they get, will largely be decided not on evidence-based best practices but on their employment benefits and income level: Those who can afford it pay for it privately. Those who cannot are stuck on long wait lists, or have to fall back on prescription medications. Or get no help at all. But according to a large and growing body of research, psychotherapy is not simply a nice-to-have option; it should be a front-line treatment, particularly for the two most costly mental illnesses in Canada: anxiety and depression - which also constitute more than 80 per cent of all psychiatric diagnoses.
  • Why aren't we providing evidence-based care?" .. The case for psychotherapy Research has found that psychotherapy is as effective as medication - and in some cases works better. It also often does a better job of preventing or forestalling relapse, reducing doctor's appointments and emergency-room visits, and making it more cost-effective in the long run.
  • Therapy works, researchers say, because it engages the mind of the patient, requires active participation in treatment, and specifically targets the social and stress-related factors that contribute to poor mental health. There are a variety of therapies, but the evidence is strongest for cognitive behavioural therapy - an approach that focuses on changing negative thinking - in large part because CBT, which is timelimited and very structured, lends itself to clinical trials. (Similar support exists for interpersonal therapy, and it is emerging for mindfulness, with researchers trying to find out what works best for which disorders.) Research into the efficacy of therapy is increasing, but there is less of it overall than for drugs - as therapy doesn't have the advantage of well-heeled Big Pharma benefactors. In 2013, a team of European researchers collated the results of 67 studies comparing drugs to therapy; after adjusting for dropouts, there was no significant difference between the most often-used drugs - selective serotonin reuptake inhibitors (SSRIs) - and psychotherapy.
  • The issue is not one against the other," says Montreal psychiatrist Alain Lesage, director of research at the Douglas Mental Health University Institute. "I am a physician; whatever works, I am good. We know that when patients prefer one to another, they do better if they have choice." Several studies have backed up that notion. Many patients are reluctant to take medication for fear of side effects and the possibility of difficult withdrawal; research shows that more than half of patients receiving medication stop taking it after six months. A small collection of recent studies has found that therapy can cause changes in the brain similar to those brought about by medication. In people with depression, for instance, the amygdala (located deep within the brain, it processes basic memories and controls our instinctive fight-or-flight reaction) works in overdrive, while the prefrontal cortex (which regulates rational thought) is sluggish. Research shows that antidepressants calm the amygdala; therapy does the same, though to a lesser extent.
  • But psychotherapy also appears to tune up the prefrontal cortex more than does medication. This is why, researchers believe, therapy works especially well in preventing relapse - an important benefit, since extending the time between acute episodes of illnesses prevents them from becoming chronic and more debilitating. The theory, then, is that psychotherapy does a better job of helping patients consciously cope with their unconscious responses to stress.
  • According to treatment guidelines by leading international professional and scientific organizations - including Canada's own expert panel, the Canadian Network for Mood and Anxiety Treatments - psychotherapy should be considered as a first option in treatment, alone or in combination with medication. And it is "highly recommended" in maintaining recovery in the long term. Britain's independent, research-guided scientific body, the National Institute for Health and Care Excellence, has concluded that therapy should be tried before drugs in mild to moderate cases of depression and anxiety - a finding that led to the creation of a $760million public system, which now handles therapy referrals for nearly one million people a year.
  • In 2012, Canada's Mental Health Commission estimated that only about one in three adults and one in four children are receiving support and treatment when they need it. Ironically, anti-stigma campaigns designed to help people understand mental illness may only make those statistics worse. In Toronto, for instance, putting up posters in subway stations in 2010 had the unexpected effect of spiking the volume of walk-ins at nearby emergency rooms by as much as 45 per cent in 12 months. Dr. Kurdyak treated many of them at CAMH. The system, he says, "has been conveniently ignoring this unmet need. It functions as if two-thirds of the people suffering won't get help." What would happen if the healthcare system outright "ignored" two-third of tumour diagnoses?
  • Essentially, argues Dr. Lesage, adding therapy into the health-care system is like putting a new, highly effective drug on the table for doctors. "Think about it," he says. "We have a new antidepressant. It works as well as many others, and it may even have some advantages - it works better for remission - with fewer side effects. The patients may prefer it. And [in the long run] it doesn't cost more than what we have. How can it not be covered?" ..
  • A heavy price This isn't just a medical issue; it's an economic one. Mental illness accounts for roughly 50 per cent of family doctors' time, and more hospital-bed days than cancer. Nearly four million Canadians have a mood disorder: more than all cases of diabetes (2.2 million) and heart disease (1.4 million) combined.
  • Mental illness - and depression, in particular - is the leading cause of disability, accounting for 30 per cent of workplace-insurance claims, and 70 per cent of total compensation costs. In 2012, an Ontario study calculated that the burden of mental illness and addiction was 1.5 times that of all cancers, and more than seven times the cost of all infectious diseases. Mental illness is so debilitating because, unlike physical ailments, it often takes root in adolescence and peaks among Canadians in their 20s and 30s, just as they are heading into higher education, or building careers and families. Untreated, symptoms reverberate through all aspects of life, routinely trapping people in poverty and homelessness. More than one-third of Ontario residents receiving social assistance have a mental illness. The cost to society is clearly immense.
  • Yet, when family doctors were asked why they didn't refer more patients to therapy in a 2008 Canadian survey, the main reason they gave was cost. For many Canadians, private therapy is a luxury, especially if families are already wrestling with the economic fallout from mental illness. Costs vary across provinces, but psychologists in private practice may charge more than $200 an hour in major centres. And it's not just the uninsured who are affected.
  • Although about 60 per cent of Canadians have some form of private insurance, the amount available for therapy may cover only a handful of sessions. Those with the best benefits are more likely to be higherincome workers with stable employment. Federal public servants, notably, have one of the best plans in the country - their benefits were doubled in 2014 to $2,000 annually for psychotherapy. Many of those who can pay for therapy are doing so: A 2013 consultant's study commissioned by the Canadian Psychological Association found that $950-million is spent annually on private-practice psychologists by Canadians, insurance companies and workers compensation boards. The CPA estimates t
  • These are the patients that family doctors juggle, the ones who eat up appointment time, and never seem to get better, the ones caught on waiting lists. Sometimes, they have already been bounced in and out of the system, received little help, and have become wary of trying again. A 40-something mother recovering from breast cancer, suffering from chronic depression post-treatment, debilitated by fear her cancer will return. A university student, struggling with anxiety, who hasn't been to class for three weeks and may soon be kicked out of school. A teenager with bulimia removed from an eatingdisorder program because she couldn't follow the rules. They are the ones dangling on waiting lists in the public system for what often amounts to a handful of talk-therapy sessions, who don't have the money to pay for private therapy, or have too little coverage to get the full course of appointments they need.
  • Canada's investment does not match that burden. Only about 7 per cent of health-care spending goes to mental health. Even recent increases pale when compared to other countries: According to a study by the Canadian Mental Health Association, Canada increased per-capita funding by $5.22 in 2011. The British government, meanwhile, kicked in an extra 12 times that amount per citizen, and Australia added nearly 20 times as much as we did. Falling off a cliff, again and again
  • In Winnipeg, Dr. Stanley Szajkowski watched for months as his patient, a woman in her 80s, slowly declined. Her husband had died and she was spiralling into a severe depression. At every appointment, she looked thinner, more dishevelled. She wasn't sleeping, she admitted, often through tears. Sometimes she thought of suicide. She lived alone, with no family nearby, and no resources of her own to pay for therapy. "You do what you can," says Dr. Szajkowksi. "You provide some support and encouragement." He did his best, but he always had other patients waiting.
  • hat 30 per cent of private patients pay out-ofpocket themselves. When the afflicted don't seek help, the cost isn't restricted to their own pocketbook. People with mental-health problems are significantly more likely to abuse drugs and alcohol, and to become physically sick, further increasing health-care costs. A 2014 study by Oxford University researchers found that having a mental illness reduced life expectancy by 10 to 20 years, roughly the same as did smoking and obesity. A 2008 Statistics Canada study linked depression to new-onset heart disease in the general population. A 2014 U.S. study found that women under the age of 55 are twice as likely to suffer or die from a heart attack, or require heart surgery, if they have moderate to severe depression. The result: clogged-up doctors' offices, ERs, and operating rooms. And an inexorable burden for the patients' families forced to fill the gaps in caregiving - or carry on when they lose a loved one.
  • Patients refer to it as falling repeatedly off a cliff. And they can only manage the climb back up so many times. Family doctors interviewed for this story admitted that they are often "handholding" patients with nowhere else to go. "I am making them feel cared for, I am providing a supportive ear that they may not get anywhere else," says Dr. Batya Grundland, a physician who has been in family practice at Toronto's Women's College Hospital for almost a decade. "But do I think I am moving them forward with regard to their illness, and helping them cope better? I am going to say rarely." More senior doctors have told her that once in a while "a light bulb goes off" for the patients, but often only after many years. That's not an efficient use of health dollars, she points out - not when there are trained therapists who could do the job better. However, she says, "in some cases, I may be the only person they have."
  • Family doctors aren't the only ones struggling to find therapy for their patients. "I do a hundred consultations a year," says clinical psychiatrist Joel Paris, a professor at McGill University and research associate at the Montreal Jewish General, "and one of the most common situations is that the patient has tried a few anti-depressants, they have not responded very well, and from their story it is obvious they would benefit from psychotherapy. But where do they go? We have community clinics here in Montreal with six-to-12-month waiting lists even for brief therapy." A fractured, inefficient system
  • "You fall into the role that is handed to you," says Antoine Gagnon, a family doctor in Osgoode, on the outskirts of Ottawa. He tries to set aside 20-minute appointments before lunch or at the end of the day to provide "active listening" to his patients with anxiety and depression. Many of them are farmers or self-employed, without any private coverage for therapy. "Five of those minutes are spent talking about the weather," he says, "and then maybe you get into the meat of the problem, but the reality is we don't have the appropriate amount of time to give to therapy, even to listen, really." Often, he watches his patients' symptoms worsen over several months, until they meet the threshold of a clinical diagnosis. "The whole system could save on productivity and money if people were actually able to get the treatment they needed."
  • But these issues aren't insurmountable, as other countries have demonstrated. Britain, for instance, has trained thousands of university graduates to become therapists in its new public program, following research showing that, as long they have the proper skills, people don't need PhDs to be effective therapists. Australia, which has created a pay-for-service system, also makes wide use of online support to cost-effectively reach remote communities.
  • Except for a small fraction of GPs who specialize in psychotherapy, few family doctors have the training - or the time - to provide structured therapy. Saadia Hameed, a GP in a family-health team in London, Ont., has been researching access to psychotherapy for an advanced degree. Many of the doctors she has interviewed had trouble even producing a clear definition of therapy. One told her, "If a patient cries, than it's psychotherapy." Another described it as "listening to their woes." A 2007 survey of 163 family doctors in Ontario found that almost four out of five had not received training in cognitive behavioural therapy, and knew little about it. "Do family doctors really need to do that much psychotherapy," Dr. Hameed asks, "when there are other people trained - and better trained - to do it?"
  • What further frustrates treatment for physicians and patients is lack of access to specialists within the system. Across the country, family doctors describe the difficulty of reaching a psychiatrist to consult on a diagnosis or followup with their patients. In a telling 2011 study, published in the Canadian Journal of Psychiatry, researchers conducted a real-world experiment to see how easily a GP could locate a psychiatrist willing to see a patient with depression. Researchers called 297 psychiatrists in Vancouver, and reached 230. Of the 70 who said they would consider taking referrals, 64 required extensive written documentation, and could not give a wait-time estimate. Only six were willing to take the patient "immediately," but even then, their wait times ranged from four to 55 days. Psychiatrists are in increasingly short supply in Canada, and there's strong evidence that we're not making the best use of these highly trained specialists. They can - and often do - provide fee-for-service psychotherapy in a private setting, which limits their ability to meet the huge demand to consult with family doctors and treat the most severe cases.
  • A recent Ontario study by a team at CAMH found that while waiting lists exist in both urban and rural centres, the practices of psychiatrists in those locations tend to look very different. Among full-time psychiatrists in Toronto, 10 per cent saw fewer than 40 patients, and 40 per cent saw fewer than 100 - on average, their practices were half the size of psychiatrists in smaller centres. The patients for those urban psychiatrists with the smallest practices were also more likely to fall in the highest income bracket, and less likely to have been previously hospitalized for a mental illness than those in the smaller centres.
  • And those therapy sessions are being billed with no monitoring from a health-care system already scrimping on dollars, yet spending a lot on this care: On average, psychiatrists earn $216,000 a year. There is nothing to stop psychiatrists from seeing the same patients for years, and no system to ensure the patients with the greatest need get priority. In Australia, Britain and the United States, by contrast, billing for psychiatrists has been adjusted to encourage them to reduce psychotherapy sessions and serve more as consultants, particularly for the most severe cases, as other specialists do.
  • As the Canadian system exists now, says Benoit Mulsant, the physician-in-chief at CAMH and also a psychiatrist, the doctors in his specialty "can do whatever they please. If I wanted, I could have a roster of actor patients who tell me entertaining stories, and I would be paid the same as someone who is treating homeless people. ... By treating the rich and famous, there is zero risk of being punched in the face by a patient." Left out in all this, by and large, are other professionals who can provide therapy. It doesn't help that the rules are often murky around who can call themselves psychotherapists. While psychologists and social workers are licensed under their professional associations, in some provinces a person can call himself a marriage counsellor or music therapist with no one demanding they be certified. In 2007, Ontario passed a law to regulate psychotherapists, requiring them to register with a provincial college that would set standards and handle complaints. Currently, however, the law is in limbo, although the government has said it will finally bring it into force by December. The brain keeps many secrets
  • Science, however, has yet to find depression's equivalent of insulin. Despite being scanned, poked and stimulated over and over and over again, the brain keeps its secrets. The "chemical imbalance" theory is now viewed as simplistic at best. It may not do much for patients, either: A 2014 study published in the journal Behaviour Research and Therapy suggested that, rather than reassuring them, focusing on the biological explanation for depression actually made patients feel more pessimistic and lacking in control. SSRIs work by increasing the amount of serotonin, a chemical that helps deliver messages within the brain and is known to influence mood. But researchers aren't sure why the drugs help some patients and fail with others. "Basically, it's like we have a bucket of water and we pour it over the patient's head," says Dr. Georg Northoff, the University of Ottawa's Michael Smith chair of Neurosciences and Mental Health. "But you want a drug that injects the water in a very specific brain regions or brain system, which we don't have."
  • Critics of therapy have argued that it's basically "good listening" - comparable to having a sympathetic friend across the kitchen table - and that in the real world of mercurial patients and practitioners of varying abilities, a pill just works better. That's true in many cases, especially when the symptoms are severe and the patients is suicidal: a fast-acting medication is safer, and may even be necessary before starting talk therapy. The staunchest advocates of therapy do not suggest it should be the first course of treatment for psychosis, or debilitating chronic depression, or mania - although, in those cases, there is evidence that psychotherapy and medication work well in tandem. (A 2011 meta-analysis found that patients with severe depression who received a combination approach had higher recovery rates and were less likely to drop out of treatment.) But drugs also don't work as well as the manufacturers would like us to think. Roughly one-third of patients given a drug will see no benefit (although they often respond to a second or third medication). In randomly controlled trials, drugs often perform only marginally better than sugar pills.
  • Yet it's talk therapy that the public often views most skeptically. "Until you go to a therapist, or a member of your family has a serious psychological problem, people are unsympathetic [about therapy]," says Dr. Paris, the Montreal psychiatrist. "They are very skeptical, and they don't believe the research. It's amazing, because pharmaceutical trials will get approval for a drug on the basis of two clinical trials that they paid for. And we have 100 clinical trials and no one believes us."
  • Dr. Ajantha Jayabarathan, an assistant professor at Dalhousie University's medical school, spent her early years as a family doctor in Spryfield, N.S., trying to manage an overload of mental-health cases. Most of her patients had little insurance; there was one reduced-cost counselling service in town, but the waiting lists were long. In 2000, her group practice became a test site for a shared-care project, which gave the doctors access to a mental-health team, including weekly in-person consultations with a psychiatrist. "It was transformative," she says. "We looked after everything in-house.
  • Over time, Dr. Jayabarathan says, she learned how to properly assess mental illness in patients, and how to use medication more effectively. "I just made it my business to teach myself what to do." It's the kind of workaround GPs are increasingly experimenting with, waiting for the system to catch up. Who would pay - and how?
  • The case for expanding publicly funded access to therapy is gaining traction in Canada. In 2012, the health commissioner of Quebec recommended therapy be covered by the province; it is now being studied by Quebec's science-based health body (INESSS), which is expected to report back next year. A new Quebec-based organization of doctors, researchers and mental-health advocates called the Coalition for Access to Psychotherapy (CAP) is lobbying the government.
  • In Manitoba, the Liberal Party - albeit well behind in the polls - has made the public funding of psychologists one of its campaign platforms for the province's spring 2016 election. In Saskatchewan, the government commissioned, and has since endorsed, a mental-health action plan that includes providing online therapy - though politicians have given themselves 10 years to accomplish it. Michael Kirby, the former head of the Canadian Mental Health Commission, has been advocating for eight annual sessions of therapy to be covered for children and youth in need.
  • There are significant hurdles: Which practitioners would provide therapy, and how would they be paid? What therapies would be covered, and for how long? Complicating every aspect of major mentalhealth change in Canada is the question of who should shoulder the cost: the provinces or Ottawa. In a written statement in response to questions from The Globe and Mail, federal Health Minister Rona Ambrose lobbed the issue back at her provincial counterparts, pointing out that the Canada Health Act does not "preclude provinces and territories from extending public coverage to other services or providers such as psychologists."
  • One result can be overloaded family doctors minimizing mental-health problems. "If you have nothing to offer someone," asks Dr. Anderson, "how much are you going to dig around to find out what is going on?" Some doctors also admit that the lack of resources can lead to physicians cherry-picking patients who don't have mental illness. And yet family physicians alone bill about $361million a year for counselling or psychotherapy in Canada - 5.6 million visits of roughly 30 minutes each. This is a broad category, and not always specifically related to mental health (some of it includes drug counselling, and a certain amount of coaching is a necessary part of the patient-doctor relationship). When it is psychotherapy, however, doctors admit it's often more supportive listening than actual therapy.
  • So how would Canada pay for access to such therapy? It wouldn't be cheap, in the short term. The savings would come from what Canadians would not have to spend in the long term: in additional medical and drug costs, emergency-room visits and hospital stays, and in unnecessary disability payments, to say nothing of better long-term health outcomes for patients given good care earlier. Some of the figures being tossed around sound staggering. Rolling out a version of Britain's centre-based program across Canada would cost $950-million. Michael Kirby's plan would amount to $1,000 annually per patient. A 2013 report commissioned by the Canadian Psychological Association calculated that, based on predicted need, and assuming no coverage from private health-care plans, providing an average of six sessions of therapy a year would cost an estimated $2.8-billion annually.
  • But any of those figures would still be a fraction of the roughly $210-billion that Canada spends annually on health care. Figuring out how to make the system most costeffective is, according to sources, currently delaying the INESSS report to the Quebec government. "You need to facilitate the government," says Helen- Maria Vasiliadis, a professor of community health at the University of Sherbrooke. "You can't be going to policymakers and showing them billions and billions of dollars. People start having heart attacks. With evidence in hand, we have to present possible solutions."
  • An insurance-based plan is the proposal that has emerged from the Quebec-based CAP group, which sent its proposal to Quebec's health minister last month. In its design, the system would work much like Quebec's public drug plan - Quebeckers not covered through work plans would contribute to a provincial insurance program for therapy. That would be similar to the system that Germany has used for decades. One step forward, one step back
  • Last year, the Sherbrooke clinic where Marie Hayes works received provincial funding for a part-time psychologist and a full-time social worker. With a roster of 25,000 patients, the clinic team laid out clear guidelines for the psychologist, who would consult on cases and screen patients, and be limited to a mere four sessions of actual counselling with any one patient. "We wanted to be careful she didn't become a waiting list - like everything in the system," says Dr. Hayes. The social worker helps guide patients into services such as housing and addiction counselling. They have also offered group sessions for depression management at the clinic. As stretched as those new professionals are in such a large practice, Dr. Hayes says the addition of that mental-health team is improving the care she can provide patients. Recently, for instance, the 32- year-old mother with anxiety attended sessions with the psychologist. "She is making progress," says Dr. Hayes, "slowly."
  • At Women's College Hospital in Toronto, Dr. Grundland is not so lucky. Asked to describe a difficult case, the family-practice physician mentions a patient suffering from depression after a lifechanging accident. Every month, doctor and patient would repeat the same conversation they'd already had more than a dozen times - and make little real headway. Her patient, says Dr. Grundland, needs a trained therapist: someone she can see regularly, to help her move past her frustration, counsel her about addiction, and ease the burden on her family.
  • But there's no extra money in the patient's budget for a psychologist. "I do my best," Dr. Grundland says, "but it's not my area of expertise." Meanwhile, the patient isn't getting better, and in the time that it takes to make it through one appointment with her, Dr. Grundland could see three other people with problems she was actually trained to treat. "But," says Dr. Grundland, "she has nowhere else to go." Erin Anderssen is a feature writer at The Globe and Mail. OPEN MINDS How to build a better mental health care system
  • The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. While CAMH professionals are quoted in this story, the organization had no involvement in the creation or production of this, or any other story in the series. $20.7-billion The cost, according to a 2012 Conference Board of Canada report, of lost productivity each year due to mental illness. What else does $20-billion represent?
  • $20B: Canadian spending on national defence, 2012-13 $20B: Market valuation of Airbnb, 2015 $21B: Kitchener-CambridgeWaterloo region's GDP, 2009 $21B: Amount food manufacturing contributed to the economy, 2012
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