For those of you who prefer to read about it, see below…
Being a patient in the Canadian mental health system right now can be frustrating.
It begins with the belief that we are always supposed to be happy, apparently pretty much all the time. When we ask someone how they are, if they answer “Ok”, we often respond with a concerned “What’s WRONG? Why just ok?”. Even when really bad things happen to people, we have a tendency in our culture to say things like “look at the bright side”. The DEFICIT model of mental health plays a significant role in perpetuating and reinforcing these beliefs.
In short, if someone is struggling with their mental health, if they are anxious or sad about something, we tell them there is something WRONG with them.
Understandably, this actually increases STIGMA and makes it less likely people will seek help early, which we know is associated with more complications and worse outcomes. It also often makes their symptoms worse, because it promotes isolation and feeling like they are doing something wrong when they aren’t happy, so they withdraw from their social groups, after all, we don’t want to be a “burden”.
I see people daily who tell me there is something wrong with them because they are sad or anxious, even when they are on the verge of being homeless, are in an abusive relationship, are being bullied or unappreciated at work, were just widowed or have a sick child.
The DEFICIT model does not really allow for anyone to be appropriately sad or mad about anything. This is quite shocking when you pair it with all the research that shows that the Social Determinants of Health, like having adequate housing, a supportive social group and having access to healthy foods can make such a difference to physical and emotional health, yet there is little room to acknowledge this in the existing DEFICIT model.
When people eventually do seek help, we tell them they need to go see an EXPERT, an external person, like a Psychiatrist, Psychologist or other mental health professional, who holds all the knowledge and control about how they do from then on.
Our system promotes a reliance on the mental health professional for all the answers, which creates a feeling of helplessness and passivity in the client/ patient (the technical term is that it creates an external locus of control). We know from research that feeling like we don’t really control what happens in our own care is associated with poor coping and worse physical and mental health outcomes. It also decreases the patient’s sense of responsibility and engagement in their own care.
Now layer onto this that the only way to get access to these experts, is by going to a hospital or clinic, so we have a CENTRALIZED Model.
In short, we are relying on a very limited and expensive resource. The only way to increase these resources, is to train and pay more experts and to create more hospitals or clinics. This is a very expensive undertaking for any one system to have to shoulder.
Consequently, we end up having long wait times, which forces the system to be CRISIS DRIVEN, and it becomes reactive, instead of proactive. This happens despite all of the evidence supporting the long term cost savings, as well as the mental and physical benefits of primary and secondary prevention strategies, and we end up treating people WHEN they get ill, so DURING their illness and at best for a period after for maintenance.
As in most crisis driven systems, there are frequent changes as it strives to adapt to increasing demands. As a result, there are unclear expectations, both for patients and care givers working in the system, as clarity about goals and roles in treatment shift. Also not surprisingly, communication often breaks down in crisis, so there are often delays in communication about available resources.
The combination of these factors leads to decreased quality of care available, as the time allocated for optimal case management is reduced, contributing to decreased job satisfaction and burnout in mental health workers who WANT to provide good care. Burnout increases clinician turnover, which then leads to poor continuity of care. This situation is made worse by the pressure for rapid discharge of patients in order to manage wait lists, and them often being discharged to inadequate community resources or support.
As you might expect, insufficient resources and poor continuity of care leads to worse outcomes, high levels of relapse and an even greater need for more experts, hospitals and clinics.
So when we look at the big picture, it becomes clear why we have a mental health crisis in Canada at the moment. We have caring, committed clinicians and staff who want to make a difference, but get stuck in a system that struggles to effect long term meaningful change.
I believe the solution is not in increasing the number of experts and clinics, but rather through enhancing our current model by creating a new branch of Psychiatry that is focused on studying the neurobiology of wellness and prevention, and disseminating this information to promote capacity in front line workers, who are the first contact for people with mental health issues. This would be the role of Positive Psychiatry.
Unlike the DEFICIT, EXPERT & CENTRALIZED model of the current system, Positive Psychiatry is a Resilience & Wellness based, Capacity building & Decentralized model of mental health.
It is aimed at understanding and promoting physical and mental health BEFORE, DURING and AFTER illness, through the study and application of Psychosocial and behavioral interventions founded in neurobiology in order to promote resilience.
The foundation of Resilience lies in the belief that we are inherently well and we experience mental and physical symptoms as a form of negative feedback from our bodies telling us that something needs to be addressed (see 5 min animated Strong & Healthy Self video).
Promoting a resilience model would reduce stigma and encourage patients and clinicians to focus on addressing the social determinants of health. It would also increase patient accountability and foster a sense of curiosity and empowerment in the face of symptoms, promoting an internal locus of control, as they are encouraged to reflect on what aspects of their lives may be off balance.
Similar to Positive Psychology, an important part of our role in Positive Psychiatry would be to study wellness. After all, if we want to know more about disease, we need to study disease, but if we want to know more about wellness, we need to study wellness.
“Health is more than the absence of disease” – WHO definition of Health (1948)
In our case, specifically the neurobiology of wellness in order to promote and to disseminate this information and for capacity building in front line workers, like teachers, clergy, GPs, Pediatricians, and therapists. By promoting and disseminating the tenants of Positive Psychiatry across professions, we can distribute mental health costs across multiple systems.
The decentralized model of Positive Psychiatry would also explore and expand the role of technology in increasing access to mental health resources. This distributed approach will reduce wait times and the acuity of presenting patients. The ability to distribute the care and cost of patients/ clients across multiple systems also allows for prevention and early intervention strategies. All together, these elements will reduce the rates of burnout in staff, allowing for better continuity and quality of care within our existing system.
Positive Psychiatry would also bolster the available community resources, and facilitate more primary, secondary and tertiary prevention strategies.
Clinicians and scientists throughout the world are already studying the neurobiology of wellness and have begun applying their findings clinically.
This has lead to the creation of the Association for Positive Psychiatry of Canada, a place where like-minded individuals can connect to collaborate, share information, and inspire one-another, and where partners can gain access to valuable training and resources. We are an inclusive organization, consequently, we welcome both Canadian and International members and partners.
I am inviting YOU to become a member or a partner. Share or suggest resources, or collaborators and most importantly, share the information with your friends. Let’s find out what wellness is all about and spread the word!
For those of you who want even more information, below, is a replication from the Positive Psychiatry book published this year (2015), further highlighting the differences between Traditional Psychiatry and Positive Psychiatry.