The Question: My partner has been trying to get help for depression, addiction and anxiety issues. He was put on a wait list for a prescription assessment but won't be seen for three months. Unless you are at serious risk of suicide or about to physically harm others, the system doesn't seem to care. Is there any way we can speed up this process?
The Answer: It sounds as if your partner may have what health-care providers refer to as "dual diagnosis" – a substance-abuse problem combined with a psychiatric disorder. It can include a patient with psychotic illness using crack cocaine or someone with anxiety trying to quell symptoms with alcohol. You want to make sure your partner gets into the right treatment program as one size definitely does not fit all.
"There are real obstacles to accessing service, whether it's in a major urban centre in Toronto, or in a small, northern community," according to David Goldbloom, a professor of psychiatry at University of Toronto, who pointed out that six million Canadians each year meet the criteria for a diagnosable mental disorder.
While going to a family doctor is the usual route to help, don't count on that physician being able to fast-track your partner to a specialist. It's not for lack of effort; it's just that many doctors have similar problems obtaining help for their patients due to finite health resources and a system that isn't well-organized.
"What general practitioners have encountered often is either tremendously long wait lists or people [psychiatrists]saying, 'I'm not taking any patients,'" notes Dr. Goldbloom, who is also senior medical advisor at the Centre for Addiction and Mental Health in Toronto.
A recent study in The Canadian Journal of Psychiatry found that of 230 Vancouver psychiatrists contacted regarding a depressed man, 160 were unable to accept a referral; 70 would consider a referral but could not provide estimated wait times. Six offered appointments, ranging from four to 55 days from the date of enquiry.
Even within provinces, accessing care can vary. Victoria Mental Health and Addictions Intake will accept referrals from physicians and nurse practitioners; in Vancouver people can self-refer by phone through Vancouver Coastal Health. For more specialized care, physicians can refer patients to BC Mental Health & Addictions Services.
My advice is to start but don't stop with your family doctor. Since you are based in Toronto, your partner could also self-refer to the Centre for Addiction and Mental Health, which will be able to do an assessment. The wait list there is weeks and it can match your partner with services within or beyond CAMH. Self-help groups can also be useful.
I wish there was a magic bullet for your partner's problem but there's no easy way to fast-track a referral in the public health-care system.
The following list of websites and resources may be helpful in obtaining mental-health services.
Metro Addiction Assessment Referral Service: 416-599-1448
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org.