How to Reinvent Mental Health Care with Dr. David Goldbloom

For too long, getting adequate mental health care has been difficult. There's the stigma that, unfortunately, comes with saying you need help. And once you are ready to seek out care, where do you go? Who do you turn to? How can you get the mental health care you need in a timely fashion? Dr. David Goldbloom is a celebrated psychiatrist, professor and the senior medical advisor for Toronto's Centre for Addiction and Mental Health. In his new book, We Can Do Better: Urgent Innovations to Improve Mental Health Access and Care, Dr. Goldbloom suggests clear solutions to many of these problems. This week, he joins Medcan CEO Shaun Francis to discuss how we can reinvent our mental health care system and what we can do for the people in our own lives.

LINKS

• Read more on Dr. Goldbloom and his work at CAMH here.
• You can buy his book, We Can Do Better, at Indigo.
• Check out this recent op-ed by Dr. Goldbloom in the Globe and Mail.
• Read this paper he co-authored last year on the future of apps in psychiatry, and watch a talk he gave at Casey House in Toronto on the stigma of mental health.
• Learn more about the mental health guidelines and resources set out in the National Standard of Canada for Psychological Health and Safety in the workplace here, and consider signing up for the Mental Health First Aid course here.

INSIGHTS

• We all know that COVID-19 has been hard on our mental health — depression and anxiety, in particular, spiked earlier on in the pandemic. But Dr. Goldbloom, who also worked during SARS, says he has seen a difference with how we regard our mental health during crises: "There is greater awareness of the mental health implications when dealing with the spread of highly infectious, and even lethal, viruses through our community," he says. "I err on the side of optimism, perhaps, in thinking that we're better attuned than we were." Basically, the fact that we've been talking about our mental health during the pandemic is an improvement. [02:26]
• At this point, no one would blame you for being sick of only communicating with people over video chats, but virtual therapy can actually be highly effective. Dr. Goldbloom has used the technology to provide care to small communities in Northern Ontario for 20 years, and loves how convenient it is for people who may have difficulty accessing in-person therapy otherwise. There's also research to back up its usefulness: Dr. Goldbloom says it's likely you'll form just as great a connection with a psychiatrist virtually as you would in their office. That doesn't mean in-person therapy is going to disappear, but he does think digital alternatives should remain viable long after the pandemic is over. [04:47]
• "In Canada, our system of health care has been constructed around the idea that [it's] provided by doctors, and often in hospitals. In the reality of the 21st century, most health care is received outside of hospitals, and should be delivered by multiple disciplines—not just physicians—but it's hard for public funding to pivot as quickly as it needs to," says Dr. Goldbloom. "That creates all kinds of bottlenecks and barriers for people who are seeking [care], so we've got a problem. When you say the system is broken, I'm not sure we could even describe it as a system. It's a loosely-woven fabric of different services and providers, and navigating it … is a pretty major challenge." [15:45]
• So, if our "system" is in that much disrepair, what can be done? Dr. Goldbloom has a few innovative ideas. One is something that's already starting to be implemented around the world: Youth-focused community hubs. Ideally, these are places where adolescents can seek mental, and certain kinds of physical, health treatments in an easy environment. This will make accessing care much easier, especially as it will help them avoid unnecessary hospital visits. Another solution Dr. Goldbloom would like to see is the continued development of virtual-based cognitive behavioural therapy. By this, he doesn't mean more Zoom calls, but web-based tools where people can complete online assessments and receive a custom plan that is monitored by a licensed therapist. The goal behind innovations like this is to give people more flexibility in their treatment, and make progress at their own pace. [17:49]
• "We need to think of ways to expand the net of services that are covered," says Dr. Goldbloom, pointing to the United Kingdom, which offers mental health care through the National Health Service, as an example of success. He also argues that the private sector can help, too. "When you treat people for mental health problems, you realize a return on investment," he says, adding that Deloitte or PricewaterhouseCoopers have done studies that prove this. "It's good for the bottom line." Employers can help by adapting their offered insurance programs, and by making changes in workplace policies and culture by adopting mental health care standards. [24:49]
• And if you have someone in your own life who may need help? You're not going to want to do a huge, Hollywood-style intervention, first of all. Instead, start by figuring out who they have the best connection to in their own life—maybe a parent, a friend, even a close colleague. "That person has to be prepared to be a bit of a pest," says Dr. Goldbloom, as people who are struggling often tend to fend others off. This person has to be ready to stick with the process and make sure the other person knows you're not going anywhere. What they need is the time and space to feel heard. [29:23]