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Lack of Mental Health Care ‘Embarrassing,’ says Michael Kirby
By Pamela Cowan, Leader-PostJune 26, 2009
Former Liberal senator Michael Kirby is embarrassed. “We closed the insane asylums and decided that instead of institutionalizing or warehousing people, we would create community-based beds … They closed the institutional beds, but were very slow on opening community beds,” says Kirby. “I’m embarrassed to say this as a Canadian, but we have really made the streets and the prisons the asylums of the 21st century.”
It’s a message the head of the Mental Health Commission of Canada has repeated many times. And Kirby will continue until mental health is out of the shadows at last.
Many Canadians are personally affected by mental illness. Kirby is no exception. For years, as he advocated on behalf of his sister who suffered from severe depression, he got a first-hand look at the gaps in the mental-health system.
He heard hundreds of stories about the system’s failures when he chaired a Senate committee that produced the first national report on mental illness, “Out of the Shadows at Last.” The report was released in 2006, and a year later, the federal government created the Mental Health Commission of Canada to address the state of mental-health care.
When people were institutionalized, Kirby says, those with mental illness at least got three meals a day and a roof over their heads. Today, across the nation, there’s a lack of affordable, supportive housing for those who are mentally ill. To address this glaring omission, one of the commission’s key initiatives is focusing on homelessness research demonstration projects. Another of its priorities is an anti-stigma campaign.
Judge Clifford Toth says homeless people often have severe mental health problems.
“They may not be homeless because they can’t pay the rent, they may be homeless because no one will have them for any length of time and they have special housing needs,” says the Regina provincial court judge.
But progress is slow in changing fundamental beliefs and attitudes.
“While we’re making progress,” Kirby says, “you’re looking at a decade or more before most of the stigma attached to mental illness largely dissipates.”
When asked if the beheading of Tim McLean by Vincent Li on a Greyhound bus in Manitoba in July worsened the stigma facing those with a mental illness, Kirby says the potential for violence is about the same whether you have a mental illness or you don’t have a mental illness — but the stereotype is quite different.
“When you have a story like that, particularly one that was that gruesome, it stays in people’s minds and reinforces the negative view that a lot of people have … ” Kirby says. “I think that it perpetuates the stigma as opposed to making it worse.”
One in five Canadians experiences some form of mental or emotional health problem every year. Two thirds will not seek treatment because they fear they will be labelled and viewed as dangerous.
Stigma is an age-old problem, Kirby says; it goes back centuries to when the medical profession severed the head from the body.
“There was perceived to be no connection between the two,” he says. “That’s of course where all of the current evidence is showing they were wrong. The wonderful thing about aboriginal Canadians and aboriginals around the world is that they’ve known for centuries that you couldn’t treat just the physical without treating the mental. You have to treat the person as a whole.”
Jayne Whyte, a 61-year-old Fort Qu’Appelle woman, has battled the stigma surrounding mental illness for years. Whyte remembers being chastised by her mother in 1967 because she spoke about her mental illness during a phone call.
“I said, ‘I’ve been to the psychiatrist and he says I’m schizophrenic,’ ” Whyte recalls. “My mother said, ‘We’re on a party line in rural Saskatchewan!’ They talked about their gall bladders and sciatica on the party line, but they didn’t talk at that time about cancer, and I think that mental health is
in that same place. People are so scared about it that they don’t talk about it.”
Whyte believes it’s easier to be open about her mental illness than to try to conceal it. “But I certainly understand why people do,” she says. “I remember coming out of a grocery store, and just before the screen door slammed I heard one clerk say to the other, ‘She doesn’t look crazy.’ That’s where the stigma comes from — people look at you differently.”
Dr. Mansfield Mela, a Saskatoon forensic psychiatrist, says some mentally disordered patients face a double stigma — they are in trouble with the law and they are mentally ill. He, like many in the judicial system, describes the court as a revolving door for the mentally ill.
Without community supports, some people with mental disorders stop taking their medications and discontinue their treatment. If they act out, that can land them in trouble with the law and since there are not enough treatment facilities, they end up in jail. When they are released, the cycle begins again.
Kirby says: “One of our advisory committees, Mental Health and the Law, which is chaired by Justice Ted Ormsted, the Ontario Supreme Court judge who created the first mental health court in the western world, is looking at the revolving door issue.”
The mentally ill shouldn’t be involved with the judicial system in the first place, Kirby says.
“When it comes to housing and everything else, prison is the last stop,” he says. “It’s the one place they have to give you housing. We and other countries have been pretty slack … That is why dealing with this is a pivotal issue for us.”
Canada’s only mental health courts are in Toronto and Ottawa. Every year 2,500 people appear in the Toronto court and more than 2,000 in the Ottawa court.
Canada is the only G8 nation that doesn’t have a strategy for addressing mental illness. To remedy that, the mental health commission is working on a strategy that focuses on specific groups of Canadians, including children, youths, seniors and aboriginal, Inuit and Metis people, as well as people with mental illness involved in the criminal justice system.
The process is being done in two stages.
“The first stage is to determine, what should a revised mental health system look like? Where are we, where would we like to go? The second question is, how do we get there?” Kirby says.
For three months, beginning in February, the mental health strategy team travelled to 13 Canadian communities to get feedback on the draft document, called “Toward Recovery and Well-Being”. By summer’s end, Kirby expects the commission will embark on the second stage and expects the final strategy to be released in 2011.
In 2002, Romanow’s Commission on the Future of Health Care in Canada referred to mental health as the orphan of the health-care system.
Seven years later, Roy Romanow says it’s a tragedy, but mental health continues to be an orphan.
Saskatchewan’s former premier credits the federal government for establishing the commission, which raises the profile of the inadequacies of mental health care. Romanow respects Kirby and the relatively new commission, but he says work should have at least begun on providing two types of homecare services for those with mental illness.
“One should be case management where appropriate professionals work directly with the individual who is ill and the whole myriad of other health-care providers and community agencies which are in place but are basically not connected to mental illness,” Romanow says.
He also believes mental health professionals should be available to respond to disruptive individuals who have serious mental illnesses and are acting out at home. Without these services, a patient can be a threat to himself or others, face legal difficulties or trigger an unnecessary hospitalization, Romanow says.
“Since we are into an aging population and looking at issues like dementia and Alzheimer’s and things of that nature … this is all the more important,” he says. “I would have thought that the evidence is pretty clear now that some form of homecare integrated approaches were long overdue and that the profile that the commission has received by virtue of being pulled out of the system — kind of in a one-off situation — would have eased that crisis a bit. It’s early. I don’t want to be judgmental but so far there hasn’t been as much of a positive impact as I would have liked.”
Dwight Nelson, CEO of the Regina Qu’Appelle Health Region, is optimistic that improvements to mental health services are in the offing.
The region is embarking on a new plan for mental health and addictions. Over the next few months, a steering committee will be set up that will include the major organizations and agencies that deliver mental health services, in addition to RQHR staff.
“It won’t just be the health system, although we have a role to play,” Nelson says. “The schools have a role to play, as well as organizations such as the Canadian Mental Health Association. Then in the fall we’re hoping to kick it off with a community forum on mental health and hear from lots of people about what’s working and what’s not working.”
He believes change is possible because of the spirit of co-operation that exists in the province.
“In Saskatchewan and Regina, we do some of the intersectoral work better than some other cities in the country do,” Nelson says. “The agencies do tend to know each other, they do collaborate better than in a lot of places.”
Nelson acknowledges that mental health has been under-resourced from both a personnel and budget perspective. Currently Regina has 8.5 psychiatrists for adults and 3.5 for children. That is less than half the number of psychiatrists in Saskatoon.
Hospitals in Saskatoon are able to recruit and retain more psychiatrists primarily because of the comprehensive psychiatric training programs offered at the University of Saskatchewan.
“It’s been challenging on the recruitment end for a number of years, but we’re working with the College of Medicine and trying to do more,” Nelson says.
The Queen City’s lack of psychiatrists directly impacts the Regina Police Service.
Staff Sgt. Curtis Kemp says officers and suspects often wait for hours in emergency room departments until a psychiatrist is available to assess the person in custody. Kemp proposes the health region consider replicating a project that’s in operation in Vancouver, where a registered psychiatric nurse is available to accompany police officers on mental health calls and immediately assess whether a suspect requires psychiatric care.
When asked if that is a possibility in the RQHR, Nelson replies, “We would absolutely explore the options.”
David Fan, CEO of the Prairie North Health Region, says Saskatchewan has lost much of its reputation for being a world leader in providing mental health services.
For years, staff and patients at the aging Saskatchewan Hospital in North Battleford have waited for the provincial government to provide funding to replace the province’s only psychiatric rehabilitation hospital.
“Mental health has traditionally received less funding attention over the years,” Fan says. “It is difficult to stack up against acute-care hospital care. There’s demand for more CTs, more MRIs, more surgery — I’m not suggesting that isn’t important. It’s a matter of prioritization, but mental health tends not to get the attention it deserves.”
Health Minister Don McMorris acknowledges the lack of community resources, saying: “If we could go back a number of years, we’d probably do things differently. You can’t put the toothpaste back in the tube.”
Kirby hopes the day will come when all Canadians understand that a mental disorder is an illness just like cancer or diabetes.
“You shouldn’t think any differently about somebody simply because their illness is above the neck rather than below the neck,” he says. “There’s huge hope of recovery for people with a mental illness. What I mean by recovery is they’re able to lead a pretty normal and productive life consistent with the limitations of their illness just as a diabetic is able to lead a pretty normal life subject to their illness, which may mean taking insulin. For the vast majority of people with a mental illness, they can recover within that definition of recovery.”
He says the only way to keep mental illness out of the shadows forever is to create a national social movement.
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