Should we take the meds before we check our heads?
There are less than 5,000 psychiatrists in Canada.
The demand far outweighs the supply, and medicating is the first line of treatment; however, the problem is that suppressing mental illness won’t heal it.
About three years ago, I didn’t feel good…in my brain.
I went to my family doctor’s office – a large clinic that operates like a factory, where a continual line of people are seen, then quickly dealt with so that doctors log the maximum number of patients per hour.
About a year earlier, I had been working with another family doctor (at the same clinic), with whom I’d shared my feelings of depression, explaining that I’d felt this way for almost my entire life, and that I’d seen mental health professionals since my late teens, but no one could ever help.
Although the people that I saw – three psychiatrists in total, were great at listening to me talk and asking what seemed like the right questions to provoke helpful responses, no one was ever able to tell me why I felt the way that I did.
I felt crazy but I wasn’t legit crazy (medically diagnosed). It was incredibly stressful and it took a terrible toll on my self-esteem.
The family doctor asked me to consult my previous [most recent] psychiatrist, whom I had seen for over two years, to have him sign off on my proposed use of anti-depressants – a last resort, and, at the suggestion of my mother who felt I should “just try something” to handle my angry outbursts and melancholic attitude.
I had never considered medication for my underlying depression, relying on alcohol, marijuana, sex, partying, shopping or talking to my friends to try to soothe the lonely sad/mad-ness, but now I entertained the idea of trying something new.
I had to make the appointment with him – he was no longer focused on clinical practice, so it was a tricky situation, but I managed to arrange to see him briefly, explained that I was not feeling well and that I needed him to get help.
But, had I not been a patient of his already, what could have been done for me? Where would I have gone to get help?
Wait times for a new patient to see a psychiatrist are over a month; a long time in a depressed, mentally-ill person’s world, and a lot [of bad things] can happen during those weeks.
The family doctor was clearly uncomfortable prescribing basic anti-depressants, yet, from my experience with other doctors, medication for physical pain would have been scribbled on a pad and handed over.
There really was no alternative.
The meds didn’t feel right and, after a while (eight months or so), I decided to stop using them. I had no support from the psychiatrist and the family doctor was obviously unfamiliar with psychiatric meds, so there were no follow-ups, and I was on my own to navigate the experience.
By this time, the original family doctor that I had been working with had suddenly left the practice, and a new doctor had taken over for her. I brought stopping the meds up with the new doctor, and I explained how I was slowly weaning myself off of the low dose that I was on (according to internet research from various sources). She said “Oh, ok. Be careful.” and that was that.
A few weeks later, still feeling “blah”, experiencing strong sadness, anger and depression, and still weaning because I’d read that the withdrawal process could be harsh, I went to see my family doctor again; I’d decided that I needed more specialized help than she could provide.
She was surprised to hear that I had not yet gone off the meds, responding with (and I can’t forget because it triggered the horror of the next few years), “Oh, you’re still not off of them?”
With what I perceived as an air of judgement, and with no offer of guidance to help me safely get off the meds (or to stay on them if they were necessary, perhaps at a different dose), I was taken aback, so much that I just stared at her, speechless for a good 10 seconds (which is forever in my world).
It was then that I told her I needed to see a psychiatrist.
Her response: “OK, you find someone that you want to see and I’ll write the referral.”
I asked if she had any ideas for someone that was nearby as my previous psychiatrist – he who had signed off on the meds – had gone into academics and wasn’t seeing patients anymore, but she said no.
I didn’t go back to see the family doctor for over two years because of that conversation, opting to go to a walk-in if I needed physical medical attention, because I was so angry at the lack of support, that I didn’t want to freak the fuck out on her for being so unhelpful and push myself further into depression from my angry outbursts.
When a patient asks their doctor for medical help, it is the doctor’s
job duty to accommodate and help the patient to get care via referral if it’s outside of their clinical competence (their knowledge of a specific type of care, in my case, Psychiatry).
Where I live, doctors must abide by the College of Physicians and Surgeons of Ontario’s Mandate on Professional Obligations & Human Rights.
When it comes to mental health, the very fact that the patient has a mental health issue often precludes them from being able to function in a “normal” capacity, and can lead to further damage, as it did for me – causing me anxiety at not being able to get medical treatment while experiencing feelings of neglect and betrayal at the hands of a doctor that was supposed to help.
I was completely distraught and felt helpless, rejected and alone.
I spent hours online, searching for doctors and clinics and mental health programs to help me not want to kill myself, getting angrier and angrier at everyone around me, embittered at the lack of community support.
There were programs at hospitals with months-long waiting lists, there were doctors in other cities, two hours away, then there was the private psychotherapy route that, for someone who was seriously in debt and not able to work due to debilitating depression, $150 – $250 an hour wasn’t going to work. I didn’t have health insurance, and was not on any type of government assistance. My savings had dwindled, and I was barely able to buy groceries or pay the bills.
In a state of severe panic and depressed frustration, I ended up going to the closest hospital for crisis care. I’d read online that it was possible to walk-in on certain days and be seen by the attending psychiatrist.
I sat for over three hours in the waiting room while other patients experiencing mental health concerns surrounded me. I could feel their energies; depressed, dark and hopeless. The room’s décor reflected the same vibe, and I was annoyed at the lack of effort in trying to make the space more peaceful, many times wanting to get up and leave, but this was the end of the line. I had no other place that I could go to get help; this clinical, white-walled room with frowning staff members, protected behind thick glass, and a bunch of ‘crazy’ people forced to look, either, at the ceiling or at each other because of the room’s layout, made me even more tense and uncomfortable.
My blood was beginning to boil, and the anger began to show itself, with louder-than-necessary comments about the wait time, the staff and the colour of the sky. I was losing it.
Prior to seeing a doctor, and still frustrated from the lengthy wait, I was seen by a nurse who began asking me a list of generic questions. She was grouchy and unwelcoming. It made me even angrier because, here I was in crisis and this person was just “doing her job”, no different than one of the uncomfortable chairs in the waiting room, except that she could talk.
At times, I replied to her with frustration and was given “a look”. I wanted to leave but, again, where was I going to go?
It was a terrible experience, but I was at rock bottom and I had no other choice. How could this front-line nurse, working in the psych ward of a hospital, lack compassion for those of us who needed it most? To put it simply, she was ignorant, meaning lacking knowledge of the situation.
She could attend seminars and read all the clinical research available regarding mental health, but she did not have the empathy to understand what it was like to be sitting in that uncomfortable chair, trying to find the words to answer questions about something that’s happening to you that you don’t/can’t understand.
By the very nature of mental illness, the patient should have as much assistance as possible in trying to ascertain what, exactly, is going on, and healthcare teams should use extra care, effective training and patience in drawing out that information.
After another hour in the waiting room, I was brought in to see the attending psychiatrist. To her, I explained my feelings and my experience, my medical history, both, personal and familial, and my ideas on what I was going through.
Grateful to have found someone that was listening to my concerns, I asked if I could begin to see her for regular therapy; I no longer wanted to be medicated, but felt that talk therapy (which I later came to discover is called DBT – Dialectical Behavioural Therapy), would be the most effective for me. That idea was quashed, saying that she didn’t do talk therapy because she didn’t have the time, but that she was good with prescribing me meds (something that started with a C that I’d never heard of), and see me for 15-minute follow-ups.
That was not good enough for me – and besides, how could she know enough about me after 20 minutes to confidently prescribe? I knew that wouldn’t work. It was a band-aid solution that so many of us suffering from serious mental illness must accept because there is no alternative.
Instead of solving the problem, we are postponed and chemically-incarcerated for an indefinite period of time; medication is the new asylum.
There are less than 5,000 psychiatrists in Canada.
The demand far outweighs the supply, and medicating is the first line of treatment; however, the problem is that, unlike broken skin, mental illness won’t heal itself with a cover-up – it needs the proper care and attention in order to get better.
Imagine an oncologist saying “We’ve found a pretty big nodule on your lung, so here are some meds. They’ll keep you calm and you won’t cough as much. Take care, now.”
It would be preposterous for that doctor to not follow up with, at least, a series of x-rays to ascertain the severity of the mass, and to expect the patient to just continue on with a cough suppressant. But this is what the current psychiatric system does.
There are people who have been medicated for years, decades, and will never have the opportunity to delve deeper into the underlying causes of their mental illness to actually work toward healing it because a “psychiatric x-ray” is not a thing…yet.
I understand that many conditions must be treated with medications, however, to avoid blindly “trying out” different meds, isn’t it better to have as solid an understanding as possible of the issue before filling ourselves with chemicals that have side-effects we haven’t even discovered yet? Or, in my case, using the wrong meds and causing further harm to my health?
Should we take the meds before we check our heads?
Psychiatrists make, on average, the lowest salary of all doctors in Canada. Unlike a family doctor, who can see a multitude of patients and, usually, immediately assess (or refer) the issue and move on to the next patient, psychiatrists have a much smaller patient base, since diagnosing mental illness is a very lengthy process that can’t be done in a single visit, so the shortage makes sense. But it’s a chicken-and-egg situation and isn’t doing anything for the state of mental healthcare.
As our population continues to grow, so does the need for increased care, both, physical and mental.
Through a friend, I was able to find a family doctor that offers psychotherapy as part of her practice. Covered by OHIP (my Provincial Healthcare Plan), I have met with her usually every two weeks for almost two years, possible only because it’s covered and not out-of-pocket, and, together, with bi-monthly consultations from a psychiatrist, we managed the pain that I was experiencing and received a diagnosis – the keystone to every illness.
I am now much healthier, and the symptoms of my previously undiagnosed life-long mental illness (with no “cure” except DBT), is much better understood, making me more confident and, therefore, able to take a leading role in my own health management and emotional regulation – without thoughts of self-harm and without medications that didn’t work but made me sadder, angrier and physically unhealthy.
I was lucky. It is very, very, very rare to find such a doctor, but that is, both, the problem and the solution:
Why are psychologists not included in our provincial healthcare programs?
In 2018, the Nova Scotia Liberals moved and resolved to include mental health care in the Federal Medicare and Canada Health Act, but red tape is often very sticky and difficult to get through and, as someone told me: we, as individuals, can use common sense, but when it comes to the government – an impersonal body of collective and opposing thoughts intended to represent the masses – common sense is a paradox; it cannot exist.
So, we’ll probably be waiting a while until anything is done on that front, as a resolution is just an opinion – so really no more effective than an audience of parents applauding after a school’s Holiday concert.
In 2015, an article entitled The Case For Publicly Funded Therapy, was published by the Globe & Mail. It took an in-depth look into the family doctors on the front-lines that are dealing with the mentally-unhealthy patients that would be better served by dedicated, professional psychologists.
My own story is further proof of that.
Had my doctor had OHIP-funded psychologists’ information at her disposal – just like the dermatologist or the ENT to whom I’d been quickly and effortlessly referred – I could have received effective treatment faster, therefore not spiraling into the severe depression or experiencing the treacherous pain of living with it for such a long time, affecting my own health and the health of my family who was with me, throughout.
Most recently, in September of 2018, the Canadian Mental Health Association (CMHA), released a paper called Mental Health in the Balance: Ending the Health Care Disparity in Canada, calling for new legislation to bring mental health care to the same level as physical healthcare.
Over half of Canadians consider depression and anxiety an epidemic.CMHA – Ending the Health Care Disparity in Canada (2018).
Epidemics are things like Yellow Fever, Malaria, Smallpox and AIDS – illnesses that killed (and continue to kill) a massive number of people because they weren’t/aren’t efficiently and effectively treated.
According to the study, eighty-five per cent of Canadians say mental health services are among the most underfunded services in our health-care system—and the majority agrees (86%) that the Government of Canada should fund mental health at the same level as physical health.
Those that don’t agree have, most likely, never directly experienced mental illness…yet.
I admit that I felt the same way about it until it happened to me. “People can change their mindset,” I would say, “It just takes strength.” But when you’ve been “taken over” and have lost control of your ability to manage your mind, that way of thinking makes no more sense than saying a paraplegic can get up and walk if they will themselves to do it. Ignorance.
Many hardliners (those “non-agree-ers”) will use the economic argument, feeling that additional spending on healthcare for something that people can “get over”, is a waste of tax dollars, however, the CMHA’s paper finds that, in addition to improving quality of life and health outcomes, mental health promotion, mental illness prevention and early intervention can reduce the burden on our health-care system.
A recent study on the treatment of depression estimated that every dollar spent on publicly funded psychological services would save two dollars for the health system.CMHA – Ending the Health Care Disparity in Canada (2018).
Make a difference by contacting your MPP (Member of Provincial Parliament), your MP (Member of Parliament), your State Congressperson or whomever represents you and your health interests in the place where you live, work and pay taxes and telling them what you think.
Every voice matters. Make ’em hear yours!
Having experienced it first-hand, I have offered you my story without embellishment, but with the desire to effect change so that no one else has to go through what I did and, if they must, perhaps it’ll be a bit (or a lot) easier.
It’s a terrible, lonely and sad place to be and it’s not a fate that I wish upon my worst enemy, although, it recently came to my attention that my actual worst enemy was beginning to experience what I had gone through, but that’s a story for another time…