Opinion: It’s not enough to simply link to resources, mental health care must begin in classrooms

We must re-orient academics to include mental health education

Opinion: It’s not enough to simply link to resources, mental health care must begin in classrooms

There is more behind U of T’s high rankings than meets the eye.

Despite the university’s rising reputation of high academic excellence, student well-being is plummeting. The university is drastically failing to take effective steps toward combatting the urgent mental health crisis. We need a critical re-evaluation, re-calculation, and reformation of U of T’s mental health policy and the administration’s approaches to student well-being.

Following the fourth death of a student on the grounds of UTSG in less than two years, students continue to tirelessly ask the question, “How do you sleep at night?”  to administration, an admonition and a plea to raise alarms that should have sounded off far sooner.

Which resources are currently available to students in crisis?

The Health & Wellness website lists resources such as workshops, emergency hotlines, and information on counselling appointments. This digital space is one of the main places where mental health resources at U of T are accessibly described.

However, the website’s vision to improve mental health resources, exemplified by its comment that, “We all have a role to play in mental wellness on campus,” comes off as blank statements lacking proactive steps to back them up.

Without an effective path to actually move toward improving mental wellness, circulating a website link of resources for the sake of claiming that there are resources doesn’t do much for making a change. 

Simply noting that ‘the resources are there’ is not enough. Making resources available on an online or physical platform only begins to take on meaning when students who require help begin to feel like they can engage and reach out to the resources in front of them.

Access to mental health resources and tools is something that every academic institution should have, but many are lacking. Mental health resources are, in theory, present on campus grounds, but they are not actively and visibly accessible to students.

The reality is that U of T’s administration is a reactive, rather than proactive, administration.

It’s playing a game of catch-up with its students when it comes to opening up the conversation on mental health. The third phase of the Mental Health Task Force makes this clear. It consists of a summary of what students have long tried to communicate to administration.

Discussions of mental health must be integrated into the various structures that affect the daily lives of students — such as classrooms — instead of separate structures outside of the academic scope of the university. They need to become a part of the university instead of something separate from it.

In a large institution like U of T, resources must trickle down into program and classroom-oriented designs, instead of waiting for students to reach out of their own volition.

While it is recognized that our professors and teaching assistants are not our therapists or counsellors, there is nothing wrong with ensuring that educators are able to identify signs and symptoms of student distress as a part of the internal structure and design of specific academic programs. In the kaleidoscopic maze that is U of T, mental health awareness and discussion must migrate from the closed doors of administration into the classrooms where students are present.   

In a university where students have familiarized themselves with a toxic mindset that equates stress to success, the harmful academic culture must be remoulded.

Students can no longer stand as just a number that either stays or gets excluded from the system based on a calculated grade. As expressed by Guelph University’s approaches to mental health and commitment toward taking proactive steps to supporting the mental well-being of students, we must adopt a whole-person view of students when addressing the mental health crisis. This is especially true at a university like U of T, whose large population makes it easy to feel like just another number.

Living behind the shadow of academic success that solely focuses on U of T’s well-renowned ranking amongst other universities blatantly ignores the personal needs of students that live beyond the headlines of “top [university] in Canada.” Moreover, it sends a message of sheer ignorance that silences the voices of students who are making powerful pleas for change in the way the university externalizes mental health resources.

The personal concerns that are impacting students’ day-to-day lives as members of an academic institution must become an essential institutional priority instead of a side issue that is discussed every time a student dies.

The mental health issue on campus is obvious. U of T can send around links to resources such as Good2Talk, Health & Wellness counselling, and different phone numbers to call. But the administration needs to realize that this is not about resources and a long list of phone numbers. This is about structures that have allowed mental health problems to persist on campus, and how they must be re-evaluated and rebuilt.

Mélina Lévesque is a fourth-year Anthropology and Political Science student at Victoria College.

“We’ve been leaving patients behind this whole time”: caring for CPR providers

How experts in Peel Region have provided mental health support to lay-responders

“We’ve been leaving patients behind this whole time”: caring for CPR providers

Over 400,000 people in North America experience a sudden cardiac arrest outside of a hospital each year. Nearly half of these patients receive cardiopulmonary resuscitation (CPR) from a bystander providing first aid.

Whether a bystander is waving the ambulance down or physically performing CPR, involvement in any capacity can be traumatizing.

However, bystanders, also known as lay-responders in this capacity, are largely ignored by emergency services following the incident. “We call them the forgotten victims,” said Dr. Katie Dainty, a professor at U of T’s Institute of Health Policy, Management and Evaluation, in an interview with The Varsity.

“We’ve been leaving patients behind this whole time.”

Current research shows that lay-responders face a heightened risk of suffering from post-traumatic stress disorder (PTSD), as well as lasting stress, anxiety, and sleeplessness.

A promising approach to provide better care

Dainty co-authored a recent paper with Paul Snobelen, a community resuscitation specialist at Peel Region Paramedic Services, on the implementation of the Lay Responder Support Model in Ontario’s Peel region, approved in 2014. The system’s aim is to screen lay-responders for risk of mental health concerns, and offer them support proactively.

The model has helped address acute stress reactions by lay-responders, and aims to mitigate the risk for lay-responders in experiencing PTSD. The system has three stages.

First, the program’s operators identify and engage with everyone involved in a medical incident — from witnesses to CPR providers. When a cardiac arrest occurs in a public place in Peel region, Snobelen receives information by paramedics involved.

He then collects information and makes initial contact with those involved. “I try to… touch base with everyone involved in the incident, thank them for their response, [and] tell them to note down any questions that come up in the course of the day,” said Snobelen to The Varsity.

In the second stage, the lay-responders are invited to participate in a debrief within a couple days of the event. “Almost every single individual I’ve offered this to has said yes,” he said. “Very few have declined.”

The debriefing allows lay-responders to process the event, ask questions, and discuss their experiences. “I build a timeline with people together. What we do is a more collaborative approach,” said Snobelen.

“This gives an opportunity for everyone to hear [each] other’s involvement and… highlight how everybody’s role was critical to helping that person.”

Another key aspect of the debriefing is answering the lay-responders’ technical questions. Snobelen, recalling a major lesson from the model’s implementation, said that lay-responders often experience cognitive distortion.

These distortions are negative biases in thinking, whereby people convince themselves of untrue beliefs. For example, lay-responders may believe themselves to be responsible for a patient’s death, especially when they break ribs while performing CPR.

He added, “A big element of these debriefings is addressing the cause of cognitive distortions through discussing the technical aspects of CPR performance.”

The final stage of the model is to follow up with lay-responders in three steps. This involves discussing self-care strategies, encouraging them to reach out for non-professional help, and facilitating referrals to professional counsellors if necessary.

The impact of the program

“We have yet to do a longitudinal study, but the initial feedback has been great,” said Dainty. “[The model] is so important because it gives people [a] safe space and is crucial in normalizing their reactions to such a critical incident.”

Reflecting on his experiences with the model, Snobelen recalled interacting with a mall security guard in two separate incidents. The guard went from feeling hesitant about performing CPR to becoming confident in his abilities.

Snobelen has further observed behavioural changes in individuals, before and after attending the debriefing, which has instilled confidence in him about the positive impact of the model.

Potential expansion

However, according to the authors, institutionalizing and implementing the model at a large scale is difficult due to limited resources.

To expand the program outside of Peel region, Snobelen proposed multiple solutions involving different community partners. Extending Ontario paramedics’ peer support teams to the community, he said, could be a potential solution.

He also noted that of lay-responders often reach out to their first-aid instructors with questions. He remarked that the Canadian Red Cross might be able to collaborate in developing a training program, which could train first-aid instructors to facilitate debriefings.

“I’d [also] like to see a [Continuing Education Model] for therapists and counsellors,” Snobelen said, “so they are able to help their clients better in their own practice.”

Opinion: Ford burst our bubble — university health care coverage suffers under new policy changes

The UTSU can only do so much to mitigate Ford’s damage

Opinion: Ford burst our bubble — university health care coverage suffers under new policy changes

The Ford government’s changes to OHIP and introduction of the Student Choice Initiative (SCI) have brought a number of pressing issues, including access to health care for university students. The University of Toronto Students’ Union’s (UTSU) health care plan is bearing the brunt of the damage.

The UTSU health care plan is meant to fill gaps in other coverage students may have, including OHIP. However, Ford’s cuts to OHIP have made covering all gaps unfeasible, prompting major shifts in the UTSU Health and Dental Plan.

The UTSU’s coverage for prescription drug costs has been reduced from 90 per cent to 80 per cent of the cost of each prescription, up to $5,000. This applies not only to drug prescriptions, but also to vaccines — which have been fully covered to a maximum of $200 in past years.

Mental health services have also been affected: as opposed to providing $125 per visit for up to 20 visits, the new health care plan only covers $100 per visit for up to 15 visits. It’s important to note is that unlike prescription drug care coverage, mental health funding is being capped by both cost and number of visits.

In an attempt to offset these cuts, the UTSU has implemented coverage for visits to registered psychotherapists, in addition to visits to standard psychologists, clinical counsellors, and licensed social workers. This change may seem minute, but it will go a long way to help students.

What is most worrisome about the UTSU’s changes is not its immediate effects but rather its implications for U of T students. In the statement that the UTSU released regarding changes to the health and dental plan, the union acknowledges that there is a mental health crisis at the university.

Mental health is a high priority for the UTSU: in a statement following a student’s death in September, it committed to continue to place its “resources behind addressing the mental health crisis.” Even though it must contend with Ford’s difficult cuts, it should put all its efforts into tackling this crisis. In terms of policy, this means collecting as many resources as possible.

At the UTSU Board of Directors Meeting in late August, Studentcare, the health and dental care provider of the UTSU, sent a message noting that “a lower claims trend was had for mental health coverage in comparison to other parts of the plan.”

In response to this, the UTSU decided to concentrate more on other areas of health coverage, as mental health seemed to be of lesser concern. This projection was also based on the fact that the UTSU would no longer be covering students at UTM, meaning that fewer resources would be needed. However, these predictions do not necessarily translate as facts, meaning that the students at UTSG may be left without sufficient access to resources.

The UTSU is cognizant of this and is taking active measures to improve health care coverage for the following school year. UTSU President Joshua Bowman explained that the executive team is working on restructuring the Student Aid program to “bridge the financial gap in coverage.”

The UTSU hopes to establish a referendum which would allow for students to re-appraise the cost of the plan and possibly charge students more in certain areas and less in others, depending on their needs. These changes would aim to both meet the individual needs of the student while accommodating for financial barriers.

Of course, the UTSU is only a student governing body, and as such, some changes are beyond its reach. The greatest barriers to equitable access to health care are Ford’s changes to OHIP and implementation of the SCI. The true arbiters of change are the members of the Legislative Assembly of Ontario.

Just as they were the ones who created these barriers, they are the ones who can break them down. And in light of the mental health crisis, these policies are only driving us further away from the help we need and straight into the arms of physical, emotional, and financial instability.

The Ford government must recognize the harm that is already stemming from these dangerous policies and do everything it can to mitigate this harm and reverse it. Otherwise, it will only be a matter of time until Ford bursts our bubble.

Yana Sadeghi is a first-year Social Sciences student at New College.

Opinion: Mental health services for youth don’t need to be inaccessible

A growing body of research sheds light on solutions to unique obstacles faced by youth

Opinion: Mental health services for youth don’t need to be inaccessible

This past year alone marks the deaths by suicide of three students at the University of Toronto. Their aftermath opened a barrage of criticisms toward the administration for their lax services for at-risk youth. While alarm bells have been rung for increased mental health and substance use services across campus, systemic change has been slow to come.

Indeed, the issue of mental health accessibility for youth — on and off campus, throughout the province, and across the country — remains a pressing policy and health care concern affecting millions of Canadians.

Among the sobering statistics that shroud youth mental health are the following: some 12.6 per cent of people under 18 years of age in Canada experience mental health and substance use disorders, while Statistics Canada cites suicide as the second most common cause of death, after accidents, among youth aged 15 and over. Importantly, Indigenous youth are disproportionately affected by suicide and addiction, and little research thus far has focused on this issue.

Many youth facing mental health challenges avoid treatment

Who are ‘youth,’ anyway? The McCain Centre for Child, Youth & Family Mental Health at the Centre for Addiction and Mental Health (CAMH) roughly categorizes those ages 12–25 within this demographic, though CAMH more broadly includes those up to 29 years old in their definition.

Unquestioningly, this demographic is particularly susceptible to various mental health challenges as they pass through the hoops of development: commencing and finishing a university or college degree or vocational program, navigating the ebbs and flows of intimate relationships, and searching for employment.

Despite numerous treatment options available for youth, many still go untreated. Why is this? The reasons are plentiful: youth’s preference for self-managing, societal stigma, lack of assessments and screening, and even system fragmentation. With these barriers in mind, how can Canada’s health care system improve and cater diligently and efficaciously to youth across the country? 

The solutions, too, are plentiful

When I asked Dr. Joanna Henderson, Director of the Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health at CAMH, and Associate Professor of Psychiatry at U of T, if mental health services for youth are adequate, or even optimal, her answer was a hard no.

Henderson has worked with many teams and professionals to increase mental health and substance use services for youth. She explained that good services involve “creating spaces for young people who can walk in without an appointment or referral, and access high quality mental health and substance use services as an entry point.”

Long wait times, however, are a ubiquitously understood concern across the health care continuum, leaving young people with few, and often inadequate, options to choose from. The trope of “service delayed, service denied” captures this concern. 

“When young people have to wait for service, several things happen,” Henderson said. “One, the symptoms they were originally presenting for become exacerbated, so they get worse. Two, the impact on their functioning can have significant long-term consequences. And three, the overall [health] outcomes are poorer.”

“From a system perspective, that means our delays have increased the cost of providing care to young people.”

In Canada alone, the economic burden of mental illness is high, with an estimated 51 billion dollars spent per year. This includes “health care costs, lost productivity, and a reduction of various quality-of-life health indicators.”

To be clear, this also means that young people requiring mental health and substance use support resort to emergency rooms where they may be hastily ushered in and out, without receiving thorough long-term care. 

So what do youth-friendly mental health and substance use services look like? Among the many salient features, they are inclusive, safe, confidential, bright, and comfortable. Equally as critical, however, is that they involve consulting with youth for their input. 

“How is it that the whole commercial for-profit industry figures out how to sell their product or their service?” Henderson asked. “You engage with and learn from consumers. We fail to do that in mental health and in health largely.” 

Solutions to increase accessibility of mental health services for youth

The research on this is clear. A cardinal rule for youth-friendly services involves youth actively engaging with the system — from policy development to the implementation of strategies and programs. 

We know that youth-friendly services can benefit immeasurably by having youth co-design these spaces, but we also know that to do so, current systems that feature the old-fashioned clinical model of care, whereby one presents a set of symptoms and is discreetly greeted, treated, and discharged, ought to be neatly folded and set aside for more modern and progressive models. 

An optimal system, therefore, requires a flexible model of care. For starters, it’s making programs visible to youth so that they know where they can go when they need help, and one they can choose to enter and leave as they wish, without the rigidity of a treatment timeline and discharge date.

This includes drop-in visits and telephone conversations, where hours of operation are accessible, such as during weekends and evenings when youth would not need to worry about missing school or work. Artistic and innovative approaches to treatment, emphasizing non-verbal methods of communication such as music and drama therapy, could also be more accessible to youth. 

Additionally, youth-friendly mental health and substance use services ought to be accessible in communities where public transit exists. Costs, too, must be fair and inexpensive, as Hawke and colleagues note in their recently published paper on this topic: “Youth who cannot afford services will not likely access them.” 

Inclusivity mandates changing outreach platforms and engaging with technology to relate to and connect with youth. Social media platforms are pertinent sites of connection, as are websites that are colourful, up-to-date, and practical.

Steering clear from “disease language,” Henderson remarks, can shift the conversation away from pathologizing and lead youth to feel genuinely heard and understood.

Given also the wide range of development during this period of one’s life, youth services ought to be comprehensive and individualistic. There is no one-size-fits-all model, and clumping youth together under a monolithic category fails to address the transient and not-so-transient challenges children and adults experience.   

The solutions to providing youth-friendly services are exhaustive, albeit refreshingly so. It’s good to know that we matter, but it’s perhaps more important to know that the system, warts and all, is gradually shifting to welcome youth input.

This can be achieved by hiring caregivers whom young people can bond and relate to, and expanding our very conceptions of mental health and the unique pins and needles experienced by every young person.

If you or someone you know is in distress, you can call:

  • Canada Suicide Prevention Service phone available 24/7 at 1-833-456-4566
  • Good 2 Talk Student Helpline at 1-866-925-5454
  • Ontario Mental Health Helpline at 1-866-531-2600
  • Gerstein Centre Crisis Line at 416-929-5200
  • U of T Health & Wellness Centre at 416-978-8030.

Warning signs of suicide include:

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Acting anxious, agitated, or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. If you suspect someone you know may be contemplating suicide, you should talk to them, according to the Canadian Association for Suicide Prevention.

“If you’re not studying women at all, you’re biased”

Rehabilitation Science Graduate Students’ Union hosts panel discussion on brain health in women

“If you’re not studying women at all, you’re biased”

The Rehabilitation Science Graduate Students’ Union hosted its inaugural Speaker Series event to discuss women and brain health on March 25. The panel was held at the Rehabilitation Sciences Building.

Kyla Alsbury, PhD student in Rehabilitation Science, explained that the Speaker Series is a reincarnation of what was previously a monthly awareness project.

Mary Boulos, master’s student in Rehabilitation Science, hopes that these events will bridge the gap between research and the community.

“We’re doing research on these different diseases and disorders, but those findings aren’t being shared with the people who are most affected,” said Boulos. 

The goal of the event was to share research and engage with members of the community who are affected and ultimately better their health.

The speakers included Professor Gillian Einstein from the Department of Psychology and adjunct scientist at Women’s College Hospital, who discussed the relationship between sex, gender, and women’s brain health; Reema Shafi, a PhD candidate at the Rehabilitation Sciences Institute, who explained the vulnerability of women’s brain after concussions; and Melissa Biscardi, who recently completed her master’s degree and spoke about the endocrine reproductive health outcomes of women after brain injury.

Mental rotation differences between the sexes

Einstein explained that women’s brain health is important, simply put, because “thinking about… organisms [with XX chromosomes] brings new ideas.” Taking sex into account, Einstein said, “ensures that we can develop effective and safe treatments for  [people with XX chromosomes].”

There are differences in biology, such as phenotypic expression, gene expression and epigenetic signatures, and life experience, when comparing to organisms who possess XY chromosomes to those with XX.

Members of Einstein’s lab created an experiment to determine whether sex plays a role in mental rotation tasks and when transcognition is formed.

Different groups of people were asked to complete a Vandenberg and Kuse mental rotation task. People with XX chromosomes in the follicular and luteal stage of their menstrual cycle, female-to-male transgender people on testosterone hormone therapy, and people with XY chromosomes were asked to complete the task, which shows a 3D representation of an object. The subjects then had to match that impression to another one of the same object from a different angle. 

It was found that people with XX chromosomes at low estrogen states did as well as people with XY chromosomes and people with XX chromosomes on hormone therapy. Therefore, a sex-based difference in performance is seen in the luteal phase. They also discovered that the hormone therapy that female-to-male transgender subjects receive allows them to test as cisgender males.

Concussions and menopause

Biscardi discussed the state of menopause in women who suffered a traumatic brain injury.

She explained that “most women experience new onset of changes in menstruation despite being at least one year post-injury.”

Furthermore, in the tested sample, Biscardi found that menopause symptoms were more intense when compared to the general population.

As the symptoms of menopause and post-concussion are similar, Biscardi noted that investigation is needed to determine which symptoms are due to menopause and which are due to concussive effects.

Shafi explained that there is evidence of females experiencing vulnerability after a concussion due to a combination of factors such as structural disadvantages, which can affect cognitive processing after a concussion.

Following the speakers, there was a short panel discussion with questions from the audience.

Einstein explained that in terms of research funding, she finds a lack of understanding, saying that “if you’re only doing research in females, they really don’t know why you’re doing that.”

“Fifty per cent of the population is women,” said Shafi. “So if you’re not studying women at all, you’re biased [against] women. You have to have a reason to not study sex and gender.”

Moving toward trans-inclusive healthcare in Canada

U of T researchers advocate for affirming and personalized health care practice for LGBTQ+ individuals

Moving toward trans-inclusive healthcare in Canada

Canada’s transgender population continues to face challenges from transphobia and discrimination, which, among other factors, influences their health and development.

Recent efforts by the Canadian government and affiliated agencies address issues that LGBTQ+ communities face.

In 2016, the Canadian federal government passed Bill C-16, which amended the Canadian Human Rights Act to include gender identity and expression as one of the prohibited grounds of discrimination.

In the health care setting, LGBTQ+ individuals face multiple barriers that contribute to the disparities in the management and care of these individuals.

Alex Abramovich, Assistant Professor at the Dalla Lana School of Public Health and Independent Scientist at the Centre for Addiction and Mental Health (CAMH), has been studying the health care needs of LGBTQ+ youth for more than a decade.

From his experience working with young trans people, Abramovich wrote to The Varsity that this population has an unmet need for mental and physical care.

Many transgender individuals are “unable to come out and speak honestly about their identity and healthcare needs because they may not know whether or not it will be safe to do so,” wrote Abramovich, explaining how gender identity affects access to health care.

He added that some trans youth do not even have a family physician due to “previous experiences where their gender identity and sexual orientation were pathologized.”

To address the urgency for improved health care accessibility by trans populations, Abramovich recently co-authored an article in the Canadian Medical Association Journal (CMAJ) that provides comprehensive steps for physicians to follow to become more trans-inclusive and trans-competent.

One of the recommendations listed in the article was to privately ask all patients what name and pronoun they go by, instead of making assumptions based on perceptions of their voice, appearance, or name and sex listed on their health card.

Another key recommendation made in the article was to ensure that patients are addressed with a gender-affirming approach that does not view gender variance as pathological.

“These are just some of the things that health care professionals can implement immediately,” wrote Abramovich, expanding on the purpose of publishing such health care recommendations.

Staff Physician and Adolescent Medicine Specialist at St. Michael’s Hospital, Joey Bonifacio, argues in a review article recently published in CMAJ that adolescents’ mental health improves when they receive gender-affirming care.

Bonifacio mentions that primary care providers are equipped with some published medical guidelines on providing care for the transgender population. However, practice is hampered by a lack of experience and training in trans health issues.

He suggests that primary care providers support trans adolescents with gender dysphoria by facilitating discussions about the “timing of social transitioning, reviewing and overseeing the potential use of medical management, and connecting them with local community resources and supports.”

Besides improving the management and care of trans individuals, U of T-affiliated researchers suggest that routine data collection can “contribute to evolving norms in Canadian society regarding sexual orientation and gender identity.”

Currently, there is a lack of national and territorial data on trans populations, mainly because there is no standardized way of collecting and analyzing data about gender identity.

Andrew Pinto, Assistant Professor in the Department of Family and Community Medicine at U of T and Staff Physician at St. Michael’s Hospital, tackled this challenge with his research group by examining how Canadian patients react to being asked routinely about sexual orientation and gender identity.

By administering a sociodemographic survey of all patients in the waiting rooms of St. Michael’s Hospital on a regular basis and later conducting semi-structured interviews with 27 patients, Pinto and his research group found that the majority of patients appreciated the variety of options available for both the sexual orientation and gender identity questions.

However, some patients felt discomfort in answering such questions, and some felt that their identities were not reflected in the options despite efforts to provide diversity in survey responses.

Based on these research findings, the authors suggest that an open-ended option such as Identity not listed (please specify) could be included in addition to prespecified options. They also suggest that health care organizations should set the stage for asking these questions by explaining how the data will be used and ensuring that clinics are LGBTQ+-positive spaces.

Pinto and his colleagues hope that further research will be done in a variety of Canadian and international settings in consultation with LGBTQ+ communities, as such data can help organizations identify health inequities and build a framework with improved and inclusive care.

Bridging the technological divide in Canadian health care

Electronic Medical Records and patient care

Bridging the technological divide in Canadian health care

In Canada, a battle rages in health care. On one side stands a relatively stagnant health care system, already expensive but comparatively effective, with a legacy of poor technology integration. On the other side, investment in technology has the potential to not only reduce costs but also produce better patient care.  

Initially, further tech-focused investment would make health care even more expensive for the government. In Ontario alone, health care spending equates to 43.2 per cent of all provincial expenditures. Across Canada, health care amounts to about 11 per cent of gross domestic product (GDP), or $4,919 per year per person, as of this year. As a percentage of our GDP, we have the fourth most expensive social health care system of 28 comparatively wealthy countries, falling short of only Switzerland, France, and Norway. However, our above-average spending nets above-average results.

Compared to other wealthy nations, Canadians experience an above-average quality and quantity of health care. Canada consistently ranks highly on the majority indices that measure efficacy, despite having fewer physicians, long wait-times, and less equipment. Canada is ranked first at preventing and reversing debilitating illness, and also boasts above average cancer survivorship rates, above average healthy-age expectancies at 73.2 years, and above-average life expectancies at 81.9 years. These accomplishments have been achieved with our existing low-tech system. For example, we are without a consistent system and centralized database for recording personal medical information or automatically communicating medical files, at times even at the same hospital.

The adoption of Electronic Medical Records

To learn more about Canada’s relationship to health care technology, I investigated Canada’s partial adoption of Electronic Medical Records (EMRs). I spoke with Dr. Muhammad Mamdani, Director of the Li Ka Shing Centre for Healthcare Analytics Research and Training at St. Michael’s Hospital in Toronto; corresponded with Christina Christodoulakis, a PhD candidate in computer science at the University of Toronto; and interviewed Davey Hamada, a registered nurse in British Columbia.

According to Mamdani, “there seems to be a general consensus that the adoption of tech [into health care] is a good thing.” Christodoulakis’ U of T-based research reflects this: she found that in Canada, about seven per cent of tests are ordered because practitioners are unaware of already relevant results. A central database of EMRs that is used and updated consistently would solve this problem. The benefits of EMRs include improved speed of finding records, prevention of handwriting illegibility, aid in the early identification of diseases, assistance in targeting services based on risk, help with long-term monitoring of patients, and improved immunization consistency.

Hospitals and smaller family practices have been slowly and irregularly integrating EMRs for the past 30 years. Most of these earlier databases were designed by software engineers with little input from medical professionals. This meant that their software was not functional for practitioners — sometimes queries were too rigid or irrelevant information was readily displayed while critical information was hard to find. According to Christodoulakis, “some physicians reported that they sometimes stop using EMRs because hunting for menus and buttons disrupts the clinical encounter and hinders doctor-patient interaction.”

At present, software packages from different manufacturers seldom work together. Mamdani explained that “often patient records have to be printed out and delivered by mail.” This slows down the treatment process and further clogs the system. This lack of electronic communication also exists within institutions, where medical professionals print records for hand delivery. The poor integration of software and communication often opens the door for third-party organizations to perform patchwork to mend discontinuous records together, as is the case with Alberta Netcare and ConnectingOntario. But it is important to note that privatizing health care record management can carry serious consequences for patients and the health care system as a whole.

Though records are currently scattered among hard copies and various software, it is possible to unite the system. As Christodoulakis’ research notes, adopting or changing EMR systems requires “training, maintenance, IT support, system upgrade and data storage, governance and migration costs,” often too expensive a barrier for small and medium-sized institutions. Based on an estimate from 2010, the financial cost equates to $10 billion. But integration of an efficient database of medical records is just the tip of the iceberg.

Addressing the divide

According to Hamada, “health care providers have been in many ways slow to adapt to the technological boom.” He explained, “This is in part due to our education, which is lacking in any content regarding technological innovation and also the lack of foresight in the institutions that we work for.” Hamada’s workplace has not adopted EMRs, seldom uses software beyond email, and the state-of-the-art equipment he uses runs on an operating system that has not been supported since 2014.

For Hamada, adapting to changing tech is easy. But at his workplace, a recent change in the process of ordering porter services, or facility managers, continues to confuse many despite having support hotlines available throughout their upgrade. Mamdani and Christodoulakis both confirmed that some health care professionals are resistant to the technology making its debut in the health care system.

This is in part because people dislike change and re-learning concepts, but also due to a lack of transparency in data use. Hamada reports that at his workplace, data is collected but its use is a mystery. “In order for nurses to see data as a positive thing, there needs to be greater transparency and involvement around changes made based on evidence,” he said.

Mamdani, a renowned leader in health care, has emphasized facilitating communication between disciplines throughout his career. He integrates tech, economics, and data science into his team, and advocates for strong leaders to continue to bridge the technological gap. He believes that this systemic divide will continue to exist until teams learn to find a common language and talk to each other.

Mamdani’s team includes a few data scientists who work closely with health care professionals to build a data-friendly culture. Their research has been able to predict, with 80 per cent accuracy, the length of patient stays. Data science facilitates communication with the whole team and allows a more unified progression for the patient’s care. His team has also been able to predict trends in staffing, which saves approximately $200 million for St. Michael’s Hospital and could save up to $800 million for others.

Technological change, along with all of its benefits, comes with a very real cost. In Hamada’s workplace, the technology remains in the shadows because qualified health care professionals excel at what they are best at — taking care of people. The numbers show that Canadian health care is effective, even without consistent EMRs or databases that communicate. The cost of tech disturbs that status quo. But a centralized database would likely reduce redundancies in health care and improve efficiency. Advanced analytics has the strong potential to push our health care system to better look after us, especially as our population ages.

Improving outcomes and better integrating the health care system into the digital world is an important pursuit — but it must be checked with an emphasis on people and care over all else. In an ideal application, technology would and should improve our ability to take care of one another.

The Varsity has reached out to Campus Health Services, which declined the interview request, as well as the Gerstein Crisis Centre.

Free pharmacare — if you’re younger than 25

Is the new OHIP+ program really a step in the right direction?

Free pharmacare — if you’re younger than 25

If you were to ask random passersby for examples of distinctly Canadian things, you would be sure to collect an eclectic mish-mash of responses. These would likely be topped by maple syrup and hockey, perhaps with an honourable mention of colourful money and the CN Tower. Among these answers would likely be our universal healthcare system.

Given that nearly all developed nations, with the noticeable exception of the US, have adopted some form of free, accessible, universal healthcare, it may be considered odd that Canadians take such pride in a system that is not unique to them.

Statistics Canada reported in its 2013 General Social Survey that our health care system was our second greatest source of national pride, tied with Canada’s armed forces, with 64 per cent of Canadians polled reporting being proud of it.

Yet, despite the lavish praise, Canada’s national health care system lacks what many systems in other developed countries have: a subsidized prescription drug program.

Approximately one in 10 Canadians are forced to forego prescribed medication due to financial difficulties. Such difficulties are one of the many issues that the Government of Ontario chose to tackle in its 2017 budget with the introduction of the new OHIP+ program.

Having come into effect on January 1 of this year, OHIP+ provides more than 4,400 medications — that were only partially covered by the existing Ontario Drug Benefit plan — free of charge to anyone under the age of 25 in Ontario with a health card number.

“Young people aged 19-24 are less likely to have access to prescription drug coverage or the financial means to pay out-of-pocket due to higher unemployment and lower incomes,” wrote David Jensen from the Ministry of Health and Long Term Care’s Communications and Marketing Division. “The unemployment rate for youth (aged 15-24) in Ontario is almost three times higher than the unemployment rate for adults over the age of 25.”

Dr. Danielle Martin of U of T’s Institute of Health Policy, Management, and Evaluation and the university’s School of Public Policy and Governance sees OHIP+ as a step forward for the province.

“The introduction of OHIP+ is an amazing accomplishment for young people and their families in Ontario. Doctors often see families in our offices who cannot afford to pay for their prescription medicines, and sometimes those medicines are lifesaving or critical to a child or youth’s quality of life,” explained Martin.

Martin is one of the authors of the Pharmacare 2020 report, which calls for universal national coverage of some medications, and she has defended single-payer health care systems before the US Senate.

She made it clear, though, that this program is just the first step. “Covering prescription medicines for people up to age 25 is a critical step on the road to universal pharmacare in Canada, and it will make a big difference for a lot of people. Now we just need to close the gap between ages 25 and 65.”

Painting OHIP+ as the best step toward a universal pharmacare program is not the most accurate depiction. A recent Parliamentary Budget Officer report shows that introducing a fully universal program right off the bat would in fact be cheaper than OHIP+ in the long-term.

This has prompted some criticism of OHIP+. U of T’s Dr. Jessica Ross is among its critics, stating that “OHIP+ is a small step forward, but not a smart one” in an opinion piece published by the Toronto Star. Instead, Ross supports the adoption of free pharmacare for Ontarians of all ages.

There are also concerns about how the province will pay for OHIP+ — with a $465 million price tag, the expansion will not come cheap.

Despite being included in what the Liberal Party describes as a balanced budget, the $465 million figure is dubious, as a breakdown is not included in the budget document itself. This caused Ontario New Democratic Party leader Andrea Horwath to postulate that the expansion was a last-minute addition to the budget.

Regardless, the reception among some U of T students has been warm. “OHIP+ is a net positive for students everywhere,” said UTSU Vice-President Internal Daman Singh. “We expect it to complement the UTSU plan, and we don’t foresee any negative impact.”

The more cynical among us may wonder about the timing of the expansion. It is not out of line to think that the introduction of OHIP+, in conjunction with the minimum wage hike and recently improved OSAP benefits, is a play by the Liberals to woo young voters before the upcoming provincial election this summer.

How effective is this move? Only time — and the ballot boxes — will tell.