Commentary: Minding the Gap in Access to Mental Health Services - Calling for Smart Funding, Not Just More Funding.

In response to the paper by Gatov and colleagues (2023), the authors of this commentary, both psychiatrists, consider ways of addressing long-standing gaps in access to mental health services in Canada. They note the innovation seen during the COVID-19 pandemic with the rise of virtual care because of viral threat and economic imperative. Drawing on examples, including the UK-based experiment with publicly funded psychotherapy, they discuss the need for more flexible provider models of care (read: non-physician), better data collection and the potential of artificial intelligence.

Magnetic seizure therapy (MST) for major depressive disorder.

Electroconvulsive therapy (ECT) is effective for major depressive disorder (MDD) but its effects on memory limit its widespread use. Magnetic seizure therapy (MST) is a potential alternative to ECT that may not adversely affect memory. In the current trial, consecutive patients with MDD consented to receive MST applied over the prefrontal cortex according to an open-label protocol.

Electroconvulsive therapy for depression with comorbid borderline personality disorder or post-traumatic stress disorder: A matched retrospective cohort study.

Background: The impact of comorbid borderline personality disorder (BPD) or post-traumatic stress disorder (PTSD) on clinical and cognitive outcomes of electroconvulsive therapy (ECT) in patients with major depressive episodes (MDE) is unknown.

Objective: Compare clinical response and adverse cognitive effects for MDE patients with comorbid BPD or PTSD to MDE only.

Methods: In a matched retrospective cohort study of 75 patients treated with ECT at an academic psychiatric hospital with DSM-IV MDE and either comorbid BPD, PTSD or both (MDE + BPD/PTSD), 75 MDE patients without BPD or PTSD (MDE-only) were matched.

Moving Out of the Office: Removing Barriers to Access to Psychiatrists.

Our paper offers a perspective on barriers to access to psychiatric care. Research shows that access depends not simply on the total number of trained specialists but also on their kind of practice. In some large cities, some practitioners follow a small number of patients in long-term psychotherapy, a practice supported by government insurance, which places no limits on the number of sessions or treatment duration.

Universal coverage without universal access: a study of psychiatrist supply and practice patterns in Ontario.

Background: We studied the relationships among psychiatrist supply, practice patterns, and access to psychiatrists in Ontario Local Health Integration Networks (LHINs) with differing levels of psychiatrist supply.

Methods: We analyzed practice patterns of full-time psychiatrists (n = 1379) and postdischarge care to patients who had been admitted to hospital for psychiatric care, according to LHIN psychiatrist supply in 2009. We measured the characteristics of psychiatrists' patient panels, including sociodemographic characteristics, outpatient panel size, number of new patients, inpatient and outpatient visits per psychiatrist, and percentages of psychiatrists seeing fewer than 40 and fewer than 100 unique patients.

Mental Health Commissions: making the critical difference to the development and reform of mental health services.

Purpose Of Review: Several Mental Health Commissions (MHCs) have emerged in developed countries over recent years, often in connection with mental health reform strategies. It is timely to consider the types of MHC which exist in different countries, their characteristics which may contribute to making them more effective, and any possible limitations and concerns raised about them.

Recent Findings: The emerging literature on MHCs indicates, particularly with the wider types of MHCs, that they may contribute to the substantial enhancement of mental health resources and sustainability of services; mental health reform is much more likely to be implemented properly with an independent monitor such as a MHC which has official influence at the highest levels of government; and they can encourage, champion and monitor the transformation of services into more evidence-based, community-centred, recovery-oriented, consumer, family and human rights-focused mental health services.

Weekend prescribing practices and subsequent seclusion and restraint in a psychiatric inpatient setting.

Objective: This case-control study examined the role of early medication management in preventing seclusion and restraint.

Methods: Data were extracted from the medical records, including whether standing medication was increased, decreased, or left unchanged during the first 48 hours of hospitalization.

Results: Compared with inpatients who did not experience seclusion or restraint (N=39), those who did (N=39) were younger (p=.

Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak.

Objective: This study aimed to determine the incidence of psychiatric disorders among health care workers in Toronto in the one- to two-year period after the 2003 outbreak of severe acute respiratory syndrome (SARS) and to test predicted risk factors.

Methods: New-onset episodes of psychiatric disorders were assessed among 139 health care workers by using the Structured Clinical Interview for DSM-IV and the Clinician-Administered PTSD Scale. Past history of psychiatric illness, years of health care experience, and the perception of adequate training and support were tested as predictors of the incidence of new-onset episodes of psychiatric disorders after the SARS outbreak.

Community treatment orders in Toronto: the emerging data.

Objective: Over a 4-year period in Toronto, this study aimed to compare individuals on a community treatment order (CTO) with individuals not on a CTO in terms of sociodemographic and clinical variables, hospital use, and continued engagement with health services on exit from the case management program. Hospital stay reductions from preadmission into the program to various postadmission periods were compared across the 2 groups.

Methods: Descriptive statistics and tests of statistical significance (chi-square and t test) were run on regularly collected administrative data for both groups.