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Night at the museum

Re Prince Harry To Keep ROM Lifetime Membership (Online, Jan. 21): It’s good to see that the Royal Ontario Museum is still accepting Harry and Meghan. But in life, nothing lasts forever – we must either adapt or die. That’s why, as an avid supporter of a limited monarchy, I was happy when the Queen agreed to a compromise with Harry and Meghan that meets the needs of the Royal Family.

Of course, not all changes are for the better – consider the architectural alterations to the ROM – but I think this new royal social arrangement honours the past as it recognizes the future.

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Ken DeLuca Arnprior, Ont.

Firewall down

Re Cyberwar Is Coming To A City Near You (Opinion, Jan. 18): I believe cyberwar is already here.

The breaches of recent years – LifeLabs, Equifax, the city of Atlanta – should not be detached from the ratcheting up of geopolitical conflict. Increasing hostility between nations is reflected in our ever more hostile cyberlandscape, one populated by actors wreaking indiscriminate harm. Unfortunately, the private and public sectors alike have mostly underinvested in robust defences. That status quo should be seriously rethought, and as a top priority.

Cyberwar isn’t on the horizon; I see it’s banging at our door.

Rick Costanzo CEO, Rank Software; Toronto

Mind the gap

Re The Doctor Won’t See You Now (Folio, Jan. 18): There are some solutions already in place that could be scaled to provide improved access to mental-health care.

British Columbia has free access to cognitive behavioural therapy for people with mild to moderate depression and anxiety through the Bounceback program, which is provided in collaboration with primary care. An evaluation of the program published in the BC Medical Journal in 2019 showed that 68.5 per cent of the 5,537 patients referred achieved recovery. A similar program is now operating in Ontario. And for more than 30 years, Hamilton has had a shared care program that provides rapid access to psychiatry to primary-care doctors.

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For people with complex conditions such as schizophrenia, stepped care gets impressive results. Over three years, multidisciplinary teams which include psychiatrists and other mental health professionals were able to avoid over 32,000 days of hospital admissions.

Better integration of psychiatry with primary care, as proposed by the Canadian College of Family Physicians, would improve access and achieve better outcomes than the status quo.

Steve Lurie Executive director, Canadian Mental Health Association, Toronto Branch

If we want to make a real difference in reducing the need for more psychiatrists, we should do more before someone gets sick in the first place. In the psychiatric facility where I spent my working life as a psychologist, the majority of patients I assessed reported a dysfunctional childhood.

The ingredients for the inoculation of mental illness are now being taught in schools that include psychological well-being along with traditional subjects. Social-emotional learning skills are now being advocated by organizations promoting mental health, potentially making up for whatever was happening in a child’s home environment. I believe there is every sign that teaching children more productive ways of handling life’s difficulties can significantly reduce the need for psychiatric care.

Stuart Ross Guelph, Ont.

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Non-medical psychotherapists generally provide quality talk therapy that can be as good or even better than medically trained professionals. But since they are not covered by public health care, their private fees deter a large segment of Canadians. How about a universal fee schedule, based on a person’s income, that applies to both medical and non-medical modalities of therapy?

The wealthy could easily afford an hourly fee of $120 or more. Such a model could free up public dollars for those who need it most and allow psychiatrists to concentrate on more severe cases of mental illness. Medical and non-medical professionals should share equally in shouldering the spectrum of suffering – from each according to his means, to each according to his needs.

James FitzGerald Toronto

As a hospital-based psychiatrist, I agree that changes are needed in how we approach mental-health care. However, simply having psychiatrists seeing more patients would not address the gaps that impact recovery at all stages: income support and vocational rehabilitation, safe and supportive housing, substance-use-disorder treatment and access to psychotherapy.

Trying to treat people while these gaps persist feels like a drop in the ocean of human suffering.

Laila Jamal Toronto

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As a case manager in mental health and addictions in downtown Toronto, I would be the first one to say we need more psychiatrists. But that isn’t news to me. Doctor shortages in many areas of medicine are well known, often discussed and never disputed. But I have also seen that all mental-health services are dramatically underfunded and overburdened.

Last week, for example, I made an emergency home visit to make sure a client was safe, which kept her out of the hospital, no psychiatrist needed. Community mental-health workers are just as important to the system, but as long as doctors remain the focus of policy discussion, funding will likely stay out of communities – and emergency rooms will overflow.

Andrea Jakaitis Toronto

Within medicine, I have found that psychiatry is treated like a poor second cousin. The stigma visited on those with mental illness is displaced onto those, like myself, who treat these complex illnesses.

Treatment is often managing chronic symptoms, always a more expensive endeavour than obtaining a cure. Yet it is the psychiatrist who seems to be blamed for lack of services. My small finger is already stuck in the dam of keeping back some of the mental-health need.

I am not sure I can turn myself into a plate-spinning juggler to address the vast gap in services caused by years of underfunding. There is a mountain of statistics, but numbers don’t necessarily measure the humanity of the work. Humanity takes time and patience. Let us not forget this part of the equation.

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Heather Weir Toronto

As a psychiatrist and career insight-oriented psychotherapist, I beg readers to consider that there are two aspects to modern psychiatry: medical and psychodynamic; brain and mind. The brain may be the primary cause of a disorder and affect the mind; as well, the mind can be the root cause affecting the brain.

I find that medical psychiatry errs in defining psychiatric problems as brain diseases, and that medication offers, at best, a temporary symptomatic remedy. Psychodynamic psychiatry believes that the mind is most often the cause of human mental suffering. It addresses that cause in a therapeutic healing relationship and I find it has demonstrable lasting results. And it takes time. Things of lasting value do not spring up overnight or from a pill. Ask my patients.

Would that medical and psychodynamic psychiatry work together, rather than in opposition.

Howard Taynen Ancaster, Ont.

Editor’s note: Jan. 24, 2019: A previous version of this article referred to a Hamilton program which helped avoid over 32,000 days of hospital admissions. In fact, this statistic should have been in reference to a stepped care program.

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