The Emptying Pot: On mental disabilities and health-care shortages
Updated: Mar 6, 2023
By Kyron Beaton
A shortage of healthcare professionals, including psychologists and therapists, is preventing special needs children from receiving the care they need.
Talino Bruno is a therapy psychologist who specializes in diagnosing and treating mental disabilities. He has held his position for over two decades at the Primary Care Network, located in Burnaby, B.C.
He answered 12 questions about mental disabilities, including how people have viewed them in the past and present, and whether our treatment of mental disabilities is changing for the better or worse.
1. How would you compare mental disabilities with mental health?
TB: I guess, when you're looking at it, there's a lot of overlap. But when you're dealing with mental disabilities, or mental health or whatever you want to call it, it's when your daily activities are impacted to a point where you're not able to do what you want to do, or feel like you want to feel. So everybody gets depression, everybody gets anxiety, but it's not to a level where it can be diagnosed. So if you're nervous or anxious for about an hour, that's not that big a deal. But if you're always anxious, and it stops you from going out, meeting up with friends, doing shopping or daily activities, it becomes an issue. So a lot of the time you look at the intensity, the duration, and the impact that it has to determine if it's an issue that needs to be addressed.
2. How would a mental disability harm someone's mental health?
TB: It really depends on what it is because there's overarching varieties. But one of the biggest issues is lack of motivation or lack of willingness to try things, which may stop you from actually getting treatment, or getting support that you may need. So for example, if somebody is dealing with depression, and they lack any kind of motivation, or any sort of drive, it may be very difficult for them to get to therapists' appointments, or attend a group, or even just go out and do any kind of sort of exercise, which may help actually alleviate the mental health issues.
3. Have society's views of mental disabilities changed from the beginning of your studies to now?
TB: Considerably, actually, even within the last 10, 15 years. I think the stigma of mental health has lessened to a certain point. There's still stigma depending on the mental health
issue that you're dealing with. But 20 something years ago, a lot of times it was you were
seen as flawed or somehow broken. If
you were depressed or anxious, you're expected to just kind of suck it up and walk it off and not realize how debilitating it is. And I think within the last 10 years or so, we've had a much better awareness of what actual mental health issues are and what they can do. Even with the Canucks, like the hockey team, with their mental health days, and celebrities or athletes coming out about their mental health struggles, I think that's really helped. But I think it's become a lot less stigmatized for the most part. We're still kind of stigmatizing addictions and substance use as almost kind of an issue of being too weak that you can't stop. And that's got a ways to go. But in general, most typical mental health issues have been less stigmatized than they used to be. There's still a lot of misinformation or still a lot of stereotypes of what mental health is, what quote unquote, crazy is. So there's still a long way to go with that respect.
4. Does this differ from how people saw mental disabilities 20 years ago?
TB: One of the variations was that it was bad parenting, right? Your parents made mistakes when they raised you, or they didn't raise you properly, and that's why you're like this, or you weren't grateful enough. You know, "What do you have to be depressed about? What do you have to be anxious about?" And if you are anxious or depressed? "Well just get up and do things. Don't just sit on the couch and just watch TV." So it was almost, in a way, looked at as almost kind of a moral shortcoming, or you weren't strong enough, or you weren't smart enough. In a nutshell, it would be that a lot of people thought you could control it a lot more than you actually can.
5. When it comes to long-term benefits, how important is early intervention after identifying mental disability in a child?
TB: Crucial. Because once you identify a potential mental illness or mental issue or any kind of developmental issues, whatever it is, in a child, the hope is that you can then bring to bear all the kinds of resources that are available to kind of stop the illness from getting worse. There's different levels from a developmental, neurological level. You actually help the brain develop in a more healthy manner, and so you're able to kind of accommodate that. But it's also that you're stopping future worsening of the symptoms. So, for example, if somebody is anxious, and they go to school, but they're always anxious about going to school, well, they're less likely to kind of engage, maybe let's say engage with friends or make friends, or engage in schoolwork, or because they have some issues that they just don't want to engage in. If that's not addressed, that builds on itself. Now you start getting into kind of self-esteem issues, you know, "I'm stupid" or "I'm lazy" or "nobody likes me", which adds other layers to the mental health that you may have been able to deal with earlier. So with somebody with anxiety, if you deal with it earlier, you can lessen the anxiety and they may be able to function better in classrooms, or function better in social settings... Now, having said that, even if something is treated, there's no such thing as too late. But you're adding layers to it if you do wait too long to deal with it. Or if it goes untreated.
6. Mental disabilities such as autism lie on a spectrum. Could you explain what spectrums are in relation to these specific types of disabilities?
TB: A lot of the mental health issues that we deal with more or less originate from the same part of the brain, which is kind of the central part of the limbic system of the brain... With autism, there's a variation of what somebody has that has autism, right? Totally verbal, totally non-verbal, totally social, totally non social, catatonic, outgoing. The same with depression or anxiety, which we'll just use those as the kind of common disorders that we typically deal with. You know, everybody gets depressed, everybody gets anxious at least once in their lives, right? And studies have shown that most people do a lot more than that. But aside from that, it's not so much that you have that. It's how long does it last, as I was mentioning earlier. For somebody, depression can be on a continuum. So a low mood, just feeling kind of down or blue, all the way to feeling suicidal or actively suicidal, and then everything in between. With anxiety, you can be a little nervous, a little bit stressed which is different than anxiety, but for our sake, we'll just use it as an example. You can be kind of a little bit anxious about, for example, taking a test at school, which is normal. Or you can have such a fear of tests that you refuse to take anything that remotely resembles a test, because you become incapacitated. You could have a panic attack. So all mental health issues are on a spectrum... (from) mild to severe.
7. Can mental disabilities actually be cured, or do you believe they can only be treated up to a certain degree?
TB: It depends on what cure means, right? I mean, you can, quote unquote, cure depression, if it's situational. You can have depression for a year, and then never have it again. So you're technically cured. It's the same with drinking or alcoholism. If you stopped drinking, you're technically no longer an alcoholic. If something is genetically based, for example, or based within the brain chemistry, yes, it's definitely possible that things can be treated. Medications can be created or treatments can be created, that can maybe treat the disorder kind of a little bit of a ways away from that. But I think there's that constant drive to try to figure out how to treat, and what we're doing is we're just basically dealing with the symptoms a lot of times, and maybe improving the symptoms or sometimes even just getting rid of the symptoms altogether. But you may not get rid of other symptoms, specifically like let's say with autism. You can deal with certain symptoms, but there's other symptoms that you just can't (deal with) because it's just the way that the neurochemistry is wired, so that you just can't do that, right? So I think ideally, yes, there's always the drive to kind of cure something. But, you know, we're not there yet.
8. Recently, the B.C. government announced it was putting funds into a pilot program for family connections centres, places where families of autistic children can be connected to more resources in order to help the child. Why or why not would you support this pilot program?
TB: I would definitely support it. I mean, the more support you have, typically, the better the situation is (as) you're not feeling isolated. Let's say parents with kids with autism, or even adult kids with autism, or just even adults with autism. As much as they may know that autism is actually relatively common, you know, it's not something that's fairly uncommon, there is still that feeling of being alone, if you don't have that support. There's still that feeling of being isolated. And so it's always helpful when you can meet with other people and gather resources, gather ideas, gather advice that you may not have had before or you hadn't thought about before. So it's a great way of information sharing. It's a great way of supporting. I'm totally on board with anything that helps connect people that might potentially be marginalized because of the disorder. Or even parents just (getting) a better connection with the community. The one downside with any kind of support or issues like that would be that people tend to share "war stories", and it can be triggering for people. It's like, "oh, yeah, see? There's no hope because it doesn't work for anybody." But that's the rarity... and it's a risk worth taking, given what the benefits are of having a central hub, for example, for information and for resources. That's one of the hardest things that parents need to deal with, is "Where do I get support for my kid? How do I get support for my kid? Or how do I get support for myself? Where do I go?" And so, if you have a place that is a kind of a one-stop shop, that's ideal.
9. Of the yearly funds that the BC government plans to invest on these similar programs for autism, $3 million remains unallocated. If you had the ability, where would you allocate those remaining funds and why?
TB: I think $3 million is not much, mind you, but I would allocate in screening for the most part, in screening earlier. And not even just earlier screening, but earlier assessment, like quicker assessment, cutting the wait time for an assessment for somebody who's like, say, a child who's two years old (who starts showing) the red flags for autism. They may wait up to two to three years for an assessment. And that's where I would allocate the money, is to shorten the amount of time it takes to be assessed with autism or whatever other disorder that you're focusing on. Specifically with autism, I would say that just shortening the amount of time it takes to actually be assessed, because once you get assessed, then that opens the gate to resources, financial and supportive.
10. Why do you believe people are waiting two to three years for an assessment?
TB: Well, it's the lack of people that can actually do the resources, that can actually do the assessments. It's a specialized skill to be able to assess. And typically, psychologists, school psychologists or psychiatrists (are what's missing), and we don't have that many of them. And so, because somebody is a psychologist doesn't mean that they can assess. Typically, for autism, you have to have specialized training for that and you have to be interested in that. So, you know, if you have 10 Psychologists, you might have one out of those 10, for example, that will want to specialize in autism for doing assessments. So it's a small number of people that can actually do the assessment.
11. How come so few people want to specialize in this?
TB: It's a good question. We have kind of a shortage of family doctors, so general family doctors. There's a whole host of reasons. It's like, you know, somebody's passion. If somebody's into neurology, they want to become a neurologist. If somebody's into anesthesia, they want to be an anesthesiologist. It's your passion. Plus, also, I think the amount of time that's spent in school to do something and the amount of money that's invested. People want to make money afterwards. They want to recoup their money, and also realizing it's kind of a Catch 22 situation, in that people realize that there's such a long waitlist, and there's so much of a shortage in people being able to do assessments that they don't want to get into it because then they feel they'll be burnt out. But because they don't join into it, you don't get more people that would lessen the amount of burnout, if that makes sense. So I think it comes down to what people are passionate about, what people feel would be best for their lives and how much work it entails to be able to do something.
12. Any final thoughts?
TB: What it comes down to, unfortunately, is finances. We have the money to allocate to certain situations. And there's a pot, but everybody wants something from the pot to support their needs, right? And usually it's the squeaky wheel will get the grease. People that have a louder voice tend to be recognized more than others, right? So I think that's part of it. I think that's where, you know, the Autism Society and things like that (where) they're able to do that. They're able to create recognition by having Autism Month for example, or specific days at Canucks games or what have you. So that increases the recognition of what it is, and also that idea that almost everybody knows somebody that's autistic or has a child that's autistic. So the more comfortable I guess you are with a situation, the more likely you are to provide support now... Once there's a familiarity, it's like, "okay, yeah, this seems like a worthy cause."
This transcript has been edited for length and clarity.
kyronbeaton@gmail.com
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