Combination Therapy

Our current healthcare system provides fast and easy access to pharmaceuticals but limited access to psychiatrists and other behavioural therapies.

When aiming to achieve optimal health (physical, mental and spiritual), for some of us the best combination is medication (as and if needed) and being able to talk candidly about what’s going on in our minds (to feel supported and to feel heard, understood and less isolated).

For a related and personalized post that about my reflections on the value of psychiatry, check out “Unwinding”, it’s at:



Finding a psychiatrist in Toronto is like hunting a unicorn:

How far will people go to seek help? As far as they need to in order to speak to someone and feel better.

By: Jowita Bydlowska Special to The Toronto  Star, Published on Thu Apr 09 2015:

It was September and I just came back from one of those epic summers that ruins you forever in a good way because of too many boys and too much drinking and dancing. I was in my 20s and moving into a new place — a windowless basement room in a house I shared with four chirpy teachers-to-be — and one night, I became aware of great sadness. It was filling every black corner of that basement suffocating me — it was like one of those lucid dreams where you know you’re asleep and try to scream.

The sadness wouldn’t lift so I went to student mental-health services and saw someone the next day. For free.

The therapist was barely older than me, a psych grad to my psych undergrad. She was keen on talking about my mother and my grandmother; she believed in intergenerational trauma, for example, my grandma’s war trauma was also my trauma — what? We parted ways but I came away with the idea that getting free mental-healthhelp was as easy as making a reservation at a crappy restaurant.

I don’t mind medication (much) but I’ve always been a firm believer in talk therapy. The best is a combo: medication (if you absolutely need it) and talking. I’ve gone through a number of psychotherapists — I always took advantage of my medical benefits when I had benefits — and I’ve found psychiatrists to be the most reasonable out of the bunch. At least they don’t ask you to scream into a pillow (that happened — it didn’t work for me).

There are many different kinds of psychotherapists — general practitioners (GPs) with additional training, psychiatrists, psychiatric residents, psychologists and other health-care professionals, such as nurses and social workers. Psychiatrists and GPs are covered under the Ontario Health Insurance Plan (OHIP); the rest are not.

For me, paying for therapy (in Toronto, fees range $40 to $200 per hour) would be a luxury — but mental-health services shouldn’t be a luxury. I’m currently seeing a referral psychiatrist, for free. He is supposed to pass me on to a psychotherapy-bent GP. I’d prefer another psychiatrist but there seems to be a shortage of those — I’ve tried to find one for years and I’ve been driven crazy — it’s like hunting a unicorn.

Except that there isn’t a shortage: According to a 2014 study on psychiatrist supply and practice patterns in Ontario by Paul Kurdyak and others, there are lots of psychiatrists in Toronto. The problem is that although they see their current patients on a frequent basis, they don’t often take on new patients (my referral psychiatrist confirmed this). Additionally, the study found: “Patients who were seen more frequently were wealthier and less likely to have had a prior psychiatric hospital admission.” I’m wondering if that has to do with the wealthier having more access to mental-health services in general and perhaps arriving at psychiatrists in relatively good shape, mentally.

The study also suggests: “A proportion of psychiatrists may elect to provide care to a small number of patients whose care is relatively easy to manage and who reliably show up for their appointments, since this is easier than providing consultations or acute care to seriously ill, unstable patients with schizophrenia, bipolar disorder or severe depression.” In other words, a cute mini-depression accessorized with a Chanel purse is preferred.

I know of three tricks for getting a free therapist. The first trick is to go on many waiting lists. Then you can sit back and relax for six to 18 months and place bets on whether a GP from Siberia (Ajax) or Mars (Oshawa) will call you first. I’m on two different lists. I did get a call recently that a spot opened a two-hour drive away from where I live. I turned it down — I guess I’m not desperate enough.

The second trick is to ask around, see if you know a guy who knows a guy who knows a guy…I got a guy that way once, but this shouldn’t be as complicated as finding someone to sell you an endangered tropical fish. I’ve exhausted my guys who know guys — I suppose I could start asking strangers on the street but I’m not desperate enough.

I also have a friend who had another trick. He would show up at the Centre for Addiction and Mental Health (CAMH)’s emergency department threatening suicide — even when he wasn’t suicidal — because that would get him seen by a psychiatrist stat. That is a horrible thing to have to resort to but I won’t lie — I thought about it once after yet another “there’s a list…” kind of feedback. Thankfully, right now, I’m not desperate enough.

Right now, all I know is that when my time with my shrink runs out, I might end up trekking out to the suburbs or I’ll end up with another pillow-screaming proponent and go broke. Come to think of it, I do feel like screaming into a pillow over all of this.

Jowita Bydlowska is the author of Drunk Mom, a memoir.