To fix the wiring in your house, you need an electrician. To fix the pipes, you need a plumber.

To address mental health problems in a multi-generational family, you need to engage with persons with specific roles and functions and specialities.

Let’s look at 3 roles: the therapist, the coach and the mental health advisor.

The therapist ( a social worker, psychotherapist or psychiatrist) enters into a therapeutic alliance ( relationship) with the patient.

This role is carefully defined by the provider’s approach to mental health. The provider’s regulator ( College) has much to do with how the relationship unfolds. It is essential that the provider use motivational interviewing strategies to engage the patient with the objective of getting healthier. The therapist can’t push too hard or the therapeutic alliance will be damaged and the process will stop.  The process is typically incremental. Small steps over time.  The goal is to keep the patient involved over time.  And there are over 300 therapeutic models that can be employed to assist the patient. Maybe more than 300 models. So this choice of therapeutic model is complex.

The coach takes a different approach. Coaching is goal oriented. There is a goal and an outcome. The coach is there to reinforce this process of trying to reach those goals. Consequences or alternative strategies might result if the patient fails to attain the goals.  The relationship with the coach is about negotiating the goals and then reinforcing the process of attempting to attain them. There can be friction in this relationshp but that is factored into the approach. Coaching might be shorter term than therapy because it about clearly defined goals over a certain time horizon.

The advisor is different. The mental health advisor for the family is the architect of the entire solution. This relates to both the family system and the person of concern. The mental health advisor defines the problem or problems involving both the family system and the person of concern. Then the mental health advisor orchestrates the solution with an integrated team of providers. These can be therapists or coaches using many different modalities from family system coaching to music therapy to wilderness therapy. The mental health advisor must have a complete understanding of all the options available to address the problems. The approach has to be comprehensive. It is sometimes costly and the mental health advisor will help with the budget for these services.

Case Study:

Andy was 9 years of age. He had a bad temper and would act out periodically. His older brother would taunt him. His father had big expectations about his sports performance.

One day, he ran screaming into the kitchen, grabbed a sharp knife and threatened to self harm.

That is a crisis for this family. Our job at RCM Health Consultancy was to take the role of mental health advisor for the family.

It took a village to address this set of problems because it involved all the members of the family.

Our job was to mobilize an integrated team of providers to assist and to address the root cause of Andy’s acting out.

Our process worked to assist Andy and the family.

This is often a work in progress requiring tweaking over time as the children grow and mature and the family system seeks to adapt.

Raymond Rupert

CEO

RCM Health Consultancy Inc.

647 350 5500

info@rcmhealthconsultancy.com

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If family doctors give about 50% of all flu vaccines, then why would Public Health not involve family doctors in the distribution of COVID 19 vaccine?

This is a head scratching moment.

Lives depend on this very poor decision about distribution.

Who is making this decision? Public health? Provincial health? The Feds? The bureaucrats? Who?

Has anyone asked the authors of BlitzScaling what to do? That is Reid Hoffman and Chris Yeh.

If you asked Hoffman, of Linkedin fame, and Yeh what to do they would say that we need “SCALEABLE DISTRIBUTION”.

Using hockey rinks and community centres for COVID 19 vaccine distribution is not scaleable distribution.

Using established distribution channels such as family doctor’s offices and pharmacy chains is scaleable distribution.

The Public Health folks should ask logistics experts knowledgeable in healthcare what to do and not those with the knowledge of moving tanks and battalions.

Ask the experts at the Rotman Business school or the Schulich School of Business or the Ivey School of Business about scaleable distribution of COVID 19 vaccine.

Lives depend on how this is done.

Why are we acting like ludites when approaching Vaccine distribution?

And let’s not forget about the vaccine database that is being developed too late to be of any use.

That’s another $16M mistake.

Let’s put the smart and informed decision makers to work fixing this mess.

Raymond Rupert patient advcoate and health system disruptor for the public good.

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The search for suitable anti-inflammatory drugs for covid-19 has already turned up one, dexamethasone. It is a cheap steroid that dampens the immune system across the board.

In contrast, tocilizumab and sarilumab are more targeted. They are both made of antibodies that block the effect of interleukin-6, a protein that stokes the immune response and has been prominent in patients with covid-19.

Nearly 36% of patients in the standard-treatment group died, compared with 27% of patients in the group that also received tocilizumab or sarilumab. In other words, it cut the death rate by about a quarter.

Moreover, the patients treated with these drugs recovered faster and were discharged from hospital 7-10 days earlier.

source: The Economist  Jan 7 2021

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I’m a clinical trials geek. I keep hearing people talk about the seven to 10 years it takes to make a vaccine and how dangerous speeding this up might be. The word that keeps popping up is “rushed”, and it is making the average person nervous about vaccine safety. So, as a clinical trials doctor, I am going to tell you what I do for most of those 10 years – and it is not very much.

I’m not lazy. I submit grants, have them rejected, resubmit them, wait for review, resubmit them somewhere else, sometimes in a loop of doom. When I am lucky enough to get trials funded, I then spend months on submitting to ethics boards. I wait for regulators, deal with personnel changes at the drugs company and a “change of focus” away from my trials, and eventually, if I am very lucky, I spend time setting up trials: finding sites, training sites, panicking because recruitment is poor, finding more sites. I then usually have more regulatory issues and, finally, if my big pot of luck is not used up, I might have a viable therapy – or not.

At this point, it might get delayed because of questions over profitability or any number of other obstacles. I’m not even going to go into the years it normally takes to get the “preclinical” studies, the ones before the human trials, done.

So next time somebody expresses concern at the astonishing speed the vaccine trials have happened at, point out to them that 10 years isn’t a good thing, it’s a bad thing. It’s not 10 years because that is safe, it’s 10 hard years of battling indifference, commercial imperatives, luck and red tape. It represents barriers in the process that we have now proved are “easy” to overcome. You just need unlimited cash, some clever and highly motivated people, all the world’s trial infrastructure, an almost unlimited pool of altruistic, wonderful trial volunteers and some sensible regulators.

With all of this and the clock ticking on a global pandemic killing people by the second, it turns out we can do amazing things. The vaccine trials have been nothing short of a miracle. A revolution in how we do trials that when you think about it is perhaps not that surprising given our ability to innovate when we really need to.

Three vaccines have already broken cover and demonstrated efficacy higher than we had hoped

And we really need to – necessity being the mother of invention. Safety has not been compromised. All trials have been through the correct “phases” or process of any normal drug or vaccine. Hundreds of thousands of the very best of us volunteered and had an experimental vaccine. The world watched so closely that when a single person fell ill, we were all debating it.

To date, there has not been a single associated death related to Covid vaccines and only a handful of potentially serious events. Just imagine watching everybody in a small city for six months and reporting every single heart attack, stroke, neurological condition or anything that might be judged serious. How astonishing is this? It has been a triumph of medical science.

I haven’t even touched on the lucky confluence of timing that meant this all happened at a time when sequencing all the genes in a person or virus is so routine nobody bats an eyelid. This turbocharged the early preclinical science needed as the foundation stone of several new technologies at the right point to be exploited.

At this time, three vaccines have already broken cover and demonstrated efficacy higher than we had ever hoped. The bar was set by regulators at around 50 per cent. Both Moderna and Pfizer reported 95 per cent efficacy, and Oxford University reported 90 per cent efficacy for a particular dosage regimen. Safety data is still to follow, but the track record of vaccines is excellent, and I am an optimist.

None of this is to downplay the challenges still ahead. It is also not to say vaccines are without safety questions still to be answered. It has been, however, a triumph of good process and great people. I am confident that when regulators pore over the safety and efficacy data, closely followed by every interested scientist in the world, that vaccines will only be used if their benefits clearly outweigh the risks – and you should be confident too.

Mark Toshner is a director of translational biomedical research at the University of Cambridge. This article first appeared on The Conversation

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