Awhile ago, I was informed that I lived in the Mecca of mental health services: Toronto. There are 700 psychiatrists at the University of Toronto alone plus community psychiatrists, too few OHIP-covered psychologists and social workers, and a plethora of private-pay therapists in this city. These are in number completely inadequate to meeting the mental health needs of Torontonians, especially those of us with brain injury or complicated mental illnesses. So if Toronto is Mecca, then Canada and her provinces are absolutely failing its citizenry.
Robin Williams’s tragic suicide brings this home, for as someone said on Twitter: if he with all his wealth and apparent mental health help cannot overcome his demons, then how can we mere mortals with limited access to services?
(Personally I think mere mortals have a better chance in one respect: with no worry of anyone including shrinks selling your story, you’re free to expose all.)
The report “The efficacy and effectiveness of psychological treatments” published by the University of Ottawa in September 10, 2013 said:
“In the treatment of anxiety and related disorders, there is strong evidence to support the use of psychotherapy as a first line treatment. This holds across the lifespan for generalized anxiety disorder, social anxiety disorder, specific phobia, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder.
Although the strength of evidence varies considerably across the treatment of anxiety and related disorders, in general, psychotherapy and medication appear to be equally effective. For many of these disorders the rates of premature termination of treatment are lower for psychotherapy than for pharmacotherapy.” (Bolding mine.)
In other words, meds alone don’t cut it for those of us with PTSD (post-traumatic stress disorder). We need humans to truly help those of us with brain and mental health issues like PTSD. That makes sense because we are social animals. Every aspect of our health from hearts to brains work better when we are connected to other human beings. And in our judgemental world, having a connection to a professional who treats you as a normal human being who is having a little difficulty while recognizing the true severity of that difficulty makes an enormous difference.
We have as much right to receive medicare-covered treatment by a (neuro)psychiatrist or registered psychologist as people with cancer do from an oncologist.
I was informed that I was lucky to have my neurodoc. Luck had nothing to do with it.
For years and years I did not have competent mental health help, competent for my complex case that is. A counsellor who doesn’t understand brain injury and won’t educate himself is not competent for me though may be competent for a person with a touch of anxiety.
By the mid-2000s, I had given up on getting the kind of psychiatric or psychological help I needed and thought I could get by. Also, I’m not naturally inclined to ask for help: I was taught to stand on my own two feet. I lived with people who saw interdependence as dependence, and I’d learnt it didn’t pay to ask for help. As a result, throughout my continuing brain-injury recovery, I’ve had to learn over and over again how to ask for help. I can’t imagine how more difficult it is for people with depression whose illness impedes that ability on top of living in a society that resents being asked.
Be independent! is the North American mantra.
But by 2009, I was heading downhill psychologically. I think when a fight is over, as my insurance one was, that’s when you feel its emotional and psychological effects. They rise up and demand to be heard. And so began round two of seeking a mental health professional.
I asked and asked and asked. I asked doctors, people I knew, CCAC (Community Care Access Centre) people. I got a couple of names. No new patients, was the reply from those names. I kept begging and looking around for more names. No one knew who understood brain injury; no one knew neuropsychiatrists who were taking new patients with less than a two-year wait. I finally passed out, figuratively speaking, from the utter exhaustion of looking.
Then my skin began to shred. I was sent to a dermatologist, who noticed I was not all right. I’d seen all kinds of medical people before I saw him; he was the first to look into my eyes and ask me how I was doing.
He said he could refer me to a neuropsychiatrist. You’d think the fight was over.
I was referred to the community clinic by accident, which called me and agreed my case was too complex for them. Back to bugging the doctor to call the right clinic and then to wait in dermatology until the referral was written and, I think, faxed, though I was dead tired and wanted to go home, as was usual whenever I saw a specialist.
Then I waited.
I had an appointment! But that didn’t mean I was in. The first appointment was an intake assessment, kind of like the one I had had at the Toronto Rehabilitation Institute and at CCAC, to assess the severity of my case and to see if I met the criteria to be treated, only this one was mercifully shorter.
I obviously was considered fucked up enough to merit the services of a highly specialized physician. But I wasn’t able to start treatment yet. I needed to meet with him about three times for a detailed history.
I waited for those appointments.
And I waited.
Finally, I saw him for those appointments. Now I could book treatment appointments. But only for every other week. And I had to wait too for those to start.
Back then, I was still “recovering” from having years of several-times-per-week medical appointments, and so I was fine with every two weeks. Monthly would have suited me. You see, I knew I needed the help, but brain work for whatever reason is tiring and hard. I dreaded it.
Two years after I began seeking help, I had it.
Anyway, I waited two months for my first treatment appointment. You see, being rare as hens teeth, neuropsychiatrists are booked up the wazoo. In fact, any time I was even a day late in booking my two-month allotment of appointments, I’d end up with no appointment from anywhere for a week to a month. My neurodoc said: when that happens, be like his other patients who’d call incessantly to see if there was a cancellation.
I don’t know how they do that. My brain says I’ve made the call, whyyyyyy do I have to call again. Then promptly forgets. One would think if I can persist in looking for help, I could be persistent in phone calls. But nope. It also doesn’t help that I have very, very bad associations with making phone calls after my brain injury.
Anyway, we seem to have solved that apparently unique problem. And so far this year, I have had appointments every week.
Yes, weekly. When my neurodoc wanted to work with me on family issues in a particular way, I made a deal: I’d go along with his plan if he saw me weekly. He agreed readily, and I waited two months for the new schedule to start.
All was peachy until I began to go downhill a year ago because of an event that, well, threw me a shock ball. For the last several months I’ve been agitating for twice a week because I knew I was deteriorating and needed more mental health support. He is so busy and in demand that this he has trouble doing; but recognizing the complexity of brain damage plus rapid healing from brain biofeedback plus emotional indifference morphing on and off into emotional reactions to events that happened over 10 years ago plus PTSD plus plus plus, he decided to begin calling me on pre-agreed days and times. As I said, me making phone calls, even when in distress, doesn’t work too well. Knowing I can count on him to call is helping.
So if this is Mecca where you have to fight every step of the way from finding names to getting in for an assessment to being booked for treatments to being booked in for the frequency you need to getting calls, then God help Canadians outside of Toronto in severe mental and emotional distress, especially those who cannot ask for help and particularly those of us in the brain injury community who require rare highly specialized help and are encouraged by loved ones and the system not to try but to accept where we are and to take our meds like good little girls and boys, meds that may or may not help with the symptoms but won’t get us functioning to our full potential again.