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Dr. David Goldbloom took your questions

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2. Stress reduction and promoting things in our lives that give us both pleasure and a sense of competence.

3. Promoting healthy relationships- this is a lifelong task but there is emerging evidence from the work of Dr. David Wolfe of CAMH about the importance of this for mental health.

4. Allowing people to acknowledge difficulties and unpleasant feelings rather than looking on this as a sign of weakness or shame.

5. Family dinners: There is excellent evidence that this low-tech social intervention is associated with a whole variety of signs of good mental health and success in school and relationships. Families of adolescents that had 5-7 meals together per week looked very different than those who had 2 or fewer.

Clearly, these are very general approaches because we don't have specific evidence about interventions that successfully lead to avoidance of mental illness.

Rob Swanson from Edmonton writes: Thank you to The Globe and the good Dr. for attempting to raise awareness. From the perspective of a person who has been through the system a half dozen times and on as many as a dozen different and expensive meds at the same time, to little effect, and knowing that no wish list can or should be fully funded in an age of increasing costs, I question the ability of the existing system to measure its effectiveness going forward using existing methods. How do you suggest the industry measure itself and apply any increased funding in the most effective way for the patients and the taxpayers?

Dr. Goldbloom: There has to be a better emphasis on the quality of outcomes - from the perspectives of people with mental illness, their families, and health professionals. While it is easier to count numbers of beds filled, numbers of people seen, numbers of prescriptions written, this doesn't tell us about quality but only quantity. Increasingly, health care services are trying to measure both outcome and satisfaction (not always exactly the same thing) and eventually this will get linked to funding.

Emma Hawthorne from Canada writes: Why is it that in Canada only the well-heeled can afford the skilled psychotherapy provided by psychologists and social workers? Why aren't interested professionals from these groups invited to join OHIP?

Dr. Goldbloom: I can't speak for the decision-makers at OHIP. Some people are able to access non-MD therapists through benefits plans from work, but this leaves many Canadians unable to do so. In other jurisdictions, there has been public funding for skilled psychologists to deliver evidence-based treatments.

Cecilia Belcastro from Toronto writes: A huge barrier to the mentally ill is being adequately prepared for the workplace. In your years of dealing with patients, how often do you see those with serious mental illness (bipolar, schizophrenia) successfully transistion into a career? What has become the typical lifestyle of these patients?

Dr. Goldbloom: If you had asked me this 10 years ago, I might have said that very few of people with schizophrenia whose care I have been involved with made successful, sustained transitions to the workforce - and, to a lesser extent, people with bipolar disorder. Thankfully, that is starting to change but not fast enough. How can we expect people to recover a sense of well-being without the monetary and other rewards and feedback that the workplace provides? While some people with long-term illnesses will at times be too ill to work, our society has traditionally overestimated the inability of people with severe mental illnesses to work, depriving them of the dignity that work provides. People who are unemployed are at risk for loneliness, poverty, and physical inactivity.

Josiah Smith from Japan writes: Thank you for your time, Dr. Goldbloom. A lot of people seem to be under the impression that mental illness is something you should be able to overcome with an act of will, that you should be able to 'get over it and move on,' and that if you can't, you are weak and somehow contemptable. What do you suggest as a way to change this perception?

Dr. Goldbloom: This is a common perception - and yet it's one that people wouldn't have of others who are facing acute or chronic physical illnesses. Step one is getting people to understand it as an illness rather than a character flaw or sign of weakness.

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Face it. Fund it. Fix it.

In Breakdown, The Globe and Mail documents the enormous, unaddressed cost of mental illness to Canadian individuals, families and society. The series closes with a search for solutions.


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