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Reading of the Week: Pushing Past the Headlines – Substances & Health Services, and Medically Assisted Death & Cost Savings

From the Editor

It makes sense that those with substance use problems and mental illness consume more health resources – but how much more? As Canadians opt for medical assistance in dying, what will the impact be on health spending?

Readings don’t necessarily follow a theme. But this week, we push past newspaper headlines to consider two topical issues in more detail, tapping the latest in the literature.

Pushing past the headlines

In the first paper, Graham et al. consider health costs and utilization for people with mental health and/or substance use problems. Spoiler alert: these individuals are much more likely to use health services, resulting in higher costs. That’s not exactly a surprise, but Graham et al. provide a detailed analysis in an area that has been understudied.

In the second paper, drawing from Dutch data, Trachtenberg and Manns estimate the savings from medically assisted death.

Both papers are timely. Both reach interesting conclusions.

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Reading of the Week: Physician, Heal Thyself? The Gold et al. Study on Docs and Disclosure (and Mental Illness)

From the Editor

If you had depression, would you tell people?

This week’s Reading is a paper from General Hospital Psychiatry that considers just this question. In it, the authors surveyed American female physicians, asking about mental disorders and why they would or wouldn’t choose to get help – and to tell people.

Would you share your mental health history?

This paper is paired with an essay written by Dr. Nathaniel P. Morris, a Stanford resident of psychiatry, who mulls mental illness and disclosure – and has a big disclosure of his own.

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Reading of the Week: Drugs, Drugs, Drugs – Vermont Tries To Break The Addiction Cycle, and Minister Philpott Weighs In On Opioids

From the Editor

“I don’t think that we can sit back and be complacent for one moment,” said Toronto Mayor John Tory in a media interview in which he called for an ‘all hands on deck’ approach to dealing with opioids.

It’s a comment on our times when the mayor of Canada’s largest city is focused on the use (and abuse) of opioids. And so are others – opioid addiction has sparked conversations across North America, from big city Canada to rural America. In 2014, Peter Shumlin, governor of the second smallest state in the U.S., devoted his annual address to the opioid problem striking “every corner” of Vermont.

Vermont: hills, lakes, opioids

How we deal with opioids is complicated, touching on everything from drug regulation to clinician education. But the legal response is particularly interesting – the intersection of the law, addiction, and public policy. And so, in this Reading, we look at the Green Mountain State. In a Wall Street Journal essay, reporters Jennifer Levitz and Scott Calvert discuss Vermont’s experimentation with mandatory treatment for minor drug-related crimes – and the struggles of a young user.

We also consider federal Minister of Health Jane Philpott’s recent essay on the opioid issue, which ran in The Globe and Mail last week. She calls on us to address the roots of the issue – which “are tangled and deep.”

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Reading of the Week: Can We Predict Relapse in Depression? The Judd et al. Paper from The American Journal of Psychiatry

From the Editor

Is he going to get sick again?

It’s a question that we often ask when a patient overcomes depression and happily leaves our office. For many patients, depression is a chronic illness – and so, remission is followed by relapse. Is it possible to predict patients with depression who are in remission but at risk of relapse?

Can we predict a future relapse – or is this an exercise in fortune-telling?

This week’s Reading is a paper from The American Journal of Psychiatry. Drawing on a long-term study, they look at the pattern of acute illness, remission, and relapse. Using statistical analyses, the authors seek to find a way of predicting relapse.

Spoiler alert: they do.

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Reading of the Week: The Best of 2016 (and a Look Ahead to 2017)

From the Editor

It’s a Reading of the Week tradition that we end the year by considering the best of the previous 12 months.

And this year we have had great material to consider. Readings were drawn from diverse publications, including journals, but also newspapers and magazines; one Reading was a speech given by the Prime Minister of the United Kingdom. (On the rich diversity of material, I made a similar comment last year.)

If once no one seemed to discuss mental illness, today these issues are being talked about.

But instead of just looking back, let’s take a moment to look ahead.

For those of us concerned about mental health services, 2017 looks like it will be a great year.

Consider:

· Though the provinces and the federal government failed to make an historic deal in 2016 that would invest in mental health services, federal and provincial ministers of health all agree that mental health needs to be a priority, and some type of deal is likely to happen.

· In 2016, Starbucks Canada made headlines for its investment in mental health benefits for employees; it’s highly likely that other companies will follow this lead in the coming months.

· In the past year, more people spoke out about their mental health problems, including a famous singer and an Olympic swimmer; in 2017, more people will find their voice and share their stories.

So – Happy New Year.

Thanks to all those who made suggestions for Readings. And thanks to Dr. David Goldbloom for his three guest contributions, as well as to my father and to my wife for their editing.

There will be no Reading next week.

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Reading of the Week: Remembering Dr. Elliot Goldner

From the Editor

I met him just once. Dr. Elliot Goldner was invited to give the Distinguished Member Lecture at the Canadian Psychiatric Association’s 2015 Annual Conference in Vancouver. Before a packed room, he gave a lucid speech on the state of the system – a speech peppered with insights and statistics, drawn from numerous papers; it was mesmerizing. After, he stayed to talk with people, and I joined the group that had gathered. Late for my own presentation, I received angry texts from my co-presenter. I couldn’t resist the opportunity to talk further about the access issues that he had so clearly discussed.

But if we met just once, over the years, I have read many of the papers that Dr. Goldner wrote and co-wrote. A Goldner paper – like a Goldner presentation – is impressive and memorable.

Dr. Goldner died in late November.

Dr. Elliot Goldner

In this Reading, we look at his life and career through the comments of some colleagues. We also consider his 2011 Canadian Journal of Psychiatry paper on access and psychiatry.

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Reading of the Week: Does Psychiatry Need Rebranding?

From the Editor

Is psychiatry in need of rebranding?

Time for a new name?

It’s easy to think about the incredible progress our field has made in the past decades: the rise of more evidence-based treatments; the fading of stigma; the political dialogue that has begun.

But is “psychiatry” holding psychiatry back? That is, is our old name cutting into our new reality.

In this week’s Reading, we take a look at a short but provocative blog that argues for a rebranding.

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Reading of the Week: The Future of Psychiatry – Part II of II

From the Editor

Is mental health becoming too technical (and forgetting patients as a result)?

The future of us clinicians?

This is the second Reading in a two-part series considering the future of mental health – not in terms of distant developments like biomarkers and genetically-tailored drugs – but rather by looking at measurement-based care and the evolution of the field.

Last week, measurement-based care.

This week, the end of the art of care?

This week, we look at an editorial The British Journal of Psychiatry that warns against physicians becoming “well treated skilled workers.”

And, continuing the consideration of ‘the future,’ we also consider a new paper that has received much attention. Can a web-based intervention help with insomnia? Spoiler alert – as The New York Times reported last week, “more than half of chronic insomniacs who used an automated online therapy program reported improvement within weeks and were sleeping normally a year later.”

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Reading of the Week: The Future of Psychiatry – Part I of II

From the Editor

Should mental health clinicians embrace measurement-based care? Or is mental health becoming too technical (and forgetting patients as a result)?

The future?

When we speak about the future of mental health, we often think in terms of biomarkers and genetically-tailored drugs. And while they may be part of the distant future, can we improve clinical work in the near future?

Over the next two weeks, we will mull the future of psychiatry in terms of practice and measurement-based care. Measurement-based care has been defined simply by Scott and Lewis as “practice of basing clinical care on client data collected throughout treatment.”

This week, measurement-based care.

Next week, the end of the art of care?

While these two Readings were published in two different journals, they seek to address the future of the field, perhaps in somewhat contrasting ways.

This week, we look at a new paper published in the Psychiatric Services that offers a review of measurement-based care studies.

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Reading of the Week: The NEJM on “Our Struggle to Care for People with Serious Mental Illness”

From the Editor

What can we do for those with severe mental illness?

Homelessness: can we do better?

This week, we look at a series of excellent essays that have run on mental illness in The New England Journal of Medicine. They are well written and insightful. We particularly focus on the first of the three essays, which considers treatment and rights.

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