Experts call for postponement of MAID for people with mental illness

Canada is unprepared to expand dying medical assistance for people with mental disorders, and psychiatrists across the country have warned of patients who need access to better care, including addiction services. It’s incredibly concerning,” said a group representing experts across the country.

The Canadian Association of Psychiatric Chiefs, which includes psychiatric chiefs from all 17 medical schools, issued a statement on Thursday calling for a postponement of changes that were scheduled to take effect in mid-March.

The statement also said that the lack of public education on suicide prevention and the agreed definition of irreversible, i.e. at what point one cannot recover, are also important and unresolved issues. .

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

Taylor, who is also director of psychiatry at the University of Calgary, said, “To raise awareness of this change, and to establish guidelines and standards that clinicians, patients, and the general public can use to become more educated and informed, we need to: We need more time,” he said. .

Canada is committed to implementing MAID by keeping the safety and security of people with mental disorders at the forefront, according to a statement from the office of Federal Health Minister Jean-Yves Duclos.

“We will continue to listen to expert opinions, including those on the front lines and those with lived experience, and will work with our State and Territory counterparts to ensure that MAID becomes available. We ensure that we have a strong framework in place to guide MAID assessors and providers before people whose only underlying medical condition is a psychiatric disorder.”

The Secretariat did not specify whether the planned implementation on March 17 would be delayed.

Dr. Jitender Saleen, director of psychiatry at the University of Manitoba, said the group’s annual meeting in October discussed many controversial issues about which mentally ill patients would be eligible for MAID. said. Canada for people with disabilities.

“If a person only wants MAID for a mental health condition, there are no clear criteria for defining who is eligible. What are the actual number and types of evaluations required?” he said.

Sareen also called for training for healthcare providers conducting assessments to begin sooner than the planned rollout next fall. Psychiatrists want to clarify what might demand suicide compared to MAID, and it is up to them to decide the course of treatment or offer euthanasia. he added.

“There is still controversy about it among health care providers. Some think suicide is impulsive and self-destructive. But that is not always the case. You can think about suicide without having a mental health condition such as depression or schizophrenia.”

Patients in rural areas may not have access to mental health care, and those suffering from addiction with little or no access to harm-reduction services, such as monitored injection sites, may suffer until they seek MAID as a loophole. , said Saleen, who specializes in addiction services.

“We are in the middle of an opioid epidemic, and we are in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are at an all-time high,” he said. I got

“As a group of national department heads responsible for medical education for both psychiatrists and the population, we say, ‘Look, let’s put aside whether we agree with this change in law.’ I am concerned that we are not ready for March.”

A congressional committee considering legislation extending MAID to persons with mental disabilities is expected to issue an interim report in June and a final report in October. However, it has been postponed until February.

The expert panel’s final report came out with 19 recommendations, including training physicians and nurses to assess MAID requirements to address topics such as the impact of race, socioeconomic status, and cultural sensitivities5. released in May.

The report also notes that the expansion of MAID will create additional challenges involving older people, people with neurodevelopmental or intellectual disabilities, and those in prisons who have a higher prevalence of mental disorders compared to the general population. said to occur.

The panel relies on evidence from Belgium and the Netherlands, which it says has the broadest set of safeguards, protocols and guidance overall.

Dr. Derrick Smith, a Vancouver psychiatrist and former director of Dying With Dignity, said MAID is no doubt a divisive topic among his peers across Canada, but the Special Congress He said he believed it would be necessary to wait for the committee’s decision. “Before you try to delay the process” final report.

Lack of access to care for mental health is no different than lack of access to care for physical illness, Smith said, so any delay in implementing the new law would be grounds for discrimination.

“The healthcare system is collapsing all around us, but that’s a whole other issue,” he said. Why do we stigmatize mental illness?”

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

“This includes promoting good mental health by providing housing, income, and food assistance to help people stay healthy, safe and out of poverty, and create conditions that may mitigate MAID demands. It involves recognizing the social determinants that are prerequisites for,” it said in a statement.

This report by the Canadian Press was first published on December 1, 2022.

This article was produced with financial support from the Canadian Medical Association.