Canada's mental-health system is underfunded and poorly co-ordinated and needs a complete overhaul to meet the needs of patients and their families, the Mental Health Commission says in its long-awaited national strategy.
The 152-page document recommends an immediate infusion of $4-billion annually for mental-health care; calls on employers to implement psychological health and safety standards to protect workers; says efforts to divert people with severe mental-health problems out of the justice system and into care need to be accelerated; and embraces a "housing first" philosophy to get homeless people suffering from mental illness off the streets.
The Globe and Mail obtained a copy of the strategy, entitled "Changing Direction, Changing Lives," under embargo but is publishing before the Tuesday release date because of leaks to other media outlets.
Until now, Canada has had the dubious distinction of being the only G8 country without a mental-health strategy but the Mental Health Commission of Canada says it now has a "blueprint to translate aspiration for change into action."
An estimated 6.7 million Canadians suffer from mental illness at any given time. Last year alone, spending on mental-health services totalled $42.3-billion and the impact on the economy was even greater.
"This is an ubiquitous Canadian problem and an ubiquitous global problem," said David Goldbloom, a psychiatrist and chairman of the MHCC. "There are significant barriers – in the health-care system, in the workplace and in the community."
To break down those barriers – and address the problem of stigma in particular – the strategy proposes six "strategic directions" that should be pursued, and makes numerous recommendations in each area:
- Promoting mental health and prevention of mental illness;
- Fostering recovery and upholding rights;
- Providing access to the right services, treatments and supports;
- Reducing disparity and addressing diversity and those suffering mental-health problems;
- Working with first nations, Inuit and Métis, communities where addictions and suicide are major problems;
- Mobilizing leadership and fostering collaboration.
Dr. Goldbloom stressed that the commission is not a funding agency so its role is to promote a vision and promote buy-in by putting forward good research, highlighting best practices and facilitating co-operation between various stakeholders.
"We're not an advocacy organization, we're a catalyst," Dr. Goldbloom said.
To underscore the approach, the strategy is peppered with examples of successful mental-health programs from around the country, such as Partners For Life, an innovative suicide prevention program that has reached 750,000 high-school students in Quebec, and the Seniors Mental Health Outreach Team that follow up on referrals from police, social services and physicians to ensure seniors with mental-health problems get follow-up care.
The strategy does not deal much with monetary issues, with one exception; it says that, currently, 7 per cent of health dollars in Canada ($14-billion) are spent on mental-health care and recommends that be increased to 9 per cent ($18-billion).
"We need more money for mental health, but we also need to spend it more wisely," said Louise Bradley, the chief operating officer of the MHCC and a psychiatric nurse by training.
She stressed too that the needs of mental-health patients cannot be met exclusively by the health system, that changes are required in social services, education, housing and corrections.
A draft of the strategy, released in 2009, was met with sharp criticism, particularly from families of people living with severe mental illness. They complained that too little attention was paid to neuroscience and the right to treatment, and too much credence given to the civil libertarians and anti-psychiatry activists.
Dr. Goldbloom said that the final version of the strategy is very different and, in particular, pays far more attention to the needs of those with severe mental illness and their families. The report states that "treatment of people with severe illness is a gauge of system success."
The MHCC chairman conceded, however, that it is impossible to create a blueprint for change that will please everyone. "My hope is that everyone will see they like 80 per cent of the strategy and support the overall thrust. That's the only way we'll be able to mobilize and move forward."
The Mental Health Commission of Canada was created in 2007 in response to a damning Senate report on the state of mental-health care entitled "Out of the Shadows at Last – Transforming Mental Health, Mental Illness and Addiction Services in Canada."
The MHCC has an annual budget of $15-million.