'Trust is far superior': What this Toronto psychiatrist learned from supporting a relative with schizophrenia

As a psychiatrist, Dr. Saadia Sediqzadah works primarily with patients who have schizophrenia, or some form of psychosis. But the nuances and complexities of supporting someone with mental illness is also something she has learned a lot about from her own family.

When she was in her third year of medical school at the University of Toronto, starting to pursue psychiatry in earnest, a beloved family member was diagnosed with schizophrenia.

"It was really, really tough," she told The Sunday Magazine's Piya Chattopadhyay. "It was this complicated dance where I would step in to help and he would step back."

That's why she now starts by building a rapport with patients early on, instead of trying to push someone into treatment or challenge their delusions right away, said Sediqzadah, who works at St. Michael's Hospital in Toronto.

"I [have] really come to believe that if I focus more on … building a relationship, it is that much more likely that my patient will want to attend a followup. And it is in that followup that we can ultimately meet the goals of diagnostic assessment, coming up with a treatment plan. But the foundation ultimately is built on trust," she said.

Imagine when you're already feeling paranoid and then having the sense that your family member is monitoring where you are.- Dr. Saadia Sediqzadah

Trying to support

When her relative was first diagnosed, Sediqzadah went into "doctor mode" and rushed home from school to try to get him into treatment. But her relative didn't think he was sick or in need of help, she said.

"[A] core feature of psychotic illnesses is insight — recognizing that there is a problem. For many mental illnesses, patients can be motivated to come in because they know something is up and they need the help," she explained.

"But one of the problems with an illness like schizophrenia is that you believe the delusions and the hallucinations. So you don't think that there is a problem."

Her family's efforts to intervene eventually led her relative to cut them off.

"Imagine when you're already feeling paranoid and then having the sense that your family member is monitoring where you are," she said.

[In] that first appointment — I don't want to put pressure on the individual to give me as much information as possible. If anything, I would prefer to just take a step back and just get to know you.- Dr. Saadia Sediqzadah

Housing, finances key in treatment

Sediqzadah's approach to supporting her relative evolved over time. Rather than focusing on getting him into treatment, she focused on making sure he was safe, housed and willing to speak with her family. 

"It was a little bit hardheaded of me to focus so much exclusively on the medical piece," she told Chattopadhyay. "The therapy, the relationship, the alliance, the trust is far superior."

Even though he didn't respond, she and her family would send their loved one texts almost daily.

"I wholeheartedly believe that he always knew in the back of his mind that we were there for him. That was ultimately, I think, what led him to come back to us," she said.

It's a lesson she's taken to heart as a psychiatrist.

"[In] that first appointment — I don't want to put pressure on the individual to give me as much information as possible. If anything, I would prefer to just take a step back and just get to know you."

When there is trust, she said her patients are more likely to attend future appointments and she is more likely to come up with a treatment plan that works for them.

Access to housing and access to financial means are just as important.- Dr. Saadia Sediqzadah

With psychosocial interventions a top priority, it was also important for her to work in a clinic alongside allied health-care professionals, including social workers, nurses and occupational therapists. 

She said she and her colleagues try to make sure their patients have access to secure housing, disability support and other financial resources.

Oftentimes she helps them access the Ontario Disability Support Program by assisting with the application. During the pandemic, she and her colleagues have also assisted patients with applying for the one-time payment of $600 the federal government gave to those who receive a disability tax credit.

"Part of wearing my doctor hat is not only these medical pieces, but also thinking about the social aspects, those social determinants of health that are super important … and perpetuating factors in a patient's mental illnesses," she said. "Access to housing and access to financial means are just as important."

Mental distress not a criminal act: Sediqzadah

Another issue Sediqzadah is now focusing on is the role of police in mental distress calls.

When police fatally shot Ejaz Ahmed Choudry, 62, during a mental health crisis, it hit close to home.

"What happened to Ejaz Choudry is truly my worst nightmare for my family member," she said in an interview with Metro Morning in June.

The fact that it would be the police responding, I think criminalizes it. [It] tells us that having a mental distress is a criminal act.- Dr. Saadia Sediqzadah

Sediqzadah was one of the signatories on a letter to Toronto City Hall that demanded change to use-of-force laws during interactions with civilians, and defunding Toronto police and reallocating that budget towards emergency services to support mental health needs.

"I don't think police should be involved in bringing patients to hospital when we're concerned for a psychiatric reason," she told Chattopadhyay.

"The fact that it would be the police responding, I think criminalizes it. [It] tells us that having a mental distress is a criminal act."

It's a sentiment shared by the Centre for Addiction and Mental Health, which also urged the removal of police from front lines for people in crisis. In an email to CBC News in June, Toronto Police Services Board Chair Jim Hart said the board remains "very supportive" of the existing mobile crisis team program, but that it is "committed to working to explore enhancements of and alternatives to this concept."

Sediqzadah said patients who are brought to the hospital in cop cars are often in tears, and wonder why they were put in the back of a cop car for having suicidal thoughts. In those moments, Sediqzadah tells them, "I want to remind you that there is nothing criminal about feeling suicidal."

"Those few words can be so powerful for a patient [in] such a vulnerable moment," she said.

Health-care providers are also trained in de-escalation, especially those of us who work in the emergency department.- Dr. Saadia Sediqzadah

Sediqzadah is mindful that there are situations where a person in distress might be threatening to harm themselves or others, or have a weapon on them.

"Health-care providers are also trained in de-escalation, especially those of us who work in the emergency department. And those of us who work in health care, we don't work with weapons — I mean traditional weapons," she said.

She noted "the emergency department can also be a place where there can be weaponization," referring to the use of restraints.

"So I want to be mindful that the medical system can be complicit in many ways as well. But we don't work with guns, for example. We don't work with Tasers in health care."

She argues members of the health-care community have expertise to bring to crisis de-escalation.

"What we need is the political will and the resources and to be invested by our municipal and provincial governments to provide alternative responses," she said. "I'm asking that we commit to and move towards a model where we can respond to these mental distress calls without involving the police."

Earlier this month, Native Child and Family Services introduced a pilot project in Scarborough in which Indigenous-led crisis teams would replace police on mental health calls and wellness checks. Meanwhile, Kitchener-Waterloo piloted a program that pairs police and mental health workers to handle mental health calls, but the program could only respond to about half of the police's requests for service. Aside from these types of city-specific programs, there has been no significant overhaul in any Canadian province to date on improving the quality of crisis care and finding alternative solutions.

'In the right profession'

In the meanwhile, Sediqzadah said she and her colleagues continue to provide patient care beyond diagnostic assessments and psychotherapy.

As for her own relative, Sediqzadah said he is doing much better because he's finally on treatment and getting the care that she and her family had always hoped he would. 

"It is one of the most rewarding experiences of my life, and it's a really good reminder to me that I'm in the right profession," she said. 

"It can be really tough sometimes. You feel like you don't have a lot of hope to work with. But then I will have some cases, especially that of my family member, where I see things really turned around for the better. It fills me with a lot more hope and inspires me to continue to do this job."

Interview produced by Pauline Holdsworth.