“We are judged as a society by how we treat our most vulnerable and older people. People who have a disability, people who are struggling with a serious mental illness are often vulnerable. So I take up the space someone gives me in trying to advocate for people who can’t advocate for themselves.”
Author, educator, public speaker, prolific Op-Ed writer, award-winning podcaster, and now diagnostic software developer, Dr. Diane McIntosh does anything but maintain the status quo. As a practicing psychiatrist for nearly 25 years, Dr. McIntosh is in a unique position to accurately assess our mental health system, and she has not shied away from candidly exposing patient mistreatment and a structure that perpetuates the stigmatization of psychiatric diagnoses while reinforcing a transactional approach to patient care.
Dr. McIntosh’s crusade to improve the mental health system stems from her experience navigating an infrastructure lacking in the compassion that should underpin all healthcare. Most physicians enter medicine with an intention to help and heal, but these noble goals are often lost in a system that rewards efficiency and expediency over kindness and empathy. According to McIntosh, psychiatric patients often find themselves at the mercy of overstretched providers and a broken system that for many reasons is unable to provide optimal care. Additionally, incorrect diagnosis (and treatment) occur in up to 70% of initial psychiatric diagnoses, something ostensibly avoidable if consistently applied, evidence-based processes were followed by all mental health practitioners. The end result is that a correct diagnosis can allude patients for years, with many intervening incorrect diagnoses and assessments. Patient care, including prescriptions and treatment plans, can look piecemeal, knee jerk and habit-based when overtaxed, under-resourced practitioners feel so much pressure to get to their next patient.
Dr. McIntosh has refused to resign herself to a system that has not only let her down but has also let down so many of her patients. Instead, she is using her voice in as many ways possible to affect change and create a more equitable balance of power between patient and caregiver. Her book, “This is Depression” demystifies many of depression’s complexities and clearly illustrates treatment options in language accessible to all readers. For those preferring podcasts, she and ex-NHL goaltender Corey Hirsh are the hosts of “Blindsided,” an award-winning (Webby-nominated) podcast that explores the impact of mental illness through the experiences of professional athletes, showing that mental health struggles know no economic or demographic bounds, and do not discriminate based on apparent “privilege.” As a writer of Op-Eds, Dr. McIntosh also addresses a number of egregious outcomes of a system inadequately positioned to support the impact of a poisonous drug supply, homelessness and mental health crisis. She details that the escalation of these crises points to oversights such as a lack of funding and the dismissal of relevant solutions such as “research evidence supporting the life-saving value of supervised injection sites.” Her brave stance and tendency to speak her mind have put her in high demand as a panellist and keynote speaker on issues concerning mental health — pre-pandemic, her travel schedule took her to many corners of the world to share her views. Today, Dr. McIntosh works closely with a team of software engineers to develop a technology platform (funded by Telus) that will revolutionize and standardize mental health diagnoses and treatments. By inviting primary care physicians to participate in a systematic diagnostic process, Dr. McIntosh’s technology platform will help to both unburden an overtaxed mental health system, as well as democratize a process historically guarded by those specializing in psychiatric care. The end result of all these efforts, she hopes, is to educate and empower the consumer and to galvanize professionals and patients alike to fight for better mental health treatment.
Diane McIntosh began medical school after first completing her pharmacy degree and then recognizing her deep passion for the field of medicine. Despite being afflicted by the self-doubt and imposter syndrome that plague many young people, particularly young women, Diane endured the rigorous medical school application process and gained entry to a world she immediately loved — obstetrics, surgery, dermatology, everything. She found all areas of medicine interesting, but the area she found most fascinating was psychiatry.
After a short stint in a pediatrics residency, McIntosh switched to psychiatry but recalls the resistance she met when she chose the specialty over more esteemed specialties such as radiology, ophthalmology, and surgery. Psychiatry is known for its lower remuneration and less prestigious appeal, and Diane recalls being asked by her pediatrics program director “why she would throw her life away like that” when deciding to switch out of pediatrics in order to pursue psychiatry. The lack of esteem for family practice and psychiatry, the backbone of our medical system, stood out as anathema to the values that drew McIntosh to medicine. It was at this stage that Diane’s internal compass won out — she followed her internal pull towards an area where she felt she could make a meaningful difference, as opposed to areas the medical field and society seemed to value. It was also at this stage that systemic biases became apparent.
In reflecting on why these biases against psychiatry exist in medicine, Dr. McIntosh offers a variety of explanations as to their origins. To start, there are some things that differentiate psychiatry from many other practices, such as the lack of objective tests, like x-rays and blood tests to “show” that someone has a psychiatric illness. Historically, there have also been a lot of odd theories about mental illness and they were not always understood to be the brain disorders that they are. One of the most persistent faulty theories was that mental illness was caused by the mother, that a less-than-adequate mother was to blame for mental illness in their children. Numerous other scientifically unfounded theories took hold in psychiatry for decades, and although now debunked, still cloud the overall perception of mental health care and contribute to the stigmatization of patients.
Today, part of Dr, McIntosh’s goal is to help the public understand that mental illness is caused by a combination of biological, psychological and social factors. Based on research and scientific data, mental health practitioners now know that these three factors interact together to trigger mental illness, and there is not just one root cause. Biological factors (genes, hormones, brain chemistry, brain injury), psychological factors (whether you experienced trauma, your unique temperament and coping mechanisms) and social factors (financial trouble, a marital breakdown) may interact to precipitate a “brain disorder.” Dr. McIntosh adds that the psychiatric field also knows more about genetics and understands them as the core of many mental illnesses and far more powerful than previously realized. The mental health field now recognizes polygenic inheritance (a number of genes that work together) as a contributing factor to a biological vulnerability for mental illness. The field also has more data and research on the impact of trauma and abuse as epigenetic triggers that lead some genes to turn on and others to turn off, making individuals more at-risk for mental illness. Science also shows that what happens in utero and during the first few years of life when the brain is developing can be the most impactful on your risk for mental illness. Other environmental triggers also cause epigenetic changes, such as smoking cannabis (THC).
In spite of significant advancements in the understanding and treatment of mental health disorders, one of the main weaknesses within the system is the risk of physician burnout. Administrative and political issues such as the fight to get medications covered, inter-practitioner disagreements regarding patient treatment, time pressures and a systemic lack of compassion towards mental health patients create an environment rife with negative influences that contribute to psychiatrist burnout. This can show up as cynicism and lack of drive, not due to a lack of desire to help the patient become well, but a lack of drive to fight a continually uphill battle.
Dr. McIntosh reflects on her own experience with burnout as a reaction to the way her patients living with mental illness were treated in the healthcare system. Observing that it is a systemic issue, and not an individual practitioner issue, she reveals that patient treatment often reinforces all the worst stereotypes and stigmas associated with mental illness. In-hospital, medical practices like taking a patient’s clothes and treating them like they will hurt us reinforce stereotypes like, “you can’t trust people who are mentally ill,” or “they are all dangerous.”
On top of physician burnout, Dr. McIntosh also emphasizes that the mental health field suffers from a lack of funding for psychiatric medications. It costs more than $1 billion to bring a drug to market and pharmaceutical companies are reluctant to invest in an area where blocks to approval are more stringent and rigorous than in other areas of medicine. Dr. McIntosh points to the significant advancements in cancer treatment and improved survival rates due to research and development of new drugs. “When I was in pharmacy school,” Dr. McIntosh offers, “ the death rate from childhood leukemia was 95% and now the death rate is less than 5% due to the development of new drugs.” By contrast, research into novel psychiatric treatments falls far behind. Mental illnesses are associated with significant morbidity and mortality, not just from suicide but also due to an increased risk of physical illnesses, like obesity and heart disease. Yet, funding research and development has not been a priority over the past several decades. The recent introduction of esketamine makes it the first new antidepressant approved by regulators in the past thirty years that has a novel mechanism of action. Esketamine is delivered via a nasal spray and affects a different system from traditional antidepressants, which typically affect the monoamine system (serotonin, dopamine and norepinephrine). It can be prescribed for very severe depression and suicidal ideation and seems to be rapidly effective. Like all antidepressants, esketamine promotes the growth of new brain cells, but it appears to turbocharge that effect, which might be the reason for its rapid benefits.
It is not just the delivery of pharmaceutical treatment that Dr. McIntosh is focused on. Championed by the CEO of Telus, Darren Entwistle, she and her team, including several software engineers, computer scientists and strategists, continue to build Canada’s most robust technological diagnostic tool. Soon, family practitioners and nurse practitioners, the backbone of our mental healthcare system, will have access to an evidence-based diagnostic tool that will apply consistency and scientific rigour to the psychiatric diagnostic process. McIntosh adds, “Every family doctor and nurse practitioner that is more confident, more rational in their choices, helps hundreds, even thousands, of people.”
As Dr. McIntosh’s role as a practicing psychiatrist evolves into that of a visionary and vocal leader in the world of medicine, her focus on what is important remains firmly in place. She followed her passion into medicine and then into psychiatry and is following her passion in the fight for more compassionate care. “We are judged as a society by how we treat our most vulnerable,” emphasizes McIntosh. “People who have a disability, people who are struggling with mental illness are often vulnerable. So I take up the space someone gives me in trying to advocate for people who can’t advocate for themselves.”
Written by: Tassan Sung, Women’s LEAD Chair