The future for the treatment of mental health in Canada looks a lot different from the past. It’s very likely to include screening for therapies that are personalized and markers based on molecular analysis.
However, the present, in certain aspects, is according to speakers on a panel last week held in The Globe and Mail.
“We have seen a great deal of changes in mental-health-care delivery before 30 years,” Vicky Stergiopoulos, physician-in-chief in Toronto’s Centre for Addiction and Mental Health (CAMH), told 200 mental-health supporters and advocates. “We have seen the mass closure of provincial psychiatric beds and the introduction of provisional care locally. … And we also saw the introduction of drugs that may treat mental-health problems.”
And even though Dr. Stergiopoulos characterized the changes as mostly positive, she also noted that they “leave us with important issues.”
The major issue, according to Dr. Stergiopoulos and echoed by Rachel Cooper, a mental-health urge with personal experience of mental illness herself, is the lack of community support for those who have mental-health issues.
“I believe mental illness often is exacerbated when people are isolated,” Ms. Cooper said. “We need to make sure that the communities people reside in are supportive, which means that people will need to feel they can receive care — whatever that maintenance might be for them. It can be cognitive behavioural therapy, it could be helping to learn parenting skills, it might be helping them hunt for employment, it could be helping them get their medical needs met so that they feel that they could go on with their lives”
Based on Dr. Stergiopoulos, this year one in five Canadians will experience mental illness, and from the time someone reaches 40 years old, he or she has a 50-per-cent likelihood of having already had mental illness. Those numbers underscore the need bridging the gap versus mental illness is treated.
“I believe standardization of care is one means to do that,” the physician said. “And there are attempts to do that through therapy guidelines and through critical-care pathways so that in the event you’ve got a particular condition for a similar treatment wherever you are treated.”
Dr. Stergiopoulos also stressed that mental illness treatments would benefit from measurement-based care.
“We realize that in jurisdictions where results have improved for individuals experiencing mental-health states there have been investments in not only enhancing access but also measuring the results of the care.”
When it comes to diagnosis, the panel contrasted mental illness and cancer. Based on CAMH scientist Etienne Sibille, 20 or 30 years ago cancer was characterized by the body or organ part it affected: like breast cancer, lung cancer or brain cancer.
“Now, a patient comes to the clinic and receives a molecular analysis and they are told this is the sort of cancer which affects these molecules and we are going to take care of it in a particular way. The definition does not respect the categorization based on organs any more,” Dr. Sibille stated.
“I believe, moving to the future, we’ll have a new definition of emotional disorders. We’ll say, ‘We’ve work on this amount of, let us say, brain inhibition,’ or ‘We will need to work on this calorie facet’ And those will be targeted and treated differently.”
Medical professionals are already able to measure an aspect of brain function through transcranial magnetic stimulation, Dr. Sibille said, in precisely the exact same manner one would measure cholesterol levels or blood pressure. And tests are in development.
“We’ll have better, more personalized and more targeted therapies,” Dr. Sibille stated. “And if they’re targeted there will be fewer side effects and increasing compliance.”
Over all, the panelists agreed that conversations about the issue are only beneficial if folks can not get, although there’s much less stigma surrounding mental illness than a generation ago.
“If we will discuss stigma and people understanding that mental illness may be a part of life, we also need to discuss how people can get support,” Ms. Cooper said. “I have seen a change over time, but we still have a good deal more shifting to perform.”