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.

Mental Illness Awareness Week: Canada Stands Ready for Positive Change

An opinion piece posted on October 4th by the Mental Health Commission of Canada:

Op-Ed to coincide with Mental Illness Awareness Week

By Louise Bradley (pictured)

I have worked in the mental health field in Canada for over three decades, and I can say without exaggeration that never before have I seen such a high level of awareness about mental illness in this country. At last, mental health and mental illness are taking centre stage.

From coast to coast to coast, Canadians are stepping forward to talk publicly about their own personal experiences with mental health problems and mental illnesses, and by taking this courageous action, they are making a real difference to countless others.

In September, after 17-year-old high school student Chris Howell, who had been bullied since grade school, committed suicide, 150 friends and family gathered in front his school to mourn his loss and call for an end to bullying. “I just want to stop it,” Chris’s mother Judy told the Hamilton Spectator. “I don’t want anyone else to have to pay.”

For their part, after their son Jack, a first-year student at Queen’s University, took his own life last year, Eric and Sandra Windeler established The Jack Project, a national program to help Canadian youth achieve optimal mental health as they transition from late high school into their college, university or independent living years.

And then there are people like Harmony Brown, Jeremy Bennett, Roberta Price, Shana Calixte, and Steeve Hurdle, who are this year’s “faces” in the Face Mental Illness Campaign coordinated by the Canadian Alliance on Mental Illness and Mental Health as part of this week’s Mental Illness Awareness Week national public education campaign.

By sharing their personal stories, these five, too, are helping to end stigma and bring mental illness out of the shadows forever.

Today, hundreds of organizations across the country are working tirelessly to raise public awareness about mental health problems and mental illnesses through advocacy and by providing services and supports to those in need.

Canadian companies, including Bell Canada, RBC, Great-West Life and Canada Post, are investing millions of dollars to raise awareness about mental health, improve children’s and workplace mental health, and support organizations on the mental health front lines.

Governments across the country are also addressing mental health in more meaningful ways with new strategies, action plans and investments.

Thousands more individual Canadians are empowering themselves by learning how to spot the signs of mental health problems in family, friends and even themselves through courses being offered by Mental Health First Aid Canada. To date, over 42,000 Canadians have become mental health first aiders.

It is little wonder we are seeing such a ground swell of action and support for mental health.

Canadians have woken up to the fact that ignoring mental health is detrimental to individuals, families, and communities, as well as our society and economy as a whole.

They are becoming aware that there is no health without mental health, and that no one is immune from mental illnesses. This year alone, more than seven million Canadians—that is one in five people—will experience a mental illness personally, and in turn, this will impact family, friends and colleagues.

We are making progress in changing attitudes about mental health, but there is still much work to be done.

We need to be doing more to improve access to mental health services, decrease stigma, support the needs of families caring for ill relatives, invest in research spanning the full spectrum of issues relating to mental health and mental illness, promote mental health, and prevent mental illness so that every Canadian has the opportunity to achieve the best possible mental health and well-being. All this and more will be addressed in the first-ever Mental Health Strategy for Canada, which the Mental Health Commission of Canada will release next year.

What can you do to help?

To start, I urge all Canadians to pledge to the cause of mental health, not just during this Mental Illness Awareness Week, but 365 days a year, by supporting a family member, a friend, a colleague, or a neighbour living with a mental health problem or mental illness and helping them build a better life for themselves. And potentially everyone will have a role to play in bringing the Mental Health Strategy for Canada to life and ensuring it has maximum impact.

Now more than ever, we have an opportunity to build a society that values and promotes mental health and helps people living with mental health problems and mental illnesses to lead meaningful and productive lives.

This will require some fundamental changes to our systems of mental health care and also to our collective way of thinking about mental illness, but if the past year is anything to go by, Canadians are ready to take on this challenge and ready, willing and able to work together to achieve positive change.

Louise Bradley is President and CEO of the Mental Health Commission of Canada.

Image credit

Also see:

Housing first for the mentally ill: Former MP wants changes to assist those in need

Public to get say on Nova Scotia's mental health system

An article published in today's edition of The Chronicle Herald:

By John McPhee, Health Reporter

The committee charged with creating the province’s long-awaited mental health and addictions strategy will embark on a series of public meetings next week.

The provincial advisory committee will hold the first of six meetings Monday in Greenwood to get feedback on how programs and services can be improved.

The NDP government first announced its intention to create a strategy last spring. The committee co-chairpersons — Michael Ungar [pictured], a professor of social work at Dalhousie University, and Joyce McDonald of [The Empowerment Connection] — were announced in June and the rest of the committee in the fall.

It is composed of 12 health experts, researchers, mental health clinicians and people living with or affected by mental illness.

The committee kept a low profile since that time, but it has been holding consultations with health-care providers and advocacy organizations, said a spokeswoman from the Health and Wellness Department.

"We’re just letting them do their work and we don’t want to complicate that or distract them," Patricia Murray, acting executive director of mental health and addictions, said in an interview. "It’s a huge job they’re doing and we’re just anxiously anticipating the end result that they’re able to submit."

The committee has met with about 50 groups and more meetings are planned, a recent Health and Wellness Department news release said.

The move to revamp the system has been sparked by concerns about long waiting lists for treatment and how mentally ill people are treated in the justice system, as highlighted by Judge Anne Derrick’s report in December 2010 on the death of Howard Hyde. Hyde died Nov. 22, 2007, after a violent conflict with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.

Mental health advocate Stephen Ayer of Halifax has criticized the province for being too slow in dealing with the problems in the mental health system. Ayer, the executive director of the Schizophrenia Society of Nova Scotia, welcomed the consultations.

One committee member and staff from the Nova Scotia Health Research Foundation met with the society about three weeks ago. "It was very useful," Ayer said in an interview.

But he is concerned the consultation thus far has been with the people who provide the services, not with those who use the services. At his urging, the committee will meet with people with mental illnesses next month.

As for the strategy, "we are looking forward to seeing some movement in terms of improvements in access to services," he said.

Besides the public meetings, people can also provide input online or through the mail. For more information, go to www.nshrf.ca/mentalhealthandaddictionsstrategy or call 424-4043.

The committee is expected to submit its recommendations to Health and Wellness Minister Maureen MacDonald in the fall.


SCHEDULE

Schedule of public meetings on the province’s mental health strategy:

• April 18: Greenwood, 8 a.m. to noon, 14 Wing Greenwood, Birchall Training Centre, Chamber Room

• April 26: Amherst, 8 a.m. to noon, Tantramar Theatre, 98 Victoria St. E.

• April 27: Sydney, 8 a.m. to noon, Cape Breton University, 1250 Grand Lake Rd., multi-purpose rooms A and B

• May 3: Halifax, 1 to 5 p.m., Saint Mary’s University, Burke Building, Burke Theatre B (entrance off Inglis Street)

• May 5: Bridgewater, 9 a.m. to 12:30 p.m., South Shore Regional Hospital, lecture rooms 1 to 3 (third floor)

• May 16: Halifax, 8 a.m. to noon, Universite Sainte-Anne, Campus de Halifax, 1589 Walnut St. It will also be broadcast to campuses in Tusket, Petit de Grat, Church Point and Grand Etang.

Image credit

No health without mental health: a cross-government mental health outcomes strategy for people of all ages (UK)

Please click on the image to magnify it.

Published February 2nd, 2011. To download the entire document (PDF), please click here.

For related documents, please click here.

Nova Scotia Mental Health Strategy Background Document

An email received on February 21 from the Nova Scotia Health Research Foundation:

In March, 2010, the Nova Scotia Government announced that it would be preparing a Mental Health Strategy to revamp mental health and addiction services in the province. The strategy will address concerns raised in the May 2010 Auditor General’s report. We were asked by the Minister of the Department of Health and Wellness to support the development of a Mental Health Strategy. In our role, we will oversee a neutral, comprehensive consultation process to ensure that the knowledge and input of stakeholders is included. We are also acting as secretariat to the Mental Health Strategy Advisory Committee, which was appointed by the Minister.

As part of our work, we have developed a background document, the Mental Health Strategy Background Document: A summary of the current state of mental health and addictions services in Nova Scotia. The purpose of this document is to describe the current state of publicly funded mental health and addiction services in Nova Scotia. The document will be a living document and will be updated and modified throughout the consultation process as more information becomes available. We will use the document to focus initial discussions with key stakeholders and will use an updated version to inform public consultations. The document will be updated regularly.

We thought that your organization would be interested in reviewing a copy of the enclosed background document.

To download the entire document (PDF), please click here.

Also see:

Mental Health Strategy

Compelling new report shows why mental health ‘must be at the heart of public health’

Please click on the image to magnify it.

An October 26th media release from the Royal College of Psychiatrists (U.K.):

Psychiatrists are today calling on the government to put mental health at the heart of their new public health strategy, which is due to be unveiled later this year.

The Royal College of Psychiatrists (RCPsych) has published a compelling bank of evidence showing why public health strategies cannot afford to ignore mental health. The position statement, No health without public mental health: the case for action, shows that:

• People with a mental disorder smoke almost half of all tobacco consumed in the UK and account for almost half of all smoking-related deaths.

• Depression doubles the risk of developing coronary heart disease.

• People with schizophrenia and bipolar disorder die an average 20 years earlier than the general population, largely owing to physical health problems.

• People with two or more long-term physical illnesses have a 7 times greater risk of depression.

• Children from the poorest households have a three-fold greater risk of mental ill health than children from the richest households.

RCPsych President Professor Dinesh Bhugra said: “Historically, government public health strategies have concentrated on physical health and overlooked the importance of both mental illness and mental well-being. But there is no health without mental health. There is vast evidence to show that mental illness is associated with a greater risk of physical illness – and physical illness in turn increases the risk of mental illness. It’s clear that strategies to improve the health of the nation will only be effective if they address mental health and wellbeing as well.”

In the position statement, the RCPsych calls on the Coalition government to make a series of important policy changes, including:

• Tackling substance addiction through a minimum alcohol pricing policy and an evidence-based addictions policy.

• Prioritising mental health within smoking cessation programmes.

• Targeting public mental health interventions for people at higher risk, for example children in care and those who are unemployed or homeless.

• Promoting the importance of mental health and well-being in older age.

Professor Bhugra said: “Earlier this month, a study revealed that mental illness costs the economy £105 billion a year in England alone, and is the single largest source of burden of disease. Including mental health at the heart of the public health agenda will improve people’s lifestyles and reduce health-risk behaviours, thereby both preventing physical illness and reducing the burden of mental illness on society.”

He continued: “Our new position statement makes clear recommendations for political action and policy change. I hope that the evidence we present today can persuade government at all levels, as well as wider society, of the need for action and the benefits it will bring.”

Responding the launch of this new report, Care Service Minister, Paul Burstow MP, said "The Government is clear that there is no health without mental health. That is why we will publish both a public health White Paper and mental health strategy that will break new ground. If the right action is taken early in people's lives, it’s possible to make a big difference. The right support at the right time can help people realise their potential, cope with adversity and hold down a job. This is good for the individual and good for society too."


For further information, please contact Liz Fox or Deborah Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127
E-mail: efox@rcpsych.ac.uk or dhart@rcpsych.ac.uk


Note to editors:

The new position statement, No health without public mental health: the case for change, was published on 26 October by the Royal College of Psychiatrists.

Members of Mental Health Strategy Advisory Committee Named

A media advisory released today by the Nova Scotia Department of Health:

People struggling with mental health and addiction issues are another step closer to getting the care they need in every region of the province.

Health experts, researchers, mental health clinicians and people living with or affected by mental illness are among the 12 members appointed today, Sept. 29, to Nova Scotia's Mental Health Strategy Advisory Committee.

They will join co-chairs Michael Ungar and Joyce McDonald who were announced in June.

"This diverse group of people bring a wealth of professional, clinical and personal experience to this opportunity to create a mental health strategy for Nova Scotia," said Health Minister Maureen MacDonald. "Their work will help us ensure better health care for you and your family."

The mental health strategy was announced in the March Throne Speech and helps fulfill a commitment by government to revamp mental health and addiction services across the province. The advisory committee will develop a consultation process and recommendations for a Mental Health Strategy.

Ms. MacDonald also announced the Nova Scotia Health Research Foundation will work closely with the advisory committee on the development of the strategy. It will gather evidence and support extensive consultation to ensure informed development of the strategy.

"Given its scientific expertise and methodology, the foundation is well-equipped to help the advisory committee ensure the strategy includes the best evidence available," said Ms. MacDonald.

"We are pleased to contribute our knowledge and expertise to the development of the strategy," said Krista Connell, chief executive officer of the Nova Scotia Health Research Foundation. "The combination of our consultative approach and our expertise in gathering the best knowledge available will help the advisory committee develop a strategy that addresses Nova Scotia's needs."

The foundation will also provide administrative and logistical support, offer project management and help oversee the development of the strategy.

The advisory committee is expected to meet with Ms. MacDonald and the foundation in October to review the terms of reference and to develop a meeting schedule. Ms. MacDonald anticipates receiving the advisory committee's recommendations by the summer.

The members of the advisory committee are:

• Frank Beazley, Halifax, Chief of Police, Halifax Regional Police

• Dr. Simon Brooks, Bridgewater, chief of psychiatry, South Shore District Health Authority

• Andy Cox, Halifax, mental health advocate, IWK Health Centre,

• Paul d'Entremont, West Pubnico,Yarmouth Co., founding member and executive director of Réseau Santé – Nouvelle-Écosse

• Daphne Hutt-MacLeod, Eskasoni, Cape Breton, director of Eskasoni Mental Health Services

• Jessica Inkpen, a young woman from Halifax who has struggled with anorexia for many years

• Lana MacLean, Halifax, a social work clinician who works extensively with the African Nova Scotian community

• Cecilia McRae, Merigomish, Pictou Co., president of the Schizophrenia Society of Nova Scotia

• Patti Melanson, Halifax, co-ordinator of the North End Clinic's Mobile Outreach Street Health Program

• Dr. Paige Moorhouse, Halifax, principal investigator for several provincial and national grants on geriatric mental health

• Kathleen Thompson, Halifax, mother of a young woman who is battling an eating disorder, Halifax

• Catherine Thurston, Tidnish Bridge, Cumberland Co., former director of Mental Health Services for the Cumberland Health Authority.
  

Additional biographical information on committee members is available at gov.ns.ca/health/mhs/mental-health-strategy.asp.


FOR BROADCAST USE:

People struggling with mental health and addiction issues are another step closer to getting the care they need in every region of the province.

Health Minister Maureen MacDonald announced the 12 members of the advisory committee working on recommendations for the province's new mental health strategy today (September 29th).

The strategy will revamp mental health and addiction services in the province.

The committee members include health experts, researchers, mental health clinicians and people affected by mental illness.

The advisory committee is expected to report back to the minister with its recommendations next summer.

-30-

Media Contact:

Brett Loney
Department of Health
902-424-303
E-mail: brett.loney@gov.ns.ca

Also see:

Area resident appointed to province’s Mental Health Strategy Advisory Committee

New Horizons: A shared vision for mental health (U.K.)

Please click on the image to magnify it.

To download the entire document (PDF), please click here.

Also see:

Confident Communities, Brighter Futures: A framework for developing well-being (PDF)

Flourishing People, Connected Communities: A framework for developing well-being (PDF)

Realising ambitions: Better employment support for people with a mental health condition (PDF)

Work, Recovery and Inclusion: Employment support for people in contact with secondary care mental health services (PDF)

Mental Health in Scotland

MENTAL HEALTH AUDIT

An editorial published in today's edition of The Chronicle Herald:

Slippery standards

NOVA Scotia has long pointed out that it’s the only province in Canada with mental health standards.

And yes, adopting those standards in 2003 was certainly a laudable step towards improving mental health services in this province.

Having standards on paper, however, is one thing. Ensuring they’re being complied with, or, more basically, seeking sufficient funding to do so, is another.

The problem, as Auditor General Jacques Lapointe’s 2010 review of mental health services makes painfully clear, is that the Department of Health seems to have done neither.

Mr. Lapointe was unable to assess whether the department had even asked for the money to meet the standards — an estimated $23.5 million — as the department, following instructions from cabinet officials, denied him access to budgetary requests and possible departmental plans to improve accountability.

This is the same problem that led Mr. Lapointe to criticize the government’s "pervasive policy of secrecy" that prevented him from even auditing Nova Scotia Business Inc. and the Industrial Expansion Fund (IEF).

What the auditor general did uncover, looking at mental health standards and services, showed there’s lots of room for improvement.

The four health authorities audited in depth — Capital Health, Colchester East Hants, Annapolis Valley and IWK Health Centre — met all the standards selected for review in just 14 per cent of 388 files.

Meanwhile, some standards were so poorly written that staff at the DHAs were asking the auditor general’s staff for help in interpreting compliance.

Mr. Lapointe also found no way to compare waiting times for mental health outpatients, the only category tracked, across the province. That meant the department was also unable to do so, he added. Not surprisingly, Mr. Lapointe concluded that mental health patient care could be suffering as a result of these problems.

The Department of Health says a new mental health strategy, along with a plan to address meeting the standards, is to begin this fall.

The auditor general has certainly laid out, in convincing detail, just how this needs to be done.

Speech from the Throne 2010

An excerpt from today's Speech from the Throne:

My government will undertake a new Mental Health Strategy to revamp mental health and addiction services. And the provincial Mental Health Court is already helping to ensure that those who suffer with mental illness are treated with the respect and care they deserve, while ensuring that the justice system is also well served.

To download the entire Speech from the Throne 2010, please click here (PDF)

Please click on the image to enlarge it.

The Mental Health Commission of Canada Announces a Framework for a Mental Health Strategy for Canada

An email received today from the Mental Health Commission of Canada:

We are extremely pleased to provide you with a link to the Mental Health Commission of Canada document Toward Recovery and Wellbeing: A Framework for a Mental Health Strategy for Canada.

The framework is truly the product of a remarkable amount of input from all corners of Canada over the past year and half. It draws on the wide diversity of experiences, voices and thinking of thousands of people like you or your organization for what a mental health strategy for Canada must achieve. It has also built on the efforts undertaken by so many over the years to champion the importance of a mental health strategy for Canada.

Seven interconnected goals are presented to point the way to a comprehensive and person-centred mental health system for our country: one that both promotes the recovery of people living with mental health problems and illnesses, and fosters the mental health and well-being of everyone living in Canada.

This document is not yet a strategy - it is the framework to help us create one. The ongoing input from people like you from every part of the country will be essential to the success of the next phase of developing a Mental Health Strategy for Canada. We are confident that working together we will be able to define practical solutions and develop action plans to achieve our shared vision for the long awaited mental health strategy for Canada.

In the coming months we will be communicating more details about how the next phase of our work will be structured.

Also see:

Mental Health Commission releases framework for mental health strategy

System is in chaos, mental health advocates say

An article published in the October 1st edition of Metro Halifax:

By Paul McLeod

Mental health advocates from various fields met in Province House yesterday to warn the system is in a state of chaos.

They say mentally ill people are slipping through the cracks because outreach staff are too overburdened to keep up. However, they said the first and most urgent step is cheap and easy to fix.

Nova Scotia currently does not have a comprehensive mental health strategy. They said that needs to change

“They are our family, our friends and our coworkers,” said Stephen Ayer [pictured, left], executive director of the Schizophrenia Society of Nova Scotia.

“As many people as I am able to help, I know there are just as many who continue to suffer alone wondering what exactly is wrong with them, wondering if anybody can help. Sadly, some don’t survive. They die by suicide.”

Ayer estimated 180,000 Nova Scotians will battle mental illness at some point. But he said people still suffer in silence and shame because of social stigma, while issues like swine flu get swift government action.

In the meantime, they’ve taken new action to get the word out. Yesterday they announced the website oneinfive.ca, dedicated to raising awareness about mental health issues in Nova Scotia. The name comes from global studies showing one in five people will deal with serious mental health issues at one point in their life.

Along with information and personal testimonials, the site allows visitors to sign a petition and send letters to politicians urging the creation of an overarching strategy.

Liberal MLA Diana Whalen, who helped organize the event, has put forward a bill to create an advisory council on mental health made up of educators, psychiatrists, mental health consumers and their family members.

The council would advise government on how to best meet the mental health needs of the province.

Photograph by Ryan Taplin, Metro Halifax