Healthcare, News

Canada Health Transfer Payments

I came across an article on the Canadian Health Transfer payment system in The Record. The more I read, learn and work in and around the healthcare system, the more I want to see it change. Our current system is not working and as the population continues to ‘grey’ even more change will be needed.

Starting next year in 2014,

“In the federal budget of 2007, Stephen Harper’s government announced that the health transfer would be allocated on a strict equal per capita basis beginning in 2014. What this means is that each province will receive a health transfer amount according to the size of its population, regardless of the income, demographic, geographic or other conditions of the province.”

“In theory, the health transfer should uphold the five criteria of the Canada Health Act: public administration, comprehensiveness, universality, portability and accessibility of health services — thereby encouraging a sense of common citizenship even if there are differences in how Medicare is managed and delivered across the provinces.”

This is a concern. A proposal by Gregory P. Marchildon and Haizhen Mou is: an alternative formula that adjusts for two health-care cost drivers over which provincial governments have no control: demographic aging and geographic dispersion. Those provinces and territories with both a more highly dispersed and an older population would receive more of the health transfer. Those that have a younger demographic or are more densely populated (urban) would get less.

I attended a staff development workshop this past week that focused on the trends in aging and technology. Richard Adler was the presenter. He is a great speaker that has passion, conviction, good ideas and he along with many others can identify the changes that are needed. Healthcare falls into this category. Canada has a good basic universal healthcare system, but each province and territory cannot meet the demands of their respective population. If the federal government is going to provide transfer payment bases solely on # of people living in each province or territory and not taking into account the age of the majority, geographic demographics of where many live-in urban area or rural, provinces and territories will have difficulty in best servicing its residents. That means the province or territory has to be creative in how best to provide services and may have to further tax its residents to provide a decent level of healthcare.

Now, I live in Quebec, which is one of the highest, if not highest taxed province. Quebec does offer pharmacare coverage for those that are older adults/seniors, low-income or do not have supplemental health insurance. There are yearly deductibles that must be met and the rate charged depends on one’s income bracket, but I believe it is the only province/territory to offer this. What does everyone else do to purchase/pay for medications in other provinces/territories?

The coverage or basic coverage should be the same in all provinces/territories and if one travels elsewhere in Canada-they should have the same coverage in the province they are visiting as the one they left temporarily.

What are you thoughts? What do you think of the suggestions by Marchildon and Mou? Do you have alternative suggestions or ideas? I would love to hear them……

By Victoria Brewster, MSW

Health Conditions/Diseases, Healthcare, News

Waitlists in Canadian Healthcare

Perhaps because I work in social services with seniors, I am drawn to any information that focuses on Canadian healthcare. The most recent article I read focuses on the cost of waitlists.

Imagine you have a ‘non-urgent’ health condition, would you want to wait months to see a specialist? If you are in constant back pain, unable to work because of the pain, would you want to be placed on a wait list for months to see a specialist?

The article’s author describes a story of a family member diagnosed with a spinal ailment that has worsened to the point where mobility is severely impaired and the afflicted individual is in constant pain. Continued employment as an agriculture laborer has become impossible. The general physician suspects a spinal fusion is needed and makes a referral to a specialist. Nine months later the patient sees the specialist who confirms the need for surgery and is placed on a wait list which could take 12+ months to occur! This back pain is considered ‘non-urgent’ here in Canada. From the  initial appointment with the general physician to surgery-2 years in total.

In February of 2013, the Organization for Economic Development and Co-operation released a report entitled Waiting Time Policies in the Health Sector. The 13-country survey found that Canada has the longest elective surgery waiting times (an average of all elective surgeries), with 25 per cent of patients waiting more than four months compared with 8 per cent in New Zealand; 7 per cent in France, Switzerland, and the United States; and 5 per cent in the Netherlands and Germany.

Imagine being in constant, chronic pain waiting for ‘elective’ surgery, unable to do anything about it. The government rationalizes that the person will most likely not die waiting for this orthopedic surgery, so it is not deemed necessary, but the individual cannot function as they once did-a significant deterioration in quality of life, as well as a deterioration in the health condition itself occurs costing money to the health and social services system.

Canada is the only country with laws that take away a patient’s right to pay privately for health-care services. The result is the same as it would be for any service for which competition is forbidden: a sclerotic, inflexible system that stifles innovation, takes away freedom of choice, and costs taxpayers and employers dearly.

Is a two-tier system the way to go? Those with the financial means can privately pay for surgery and those who cannot will suffer. It is a tough question to answer, but I can share that there is no justice or equality in a two-tier system. I do believe solutions exist and everyone involved in healthcare or social services  should share solutions, but we need a government that is willing to listen and really address this issue or change will not occur.

Victoria Brewster, MSW

*First published at:


Canada’s Two-Tier Health System-Part I

Canada’s Health System is a bit different than that of the United States or other countries, and contains many levels of coverage. Canada has socialized medicine which is available to all permanent residents and citizens, and which provides basic coverage of medical and health needs. Beyond that there is also private access to health care which comes from either one’s employer (employer pays part of the health insurance), with the employee paying the balance, or offered by the province or territory. Depending on the plan chosen by the employer, the coverage of additional access to care might include coverage of: dental, pharmacare, therapy/counseling, private hospital room, travel insurance so one is covered outside of Canada, and basically anything not covered by the basic socialized medicine plan. Provinces and Territories can provide private coverage to their citizens as they choose. For example, Quebec offers pharmacare coverage while many other provinces do not.

The next level of coverage is for those which have the finances to pay for whatever they need with their own money. This is the public vs. private divide, more commonly defined as the two-tier health system. The issue is there should not be a private vs. public option, as those without the finances to purchase additional health insurance are left without. In some cases, doctors even opt to treat only those who can privately pay. So, the divide is those with the monetary means and those without; wealthy against the poor.

This needs to change and it is up to healthcare professionals, government bodies and every resident or citizen of Canada to speak up and advocate for change. In the following series I will discuss this system, it’s implications, and it’s possible solutions further.

Written by Victoria Brewster, MSW

*First posted at:

Healthcare, News, Social Work/Helping Profession/Mental Health

Seeking Action for Safety in Long Term Care Facilities

Advocacy, one of the core competencies in the profession of social work. It is one skill that I was taught both in graduate school and as a professional over the past 15 years, it is a skill I take to heart.

On February 9, 2013 a documentary W5, Crisis in Care, reported by Sandi Rinaldo and the CTV team of investigators, was released. This investigation uncovered horrific statistics and stories of abuse taking place in Long Term Care facilities in Canada. The focus was on residents with dementia assaulting and killing other residents.—crisis-in-care—february-9-2013/#clip862011

After viewing it, the natural human response is to wonder how something this horrendous could happen. Further questions of who is at fault and what solutions will facilitate the needed changes, come to mind as well. Finger pointing and blaming will not provide solutions or changes. Staff that work in residences and Long Term Care (LTC) facilities, for the most part, are very good at their job and demonstrate the skills of empathy, compassion, and hard work.

A team of three dedicated professionals who all belong to the professional LinkedIn group, Gerontology Professionals of Canada, decided to team up to formulate a response to the W5 documentary, Crisis in Care. Eleanor Silverberg, BA, Psych, MSW, RSW drew up the initial draft and is the main author, asked Angela Gentile, BSW, RSW and  Victoria Brewster, MSW for their contributions. Seeking Action for Safety in Long Term Care Facilities was completed on February 20, 2013, and was forwarded to the following individuals/organizations as of February 23, 2013:

•W5, Sandi Rinaldo, the investigative team and the producers
•Federal Health Minister, the Honourable Leona Aglukkaq
•Alzheimer Society of Canada, CEO, Mimi Lowi-Young
•Alzheimer Society of Ontario, CEO, Gale Carey
•Alzheimer Society of Manitoba, CEO, Sylvia Rothney
•Federation of Quebec’s Alzheimer Society, CEO, Sandro di Cori
•Ontario Minister of Health and Long Term Care, Deb Matthews
•Quebec Minister of Health and Social Services, Dr. Réjean Hébert
•Manitoba Minister of Health, Hon. Theresa Oswald
•Canadian Alliance for Long Term Care
•Healthy Living, Seniors and Consumer Affairs Minister of Manitoba, Hon. Jim Rondeau
•Misitere de la santé des Services sociaux- Services Quebec

The site, Action for Safety, created by social worker, Angela Gentile will continue to be a place where updates will be provided, as well as a place where other professionals, families and concerned individuals can express their views, working together on behalf of the vulnerable residents in Long Term Care facilities.

It is worthwhile to read the full response which describes the issues, provides some examples of assaults and deaths that have occurred in Canada while making suggestions for solutions. It is not possible that these horrible tragedies have only occurred here in Canada. It is not possible that budget cuts, reduced staff, lack of education, and a lack of awareness only effect Canada when it comes to LTC facilities and the disease of Dementia.

The link to Action for Safety has been shared with friends, family, colleagues, on social media through LinkedIn, Twitter, and Facebook with an end goal of obtaining solutions to a very serious issue. This will continue along with contacting media to further bring the issue to light and raise awareness.

It is necessary for professionals to unite over a cause while advocating for needed change and I consider myself fortunate to have been a part of this project. A special thank you to Eleanor Silverberg and Angela Gentile!

Written by Victoria Brewster, MSW

News, Social Work/Helping Profession/Mental Health

DSM-5 Changes: A Continuation

I continue to come across articles and information regarding the soon to be released DSM-5. Reading this link will provide quite a bit of information on the upcoming changes to the DSM. I have to wonder if our society is becoming too focused on a diagnosis and pharmacare.

“After the American Psychiatric Association (APA) approved the latest version of its diagnostic bible, the DSM-5, psychiatrist Allen Frances, the former chair of the DSM-IV task force and current professor emeritus at Duke, announced, “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry.”

That statement alone says it all especially coming from a psychiatrist.

Get ready to hear about a new mental illness diagnosis for kids: ‘disruptive mood dysregulation disorder‘ (DMDD)… Frances concludes DMDD “will turn temper tantrums into a mental disorder.”…

“What constitutes binge eating disorder? Frances reports, “Excessive eating 12 times in three months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM-5 has instead turned it into a psychiatric illness called binge eating disorder.”

The DSM-5 also brings us “minor neurocognitive disorder” — the everyday forgetting characteristic of old age. Francis states, ”Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia.”

“First time substance abusers will be lumped in definitionally with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.” DSM-5 also introduces us to the concept of “behavioral addictions,” which Frances points out “eventually can spread to make a mental disorder of everything we like to do a lot.”  And Frances adds that “DSM-5 obscures the already fuzzy boundary between generalized anxiety disorder and the worries of everyday.”

What about grief and bereavement which are also re-categorized in the upcoming DSM? Normal human grief, which I covered in another write-up here on SJS becomes yet another diagnosis: “In removing the ‘bereavement exclusion’, the DSM-5 encourages clinicians to diagnose major depression in persons with normal symptoms of bereavement after only 2 weeks of mild depressive symptoms.” Grief usually runs its course within 2-6 months and typically does not require treatment with medications. In addition:

The proposal by the DSM-5 Neurodevelopmental Work Group recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors.

Much of what I have read from parents and professionals is concern that the new definition of autism in the DSM-5 will exclude many people from both a diagnosis and state/provincial services that depend on a diagnosis.

The DSM has been looked at over the years, changes made by dropping diagnoses and creating new ones, but to what benefit? Studies that have been done over the years have caused some embarrassment regarding the DSM. For example, Read further about the 1973 study. In the study Eight pseudopatients were sent to 12 hospitals, all pretending to have this complaint of hearing empty and hollow voices with no clear content. All were able to fool staff and get hospitalized.

The 1980 DSM-III was dramatically changed to include concrete behavioral checklists and formal rules to solve the diagnostic reliability problem, hmmm…did it work?

I have the DSM-IV at a cost of $95 in 1995, and used it in graduate school and then professionally for 1 1/2 years with children. I had to choose a diagnosis for the insurance companies to pay for the therapy and treatment that was being provided and it had to be a diagnosis that the insurance company agreed with. I am not a fan of labeling people, especially children, as the diagnosis follows them around for many years if not their entire life. A label does not define a person, but unfortunately many become their label.

Should we focus more on treating the symptoms and less on the diagnosis? Are there alternatives to pharmacare? What changes can be made in the classroom or work setting to assist the person best? Have many of these diagnoses been created for insurance reimbursement purposes, especially when considering the new ones? Are everyday life choices and events being turned into a diagnosis?

The suggested price for the new DSM-5 is $199.00 U.S.! That is one expensive book.

Written by Victoria Brewster, MSW

*First published at:

Social Work/Helping Profession/Mental Health

System Malfunction: Mental Health Issues

Mental Health is an area that certainly needs improvements along with properly trained professionals. These professionals whether nurses, social workers, physicians or administrative staff  need regular skill upgrades provided by their employer, of their own choice/initiative or as required through the state, province or the profession itself.

Below is an example of what should not happen when an individual who has a history of depression goes off their medications of their own doing, exhibits behavior that causes one to pause and asks for help to make changes to this downward spiral.

A patient goes to his physician and shares that he has stopped taking his lithium and Paxil, admits to having returned to the habit of drinking one or two six-packs daily and more on weekends, stopped going to work and was fired. This man has no energy or ambition, is not sleeping well and recently had gotten angry with a neighbor and tried choking him. When asked him if he had other times when he considered doing things that might harm others, he said he had been driving around with his loaded gun, feeling very angry and wondering if he would feel better if he shot somebody, and whether it would be better to shoot somebody he knew or a stranger. Are these not warning signs that something serious is going on here! That little red flag should be in each of our minds with this information.

The man and the physician talk briefly about the fact that the medicines might have stopped working because of the alcohol, but that he was now dangerously depressed, and that the options were to go directly to the crisis unit for admission or, if he refused, I would call the police. He readily agreed to admission. “That’s why I’m here doc. I need help before it’s too late.”

His wife drove him straight to Crisis in the hospital across town, where he was evaluated. They called and told me the decision had been made to admit him.

Now, without relaying more information-what are your thoughts? What do you think will happen once he is at the hospital? Will he be admitted, sent way with a prescription or kept for observation until the morning? Which professional will make this decision and what is the reaction  of the physician who convinced the patient to go to the hospital?

Below are excerpts

He had been seen and evaluated by the nurse practitioner on call, was felt to be seriously depressed and “at major risk for harming himself or others.” It was late in the day, there was no bed available on the psych floor, and the psychiatrist had left for the day. The man was kept overnight in the emergency room for admission in the morning. During that time, he underwent the standard and metabolic screening and physical exam by the emergency room physician whose note confirmed the patient’s description of events.

Early Saturday morning he was visited in the ER by an intake worker. She reviewed the chart and spoke to someone on the psych floor, after explaining he did not need inpatient care. The man was discharged home with (written) instructions to see his primary physician to restart his medications. He was also told to call for an outpatient counseling appointment.

The phone call was made and he was told that the counseling sessions were booking into the fall and he would be put on a waiting list. If services were needed sooner, he should contact his primary physician or return to the Crisis Unit in the ER.

This is the unfortunate reality today. Not enough Mental Health workers to provide needed services, untrained staff, wait lists, budget cuts and it is the individuals suffering from mental health issues that are left to their own devices and every country has been witness to the types of tragedies that occur because of the above.

It took another 5 days before this man was admitted to the psychiatry floor of a local hospital, friends and family stepping in to provide assistance and a caring physician. What about those without friends or family? Those without a family or primary physician?  What about those individuals who do not seek help and do not recognize that their life is taking a downward spiral?

No country can afford to continue along its current path of reducing services or having untrained professionals. Mental Health issues are increasing not decreasing!  Has the world not learned from all the recent shootings?

Any individual who tells a professional or goes to a hospital or clinic seeking help because there is admitted risk of hurting/harming self or someone else, needs to be admitted for observation and placed in a safe environment. No bed in psychiatry? Place them in another bed, keep them in the ER, contact the physician who helped with the original admittance. DO NOT send the person home.

Written by Victoria Brewster, MSW

*First posted at:

News, Social Work/Helping Profession/Mental Health

Leadership and Teamwork in Helping Professions

Leadership, teamwork, management, structure of an organization; these are not typical words used in social work or any helping profession from the professionals themselves as they are often very focused on the clients, patients, clientage and recently I heard the term service user (from workers in the UK). Personally and professionally I find the term service user to be extremely impersonal. Client can be used in any profession and patient tends to have a medical basis to it.

I have come across a lot of information, articles and discussions lately that have to do with leadership, management, teamwork and coaching. I soaked it all in and then reflected. I thought of past jobs both in the social work field and otherwise and further reflected.

Ask, listen and talk; 3 basic words that hold so much leverage and potential in them. Now, these concepts are easily linked to social work and other helping professions. I like to think we are some of the best listeners out there. We have been trained to be that way, but are we truly? Are these 3 words woven into the fabric of your organization? Are they an integral part of your employment/employer and have you ever stopped to think about it? Or maybe they are ideas you would like to see take shape in your organization between management and front-line?

What about the words consensus, conformity and creativity? In discussing potential changes or voting in a case review as to the best way to approach a client or situation we would like to reach consensus-is it truly possible? Sometimes and other times we have to be happy with the majority. Conformity-here is a tricky word as it depends on the situation. There are times as a professional you want to see conformity from a client, but in an organization? Do we really want all the employees to be the same? To think the same? To approach problems and difficulties the same way? What about creativity? I love this word and as a professional, in the organization I work for-I want to see this from leadership, management and front-line staff. There is no one way to approach a problem or to find a solution-creativity gets the gears turning.

How about 12 words that can be addressed, sought and reflected upon by any organization? Empathy, forgiveness, humanity, humility, recognition, discretion, thoughtfulness, consideration, compassion, gratitude, appreciation and compliance. Now as a social worker, one who works in the social services field, mental health field or other helping profession, these 12 words for the most part are known to us and used often. Think of them as a reminder. As front-line staff I find it is easier to focus on these words as we use them daily in our interaction with clients. When it comes to management, sometimes a review is needed as they are removed from the daily interaction with clients and dealing with issues that do not need to enter the front-line workers thoughts. When it comes to interaction with management and front-line-these same 12 words need to be remembered, reflected upon and used in the interactions between levels in any organization to encourage participation, solutions, new ideas or areas to focus on and to increase moral.

How can you increase the performance of your team?

  • Listen at a deeper level and stay focused on the person in conversation.
  • Expect something special to come out of every dialogue.
  • Encourage the heart and acknowledge their gifts.

Be intentional about listening at a deeper level, and acknowledge with authenticity. I guarantee, if you improve these two things, your team will increase their performance. Asking both employees and colleagues how they learn best; visual, auditory, written, discussion, kinesthetic or a combination thereof. We learn: 10% of what we read 20% of what we hear 30% of what we do 50% of what we both see and hear 70% of what we discuss with others 80% of what we experience personally 95% of what we teach other. (Glasser, in Taylor S. and McKenzie, I. The Team Solution. Curriculum Perspectives (1995), p.23)

Encourage growth of the individual, learning how that person has grown/learnt within the team or can learn within the team. Two key elements for me are to create a professional relationship built on mutual respect and accept that the people I am working with have as much knowledge and ability as me.

“An essential part of true listening is the…temporary giving up or setting aside of one’s own prejudices…so as to experience…the speaker’s world from inside his shoes. True listening…involves a total acceptance of the other. Sensing this acceptance, the speaker will feel less and less vulnerable and more and more inclined to open up the inner recesses of  his or her mind to the listener. As this happens, speaker and listener begin to appreciate each other more and more, and the duet dance of love is begun again.”~ Scott M.Peck, MD

Written by Victoria Brewster, MSW