Houses of Cards

Between Internal last block and Psychiatry this block, social factors have featured pretty prominently. It's been a good demonstration of the importance of having a support system and personal resources in maintaining health, as well as a fairly meaningful lesson on the limits of modern healthcare when these social factors are absent.

What struck me was how someone who seemed to be leading a reasonably complete life could have that life fall into complete disarray if just one critical support piece is taken away. That support might have been a job, a vehicle, a family member, a friend, any number of things - but once it was gone, health started to decline quickly. Many times it was a snowball effect, where losing one support would result in other supports falling away either directly (eg spouse dies and they used to be the driver in the family) or indirectly (eg person loses job, has episode of depression, loses interest in activities, loses supportive friends associated with those activities).

Listening to some patients' stories, I can't help but see us all as giant houses of cards, seemingly well-constructed when everything's going well and each piece is in place, but quickly collapsing into a big heap of nothingness when just one piece is pulled away.

Granted, I've seen many instances where a patient recovers quite well despite losing a major support in their lives, where the other supports they have simply fill in the gaps or new supports are marshaled to help. Still, take away one more support from some of these patients and it's a short path to being in a very difficult situation. It's important - critical, I would say - from an individual perspective to develop social supports and to have personal resources available. Yet, even well-supported patients can falter if their life sustains just the right combination of minor insults.

My reaction to this is to push for adequate institutional supports. When everything goes south, what should we have in place to pick people up? And to what degree should the healthcare system be involved with these institutional supports, particularly in Canada, where healthcare is one of our primary institutional support systems? We've got a pretty complex network of publicly and privately funded resources for patients or people in general when they need help. These resources do a lot of good. But they have their limitations too, and plenty of people fall through the cracks. Those cracks could use some filling in.