Why Power Tends to Corrupt and why Absolute Power Corrupts Absolutely

Power tends to corrupt, and absolute power corrupts absolutely written by Lord Acton. He had observed that a person’s sense of morality lessens as his or her power increases. That quote pretty much defines how politics work. When one gets into power, one can change and be easily manipulated by the system. Power means the ability to do something or act in a particular way, especially as a faculty or quality. Mental health is one of the biggest challenges we face in Canada as not enough funds are available in healthcare to provide for everyone in need. Cost containment is the biggest barrier when it comes to mental health in our health care system. Cost containment is the capacity of a system to control expenditure. Canada only funds 70% publicly in the health care system (Fierlbeck K, 2011). We do not have enough psychiatrists, psychologists, councillors, etc., to treat everyone properly, and then some chose not to get treated. Some people do not have the funds to cover their expenses when it comes to mental health. It can cost hundreds of dollars to talk to a mental health specialist and or pay for meds.

According to Health Canada, at least 20% of Canadians will experience mental illness; the remaining 80% will be affected by mental illness in family members, friends, and colleagues. (Druss BG, Rosenheck RA, 2000). The Canadian Psychiatric Association states that at least 2/3 of all Canadians are touched by anxiety and depression. Estimated economic costs (health care costs and loss of work productivity) of mental illness in Canada was at least 7.3 billion in 1993 (Fierlbeck K, 2011). But, in the past decade is was more than $33 billion. By 2020, depression will be the single most expensive cause of lost workplace productivity due to disability. In 2000, more than 3 billion prescriptions were filled for psychiatric drugs in the US and Canada. Sadly, at least 4000 people will commit suicide in Canada this year (McLellan At, 2000).

.The World Health Organization definition states, “Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and can make a contribution to his or her community.” Canada is the only G8 country that does not have a mental health strategy. In August 2007, the prime minister announced the creation of the Mental Health Commission of Canada. That will commit $15 million a year. The commission has 3 strategic initiatives: developing a mental health strategy, combat stigma and discrimination, and promoting knowledge exchange. Family physicians are the initial contact for about 85% of people with mental health problems (McLellan At, 2000).

There is no explicit right in the Canadian Charter of Rights and Freedoms that there is no right to health care (Fierlbeck K, 2011). The Canadian Health Act only covers medically necessary, and provinces determine what is medically necessary. Since the establishment of the Charter in 1982, there have been very few successful challenges in health care challenges under the charter have focused on three specific rights: equal right (section 15), mobility rights (section 6), and rights to life, liberty, and security (section 7) (Fierlbeck K, 2011).’  Although they are likely to have worse physical health problems than the general population, persons with mental illness—severe mental illness—are less likely to use general, preventive and specialty healthcare services. Clinical experts now view substance misuse disorders as chronic diseases, which are often associated with various other side effects and consequences (e.g. kidney disease, diabetes and major depression). The Institute of Medicine report on Improving the Quality of Health Care for Mental Health and Substance Use Conditions noted the need for health care delivery to understand and respond to the interactions between mind/brain and body.

Primary care is seen as a focal point for integration, often being the first or only point of entry to the health care system for individuals with a host of mental and physical health problems (Fierlbeck K, 2011). Integration of mental health and addiction services into primary care is supported internationally as a strategy to improve access to person-centred mental health care. Several models have been proposed. In general, it suggests that persons with low mental health and substance use complexity/ risk be followed in the primary care system with specialty consultation accessed as needed. In contrast, individuals with high mental health and substance use and physical health complexity are served in the specialty mental health and substance use care system, coordinating primary care (Fierlbeck K, 2011).

To manage patient mental health and substance use needs in the primary care setting, the model suggests using standardized screening tools and the inclusion of a behavioural health provider to assist with assessment, treatment and care management. The primary care physician (PCP) and a psychiatrist or other mental health professional are concurrently involved in the patient’s treatment, but the PCP typically remains the ongoing health-care provider. There are several benefits associated with IC (Druss BG, Rosenheck RA, 2000). One is increased population access to mental health care. This is important because many individuals with mental health needs do not receive mental health services. PCPs are the most commonly contracted providers and often the only providers contacted for mental health care.17–19 In the United States and Canada, studies have found that PCPs are responsible for prescribing between 60 and 80% of psychotropic medications (Druss BG, Rosenheck RA, 2000).

The number of children on prescription drugs such as Prozac, Ritalin, and Risperdal tripled from 1987 to 1996. At one point in 1996, there was such a surge in the prescription Ritalin that the drug manufacturer could not make enough of the drug to meet the skyrocketing demand. Prescriptions for selective serotonin reuptake inhibitors (SSRIs) like Prozac, Paxil, Zoloft, Luvox, and others used to treat depression and anxiety increased by 62% older children and teenagers (Ambulatory Pediatrics, March/April 2002; 2). These drugs are used to control the symptoms and not the disease itself.  Zyprexa has been linked to a greater risk of developing sugar diabetes and is more likely to be obese (British Medical Journal, August 3, 2002; 325 (7358): 243).

Power corrupts, and when the state of our mental health is in our government’s hands, it does not leave much room to fix the issues that the government denies. If we want a better, healthier society, the government should be spending far more on mental health than they do. 23% of our overall health care costs are for mental health care issues. And only 7.2% of the health care budget is for mental health.  The cost containment issues could be solved through better government programs, more funding towards mental health, bringing in more mental health professionals, make bigger incentives for health care professionals to work in Canada. If 86% of our mental health issues are brought up to our family and regular doctors, they should be better trained at dealing with these mental health issues and not just throw pharmaceuticals at the problems. As it just masks the problems and does not solve the underlying issues. Initiating a universal basic income could dramatically reduce mental illnesses and the costs associated with them. The study in Manitoba with UBI showed it reduced health care costs by 8%. Philanthropy could be the initiator of a UBI program before and better than any government agency (Nettle B, 2011). Health care in Canada has become a business, and it has gone away from being about the citizens.

Sources:

Carney CP, Allen J, Doebbeling BN. Receipt of clinical preventive medical services among psychiatric patients. Psychiatric Services 2002; 53(8):1028–1030.

Committee on Crossing the Quality chasm: Adaptation to mental health and addictive disorders. Improving the quality of health care for mental and substance-use conditions: Quality chasm series. 2006.

Druss BG, Bradford DW, Rosenheck RA, Radford MJ, Krumholz HM. Mental disorders and use of cardiovascular procedures after myocardial infarction. Journal of the American Journal Association 2000; 283(4):506–511.

Druss BG, Rosenheck RA. Locus of mental health treatment in an integrated service system. Psychiatric Services 2000; 51(7):890–892.

Fierlbeck, K. (2011). Health Care in Canada. Toronto, Ontario: University of Toronto Press.

McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA 2000; 284(13):1689–1695.

New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. 2003; DHHS pub SMA-03-03882. Available at: http://store.samhsa.gov/product/Achieving-the-Promise-Transforming-Mental-Health-Care-in-America-Executive-Summary/SMA03-3831

Unutzer J, Schoenbaum M, Druss BG, Katon WJ. Transforming mental health care at the interface with general medicine: report for the President’s commission. Psychiatric Services 2006; 57(1):37–47.

World Health Organization. Mental health: a state of well-being [Internet]. Geneva (CH): World Health Organi- zation; [updated 2014 Aug; cited 2015 Sep 26]. Available from: http:// www.who.int/features/factfiles /mental_health/en/

World Health Organization (WHO), World Organization of Family Doctors (Wonca). Integrating mental health into primary care. A global perspective. 2008.

 

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