Grieving mother launches drive to reform emergency psychiatric units.

By late November, Ottawa wedding photographer Ryan Parent was in crisis. He was struggling under the weight of depression and anxiety, a burden made worse by his fear of returning to hospital.

Parent, 37, had gone to The Ottawa Hospital in June because a friend was alarmed by his manic behaviour and by his online posts about the Earth being flat.

In the emergency department, doctors referred him to the hospital’s Psychiatric Emergency Services (PES) unit for a more thorough assessment.

Both the General and Civic campuses have secure PES units inside their emergency departments. The units feature spartan, windowless rooms to limit the visual stimulation of patients. They’re designed to ensure that both patients and staff are safe while the individual is assessed and a mental health referral is made.

Parent spent 56 hours in one of the rooms at the General campus, waiting for a bed to open up on the hospital’s psychiatric ward. Ryan’s grandmother, Ruby Parent, visited him in the PES unit on June 3. She said his room opened to a small anteroom, from which a locked door led to the hospital hallway. The anteroom featured a window with bars through which patients could speak to a nurse.

This is a picture that Ryan Parent took of his room at The Ottawa Hospital’s PES unit. OTTWP

Ryan, she said, was well treated by staff and received permission to go for a walk. “But it was not a nice place, it was just like a cave,” she said, “and I think it must have been very despairing for him.”

A bed did not become available, so Parent was eventually discharged without a new diagnosis. At home, he told his mother he would never go back to what he called “that jail cell.”

“He said it was the most traumatic time of his life,” said his mother, Ellen Parent.

Ryan continued regular visits with an outpatient psychiatrist, but his mental state declined that summer. His fear of returning to The Ottawa Hospital mounted.

On the evening before he died, Ryan was in a paranoid state. He closed all the blinds, set the family’s home alarm system and discussed with his mother his fear that he had done something wrong, and would be locked up. They talked about going back to the hospital for help the next day.

“On the morning of his death, Ryan came into my room and said that he loved me but that he didn’t want to go back to the hospital,” Ellen Parent said. She told Ryan that was OK.

Ryan returned to his room. Later that morning, Parent discovered him slumped in his closet. He had hanged himself.

“My son who so badly wanted to live took his own life,” said Parent, who firmly believes her son’s experience in the PES unit played a role in his death.

“I do feel strongly about the fact that the ‘cell situation’ prevented Ryan from seeking more help — he was left with feelings of hopelessness and unrelenting fear. … I’m not saying that was the cause of his suicide, but he became terrified of the hospital.”

Ryan Parent is not the only patient who has been unsettled by the hospital’s secure and sterile PES unit. This newspaper spoke with two other psychiatric patients who were also disturbed by their experiences in the units.

But Dr. Katharine Gillis, head of The Ottawa Hospital’s department of mental health, defended the PES units as state-of-the-art.

She said they were created to give patients a private, safe and calming environment where they could be assessed by a dedicated team that includes psychiatrists, mental heath nurses and social workers. Previously, Gillis said, people who were having a mental health crisis were assessed in boisterous emergency departments, often in cubicles that offered little privacy.

Many people who come into the PES unit, she noted, are having an acute mental health crisis. “You have individuals who are really struggling: They’re over stimulated; they’re sensitive to their surroundings, to people being around,” Gillis said. “So we deliberately, in crafting these types of spaces, aim to have them provide low stimulation.”

Security measures, she said, are tailored to the individual. “When we think about a good patient experience, I think safety is an essential component.”

Although she could not speak to the specific details of the Ryan Parent case, Gillis said secure, low-stimulation PES units are now a standard hospital feature. “These elements may potentially appear unusual to someone who may see it, but these things are really part of what we want for this very acute, agitated phase,” she said. “This is not unique to The Ottawa Hospital.”

Dr. Gillis said there’s no defined limit of time for a patient stay in the PES unit. Staff will take the time they feel is appropriate to make a good assessment, she said, while keeping patients reassured and informed about the process.

“Our patient guiding principles are respect, compassion and safety,” she said.

Ellen Parent, however, contends the units are inhumane; she wants to see them eliminated.

“I feel it’s my duty to try to prevent anyone else from every going through that experience again,” she said. “A patient in distress does not need to be put in solitary confinement for hours on end.”

Ryan is not the only patient who has expressed concern about the units.

Joanne, 34, said she was three months pregnant and extremely depressed when she went to The Ottawa Hospital in April 2016. She went to the emergency department and explained to medical staff that she could not stop crying. She said she was having suicidal thoughts.

Joanne said she was sent to the PES unit for a psychiatric assessment. She spent 24 hours in the unit before being transferred to the hospital’s psychiatric ward.

“It was a very scary experience,” Joanne said of her stay in the PES. “It honestly felt like a jail cell.”

Joanne would spend two months in hospital and be diagnosed with depression, an eating disorder and obsessive-compulsive personality disorder. But it is her time in the PES that bothers her most.

“I would like them to remove it or at least don’t make it seem like we’re in jail,” said Joanne, who gave birth to a healthy son late last year. “We have mental illness, but we didn’t ask for that.”

Another psychiatric patient, Deanna, has twice stayed in the PES unit. She suffers from anxiety, post-traumatic stress and chronic pain. She called the unit “a dungeon.”

Deanna said her shoes, clothes and phone were taken when she entered the unit. She had to obtain permission to go outside for a smoke, and was accompanied to the bathroom by staff. (Gillis said security measures are individualized based on an assessment of each patient’s condition.)

Deanna said she felt so humiliated and isolated after her second stay in the PES that she has vowed not to go back.

Now 34, Deanna said the psychiatric ward is a more “humane” place where patients can wander around — the ward’s doors are secured — and visit a common area to read, watch TV or talk. She said she’d like to see the PES units revamped along similar lines.

“I don’t want to be treated like I’m an inmate down at Innes (the Ottawa-Carleton Detention Centre on Innes Road),” she said.

Parent contends psychiatric patients should be treated like anyone else who comes into the hospital, and assessed in the emergency department, not sent to a unit that can magnify their sense of isolation and paranoia. This is the situation at most other Ottawa area hospitals, including the Queensway Carleton Hospital, where a crisis-intervention team assesses acute mental health patients in regular emergency department cubicles.

“It’s just so wrong to send vulnerable people into that cell kind of situation, it has to stop,” Parent said. “I think every day of the people being put in there.”

Gillis said the hospital will be consulting with its patient and family advisory group before designing a PES unit for the new Civic campus, which is expected to open in 2026.

Resposted from:

Hospitals as a Safe Space for Opioid Injections?

Interesting opinion piece I came across in the NY Times regarding the promotion of safe injection sites in hospitals.

In all honesty, I have the agree with the rationale behind this thought. As healthcare providers we can’t tell our patients to do something and expect them to follow through, particularly when battling addiction. What we can do as professionals is build trust, the foundation of any healthcare provider-patient relationship. It’s the one aspect we can control, by telling or restricting a patient from doing something because of fear, patients will rebel. It’s similar to telling a teenager they can’t drink, chances are when they do have the opportunity to sneak out (which they will) and have the chance to drink they don’t maintain control.

By promoting a safe environment for patients, we can delve deeper into understanding their addiction and working with them to promote health, rather than being seen as the unreasonable dictator. With opioid use on the rise, it’s important our healthcare system is doing what we can in promoting the best interests of our patients. While illegal drug use is obviously not condoned, promoting patient centred health care is, and we need to do a better job at understanding the complexities of treating drug addictions. In health promotion you are taught that you can’t encourage or expect change if someone doesn’t want it or is restricted. So why not start with treating the addiction in a safe space and building patient trust?



HANOVER, N.H. — “How am I feeling, Doc?” my new patient answered. “I’m feeling like a caged dog.”

Hospitalized for a heart-valve infection resulting from injection drug use, my patient had purple hair and arms covered with hand-drawn tattoos. She smelled unwashed.

“I can’t go out to smoke. My boyfriend can’t visit,” she said. She gestured to the security guard in the doorway. “I can’t even pee without her watching me!” The guard rolled her eyes.

So, rather than building a therapeutic bond through small talk or discussion of her symptoms, we spoke of her confinement. The ban on visitors and the other unusually restrictive terms of her hospitalization were not a consequence of her drug addiction. They resulted from her behavior in the hospital.

Once a nurse found the patient in the bathroom shooting heroin into her I.V. line, the sink spotted with blood. A housekeeper changing bedclothes was almost spiked by a used needle hidden under the mattress. A constant influx of boisterous visitors came to her room day and night, some delivering heroin.

With quality of care, professional propriety and staff safety at risk, polite conversations escalated to rancorous confrontations. Finally, the patient got an ultimatum: She would receive care with a 24-hour guard in her room, with no exit and no visitors; or she could leave.

It is a new world in health care as America grapples with an epidemic of opioid drug abuse. The Centers for Disease Control and Prevention reported that opioid overdoses killed over 28,000 people nationwide in 2014, more than ever before.

From heart-valve infections to drug overdoses, the casualties of this epidemic wash up in our hospitals. It has changed my hospital service significantly. Almost every day, we try to save a young person dying from infectious complications of injection drug use.

Addicted patients usually bond with their providers over the shared goal of healing. Yet these interactions, which often bridge divides of class, culture and personal psychology, can break down. When addicted patients inject drugs in the hospital, doctors and nurses can find themselves cast in the role of disciplinarians, even jailers.

Confining patients to their rooms, restricting their activities and posting guards is expensive. It may also compromise a patient’s well-being: Ambivalent providers may visit less often, educate patients less avidly and spend less time devising the best treatments.

The worst effect of confining addicted patients in the hospital may be the damage to the patient-provider bond. I couldn’t blame my patient for feeling caged, even if she had brought those consequences on herself. Her nurses told me they felt conflicted, too. They wanted the simple bond of caregiving back — and they wanted the patient to stop getting high and jeopardizing staff safety.

The problems presented by injection drug use are legion, but creative solutions exist. One is the provision of safe drug-use rooms. Cities as far-flung as Vancouver, British Columbia, and Paris and Berlin have opened safe, well-lit rooms where addicts can get clean needles and other equipment without fear of incarceration. In New York State, Ithaca and Manhattan are considering similar initiatives. Such facilities can also connect addicts to needed services like preventive testing, acute care and treatment for addiction.

Safe drug-use rooms are typically designed to help keep addicts out of the hospital, but they could work for addicts within hospitals. A safe place to inject for addicted patients in the hospital could reduce conflict with staff, protect patients and providers from dirty needles and other drug hazards, and enable patients to receive respectful, high-quality care when back in their hospital beds. Safe drug-use rooms could also offer treatment for addiction, a step often neglected in hospitals.

The creation of these rooms for hospitalized addicts won’t be easy. There will be legal liability concerns, and hospitals must safeguard against the risk of overdose or unseemly behavior. It will be worthwhile to tackle these issues if it enables the provision of compassionate care for at-risk patients whose treatment would otherwise be endangered by conflict with providers.

As for my patient, I looked her in the eye and told her I was sorry she felt caged, and that I cared. In time, she relaxed, and trust grew. We discussed her symptoms, her life, and how we hoped to get her better.

We hadn’t cured her yet, not even close. Many challenges remained. I was glad we now had a chance to face them together.

Ethical Proponents of Patient End-of-Life Decision Making Using Functional Magnetic Resonance Imaging Techniques

Major medical advancements have revolutionized the field of medicine in recent years, including procedures such as the one undertaken by Dr. Adrian Owen and his research team regarding the use of functional magnetic resonance imaging (fMRI) to detect levels of consciousness in permanently vegetative state (PVS) patients. Similar to other medical interventions, this technique has led to ethical dilemmas amongst members of the medical community, regarding the ability of PVS patients and their families to make decisions regarding the withdrawal of life-sustaining interventions.  Prior to this discovery, little exchanges of information had been done with patients who have been diagnosed as being in a PVS.  Furthermore, initial findings from the research that has been undertaken may help support the notion that this technique should play a role in allowing patients and their families to make choices in regards to end of life decisions, despite their physical and mental state. Initial findings have led to two distinct arguments within the ethical realm surrounding the idea of asking these patients questions regarding end-of- life decisions and what can and should be done to improve their quality of life. The context of this paper will be supported by the ideas behind individuals right to life supporting the direction of health care moving patient autonomy. Thus, I believe that patients that have successfully undergone Dr.Owen’s technique should have the right to make their own choices regarding end of life decisions as supported by the principles of liberalism due to their conscious awareness of their surroundings.


Within the past few months, a breakthrough has been seen in regards to patients who have experienced traumatic brain injuries leaving them in vegetative states. This breakthrough method involves monitoring real-time brain activity with the use of an fMRI- by visualizing the flow of oxygenated blood through the brain as the patient answers specific questions (Mole, 2012). Patients are therefore trained and instructed to imagine doing tasks such as playing tennis to simulate the answer no, and to visualize walking through their homes as yes (Blackwell, 2013). Thus, when being asked questions the thoughts from the patient cause different regions of the brain to light up and is then captured on fMRI scans which captures brain activity over time (Blackwell, 2013).  This method is the first technique that has shown clinically vegetative patients answering questions pertaining to their condition (Mole, 2012).

Prior to the discovery of this technique, it was noted that PVS patients were seen to be unable to respond to stimuli from the outside world. Patients in permanently vegetative states (PVS) have been characterized as being “awake”; mainly due to the fact that their eyes are open (Blackwell, 2013).  However, they were thought to be incapable of responding to any form of stimuli or possessing any form of thinking capabilities (Blackwell, 2013). It has been noted that some PVS patients may emerge to higher levels of consciousness, however many others remain unchanged for years in a vegetative state (Blackwell, 2013).  Thus, Dr. Owen’s findings help to support the idea that if these patients are indeed conscious, then PVS patients in these should have authority to make their own decisions regarding the removal of life support.

            Similar to other medical interventions and techniques, these recent findings have raised several ethical questions. One question relates to Owen’s technique of testing consciousness itself. Dr. Owen’s findings have been contested on the findings that these individuals are not conscious and that the findings should have no bearing on end-of-life decisions. I will not deny that the technique does require improvement, however, I feel that it does offer some insight into initial stages of testing the levels of consciousness in PVS patients. Generally, it is agreed that this technique relays an opportunity for these patients to provide important information pertaining to things such as pain and discomfort (Cyranoski, 2012).

What has generally not been agreed upon is the idea surrounding whether these patients should be able to choose death rather than remaining in a PVS. John Stuart Mill’s principle of liberty helps to rebut the presumption that if found to be conscious, patients should be able to come to a decision that reflects their own values and beliefs. Mill’s principle also promotes the notion that “a person is sovereign over his or her own body and mind” (Glannon, 2005). If this technology proves to be effective, it would allow medical practitioners and the patient’s family to explore the individuals’ thoughts to make an informed decision. Individuals could therefore decide on treatment plans that reflect their own values, rather than decisions that solely reflect the interests of practitioners and their families. Critics have also expressed concern in regards to the premise of answering yes or no questions as reflecting the idea that a patient therefore has some level of consciousness and therefore does not completely understand their mental state or cognitive abilities (Cyranoski, 2012).  However, Owen’s has stated that the task is no easy feat, as it requires patients to focus on the task for 30 seconds and then rest for another 30 seconds (Cyranoski, 2012). The treatment has been proven to work in all patients, with only one in five responding to the technique. However, we should not limit this treatment to help in end-of-life decision making for the small proportion of PVS patients when it may lead to a better understanding of consciousness and the condition, which will benefit future PVS patients and society. Individual freedom should only be restricted if the treatment proves futile or would harm others. Other implications revolve around the idea that even if patients are able to make a full recovery (seen in some patients with serious brain injuries), many patients remain incompetent and unable to care for themselves (Blackwell, 2013).

Critical Discussion:

Liberalism is an ethical theory that focuses on “the rights, interests, and reasoning of individual moral agents” (Glannon, 2005). The theory states that individuals should have the right to a good life, provided it does not have any interference on other individuals to do the same (Glannon, 2005). In the case of Dr. Owens’ fMRI technique, I believe that this would not impact the ability of others to have a good life, considering these individuals may be fully conscious. The first distinction liberalism states is that there should not be one conception of an overarching moral value that all individuals should live and abide by (Glannon, 2005). The second distinction points to the idea that “the interests of individuals should not be sacrificed for the interests of the larger society” (Glannon, 2005).

Taking patients off life support would impede on the individuals ability to enjoy life. One interpretation of the neuroimaging evidence surrounds the idea that “patients who are able to obey instructions and demonstrate patterns of activation of functional imaging may be completely aware of their surroundings” (Wilkinson, Kahane, Horne, & Savulescu, 2009). This procedure has led to reconsideration of the patient’s prognosis, since doctors have a clearer understanding of the patient’s needs and mental functioning. Consciousness may also become an important factor in the treatment of patients who show signs of consciousness. This consciousness may indicate that the patients in PVS are aware of their surroundings including family and friends, and therefore might be able to take pleasure from those things (Wilkinson, Kahane, Horne, & Savulescu, 2009).  This idea helps to reinforce the second distinction of liberalism that was previously mentioned. If these patients are conscious and aware of their surroundings, it helps support the idea that they can still experience pleasure. Morally, it would be wrong to assume that since an individual is not awake and moving around that their life is not as “good” as others. I agree with the argument Glannon (2005) sets out in stating that it is wrong to set out a conception of what constitutes a good life for everyone to adopt. All individuals have the right to embrace their own values and beliefs and if the advancement technology supports the notion that the patients are indeed conscious, then they are entitled to make their own decisions.

The removal of life-sustaining interventions has been noted to go as far as violating the ethical principle patient autonomy. This deontological principle is concerned with things such as “a patient’s rights, dignity, and values, as well as the doctor’s corresponding duty to respect them” (Glannon, 2005). A counter argument to this ethical principle may include the notion of informed consent and how patients are not entitled to all treatments they request. Informed consent has been noted to be a practical application of respect for personal autonomy (Glannon, 2005). Glannon (2005) points out that in most cases doctors are required to provide treatment, and patients have the right to access it if it entails therapeutic benefit. Some may say that keeping patients on life support has no therapeutic benefits since the PVS patient will most likely not return to normal functioning. Families of PVS patients may argue that the issue here is more about the quality of life, and that keeping him on life support may undermine his dignity. However, I believe that the real issue here is the sanctity of life. Prior to this technique it was thought these patients were unaware of their surroundings, the fact that Owen’s findings support the signs of consciousness indicates that the person “still exists”. Since these patients were taught to answer questions, it could be said that future technological advancements may help them to lead a more meaningful life with the ability to communicate their thoughts to the outside world and allow them to further expand on their wishes and beliefs in regards to their future treatment. Glannon (2005) points out that physicians should not coerce patients or family into withdrawing treatment. If found conscious, patients should be allowed to understand their own condition, the benefits and costs of continued interventions in order to formulate their own opinions reflecting their own values and beliefs.
PVS patients should have the right to access those treatments if they choose to do so since it does involve their interests and well-being. Many people have thought for years that these patients had no sense of consciousness or awareness, with this recent advancement it offers some indication that the medical community can work to improve the lives of these patients (Panksepp, Fuchs, Garcia, & Lisiak,, 2007). Future technological advancements seek to understand and allow patients to communicate their thoughts, which may allow them to lead meaningful lives. Other findings have also found that some patients are able to retain consciousness after their brain injuries, noting that patients studied earlier, who showed a higher level of associative cortices, were more likely to improve clinically (Wilkinson, Kahane, Horne, & Savulescu, 2009).  If the preliminary findings are true, it would be immoral for doctors and the patient’s families to remove patients from life support, since neuroimaging might be able to detect patients who are more likely to experience full recoveries. Removing life support of a PVS patient is inhumane in the sense that because they are seen as being physically responsive to outside stimuli they are not leading a “good life”.
It is important to note that we do not want autonomy to be the sole focus of medical treatment; we want physicians to be compassionate in helping to make decisions. PVS patients should have the opportunity to be able to communicate to the outside world and be able to decide whether they want to continue treatment or end it. However, sometimes physicians are stuck in an ethical dilemma revolving issues surrounding justification of allocating scarce medical resources in allowing patients to access this technique. One objection to the idea of liberal ideals includes the burden that these patients place on the health care system in terms of both access to treatment and the cost of life support. Based on the idea PVS patients are not making contributions to society, society may see these patients as being a burden to support. However, just because they are not “contributing members” that does not mean PVS patients should not have the opportunity to choose their own “fate”. If they have some form of conscious awareness then they should be entitled to the same rights as everyone else. It is not justifiable to remove a patients feeding tube if they are found to be aware of their surroundings, just because they are not responsive to outside stimuli.

There is no solid definition of what constitutes as a life, some argue that it involves being able to sustain your own biological functions, others see it as having the ability to reason and understand things such as questions. To support my argument, I look to the Charter of Rights and Freedoms, which helps to formalize basic ethical and moral principles that are practiced in Canadian society. Section 7 helps to encompass principle such as autonomy, and states “everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice” (Canadian Charter of Rights and Freedoms, 1982). Since it is so broadly worded I feel that this supports and protects the ability for the patient to make his or her own decision regarding their right to life. In this context, liberty would particularly support the notion that patients should have the right to make their own decisions in regards to sustaining life support. By using this as a protection measure we as a society allow people to realize their full potential. The Charter helps to support this notion of allowing people to uniquely define their own definitions of what is good and formulate their own context of autonomous choice, including the ability to define happiness and values. Society’s role is to embrace the diversity of the individual, regardless of things such as origin or their physical or mental status. One cannot deny the issue here is that this right occurs in exchange with the individual acknowledging responsibility for their own fortunes and that of the community (Glannon, 2005). Positivist liberals may argue that having an absolute right to do something is useless if the individual does not have the capacity to do so. However, I think that prior to the discovery of Owen’s technique, this would have been a valid argument but,I would now argue that the initial findings suggest that some PVS patients’ do have some form of mental consciousness to support their ability to at least contribute on some level their own decision.

The fMRI technique is not effective for all PVS patients; current research has shown that roughly only one in five patients have been able to communicate with the outside world (CBC, 2013). It is important to note that the technique itself uses limited resources, one being the fMRI machine itself. However, all patients and their families should at least have the opportunity to access this limited technology to help them in the decision making process, particularly due to their vulnerable state. This begs the question of where do we draw the line of allocating these resources for families and patients to communicate with the outside world. It is justifiable as seen in cases from Alberta that life support should be terminated if this technique unanimously proves that the patient is without any form of awareness or hope of being able to recover and other treatments have been proved futile (Blais, 2012). I would argue that PVS patients’ that have undergone the fMRI scan unsuccessfully could morally be taken off life support, since future treatment is futile and not beneficial. However, in the case of successful patients, they should have the right to express their own individual decision, since they do have the opportunity to have their values and beliefs reflected in their choice.

         Overall, initial findings support the notion that PVS patients are indeed somewhat conscious and aware of their surroundings on some level. Dr. Owen’s findings should therefore have an impact on end-of-life decisions made by both the family and the patient themselves. Following the principles of liberalism “the good life is necessarily a freely chosen one in which a person develops unique capacities as part of a plan of life” (Stanford, 2010.). Living in a society where individual autonomy is promoted, we should take effort to protect vulnerable populations such as those in PVS in upholding the basic principles of justice such as the right to life and liberty. Although initial findings have been supportive of the idea of PVS patients being somewhat conscious, more conclusive research and technology is needed, particularly in regards to decoding the patients’ thoughts and needs before this technology can fully be integrated into the context of end of life decision-making processes. Solely based on the current information and research that is provided, my position stands in saying that this treatment should play a pivotal role in allowing PVS patients and their families to make end-of-life decisions.



Blackwell, T. (2012, November 18). Trapped in a motionless body? Scientific advances raise new questions about the ‘vegetative’ state. National Post. Retrieved March 5, 2013, from

Blais, T. (2012, September 14). Decision stayed to take girl, 2, off life-support. Owen Sound Sun Times. Retrieved March 15, 2013, from

News. (2012, September 13). Canadian in ‘vegetative state’ communicates to scientists. Retrieved March 15, 2013, from

Canadian Charter of Rights and Freedoms, s 2, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11.

Cyranoski, D. (2012, June 13). Neuroscience: The mind reader. Nature Publishing Group. Retrieved March 15, 2013, from

Glannon, W. (2005). Biomedical ethics. New York: Oxford University Press.

Liberalism (Stanford encyclopedia of philosophy). (2010, September 16). Stanford Encyclopedia of Philosophy. Retrieved March 2, 2013, from

Mole, B. M. (2012, November 14). An unconscious man talks. The Scientist Magazine. Retrieved March 15, 2013, from–Unconscious–Man-Talks/

Panksepp, J., Fuchs, T., Garcia, V. A., & Lisiak, A. (2007). Does any aspect of mind survive brain damage that typically leads to a persistent vegetative state? Ethical considerations. Philosophy, Ethics, and Humanities in Medicine, 2(32), 1-11. Retrieved March 10, 2013, from

Wilkinson, D. J., Kahane, G., Horne, M., & Savulescu, J. (2009). Functional neuroimaging and withdrawal of life sustaining treatment from vegetative patients. Journal of Medical Ethics, 35, 508-511. Retrieved February 27, 2013, from

The Effect that Wealth has on Population Health

The relationship between health and wealth has become one of the most examined areas in the field of social determinants of health. The material studied in class has shown that social determinants of health such as income and workplace conditions have a greater impact on ones health than lifestyle factors. It has become clear to me that the policies that have been implemented by modern policy makers has impacted the way resources such as wealth have been distributed thereby causing equity to increase within countries such as the U.S and Canada and impacting the health on the lower end of the social ladder.

The article ‘Why Billionaires are Bad For Your Health’ opened my eyes to the way their income and power has influences policy makers. McQuaig and Brooks (2010) drew upon the notion of how height is a useful measure of citizens well being to develop and thrive under the nations socio-economic conditions (p. 150). It also indicates how well society is taking care of it’s young due to the fact that height is set in the adolescent years. Ironically Americans used to be the tallest people in the world but due to the introduction of neo-liberal policies and a lack of universal health care that is not the case anymore. In comparison Scandinavian people are now the tallest people due to having a much more equal society. Therefore, the social gradient pattern is society can be correlated with the height of its citizens (McQuaig and Brooks, 2010).

Neo- liberal policies have given a small portion of society more power and wealth while decreasing the amount of power average laborers have in fighting for equitable workers rights (Martinez & Garcia, n.d). The theory also encourages government cutting to public social services such as education and health care. The policy makers who implement these policies likely do not feel the effects of their policies as evident in the movie ‘Life Under Mike”. The film investigated the effects that Premier Mike Harris’s drastic social assistance cuts had on low-income citizens.  The cuts led to an increase in homelessness and poverty across Ontario thereby showing the importance of having a strong social safety net for people to fall back if needed to make ends meet (Guerrilla Films Inc., 2000). The movie gave one important parallel with a food server showing the elaborate and expensive food that was available for the politicians to eat in comparison to the people on the lower end of the social ladder barely being able to afford basic needs.
Overall, as documented in the article “Sick of Poverty” the socio-economic status gradient (SES) has been studied in many cities and nations to document diseases and cancers (Sapolsky, 2005). Sapolsky (2005) notes that people with low socioeconomic status have a increased morbidity rates as well as shorter life spans than their wealthy counterparts. However, it has been noted that the difference is not due to “lifestyle factors” but rather to psychosocial stress that people in the bottom rung of the social ladder face. Sapolsky (2005) argues that psychosocial stressors are not distributed evenly among social classes. The poor have more physical stressors (manual labour, hunger, sleep deprivations) as well as psychological stressors (lack of control at work) and lack of social support (Sapolsky, 2005). All these stressors place a heavy toll on ones body and constantly being stressed can lead to a worsening of ones cardiovascular health as Sapolsky (2005) points out.

The ramifications of being in the lower end of the social ladder has drastic consequences on ones health by increasing incidences such as disease and shortening of ones life expectancy. Thus, my understanding is that policy makers and corporations need to help close the gap between the rich and poor and create better workplace conditions in order to make health more equitable between all the social classes.



McQuaig, L. & Brooks, N. (2010). Why billionaires are bad for your health. In The Trouble with Billionaires. Toronto: Viking Canada, ISBN 9780670064199, pp 149 of 272.

Motluk, J. E. (Director). (2000). Life under Mike [Documentary]. Canada: Guerrilla Films Inc.

Martinez, E., & Garcia, A. (n.d.). What is neo-liberalism?. CorpWatch : Index. Retrieved October 14, 2011, from

Sapolsky, R. (2005, December). Sick of poverty. Scientific American, n.a, 94

Atikokan, Ontario: A Rural Community Health Assessment

History of Atikokan, Ontario:

Atikokan, Ontario, is located in Northwestern Ontario, approximately 200km west of Thunder Bay (, 2012). The town is often referred to as the canoeing capital of Canada. It is also known for being a safe, and healthy community with a diverse economy, and strong ties to the wilderness. Atikokan was originally established as a rail stop for the Canadian Northern Railway in 1882. The name “Atikokan” is thought to have been derived from the Ojibwa-Chippewa word for “caribou bones” (, 2012) as the town site was at one time the wintering grounds for herds of caribou- where many of them ended up passing away on the lands. The late 1600’s saw the introduction of many Europeans tourists travelling through the area, including Jacques de Noyon, one of the first European settlers to do so. The 1730’s brought along the opening of an interior fur trade and by the 1740’s, French fur traders in the area were well established to compete with the Hudson’s Bay Company (the largest fur trader in North America) (, 2012).  However, by 1821 declining fur catches caused the company and Hudson’s Bay to merge together. In 1883, sawmills were established in the region, with many of the materials providing timber for the development of the mine sites contributing to the towns economic growth.  By 1899, the east-west section of the Canadian National Railway (formerly known as the Canadian Northern Railway) was built through Atikokan as demands for transportation services increased after a number of mines were discovered. Upon hearing of the construction of the railway, many non-aboriginal settlers began to flock towards the area. Along with the settlers, came the development of much of the towns’ infrastructure, including construction of a hotel, general store, and post office (, 2012). In 1940, a small hospital was erected at the Steep Rock Iron Mines Ltd. site approximately 14.5km from Atikokan (, 2012).  Prior to this, hospital and medical services were limited to a small Red Cross outpost that operated from the inside of a train care.

Definition of a Rural Community:

            Essentially, Atikokan is a small town located in the Rainy River District in Northwestern Ontario. As defined in class, there are three things that help when defining a rural community. These factors include the rural area being located outside a population centre, having a population of a least 1,000 people, and having a population density of 400 persons or more per square kilometer. Therefore, one of the reasons it is considered a rural area is due to the fact that it is located outside of a major population centre; the closest being Thunder Bay, Ontario. There would be a very small chance that workers would commute between Atikokan and Thunder Bay, as the travel time would amount to 2.5 hours each way. Thus, the relationship would be considered as being weak when looking at the metropolitan influenced zone (MIZ). Secondly, the population density of Atikokan is 8.7/km2   as per the 2011 National Household Survey (Statistics Canada, 2013). As a result, Atikokan has a population density well below the 400 persons per square kilometer, based on its current census population count. Thirdly, Atikokan has a population of 2,787 people, which is considered a small population centre (Statistics Canada, 2013). In my opinion, I would say that the two strongest factors that would make Atikokan a rural community, is its geographic location and the size of its population.

SWOT Analysis:


o   Strong ties to the wilderness, especially in relation to being an outdoor tourist recreation destination

o   Strong health care sector- ambulance, chiropractic, counseling, dental, hospitals/clinics, optometrist, 41-bed hospital, emergency care, and youth services

o   Diverse economy- based on forestry, government services, retail services, thermal generating station


o   Shrinking population

o   High rates of youth obesity and overweight children

o   High unemployment rate- much of the employment is seasonal


o   Resolute Forest Products to build a new sawmill in the Atikokan area

o   Atikokan General Hospital accepted a grant of $8,487 from the Northern Cancer Fund of the Thunder Bay Regional Health Sciences Foundation

o   Transportation into and out of Atikokan, particularly taking advantage of the Trans Canada Highway


o   Not enough Health care funding from the province/ state of current contract negotiations between province and health care workers

o   Collective agreement representing some health care workers in Atikokan expire in late 2014

o   Downturn in the forestry industry


Similar to many other northern communities rates of obesity are high in Atikokan. A study conducted by the Northwestern Health Unit, located in Atikokan, highlighted two areas as being inadequate, which were physical activity and nutrition (Northwestern Health Unit, 2014). The study found only 0.74 per cent of students claimed to get the recommended daily food servings as set out in the Canada Food Guide (NHU, 2014).  This is quite alarming, considering healthy eating, particularly of fruits and vegetables, is considered one of the key measures in the prevention of chronic disease. Therefore, the health unit in Atikokan, has plans to continue to collect data through to 2016, in hopes that the unit will be able to see whether its target programs to help combat this issue are helping teens make healthier choices (NHU, 2014). The health unit has specific programs such as the creation of apps and more targeted information for youth to use on their website highlighting healthy eating basics, and drug and alcohol use (NHU, 2014). Furthermore, Atikokan has acknowledged the problem of youth obesity and in conjunction with the Heart & Stroke Foundation formed a program called ‘Atikokan Youth Initiatives- Healthy Choices’, which seeks to bring together community partners to plan activities that will bring together all members of the community and get more youth involved in community programming (HSFSpark, n.d.). Together this program seeks to spark discussion, design solutions, and plan activities that aim to see more youth involved in active community programs. In my opinion, this program would be highly beneficial, as it would allow the community to take initiative in addressing and fixing some of the towns health problems. Since it is a subdivision of the Heart and Stroke Foundation, the Atikokan Youth Initiative program allows the community to have a stronger sense of investment and efficacy, due to the community being able to define the problem and come up with solutions themselves.

Another weakness within the town has been the noted decrease in population. As noted in the 2011 census, Atikokan has experienced a 15.4% decrease in the number of residents residing in the town. As of 2011, 2787 residents lived in the town, compared to 3293 in 2006 (Statistics Canada, 2013). While the population decreased, the median age in the town saw an increase from 43.0 years to 48.5 years.  As the town continues to age, it would be important to have transportation options for those who do not own a car or are not within relative distance to the destination they are aiming to get to. Fortunately for the residents of Atikokan, various forms of transportation offer their services. Although Atikokan does have its own General Hospital, similar to many other rural communities, Atikokan has experienced a decreased amount of health care funding over the years and thereby limiting the amount of services the local general hospital could offer.  Therefore, for patients to have access to more comprehensive and complex health services, they would have to go to larger centre, such as Thunder Bay, to receive care. Luckily, coaches are relatively frequent and cheap for residents to access. Although many complex and expensive treatments are often located in more populated centers, the town has been able to seize an opportunity through the Northern Cancer Fund of the Thunder Bay Regional health Sciences Foundation to fund the purchase of a new chemotherapy treatment chair and a fridge for maintaining and storing the hospitals stock of chemotherapy medications as of October 21, 2014 (Progress, 2014). This is a huge event for a small town such as Atikokan, and I would think many residents would be able to benefit from this grant, as cancer touches the lives of many, and I am sure many residents would be grateful having the chance to be treated close to home.

It has been noted that there are two factors that heavily contribute to the elevated unemployment rates (approximately 8.4%) in the town in comparison to the Ontario (approximately 7%) and Canada unemployment rates (Statistics Canada, 2013). The first factor relates to Atikokan’s reliance on natural resources, which leads to the creation of a number of seasonal opportunities. For example, similar to many other towns across Northern Ontario, many tourist camps close during the winter. Secondly, there is also a lack of marketable skills and knowledge demonstrated by a number of Atikokanites (, n.d.).   Many of the positions in the town that require specific expertise are often filled by people who come from out of town who have the required knowledge and trades. However, Atikokan has a very diverse economy and there are other means for residents to seek employment and capitalize on the towns’ strengths, such as outdoor recreation and natural resources. The once-struggling forestry sector in Northwestern Ontario, and specifically Atikokan, has also received positive news as a new sawmill and economic partnership is to be completed by late 2014 by Resolute Forest Products. Fortunately for the town, the mill will employ about 90 people and add additional indirect jobs related to hauling lumber and residual chips (CBC News, 2013).  Furthermore, the introduction of this partnership will aid in providing economic stability for the towns future, particularly with the company agreeing to supply the Ontario Power Generation plant, a significant employer in the community, with wood pellets for the next 10 years.

Works Cited

Progress. (2014, November 21). Northern cancer fund backs equipment upgrade at AGH. Atikokan Progress and Printing RSS. Retrieved October 20, 2014, from

Atikokan youth initiatives – healthy choices | Spark. (n.d.). Heart and Stroke- Spark. Retrieved October 28, 2014, from

CBCNews. (2013, January 31). Resolute Forest Products to build $50M Atikokan sawmill. CBCnews. Retrieved October 28, 2014, from

CBCNews. (2014, September 30). Unifor rallies in Thunder Bay over health care, contract issues. CBCnews. Retrieved October 28, 2014, from

Community history. (n.d.). Home. Retrieved October 28, 2014, from

Compass survey results 2014. (n.d.). Northwestern Health Unit. Retrieved October 15, 2014, from

Experience Atikokan. (n.d.). Experience Atikokan : Atikokan Economic Development Corporation. Retrieved October 28, 2014, from

NHS profile- Atikokan, 2011. (2013, September 11). Statistics Canada. Retrieved

October 25, 2014, from








The Not so Hidden Impact of Mental Illness

Mental illness. The neglected component of our health care system, largely due to its “invisible” nature. The truth is, mental illness exists, and it has a wide effect on our economy and healthcare system. These “hidden” illnesses leach into our schools, workplaces, homes, and our emergency departments.  In Ontario, mental illness will affect 1 in 5 individuals during their lifetime with few who will receive appropriate care. For those that do seek treatment, many find a mental health system that is over-burdened, underfunded, and difficult to navigate.  Mental health is considered the poor second cousin to the primary health care system, despite its impact on the Ontarian economy being larger than all cancers combined with an estimated loss of $39 billion a year and mental illness often affecting those in their prime work years.[1]

So what’s the problem?

Psychiatric medications have become the most widely used tool for treating many mental illnesses, even when there is strong evidence pointing to anti-depressants having a limited effect in treating those suffering from less severe forms of depression.[2][3]   More surprisingly, there is an abundance of evidence that point to psychotherapy being just as effective or even better than many of the medications prescribed by physicians. That is not to say that medications shouldn’t be offered at all, in fact, many illnesses may best be treated using a combination of both psychiatric medications and psychotherapy. The problem now is that prescribing medications has become the default solution, yet guidelines and evidence-based practice show that these treatments do not work well on their own.  Another problem is coverage, as those seeking help face long wait times, lapses between getting an assessment and receiving support, and a lack of age appropriate services close to home[4]. The mental health care system in Ontario needs an overhaul in regards to supporting those suffering from mental illness. Therefore, three solutions may be able to get our system to where it needs to be.  Changing the system would be no easy feat, incremental changes would be made over time to achieve a long-term goal of a more comprehensive mental health system.

Three solutions to consider:

The first solution involves lobbing our province to cover at least $1,000 per person regardless of age. An idea similar to an initiative proposed by Senator Michael Kirby who proposed $1,000 for every child in Ontario, which would cover approximately 8 therapy sessions.[5] In essence, if every eligible child took up the offer it would cost the system $500 million. Regardless of how much it would cost to provide every Ontarian access to this fund, it would be a small price to pay in comparison to the $39 billion lost annually due to the economic loss tied to mental health. A second solution relates to the accessibility of our mental health services, particularly those that can provide psychotherapy, such as Cognitive Behavioural Therapy (CBT). Currently, psychiatrists are the only provider whos are covered OHIP. However, with growing wait times for patients seeking help, a more comprehensive and expanded model should include Psychologists and social workers. Neither of which are covered by our supposedly “comprehensive” health care system.  These professionals could work with patients experiencing less serve forms of mental illness, and allow psychiatrists (the only medication prescribing body) to work with more severely impacted patients. Lastly, our system appears to underuse and underfund the treatment of CBT[6], a guideline-endorsed, evidence-based treatment, representing a serious gap in treating mental health illnesses. Cost-effectiveness data has consistently shown that where issues such as quality of life, quality of care, and cost to society were measured in comparisons to many other treatments, CBT was the most cost-effective choice with both short-and long-term advantages.  However, it should be noted that much of the evidence out there is internationally-based, and research is needed to fully evaluate the economic impacts of CBT in Canada[7]. These three solutions would need to work in conjunction with one another to achieve the common goal of making a more comprehensive mental health care system.

Successful implementation of these three recommendations would create an ideal system involving non-physicians delivering care to the patient to help manage patient care. The solution proposed aims to ensure that everyone who needs access to mental health care services is able to access it in a reasonable time and receive the right support. Our health care system should be placing mental health on an equal footing with primary health care by following best-practice guidelines, a practice similar to what is seen in the UK and Australia.[8] As the World Health Organization states:  health is “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”.  So why are we allowing our system to leave behind those suffering from mental illness?