Transcript: Solving the Problems in Mental Health | May 04, 2021

Steve sits in a room with white walls, a low slanted ceiling and several framed pictures on the walls including one of George Drew and one of Walter Kronkite. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a pale blue shirt and a black tie.

A caption on screen reads "Solving the problems in mental health care. @spaikin, @theagenda."

Steve says PEOPLE COPING WITH MENTAL ILLNESS OFTEN ENCOUNTER SERIOUS OBSTACLES TO ACCESSING THE RIGHT TREATMENT IN A TIMELY FASHION. LONG-TIME MENTAL HEALTH LEADER DR. DAVID GOLDBLOOM KNOWS THAT PROBLEM BETTER THAN MOST, AND HIS NEW BOOK OFFERS SOLUTIONS. IT'S CALLED, "WE CAN DO BETTER: URGENT INNOVATIONS TO IMPROVE MENTAL HEALTH ACCESS AND CARE." HE IS SENIOR MEDICAL ADVISOR AT CAMH, THE CENTRE FOR ADDICTION AND MENTAL HEALTH, AND A PROFESSOR OF PSYCHIATRY AT THE UNIVERSITY OF TORONTO.

David is in his late fifties, clean-shaven, with wavy white hair. He's wearing a gray suit and a pink shirt.
A picture of his book appears briefly on screen. The cover is pale blue and white, with drawings of clouds.

Steve continues HE JOINS US NOW FROM LIKE AN INCREDIBLY BEAUTIFUL OFFICE SOMEWHERE IN... WHERE ARE YOU ANYWAY, DR. GOLDBLOOM?

David says I'M IN MY BAT CAVE IN MIDTOWN TORONTO WHERE I'VE BEEN FOR MUCH OF THE LAST YEAR AND A BIT.

Steve says I CERTAINLY GET THAT. JUST BEFORE WE DIVE IN HERE. IT OCCURRED TO ME THAT THERE ARE ACTUALLY FOUR DIFFERENT WAYS OF SAYING THE TITLE OF YOUR BOOK. "WE CAN DO BETTER." "WE CAN DO BETTER. "WE CAN DO BETTER." OR "WE CAN DO BETTER." AND THEY ALL MEAN I THINK SOMETHING SUBTLETY DIFFERENT. WHERE DO YOU THINK THE EMPHASIS SHOULD BE IN THAT TITLE?

The caption changes to "David Goldbloom. Author, 'We can do better.' Centre for Addiction and Mental Healt."

David says I ACTUALLY THINK IT GOES ON ALL FOUR WORDS, AND LET ME EXPLAIN WHY I THINK THAT'S THE CASE. YOU KNOW, THERE'S A VERY FUNNY VIDEO CLIP OF DIFFERENT ACTORS SAYING "TO BE OR NOT TO BE." FAMOUS ACTORS WHO HAVE ALL PLAYED HAMLET. AND EACH OF THEM EMPHASIZES A DIFFERENT WORD AND THE MEANING SHIFTS. I WOULD PUT THE EMPHASIS ON "WE," BECAUSE THIS IS INDEED ABOUT ALL OF US. "CAN" BECAUSE IT'S FEASIBLE, AND THAT SHOULD INSPIRE HOPE. "DO" BECAUSE ACTION IS INVOLVED. AND "BETTER" IS BECAUSE THE STATUS QUO IS UNACCEPTABLE. SO WITHOUT WISHING TO DODGE YOUR QUESTION, STEVE, THE EMPHASIS IS ON ALL FOUR WORDS.

Steve says NO, I THINK THAT MAKES A LOT OF SENSE. I DO WANT TO TAKE YOU BACK JUST BRIEFLY ABOUT 8 YEARS AGO, WE DID A NUMBER OF PROGRAMS DOWN IN THE MARS DISCOVERY DISTRICT IN DOWNTOWN TORONTO FEATURING AWARD-WINNING INNOVATIONS OUT OF THE HEALTH CARE SECTOR. MANY OF THOSE ARE IN YOUR BOOK. YOU DO TALK ABOUT THEM. AND THE YOUNG SCIENTISTS WE FEATURED THEN ARE NOW LEADERS IN THEIR RESPECTIVE FIELDS. BUT AFTER 8 YEARS, APPARENTLY THESE TREATMENTS ARE STILL NOT REALLY VERY WIDESPREAD IN THEIR USE. AND I WONDER IF YOU HAVE A THEORY AS TO WHY THAT IS.

David says WELL, YOU KNOW, THERE'S EVIDENCE THAT THE TIMELINE FROM DISCOVERY AND INNOVATION TO IMPLEMENTATION THROUGHOUT HEALTH CARE CAN BE AS LONG AS 17 YEARS, WHICH SEEMS UNFATHOMABLE EXCEPT THAT I WOULD SAY, NUMBER ONE, OLD HABITS DIE HARD. AND FOR ALL OF US AS HEALTH CARE PROVIDERS, WE LEARN TO DO THINGS A CERTAIN WAY AND THEN WE GET INTO OUR CLINICAL ROUTINES, AND LEARNING TO DO THINGS A VERY DIFFERENT WAY OR THINK ABOUT THINGS A DIFFERENT WAY IS A CHALLENGE FOR ALL OF US. THE DIFFERENCE NOW I THINK IS THAT IN THE CONTEXT OF THE PANDEMIC AND THE EMERGENCE OF A VACCINE WITHIN MONTHS, WHEREAS THE PREVIOUS RECORD FOR VACCINE DEVELOPMENT WAS I THINK 8 YEARS, THERE IS AN EXPECTATION I THINK IN THE GENERAL PUBLIC THAT WE NEED TO DO THINGS FASTER. AND I THINK ONE OF THE BENEFITS, IF YOU'RE LOOKING FOR SILVER LININGS AROUND THE HORROR OF THE PANDEMIC, IS THAT THE PUBLIC IS GOING TO TURN UP THE HEAT ON EXPECTING BETTER THINGS.

Steve says DO YOU NOT FIND IT PASSING STRANGE, THOUGH, THAT ARE OTHER COUNTRIES IN THE WORLD THAT ARE USING OUR TECHNIQUES EVEN MORE BROADLY THAN WE ARE?

David says IT IS ALWAYS A LITTLE STRANGE. BUT, YOU KNOW, MY EXPERIENCE OF GOING TO OTHER COUNTRIES IS THAT THERE ARE THINGS WE'RE DOING IN CANADA THAT THEY'RE ENVIOUS OF AND WE'RE ENVIOUS OF THINGS GOING ON ELSEWHERE. SO, YOU KNOW, IT ALL COMES OUT IN THE WASH, I GUESS. BUT WHEN YOU'RE LIVING HERE AND LOOKING AT THE LANDSCAPE INTERNATIONALLY, YOU DO ASK, WELL, WHY CAN'T WE DO THAT HERE?

Steve says LET'S DIVE IN AND READ AN EXCERPT FROM THE BOOK NOW AS WE CONTINUE OUR CONVERSATION AND I'LL ASK TONY BURKE, WHO IS HELPING US OUT TODAY WITH THE BUTTONS, TO PUT UP THIS EXCERPT. CURRENTLY, YOU WRITE...

A quote appears on screen, under the title "Simpler interventions." The quote reads "Currently, there is little logic in who gets what kind of help; it can be more a reflection of where you live, how much money you have, or who you know. Some people end up getting no help at all, while others use highly specialized resources when a simpler intervention could work. In fact, this isn't just an issue for mental health care; it's about how we approach health in general."
Quoted from David Goldbloom, "We can do better." 2021.

Steve says YOU POINT OUT THAT WE SEEM TO BE STUCK IN A MODEL OF MENTAL HEALTH CARE DELIVERY WHERE PEOPLE MAY BE, FOR EXAMPLE, TREATED FOR A LONGER PERIOD OF TIME THAN THEY NEED TO BE. WHY DOES THAT HAPPEN?

David says WELL, I THINK IT HAPPENS BECAUSE PEOPLE GET INTO A GROOVE... LET ME BE CLEAR. THERE ARE SOME PEOPLE WHO DO NEED LONG-TERM TREATMENT, AND I WOULD INCLUDE SOME OF MY PATIENTS IN THAT CLUSTER OF PEOPLE WHO NEED LONG-TERM TREATMENT, WHO ARE DEALING WITH CHRONIC ILLNESS, AND FOR WHOM A BRIEF INTERVENTION IS NOT GOING TO MAKE A DIFFERENCE. BUT THERE'S ALSO THE REALITY THAT WE GET COMFORTABLE IN OUR RELATIONSHIPS WITH OUR PATIENTS AND VICE VERSA, AND THAT MAY LEAD TO A CONTINUATION OF TREATMENT WHEN PEOPLE ARE ALREADY ON THE FLATTER PART OF THE CURVE. THAT THE INITIAL BENEFITS HAVE BEEN A STEEP RISE, AND THEN THINGS CONTINUE. AND WHEN THAT HAPPENS, THERE ARE OPPORTUNITY COSTS. AND THE OPPORTUNITY COSTS ARE, GIVEN THE FINITE NUMBER OF PROVIDERS WE HAVE, THAT THERE ARE OTHER PEOPLE ON THE OUTSIDE WHO ARE NOT GETTING IN.

Steve says DO YOU THINK THAT MOST OF YOUR COLLEAGUES KNOW WHEN SHORTER-TERM TREATMENT IS PREFERABLE?

The caption changes to "David Goldbloom, @CAMHnews."

David says I THINK SO. AND I THINK THAT THERE HAS BEEN A PUSH TO RECOGNIZE OUR RESPONSIBILITY TO MEET NEED. THE NEED IS SO PALPABLE. AND THE CALLING OUT FOR HELP SO MUCH MORE PUBLIC AND LOUD THAN IT USED TO BE. BUT I THINK MOST PEOPLE HAVE A REAL SENSE OF URGENCY, AS CLINICIANS, ABOUT TRYING TO HELP PEOPLE AS MUCH AS... AS MANY PEOPLE AS POSSIBLE AND ALSO LOOKING AT WHAT'S THE SHORTER-TERM INTERVENTION I CAN DO THAT WILL MAKE A PALPABLE DIFFERENCE?

Steve says WE KNOW, EVEN BEFORE THE PANDEMIC STARTED, OF COURSE, THAT DEPRESSION WAS FAR TOO PERVASIVE IN OUR SOCIETY, AND IT HAS ONLY GOTTEN WORSE DURING THE COURSE OF THE LAST 14 MONTHS. THERE ARE MANY MEDICATIONS TO TREAT IT. BUT FINDING SORT OF THE RIGHT MIX FOR THE RIGHT PEOPLE AT THE RIGHT TIME HAS ALWAYS PROVED PROBLEMATIC FOR MANY, MANY PEOPLE.

David says RIGHT.

Steve says ARE WE GETTING BETTER AT THAT?

The caption changes to "For more stories and information: TVO.org/MentalHealthWeek."

David says I THINK WE'RE GETTING BETTER, ALTHOUGH WE HAVE NOT ELIMINATED THE TRIAL AND ERROR THAT GOVERNS OUR SELECTION, FOR INSTANCE, OF AN ANTIDEPRESSANT. WE TRY TO PREDICT, BASED ON SIDE EFFECTS PROFILE OR WHETHER THAT PERSON HAS BENEFITTED PREVIOUSLY FROM A PARTICULAR ANTIDEPRESSANT OR SOMEONE ELSE IN THEIR FAMILY HAS. BUT I THINK ONE OF THE NEWER INNOVATIONS HAS BEEN THE USE OF PHARMACO GENETICS, WHICH IS LOOKING AT PEOPLE'S GENETIC PROFILES AND TRYING TO FIGURE OUT FROM THAT WHICH ANTIDEPRESSANT THEY MIGHT BEST TOLERATE OR RESPOND TO, AND THUS MAYBE ELIMINATE SOME OF THE STEPS IN THE PROCESS AND SOME OF THE COST AND SOME OF THE DELAY AND SOME OF THE SUFFERING.

Steve says UNDERSTOOD. LET'S PLUCK ANOTHER EXCERPT OUT OF THE BOOK AND I'LL GET YOU TO COMMENT ON THIS AS WELL. TONY, IF YOU WOULD?

Another quote from David's book appears on screen, under the title "The right entry point." The quote reads "Clinicians are very good at providing service to the people who come to see them, but less good at thinking about the people who don't come -and why they aren't seen. That makes sense. As clinicians, our first priority is understandably the person sitting inn front of us in our offices and clinics, not the invisible person who hasn't found the right door to enter."

Steve says OKAY. ALL WELL AND GOOD. BUT HOW DO... HOW DOES YOUR PROFESSION BEGIN TO THINK MORE EFFECTIVELY ABOUT THAT PERSON WHO HASN'T FIGURED OUT YET HOW TO GET INTO THAT DOOR?

David says RIGHT. AND THIS IS WHAT I WAS REFERRING TO EARLIER IN TERMS OF OPPORTUNITY COSTS, IN TERMS OF PEOPLE NOT GETTING ACCESS. THERE ARE A NUMBER OF WAYS THAT WE CAN CREATE MORE DOORS. AND SOME OF THEM ARE PHYSICAL. AND SOME OF THEM ARE VIRTUAL. IN TERMS OF PHYSICAL DOORS, ONE OF THE STRIKING CHANGES OVER THE LAST SEVERAL YEARS IN CANADA HAS BEEN THE EMERGENCE OF INTEGRATED YOUTH SERVICES. WE'RE ALL TOO FAMILIAR WITH THE DELAYS THAT A NUMBER OF YOUNG PEOPLE FACE IN ACCESSING MENTAL HEALTH CARE. AND WHEN THOSE DELAYS ARE MEASURED IN MONTHS OR EVEN YEARS AGAINST THE DENOMINATOR OF HOW YOUNG SOMEONE IS, THEY REALLY BECOME UNCONSCIONABLE DELAYS. THE DEVELOPMENT OF INTEGRATED YOUTH SERVICES THAT ARE COMMUNITY-BASED, THAT ARE NOT APPOINTMENT-BASED, THAT ARE WALK-IN, THAT ARE PLACES WHERE YOUR INITIAL ASSESSMENT HAPPENS NOT WITHIN MONTHS BUT WITHIN HOURS, MEANS THAT YOU'RE GOING TO BE ABLE TO REACH A LOT OF YOUNG PEOPLE WHO PREVIOUSLY MIGHT NOT HAVE BEEN ENGAGED BY THE TRADITIONAL SYSTEM. AND WE ALREADY HAVE EVIDENCE EMERGING FROM THE RESEARCH BEING DONE IN CANADA THAT WE'RE REACHING SOME OF THOSE YOUTH WHO MIGHT OTHERWISE FEEL MARGINALIZED OR EXCLUDED. SO THAT'S A PHYSICAL EXAMPLE. BUT THEN THERE'S THE VIRTUAL WORLD. AND AGAIN THE HEAT WAS TURNED UP BY COVID. AND MAKING HEALTH CARE AVAILABLE VIRTUALLY IN A MEANINGFUL WAY IS PART OF THAT SOLUTION AS WELL.

Steve says LET ME FOLLOW UP ON THIS ANGLE OF YOUNGER PEOPLE AND HOW THEY CAN GET IN, BECAUSE OF COURSE FAR TOO MANY OF THEM END UP GETTING INTO THE SYSTEM BECAUSE THEY'RE IN CRISIS AND THEY END UP GOING TO AN EMERGENCY DEPARTMENT AT A HOSPITAL. YOU TALK ABOUT AN ORGANIZATION CALLED THE STRONGEST FAMILIES INSTITUTE WHICH IS IN NOVA SCOTIA. MAYBE YOU COULD HELP US UNDERSTAND HOW THEY GO ABOUT TREATING KIDS?

David says WELL, ONE OF THE GREAT THINGS ABOUT THE STRONGEST FAMILIES INSTITUTE, WHICH HAS BEEN AROUND FOR A WHILE, IS THAT IT'S A TELEPHONE-BASED SERVICE, THAT IT USES COUNSELLORS WHO ARE NOT FROM THE TRADITIONAL STOCK OF COUNSELLORS. THEY ARE PEOPLE OFTEN WITH AN UNDERGRADUATE DEGREE WHO ARE CAREFULLY COACHED, TRAINED, AND SUPERVISED TO DELIVER CARE TO ENTIRE FAMILIES, AND THEY REALLY DELIVER IT FROM A CALL CENTRE. AND THEY DELIVER IT IN THE EVENINGS, WHEN FAMILIES ARE MOST LIKELY TO BE TOGETHER, WHICH IS A SIGNIFICANT SHIFT FROM THE 9-TO-5 WEEKDAY WORLD OF MENTAL HEALTH DELIVERY WHICH IS FOCUSED MUCH MORE ON A PATIENT- AND FAMILY-CENTERED PERSPECTIVE, AND THEY CAN MAKE A REAL DIFFERENCE WORKING WITH FAMILIES OF YOUNG CHILDREN WITH ATTENTIONAL PROBLEMS, BEHAVIOURAL PROBLEMS, WORKING WITH THE WHOLE FAMILY IN THE EVENINGS AND VIA SOMETHING AS TECHNOLOGICALLY LOW-TECH AS A TELEPHONE.

Steve says LET ME BRING YOU BACK TO THE PROVINCE OF ONTARIO. HOW WELL DO YOU THINK WE DO HERE AT DEALING WITH THIS AGE OF CLIENTELE?

David says WELL, YOU'D BE BETTER TO ASK THE PARENTS OF KIDS WHO ARE STRUGGLING. AND THEY WILL TELL YOU: NOT WELL ENOUGH. NOT GOOD ENOUGH. AND WE'VE GOT SOME SIGNIFICANT FAMILY ORGANIZATIONS WHO HAVE BEEN BEATING THE DRUM, APPROPRIATELY, TO TRY TO RAISE MORE ATTENTION, MORE FUNDING, MORE RESOURCE SO THAT YOUNG PEOPLE GET THE HELP WE NEED... OR THEY NEED. SO THERE IS FORTUNATELY HUGE ROOM FOR GROWTH, ALTHOUGH THAT'S ALSO UNFORTUNATE.

Steve says I DON'T KNOW IF THERE'S A TURF WAR GOING ON HERE, BUT MAYBE YOU CAN HELP US UNDERSTAND THAT. BECAUSE OF COURSE IF YOU NEED MENTAL HEALTH SERVICES, THERE ARE SOCIAL WORKERS, THERE ARE PSYCHOLOGISTS, THERE ARE FAMILY DOCTORS... NOT JUST PEOPLE WHO ARE, IF I CAN PUT IT THIS WAY, AT THE TOP OF THE FOOD CHAIN, WHICH IS WHERE YOU ARE. AND I WONDER WHETHER YOUR PROFESSION IS AT THE POINT WHERE IT'S PREPARED TO SORT OF LOOSEN THE REINS ENOUGH TO ENSURE THAT THERE IS A BROADER ROLE FOR MORE PEOPLE WHO CAN PROVIDE MORE HELP?

David says IF WE LOOK AT SOME OF THE MOST SUCCESSFUL INTERVENTIONS AROUND IMPROVING ACCESS TO HEALTH, IT'S OFTEN BEEN BY CREATING A WHOLE NEW CADRE OF MENTAL HEALTH PROVIDERS. THE HUGE EXPERIMENT IN ENGLAND TO IMPROVE ACCESS TO PSYCHOLOGICAL THERAPIES DIDN'T RELY ON TRADITIONAL RESOURCES BUT TRAINED UP A WHOLE NEW GROUP OF PEOPLE IN VERY SPECIFIC PSYCHOTHERAPY SKILLS AND MADE THOSE RESOURCES AVAILABLE TO THE PUBLIC. IN TERMS OF GUILD CONCERNS, THAT SOMEHOW WE WOULD BE LOSING PATIENTS OR CLIENTS, THERE IS SO MUCH WORK TO GO AROUND. NOBODY IS GOING TO GO HUNGRY LOOKING FOR PEOPLE TO HELP.

Steve says CAN I JUST DO A FOLLOW-UP ON THE U.K. EXAMPLE, BECAUSE THAT'S INTERESTING. I LEARNED FROM YOUR BOOK THAT YOU DON'T NEED A REFERRAL FROM A GENERAL PRACTITIONER TO GET INTO THE SYSTEM IN THE U.K. YOU CAN JUST... YOU CAN REFER YOURSELF. HOW DOES THAT WORK? BECAUSE I GUESS IT'S DIFFERENT FROM THE WAY WE DO IT HERE.

David says IT'S VERY DIFFERENT. I MEAN, OUR SYSTEM TRADITIONALLY, IN TERMS OF ACCESS TO PUBLICLY FUNDED CARE... AND I WANT TO EMPHASIZE THAT THE IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES IN THE U.K. IS PUBLICLY FUNDED THROUGH THE NATIONAL HEALTH SERVICE. IN CANADA, IF YOU WANT TO GO THAT ROUTE, YOU TYPICALLY GO THROUGH OUR FAMILY PHYSICIAN OR NURSE PRACTITIONER WHO IS THE QUARTERBACK, OVERSEEING YOUR HEALTH. SO THIS WAS A BIG SHIFT TO DO THIS THE WAY THEY DID IT IN THE U.K. BUT IT HAS WORKED OUT VERY WELL. AND THE PEOPLE WHO SELF-REFER ARE PEOPLE WHO ARE GENUINELY IN NEED. WE HAVE, YOU KNOW, THE BEGINNINGS OF SOME OF THAT IN CANADA. RIGHT NOW IN ONTARIO, ONTARIANS CAN SELF-REFER FOR WEB-DELIVERED THERAPIST-GUIDED COGNITIVE BEHAVIOURAL THERAPY, WHICH THE PROVINCE HAS MADE AVAILABLE FOR FREE TO CITIZENS OF ONTARIO.

Steve says HOW EFFECTIVE DO YOU THINK THAT IS, PARTICULARLY AT A TIME WHERE MANY OF US ARE NOT REALLY ALLOWED OUT OF THE HOUSE THESE DAYS?

David says WELL, THE BEAUTY OF DOING IT IS IT'S ALL DONE THROUGH YOUR COMPUTER. SO IF YOU WERE LOOKING FOR AN INTERVENTION THAT WAS TAILORED TO THE RESTRICTIONS OF THE PANDEMIC, IT WOULD IN FACT BE INTERNET-DELIVERED COGNITIVE BEHAVIOURAL THERAPY. AND IN TERMS OF EFFECTIVENESS, RECENT STUDIES IN THE LITERATURE HAVE SHOWN THAT IT IS AS EFFECTIVE AS OUR TRADITIONAL FACE-TO-FACE DELIVERED COGNITIVE BEHAVIOURAL THERAPY.

Steve says LET'S GO A LITTLE FURTHER DOWN THIS ROAD HERE. MENTAL HEALTH APPS. HOW EFFECTIVE CAN THEY BE?

David says WELL, THE APPS WORLD IS EXPLODING. AND, YOU KNOW, ONE OF THE BEAUTIES OF APPS IS THAT, AS OPPOSED TO YOUR THERAPIST, THEY'RE ALWAYS AVAILABLE. AND WHEN YOU USE THEM, THEY'RE ALWAYS THINKING ABOUT YOU AND RESPONDING TO YOU. A NUMBER OF APPS HAVE BEEN DEVELOPED IN INDIA, IN THE UNITED STATES, AND ALSO IN CANADA TO TRY TO IMPROVE ACCESS TO SOME PRETTY FUNDAMENTAL PSYCHOTHERAPY. AND ONE OF THE THINGS THAT'S STRIKING ABOUT SOME OF THESE APPS IS THAT THEY LEVERAGE THE POWER OF ARTIFICIAL INTELLIGENCE SO THAT THE APPS LEARN ABOUT YOU AND ALSO REMEMBER THINGS ABOUT YOU. THAT SOME OF US HUMANS MIGHT OTHERWISE FORGET FROM TIME TO TIME. SO I THINK THAT THERE IS HUGE POTENTIAL HERE. THE EVALUATION OF APPS HAS LAGGED BEHIND THEIR DEVELOPMENT AND DISSEMINATION, AND THERE'S A BIT OF CATCH-UP GOING ON, AND UNDERSTANDABLY THERE ARE ALSO CONCERNS ABOUT PRIVACY THAT NEED TO BE ADDRESSED WITH THE USE OF APPS AS WE BELATEDLY DISCOVERED WITH FACEBOOK AND OTHER FORMS OF ONLINE INTERACTION.

Steve says I BET, THOUGH, THAT WHEN YOU GOT INTO THIS PROFESSION, HOWEVER MANY YEARS AGO IT WAS, YOU PROBABLY SAID TO YOURSELF AT THE TIME, TORONTO AT LEAST THANKFULLY I'M IN ONE THOSE PROFESSIONS THAT WILL NOT BE REPLACED BY MACHINES. BECAUSE WHAT I DO IS SO UTTERLY PERSONAL AND UNIQUE IN EACH CASE YOU COULD NEVER BE REPLACED IN THAT WAY. THAT MAY NOT BE TRUE ANYMORE; IS THAT FAIR TO SAY?

David says I DON'T THINK THAT IS FAIR TO SAY. I THINK WHAT HAPPENS IS IT WILL REDEFINE WHAT WE DO AT A HUMAN LEVEL, AND, YOU KNOW, THERE HAVE BEEN ALL KINDS OF INNOVATIONS THROUGHOUT HEALTH CARE WHERE MACHINES CAN DO THINGS THAT HUMANS USED TO HAVE TO DO. ELECTROCARDIOGRAMS THAT MEASURE YOUR HEART RHYTHM USED TO BE SIMPLY A PRINTOUT THAT A HUMAN HAD TO INTERPRET. NOW THE PRINTOUT COMES WITH AN INTERPRETATION. BUT THEN THE HUMAN CARDIOLOGIST READING THAT INTERPRETATION HAS TO APPLY IT TO THE BACKDROP OF THE INDIVIDUAL, THE PHYSICAL EXAM, AND THE CLINICAL REALITY. SO THESE ARE TOOLS THAT ALLOW US TO BE I THINK A LITTLE MORE REFINED IN WHAT WE DO AS HUMANS. THEY DON'T REPLACE US.

Steve says ALL RIGHT. IN OUR LAST FEW MOMENTS HERE, LET'S LOOK VERY SPECIFICALLY AT THE PANDEMIC. WE ARE LEARNING ALL SORTS OF NEW THINGS ABOUT THE KINDS OF MENTAL HEALTH TREATMENTS THAT ARE POSSIBLE DURING THE COURSE OF A PANDEMIC THAT WE MIGHT NOT HAVE DISCOVERED HAD THIS NOT HAPPENED. I WONDER HOW YOU THINK IN THE LONG RUN IT WILL... IT WILL AFFECT OR CHANGE THE MENTAL HEALTH CARE SYSTEM IN THIS PROVINCE AND HOW IT WILL DEAL WITH OUR NEEDS GOING FORWARD.

David says WELL, LOOK. ONE OF THE BIG CHANGES FOR ME AS A PSYCHIATRIST IS WORKING VIRTUALLY FOR THE LAST 15 MONTHS THROUGH TELEVIDEO. AND I USED TO DO A LOT OF TELEVIDEO TO NORTHERN ONTARIO. BUT NOW I'M DOING IT TO DOWNTOWN TORONTO. AND IT IS FOR PATIENTS OFTEN A VERY POSITIVE EXPERIENCE, AND WE HAVE SURVEY DATA THAT SHOWS THAT. BUT IT'S ALSO ABOUT BRINGING CARE TO PEOPLE'S HOMES RATHER THAN PUTTING THE ONUS ON THEM TO COME DOWNTOWN OR TO TRAVEL OR TO GET CHILD CARE OR TO TAKE TIME OFF WORK. SO IN THAT RESPECT, IT CAN BE A LOT MORE PATIENT-CENTERED. AND THE GOVERNMENT MOVED TO FUND IT SO THAT PEOPLE LIKE ME ARE PAID FOR PROVIDING THIS KIND OF WORK. I THINK POST-PANDEMIC, THIS KIND OF VIRTUAL CARE IS HERE TO STAY IN THE MENU OF OPTIONS ABOUT HOW PEOPLE CHOOSE TO GET HELP.

Steve says WELL, THAT'S THE KEY QUESTION, ISN'T IT? BECAUSE IN MY CONVERSATIONS WITH PEOPLE INSIDE OHIP IN THE PAST, THEY'VE ALWAYS BEEN LEERY ABOUT GIVING DOCTORS THE RIGHT TO TREAT VIRTUALLY BECAUSE THEY WERE NEVER... YOU KNOW WHAT? LET'S BE BLUNT. THEY WERE NEVER REALLY SURE ABOUT HOW MUCH FRAUD WOULD GO ON IN THE SYSTEM AND PAYING DOCTORS FOR THINGS THAT NEVER ACTUALLY HAPPENED BECAUSE THERE WAS NO EXAMPLE OF A PATIENT WALKING THROUGH THE FRONT DOOR OF A CLINIC. HOW SURE ARE YOU THAT IN FACT THIS NEW OPTION OF VIRTUAL CARE IS GOING TO STICK AROUND POST-PANDEMIC?

David says WELL, LOOK. I'M NOT THE GUY PULLING THE LEVERS WITHIN THE GOVERNMENT ON THIS, BUT I THINK THAT THERE IS HUGE PUBLIC APPETITE FOR IT THAT DIDN'T EXIST PREVIOUSLY. AND AS FOR FRAUD, FRANKLY, YOU STILL HAVE TO WRITE A NOTE ON YOUR PATIENT, AND PEOPLE CAN ASK FOR THOSE NOTES AND THEY CAN INTERVIEW PEOPLE AND SAY, "DID YOU SEE DR. GOLDBLOOM ON THIS DAY?" AND THEY USED TO DO THAT WHEN IT WAS IN-PERSON VISITS AS WELL. FRAUDSTERS WILL ALWAYS FIND A WAY. BUT HONESTLY, I DON'T THINK MY COLLEAGUES ARE FRAUDSTERS TRYING TO BILK THE SYSTEM. WE'RE JUST TRYING TO BRING CARE TO PEOPLE WHO ARE CONSTRAINED BY THE EXIGENCIES OF THE PANDEMIC.

Steve says IN WHICH CASE, LET'S FINISH UP ON THIS: IS IT DIFFICULT TO REMAIN OPTIMISTIC ABOUT WHAT YOUR PROFESSION CAN DO IN THE FACE OF INCREDIBLY TRYING TIMES THAT PEOPLE ARE LIVING THROUGH RIGHT NOW?

David says NO, IT'S NOT DIFFICULT. AND I SAY THAT BECAUSE I HAVE THE GOOD FORTUNE OF KNOWING A LOT OF PEOPLE IN VARIOUS MENTAL HEALTH DISCIPLINES AND HOW DEDICATED THEY ARE TO PROVIDING PEOPLE WITH THE HELP THEY NEED. AND WE ALSO GET TO SEE THE REWARDS, RIGHT? WE GET TO SEE PEOPLE GET BETTER. AND THAT IS HUGELY MOTIVATING AND GALVANIZING.

The caption changes to "Producer: Sandra Gionas, @sandragionas."

Steve says YOU KNOW, I WANT TO MAKE SURE I SAY THE TITLE OF THE BOOK THE WAY YOU SAID IT WHEN I ASKED IT IN THE VERY FIRST QUESTION. LET ME TRY BY SAYING. WE CAN DO BETTER, EMPHASIS ON EACH INDIVIDUAL WORD BY DAVID GOLDBLOOM. THANKS A LOT FOR COMING ON "THE AGENDA" TONIGHT. SO MUCH GOOD INFORMATION IN THIS BOOK AND WE'RE GLAD YOU WROTE IT.

David says THANK YOU SO MUCH, STEVE.

Watch: Solving the Problems in Mental Health