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Health

Canada should delay MAID for people with mental disorders: psychiatrists

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Canada is not ready to expand medical assistance in dying for people with a mental disorder, leaving psychiatrists across the country “incredibly concerned” about patients needing better access to care, including for addiction services, says a group representing the specialists across the country.

The Association of Chairs of Psychiatry in Canada, which includes heads of psychiatry departments at all 17 medical schools, issued a statement Thursday calling for a delay to the change set to be implemented in mid-March.

Lack of public education on suicide prevention as well as an agreed-upon definition of irremediability, or at what point someone will not be able to recover, are also important, unresolved issues, the statement says.

“As a collective organization, we recognize that a lot of work is being done in Canada on this issue,” Dr. Valerie Taylor, who heads the group, said in the statement.

“Further time is required to increase awareness of this change and establish guidelines and standards to which clinicians, patients and the public can turn to for more education and information,” said Taylor, who is also chair of the psychiatry department at the University of Calgary.

A statement from the office of federal Health Minister Jean-Yves Duclos says Canada is committed to implementing MAID for those with a mental disorder by keeping their safety and security at the forefront.

“We will continue to listen to the experts, including those at the front lines and those with lived experience, and collaborate with our provincial and territorial counterparts to ensure that a strong framework is in place to guide MAID assessors and providers before MAID becomes available to those for whom mental disorders is the sole underlying condition.”

The office did not say whether the implementation expected on March 17 would be delayed.

Dr. Jitender Sareen, head of the psychiatry department at the University of Manitoba, said many controversial issues were discussed at the group’s annual meeting in October regarding which patients with a mental disorder could be eligible for MAID, seven years after the practice was legalized in Canada for those with a physical ailment.

“If a person wants MAID solely for mental health conditions, we don’t have the clear standards around definitions of who’s eligible. How many assessments and what kinds of assessment would they actually need?” he said.

Sareen also called for training for health providers doing the assessments to begin sooner than its expected rollout next fall. Psychiatrists want clarity on what could be a request for suicide compared with MAID, leaving them to determine a path toward treatment or providing euthanasia, he added.

“There is still controversy around that between providers. Some people believe suicide is impulsive and self-destructive. But that’s not necessarily the case. People can have thoughts about suicide without a mental health condition, an active condition like depression or schizophrenia.”

Patients in rural communities may lack access to mental health care, and those struggling with addiction who have little to no access to harm-reduction services like supervised injection sites could also be left suffering until they try to seek MAID as a way out, said Sareen, who specializes in addiction services.

“We’re in the middle of an opioid epidemic. And we’re in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are the highest ever,” he said.

“As a group of department heads in the country who are responsible for medical education both for psychiatrists and residents, we’re saying, ‘Look, let’s put things aside as far as whether we agree with this law change or not.’ We’re just concerned we’re not ready for March.”

The federal parliamentary committee reviewing the law to expand MAID to those with a mental disorder issued an interim report in June and expected to publish a final report in October. However, it has been delayed until February.

The final report of an expert panel was released in May with 19 recommendations, including training for doctors and nurse practitioners assessing MAID requests to address topics like the impact of race, socioeconomic status and cultural sensitivity.

The report also said the expansion of MAID raises additional challenges involving those who are elderly, have neurodevelopmental or intellectual disabilities and people who are in prison, where the prevalence of mental disorders is high compared with the general population.

The panel relied on evidence from Belgium and the Netherlands, which it said have the most extensive set of safeguards, protocols and guidance overall.

Dr. Derryck Smith, a psychiatrist in Vancouver and a past board member of Dying With Dignity, said that while there is no doubt that MAID is a divisive topic among his peers across Canada, he believes there’s a need to wait for the special parliamentary committee’s final report “before we try to slow the process down.”

Smith said lack of access to care for mental health is no different than that for physical ailments so any delay in implementing the new law is a basis for discrimination.

“The health-care system is crumbling around us but that’s a different matter altogether,” he said. “What concerns me as well is what is so special about psychiatric illness? Why are we putting stigma around psychiatric illness?”

The Canadian Mental Health Association said it is focused on ensuring Canadians have access to universal mental health care with supports that are fully integrated into the public system and available for free.

“This includes recognizing the social determinants that are prerequisites for good mental health by providing housing and income and food supports that help keep people well, safe and out of poverty, and which create conditions that may mitigate requests for MAID,” it said in a statement.

This report by The Canadian Press was first published Dec. 1, 2022.

This story was produced with financial assistance from the Canadian Medical Association.

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Health

British health researcher says authorities in Canada, US, and UK are doing nothing about thousands of excess deaths

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About six months ago, the Province of Alberta’s annual cause of deaths statistics briefly made headlines around the world.  For the first time “unknown causes of mortality” was the leading cause of death in the province.  Just a few years earlier, “unknown causes” wasn’t even on the top ten list.

Province of Alberta Cause of Death Statistics 2021

An Alberta taxpayer might expect the province to call an inquiry into this shocking development to see if there’s not some way to protect the lives of thousands of Albertans. So far this has not happened.

Now similar shocking statistics are starting to emerge nationally and around the world.  British health researcher John Campbell has looked at the data coming from Canada, Britain, the US and Australia among other nations.  He’s noticed a very significant and distressing increase in “excess deaths”.  The number of excess deaths is quickly adding up to the hundreds of thousands. Of course some of these deaths can be attributed to COVID-19, but the vast majority are not.

In this video, Dr. Campbell reveals the data he’s found and offers some pointed criticism to our political leaders. Canada is singled out as “quite pathetic” for not even sharing cause death statistics after August of 2022. Campbell says “I think we’re in somewhat of an international emergency not being responded to as I would like by our governments in any way, shape, or form.  In fact they seem to be ignoring it. As indeed do most of the mainstream media.”

“This demands an explanation. And we’re not getting one.”

From Dr. John Campbell – British health researcher / instructor

Dr. Campbell’s presentation notes including links to information sources

US, Weekly Cumulative All-Cause Excess Deaths

ttps://www.usmortality.com

https://www.usmortality.com/deaths/ex…

Excess deaths 2022 (Up to December 1st) 242,224

https://www150.statcan.gc.ca/n1/pub/7…

https://www23.statcan.gc.ca/imdb/p2SV…

Australian Bureau of Statistics

Provisional Mortality Statistics

Reference period, Jan – Sep 2022

144,650 deaths that occurred by 30 September 19,986 (16.0%) more than the historical average.

Deaths attributed to covid, 8,160

October covid deaths, 232

Australia, September 2022 13,675 deaths (doctor certified) 1,814 were coroner referred.

UK, ONS https://www.ons.gov.uk/peoplepopulati…

UK Prevalence

2.61% in England (1 in 40 people)

3.94% in Wales (1 in 25 people)

4.22% in Northern Ireland (1 in 25 people)

3.26% in Scotland (1 in 30 people)

Deaths and excess deaths

(W/E week 13th January 2023)

A total of 19,916 deaths were registered in the UK

20.4% above the five-year average.

Covid UK deaths

1,059 deaths involving COVID-19 registered (up 842 on the week)

Deaths involving COVID-19 accounted for 5.3% of all deaths UK,

Office for Health Improvement https://www.gov.uk/government/statist…

Excess deaths in all age groups, (0 to 24 years) UK,

Institute and Faculty of Actuaries https://actuaries.org.uk/news-and-med…

Mortality rates in 2022 compare to 2019 at different ages 2022,

mortality, 7.8% higher for ages 20-44

In the UK, the second half of 2022

26,300 excess deaths, compared to 4,700 in the first half of 2022 Europe,

EuroMOMO,

Bulletin week 2 2023 https://www.euromomo.eu

Pooled EuroMOMO, all-cause mortalit

Elevated level of excess mortality, overall and in all age groups.

Data from 25 European countries or subnational regions

Average levels from pre 2020 https://www.health.govt.nz/nz-health-… https://www.stats.govt.nz/topics/birt…

Year ended September 2021,

total of 34,578 deaths Year ended September 2022, total of 38,052 deaths

 

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Alberta

Alberta budget set for Feb. 28, with focus on funding for health, school growth

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By Dean Bennett in Edmonton, Alberta, Canada

Alberta Finance Minister Travis Toews says the United Conservative Party government’s 2023 budget will be delivered on Feb. 28, the first day of the spring legislature sitting.

Toews said Friday it will focus on investing in health care and school enrolment growth.

It’s expected to be the final budget before voters go to the polls for a scheduled May 29 general election.

Alberta’s fortunes, powered mainly by energy revenues and further diversification of its economy, have been on the upswing since the global economy began rebounding from the COVID-19 pandemic.

Last fall, Toews announced the current budget year, which finishes at the end of March, is expected to record a $12.3-billion surplus.

That surplus comes even with $2.8 billion being set aside over the next three years to cover inflation-fighting programs and payouts to shield Albertans — particularly families, seniors and the vulnerable — from higher costs.

Toews said while energy prices remain volatile, the outlook is for them to stay strong.

“This budget will reflect the fact that health care is a priority, that health care capacity is a priority, ” said Toews in an interview.

“Alberta is leading the nation on net-inflow migration,” he added.

“Our population is growing. Our enrolment in our K-12 education system is growing, and the budget will reflect that good news story with additional enrolment growth.”

One outstanding question after the budget will be whether Toews will run again in the May vote.

He is a first-term UCP member representing Grande Prairie-Wapiti.

Toews declined to say whether he has made a decision.

“I’ll have more to say on that one later,” he said, “I’m focused on preparing the budget.”

This report by The Canadian Press was first published Jan. 27, 2023.

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