The sad state of Canada’s health care system: A rant

This was inspired by a reaction to a post at the Psychlinks Forum about health care and mental health. At moments like this, I feel like Albert Finney screaming “I’m mad as hell and I’m not going to take it any more” out the window.

“Why are doctors in Canada always in such a rush? Do we need more doctors? More nurses?”

Yes. We need more of both. You can thank 12 years of abject mismanagement of our nation by the Jean Chretien and Paul Martin Liberals for that. They cut back on health care expenditures, downloaded the costs to the provinces, and the provinces slashed budgets, closed hospitals, fired nurses, and drove doctors out of the country. Here in Ontario, we had the Mike Harris government laying off nurses and five years later trying to bribe them to come back from the US or other provinces when they “suddenly” discovered we had a desperate shortage. Doctors also left in droves, either out of the province or out of the country or out of the profession, and now the ones remaining are so overworked they’re beginning to physically collapse under the strain.

This isn’t a problem with the medical profession. This is absolutely and entirely a situation created by short-sighted opportunistic politicians whose sole interest was in window-dressing (“look how much money we’ve been able to save!”) and getting their sorry asses re-elected. Now in Ontario we can look forward to mass retirements of our existing nurses over the next five years or so – the governments are very aware this is coming but is anyone actually planning ahead and trying to do something to fill the future shortages? Of course not. That would require vision and a modicum of intelligence, something almost universally lacking in our politicians.

“When I do go to the doctor I wait and wait and then I am lucky if the doctor will talk with me for two minutes. Recently I was at a specialist’s office and there were actually signs that said not to mention more than one problem per visit.”

I also have seen those signs. Again, this is a function of unacceptable overwork of our existing doctors and an OHIP fee schedule that doesn’t even begin to keep pace with inflation. (Psychologists don’t bill OHIP, by the way, so this isn’t a personal axe I’m grinding.) We hear about physicians making enormous salaries but these are not our family physicians or GPs – those are specialists, surgeons, etc. The family doctor is a disappearing breed on the verge of extinction unless somebody somewhere acts to reduce the appalling stress – emotionally, phsyically, and financially – placed on their shoulders by our unbelievably stupid and toally self-serving politicians. Increasingly, family physicians and new medical students are going into other less stressful and/or more financially rewarding specialties – and the line-ups in medical clinics, urgent care clinics, or emergency waiting rooms continue to grow.

Canada health system, family doctors, family physicians, general practitioners, GPs, health care, Ontario, politicians, politics of health care

Crazy: A Father’s Search Through America’s Mental Health Madness

Pete Earley is an award-winning investigative reporter whose previous books have been about spies, prisons, and the witness protection program. To some degree, this background may have prepared him to write Crazy: A Father’s Search Through America’s Mental Health Madness, released April 20, 2004, but nothing ever prepares a person for the shock of mental illness.

“I had no idea,” Earley begins.

Diagnosed with bipolar disorder, Earley’s son, Mike, recently out of college, broke into a stranger’s house to take a bubble bath and vandalized the premises. Frustration with an inability to get Mike into treatment – including his son’s periodic refusals to take medication – as well as the legal procedures surrounding mental illness, caused Earley to use his journalism skills to explore the rapid cycling that exists today between hospitals, courthouses, and jails.

The result is a unique book -one of the best -that presents “criminalization of the mentally ill” not as an abstract concept, but as one drawn in vivid, human dimensions, accompanied by objective and pained reflection. The book alternates between his son’s story in Northern Virginia and Miami-Dade County, where he was able to gain unprecedented access to one of the nation’s largest jails and its psychiatric ward, where guards freely admit to beating patients because, said one, “They’re criminals first, mentally ill second.”

Earley follows the lives of individual consumers, and talks with them and their families, both inside and outside the jail.

At one point, he interviews the parents of Robbie Sherman, a former Boy Scout, whom police had shot and killed during a manic episode. Robbie’s mother showed him a photograph of her son in a 5×7 frame. “I loved my son. Why did this have to happen,” she cried. “Why did they have to shoot him? Why wouldn’t anyone listen to me when I told them he was sick?”

“I looked at the photograph of Robbie in the gold frame,” Earley writes. “The teenager smiling at me could have been anyone’s son. He could have been Mike.” Indeed, that is one of two key points Earley hopes to make with the book to educate the public: that mental illness can and does strike anyone.

Earley’s other point is that jails have not only become our “new asylums”, but in fact are becoming “institutionalized” as part of a “continuum of care”. No metaphor seems terrible enough to convey what that means. Consumers who run afoul of the law may face an endless maze of cruel choices or dead ends. They may be sent to state or county psychiatric facilities to be “made competent”, with minimal treatment, to stand trial. By the time they are shuttled back to jail and appear in court, they may have decompensated to a state of incompetence again and therefore be sent back for more “treatment”. Treatment in jail may occur in name only. From both hospitals and jails, there often is little, if any, realistic discharge planning, and the community services which discharged consumers need too often are inadequate or non-existent.

Other obstacles to recovery exist, even when a consumer is relatively lucky.

In the case of Earley’s son, the owner of the house he broke into initially insisted that Mike plead guilty to a felony – which would have ruined any chance he might have had for getting a professional license to pursue his career. Even after being convicted only of a misdemeanor, Mike lost a job because his employer discovered that he was on probation. Never mind the fact that he had disclosed the conviction on his job application.

A principal focus in Earley’s discussion is the tension between the consumer’s right to treatment, the right to refuse treatment, and the frustration of family members or mental health professionals who want to insist on treatment.

Introducing Earley to Freddie Gilbert, one of the consumers whose cases he decides to follow, a doctor observes: “He’s been in this jail before and we know he responds well to medication. The last time he was here, we got him into treatment and he thanked us later. But now the law is forcing us to stand back and do nothing while he continues to get worse. If this man’s arm was fractured, we’d be accused of negligence and cruelty if we didn’t help him. But because he’s mentally ill, we’re not supposed to interfere until he asks.”

As a father, Earley’s sentiments on requiring treatment are clear, but he pursues the issue objectively in posing questions and establishing historical perspective that can inform all points of view. He also is supported by his son’s insistence that he write the book and use his real name, “if it would help other people understand”, despite their differences over medication.

Earley also investigates the fate of Deidra Sanbourne, whose class action lawsuit against the State of Florida caused her to be released from a state hospital after 20 years, and uncovers “an ugly truth”. After being warehoused for 20 years in a state hospital, Sanbourne ended up warehoused in a squalid boarding home, where her condition only worsened, until her death. It is that truth to which the book speaks.

“In Crazy, Earley provides a remarkable and fresh look at the US mental health system. He does so in a balanced, honest, self-reflective, and informed way. Crazy offers a unique and sensitive perspective on questions America is reluctant to address. It should be required reading for psychiatry residents, forensic fellows, and any psychiatrist interested in public sector psychiatry …

Placing his argument in historical context, he describes deinstitutionalization as a well-intentioned but poorly reasoned outgrowth of the antipsychiatry movement, which began in the 1960s … Earley describes deinstitutionalization as an “unplanned social disaster,” which … has created an environment as abusive to the mentally ill as the dreaded state hospitals of the past … Earley poignantly reflects on a society that accepts homelessness as a civil right …”
Journal of the American Medical Association (JAMA), January 2, 2007

Read the first chapter of Crazy at

bipolar disorder, criminalization of mental illness, criminalization of the mentally ill, health care, manic depression, mental health, mental illness