Thursday, September 1, 2011

Mental health strategy draft doesn’t go far enough

An article published in today's edition of The Globe and Mail:
By André Picard (pictured)

Copies of the “confidential” draft of Canada’s highly anticipated mental health strategy are circulating widely among “targeted stakeholders.” So let’s take a look at what’s being offered up.

Canada is the only G8 country without a mental health strategy, so the document – and, more important, the underlying philosophy that we need to make life better for those with psychiatric and psychological illnesses – is long overdue.

After all, one in five Canadians will suffer a bout of mental illness; it is the principal cause of absenteeism and disability, and costs the economy a staggering $51-billion annually.

A strategy is essentially a way of setting priorities, of ensuring that no group is overlooked or neglected, that services are co-ordinated and that voices are heard in the corridors of power.

The Mental Health Commission of Canada, whose role it is to draft and implement the strategy, more or less has its priorities right, as evidenced by its six “strategic directions”:
  1. Shift upstream and across sectors. This means emphasize the promotion of mental health (not merely the absence of mental illness), intervene early when people are sick – at school, at work or wherever – and tackle the stigma of mental illness.
  2. Transform relationships and uphold rights. The draft document emphasizes recovery (most, but not all, people with psychiatric illnesses get better) and the need to get the sick out of the criminal justice system.
  3. Strengthen capacity in the community. The strategy calls for a shift to community-based care and underscores the importance of housing and income support to aid the recovery of those with mental illnesses. 
  4. Improve equity. Access to mental health services varies markedly across the country and among various age groups (with access to care for children being particularly abysmal), and the gaps need to be closed. 
  5. Seek innovation with first nations, Inuit and Métis. Some communities, such as aboriginals, have specific challenges like sky-high rates of addiction and suicide that need particular attention. 
  6. Mobilize leadership. The strategy calls for a “whole of government” approach, meaning mental health is not strictly a health issue – it affects the workplace, housing, justice and so on. The draft also calls for a strengthening of the mental health infrastructure.
The commission and the strategy have their genesis in a landmark 2006 Senate report entitled Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. The 567-page report was thoughtful, reasoned, forward-looking and, sometimes, even bold in describing the shortcomings of mental health treatment, dubbed the orphan of the health system, and in proposing solutions.

The committee, headed by then-senator Michael Kirby (who now heads the MHCC), made 118 recommendations, most of which find echo in the new document.

But there are some subtle, yet important differences between the tone and content of Out of the Shadows at Last and the draft strategy.

First, the language is more bureaucratic and wishy-washy. Mr. Kirby and his senatorial colleagues were refreshingly blunt on what needed to be done; the anonymous drafters of the strategy are far more circumspect.

Far more troublesome is what you can read between the lines of the proposed strategy. There is far too much emphasis on the “recovery model” – the notion that everyone will get better with support – and not enough emphasis on brain science. It’s a legitimate approach for those with mild and moderate mental health problems but not those with severe conditions such as schizophrenia.

In fact, reading the draft strategy, one is left with an unpleasant aftertaste: the distinct feeling that psychiatry and medications have no place in Canada’s approach to tackling mental illness.

There are distinct – and sometimes clashing – views in the mental health field. But the strategy gives too much credence to social science and not enough to neuroscience.

It also pays far too much attention to the views of “psychiatric survivors” who hide their vehemently anti-treatment views in the promotion of “peer support” and the language of “rights.”

But hope – and false hope – cannot be allowed to take the place of care. Where in the strategy, for example, is the call for investment in brain research, psychiatric beds and more addiction treatment facilities?

The draft also gives short shrift to the sickest of the sick, those with severe (and often intractable) cases of schizophrenia and bipolar disorder, who often suffer from anosognosia (where people don’t even recognize they have a mental illness).

This group, while small (less than 1 per cent of those with mental illness), are those who populate our streets and prisons. They don’t need the right to refuse treatment, they need the right to be well. And their families need to be empowered to help them, not cast aside.

Susan Inman, author of the memoir After her Brain Broke: Helping my Daughter Recover her Sanity, offers up a detailed critique of the strategy’s shortcomings in this regard in her article Suppressing Schizophrenia, published this week by The Tyee.

One of the MHCC’s key goals has been to help create a social movement, one that empowers people living (or having recovered from) mental illness. This is how women with breast cancer, men with prostate cancer and people living with HIV-AIDS have brought their issues to the forefront and made great strides.

But the mental health movement has to learn an important lesson from these other movements: You have to be inclusive, you have to embrace science, you have to be mainstream and you cannot allow those with ulterior motives to set the agenda.

There is a lot of good in Canada’s draft mental health strategy. But it’s not good enough yet.

Also see:

An open letter to Canadians from the Mental Health Commission of Canada

North Shore Schizophrenia Society Advocacy Bulletin (September 2011)

No comments: