A wall with the word ‘madness’ scratched into it at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, July 23, 2009. The Mental Health Commission of Canada says “gatekeepers” need better training in order to promote mental health.
Jul 19, 2011 – 6:00 AM ET | Last Updated: Jul 18, 2011 10:05 PM ET
Canada needs a “dynamic, broadly based social movement” to improve its citizens’ mental health, a “whole-of-government” approach that unites everyone from political leaders to “experts by experience,” according to a national strategy five years in the making.
The goal, according to the Mental Health Commission of Canada, should be a “cultural shift toward recovery,” which favours real improvement over ideal cure, and is informed by “multiple sources of knowledge,” including the traditions of restorative justice and the hard-won wisdom of people in recovery.
The 37-page draft strategy document, obtained by the National Post, also seeks to reduce the stigma of suicide; calls for an end to “seclusion and restraint” of psychiatric patients; and demands that, in criminal record checks, police stop disclosing information about people they have driven to hospital in a mental health crisis.
“This practice inhibits people’s ability to volunteer or get a job, and should be stopped,” reads the report, Mental Health Strategy for Canada — Draft,
Not For Circulation. A final version is expected to be presented to the MHCC’s board in October, and released publicly next year.
The strategy acknowledges the federal government’s arm’s-length role in health-care delivery, but argues that mental health is not purely a health issue,
as it also involves criminal justice, housing, finance and child services. The MHCC’s broad solution is to “shift upstream and across sectors” by taking
a “whole of government” approach, in which actions are nationally co-ordinated, and “leadership [is] located at the highest level possible within government and the bureaucracy.”
Clinically, the strategy calls for a “genuine partnership” between care-givers and people with mental illnesses, who should be offered “self-directed care-funding initiatives,” so they can “directly manage part of their social service and health budgets.”
“The expertise gained from lived experience should be complemented by professional expertise, not dominated by it,” the report reads.
“Not only will this change in the distribution of power within the mental-health system benefit users of services, it will also create a more positive context
in which mental-health providers can deploy their skills, experience and knowledge.”
Examples of self-directed care choices might include art or music therapy, or training in mindfulness techniques, said Howard Chodos, special advisor to
Finding the right balance, he said, “involves the skill and art of medicine as much as it does the science.”
“Unfortunately in mental health, there are no blood tests and there are no medical tests which tell you what illness you have, and what treatment to use,”
The strategy also calls for better training for so-called “gatekeepers” — teachers, doctors, clergy, police and prison staff — to help them recognize and
react to warning signs of suicide, and to promote mental health.
This focus on prevention and health promotion is a target of early critics of the report, who say it offers little to people with serious mental illnesses,
such as schizophrenia or bipolar disorder, which cannot be prevented by social policy, as they are organic diseases of the brain. They cite New York State’s Office of Mental Health as a cautionary tale of a system in which the “worried well” gained support at the expense of the truly sick.
Susan Inman, a Vancouver advocate for the families of people with serious mental illnesses, whose daughter recovered from schizophrenia, said the strategy’s deference to lived experience will make things worse for people who are so mentally ill they are incapable of realizing it — a condition known as anosognosia. She fears the emphasis on personal empowerment will make involuntary treatment almost impossible.
“This plan is really about mental wellness,” she said. “People with serious mental illnesses are ignored.”
Mr. Chodos said research shows a range of factors can increase or decrease the risk of even the most serious mental illnesses.
“We do not yet know that there is anything more than a genetic predisposition,” he said. “Prevention [in the strategy] is not only prevention of onset,
but also the debilitating consequences of it.”
He gave the example of homelessness, often associated with schizophrenia and substance abuse, as an area where social policy can, in fact, prevent the worst of a mental illness. He said another is cannabis use among youth, a known risk factor for schizophrenia.
He also said the MHCC’s mandate is to address the full range of mental-health problems, minor to major.
The MHCC which was established in 2007 by Prime Minister Stephen Harper on the recommendations of former Senator Michael Kirby, has a twin mission. Erasing stigma has always been the long-term project, but this formalized national strategy is the immediate goal.
The strategy comes at a crucial moment for psychiatry, not just in Canada but globally, as the discipline’s diagnostic manual undergoes a thorough revision, and old battles flare up over how to define mental illness. There is also a strong climate of suspicion about the role of drug manufacturers in the proliferation of psychiatric drugs, and about the spike in diagnoses of childhood behavioural disorders.