Canadian Psychiatry Today: An Overview of Practice in British Columbia and a Dialogue with Ukrainian Experience

Preface

1. Preface

   Preface · ~248 words

British Columbia (Chapters 1–6)

1. 1. British Columbia: Who Organizes Care

   Chapter 1 of 13 · ~1,997 words

   In this section (8)

   • Province, region and clinical team
   • Routes into care
   • An ordinary referral to a psychiatrist
   • Crisis care outside hospital
   • Who pays for consultation, therapy and medication
   • From the provincial budget to the workplace
   • Paying for longitudinal family physician care
   • Geography as part of clinical practice
2. 2. History of Psychiatry in BC

   Chapter 2 of 13 · ~1,314 words

   In this section (6)

   • Victoria, New Westminster and Essondale
   • Changes in clinical work
   • Eugenic legislation and life after surgery
   • From a single complex to regional services
   • Transfers from Riverview: clinical and everyday outcomes
   • Kwikwetlem land and new services
3. 3. Everyday Clinical Practice

   Chapter 3 of 13 · ~1,991 words

   In this section (9)

   • Acute care and psychiatry in a general hospital
   • Psychotherapy: method, intensity and access
   • Medication treatment and the next appointment
   • Who provides psychological treatment
   • Electroconvulsive therapy
   • Five years of psychiatric training
   • Electronic records, prescriptions and information transfer
   • How clinical work enters reporting systems
   • Mandatory reporting beyond the treatment team
4. 4. Care Across the Lifespan

   Chapter 4 of 13 · ~1,655 words

   In this section (6)

   • First psychosis and early intervention
   • Youth services and the transition to adult care
   • Intellectual disability and autism: supporting adult life
   • Older adults: care at home and long-term care
   • Care developed by Indigenous peoples
   • Forensic psychiatry
5. 5. Addiction, Rehabilitation and Housing

   Chapter 5 of 13 · ~1,313 words

   In this section (7)

   • Substances that changed clinical work
   • Treatment of opioid and alcohol use disorders
   • Decriminalization: a three-year pilot
   • Addiction in the general hospital
   • Persistent concurrent disorders and rehabilitation
   • Housing and Housing First outcomes
   • Family and everyday work after discharge
6. 6. Rights, Workforce and Resources

   Chapter 6 of 13 · ~2,037 words

   In this section (10)

   • Involuntary admission and treatment
   • Capacity to consent and decisions involving relatives
   • Medical assistance in dying
   • Documents accompanying restrictions on liberty
   • How patients and staff experience involuntary care
   • Admission rates over time
   • Distribution of psychiatrists and use of their services
   • How psychiatrists are paid
   • Team salaries and income after expenses
   • Funding and new treatment places

Clinical Cases & Courtroom Testimony

1. Clinical Cases (Overview)

   Clinical Cases · ~33 words

2. Case No. 1 · Pain and OUD

   Clinical Case 1 of 15 · ~2,965 words

   In this section (12)

   • Injury and postoperative pain relief
   • Development of opioid use disorder
   • First contact with addiction medicine
   • Distinguishing pain, physical dependence and OUD
   • Choosing OAT and starting treatment
   • Pharmacy dispensing, family and everyday costs
   • Psychiatric assessment after OAT begins
   • Specialized care for persistent pain
   • Resumed use and treatment review
   • Perioperative care during a further procedure
   • Treatment outcome and continuing follow-up
   • Continuing treatment between countries
3. Case No. 2 · First Depressive Episode

   Clinical Case 2 of 15 · ~708 words

   In this section (3)

   • Onset and initial consultation
   • Treatment choice and the first weeks
   • Remission, maintenance and completing treatment
4. Case No. 3 · Anxiety and Panic

   Clinical Case 3 of 15 · ~734 words

   In this section (4)

   • Symptoms amid genuine uncertainty
   • Finding continuing care
   • Treatment while waiting and subsequent CBT
   • Regaining independence
5. Case No. 4 · Alcohol Use Disorder

   Clinical Case 4 of 15 · ~590 words

   In this section (3)

   • Identifying the problem at a routine appointment
   • Treatment goals and medication choice
   • The course over a year
6. Case No. 5 · First Psychotic Episode

   Clinical Case 5 of 15 · ~721 words

   In this section (4)

   • Changes before the first contact
   • Acute treatment and early intervention
   • Clarifying the diagnosis
   • Education, family and continuing support
7. Case No. 6 · Clozapine and Pneumonia

   Clinical Case 6 of 15 · ~767 words

   In this section (5)

   • Previous course and partial stabilization
   • Monitoring treatment
   • Acute physical illness
   • Why a missed dose matters
   • Discharge and return to the community
8. Case No. 7 · Bipolar I and Court

   Clinical Case 7 of 15 · ~822 words

   In this section (4)

   • Relapse of mania
   • Inpatient treatment and a separate legal process
   • When clinical stabilization comes before a housing solution
   • Continuing care and regaining responsibility
9. Case No. 8 · Dementia and Delirium

   Clinical Case 8 of 15 · ~739 words

   In this section (5)

   • Gradual functional decline
   • What family support involves
   • Acute change after a gastrointestinal infection
   • Recovery after delirium
   • Waiting for long-term care
10. Case No. 9 · Stimulants and Housing

    Clinical Case 9 of 15 · ~751 words

    In this section (4)

    • From occasional to persistent use
    • Intoxication, psychosis, and the period after stimulant use
    • Outpatient treatment and the housing barrier
    • Risks of the unregulated market and returning to work
11. Case No. 10 · Adult Autism

    Clinical Case 10 of 15 · ~563 words

    In this section (4)

    • Reason for seeking help and developmental history
    • Access to diagnosis and costs
    • Formulation and subsequent work
    • Diagnosis and eligibility for support
12. Case No. 11 · Autism and Transition

    Clinical Case 11 of 15 · ~729 words

    In this section (5)

    • Preparing for adult life
    • A new behavioural concern and a physical cause
    • Clinical assessment adapted to communication
    • Starting adult services
    • The longer view
13. Case No. 12 · Severe Alcohol Disorder

    Clinical Case 12 of 15 · ~624 words

    In this section (4)

    • History and condition on admission
    • Withdrawal and suspected thiamine deficiency
    • What remains after the acute phase
    • Long-term addiction treatment and supported living
14. Case No. 13 · Care in Custody

    Clinical Case 13 of 15 · ~891 words

    In this section (5)

    • Admission to the institution
    • A depressive episode
    • Preparing for release
    • The first week outside
    • Three months and the following year
15. Case No. 14 · Postpartum Mania

    Clinical Case 14 of 15 · ~782 words

    In this section (5)

    • The first days after childbirth
    • Emergency assessment and safety
    • Treatment of the acute episode
    • Electroconvulsive therapy within an actual care pathway
    • Returning home
16. Case No. 15 · Forensic Rehabilitation

    Clinical Case 15 of 15 · ~598 words

    In this section (5)

    • The incident and the legal question
    • Entering the forensic psychiatric system
    • What happens between psychiatric reviews
    • The BC Review Board hearing
    • Gradual return to the community
17. Psychiatrist in Court

    Clinical Cases · Courtroom Testimony · ~492 words

    In this section (5)

    • A subpoena after acute treatment
    • Treating physician and independent expert
    • Preparing records and confidentiality
    • Questions in the courtroom
    • After testimony

Ukraine: History, System & Wartime Care (Chapters 7–10)

1. 7. Ukraine: Regions and Traditions

   Chapter 7 of 13 · ~1,237 words

   In this section (6)

   • From custodial care to specialized services
   • Lviv and Bukovyna
   • Odesa: Dispensaries, day hospitals, and social work
   • Vinnytsia and Poltava
   • Kherson and Donbas: Work, family placement, and everyday surroundings
   • Crimea and the diversity of scientific schools
2. 8. Saburova Dacha, Kyrylivska, Hlevakha

   Chapter 8 of 13 · ~1,367 words

   In this section (7)

   • Kharkiv and Kyiv: Hospital, department, and research institute
   • Scientific connections between cities
   • Occupation and the murder of patients
   • Professional resistance to political abuse
   • Intensive treatment of psychoses at Saburova Dacha
   • The Kyiv regional hospital in Hlevakha
   • Hospital continuity in the twenty-first century
3. 9. Ukraine Today

   Chapter 9 of 13 · ~1,570 words

   In this section (8)

   • Who makes decisions and pays for treatment
   • Facility budgets and staff pay
   • From first presentation to a specialized team
   • Electronic records, confidentiality, and reporting
   • The network and actual service use in 2026
   • Medication and treatment of opioid dependence
   • Patients' out-of-pocket costs
   • Legislation and professional responsibility
4. 10. Care During the War

   Chapter 10 of 13 · ~1,449 words

   In this section (9)

   • Changes in patient flow and staffing
   • Institutions in occupied territories and after evacuation
   • Symptoms in the civilian population
   • Home visits and family work
   • Reorganizing a regional ward
   • Continuity of addiction treatment
   • Military personnel, veterans, and physical rehabilitation
   • Rights and everyday treatment conditions
   • Housing after hospitalization and evacuation

Comparisons & Continuity (Chapters 11–13)

1. 11. Two Systems, Shared Questions

   Chapter 11 of 13 · ~1,919 words

   In this section (11)

   • What changes with the place of treatment
   • Geography and first contact
   • Paying for consultations, medication, and continuing treatment
   • Money, working time, and team composition
   • When the history travels with the patient
   • First psychosis and longstanding schizophrenia
   • Physical illness, intensive care, and ECT
   • Addictions and continuity of medication dispensing
   • Housing, care, and family participation
   • Legal decisions and professional time
   • Moving countries and restoring treatment
2. 12. Four Comparative Situations

   Chapter 12 of 13 · ~1,011 words

   In this section (4)

   • Comparative situation 1. Consultation for a local physician
   • Comparative situation 2. Returning to education after first psychosis
   • Comparative situation 3. Psychosis and a dangerous physical condition
   • Comparative situation 4. Stable housing after hospitalization
3. 13. Clinical Continuity

   Chapter 13 of 13 · ~269 words

Glossary & Back Matter

1. Short Glossary

   Reference Glossary · ~619 words

1. References (225)

   Clinical, Legal & Historical Sources · Total references: 225