The future for the treatment of mental health in Canada looks a lot different from the past. It's likely to include genetic screening for mental-illness markers and personalized treatments based on molecular analysis.
But the present, in some aspects, is in a state of limbo, according to speakers on a mental-health panel held at The Globe and Mail last week.
"We've seen a lot of changes in mental-health-care delivery in the past 30 years," Vicky Stergiopoulos, physician-in-chief at Toronto's Centre for Addiction and Mental Health (CAMH), told 200 mental-health supporters and advocates. "We've seen the mass closure of provincial psychiatric beds and the introduction of provisional care in the community. … And we also saw the introduction of drugs that can treat mental-health conditions."
And although Dr. Stergiopoulos characterized the changes as mainly positive, she also noted that they "leave us with significant problems."
The main problem, according to Dr. Stergiopoulos and echoed by Rachel Cooper, a mental-health advocate with personal experience of mental illness herself, is the lack of community support for people with mental-health problems.
"I think mental illness often is exacerbated when people are isolated," Ms. Cooper said. "We have to make sure the communities people live in are supportive, and that means that people need to feel they can get care – whatever that care may be for them. It may be cognitive behavioural therapy, it may be helping to learn parenting skills, it may be helping them search for a job, it may be helping them get their medical needs met so that they feel they can go on with their lives."
According to Dr. Stergiopoulos, this year one in five Canadians will experience mental illness, and by the time a person reaches 40 years of age, he or she has a 50-per-cent chance of having already had mental illness. Those numbers underscore the need to improve treatments, bridging the gap between how, for instance, a disease like cancer is treated versus how mental illness is handled.
"I think that standardization of care is one way to do that," the doctor said. "And there are efforts to do that through treatment guidelines and through critical-care pathways so that if you have a certain condition you get a similar treatment no matter where you're treated."
Dr. Stergiopoulos also stressed that mental illness treatments would benefit from measurement-based care.
"We know that in jurisdictions where outcomes have improved for people experiencing mental-health conditions there have been investments in not only improving access but also measuring the outcomes of that care."
The panel also contrasted cancer with mental illness when it comes to diagnosis. According to CAMH senior scientist Etienne Sibille, 20 or 30 years ago cancer was characterized by the organ or body part it affected: such as brain cancer, lung cancer or breast cancer.
"Now, a patient comes to the clinic and gets a molecular diagnosis and they're told this is the type of cancer that affects these molecules and we're going to treat it in a specific way. The definition doesn't respect the categorization based on organs any more," Dr. Sibille said.
"I think, moving to the future, we will have a new definition of psychological disorders. We'll say, 'We have work on this particular level of, let's say, brain inhibition,' or 'We need to work on this metabolic aspect.' And those will be treated and targeted differently."
Medical professionals are already able to measure an aspect of brain function through transcranial magnetic stimulation, Dr. Sibille said, in the same way one would measure cholesterol levels or blood pressure. And genetic tests to determine which treatments would work best on whom are already in development.
"We will have better, more personalized and more targeted treatments," Dr. Sibille said. "And if they are targeted there will be fewer side effects and increasing compliance."
Over all, the panelists agreed there is far less stigma surrounding mental illness now than a generation ago, but that conversations on the topic are only partially beneficial if people can't get the treatments they need.
"If we are going to talk about stigma and people understanding that mental illness is sometimes a part of life, we also have to talk about how people can get support," Ms. Cooper said. "I've seen a shift over time, but we still have a lot more shifting to do."