I think one of the most difficult concepts for me to grasp is how patients, especially patients with no healthcare background, can navigate the system. This thought popped up recently in a discussion with my own physician whom questioned why I wanted to resume therapy and pursue a research study focusing on depression.
Mental health services are inaccessible for most people. Considering I make a decent income and have private healthcare insurance, private therapy is also out of reach for me. Dishearteningly, in my one of my final therapy sessions with the free therapist I was assigned, we discussed the barriers many face in accessing affordable and timely care. Patients can wait up to 2 years in some areas to receive affordable mental health care. With costs of living rapidly increasing, mental healthcare simply loses priority when it comes to choosing having to survive or address ones mental health. Unshockingly, the Government of Ontario recently cut funding to programs such as AbiliCBT which aimed to improve access to free self-taught cognitive behavioural therapy (CBT) programming for people suffering from mild to moderate depression. To put it into perspective the program funding cut by the government now expects to offer 9,000 free spots compared to previous 60,000. Again decreasing access to supportive mental health care programming. Again reiterating the fact that our healthcare system is constantly on reactive mode rather than pursuing preventative or proactive measures to improve our health outcomes or the sustainability of our healthcare system.
In truth it has been a long journey and since I started this blog I would say while things are definitely better from where they are, we’re are still a ways from where we need to be. In particular, our discussions on mental health. I still feel a sense of stigma when discussing me mental health struggles, particularly from my experience within the east Asian community.
East Asian Canadians have unfortunately faced a disproportionate mental health impact from the COVID-19 pandemic as a result of targeted racist attacks, violence, and discrimination. In truth, like many minority groups, East Asians are generally less likely to seek mental health services, and the need for interventions and support designed specifically to address the needs of the East Asian Canadians is still very much needed and more willingness to discuss mental health within the community needs to be explored.
Its unfortunate mental health is still highly taboo in so many minority communities and yet while the mental health community has so many passionate advocates in the 7 years I have spent working with the community, it feels like sometimes things have not improved much. According to a survey by the Mental Health Commission of Canada, only 38.3 per cent of Black Canadians with mental health issues used mental health services between 2001-2014 compared to 50.8 per cent of White Canadians.
The truth is, family physicians are great at what they do and without them our healthcare system would certainly become overwhelmed with what would seemingly constitute as needless referrals to specialists. Family physicians are also often the first encounter many of us have in seeking help for our mental health. As a result, our system needs to find a way to help support our family physicians (and nurse practitioners) in being able to manage mental health conditions and help to find ways to make mental health services more accessible as the truth is therapy is just as much proven to be effective in mild to moderate cases of depression than just medications on its own. We need to do better to close the gap and we need to innovative ways to support professionals who come to these standstills in being unable to help provide the care patients desperately need access to.
Don’t get me wrong, I love my family doctor, but recently after having to advocate for myself for them to refer to to a psychiatrist for a program I was participating in I felt judged for wanting to seek a second opinion. It was an awkward conversation to have to navigate, that yes, while I had chosen to not continue on anti-depressants, it was assumed by them that I was simply “okay”. I have always been a highly functioning individual and hiding my depression and pushing through it has been something I have been able to do. But being a healthcare worker I have been fortunate to receive counselling support and an expedited referral to a top mental health physician for a consult to improve my care plan moving forward. On some level, I was tired of being under-treated and being at a cross roads of trying multiple medications to end up in the same spot. Being able to talk to a specialist improved my confidence in a system where historically mental illness is often under treated, confusing, and expensive. While my family doctor was amazing at helping to keep me functional, I learned there were so many more avenues for me to explore and that I had been heavily under treated over the course of the last year. Sadly, this also invoked a thought in which I realized I was part of a small fortunate subsection of people who could advocate for myself and participate in programs many people historically wait many months for. In addition, to recognizing how many people fall through the cracks of our healthcare system and are just forced to “live” with their depression.
It has truly been a while since i’ve been on here to discuss my own personal journey with my mental health. In truth, I have been living but also since leaving the PICU grappling with the aftermath of burnout, anxiety, and crippling bouts of depression some days.
Do I still have my bad days? Of course, I do. But the coping mechanisms I hav acquired have been super helpful. I am also quite lucky to be so well supported by those I love. In addition, despite feeling some guilt for “not looking/feeling depressed like in the past”, I took it upon myself to restart therapy to openly discuss my feelings and learn new coping strategies to replace ones no longer serving my benefit. I’ve since adopted the mind set that while there will likely always be setbacks and that not every day has to be a good day. At the end of the day, my depression likely wont be cured and it will inevitably be a continuous journey that needs attention and work. So yes, while on the outside things are seemingly fine, it is important to remember that sometimes you have to hit that refresh button and reach out for support again. It is okay to not feel okay and ask for help!