Vergara

You hit the nail on the head Jon, I couldn't have summarized the problems facing our system so accurately and succinctly. This is a little off topic, but I've become convinced that a big part of the solution to the shortage in mental health professionals, as well as the Canadian mental health 'ecosystem' which seems to discourage accountability and adoption of novel treatment strategies that are often well established in the U.S., is broad adoption of a two-tiered system. Of course, this will likely never happen because Canadians have been so brainwashed to believe that privatized health care is "bad", but it would come close to solving most of the serious problems in our mental health system, quite quickly. I'll illustrate this by telling the story of a family member who wasn't diagnosed with ADHD until he was in his late 20's. When he was about 27, a psychiatrist diagnosed him ADHD, after being misdiagnosed with severe anxiety disorder/OCD for over a decade. At this point the psychiatrist proceeded to put him on a combination of prozac and dexedrine, which nearly killed him, and landed him in emerg three times, followed by a 2-3 week hospital stay each time. Prozac, he learned, completely blocks the metabolism of amphetamines in some patients, causing it to build up to severely toxic levels that often induce extreme anxiety and psychosis. After he turned 30, he moved out east, where he struggled with his condition, until he finally got into a doctor who figured out why he was having so much difficulty. He was a fast metabolizer of amphetamines, and ritalin didn't work as well for him, so he needed a high off-label dose of vyvanse + dexedrine IR + antidepressant and small dose of abilify. This gave him far more stability and ability to function academically than ever before, and he was able to complete a B.Sc. in Chemistry on this regimen. Unfortunately, this doctor lost his license for patient neglect after about 7-8 years, and so the young man was again at the mercy of the system. Having just graduated, he was unable to find a doctor willing to prescribe the dosage he needed, and done well on, and is struggling to find employment, afraid that if he gets a full time job, he won't be able to function adequately on a low dose of medication. To remedy this, he went to what was supposed to be the best ADHD clinic in his city, and paid $2000 to get a mandatory ADHD assessment, which came with 3 appointments with one of the city's most prominent ADHD psychiatrists. The psychiatrist proceeded to waste about a year and half of his life, insisting he try a new formulation of methylphendiate, (a class of drug which had never worked for him), then when this failed, put him on a low dose of amphetamines, which was inadequate to control his symptoms. Feeling like he had no good options in Canada, he got a consultation with a world renowned ADHD psychiatrist in the states, who confirmed, after his assessment, that he likely needed a high dose of dexedrine, as is sometimes the case. The U.S. specialist told him that he would line blood tests of amphetamine levels to be taken 6-8 hrs after morning dosing, to see if they were within a safe range, if his Canadian psychiatrist would like. Having paid for the expensive U.S. consultation only because the Canadian psychiatrist said he would "wait and see" what the U.S. doctor had to say before making any further treatment decisions, the Canadian Psychiatrist told him, "I can't comment on the U.S. doctor's recommendations or the blood testing, which is not done in Canada, as I didn't order the consultation". This is the kind of B.S. you can come to expect if you have extensive dealings with Canada's mental health system. The scenario for an ADHD patient seeking treatment in the States is far different, though not without its own obstaces, if a person has no coverage. First of all, they can go on psychologytoday.com find an extensive list of psychiatrists, accompanied by a blurb about their level of expertise. You can contact them directly, and ask any question you like. In Canada there's no such publically available list, and you often can't communicate with the psychiatrist to ask him/her a question, "ie. do you treat fast-metabolizers" until your first appointment, after the 4 month to 2 year wait, at which point he may tell you, "no I follow CADDRA's (antiquated) protcols". He doesn't care if you can function, he has a two year waitlist, and if he's affiliated with a hospital, he can't be sued for negligence, you have to sue the hospital with their team of lawyers. Good luck with that. A two tier system would give people means to quickly access psychiatrists who actually know what they're doing, because now people would have many treatment options if they didn't, and the doctors wouldn't be protected by a team of hospital lawyers. Canadians needn't fear, they could still have access to their third-tier psychiatrists through the public system, the difference would be that now people wouldn't have to wait up to two years to access treatment, as pressure would have been taken off the public system. Though there are certainly exceptions, many of the good psychiatrists aren't sticking around anyways, at least now there would be a way to get timely, competent care if you were willing/able to pay of pocket, with the assurance of shorter wait times for those using the public system. This would inevitably raise the standards of psychiatry in the public system, as people became aware of the care people were receiving in the private system, and would soon push Canadian medical schools training psychiatrists to smarten up, and motivate psychiatrists to stay on top of their game. Of course, opening up both systems to Nurse Practitioners would only add more competition, at lower prices, which would inevitably further decrease wait times, improve standards of treatment and drive down cost. Unfortunately, most Canadians don't realize how horrible our mental health care system is, and have zero motivation to consider a two-tier system, because they have been brainwashed to believe that we have the best health care on earth.

I can't say whether Canada will soon see the need for Psychiatric Nurse Practitioners, but I can tell you that even in Toronto, when it comes to certain areas of the mental health system, the gap between what should be, and what is, is a wide one. There is a desperate need for Psychiatric Nurse Practitioners here. The bottom line is that many physicians aren't staying in Canada because of the salaries, which has translated to significant shortages in Psychiatrists nationally. Even in Toronto, which is in a better position, in terms of medical expertise and facilities, than most of the country, there is a significant shortage of physicians who treat adult ADHD, which according to the NIMH affects over 4% of the adult population, and can be more disabling than schizophrenia, when left undertreated, or treated inappropriately. The situation in western Canada is much worse, this country desperately needs an influx of skilled medical professionals who can treat the condition, but given the myopic, bureaucratic "can't do" outlook of governing health bodies here, I don't know if the need will ever be recognized in the forceable future.