Mental-health strategy calls for complete overhaul, $4-billion commitment

An article published in today's edition of The Globe and Mail:

By André Picard — Public Health Reporter

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 [pictured], 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.

Blessings from schizophrenia? Believe me, they exist

An article published in the today's edition of The Globe and Mail:

By Anne Aspler (pictured)

There was a ticking time bomb in my head that deactivated at the age of 26: the probability of schizophrenia. That’s when, for first-degree relatives, the statistical likelihood of developing the disease drops from 13 per cent to that of the general population: 1 per cent.

My mom is afflicted with schizophrenia. Despite never having had signs or symptoms, I used to live in constant fear that, one day, I might develop it. The path of my life was driven by this fear. I overworked myself to ensure a livelihood that would enable escape from the stigma of mental illness and unemployment. Becoming a doctor seemed the best I could do to champion my own mental sanity, and to further understand an illness that has never made sense to me.

For some, Christmas aggravates their heart failure – all those salty holiday indulgences. For others, the season precipitates their “brain failure” – the stress, anxiety and loneliness is amplified by the process of reflection on years past.

For part of last year’s holiday season, I found myself on the crisis-psychiatry team at one of the busiest inner-city centres in Canada: St. Michael’s Hospital in downtown Toronto. “Crazy” became the new norm, all day, every day, suicide and self-harm an acceptable and prevalent psychological exit.

My worst moment of flashback to my own experiences occurred when I had to make a phone call to the Children’s Aid Society. I’d just spent an hour developing a good rapport with a newly divorced, newly unemployed, suicidal single parent – courageous in seeking help. Calling CAS was a decision that would result in the removal of her children from her home – at Christmas.

To me, it was the ultimate betrayal of her trust. I felt as though I had betrayed my own mother. Instead of going home for the holidays last year, I externalized my distress by going to Haiti as a volunteer physician working on cholera-relief efforts.

As early as Grade 3, I had an understanding of the societal taboos around mental disease. That year, our art-project assignment was to “depict your parent’s career in a drawing.”

My mom? Unemployed. And so I developed a knack for creativity. I didn’t understand exactly what was wrong with my mother, so making up a career for her wasn’t a big stretch.

In high school, my sister and I were recruited for a University of Alberta study of children with a parent who had schizophrenia. Enrolling in this was like facing my biggest fear. I was sure the survey would uncover that, secretly, my mental stamina of steel had been blocking out symptoms that would eventually resurface with a vengeance.

Quite the opposite happened: It was a first step toward freedom. Not only did they declare my sister and I mentally “healthy”; they did something far more important to me – they normalized the disease.

I understand now that “mentally healthy versus ill” is an often unhelpful dichotomy. The psyche of the population exists on a spectrum. Scientifically, we have constructed an arbitrary standard. Past a certain point of dysfunctionality, some will be labelled, recommended for therapy and medically treated.

The rest of us can retain our status as “normal” and obtain socially acceptable therapy in the form of free counselling from family members and friends, self-therapy in the form of reflection, and perhaps moderate doses of self-medication.

Even for one individual, mental wellness fluctuates immensely over time. Practising medicine has reaffirmed for me that there is not one among us who is 100-per-cent mentally sound in all day-to-day exchanges and decision-making. Most of us could probably cite one or two mental hang-ups they could do away with. Thankfully, we escape any permanent labelling and write these off as a mood, an anxiety, impulse or worry.

I realized I'm tired of the silence around mental illness. I'm tired of contributing to the stigma by hiding the reality that these patients are our sisters and brothers, our parents, our closest friends – the ones in our lives whom we love but don’t know how to reach out to.

The reality? My mother is a great parent. With age, I’ve come to appreciate that her demeanour has given me a positive outlook on life; and it has imbued me with an inordinate capacity to tolerate chaos and disruption. They are traits that have served me well as an emergency resident physician in Toronto and working overseas in resource-poor settings in South America, Asia and Africa.

It's also taught me to value my clarity of mind and to put it to use. It gave me the opportunity to benefit firsthand from Canada’s social safety network. It has bred a doctor and a teacher (my sister) who will be strong lifelong advocates for redressing social inequity.

To my colleagues who work with those affected by mental illness: Thank you for showing them patience and understanding and treating them as equals, even when society, or sometimes their own family, doesn’t.

My mom has really done her best. She’s spent her entire life struggling to cope with the mind inside of her, as well as to cope with the reactions of the world around her.

She’s amazing, really. My sister and I will probably try to micromanage her symptoms until the end of her days. But we love her. And we owe her and her illness everything.

Anne Aspler lives in Toronto.

Photo credit

Address the real barriers

A letter to the editor published in today's edition of The Globe and Mail:

Untreated mental illness is a major risk for suicide: The rate of suicide for people with schizophrenia is 50 times higher than the general population, and 15 to 30 times higher for people with bipolar disorder (Suicide Barriers Fail To Address Root Of Problem – July 7). Suicide is the leading cause of death for 15- to 24-year-olds.

In Canada, only three in 10 adults access mental health care; the situation is worse for children and youth. While stigma may be a factor, the biggest problem is the lack of accessible mental health services and a lack of focus on early intervention. It is ironic that the share of health spending on mental health continues to decline, even though we know recessions lead to increased demands for mental-health services.

Provincial governments have an opportunity to use the increase in federal health transfers between now and 2014 to reverse this trend and focus on early intervention.

Steve Lurie [pictured], executive director, CMHA Toronto Branch

Also see:

Effect of a barrier at Bloor Street Viaduct on suicide rates in Toronto: natural experiment

Suicide barrier on Bloor Viaduct worked, but jumpers went elsewhere: study


Photo credit

Putting a Price on Mental Illness

An article published in today's edition of The Globe and Mail:

Mental illness costs the Canadian economy a staggering $51-billion annually. That number includes:

• $5-billion in direct medical costs

• $9.3-billion in lost productivity due to short-term sick leave

• $8.5-billion in lost productivity due to long-term disability

• $28-billion is attributed to "reductions in health-related quality of life" - a method used to put a dollar figure on pain and suffering.

The World Health Organization estimates that by 2020, depression will be the leading cause of disability on the planet. Employers see the impact of mental illness every day:

• 500,000 Canadians daily are absent from work because of psychiatric and psychological problems.

• 40 per cent of all disability claims, short-term and long-term, involve mental-health conditions.

• 18 per cent of workers in Canada have had a diagnosis of clinical depression.

• 8 per cent of workers currently on the job are taking drugs for a mental-health condition.

• 6 per cent of all workers are under the care of a physician for treatment of a psychiatric or psychological condition.

Sources: Centre for Addiction and Mental Health; Great-West Life Centre for Mental Health in the Workplace; World Health Organization

Also see:

When the office gives back

Breaking Through

Officer denies he doctored his report in tasering death

An article published in today's edition of The Globe and Mail:

By Oliver Moore

A police officer involved in the tasering of paranoid schizophrenic Howard Hyde could not explain why so much of his report was essentially identical to one written earlier by a colleague, but denied the suggestion he had "doctored" it.

The inquiry into the jailhouse death of Mr. Hyde also heard yesterday an allegation the unco-operative prisoner was sworn at during a rapidly escalating situation at police headquarters and told he would be "doing the ... dance next."

An altercation broke out immediately after and Mr. Hyde, who had been off his medication and acting erratically before his arrest, was tasered repeatedly. He died 30 hours later in a Dartmouth jail.

The inquiry into the November, 2007, death began hearing witnesses last week. Halifax Regional Police Constable Jonathan Edwards, the arresting officer, was on the stand all day yesterday.

Constable Edwards was one of many officers involved in the struggle that broke out during the booking. The fracas ended with the 45-year-old prisoner not breathing and having to be revived in a hallway. After he had accompanied Mr. Hyde to hospital, Constable Edwards returned to the police station to write up the incident.

A lawyer for Mr. Hyde's sister and her husband questioned the officer again and again yesterday about numerous similarities between his account and one drafted an hour earlier by Special Constable Gregory McCormick, the man who actually used the taser on Mr. Hyde.

"I am going to suggest today that you went in and used and doctored Special Constable McCormick's statement to create your own," Kevin MacDonald said. "These are identical words, they're his words ... you used his words."

Constable Edwards repeatedly denied having cribbed his colleague's report.

The inquiry also walked through the lead-up to the tasering, with Constable Edwards offering new details on the alleged risk posed by Mr. Hyde.

He testified that the booking room struggle brought the prisoner within reach of a drawer full of knives and other weapons. The drawer was unlocked and the one immediately above it was missing, he said, allowing a clear view of these weapons.

The prisoner received his first tasering seconds later.

Constable Edwards acknowledged that his notes or other paperwork do not include mention of concern over Mr. Hyde arming himself during the struggle. The officer explained the late revelation by saying he had a lot on his mind in the aftermath of the incident.

It was not clear why weapons were stored in an accessible drawer, though Constable Edwards said that is no longer the practice.

Also heard for the first time was his allegation that Mr. Hyde had earlier tried to reach for a cutting tool held by another officer, who intended to sever the drawstring of the prisoner's shorts.

That was not recorded by surveillance cameras, but some audio around the alleged incident was captured. It was then, during the rapidly building tension, Mr. MacDonald suggested, that one of the officers told Mr. Hyde he would be made to "dance."

I must note my disapproval of the media continuing to label Mr. Hyde as a "schizophrenic". In the above article, he is labelled as a "paranoid schizophrenic".

To the media:
Mr. Hyde lived with schizophrenia. He experienced schizophrenia. He had schizophrenia. Just because Mr. Hyde lived with schizophrenia, that does not completely define him as a person. Does living with diabetes totally define a person? Does the media report that a diabetic did this or did that?

Fighting against stigma

An editorial published in yesterday's edition of The Globe and Mail:

Canadian soldiers deserve the very best in mental health care

Canadian soldiers face many challenges on the battlefield in Afghanistan, but one of the most difficult often does not surface until after they return home: operational stress injuries that inflict invisible but devastating psychological wounds. In the past, the military did little to protect or rehabilitate these soldiers, leaving them to languish, ostracized and isolated. There is hope that is changing.

On Thursday, after a House of Commons defence committee report that revealed significant gaps in the military mental-health system, General Walter Natynczyk, the Chief of the Defence Staff, announced a mental-health awareness campaign, as part of a new strategy to tackle operational stress injuries in the military. The campaign also features two non-clinical mental health programs, including a speakers series and peer counselling.

The announcement is significant, because it breaks the military's silence on a sensitive subject. For people in the profession of arms, toughness is a cultural ethos. Soldiers don't like to admit to physical pain, let alone anything as invisible and intangible as psychological anguish. Those in uniform who suffer from posttraumatic stress syndrome have injuries as real as any gunshot wound, yet the stigma around psychological injuries is still so painful and career-limiting for many that they will confide behind closed doors they would prefer to have been shot.

The Canadian Forces have made progress since they arrived in Kandahar a few years ago. They are struggling to cope with a wave of young Afghanistan vets who have served in an overtasked and under-strength military. The CF are learning; joint personnel support units, to help those suffering from PTSD, have been established across the country; decompression time in Cyprus is now built in to tours of duty; Independent military-family resource centres offer a variety of programs to family members. But progress is slow, waiting lists are long, and stigma is still very real.

The military still faces significant hurdles. Cultural change does not occur overnight. In spite of programs to increase understanding of PTSD, many soldiers maintain it is career suicide to admit to an operational stress injury. As long as that view remains, OSIs, which emerge primarily through self-reporting, will remain an insidious problem.

It is easy for civilians to judge the military harshly for failing to remedy this very serious problem more completely or quickly, but the reality is that Bay Street and Main street are hardly in a position to crow about their own compassionate treatment of the mentally ill.

The military deserve the very best in care; they risk their mental health just as much their physical health in the service of the nation. Stigma and skewed perceptions about OSIs must be overcome, because the cost of failing to do so is too high, with casualties on the home front among Canadian soldiers and their families.

Bold emphasis in the text of the editorial is mine.

Nation Builder 2008: The Finalists - Casting a light on mental illness

From the December 26th edition of The Globe and Mail:

Michael Kirby wants a revolution in the way we regard diseases of the mind, and has established a unique charity to bring it about

By Erin Anderssen

OTTAWA -- As a math student at Dalhousie University, Michael Kirby [pictured] would spend long afternoons sitting in the "Roost," the top floor of his fraternity house, working through differential equations.

On occasion, he would know the answer after a quick glance at the problem.

"I realize it's going to take two hours to figure it out," he would say. "But I can just tell by looking that the answer is x=2."

And usually, recalls his fraternity brother George Cooper, now a prominent Halifax lawyer, he was right.

"He could just pierce through the central core," says Mr. Cooper, "and tell you the answer before he had actually done the heavy lifting to actually be able to prove it."

The ability to know the answer before others have even framed the question has marked Mr. Kirby's tenure as the first chair of the Mental Health Commission of Canada.

To read the entire article, click here.

Also see:

Mental Health Commission Chair Michael Kirby named to Order of Canada (December 30th, 2008).

Photograph by Ashley Fraser.

Freedom to be sick leaves families feeling chained

From today's edition of The Globe and Mail:

Caregivers who can't get mentally ill loved ones to seek help grapple with laws designed to protect civil rights

By André Picard

Mary Liz Greene [pictured] was in the midst of an animated conversation with her son when he suddenly lunged, grabbed her by the neck with two hands, then pushed his thumbs into the soft flesh of her throat, using the full force of his 6-foot, 200-pound frame.

Gasping for air, she felt the pressure let up for an instant, shoved him with all her might and fled to a neighbouring apartment to call 911.

“I'm lucky to be alive,” Ms. Greene said later, “although sometimes I doubt that.”

Her son, 24-year-old John Candow, suffers from severe bipolar disorder and, when untreated, is consumed by the delusion that he is Tony Soprano, the TV mobster. He has been living with his mother and, since he was diagnosed three years ago, has thrown knives at her, burned her with cigarettes, punched and kicked her repeatedly.

Last week's incident was the most violent yet. When police arrived, they were confronted with a psychotic young man holding a knife to his throat threatening suicide. They tasered, subdued and arrested him – and found 10 more knives in his knapsack.

When Ms. Greene, a Halifax social worker, visited her son at the East Coast Forensic Hospital a few days later, he reminded her, matter-of-factly, that he plans to kill her and chop her body to pieces.

“When John's not sick, when he's being treated, he's very loving. He's a sweet, beautiful boy,” Ms. Greene says tearfully.

But the central fact of the sordid tale is this: Mr. Candow refuses to get treatment, as is his right under Canadian law.

That right presents a dilemma for countless caregivers across the country whose loved ones have such severe mental illnesses as schizophrenia, bipolar disorder and addictions, especially when they also suffer from anosognosia – an inability to recognize they are sick.

To read the entire article, click here.

Photograph by Sandor Fizli for The Globe and Mail.

The loneliness of the psych ward

From today's edition of The Globe and Mail:

By Erin Anderssen

Ben Robinson [pictured] spent long months during his hospital stays pacing the halls alone, hoping someone would visit.

Hardly anyone did, except for his mother, even though he phoned friends specifically to ask for company. The people who eventually braved the locked ward at the Clarke Institute never stayed long. “Where are the white padded rooms?” they joked.

“It was a bit of freak show kind of thing,” says Mr. Robinson, a 24-year-old part-time student in Toronto who has been diagnosed with schizo-affective disorder – a condition defined by symptoms of both a mood disorder, such as depression, and schizophrenia. “Like, ‘Whoo, let's go see my friend in the mental hospital.' ”

Even so, those visits made all the difference, he remembers – a few moments to feel “semi-normal,” to talk to someone from the outside and forget that he wasn't free to leave. The nurses, he says, were too busy to spend much time on chit-chat; the patients didn't mix much except to watch TV in silence. Other than a daily 30-minute appointment with his psychiatrist and taking a few workshops, he spent most of his time drinking tea and walking. “It's incredibly lonely and boring in the hospital,” he says. “I needed people to be there as much as possible.”

Mr. Robinson was lucky to get any visitors: Studies suggest that as many as 40 per cent of psychiatric patients never see a family member or friend at their bedside. According to a recent survey conducted at Toronto's Centre for Addiction and Mental Health, one-third of hospitalized patients in the mood and anxiety program received no family visits – and 20 per cent were visited only once or twice. Friends were even less in evidence: More than 70 per cent of the people surveyed said they received no more than two visits, and the majority didn't see a single friend.

There's a reason why psychiatric hospitals don't usually have gift shops: Nobody buys gifts for their patients. “You go into any ward in any hospital, and you will see cards, a balloon or two, flowers, teddy bears,” says Karen Liberman, executive director of the Mood Disorders Association of Ontario. “The psych ward is virtually the only place where you see nothing and nobody.”

To read the entire article, click here.

Photograph by Deborah Baic of The Globe and Mail.

Psychiatry: A specialty relegated to the basement

An article published in the today's edition of The Globe and Mail:

By Carolyn Abraham

Jai Shah [pictured] could have been any sort of doctor he wished. Even before he graduated with honours from the University of Toronto's medical school, the 30-year-old Edmonton native had earned a master's degree in international health policy from the London School of Economics, published papers and worked for the Canadian Institutes of Health Research.

Praise follows him wherever he goes. Except for last fall – when he decided to specialize in psychiatry.

“A psychiatrist?” some of his supervisors said, “But you're smart! … You're taking the easy way out … Your patients will make your life hell … Your patients will make you depressed … What a waste of talent!”

Dr. Shah knew mentally ill people battle both their disorders and the social stigma their conditions carry. But it surprised him that psychiatrists confront a certain stigma, too.

“I'm sure the feedback has discouraged some young doctors from choosing this as their career,” said Dr. Shah, now at the Harvard Longwood Psychiatry Residency Training Program in Boston.

In fact, Susan Abbey, who heads the U of T first-year residency program in psychiatry, said the disparaging comments are “ubiquitous.”

“I don't think there's one of our incoming residents who hasn't been exposed to negative comments from family or friends or academic supervisors,” Dr. Abbey said.

Just as lawyers can face a barrage of bottom-feeder jokes, psychiatrists, both in film and real life, have long been seen as doctors of a lesser science. Even their own physician colleagues can view their patients as difficult and time-consuming. The negativity, experts say, is contributing to a national shortage of psychiatrists and shoddy care for mentally ill people.

To read the entire article, click here.

Photograph by Jodi Hilton for The Globe and Mail.

Anne of Green Gables author suicide highlights mental illness

Posted today on TheStar.com:

THE CANADIAN PRESS

FREDERICTON– The revelation that beloved author Lucy Maud Montgomery [pictured], who wrote the Anne of Green Gables books, committed suicide in 1942 is being lauded for helping generate public discussion on mental health issues.

Montgomery's battle with mental illness was known for many years, but confirmation of her death by a drug overdose at the age of 67 only came this weekend in an article written by her granddaughter, Kate Macdonald Butler, in the Globe and Mail newspaper.

In the article, Macdonald Butler said it's hoped that writing about the issue will result in less secrecy and more awareness of the suffering of people with depression.

"I have come to feel very strongly that the stigma surrounding mental illness will be forever upon us as a society until we sweep away the misconception that depression happens to other people, not to us – and most certainly not to our heroes and icons," she wrote.

To read the entire article, click here.

Also see:

The heartbreaking truth about Anne's creator


Photo credit: Library and Archives Canada / C-011299