Is talk cheap?

*approaches soapbox*

Ahem.

I’m not a politician, and I have no desire to be. But sometimes working on front lines of mental illness and seeing the vast amounts of misinformation, missing infrastructure, and systemic bullshit we have to deal with, makes me realise that if I don’t speak loudly enough for the people I advocate for, they will never get what they need.

When I start my 16-hour call shift tonight, the vast majority of the cases I am going to see are undoubtedly going to be people who have been under-served by the system. They are people who have tried seeing their family doctor and were told to wait 8 months for the referral to a psychiatrist; they are the substance users who relapsed as they were awaiting admission to a residential treatment facility; they are the “troubled teenagers” who haven’t lived in one foster home for more than a month, and were never able to form secure attachments; they are the psychotic patients who went off their meds because no one was following them closely enough; they are the folks who walked out of their GP’s office with a script for an antidepressant with a boatload of side effects because that’s easier to provide that in a 10-minute appointment than an explanation. Heck, they might get me at my 23rd hour of being awake and not get the most empathetic side of me, and feel turned away.

Psychiatrists get labelled as pill-pushers, and let me tell you why: we work in a system that has enormous amounts of infrastructure for diseases that we can treat with a medication, and almost zero infrastructure for diseases that would benefit from therapy. For medications, there is Blue Cross, there is emergency short term prescription coverage, there is a multi-billion dollar pharma industry waiting to provide patients with free samples. In this city, virtually the only free therapy that is available to the public are 6 walk-in sessions where you might see 6 different therapists (and bless the souls at Calgary Counselling Services for trying). When the rare patient comes to the ER with the means to pay for the therapy they need, there is always a wash of relief over me as I realise this patient has a really good chance to get better–because they have the means, which no matter what I do, I as the on-call resident in the ER cannot provide. Can you imagine how difficult it is as a physician, when I took an oath to try to help people and heal them to the best of my ability, to know that treatments exist for most people but are beyond my reach?

Yes, we need to talk about mental illness, but we also need the resources and infrastructure to address those who actually show up, to talk, in our emergency rooms.

But my biggest contention with this corporate celebration of mental health: let’s be clear, when we Bell-Lets-Talk about mental illness, we talk about certain trendier mental illnesses, and not others. It’s all the rage on social media to talk about your anxiety and how difficult it’s been to juggle school and work with your social commitments, but it’s not as nice to read about someone’s harrowing experience of being forcibly admitted to hospital while they were unable to decipher reality from hallucinations. And it’s much less in vogue than hearing someone openly talk about how their substance use has led to them losing every single one of their relationships, winding up homeless and unemployed as a result. My fear with this corporate exploitation is that it is even MORE discriminatory to these less sexy diagnoses, because it only becomes acceptable to talk about depression and anxiety.

I am only one tiny voice in a province and a country that is massively under-serving its mental health population, so my hope is that for my many friends who claim to have interest in mental health advocacy, that we can actually get together to influence changes in policy. I won’t go as far as to say “talk is cheap,” but the value of talk is in how directly it effects action.

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