Case for Funding Mental Health and Social Services in Canada

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Source:

http://strategy.mentalhealthcommission.ca/about/case-for-investment

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

Editorial: A better way on mental illness

An editorial published in the July 22nd edition of The Times Colonist:

Make no mistake. The Archie Courtnall Centre has been a positive contribution to mental health care in this region. For all the problems, the centre marked a step forward in care. And the willingness of the Courtnall brothers - Bruce, Russ and Geoff [pictured] - to talk about their own father's suicide, while raising millions for mental health services, has brought an increase in awareness about the reach and grip of mental illness. Russ and Geoff Courtnall have used their status as former NHL hockey players to raise money and educate.

But there is much more to do, as the history of the Courtnall centre itself shows.

The centre - effectively an emergency room for people suffering from critical mental illness - was only built because the Courtnalls helped to raise the $2.2 million required.

Any other form of emergency room, like the one opened at Victoria General Hospital in 2009, would be funded by government as part of a functioning health-care system. Yet patients with mental illness rely on charity for emergency services.

The Courtnall centre opened in 2005. A Times Colonist editorial outlined the vision of offering patients "a quiet refuge in crisis situations." Four beds would offer shortterm care of up to 72 hours. Patients would be assessed and quickly provided with needed care in the community or admitted to hospital beds.

But demand quickly swamped the centre. Within two years, director Dr. Anthony Barale resigned. "The staff of the psychiatric emergency service struggle daily to provide even the most basic medical and psychiatric care for this suffering population," he said. "And they do so with little support and the pitiful resources provided by VIHA - resources which, even by so-called Third World standards, are entirely inadequate." In the same year, then premier Gordon Campbell acknowledged a province wide failure to provide adequate mental health treatment.

Today, mental health patients routinely spend days - some more than a week - waiting for admission to too few hospital beds, sleeping in reclining chairs in the Courtnall centre that were intended for a few hours' rest.

In any other emergency room, waits under such conditions would be considered intolerable. Again, people with mental illness are treated as second-class citizens - as if their illnesses are not real, or they do not matter.

The waits will likely worsen. VIHA has reduced the number of in-patient beds available for patients with mental illness, despite having acknowledged the shortage of beds before the cuts. Increased community resources, such as outreach teams dealing with people living with serious mental illness and addictions on the streets, have helped.

But patients and families continue to experience desperate waits for care and inadequate post-release support. Already serious conditions worsen. Some people abandon the effort to get help, or fall to the streets - or like Archie Courtnall, end their own lives.

The Courtnall centre has helped. And the fundraising events this weekend - see courtnallclassic.org for details - deserve your support.

But we wouldn't accept, as a society, that care for people with heart problems or cancer would depend on the success of golf tournaments or fundraising auctions.

Our neglect carries a huge human cost, as the Courtnalls and so many others can attest. It also carries a great economic cost, as untreated illnesses worsen and people's potential is lost.

We have talked, for decades, about removing the stigma from mental illnesses and providing equitable care, as we do for most others with a medical condition. Our actions have fallen far short of that reality.

Photo credit

Up Close and Personal with the Courtnall Brothers

Also see:

Former Canucks star Geoff Courtnall opens up about father's suicide, his own depression

Mental-health patients betrayed by VIHA

VIHA cutting community mental health support

Courtnall psychiatric emergency centre overwhelmed since inception, service reductions

Mental health care for the few

An article posted on March 22nd by MacLeans.ca:

Each year, seven million of us experience mental illness. Many can’t get help.

By Ken Macqueen and Julia Belluz

On March 29, Maclean’s hosts “Health Care in Canada: Time to Rebuild Medicare,” a town hall discussion at the Winspear Centre in Edmonton. The conversation on health care, held in conjunction with the Canadian Medical Association and broadcast by CPAC, continues in coming months in Maclean’s and at town halls in Vancouver and Ottawa.

Mental illness, and what passes for Canadian mental health policy, has been called the “orphan of health care,” and perhaps that’s true. It’s also been called an invisible disease, but that’s not really the case. The mentally ill have many faces. They are in our schools, our homes, our emergency wards. They are in our jails, in our graveyards; they are on our Olympic team.

They are people with names. Jack Windeler, a Queen’s University student of great promise, began to miss classes, skip assignments, withdraw from friends. A year ago on March 27, he killed himself in his residence room. He was 18. BobbyLee Worm [pictured], a deeply troubled 24-year-old Aboriginal woman from Saskatchewan, has spent some three years locked in solitary confinement in a B.C. prison, counting the bricks of her cell. Speed skater and cyclist Clara Hughes overcame a troubled adolescence to compete for Canada at the 1996 Olympics. Afterwards, she fell into a profound depression, slogging “through quicksand and hopelessness.” She sought help. She fought back to become one of Canada’s greatest athletes, and the kind of role model who can shatter stereotypes and stigmas surrounding mental illness.

This, then, is the state of mental health policy in Canada: scattered flashes of brilliance amid quicksand, hopelessness and waste. Canada is the only G7 country without a national mental health strategy, says Louise Bradley, president of the Calgary-based Mental Health Commission of Canada, a four-year-old agency mandated to finally draft a coherent approach to the issue. She blames the shame surrounding mental health issues for the lesser priority and lower funding accorded treatment of psychiatric disorders. Bradley, a nurse and former front-line mental health worker, sees the stigma in the public, but even among health care workers and those with mental illnesses. It’s tragic, she says, since hardly anyone is untouched by the problem. When people discover her job, they always have stories. “Every time it starts out in hushed tones,” she says. “And yet here we are in 2011 still with it shrouded with embarrassment and fear.”

The need is obvious. The annual cost to the economy in lost productivity was pegged at $51 billion in a report last year by researchers at the Centre for Addiction and Mental Health (CAMH). Some seven million Canadians will experience a mental illness this year, including depression, substance abuse and psychotic episodes. Many go undiagnosed, some suffer silently, others self-medicate with drugs or alcohol. They overwhelm family doctors or jam emergency wards ill-suited to their needs. They face long waits for counselling.

“Access to mental health services overall is pretty poor,” says Steve Lurie, executive director of the Canadian Mental Health Association. “In Ontario, basically one in three adults get access. If you’re a child, it’s worse. It’s one in six,” he says. “We wouldn’t accept that for cancer. We wouldn’t accept that for heart [disease] or if you have a broken leg.” Psychiatric care is far more likely to be provided to wealthy adults, says Dr. Michael Rachlis, a Toronto-based health policy consultant. “Children and youth is much harder work,” he says, “and it tends not to pay as well as sitting in your office and seeing people who have less serious problems.”

Many of the needed public services are delivered piecemeal or they fall outside of medicare. Sarah Cannon of St. Catharines, Ont., executive director of Parents for Children’s Mental Health, lost her husband to suicide eight years ago. He suffered from bipolar disorder. Their daughter Emily received a similar diagnosis at age five. Finding quality treatment was a struggle. Emily’s teachers used different treatment strategies from those offered by her community mental health workers. “[There's] a lack of consistency,” she says, “lack of them speaking with each other.” At times, Cannon was spending as much as $800 a month on drugs not covered by Ontario’s health plan. Emily, now 14, is being effectively treated with mood stabilizers, in combination with counselling and occupational therapy. “I want a system that is integrated, that communicates and coordinates,” Cannon says, “that is funded the same way they would fund a system that treats a child with physical health problems.”

Most psychological care, for example, is paid privately, putting it beyond the reach of many. About seven per cent of government health expenditures go to mental health, well below most developed countries.

Suicide is the second leading cause of death for young Canadians. Some, like Jack Windeler, never even seek help. His heartbroken family has launched a youth public awareness campaign, honouring his final wish that others benefit from his story. Bill MacPhee, 48, of Fort Erie, Ont., is alive because he got help, eventually. He was diagnosed with schizophrenia at 24. “After that, I was hospitalized six times, lived in three group homes, had a suicide attempt,” he says.

It was medication and the help of a mentor that got him on track. In 1994, he founded SZ Magazine, for those affected by schizophrenia. As an advocate for those with mental illness, he sees many flaws in the system. Newer, more effective drugs aren’t covered by Ontario’s assistance plan for the disabled, and support systems are uncoordinated, he says. The Ministry of Health operates in one “silo,” the welfare system in another, community housing in another still. Misplaced ideas about patient confidentiality isolate parents. “Many people are being discharged out of hospital without a place to stay, without letting parents know,” he says. “They are trying to help sons and daughters—they’re not able to do that.”

Far too many who need treatment instead end up in jail, often with addictions compounding their mental illness. The number of male federal prisoners receiving drugs for mental illnesses has more than doubled in a decade, to 21 per cent. For women prisoners, the medication rate is an astonishing 46 per cent. The estimate of prisoners with psychiatric disorders ranges from 64 per cent to 81 per cent in one study by the Correctional Service of Canada. Among them is BobbyLee Worm, serving more than six years for robbery and other offences. She arrived at B.C.’s Fraser Valley Institution addicted to drugs and with a history of physical, emotional and sexual abuse. She’s spent years in segregation after repeated fights with prisoners. The isolation has caused “significant signs of psychological deterioration,” claims the British Columbia Civil Liberties Association in a lawsuit filed this month against the federal government.

The news isn’t all grim. There are good strategies in place, though they are often “well-kept secrets,” says Bradley of the mental heath commission. The commission itself is in the midst of an ambitious campaign to reduce the public stigma of mental illness, and aims to release its national mental health strategy by this time next year.

It is likely to build on the success of programs scattered across the country. Saskatchewan has been changing its delivery of services for children and youth, where mental health issues often begin. It includes parent mentoring and “preventive intervention programs” at 16 sites across the province for vulnerable children under five years old, and outreach programs in Aboriginal communities. In Saskatoon, psychologists and counsellors work from inner-city schools. Mental health is part of a larger “school wellness initiative” where speech pathologists, occupational therapists, nurses and counsellors work together. In addition, addiction workers operate in the inner city, says Rob Strom, coordinator for community and youth addiction teams in Saskatoon. “Our workers are out helping our clients get to appointments, get hooked up to the right services, taking them out for lunch or coffee, building relationships.”

Hamilton, meantime, has become a model for breaking barriers between family doctors and mental health services. Counsellors and psychiatrists are integrated into the offices of 150 family doctors in the area, in a program started in 1994, under the guidance of Nick Kates, a psychiatrist and professor at McMaster University. The program is as effective as it should have been obvious. Doctors are usually the first point of contact for those with mental issues, diagnosed or otherwise. Rather than a referral and a long wait, there’s immediate mental health counselling available, says Kates, “in an environment that people find is less stigmatizing and more comfortable.” Doctors in the program refer 11 times as many people for mental health assessments as they did before. Hospitalizations for mental health have dropped 10 per cent for patients of participating doctors, says Kates. The good news is patient-focused care saves money. “The key to successful change is not just throwing more and more resources into the system,” he says. “It’s redesigning the system and using existing resources differently.”

The same optimistic note is sounded by Dr. David Goldbloom, medical adviser for CAMH, and vice-chairman of the mental health commission. While there is a desperate need to improve services, especially for children, he says the issue is finally on the political radar. The cost of mental illness, to individuals and families, and its impact on society and the economy is too massive to ignore, he says. “Both a humanitarian and business argument can be made for doing a better job in this country around the provision of understanding, of help and of hope.”

Also see:

Sask. woman sues over solitary confinement


Photo credit

Broken Promises

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Also see:

Operation Maple

One mom's fight to get her daughter help

And article posted on December 15th by MSN News:

By Michael MacDonald, The Canadian Press

Maureen Bilerman [pictured, left] knew something was wrong when her normally shy 13-year-old daughter suddenly became incorrigible, her thoughts and actions disjointed, sometimes destructive.

"It was a light-switch effect," recalls the mother of two, her even tone hinting she has told this story many times before. "She cut our leather chair ... and became really defiant in a way she never was. Her thinking became skewed, distorted. So we right away tried to get her help."

But Bilerman's sense of urgency soon turned to frustration and anger — raw emotions common among parents and critics across Canada who say provincial governments are failing mentally ill children and youth.

"We're the best-case scenario and she's still falling through the cracks," says Bilerman, a newly minted mental health activist who has struggled for the past three years to get her daughter Sarah the help she needs.

Unfortunately, her story is not that unusual.

In a typical Canadian class of 30 students, six will suffer from some form of mental illness, but only one will receive treatment.

"I don't care in what province you're talking about, what town or what service you're looking for, you will find a waiting list that is unacceptable," says pediatrician Diane Sacks, a mental health expert and a member of the Mental Health Commission of Canada.

"There's just not enough services for kids."

For Bilerman, a writer with a background in marketing and broadcasting, that harsh reality became apparent in the spring of 2008, when Sarah overdosed on a bottle of Tylenol.

At the hospital, she was told all six beds at the Child and Adolescent Psychiatric Unit at the Moncton Hospital were full.

"They said, 'There's nothing we can do.' So they sent us home."

But Sarah was still having suicidal thoughts.

For the next six weeks, Bilerman monitored the girl 24 hours a day.

"She would be at the end of her rope, beyond suicidal, in a total state," Bilerman says, adding that the pair would head to the local emergency ward almost every week.

Again and again, they were told the Moncton facility was full and there was no other place for them to go.

The girl was prescribed drugs to stabilize her moods, but they didn't help much.

Bilerman didn't give up. She pushed hard, finally persuading health officials to admit her daughter to the unit, where a month-long stay produced a diagnosis of bipolar disorder, otherwise known as manic-depressive illness.

By that time, it had been almost a year since Sarah started showing signs of mental distress.

The diagnosis represented a big step forward for the Bilerman family, but it was only the beginning of another difficult journey.

Sarah, now 16, has since overdosed three more times.

Doctors have prescribed 20 different combinations of medication, none of which have stabilized her for very long.

The girl often stays out all night long, leaving her mother worried for her safety.

The constant stress has left its mark on the rest of Bilerman's family, which includes husband Shawn and 13-year-old daughter Rachel.

However, Bilerman's life took a sudden, positive turn four months ago when she heard a radio interview with the province's child and youth advocate, Bernard Richard.

The former cabinet minister, who is pushing for creation of a centre for children and youth with "complex needs," inspired Bilerman to take action.

She later learned that Richard has been advocating for a short-term treatment and co-ordination centre ever since he completed a disturbing report in 2008, titled Connecting the Dots.

"It was like the story of our life," says Bilerman, who recently founded DOTS NB, which stands for Development of Treatment Services for mental health in New Brunswick.

Richard's report includes graphic accounts of the challenges faced by children and youth with mental illness, suggesting too many of them are ending up in jail, penalized for behaviour that requires treatment, not punishment.

The proposed centre would offer a safe place for youth in crisis, intensive help for families dealing with mental illness and programs that would help troubled children and youth make the transition back into the community.

"The response has been amazing," Bilerman says, adding that she has been delivering speeches — up to five a day — to universities, churches, service groups and other groups.

Earlier this month, Bilerman led about 1,000 people in an unusual demonstration that grabbed the attention of the provincial government. At one point, the protesters joined hands, creating a kilometre-long human chain linking Fredericton's community mental health centre with the provincial legislature — a symbolic connecting of the dots.

Later, Bilerman presented Premier David Alward with hundreds of letters that tell stories similar to her own.

Bilerman wants Alward to approve Richard's proposal.

"It's integration of services across the province and closing some of the gaps that we know youth are falling through," she said after the rally.

Richard said the government has to act.

"When we don't provide the right responses to these kids, they end up in the justice system, in the prison system, over and over again costing millions of dollars over their lifetime," he said. "That's not to mention the hurt and damage they cause to their families, to themselves, and their neighbours and friends."

Alward said the province must do better.

"We have a responsibility, certainly as a people in New Brunswick, to move forward," he said.

The province's social development minister, Sue Stultz, says she is awaiting Richard's final report early next year before deciding how to proceed.

Photograph by David Smith, The Canadian Press

Government funding of mental health services in Nova Scotia

From a June 1st, 2010, PowerPoint presentation made by the Nova Scotia Department of Health:


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Sources of Revenue for Nonprofit Mental Health and Addictions Organizations in Canada

The abstract of an article published in the October 2010 edition of Psychiatric Services:

By Carissa Escober-Doran, B.S.N., M.P.A., Philip Jacobs, D.Phil., C.M.A. and Carolyn Dewa, M.P.H., Ph.D.

Ms. Escober-Doran and Dr. Jacobs are affiliated with the Institute of Health Economics, 10405 Jasper Ave., Suite 1200, Edmonton, Alberta T5J 3N4, Canada (e-mail: escober@ualberta.ca). Dr. Dewa is with the Centre for Addiction and Mental Health, Toronto, Ontario.


OBJECTIVE:

In Canada charitable or nonprofit organizations provide government-contracted mental health and addictions services, and they augment government funding by raising charitable revenues. This study estimated by source the revenues of nonprofit mental health and addictions organizations in Canada.

METHODS:

A list of nonprofit, service-providing organizations in Canada was developed, financial returns to the Canada Revenue Agency (CRA) in 2007 were obtained, and data were analyzed in aggregate.

RESULTS:

Information was obtained from 369 Canadian organizations, which had $915.4 million (Canadian dollars [CAD]) in total revenues: 85% were from the government, 4% were from charitable giving, and 11% were from other sources.

CONCLUSIONS:

The ratio of charitable giving to government funding of mental health care was about 0.55% ($35 million to $6.3 billion CAD). This charitable giving level cannot compensate for the relatively low levels of total government mental health spending identified in government reports.

Posting of this abstract is for the purposes of research into funding of nonprofit mental health organizations.

Chronic underfunding

A letter to the editor published in today's edition of The Chronicle Herald:

John McPhee’s worrying page-one article on June 2 refers to the fact that in Nova Scotia only 3.5 per cent of the health budget goes to mental health services. This contrasts sadly with 10 per cent allocated to mental health services in the U.K.

Is it any wonder, therefore, that our mental health services — for adults and the elderly as well as for children and adolescents — are in serious difficulties?

William O. McCormick, psychiatrist, Mental Health Services Bedford/Sackville

Auditor General's Report - Mental Health Services in Nova Scotia

An excerpt for the Auditor General’s Statement to the Media today:

A second audit covered in this report was hampered to a lesser extent by the same restrictions on information. The Department of Health, under instruction from the Executive Council Office, refused to provide us information on budget requests related to mental health services.

Treatment of mental illness is a significant part of the health care system. Mental illness accounts for over 15 per cent of the disease burden in developed countries, and for 3.4 per cent of the Nova Scotia health budget.

In 2003, Nova Scotia became the first province to implement mental health service standards. The Department was aware at the time that funding levels were inadequate to achieve these standards.

When the standards were introduced, the Department acknowledged it would take five to ten years to fully achieve compliance with them. Seven years later, our audit found that the mental health service standards were met in only 14 per cent of the cases we tested; and there is no evidence of a plan or funding to close the gap.

The Department of Health has failed to meet its legislated requirement to monitor and evaluate the quality of mental health services. The lack of departmental oversight and monitoring significantly increases the risk that the mental health care system will fail the people who need it most.

The Department of Health has accepted our report and agrees with all 19 recommendations. However, the government has a poor record of implementing our recommendations. I would draw your attention to the next chapter of this report - a follow-up on the 82 recommendations we made in June 2007. To date, the government has implemented just 27 per cent of those recommendations. This is the worst performance since we began tracking government response to our recommendations in 2002.

The Department of Health was the subject of 48 of those recommendations, and accepted all but one. Two years later, 34 recommendations - 71 per cent - were still not implemented.

This is a concern given the nature of the 2007 recommendations, dealing with issues like financial and quality controls in nursing homes and equitable placement of seniors in need of care.

To access the entire Auditor General’s Report, please click here (PDF).


Also see:

Lax oversight of mental health standards, N.S. auditor says

Targeted funding misses core areas

From the December 15th edition of the Times Colonist:

It would be a great loss if valuable agencies such as the B.C. Schizophrenia Society had to slash services -- or even close -- as an unintended consequence of a provincial government funding policy and the economic downturn.

One of the Liberal government's policy shifts after the 2001 election was a move from block funding to non-profits across the province to targeted program funding.

Where the government had reviewed an organization's overall operations and decided on an appropriate level of public funding, it adopted a new approach.

Non-profits could apply for money to cover the direct costs of specific programs. For anything else, they were on their own.

There are merits to the approach. The government has more control on how the money is used and can assess value for money spent more directly. It can set priorities, rather than leaving it up to the local non-profit to assess community needs. And ministries know where their contribution is being spent.

But the shift also created problems. Non-profits' core expenses -- rent, basic administration staff, fundraising, newsletters and programs not covered by the province -- were no longer funded. The expenses were necessary to maintain the organization, but the funding formulas didn't acknowledge that reality.

And the agencies lost the flexibility that allowed them to react to emerging needs by shuffling funding. If there was a spike in the need for services for seniors suffering from schizophrenia, for example, in the past the society could have shifted money from another program. That was no longer allowed by government.

Most rose to the challenge by seeking donations or holding fundraisers to cover core expenses. That was difficult, because donors -- like government -- respond more enthusiastically to appeals for money to support specific programs.

To read the entire article, click here.

Also see:

Sinking into debt, health care non-profits fight for survival

Image courtesy of the British Columbia Schizophrenia Society (click on the image to enlarge it).