Only at the worst possible moments
Governments and health systems organize care around crises, yet recovery is decided by everyday life, and that’s exactly where we fail to invest.
Jonathan first met the health system on the floor of an emergency room. He’d drunk himself into a crisis, and the team did what they’re trained to do: stabilize, monitor, discharge. He got a lecture. He got a referral. He was given an AA meeting list. Then he got on with the long business of suffering. For years, Jonathan bounced between moments of crisis and well-intentioned medical appointments that never touched the parts of his life that actually kept him sick. His body was treated; his days were not.
He stopped drinking more than once, but sobriety kept breaking against the same jagged realities—sleep that never settled, routines that never stuck, a home that pulled at old triggers and expectations he simply could not meet. Eventually, something different happened. He found help that worked on two fronts at once: the “why” (addressing an undiagnosed mental-health challenge he had been trying to numb) and the “how” (the practical skills and supports to make daily life manageable). Recovery finally had somewhere to live. It was the difference between crisis care and the supports that make recovery livable.
Jonathan’s name isn’t really Jonathan. It’s Irving. That person is me. My name is Irving Gold. I’m sober. I have two adult children, postgraduate degrees, and the privilege of serving as CEO of a national professional healthcare association. And I will always believe my story did not need to take as long to unfold—or cost as much—in time, money and pain, if the right supports had been in place.
Funding the crisis middle
Canada tackles addiction and mental health but it’s the overdose, the psychiatric emergency, the hospital bed, the treatment centre—and we wonders why people return through the same revolving door. We debate involuntary treatment and other crisis-centric policies as if decisiveness alone can substitute for effectiveness. Meanwhile, we underinvest where outcomes are actually won or lost: the wrap-around services and interventions aimed at prevention or post-crisis supports.
I needed help—making a week, or even a day, that worked. A home that didn’t sabotage me, a consistent way to get to school and work, a plan for triggers and cravings, a schedule that included sleep, meals and meds, and the skills to navigate real-world friction without falling apart. I also needed someone who could have spotted and addressed the mental-health issues that often drive substance use in the first place—early, not after years of damage. As a patient in the system, I witnessed first-hand how fundamental systemic changes are needed to help Canadians with addictions. I now bring that lens to my professional life.
I have worked in Canada’s health system for more than 30 years alongside clinicians, leaders and policymakers. A year ago, I became CEO of the Canadian Association of Occupational Therapists, where I see daily how well-entrenched system habits—not a lack of solutions—are standing in the way. Occupational therapists (OTs) are, as I see it, often the missing link in addiction health and social services. They’re trained to focus on people in all their dimensions, and work with them to make daily life liveable. They look at the fit between a person, their goals and their environment—and they help change what needs changing in that environment so people can participate in the roles that matter to them: student, parent, worker, neighbour, friend.
No need to invent new solutions
In addictions and mental health, that looks like prevention and early support for kids and families; practical, trigger-aware planning for the week after discharge; and hands-on help with housing, routines, transportation, work or school readiness and parenting. If that sounds like “soft” care next to emergency or addiction medicine, ask anyone who has relapsed because life outside the hospital or treatment centre was impossible to manage. Ask the emergency doctors who keep seeing the same people for the same reasons.
What’s being missed is that recovery is decided by everyday life, and that’s exactly where we are failing to invest. Reflexively our systems build solutions around physicians and nurses in crisis settings. Hiring templates, referral forms and program designs often omit OTs or relegate them to “rehab” after the drama is over. And, because we measure wait times and bed days more than we measure whether people are keeping housing, staying in school, or maintaining work, we overlook the type of professionals who can move those outcomes.
We’ve already have a workforce that sees the whole continuum of care, with embedded roles in primary care and community mental-health hubs, youth and family services, schools, housing and recovery programs and justice transitions. Critically, the moment someone leaves the hospital after an overdose or psychiatric emergency, they should be automatically connected to an occupational therapist in the community.
Matching the problem to the skill set
This isn’t about choosing one profession over another. Emergency teams save lives. Physicians diagnose and prescribe. Psychologists and social workers provide therapies and supports. Occupational therapists make the rest of life work so recovery can stick. I sometimes think about the tally of my crisis-only years: the emergency visits and admissions, the opportunities missed, the cost to my family and to the system. Multiply that by the thousands of Canadians cycling through the same door and the conclusion writes itself.
Funding prevention and post-medical supports—what OTs do every day—is not only compassionate. It’s fiscally responsible. We say we want fewer overdoses and fewer mental-health crises. Then we should stop pouring all our energy into the moment of collapse and start investing in the weeks, months and years to make it less likely. Put OTs on the field. We don’t need to wait for another debate about involuntary treatment to do it.
Irving Gold is CEO of the Canadian Association of Occupational Therapists.
Photo: Shutterstock
