You bring up three interesting areas in your question. One is about the training of professionals and who is most qualified to look after what type of patient. There's also the issue of patient access to resources, and the issue of patient compliance. I think all three are laudable objects of any study and, potentially, this study.
To answer your questions a little bit more in depth, in terms of the training of professionals, all medical doctors are trained in psychiatry. They all have training in the various medications and various other types of therapy, whether it's from a biological, psychological, or social model. All doctors should be able to do that. Sometimes the best follow-up for a patient is with their family doctor. Sometimes they have a relationship with their family doctor. If their doctor feels comfortable in those types of treatments, then that may be the best working relationship. Certainly psychiatrists are specifically trained to deal with mental illness and all of the different medications out there. Most family doctors are required to keep their continuing medical education up to date, so they should be aware of what medications are out there and the various options available.
I'm sorry that your experience is that sometimes there seems to be a lack of choice in terms of medications. I can't speak to that, but in general, family doctors are very well-trained professionals, as are psychiatrists.
In terms of access, that's an issue across the country. It's probably a bigger problem in rural areas than urban. That's been talked about by many groups. It's not a problem unique to Canada, either. The U.S. has exactly the same difficulties. Take my own hospital as an example. I work in a major hospital in a major city, and I will discharge patients from hospital. Even though I have a community practice, it's very difficult for me to see all the patients I admit. There is a problem with access in terms of who will follow up with the patient once they leave the hospital.
Access isn't limited just to psychiatrists. Psychiatrists more and more are working in multidisciplinary teams, and very often it's difficult for them to access the teams. Part of that is coordination. Part of that is a lack of funding, just not having the resources out there. In our city we have a really good mental health support team, but the waiting list to get into that team is still two months after you're discharged from hospital. That makes it very difficult.
Your last comment was on the issue of compliance. That's a separate issue. Many factors are related to compliance. It may include a patient's pre-existing ideas toward medication. It may include their family's ideas about medication. It may include what they've heard from other people. It may include the relationship with their treating professional in terms of whether or not the medication or treatment has been adequately explained. That's something that needs to be addressed as well. Compliance is a complicated issue. Again, that may be something that this study wishes to look at.