Why I Left: The Shortcomings of the Mental Health System in Ottawa
It was never the people. Most of the clinicians I have worked with were amazing and did their best. It might be cliche, but it was “the system” that broke me, the faceless, omnipotent, patriarchal institutions that made up the mental health system in Ottawa.
It took me a long time to realize that in order to improve the mental health system in Ottawa, it was not about each individual doing more or adding more psychiatrists. It was more complicated and impossible to solve on my own. Fixing a broken system requires internal organization and collaboration to provide the most effective care to the broadest swath of the population. It requires a structure that incentivizes high-quality care, rather than merely demanding higher quantities of care.
Since coming to New Zealand, I have come to appreciate how hard this is to do. New Zealand has what Ottawa does not: strong leadership across institutions with a clear, evidence-based vision informed by consultation and support from community and health care stakeholders.
Pursuing impossible ideals in lieu of realistic solutions
When we have limited resources, we need to forgo lofty ideals and be more pragmatic. We need to ask ourselves as a society what our priorities are when it comes to mental health care. We need to look at the areas of greatest concern for the population we are serving, and then we need to match this with what the evidence tells us are the areas of mental health that are actually eroding the fabric of society and the individual most.
I am not sure what the goals of the Ottawa mental health system are. There is what is plastered on websites: “We treat our patients like our loved ones”, and “Let’s help you achieve your potential!” These empty slogans ignore the reality of severe and persistent mental health conditions.
To have any chance at a full and enriched life, these patients require longitudinal care with a multi-disciplinary team. Without this, meaningful recovery to our most unwell relies on too many patient-specific and environmental factors that the medical system can not change, so in Ottawa, why do we pretend to take responsibility for them? By forcing the medical system to absorb these societal failures, the crushing weight of responsibility gets shoved onto the individual clinician at the end of the day. Under this pressure, "sustainable mental wellness" becomes an impossible goal and a source of demoralization.
As a result, behind closed doors in acute care hospitals, psychiatrists default to being driven by numbers as a measure of productivity and a sense of meaning:
- How many people have you seen?
- How many are on the waiting list?
- How many are admitted?
- How many are discharged?
- What is our funding and how do we get more of it?
In clinical case rounds, we are incredibly quick to recommend the next medication or adjustment, desperately avoiding a glaring truth: some of our cases are fundamentally palliative. In any other medical specialty, recognizing a case as palliative opens the door to maximizing comfort, minimizing invasive interventions, and preserving human dignity. In psychiatry, that conversation never happens.
Instead, the discussion immediately shifts to how quickly we can discharge the person to free up a bed, and how we can best protect ourselves legally. We practice in a North American climate where psychiatrists do not feel legally protected or given the benefit of the doubt. Publicly, we are rarely portrayed as benevolent helpers; the cultural narrative often paints psychiatry as sinister or predatory.
The misuse of inpatient care
In the hospital setting, our acute care hospitals are suffocating on patients who do not benefit from hospitalization and could have avoided admission if there had been a community-based approach instead. This is the main reason I left inpatient care. It became profoundly unrewarding. I found fewer and fewer cases that actually fell within the scope of my specialized clinical training, and the treatments available to me began to clash directly with my professional ethics.
Acute psychiatric wards are not safe havens for social crises. For many vulnerable populations, the chaotic environment of an emergency room or an acute inpatient unit actually exacerbates their trauma and instability. Managing these vulnerabilities in a dedicated community setting is not only significantly less expensive than an ER visit, but it is also vastly more humane.
When I realized that Ottawa’s current model of acute psychiatry was doing more iatrogenic harm than good—despite our best intentions—I knew I could no longer participate in it. For nine years, I watched Ottawa invest in and perpetuate a model where everyone loses.
This is no one individual's fault or responsibility (that I know of). This is how Ottawa for reasons unknown, has set up its mental health system for years. Lately things are worse as the system lacks the coordination and flexibility to deal with increasingly more complex patients, the long-term consequences from COVID, stagnant resources, decriminalization and legalization of recreational drugs and ongoing absent city-wide mental health leadership.
A Difficult Decision
The questions I have been asking, yet remain unanswered:
- Why does a major capital city lack integrated, evidence-based community mental health teams specifically designed for chronic suicidality and Bipolar disorder?
- Why are we satisfied to let the police, emergency rooms, and acute care beds be the primary gateway to mental health care?
- Why do community family doctors and psychiatrists receive practically zero structural support from major specialized institutions like the Royal Ottawa Hospital?
These questions have been whispered around every hospital water cooler I've stood by for nine years. At some point, you grow tired of having the exact same circular conversation. At some point, for your own clinical ethics and mental survival, you decide to leave.
For me, that breaking point arrived in January 2026—when I packed up my practice and left for New Zealand.
It is not simply a resource issue
No matter where I end up practicing psychiatry, I must accept that we do not have the resources to bring everyone to a place of sustainable wellness. And this goes far beyond a simple lack of funding. I am incredibly tired of people in power complaining about a lack of resources instead of looking at how we are actively mismanaging the resources we already have.
When we frame systemic failure strictly as a financial issue, we turn on one another. We become jealous and critical of other clinics or departments, believing that if they just did more, the crisis would be solved. We turn inward because we refuse to admit a fundamental truth: none of us have enough, and money alone won't fix it. Mental wellness requires structural, environmental, and societal stability far beyond what medicine can ever offer.
During my last few years practicing in Ottawa, my daily mantra became a quiet acknowledgment: "We are all drowning." I didn't use this to despair; I used it to remind myself to have radical compassion for my colleagues, my patients, and myself. We must keep asking for better funding, but we must also optimize our processes to do the most good—even when we know we cannot save everyone.